Citation Nr: 21024227 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 18-26 988 DATE: April 22, 2021 REMANDED Entitlement to an initial compensable rating for bilateral hearing loss is remanded. Entitlement to service connection for a skin disability, to include tinea pedis, erosio interdigitalis blastomycetica, and hyperkeratosis (a skin disability) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from September 1979 to October 1983, and in the USMC Reserve from October 1983 to September 1994. He was mobilized for foreign service in Southwest Asia from November 1990 to May 1991. The undersigned Veterans Law Judge presided over a Board hearing in February 2021. A transcript of this hearing is of record. 1. Entitlement to an initial compensable rating for bilateral hearing loss is remanded. The Veteran’s original claim was for bilateral service connection. The Veteran was only service connected for left ear hearing loss as of his May 2018 VA Form 9. However, the AOJ ultimately granted service connection for right ear hearing loss as well in a December 2019 Rating Decision. Accordingly, this appeal is recharacterized as above. The Veteran last attended VA hearing examinations in October 2017, December 2017, and December 2019. The December 2019 examiner found their results inadequate for rating purposes because the Veteran’s puretone threshold and speech discrimination test results did not agree. Moreover, while the Veteran testified at his February 2021 Board hearing that he was scheduled for a VA hearing examination in March 2021, March 2021 has passed, and no such examination is of record. Nevertheless, the lay and medical evidence shows a decline in hearing acuity since the last valid examination of record. The Veteran claimed a decline in his hearing acuity, noticeable after his switch in profession from law enforcement officer to psychotherapist in or about 2016. Since the Veteran’s last valid VA examination in December 2017, the evidence shows a clear increase in severity. Specifically, the Veteran’s thresholds in November 2018 at 1,000 Hz were 40 dB in the left ear and 30 dB in the right ear; at 2,000 Hz were 50 dB in the left ear and 40 dB in the right ear; and at 4,000 Hz were 55 dB in the left ear and 40 dB in the right ear. When a claimant asserts that the severity of a disability has increased since the most recent VA examination, an additional examination may be required. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 3, 77 (1994). Here, due to progressively worsening symptoms, a remand is warranted. 2. Entitlement to service connection for a skin disability, to include tinea pedis, erosio interdigitalis blastomycetica, and hyperkeratosis is remanded. Records from the Veteran’s Reserve service are sparse. February 2021 testimony from the Veteran and a buddy indicate that during combat operations in Southwest Asia, he regularly wore boots and heavy NBC protective gear. He served during periods of heavy rain, and was unable to change his footwear frequently, or otherwise practice proper foot hygiene. During deployment from 1990-1991, the Veteran experienced itching and a macerated rash on his feet and toes. The Veteran’s buddy statement indicates that the Veteran complained of foot and skin issues in service. Post service, the Veteran recalls obtaining treatment in 1994 or 1995, but has been unable to obtain these records. VA should attempt to obtain these records. As for a medical nexus, an opinion is of record addressing whether the Veteran’s skin condition is at least as likely as not caused or aggravated by Gulf War service. Now, the relevant question for a grant of service connection is whether there is a direct nexus between the Veteran’s current and in-service symptoms. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a skin disorder until a VA examiner opines as to whether the Veteran’s symptoms are related to the skin symptoms described in the Veteran’s lay testimony and buddy statements. Thus, an examination should be provided which accurately and completely assesses the current nature, severity, and etiology of any skin disorder on the feet that currently afflicts the Veteran. The matters are REMANDED for the following action: 1. Add all outstanding VA treatment records not currently associated with the Veteran’s claims file. If the Veteran has obtained treatment outside of VA, he should be afforded an opportunity to add any applicable records. The Board is particularly interested in any records that may have been produced at Highland Hospital in Rochester, NY, relating to foot skin treatment from September 1994 to September 1995. Make two requests for the authorized records from this facility unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for a VA examination by an appropriate clinician for his skin disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the Veteran’s skin disability at least as likely as not related to service, including the itchy, and at times macerated rash on both feet, in between the toes and extending onto the dorsal aspect and the soles of the feet, described to the October 2017 C&P examiner? Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran’s description of his in-service onset and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms a) align with how the currently diagnosed disability is known to develop, or b) are the Veteran’s reports generally inconsistent with medical knowledge, or are they implausible? 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral hearing loss. The examiner should review the claim file, provide a full description of the disability, and report all signs and symptoms necessary for evaluating the severity of the Veteran’s disability under the rating criteria. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Maskatia