Citation Nr: 21005802 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 17-08 088 DATE: February 2, 2021 REMANDED An initial staged compensable rating for bilateral hearing loss prior to January 18, 2017, and a rating in excess of 20 percent thereafter is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a neck disability, to include as due to a low back disability is remanded. Entitlement to service connection for a left hip disability, to include as due to a low back disability is remanded. A total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, had service from April 1969 to September 1969, from September 1975 to September 1979, and from July 1983 to July 1993. In April 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. 1. An initial staged compensable rating for bilateral hearing loss prior to January 18, 2017, and in excess of 20 percent thereafter is remanded. The Veteran testified before the undersigned in April 2020 and endorsed hearing loss that is worse than reflected by his staged ratings. However, the Board is without the expertise necessary to determine the extent of worsened symptoms exhibited by the Veteran’s disability. “VA regulations specifically require the performance of a new medical examination ... [when] ‘evidence indicated there has been a material change in a disability or that the current rating may be incorrect.’” Caffrey v. Brown, 6 Vet. App. 377, 381 (quoting 38 C.F.R. § 3.327(a)) (1994). As there is evidence indicating that the Veteran’s condition has worsened since his last VA examination of record, the Board finds that the Veteran’s claim should be remanded to provide him with an updated examination to accurately assess the current condition of this disability. In claims for a rating increase, it is first and foremost a priority to ensure that the most current assessment of the service-connected disability picture is of record. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991). During the April 2020 Board hearing, the Veteran identified relevant outstanding VA and private treatment records for bilateral hearing loss. A remand is required to allow VA to obtain authorization and request these records. 2. Service connection for hypertension is remanded. Service treatment records show elevated blood pressure readings taken thoughout service. The Board cannot make a fully-informed decision on the issue of hypertension because no VA examiner has opined whether it is related to service. During the April 2020 Board hearing, the Veteran identified relevant outstanding private treatment records for hypertension. A remand is required to allow VA to obtain authorization and request these records. 3. Service connection for a low back disability is remanded. The Board notes that the June 2015 VA low back disability examination contains an inadequate medical opinion to the extent it did not address all relevant evidence of record. The VA examination medical opinion failed to provide an adequate rationale to support each conclusion or discuss the contrary evidence associated with the record that supports the Veteran’s claims. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (a medical opinion must “support its conclusion with an analysis that the Board can consider and weigh against contrary opinions[;]” see also Nieves–Rodriguez, 22 Vet. App. 295, 304 (2008) (concluding that a medical opinion is not entitled to any weight if it does not contain a rationale that adequately connects data and conclusions). Specifically, the VA examiner noted only one instance of treatment for a lumbar muscle spasm in July 1976, but failed to address subsequent treatment during service for low back pain in August 1992. Once VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Without further clarification, the Board is without medical expertise to determine the nature and etiology of the claimed disability. Colvin v. Derwinski, 1 Vet. App. 171 (1991). In light of the above, the Board finds that a new VA examination opinion must be obtained. In a September 2017 Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire, a private physician identified relevant outstanding private treatment records for low back pain since 1995. A remand is required to allow VA to obtain authorization and request these records. 4. Service connection for a neck disability and a left hip disability, to include as due to a low back disability is remanded. The Board notes that the issues of entitlement to service connection for a neck and left hip disability cannot be adjudicated until the issue of service connection for a low back disability is addressed because they are intertwined. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). 5. A total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. The Board notes that the issue of entitlement to a total disability rating based on individual unemployability cannot be adjudicated until the hearing loss rating and service connection issues are addressed because they are intertwined. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for any treatment for bilateral hearing loss, hypertension, a low back disability, a neck disability, and a left hip disability, as well as any medical records from his previous employers as mentioned during the April 2020 Board hearing (i.e., commercial truck driving and security guard). Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA treatment records for the period from April 2018 to the Present. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral hearing loss. 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. 4. Schedule the Veteran for a VA examination for his hypertension. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is hypertension at least as likely as not related to service? Is it at least as likely as not that the hypertension (1) began during active service, (2) manifested within one-year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? The examiner must comment on the elevated blood pressures documented in service. Provide a rationale to support the opinion(s). 5. Schedule the Veteran for a VA examination for his low back disability. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the low back disability at least as likely as not related to service, including treatment in July 1976 and August 1992? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. Is it at least as likely as not that the low back disability (1) began during active service, (2) manifested within one-year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? 6. Schedule the Veteran for a VA examination for his neck disability. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the neck disability at least as likely as not related to service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. Is the neck disability at least as likely as not proximately due to the low back disability? Is the neck disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the low back disability? Is it at least as likely as not that the neck disability (1) began during active service, (2) manifested within one-year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? 7. Schedule the Veteran for a VA examination for his left hip disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the left hip disability at least as likely as not related to service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. Is the left hip disability at least as likely as not proximately due to the low back disability? Is the left hip disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the low back disability? (Continued on the next page)   Is it at least as likely as not that the left hip disability (1) began during active service, (2) manifested within one-year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Connally, 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.