Citation Nr: 21073489 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 16-62 987 DATE: December 8, 2021 ORDER Service connection for bilateral eye disorders, diagnosed as cataracts, as secondary to service-connected diabetes mellitus, is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for vertigo is remanded. FINDING OF FACT The Veteran's bilateral eye disorders, diagnosed as cataracts, are caused by his service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for bilateral eye disorders, diagnosed as cataracts, as secondary to service-connected diabetes mellitus, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Air Force from August 1969 to August 1973, including service in the Korean DMZ. This matter is before the Board of Veterans' Appeals (Board) on appeal of a June 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), that denied service connection for bilateral peripheral neuropathy; a heart disorder, to include ischemic heart disease and coronary artery disease (listed as ischemic heart disease, also claimed as coronary artery disease); erectile dysfunction; bilateral eye disorders, to include glaucoma (listed as glaucoma); bilateral hearing loss; and for vertigo. In January 2020, the Veteran appeared at a Board hearing before the undersigned Veterans Law Judge. In March 2020, the Board remanded the issues of entitlement to service connection for bilateral peripheral neuropathy; a heart disorder, to include ischemic heart disease and coronary artery disease; erectile dysfunction (listed as a penile deformity, with loss of erectile power); bilateral eye disorders, to include glaucoma; bilateral hearing loss; and for vertigo, for further development. A February 2021 RO decision granted service connection and a 10 percent rating for peripheral neuropathy of the right median nerve, effective February 4, 2015; granted service connection and a 10 percent rating for peripheral neuropathy of the left median nerve, effective February 4, 2015; granted service connection and a 10 percent rating for peripheral neuropathy of the right sciatic nerve, effective February 4, 2015; granted service connection and a 10 percent rating for peripheral neuropathy of the left sciatic nerve, effective February 4, 2015; granted service connection and a 10 percent rating for coronary artery disease, effective February 4, 2015; and granted service connection and a noncompensable rating for erectile dysfunction, effective February 4, 2015. Therefore, the issues of entitlement to service connection for bilateral peripheral neuropathy; a heart disorder, to include ischemic heart disease and coronary artery disease; and for erectile dysfunction, are no longer before the Board. The February 2021 RO decision also granted service connection and a noncompensable rating for bilateral diabetic retinopathy of the eyes, effective February 4, 2015. In a January 2021 statement of the case, the RO indicated that the issue of entitlement to service connection for bilateral eye disorders, to include glaucoma (listed as glaucoma) was still on appeal. Therefore, the Board will address the merits of the issue of entitlement to service connection for bilateral eye disorders, to included glaucoma. Bilateral Eye Disorders, to include Glaucoma Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). A veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during such service to certain herbicide agents (e.g., Agent Orange). In the case of such a veteran, service incurrence for the following diseases will be presumed if they are manifest to a compensable degree within specified periods, even if there is no record of such disease during service: chloracne or other acneform diseases consistent with chloracne, type 2 diabetes, Hodgkin's disease, chronic lymphocytic leukemia, multiple myeloma, non-Hodgkin's lymphoma, acute and sub-acute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, and trachea), and soft-tissue sarcomas. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). Effective August 31, 2010, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina), is included as a disease associated with herbicide exposure under 38 C.F.R. § 3.309 (e). (Under 38 C.F.R. § 3.309 (e), the term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of Ischemic heart disease. 38 C.F.R. § 3.309 (e) (Note 3.). On January 1, 2021, the National Defense Authorization Act for Fiscal Year 2021 has added three disorders to the list of diseases presumptively associated with exposure to herbicide agents. Specifically, it amended 38 U.S.C. § 1116(a)(2), to include parkinsonism, bladder cancer and hypothyroidism. 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Veteran is service-connected for diabetes mellitus (diabetes mellitus, type II), and for bilateral diabetic retinopathy of the eyes. He is also service-connected for peripheral neuropathy of the right median nerve; peripheral neuropathy of the left median nerve; peripheral neuropathy of the right sciatic nerve; peripheral neuropathy of the left sciatic nerve; coronary artery disease; erectile dysfunction; sinusitis; and for tinnitus. The Veteran contends that he has bilateral eye disorders, to include glaucoma, that are related to service, to include as due to Agent Orange exposure, or, more specifically, that are related to his service-connected diabetes mellitus. The Veteran reports that he was exposed to Agent Orange while serving in the Korea, and that he went to the Korean DMZ in June 1970 or August 1970. He reports that he was in the Korean DMZ for live fire training for two to three weeks. The Veteran also indicates that he was a security police officer. The Veteran served on active duty in the Air Force from August 1969 to August 1973, including service in the Korean DMZ. The Veteran's DD Form 214 lists his