Citation Nr: 21075159 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 18-50 316 DATE: December 17, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for cyst under testicles is remanded. Entitlement to service connection for right shoulder arthritis is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a respiratory disability, claimed as emphysema, is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a dental condition for compensation purposes and for purposes of VA outpatient dental treatment is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to August 1988. In January 2021, the Veteran and his wife, J.D., testified before the undersigned Veterans Law Judge (VLJ) via video conference. 1. Entitlement to service connection for hypertension is remanded. 2. Entitlement to service connection for cyst under testicles is remanded. 3. Entitlement to service connection for right shoulder arthritis is remanded. 4. Entitlement to service connection for erectile dysfunction is remanded. 5. Entitlement to service connection for a cervical spine disability is remanded. The Agency of Original Jurisdiction (AOJ) last adjudicated the claims on appeal in an April 2020 supplemental statement of the case (SSOC). Since that time, additional VA treatment records have been added to the claims file. In a September 2021 letter, the Board advised the Veteran of his right to have the AOJ review the additional evidence and informed him that he could choose to waive that right. The letter advised the Veteran that he had 45 days from the date of the letter to respond and submit a waiver and also advised that, if he did not respond by the end of the 45-day period, the Board would remand the appeal to the AOJ for review. The Veteran did not submit a waiver or otherwise respond within 45 days of the September 2021 letter. Accordingly, the Board must remand the appeal to the AOJ to consider the new evidence of record and issue an additional SSOC. 6. Entitlement to service connection for a respiratory disability, claimed as emphysema, is remanded. The claims file contains two VA opinions that address whether the Veteran currently has a respiratory disability that is likely related to his active service but, unfortunately, neither opinion in adequate. In December 2017, a VA clinician opined that the Veteran did not have a respiratory disability or lung condition related to his period of service, but the clinician did not consider or address the diagnoses of COPD and dyspnea documented in the claims file. See e.g., VA treatment records dated June and December 2012. Likewise, in September 2019, a VA physician opined that the Veteran's claimed respiratory disability is less likely related to service noting that, while the Veteran was treated for an upper respiratory infection (URI) in 1967, there is no evidence of recurrent bronchitis in the STRs and no evidence of hyperinflation or emphysema on a 2010 CT scan. Unfortunately, the September 2019 VA examiner did not address the multiple times the Veteran sought treatment for respiratory problems during service; nor did the examiner provide a complete rationale that explained his conclusion based upon the facts in this case, including the Veteran's history of smoking. Therefore, a remand is needed to obtain an adequate medical opinion. 7. Entitlement to service connection for bilateral hearing loss is remanded. During the January 2021 hearing, the Veteran and his wife testified that his hearing has worsened since his last VA audio examination in August 2019. In this regard, the VA examinations of record reveal that the hearing impairment in his right ear has not reached the severity to be considered a disability under VA law. See 38 C.F.R. § 3.385; see also VA examinations dated January 2018 and August 2019. In light of the competent lay evidence of a potential worsening of the Veteran's hearing impairment, the Board finds an additional examination is required to assess the current state of the Veteran's hearing loss disability. 8. Entitlement to service connection for a dental condition for compensation purposes and for purposes of VA outpatient dental treatment is remanded. The Veteran's claim for service connection for a dental condition includes a claim for compensation purposes and a claim for VA outpatient treatment. See Mays v. Brown, 5 Vet. App. 302 (1993). In this case, review of the claims file indicates that the AOJ adjudicated and denied the claim for entitlement to service connection for a dental disability for compensation purposes but did not refer the claim to Veterans Health Administration (VHA) for consideration of service connection for a dental disability for purposes of VA outpatient treatment purposes, as required under 38 C.F.R. §§ 17.161 and 19.9(b). As a result, this matter must be remanded to the AOJ for referral of the Veteran's dental treatment claim to the VHA for a preliminary determination pursuant to 38 C.F.R. § 3.381(a). The matters are REMANDED for the following action: 1. Refer the claim for dental treatment to the appropriate VA Medical Center (VAMC) to determine if the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161. If the VAMC determines that the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161 and requests VBA make a determination, then adjudicate the claim. 2. Arrange for an appropriate health care provider to review the Veteran's claims file and provide an opinion as to the following: (a) Identify the respiratory disabilities that have been present since March 2012, including COPD and acute bronchitis. (b) Then, for every diagnosed respiratory disability, state whether it is at least as likely as not (50 percent probability or greater) that the disability had its onset during service or is due to an event or incident of the Veteran's period of service. In answering the foregoing, the reviewing health care provider must address the multiple times the Veteran sought treatment for respiratory problems during service, his history of smoking, and any other relevant lay and medical evidence of record, to include the contention that the Veteran's current problems are a continuation of what he experienced on active duty. (c) A clear rationale for each opinion must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his bilateral hearing loss disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. If a hearing loss disability is identified in the right ear, the clinician is asked to address the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran's hearing loss had its onset during service or is related to an event or incident service, to include noise exposure? The clinician is advised that the absence of in-service evidence of a hearing loss disability is not always fatal to a service connection claims. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). The examiner should address the likelihood of delayed onset hearing loss due to noise exposure during service. The examiner should also address the lay and medical evidence of record. (b) A clear rationale for each opinion must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. The AOJ should review the entire record, including the VA treatment records added to the claims file since the issuance of the April 2020 SSOC, and readjudicate the issues on appeal. If the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.