Citation Nr: 21077428 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 15-12 260A DATE: December 29, 2021 REMANDED The claim of entitlement to service connection for a bilateral hearing loss disorder is remanded. The claim of entitlement to service connection for a right knee disorder is remanded. The claim of entitlement to service connection for a left knee disorder is remanded. The claim of entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran had active service from April 1969 to July 1970. This matter came before the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). The Board denied the claims on appeal in a June 2019 decision the Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court). In April 2020, pursuant to an April 2020 joint motion for remand (JMR), the Court vacated the Board's decision and remanded the matter so that the Board could convene a hearing, which the Veteran requested in his substantive appeal. In July 2021, the Veteran testified in a hearing before the Board. A transcript of the hearing is included in the electronic claims file and has been reviewed. A remand of the claims is necessary for additional medical inquiry. Relevant evidence has been included in the claims file since the June 2019 Board decision, and since the most recent VA compensation examination reports addressing these claims, which are dated in March 2014. The service treatment records (STRs) and induction report of medical examination note that the Veteran underwent left knee surgery prior to service. The STRs also indicate that he had mental health issues prior to service, but the induction report of medical examination is negative for a psychiatric disorder. The STRs do not indicate hearing loss during service, but tinnitus has been found service connected. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Undertake appropriate development to obtain any outstanding records pertinent to the claims. Include in the claims file any outstanding VA treatment records. 3. Schedule examinations to assess the nature and etiology of the disorders underlying the Veteran's remanded claims. After reviewing the electronic claims file, interviewing the Veteran, and examining him, the respective examiners should answer the following questions: Hearing loss: Is it at least as likely as not (i.e., probability of 50 percent or more) that bilateral hearing loss disability (as with service-connected tinnitus) had its onset during service or is related to a disease, event, or injury during service? Right knee: (a) Is it at least as likely as not (i.e., probability of 50 percent or more) that a right knee disorder had its onset during service or is related to a disease, event, or injury during service? (b) If not, is it at least as likely as not that a right knee disorder is due to or caused by a left knee disorder (if the left knee disorder is ultimately found service-connected)? (c) If not, is it at least as likely as not that a right knee disorder has been aggravated (i.e., permanently or temporarily worsened beyond the natural progress) by a left knee disorder (if the left knee disorder is ultimately found service-connected)? Left knee: (a) Is it at least as likely as not that the left knee disorder noted upon entry into service increased in severity during service? (b) If so, is it clear and unmistakable (i.e., undebatable) that the left knee disorder WAS NOT aggravated (i.e., permanently worsened) by service? In other words, is it clear and unmistakable that any increase in severity during service of the pre-service left knee disorder was due to the natural progress of the disorder? Do not address (b) if the answer to (a) is negative. (c) Is it at least as likely as not (i.e., probability of 50 percent or more) that a left knee disorder unrelated to the pre-service left knee problem had its onset during service or is related to a disease, event, or injury during service? Psychiatric: (a) What are the Veteran's current psychiatric disorders? (b) Is it clear and unmistakable (i.e., undebatable) that he entered service with a preexisting acquired psychiatric disorder? (c) If so, it is also clear and unmistakable that the pre-service acquired psychiatric disorder WAS NOT aggravated (i.e., permanently worsened) by service? In other words, is it clear and unmistakable that any increase in severity during service of the pre-service acquired psychiatric disorder was due to the natural progress of the disorder? Do not address (c) if the answer to (b) is negative. (d) If the answer to (b) is negative: is it at least as likely as not (i.e., probability of 50 percent or more) that an acquired psychiatric disorder had its onset during service or is related to a disease, event, or injury during service? If (d) is answered, it must be presumed that the Veteran did not have a psychiatric disorder prior to service entrance. Further, if (d) is answered, discuss the STRs showing repeated mental health troubles during service. 4. To each examiner: The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinions, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. (Continued on the next page) Please explain in detail any opinion provided and the supporting rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.