Citation Nr: 21020719 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 17-55 906 DATE: April 8, 2021 REMANDED The issue of entitlement to a compensable rating for bilateral hearing loss is remanded. The issue of entitlement to service connection for a sinus condition is remanded. The issue of entitlement to service connection for a skin condition is remanded. VETERAN CONTENTIONS The Veteran contends that, since being service connected for bilateral hearing loss, his hearing has gotten worse. With respect to his claimed skin and sinus conditions, the Veteran contends that he first experienced both upon his return from service in Kyrgyzstan. In Kyrgyzstan the Veteran asserts that he was exposed to a lot of burning trash and smoke and his bathwater was pumped in from a plant out on the Economy. According to the Veteran, the water was not fit to drink. After those exposures the Veteran began experiencing extremely dry cracking skin and fingernails, spots on his lower ankles, and sinus congestion that is not seasonal and makes breathing difficult. REASONS FOR REMAND The Veteran served on active duty in the Army National Guard from February to July 1991 and December 1995 to September 1996. He also served in the Air National Guard from September 2001 to May 2003, from December 2004 to March 2005, and from January to October 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision by a Department of Veteran’s Affairs (VA) Regional Office (RO). In October 2020 the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) and the transcript is of record. 1. Entitlement to a compensable rating for bilateral hearing loss is remanded. VA has a duty to provide a contemporaneous examination when the evidence indicates the current rating may be incorrect, including when a Veteran states that his condition has worsened since the last VA examination. Snuffer v. Gober, 10 Vet. App. 400 (1997). During the Veteran’s Board hearing he reported that while he does not currently wear a hearing aid, he believes he needs one. He also testified that during his February 2016 C&P Examination the examiner indicated that he would experience hearing degradation over the next few years. According to the Veteran, both the ringing in his ears and his hearing has worsened. Because of the Veteran’s testimony alleging worsening, remand is required to afford him an examination to evaluate him for increased hearing loss. 2. The issue of entitlement to service connection for a sinus condition is remanded. VA is obligated to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient evidence to make a decision on the claim. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the Veteran’s record includes episodes of sinusitis. See 10/11/2017 CAPRI. Additionally, his service treatment records evidence his concern regarding exposure to burning trash while in Kyrgyzstan and includes exposure data which depicts heavily contaminated water sources and industrial air contamination within the country. See 9/28/2015 STR. Therefore, remand for a VA examination is needed. 3. The issue of entitlement to service connection for a skin condition is remanded. Similarly, because the Veteran’s lay statements assert that he bathed with local water unfit to drink, exposure data speaks to heavily contaminated water sources and industrial air contamination, and the Veteran asserts that he did not have skin issues until his return from Kyrgyzstan, remand for a VA examination for a skin condition is necessary. The matters are REMANDED for the following action: 1. Forward the Veteran’s claims file to a state-licensed audiologist to conduct a hearing examination utilizing a controlled speech discrimination test (Maryland CNC) and a pure tone audiometry test and provide a medical opinion regarding the current state of the Veteran’s bilateral hearing loss. 2. Forward the Veteran’s claims file to an appropriate clinician to provide a medical opinion regarding the nature and etiology of the Veteran’s skin condition. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion regarding whether: It is at least as likely as not (50 percent probability or greater) that the Veteran’s skin condition is causally related to his active service, specifically exposure to air contaminated by burning trash and contaminated water. A complete rationale for the examiner’s opinion should be provided, citing to specific evidence of record, as necessary. If the examiner cannot provide an opinion without resort to 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). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. 3. Forward the Veteran’s claims file to an appropriate clinician to provide a medical opinion regarding the nature and etiology of the Veteran’s sinus condition. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion regarding whether: It is at least as likely as not (50 percent probability or greater) that the Veteran’s sinus condition is causally related to his active service, specifically exposure to air contaminated by burning trash and contaminated water. A complete rationale for the examiner’s opinion should be provided, citing to specific evidence of record, as necessary. If the examiner cannot provide an opinion without resort to 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). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. S. C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sloley, 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.