Citation Nr: 21011903 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 17-24 093 DATE: March 3, 2021 REMANDED A claim of entitlement to service connection for bilateral hearing loss is remanded. A claim of entitlement to service connection for a neck condition, to include degenerative disc disease of the cervical spine, is remanded. A claim of entitlement to service connection for a lower back condition, to include degenerative disc disease of the lumbar spine, is remanded. A claim of entitlement to service connection for a left-hand condition, to include as secondary to a neck condition and/or back condition, is remanded. A claim of entitlement to service connection for a right-hand condition, to include as secondary to a neck condition, back condition and/or left-hand condition, is remanded. A claim of entitlement to service connection for a right knee condition, to include as secondary to a neck condition and/or back condition, is remanded. A claim of entitlement to service connection for a left knee condition, to include as secondary to a neck condition, back condition and/or right knee condition, is remanded. A claim of entitlement to service connection for a right ankle condition is remanded. A claim of entitlement to service connection for a left ankle condition, to include as secondary to a right ankle condition, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from February 1984 to February 1988. He testified before the undersigned Veterans Law Judge in support of his claims in March 2020. He currently has a combined disability rating of percent 10 percent. 1. Service connection for bilateral hearing loss The Veteran was a tank system mechanic in service. VA has conceded his exposure to loud noise. Although hearing loss was found during a December 2014 VA examination, it was not of sufficient severity to qualify as a disability that could be service-connected per VA regulations. Since the Veteran’s last VA audiologic examination was 6 years ago, and there is a possibility that the Veteran’s hearing may have worsened such that he now meets the criteria for service connection, he should be afforded a new VA examination to determine the current severity of his hearing loss. 2. Service connection for conditions of the neck, the back, the bilateral hands, the bilateral knees, and the bilateral ankles The claims file contains statements and testimony from the Veteran regarding an injury to his neck, back, and right ankle in service. The Veteran testified during his March 2020 BVA hearing that he injured his neck, back and right ankle all in one incident in service. He reported that he was carrying a 50-caliber machine gun up onto the top of an armored vehicle when he slid off and caught his right ankle, which caused him to fall on the concrete on top of the gun that he dropped. He stated that his helmet jammed into the back of his neck. He also testified, and his service-medical records document, that he suffered a subsequent inversion sprain of the right ankle. The Veteran seeks service connection on a direct basis for his neck, shoulder ,and back. He also seeks service connection for his bilateral hands, bilateral knees, and left ankle on both direct and secondary bases. For conditions consisting of degenerative disc disease, service connection on a presumptive basis may be warranted. Recently, private medical nexus opinions from J.E., M.D. were associated with the claims file. Dr. J.E. lists 15 different “Service-Connected Diagnoses” with VA rating diagnostic codes in his report. The Board assumes that Dr. J.E. relates to these disorders as diagnoses pertaining to the Veteran’s claims. He also appears to list the disability ratings he believes should be assigned to the 15 different diagnoses. As the Regional Office (RO) denied several of the Veteran’s claims based upon the lack of current diagnoses in the rating decision on appeal, and the claims file reveals the Veteran has not been afforded VA examinations for any of his claims other than hearing loss, the Board finds a remand is warranted to schedule the Veteran for appropriate VA exams. The matters are REMANDED for the following actions: 1. Bilateral Hearing Loss: schedule the Veteran for an audiological examination to determine whether he currently experiences a hearing loss disability for VA purposes. If so, the examiner should prove a medical opinion as to whether the bilateral hearing loss disability is due to the conceded in-service noise exposure. The examiner is asked to provide a rationale for all opinions reached. 2. Neck, Back, Bilateral Hands, Bilateral Knees, and Bilateral Ankle Conditions: schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any neck condition, back condition, bilateral hand condition, bilateral knee condition and bilateral ankle condition. If disabilities of the neck, back, bilateral hands, bilateral knees and/or bilateral ankles are diagnosed, the examiner should initially provide a medical opinion for direct service connection - whether it is at least as likely as not that any of these disabilities are related to an in-service injury or disease, including the fall from a tank reported by the Veteran to have occurred in-service. In making these determinations, the examiner is asked to assume that the tank fall reported by the Veteran occurred. In providing his/her opinions, the examiner should specifically state whether it is at least as likely as not that (1) any diagnosed disability began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with a continuity of the same symptomatology since service. Bilateral Hands, Bilateral Knees, and Bilateral Ankle Conditions: In addition to seeking service connection on a direct basis, the Veteran has argued that he developed conditions of the bilateral hands, bilateral knees, and bilateral ankles secondary to either his neck condition or back condition. If the examiner determines the Veteran has current disabilities of the hands, knees, and/or ankles, he/she should provide an opinion as to whether these disabilities are causally or etiologically related to any diagnosed neck or back conditions; or whether (1) they are related or proximately due to a service-connected disability, or (2) have been aggravated beyond their natural progression by a service-connected disability. Right Hand, Left Knee and Left Ankle Conditions: The Veteran has also specifically argued that he developed a right hand condition secondary to a left hand condition, a left knee condition secondary to a right knee condition, and a left ankle condition secondary to a right ankle condition. If disabilities of the right hand, left knee and left ankle are diagnosed, the examiner should (in addition to providing opinions on a direct basis) be asked to provide opinions regarding service connection on a secondary basis. He/she should state whether it is at least as likely as not that these disabilities developed as a result of overcompensation of his left hand, right knee and right ankle, respectively. Conditions Manifested By Pain Alone: Lastly, if the examiner cannot diagnose the Veteran as having a specific condition other than pain (i.e., arthralgias of the bilateral knees), he/she should comment on whether the pain suffered by the Veteran results in any functional loss/impairment. If so, provide the requested opinions for the joints impacted by functional loss/impairment. The examiner(s) is asked to provide a detailed rationale for all opinions rendered. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Talpins, Patricia 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.