Citation Nr: 21011816 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 17-34 481 DATE: March 2, 2021 REMANDED Entitlement to service connection for bilateral tinea pedis is remanded. Entitlement to service connection for a right knee disability, claimed as a right leg disability is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, had service from July 1980 to July 1984. In September 2019, the Board denied service connection for bilateral tinea pedis, a right knee disability, bilateral hearing loss, and tinnitus. The Veteran appealed the Board’s decision, in part, to the United States Court of Appeals for Veterans Claims (Court). In October 2020, the Court issued an Order granting a Joint Motion for Partial Remand by the parties, vacating the decision with respect to the issue described above, and remanding the matter to Board for further action. 1. Service connection for a bilateral foot disability is remanded. The Veteran has a current diagnosis for left toenail fungus as shown by June 2014 Redding Outpatient Clinic records. As such, an addendum medical opinion is necessary in order for the Board to make a fully-informed decision on the issue of service connection for a bilateral foot disability. 2. Service connection for a right knee disability, claimed as a right leg disability is remanded. The March 2015 VA examination opinion was inadequate to the extent the examiner did not consider all theories of entitlement. An addendum medical opinion is necessary in order for the Board to make a fully-informed decision on the issue of a right knee disability because no VA examiner has opined whether it is secondary to the service-connected right ankle disability, to include as due to an irregular gait pattern. 3. Service connection for bilateral hearing loss is remanded. The Board notes that the March 2015 VA examinations contain inadequate medical opinions regarding the issue of service connection for bilateral hearing loss. 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). 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 did not explain whether the Veteran’s hearing loss was initially caused by military service. Instead, the VA examiner opined that the Veteran “had a significant amount of post military noise exposure (heavy equipment operator for 25-30 years) that likely contributed to the Vet’s current hearing loss, overshadowing any loss caused by the military.” Without further clarification, the Board is without medical expertise to determine the nature and etiology of the claimed disabilities. Colvin v. Derwinski, 1 Vet. App. 171 (1991). In light of the above, the Board finds that new VA examinations opinions must be obtained for the bilateral ankle and bilateral foot disabilities. The March 2015 VA examiner also referenced a June 18, 2014 VA audiologic report from a contracting audiologist with the Redding Hearing Institute that must also be associated with the record. 4. Service connection for tinnitus is remanded. The Board notes that the issue of entitlement to service connection for tinnitus cannot be adjudicated until the service connection for bilateral hearing loss issue 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). The matters are REMANDED for the following action: 1. Obtain the Veteran’s June 18, 2014 VA audiologic report that was scanned into VistA Imaging and associate it with the claims file. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s bilateral foot disability. The examiner must opine on the following and provide a rationale to support each opinion: (a.) whether the bilateral foot disability, to include toenail fungus, is at least as likely as not related to service, to include treatment for “trench foot” during service. (b.) Whether the bilateral foot disability, to include toenail fungus, is proximately due to a service-connected disability, to include the right ankle and/or an irregular gait pattern. (c.) Whether the bilateral foot disability, to include toenail fungus, was aggravated beyond its natural progression by a service-connected disability, to include the right ankle and/or an irregular gait pattern. A complete rationale for all opinions is required. 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s right knee disability. The examiner must opine on the following and provide a rationale to support each opinion: (a.) Whether the right knee disability is at least as likely as not proximately due to a service-connected disability, to include the right ankle and/or an irregular gait pattern. (b.) Whether the right knee disability is at least as likely as not aggravated beyond its natural progression by a service-connected disability, to include the right ankle and/or an irregular gait pattern. A complete rationale for all opinions is required. 4. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s bilateral hearing loss. The examiner must opine on the following and provide a rationale to support each opinion: (a.) Is the bilateral hearing loss at least as likely as not related to service? The medical opinion should discuss whether it is at least as likely as not the Veteran had bilateral hearing loss for VA purposes before post-service noise exposure. (b.) Is it at least as likely as not that the bilateral hearing loss (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? A complete rationale for all opinions is required. 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.