Citation Nr: 21013501 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 18-49 034 DATE: March 9, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to a disability rating in excess of 20 percent for lumbosacral strain with degenerative disc disease and intervertebral disc syndrome is remanded. Entitlement to a disability rating in excess of 20 percent for lumbar radiculopathy (sciatic nerve) of the right lower extremity is remanded. Entitlement to a disability rating in excess of 20 percent for lumbar radiculopathy (sciatic nerve) of the left lower extremity is remanded. Entitlement to total disability based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from June 1959 to June 1963. These matters are before the Board of Veterans’ Appeals (Board) on appeal from January 2018 and April 2018 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Veteran testified at a hearing before the undersigned; a transcript of that hearing is of record.   1. Entitlement to service connection for bilateral hearing loss is remanded. On December 2017 and September 2018 VA examinations, the examiners provided similar opinions that any hearing loss the Veteran had was less likely than not related to service because, although the Veteran reported hazardous noise exposure early in his service, his separation hearing test was within normal limits, and that hearing loss for pure tones does not worsen following cessation of a given noise exposure. The Board finds these opinions inadequate as they are conclusory and do not provide a clear rationale for the conclusion provided. A Veteran may establish direct service connection for a hearing disability, even if initially manifest years after separation from service, if there is evidence of a causal relation to service. Hensley v. Brown, 5 Vet. App. 155, 164 (1993). As such, remand for an addendum opinion is necessary. 2. Entitlement to increased disability ratings for lumbosacral strain with degenerative disc disease and intervertebral disc syndrome and for lumbar radiculopathy (sciatic nerve) of the right and left lower extremities is remanded. The Veteran most recently underwent a VA examination for his back condition and lumbar radiculopathy conditions in May 2019. In his November 2020 testimony before the Board, the Veteran said that his symptoms had worsened since the May 2019 examination, particularly that he could no longer walk upstairs, and that at times he now loses control of his legs. Due to the reports of increased severity of the back and radiculopathy conditions, remand is required for a new examination to assess the current severity of the disabilities. In addition, the Veteran testified that he receives treatment for his back and radicular conditions at a private facility as well as through VA. Any outstanding private and VA treatment records should be obtained on remand.   3. Entitlement to TDIU is remanded. The claim seeking entitlement to TDIU is inextricably intertwined with the increased rating claims being remanded. Accordingly, the Board will defer addressing the matter of TDIU. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from October 2020 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for any private provider who has treated the Veteran for his back and/or radicular conditions, including Nittany Valley Medical Associates. Make two requests for any authorized records from the provider or providers, unless it is clear after the first request that a second request would be futile. 3. Obtain an opinion regarding the etiology of the Veteran’s bilateral hearing loss from an appropriate clinician. An examination of the Veteran should only be scheduled if deemed necessary by the clinician providing the opinion. The reviewing clinician must provide an opinion on the following question: Is it at least as likely as not that bilateral hearing loss is related to an in-service injury, event, or disease, including noise exposure during active duty? The reviewing clinician must consider that, under applicable law, the absence of in-service evidence of a hearing loss disability is not always fatal to a service connection claim. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 4. Schedule the Veteran for an examination to assess the current severity of his service-connected lumbosacral strain with degenerative disc disease and intervertebral disc syndrome AND lumbar radiculopathy (sciatic nerve) of the right and left lower extremities. The electronic claims file must be made available to the examiner for review in conjunction with the examination. All pertinent symptomatology and findings must be reported in detail. All indicated diagnostic tests and studies must be accomplished. Any appropriate Disability Benefits Questionnaire (DBQ) should be filled out for this purpose, if possible. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 5. Readjudicate the matters on appeal, including consideration of any VA treatment records added to the record since the August 2019 statement of the case. If any benefit sought is not granted in full, issue a supplemental statement of the case to the Veteran before returning the case to the Board, if otherwise in order. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Dean 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.