Citation Nr: 21007310 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 16-02 249 DATE: February 9, 2021 REMANDED Entitlement to service connection for a left ear condition, claimed as left ear damage, is remanded. REASONS FOR REMAND The Veteran served in the Air Force from May 1999 to July 1999, from October 2001 to August 2003, from March 2004 to May 2006, and from February 2008 to October 2008, and the Air National Guard from January 2011 to August 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Appellant testified before the undersigned Veteran’s Law Judge (VLJ) at a video-conference hearing. A transcript is of record. The Board then remanded for further development in July 2019. 1. Entitlement to service connection for a left ear condition, claimed as left ear damage, is remanded. In July 2019, the Board remanded the Veteran’s claim for a VA examination to assess the nature of his left ear symptoms and whether they may be secondary to his service-connected tinnitus or linked to in-service noise exposure. The Veteran received a VA medical examination in January 2020, at which time he reported occasional left ear crackling and fullness. The examiner, a general practitioner, stated that the Veteran’s symptoms were subjective only and that objective examination was normal. He stated that, “There is no objective evidence of a chronic condition . . . The exam at today's visit was normal, and the Veteran was without complaints. He stated that he [would] have occasional ‘crackling noises’ in his left ear. Records show that his left ear complaint was likely due to sinus issues and not his tinnitus. Audiogram from 2010 was normal. A complete work-up by an ENT specialist has not been done but would be in order as well as a repeat audiogram.” The January 2020 VA examiner recommended that the Veteran undergo a work-up by an ear, nose and throat (ENT) specialist, as well as an audiogram. As noted by the Veteran’s representative in the December 2020 Brief, this has not been accomplished. Furthermore, the U.S. Court of Appeals for the Federal Circuit found that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board finds that, considering Saunders and the recommendation for further evaluation by the January 2020 VA examiner, a new examination and opinion are warranted. The matter is REMANDED for the following action: 1. Add to the file any outstanding VA treatment records for the Veteran dated since June 2020. 2. Schedule the Veteran for an examination by an ear, nose and throat (ENT) specialist. (a) After conducting any appropriate diagnostic testing, including an audiogram, the examiner is asked to identify all left ear disorders found to be present, with specific consideration of the Veteran’s complaints of left ear crackling and fullness. (b) For each diagnosed left ear disorder (other than tinnitus), the examiner should provide an opinion as to whether it is at least as likely as not (50% probability or more) that the condition was either (i) caused by, or (ii) is/was aggravated by the Veteran’s service-connected tinnitus. (c) The examiner is also asked to provide an opinion as to whether it is at least as likely as not that any diagnosed left ear disorder (other than tinnitus) is directly related to the Veteran’s in-service noise exposure. (d) In light of Saunders, the examiner should provide an opinion as to whether it is at least as likely as not (50% or greater probability) that the Veteran's reported left ear symptoms, including crackling and fullness, result in a functional impairment of earning capacity, i.e., a disability for VA purposes? If so, is it at least as likely as not (i.e., a 50 percent or greater probability) that such disability is (i) directly related to the Veteran’s in-service noise exposure; or (ii) was caused by, or (iii) is/was aggravated by his service-connected tinnitus? • In rendering the opinions, the examiner should consider the normal left ear examination findings and the Veteran’s denial of left ear symptoms in the January 2009 and September 2012 VA examination reports. The examiner should also consider the June 2013 VA treatment record reflecting that the Veteran complained of left ear fullness. A sinus issue was suspected at the time. Further, the examiner should consider the January 2020 VA examination report wherein the Veteran reported occasional left ear crackling and fullness, with normal examination of his ear. The examiner should provide a complete explanation in support of the conclusion reached. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Gonzalez, Damian 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.