occupational specialty as in security police. In a March 2020 decision, the Board found that the Veteran's report of serving in or near the Korean DMZ during his service in Korea from August 27, 1970, to September 22, 1971, was credible. The Board determined that the Veteran was presumed to have been exposed to herbicide agents (Agent Orange). Therefore, the Veteran's exposure to Agent Orange is conceded. The Veteran's service treatment records do not show treatment for right eye problems and/or for left eye problems. Post-service private and VA treatment records, including a VA examination report, show treatment for variously diagnosed right eye disorders and left eye disorders, including hyperopia of both eyes, with regular astigmatisms of both eyes, and presbyopia of both eyes; compound hyper-optic astigmatisms, with presbyopia of both eyes; diabetic retinopathy; glaucoma suspect; cataracts; and bilateral cataracts. The Board notes that the evidence of record includes opinions, as to the etiology of the Veteran's claimed bilateral eye disorders, to include glaucoma, pursuant to a September 2020 VA eye conditions examination report. A September 2020 VA eye conditions examination report includes a notation that the Veteran's claims file was reviewed. The Veteran reported that his vision became blurry at times, and that he had difficulty seeing fine print, starting in approximately in 2016. He stated that he had no other irritations or vision complaints. The Veteran indicated that his vision would fluctuate at times in relation to changes in his blood glucose levels. He related that he did not notice vision-related changes when his blood glucose levels were good. The Veteran maintained that his current symptoms remained the same since their onset, and that he had difficulty with fine details. The diagnoses were bilateral diabetic retinopathy; bilateral cataracts; and glaucoma, suspect. The examiner stated that the Veteran's eye conditions were related to his diabetes mellitus, which was secondary to herbicide exposure during service, and that was controlled with Metformin medication. The examiner reported that there were no treatments noted by the Veteran in his service treatment records. The examiner indicated that the Veteran had several conditions without visual impairment. The examiner stated that the Veteran had mild retinal changes in both eyes, which were not visually significant. The examiner related that bilateral cataracts were also present. It was noted that the Veteran was diagnosed with glaucoma, suspect, in the early 2000s, with no clinical support, and a normal IOP and ONH appearance. The examiner reported that the Veteran had a family history of glaucoma. The Board notes that the examiner provided positive secondary service-connection etiological opinions, as to the Veteran's bilateral diabetic retinopathy. As the Veteran is already service-connected for diabetic retinopathy of the eyes, the Board will not discuss those opinions. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner specifically stated that the claimed conditions of glaucoma and cataracts were less likely than not incurred in, or caused by, the claimed in-service injury, event, or illness. The examiner further indicated that the claimed condition was at least as likely as not (50 percent or greater probability) proximately due to, or the result of, the Veteran's service-connected condition. The examiner specifically maintained that the claimed condition of (bilateral) cataracts were at least as likely as not proximately due to, or the result of, the Veteran's service-connected condition of diabetes mellitus, type 2. The examiner referred to a medical treatise and indicated that the reduction in oxygen and glucose carried efficiently led to an increase in cataract formation for patients with diabetes mellitus. The examiner further indicated that the Veteran's claimed condition was at least as likely as not aggravated beyond its natural progression by a service-connected condition. The examiner referred to a medical treatise and stated that that the Veteran's diabetes mellitus condition increased the development of cataracts in patients over time due to the nature of the condition. The Board notes that the examiner, pursuant to the September 2020 VA eye conditions examination report, following a review of the claims file, specifically found that the Veteran's bilateral cataracts were at least as likely as not proximately due to, or the result of, his service-connected diabetes mellitus. The examiner also indicated that the Veteran's service-connected diabetes mellitus aggravated the development of his bilateral cataracts. The Board finds that the opinions provided by the examiner, pursuant to the September 2020 VA eye conditions examination report, in regard to the Veteran's claimed bilateral eye disorders, diagnosed as cataracts, are the most probative of record. The Board therefore finds that the Veteran's bilateral eye disorders, diagnosed as cataracts, are due to, or a result of, his service-connected diabetes mellitus. Thus, secondary service connection is warranted. See 38 C.F.R. § 3.310. The Board notes that the Veteran is already service-connected for diabetic retinopathy of the eyes. Additionally, the Veteran has been diagnosed with glaucoma, suspect, but not actual glaucoma. The Board further notes that there is no probative evidence relating any other eye disorders of record to the Veteran's service-connected disabilities, or to his period of service. As the Board has granted secondary service connection for bilateral eye disorders, diagnosed as cataracts, it need not address direct service connection, or any other theories for service connection, in this matter. