Citation Nr: 21076309 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 17-67 112 DATE: December 23, 2021 REMANDED Entitlement to an initial disability rating in excess of 10 percent for right knee patellofemoral pain syndrome with tendonitis and tendinosis is remanded. Entitlement to an initial compensable disability rating for right knee scar is remanded. Entitlement to service connection for bilateral sensorineural hearing loss is remanded. REASONS FOR REMAND Having reviewed the record, the Board finds remand is warranted. With respect to the issue of an initial increased rating for right knee patellofemoral pain syndrome with tendonitis and tendinosis, the Veteran's August 2021 testimony indicates a potential worsening of symptoms since his last VA examination. Specifically, he reported that flexion and/or extension of the left knee was limited to approximately 10 degrees. In light of this testimony, the Board finds remand is warranted for an examination to determine the current severity of the Veteran's right knee right knee patellofemoral pain syndrome with tendonitis and tendinosis. As the right knee disability claim is remanded for an examination, the Board finds the associated right knee scar claim is inextricably intertwined and must be remanded for examination as well. With respect to the hearing loss claim, remand is warranted for an examination. The November 2017 VA examiner determined that the Veteran had a diagnosis of bilateral sensorineural hearing loss, but did not provide an opinion on whether it was chronic since service, manifested within 1 year after service, or was noted in service and continuous since service. Additionally, the Board notes that the record contains conflicting evidence on whether the Veteran has hearing loss in the right ear for VA purposes pursuant to 38 C.F.R. § 3.385. Specifically, puretone thresholds from the April 2014 private audiometric evaluation differ significantly from the thresholds from the November 2014 VA examination. As it has been 7 years since his last audiometric evaluation, and in light of his August 2017 testimony of muffled hearing, the Board finds remand is warranted to clarify whether the Veteran has hearing loss in the right ear for VA purposes. For these reasons, the Board cannot make a fully informed decision on the issue and finds that remand is warranted to assess the nature and etiology of the Veteran's current hearing loss. The examiner must provide an opinion on whether sensorineural hearing loss began during active service, manifested within 1 year after discharge from service, or was noted during service with continuity of the same symptomatology since service. Finally, any outstanding VA treatment records from November 2017 to the present should be obtained and associated with the claims file. The matters are REMANDED for the following actions: 1. Obtain the Veteran's VA treatment records for the period from November 2017 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected (i) right knee patellofemoral pain syndrome with tendonitis and tendinosis and (ii) associated right knee scar. 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. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Schedule the Veteran for a VA examination for his claimed bilateral sensorineural hearing loss. The examiner must review the claims file. The examiner is asked to provide a response to the following: (a) The examiner should provide puretone thresholds and speech discrimination scores for the right and left ears. (b) The examiner should state whether the disability is at least as likely as not related to service, including conceded in-service noise exposure. (c) The examiner should state whether the disability at least as likely as not (1) began during active service, (2) manifested within 1 year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. Provide a rationale to support the opinions. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Vang, 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.