Citation Nr: 21026592 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 12-12 769 DATE: May 3, 2021 ISSUES 1. Entitlement to a rating in excess of 10 percent for a bilateral hearing loss disability. 2. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for degenerative changes, lower back (previously claimed as low back disability and back pain/swelling). 3. Entitlement to service connection for degenerative changes, lower back (previously claimed as low back disability and back pain/swelling). (Hereinafter "low back disability"). 4. Entitlement to special monthly compensation based on aid and attendance/housebound. ORDER Entitlement to a disability rating in excess of 10 percent for a bilateral hearing loss disability is denied. New and material evidence has been received to reopen the Veteran's claim of entitlement to service connection for a low back disability, and to that limited extent, the claim is granted. REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. FINDINGS OF FACT 1. The Veteran's bilateral hearing loss is manifested by, at worst, level IV hearing in the right ear and level IV hearing in the left ear. 2. In an unappealed June 2004 rating decision, the RO denied the Veteran's claim of entitlement to service connection for a low back disability. 3. The evidence received since the June 2004 rating decision, namely VA treatment records, October 2014 treatment records from Providence Family Physicians Citronelle and May 2016 Correspondence from the Veteran, is new and raises a reasonable possibility of substantiating the Veteran's claim of entitlement to service connection for a low back disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent for a bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. 2. Since the June 2004 rating decision, new and material evidence has been received with respect to the Veteran's claim of entitlement to service connection for a low back disability; therefore, the claim is reopened. 38 U.S.C. § 5108 (West 2014); 38 C.F.R. § 3.156 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1950 to July 1953 and from December 1954 to February 1961. These appeals to the Board of Veterans' Appeals (Board) are from July 2010, May 2014, and March 2016 decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. This matter has been previously adjudicated by the Board in February 2015 and June 2017. In February 2015, the Board remanded the issue of his hearing loss for an updated VA examination. In June 2017, the Board, in pertinent part, remanded the Veteran's bilateral hearing loss claim for additional development, including a new examination. The examination was to include review of a September 2013 private audiogram and provide an opinion on the level of severity shown. See June 29, 2017 BVA Decision, pg. 3. Since the Board's February 2015 remand, the Veteran formally appealed claims for service connection for a low back disability and for SMC. In his June 2015 VA Form 9, following the issuance of the statement of the case (SOC) pertaining to his back, he did not request a hearing. However, on his October 2016 VA Form 9, following the SOC pertaining to his SMC claim, he did request a hearing. He also noted that he was appealing his back, which the Board construed as a request for a hearing for this claim. In June 2017, the Board also remanded the Veteran's claim pertaining to his back and to SMC for the AOJ to schedule a hearing. However, the Board's Veterans Appeals and Controls Locator System (VACOLS) indicates that the hearing was cancelled by the Veteran. There is no indication in the claims file as to why the Veteran cancelled the hearing. As such, the Veteran's hearing request is deemed withdrawn, and the Board will proceed with its review on the present record. See 38 C.F.R. § 20.704 (d). Please note, this appeal has been advanced on the Board's docket pursuant to 38C.F.R. §20.900(c) (2018). Entitlement to a rating in excess of 10 percent for bilateral hearing loss disability. The Veteran contends that he is entitled to a higher disability rating for his bilateral hearing loss disability. See May 2010 VA Form 21-526b The Veteran's increased rating claim was received on May 25, 2010 therefore the appeal period before the Board begins on May 25, 2010, the date VA received the Veteran's claim for increased ratings, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Disability Ratings Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1 (2013); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id. In cases where the original rating assigned is appealed, as is the case with the Veteran's claims of entitlement to higher evaluations for the bilateral hearing loss consideration must be given to whether a higher rating is warranted at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Hearing Loss In evaluating hearing loss, disability ratings are derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are performed. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1922). Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity. Generally, the evaluation is determined after consideration of controlled speech discrimination ability and average hearing threshold, as measured by puretone audiometric tests in the frequencies 1,000 to 2,000, 3,000, 4,000 cycles per second (Hz). If, however, an examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc. the evaluation will be based solely on the Puretone threshold average. 38 C.F.R. § 4.85(c). If the evidence demonstrates the existence of exceptional patterns of hearing impairment, such as where testing reveals puretone thresholds of 55 decibels or more in each of the specified frequencies (1000, 2000, 3000 and 4000 Hz) or when the puretone threshold is 30 decibels or less at 1000 Hz and 70 or more decibels at 2000 Hz, the evaluation can be based on the puretone threshold average and speech discrimination ability or solely on puretone threshold average. 