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for bilateral hearing loss and for vertigo. This case was remanded in March 2020, partly to afford the Veteran a VA examination to determine whether it was at least as likely as not that his bilateral hearing loss had its onset in service, or was otherwise related to his in-service noise exposure, or to his service-connected diabetes mellitus. The examiner was to specifically address a July 2015 private medical opinion, as well as the Veteran's specific contentions regarding the onset of his bilateral hearing loss. The March 2020 Board remand also directed that the examiner address whether the Veteran's bilateral hearing loss was caused or aggravated by his service-connected diabetes mellitus. The examiner was to further issue an addendum opinion addressing whether the Veteran's vertigo was caused or aggravated by his service-connected tinnitus. Pursuant to the March 2020 Board remand, the Veteran was afforded a VA audiological examination in March 2020. There is a notation that the Veteran's claims file was reviewed. The diagnoses were sensorineural hearing loss, in the frequency range of 500 to 4000 Hertz, and in the frequency range of 6000 or higher frequencies, in the right ear, and sensorineural hearing loss, in the frequency range of 500 to 4000 Hertz, and in the frequency range of 6000 or higher frequencies, in the left ear. Tinnitus was also diagnosed. The examiner indicated that the Veteran's right ear hearing loss and his left ear hearing loss were not at least as likely as not (50 percent probability or greater) caused by, or a result of, an event during his military service. The examiner reported that there was no significant permanent shift in hearing thresholds beyond test variability from the March 1969 entrance examination to the June 1973 separation examination, which was objective evidence of no permanent auditory damage on active duty from conceded noise exposure. The examiner stated that there was no complaint and/or treatment for a hearing decrease in the Veteran's service treatment records, or at separation. The examiner maintained that although noise exposure was conceded, and the relationship of noise, auditory damage, and hearing loss was well-established, auditory damage and hearing loss were not conceded based on noise alone. It was noted that there must be a nexus of auditory damage to relate current hearing loss to military noise exposure and not to another etiology. The examiner indicated that the evidence was against a nexus, and that, therefore, it was less likely than not that right ear hearing loss and the left ear hearing loss were related to military noise exposure. The examiner stated that a letter, dated in July 2015 from Dr. R. S., indicates that the Veteran had multiple medical conditions, including ringing in the ears and vertigo, and that his hearing loss was the result of those conditions. The examiner stated that diabetes mellitus was not mentioned in the letter, nor did the letter indicate and/or suggest its connection with hearing loss. The examiner further indicated that the claimed condition was less likely than not (less than 50 percent probability) proximately due to, or the result of, the Veteran's service-connected condition. The examiner stated that there was no significant permanent shift in hearing thresholds beyond test variability from the March 1969 entrance examination to the June 1973 separation examination, which was objective evidence of no permanent auditory damage on active duty from conceded noise exposure. The examiner stated that there was no complaint and/or treatment for a hearing decrease in the Veteran's service treatment records, or at separation. The examiner maintained that a letter, dated in July 2015 from Dr. R. S., indicates that the Veteran had multiple medical conditions, including ringing in the ears and vertigo, and that his hearing loss was the result of those conditions. The examiner reported that diabetes mellitus was not mentioned in the letter, nor did the letter indicate and/or suggest its connection with hearing loss. The examiner indicated that the Veteran's claimed condition was not at least as likely as not aggravated beyond its natural progression by a service-connected condition. The examiner maintained that aggravation could not be determined due to a lack of information on hearing loss in the 1980s, which was prior to the Veteran's diabetes mellitus. The examiner stated that the next series of hearing examinations were for the years from 2016 to 2020, which was a significant amount of time after the onset of the Veteran's diabetes mellitus. The examiner related that, therefore, the lack of information in the claims file hindered an ability to give an opinion on aggravation. The examiner also maintained that the Veteran's claimed condition of vertigo was less likely than not (less than 50 percent probability) proximately due to, or the result of, the Veteran's service-connected condition. The examiner reported that tinnitus did not cause vertigo. The examiner stated that tinnitus wasn't a condition, itself, but a symptom of an underlying condition, such as age-related hearing loss, an ear injury, or a circulatory system disorder. The examiner indicated that a review of medical literature did not support tinnitus as a cause of vertigo, and that vertigo was usually caused by disorders of the parts of the ear and brain that were involved in maintaining balance, such as the inner ear, brain stem and cerebellum, and nerve tracts connecting the inner ear to the brain stem and cerebellum. The examiner referred to a medical treatise. The examiner further stated that the Veteran's claimed condition was not at least as likely as not aggravated beyond its natural progression by a service-connected condition. The examiner stated that tinnitus was a symptom, rather than