Citation Nr: 21008634 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 15-03 883A DATE: February 17, 2021 REMANDED Service connection for right knee patellar tendonitis is remanded. Service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1999 to September 2003. This matter comes before the Board of Veterans’ Appeals (Board) from April 2014 and May 2014 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The issues on appeal were remanded in October 2018 for further development. 1. Service connection for right knee patellar tendonitis is remanded. In the October 2018 Remand, the Board noted that a March 2014 VA examination report appeared to reflect that the Veteran was diagnosed with chronic right knee strain and posterior tibial tendinitis in 2003, which is within the same year of his separation from active service. In that May 2014 opinion, a VA examiner determined that the Veteran’s right knee disorder was less likely than not related to his military service, in part, because he did not have complaints of knee symptomology while in service or within a year of separation from service. The Board determined an addendum opinion was necessary to reconcile the conflicting statements regarding the history of the Veteran’s right knee condition in the March 2014 and May 2014 VA examination reports. Pursuant to the remand directives, an addendum opinion was obtained in August 2020. The examiner addressed the conflicting statements regarding the history of the Veteran’s right knee condition and noted that service treatment records contained no reference to the right knee. The Board has also reviewed the service treatment records and while they show complaints of left leg pain and references to a left leg strain, left tibia fracture, and bilateral heel/foot complaints diagnosed as plantar fasciitis- there are no complaints or clinical diagnoses related to the right leg or knee including on the July 2003 Report of Medical Assessment for discharge purposes. That said, the Veteran has asserted his right knee condition is secondary to his service-connected left knee degenerative arthritis and tendonitis/tendinosis. The VA opinions received in June 2017 and August 2020 do not adequately address whether the current left knee condition is aggravated by the service-connected right knee degenerative arthritis and tendonitis/tendinosis. This must be addressed. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Accordingly, an addendum opinion must be obtained for secondary service connection. 2. Service connection for bilateral hearing loss is remanded. Service connection for bilateral hearing loss was also remanded by the Board in October 2018 and a VA opinion was obtained in August 2020. Unfortunately, the opinion does not address the assertion that the Veteran’s current bilateral hearing loss is secondary to his service-connected tinnitus. See March 2019 VA Form 21-526EZ. An addendum opinion is necessary on that matter. The August 2020 opinion included references to the 2006 the Institute of Medicine report (IOM) and acknowledged that the IOM found there is insufficient scientific basis to conclude that permanent hearing loss directly attributable to noise exposure will develop long after noise exposure and concluded that based on their current understanding of auditory physiology, a prolonged delay in the onset of noise-induced hearing loss is “unlikely.” On remand, if relying on the IOM study, the examiner is asked to provide further clarification as to whether any contradictory findings regarding delayed-onset hearing loss in the IOM report rendered its findings less persuasive in this Veteran's case as to the question of whether delayed onset hearing loss is as likely as not etiologically related to in-service noise exposure. See McCray v. Wilkie, 31 Vet. App. 243 (2019). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right knee disability is either proximately due to his service-connected left knee disability OR is aggravated beyond its natural progression by his service-connected left knee disability. The examiner must provide fully explained rationale for each of the proximate causation and aggravation opinions. 2 Obtain an addendum opinion regarding the onset and etiology of the Veteran’s bilateral hearing loss disability. The examiner must opine as to whether it is at least as likely as not that the Veteran’s hearing loss is caused by or related to service. The examiner must also opine as to whether it is at least as likely as not proximately due to service-connected tinnitus or aggravated beyond its natural progression by service-connected tinnitus. Please explain why or why not. A complete rationale is required. In formulating a medical opinion, if relying to any extent upon the IOM study noted above, the examiner must explain whether any contradictory findings regarding delayed-onset hearing loss in the IOM report rendered its findings less persuasive in this Veteran's case as to the question of whether delayed onset hearing loss is as likely as not etiologically related to in-service noise exposure. The examiner is further advised that a negative opinion based solely on the Veteran having normal hearing at entrance and separation is not considered adequate for adjudication purposes. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.Aoughsten, Associate 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.