38 C.F.R. § 4.86. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Board has reviewed all evidence of record pertaining to the history of the Veteran hearing loss disability. The Board has found nothing in the historical record which would lead to the conclusion that further development is warranted. Discussion During the course of this appeal, the Veteran has been afforded Audiological Examinations in July 2010, June 2016, January 2018 and August 2019 to determine the severity of his bilateral hearing loss disability. The August 2019 examiner also reviewed a September 2013 private audiogram to assess the severity level of this Veteran's bilateral hearing loss disability. The Board observes that each of these examinations considered the functional impact the Veteran's bilateral hearing loss disability had on the ordinary course of his life, including his ability to work. Further, each of these examinations included audiometric and speech discrimination testing in the evaluation of this Veteran's bilateral hearing disability. See 38C.F.R. § 4.85. The Board now turns to a discussion of the Audiometric examinations afforded to the Veteran during the course of this appeal. The July 2010 audiometric results were as follows: Right Ear Hertz 500 1000 2000 3000 4000 Ave. Hz. 20 25 35 100 105 66.25 Left Ear Hertz 500 1000 2000 3000 4000 Ave. Hz. 25 25 45 95 100 66.25 Speech audiometry results using the Maryland CNC were 80 percent for the right ear and 78 percent for the left ear. The Veteran's hearing impairment was manifested by Level IV hearing acuity in the right ear. The Veteran's hearing impairment was manifested by Level IV hearing acuity in the left ear. In this case, the Veteran's hearing loss did not meet the criteria for exceptional patterns of hearing impairment under 38 C.F.R. § 4.86 (a) or (b) and therefore will be evaluated according to 38 C.F.R. § 4.85. Applying Table VII, DC 6100, these audiometric results discussed above are consistent with a 10 percent disability rating. 38 C.F.R. § 4.85. The July 2010 examiner assessed the functional impact the Veteran's hearing loss had on the ordinary conditions of life, including his ability to work. The examiner recorded the Veteran's report that he has difficulty hearing and understanding conversations, especially on the television. The Veteran stated that he must watch the speaker's face in order to communicate effectively. See July 13, 2010 Audiological examination, pg.1. The June 2016 audiometric results were as follows: Right Ear Hertz 500 1000 2000 3000 4000 6000 8000 Ave. Hz. 25 30 50 100 100 105+ 95+ 70 Left Ear Hertz 500 1000 2000 3000 4000 6000 8000 Ave. Hz. 20 25 35 95 100 90 80 64 Speech audiometry results using the Maryland CNC were 84 percent for the right ear and 84 percent for the left ear. See June 6, 2016, Audiological Examination, pgs. 1-2. The Veteran's hearing impairment was manifested by Level III hearing acuity in the right ear and Level III hearing acuity in the left ear. In this case, neither of the Veteran's ears meet the criteria for exceptional patterns of hearing impairment under 38 C.F.R. § 4.86 (a) or (b) and therefore will be evaluated according to 38 C.F.R. § 4.85. Applying Table VII, DC 6100, these audiometric results discussed above are consistent with a noncompensable disability rating. 38 C.F.R. § 4.85. The June 2016 VA examiner assessed the functional impact the Veteran's hearing loss had on the ordinary conditions of life, including his ability to work. The examiner recorded the Veteran's report he has trouble understanding what they say on TV. The Veteran is a lip watcher. He has to ask people to repeat themselves when they talk to him. See June 6, 2016, Audiological Examination, pg. 4. The January 2018 audiometric results were as follows: Right Ear Hertz 500 1000 2000 3000 4000 6000 8000 Ave. Hz. 15 30 45 100 100 105+ 110 68.75 Left Ear Hertz 500 1000 2000 3000 4000 6000 8000 Ave. Hz. 5 20 35 95 95 95 85 61.25 Speech audiometry results using the Maryland CNC were 80 percent for the right ear and 92 percent for the left ear. See January 11, 2018 Audiological Examination, pgs. 1-3. The Veteran's hearing impairment was manifested by Level IV hearing acuity in the right ear and Level II hearing acuity in the left ear. In this case, neither of the Veteran's ears meet the criteria for exceptional patterns of hearing impairment under 38 C.F.R. § 4.86 (a) or (b) and therefore will be evaluated according to 38 C.F.R. § 4.85. Applying Table VII, DC 6100, these audiometric results discussed above are consistent with a noncompensable disability rating. 38 C.F.R. § 4.85. The VA examiner assessed the functional impact the Veteran's hearing loss had on the ordinary conditions of life, including his ability to work. The examiner recorded the Veteran has to wear hear aids to hear clearly. See January 13, 2018 Audiological Examination, pg. 6. The August 2019 audiometric results were as follows: Right Ear Hertz 500 1000 2000 3000 4000 6000 8000 Ave. Hz. 30 35 45 100 105 100 105+ 71.25 Left Ear Hertz 500 1000 2000 3000 4000 6000 8000 Ave. Hz. 25 30 40 95 100 85 95 66.25 Speech audiometry results using the Maryland CNC were 84 percent for the right ear and 90 percent for the left ear. See August 26, 2019 Audiological Examination, pg. 2. The Veteran's hearing impairment was manifested by Level III hearing acuity in the right ear and Level III hearing acuity in the left ear. In this case, neither of the Veteran's ears meet the criteria for exceptional patterns of hearing impairment under 38 C.F.R. § 4.86 (a) or (b) and therefore will be evaluated according to 38 C.F.R. § 4.85. Applying Table VII, DC 6100, these audiometric results discussed above are consistent with a noncompensable disability rating. 