Citation Nr: 21014040 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 16-04 242 DATE: March 11, 2021 ORDER Service connection for herpes simplex virus 1 is granted. REMANDED Service connection for a left ear disorder, previously characterized as left ear hearing loss, is remanded. FINDING OF FACT The Veteran’s herpes simplex virus onset in service. CONCLUSION OF LAW The criteria for service connection for herpes simplex virus 1 have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1986 to September 2000. The matter comes before the Board of Veterans’ Appeals on appeal from two July 2015 rating decisions. In January 2021, he had a hearing before the undersigned Veterans Law Judge. The Veteran initially filed a claim for service connection for left ear hearing loss in January 2014. The evidence shows that, following his claim filing, he was diagnosed with a vestibular schwannoma in his left ear, as well as hearing loss. After review of the record, the Board finds that the claim for service connection for left ear hearing loss should be broadened to a claim for service connection for a left ear disorder, to include the schwannoma and left ear hearing loss. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran seeks service connection for the herpes simplex virus 1. Service treatment records show that the Veteran was treated for acute herpetic gingivostomatitis, a viral infection of the mouth that causes sores and is caused by the herpes simplex virus, in February 1988. See U.S. Nat’l Library of Med., Herpetic stomatitis, MedlinePlus, https://medlineplus.gov/ency/article/001383.htm (last visited Mar. 5, 2021). Serum testing, conducted by VA in October 2016, revealed prior herpes simplex virus 1 exposure. Further, the Veteran has competently and credibly testified that he experienced outbreaks since 1988. This is supported by medical literature, which shows the herpes simplex virus becomes dormant following the first infection and may reactivate later, causing cold sores. See U.S. Nat’l Library of Med., Herpes – oral, MedlinePlus, https://medlineplus.gov/ency/article/000606.htm (last visited Mar. 5, 2021). The Veteran is competent to report these periodic outbreaks, and his testimony was credible. Based on the competent and credible lay and medical evidence on record, the Board finds that his herpes simplex virus 1 onset in service, and the claim for service connection is granted. REASONS FOR REMAND Service connection for a left ear condition is remanded. The Board finds that the claim for service connection for a left ear condition must be remanded for an adequate VA medical opinion that addresses the favorable evidence in the claims file. In her June 2015 medical opinion, the VA examiner stated there was no permanent positive hearing threshold shift in service. The Veteran’s service records document several threshold shifts, however, including in January 1995 and January and February 2000. Furthermore, the examiner also concluded that she could not opine as to whether the Veteran’s hearing loss was related to his vestibular schwannoma and whether the vestibular schwannoma was related to service without resorting to mere speculation, but she did not provide explanations as to why not. Finally, it is not clear whether she considered the May 2014 medical statement received in July 2014. Regarding the May 2014 statement, a remand for an addendum medical opinion is necessary because this statement is an insufficient basis upon which to grant the claim as it does not contain a statement that the Veteran’s service caused his vestibular schwannoma or hearing loss. Rather, it discusses various risk factors for developing the condition, but without any discussion of military versus civilian occupational exposures, considering the Veteran’s civilian occupation as a pilot. The matters are REMANDED for the following action: Forward the claims file to a VA examiner for a medical opinion regarding the relationship between the Veteran’s service, vestibular schwannoma, and left ear hearing loss, if any. After a review of the claims file, the examiner should respond to the following: (a.) Is it at least as likely as not that the Veteran’s vestibular schwannoma began in or is otherwise related to service? (b.) Is it at least as likely as not that the Veteran’s left ear hearing loss began in or is otherwise related to service? (c.) If not, is it at least as likely as not that the Veteran’s left ear hearing loss was caused by his vestibular schwannoma? If an opinion cannot be rendered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. In rendering the opinions, the examiner must consider the following evidence: i. In determining etiology, please discuss as appropriate military versus civilian occupational exposures (Veteran fighter pilot during service but also pilot for commercial airlines for many years). ii. The May 2014 informal line of duty determination (located in Military Personnel Record received 07/17/2014); iii. The May 2014 medical statement from the Veteran’s treating provider discussing risk factors of exposure to loud noise and jet fuel (located in Medical Treatment Record – Government Facility received 07/17/2014); iv. The medical articles regarding exposure to loud noise and risk of acoustic neuroma (located in Correspondence received 07/17/2014) and on vestibular schwannoma (located in STR received 6/20/14); v. The Veteran’s service treatment records which document threshold shifts in January 1995 and January and February 2000 (the shifts are located on pages 168 and 212 in STR – Reserve STR received 05/15/2015); and vi. The Veteran’s treatment records from January 2014 through May 2014 which show diagnosis of hearing loss and vestibular schwannoma (located on pages 74 to 104 in STR – Reserve STR received 05/15/2015). MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lavan, 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.