Citation Nr: 21076272 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 14-07 068A DATE: December 23, 2021 REMANDED 1. Entitlement to service connection for a right knee disability is remanded. 2. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from June 2004 to April 2008. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision. In August 2016, a videoconference hearing was held before the undersigned; a transcript is in the record. In January 2018 and November 2020, the case was remanded for further development. [A May 2021 rating decision granted service connection for residuals of a concussion. Accordingly, that issue is no longer on appeal before the Board.] The Board sincerely regrets the further delay inherent with another remand but, unfortunately, finds that the November 2020 remand instructions were not adequately fulfilled. See Stegall v. West, 11 Vet. App.268 (1998). 1. Entitlement to service connection for a right knee disability. On May 2021 VA knee examination, the examiner opined that it was less likely than not that the Veteran's right knee disability was related to his service. She explained that although the Veteran did have knee pain in 2008 during service, X-rays were normal, and no diagnosis was provided. The examiner noted a current diagnosis of right knee acute knee sprain but that there was a lack of chronicity regarding right knee treatment in the records. In an addendum opinion, she explained that she was unable to speak regarding the likelihood that the right knee disability was due to a "wreck" during military service because there was a lack of evidence of trauma to the knee and the only notation was that a bulldozer rolled over and the Veteran sustained a wrist injury. The opinion is inadequate for rating purposes because although the examiner acknowledged the Veteran's claimed injury in service, a likely etiology of the current knee disability was not identified. Therefore, another remand for a fully adequate medical advisory opinion regarding the etiology of the Veteran's right knee disability is necessary. 2. Entitlement to service connection for bilateral hearing loss. On February 2021 VA hearing loss examination, the examiner opined that it was less likely than not that the Veteran's hearing loss is related to his service. He explained that there was no significant permanent shift in hearing thresholds beyond test variability during the period from the Veteran's entrance to and separation from service, which is objective evidence of no permanent auditory damage on active duty from conceded noise. It was noted that there was no report of complaints or treatment for decline in hearing acuity in the service treatment records (STRs) or at separation. The examiner indicated 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. The opinion is inadequate because under governing caselaw, the absence of a hearing loss in service is not fatal to a claim of service connection for hearing loss (see Hensley v. Brown, 5 Vet. App.155, 159 (1993)). Furthermore, an alternate likely etiology for the Veteran's bilateral hearing loss was not identified. A remand to obtain an adequate medical advisory opinion regarding the etiology of the Veteran's bilateral hearing loss is necessary. The matters are REMANDED for the following: 1. Arrange for the Veteran's record to be forwarded to an appropriate clinician for review and an advisory medical opinion to confirm whether he has a right knee disability (to include by virtue of knee pain causing functional impairment), and if so, determine its likely etiology. [If further examination of the Veteran is deemed necessary for an opinion sought such should be arranged.] The Veteran's claims file must be reviewed by the provider, any tests or studies indicated should be completed, and all pertinent findings should be described in detail. The consulting provider should: (a) Identify (by diagnosis) any (and each) right knee disability found (to include any due to pain causing functional impairment). If a right knee disability with underlying pathology objectively shown is not found, specifically note whether the Veteran reports having right knee pain, and if so indicate whether the pain results in functional impairment. (b) Identify the likely etiology for each right knee disability (including any due to pain with related functional joint) found, and opine whether it at least as likely as not (a 50% or better probability) is etiologically related to the Veteran's service, (to include as due to a reported vehicle accident therein). (c) If a diagnosed right knee disability is determined to not have been incurred in service, to the extent possible from the record, identify the etiology that is considered more likely (and explain why that is so). Include rationale with all opinions, citing to supporting factual data and medical principles, as deemed appropriate. 2. Also arrange for the Veteran's record to be forwarded to an audiologist or otologist for review and an advisory medical opinion addressing the etiology of his bilateral hearing loss disability. [If further audiological examination of the Veteran is deemed necessary for an opinion sought such should be arranged.] The consulting provider should: (a) Identify the likely etiology of the Veteran's bilateral hearing loss disability. Specifically, is it at least as likely as not (a 50% or better probability) that it is related to his service and acknowledged likely exposure to loud noise therein? (b) If the hearing loss is deemed to not be related to the Veteran's service, identify the etiology for the disability that is considered to be more likely (and explain why that is so). Include complete rationale with all opinions. Note that absence of hearing disability in service may not be the sole basis for concluding that hearing loss is unrelated to service. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.