a condition, and that a review of medical literature did not support that tinnitus aggravated vertigo. The Board notes that, as to the Veteran's claim for service connection for bilateral hearing loss, the examiner found that the Veteran's right ear hearing loss and his left ear hearing loss were not at least as likely as not caused by, or a result of, an event during his military service. The examiner reported that there was no significant permanent shift in hearing thresholds beyond test variability from the March 1969 entrance examination to the June 1973 separation examination, which was objective evidence of no permanent auditory damage on active duty from conceded noise exposure. The examiner also stated that there was no complaint and/or treatment for a hearing decrease in the Veteran's service treatment records, or at separation. The Board observes, however, that in regard to the Veteran's bilateral hearing loss, the absence of documented hearing loss, as defined by VA, while in service is not fatal to a claim for service connection. Ledford v. Derwinski, 3 Vet. App. 87 (1992). Additionally, when a Veteran does not meet the regulatory requirements for a disability at separation, he can still establish service connection by submitting evidence that a current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 159-160 (1993). Further, the Board notes that the examiner did not address any reports by the Veteran of hearing problems during and since service. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board also notes that the examiner indicated that aggravation of the Veteran's claimed bilateral hearing loss by his service-connected diabetes mellitus could not be determined due to a lack of information on hearing loss in the 1980s, which was prior to the Veteran's diabetes mellitus. The examiner related that, therefore, the lack of information in the claims file hindered an ability to give an opinion on aggravation. The Board observes that is unclear why a lack of information in the 1980s would cause an inability to determine if the Veteran's service-connected diabetes mellitus caused or aggravated his claimed bilateral hearing loss. The Board further notes that the examiner provided negative direct and secondary opinions as to the etiology of the Veteran's claimed vertigo. The Board notes that the examiner solely addressed whether the Veteran's vertigo was caused or aggravated by his service-connected tinnitus. The Board notes that the examiner did not address whether other service-connected disabilities, such as sinusitis and/or diabetes mellitus, caused or aggravated the Veteran's claimed vertigo. In El-Amin v. Shinseki, 26 Vet. App. 136 (2013), a decision issued by the United States Court of Appeals for Veterans Claims (Court), the Court vacated a decision of the Board where a VA examiner did not specifically opine as to whether a disability was aggravated by a service-connected disability. The Board also notes that a December 2014 ear condition examination report from Dr. R. S., indicates that the Veteran had findings, signs, or symptoms attributable to Meniere's syndrome, including tinnitus and vertigo, and also a report of staggering. In light of the above, the Board finds that the Veteran should be afforded VA examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the record, as to his claims for service connection for a bilateral hearing loss and for vertigo. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007); see also Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for bilateral hearing loss and for tinnitus, since hypertension and for arthritis, to include rheumatoid arthritis, since January 2021. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptoms regarding his claimed bilateral hearing loss and vertigo. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible), by an ear, nose, and throat specialist, to determine the nature, onset, and etiology of his claimed bilateral hearing loss. The entire claims file must be reviewed by the examiner. The examiner must conduct an audiological evaluation, including speech recognition testing, to determine whether the Veteran currently has a hearing loss disability. If hearing loss is identified, the examiner must provide an opinion as to whether it is at least as likely as not that any current hearing loss was incurred during the Veteran's period of service or was the result of exposure to loud noise during his period of service. The examiner must further opine as to whether the Veteran's service-connected disabilities, to specifically include his service-connected diabetes mellitus, caused or aggravated any currently diagnosed bilateral hearing loss. The examiner should also comment on the July 2015 opinion provided by Dr. R. S. 4. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible), by a physician, to determine the onset and etiology of his claimed vertigo. The examiner must specifically indicate if the Veteran has currently diagnosed vertigo. The examiner must also specifically indicate if the Veteran has diagnosed Meniere's syndrome. The examiner must opine as to whether it is as at least as likely as not that any currently diagnosed vertigo, and/or Meniere's syndrome, are related to, and/or had their onset during, the Veteran's period of service, to include presumed exposure to Agent Orange during service. The examiner must also specifically acknowledge any reports by the Veteran of symptoms of vertigo during or since service. The examiner must further opine as to whether the Veteran's service-connected disabilities, to specifically include his service-connected tinnitus, sinusitis, and diabetes mellitus, caused or aggravated any currently diagnosed vertigo, and/or Meniere's syndrome. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.