Citation Nr: 21023645 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-28 502A DATE: April 21, 2021 REMANDED The issue of whether the reduction of the Veteran’s evaluation for prostate cancer to 40 percent, effective September 1, 2016, was proper, is remanded. Entitlement to a rating higher than 40 percent for prostate cancer is remanded. Entitlement to service connection for vertigo is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1966 to May 1968, including service in the Republic of Vietnam. This case comes to the Board of Veterans’ Appeals (Board) from June 2016 and October 2019 rating decisions of the Department of Veterans Affairs (VA) Regional Office. Prostate Cancer The Veteran contends that his service-connected residuals of prostate cancer warrant a rating higher than 40 percent due to severe continued problems with voiding dysfunction. The Veteran wrote in June 2016 that he had not accurately represented his voiding dysfunction to the September 2014 VA examiner due to embarrassment, and that he actually had to change pads at least 6 times a day and used the bathroom 5 times a night. The Veteran was initially assigned a 100 percent evaluation for prostate cancer, effective August 16, 2010. Malignant neoplasms of the genitourinary system, including prostate cancer, are assigned a 100 percent evaluation while a veteran is undergoing active cancer-fighting treatments. Once this treatment ceases, the veteran is to be reexamined, and the disorder is rated based on residuals, such as voiding dysfunction or renal dysfunction. 38 C.F.R. § 4.115B, Diagnostic Code 7528. The regulations specifically state that the provisions of 38 C.F.R. § 3.105(e), regarding procedures for reductions in ratings, are to be followed. Id. Following a September 2014 VA examination that found that the Veteran’s treatment for prostate cancer had concluded in 2011, a November 2014 rating decision proposed to decrease the Veteran’s evaluation to 20 percent. A June 2016 rating decision was then sent to the Veteran’s that decreased his evaluation to 40 percent, effective September 1, 2016. The Board notes that while the Veteran submitted a Notice of Disagreement with the September 2016 rating decision and has indicated that he disagrees with the reduction, he has also indicated that he primarily disagrees with the assignment of a 40 percent rating following the reduction, and that he believes a rating higher than 40 percent is warranted due to the severity of his voiding dysfunction. The Board has therefore characterized this issue as both whether the reduction was proper and whether a rating higher than 40 percent is warranted. The Board finds that a remand for these issues is needed. The Veteran has not attended a VA examination for prostate cancer since September 2014, which is now over 6 years ago, and he has indicated that he was not forthcoming with the September 2014 regarding his prostate cancer residuals due to embarrassment. The Board therefore affords the Veteran another opportunity to attend a VA examination in order to adequately assess the full extent of his prostate cancer residuals and their current severity. Vertigo The Veteran contends that he has a vertigo disorder that was caused by acoustic trauma in service. The Veteran wrote in June 2016 that he suffered through a lot of noise as an armor crewman in service, and that there was noise from the tank engine, tank guns, and tank tracks. He also wrote that once in Vietnam, he had his head outside of the tank when his team fired the main gun, and the noise was deafening and caused him to have ringing in his ears for seven or eight days. The Veteran has submitted a July 2016 private audiological evaluation which diagnosed him with benign paroxysmal positional vertigo. The Veteran’s private physician wrote in November 2016 that the Veteran had chronic vertigo which had started many years ago but worsened to such an extent by 2007 that it necessitated an emergency room visit. He wrote that the Veteran was diagnosed with chronic vertigo which was likely due to acoustic trauma from exposure in Vietnam, and that he also had chronic noise exposure at the same time in Vietnam, which left him with hearing loss, tinnitus, and vertigo. While the evidence submitted by the Veteran does appear to weigh in favor of the claim, the information written by the physician appears to be mainly just a recording of the Veteran’s own reporting. The record is incomplete, and contains only the first page, and not the page with the doctor’s findings and diagnoses. The Veteran should be asked to provide the complete records related to this evaluation and treatment, as well as any other private records that are relevant to the claim. Also, because there clearly is evidence that the Veteran has a current vertigo disorder, as well as some evidence that possibly relates it to service, a VA medical examination and opinion should have been obtained on this issue. See McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The Board therefore remands this issue so that appropriate medical opinion can be obtained. The examiner is also asked to address whether a vertigo disorder is secondary to the Veteran’s service-connected tinnitus and left ear hearing loss. The matters are REMANDED for the following action: 1. Obtain all VA treatment records since October 2016. 2. Send to the Veteran and his representative a letter requesting that the appellant provide sufficient information and a signed and dated authorization, via a VA Form 21-4142 (Authorization and Consent to Release Information) to enable VA to obtain any additional, relevant private medical records relating to his prostate cancer residuals or vertigo, including the complete November 3, 2016 treatment record from Dr. H.G., and all records from the Kaplan Hearing Center. If the Veteran provides new completed release forms authorizing VA to obtain these treatment records, then attempt to obtain them with at least one follow-up request if no reply is received. 3. Schedule the Veteran for a new VA examination to address the current severity of his prostate cancer residuals. The examination may be held via telehealth during social distancing restrictions and an opinion can be provided based on other medical evidence of record. The examiner must be provided access to the Veteran’s entire claims file and must specify in the report that the claims file has been reviewed.   The examiner should then assess the current severity of the Veteran’s prostate cancer residuals for the entire period on appeal, September 1, 2016, to the present.  The examiner is also asked to state whether all treatment for prostate cancer had been concluded by that time, and whether the Veteran has had any recurrent of prostate cancer.   4. Schedule the Veteran for a new VA examination to address the nature and etiology of any vertigo disorder. If feasible, the examination may be held via telehealth during social distancing restrictions and an opinion can be provided based on other medical evidence of record.   The examiner must be provided access to the Veteran’s entire claims file and must specify in the report that the claims file has been reviewed.  The examiner should then address: a) What are the Veteran’s current diagnoses related to dizziness and vertigo? Please specifically consider the July 2016 private audiological evaluation which diagnosed him with benign paroxysmal positional vertigo. b) For all disorders found, is it as likely as not that the disorder had its onset during service or is related to any injury or incident in service, including the Veteran’s exposure to tanks and tank cannons firing in Vietnam? c) For all disorders found, is it as likely as not the disorder was either i) caused or ii) aggravated (worsened beyond the natural progression) by his service-connected tinnitus and left ear hearing loss? (Continued on the next page) A complete and fully explanatory rationale must be provided for any opinion offered.  If any opinion cannot be rendered without resorting to speculation, the examiner must explain why. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary E. Rude, 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.