38 C.F.R. § 4.85. The VA examiner assessed the functional impact the Veteran's hearing loss had on the ordinary conditions of life, including his ability to work. The examiner recorded the Veteran's family will tell him that the TV is too loud. The Veteran has to be face to face with them in the same room for them to understand them. The Veteran does lip reading and understanding in big groups is hard. See August 26, 2019 Audiological Examination, pg. 4. Pursuant to the Board's June 2017 remand, the August 2019 examiner reviewed the January 2018 results of the audiological examination. The examiner noted that results from the January 2018 audiological examination indicated normal hearing steeply sloping to a profound hearing loss bilaterally, as well. Addressing the severity of the Veteran's bilateral hearing loss based on a September 2013 private audiogram, the examiner stated that the private audiogram completed in 2013 indicated mild steeply sloping to a profound hearing loss in the right ear and normal hearing steeply sloping to a profound hearing loss in the left ear. Overall, Veteran's steeply sloping mild to profound hearing loss has been consistent across the 2013, 2018 and 2019 audiologic evaluation. See August 26, 2019 Medical Opinion, pg. 4. Analysis The Board has fully considered the Veteran's reports that his service-connected bilateral hearing loss disability creates difficulties in conversations with others; that he has difficulty hearing what is said on the television. The Board is also cognizant that the Veteran has to lip read in an attempt to understand someone who is talking to him. The Board notes that difficulty understanding conversational speech, distinguishing sounds in a crowded environment, locating the source of sounds, hearing the television, and using the telephone are each a manifestation of difficulty hearing or understanding speech, which is contemplated by the schedular rating criteria for hearing loss. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Thus, remand for referral for extraschedular consideration is not warranted on this basis. Significantly, the Board notes that while the June 2016, January 2018 and August 2019 Audiological examinations show that that Veteran's hearing loss qualifies for a disability rating that is less than the current 10 percent disability rating, the Board recognizes that there is no evidence of sustained improvement under the ordinary conditions of life, as VA treatment records continue to document that the Veteran experiences significant bilateral hearing loss treated with hearing aids. Thus, no reduction is contemplated herein. See January 13, 2018 Audiological Examination, pg. 6 re: use of hearing aids. To reiterate, the Board in no way discounts the difficulties that the Veteran experiences as a result of his service-connected bilateral hearing loss disability. In this regard, it must be emphasized that the disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. Thus, the Board must base its determination of the severity of this Veteran's bilateral hearing loss disability on the results of the pertinent and valid audiology studies. See Lendenmann, 3 Vet. App. at 34. The Board is bound to apply the VA rating schedule, under which the rating criteria are defined and limited by audiometric findings. This criteria measures hearing acuity directly in a controlled laboratory environment. Importantly, the Board notes that the August 2019 VA examiner specifically reviewed a September 2013 private audiogram to assess the severity of the Veteran's bilateral hearing loss. After reviewing this September 2013 private audiogram and the Veteran's previous audiological examinations, the VA examiner concluded that the Veteran's steeply sloping mild to profound hearing loss has been consistent across the 2013, 2018 and 2019 audiologic evaluations. See August 26, 2019 Medical Opinion, pg. 4; See also September 20, 2013 Audiogram (Premier Medical). The Board notes that this September 2013 private audiogram did not include a controlled speech discrimination test (Maryland CNC) as is required under 38 C.F.R. § 4.85(a). As such, these audiometric test results are not valid for VA compensation purposes. There are no probative objective audiometric evaluations to the contrary in the record before the Board. See 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. All potentially applicable codes have been considered in this case and there is no basis to assign a compensable during the period on appeal for the Veteran's bilateral hearing loss disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Here, the Board finds the July 2010, June 2016, January 2018, August 2019 VA audiological examinations, in conjunction with the August 2019 Medical Opinion discussed above, are adequate in assessing the level of severity of the Veteran's bilateral hearing loss disability. In summary, the Board finds that finds that the Veteran's bilateral hearing loss is manifested by, at worst, level IV hearing in the right ear and level IV hearing in the left ear. See July 2010, Audiological Examination, pgs. 1-2. Therefore, the criteria for entitlement to a rating in excess of 10 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. The Veteran has not identified any other outstanding medical records that reflect the severity of his hearing loss disability. The Board has considered all relevant evidence of record. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a disability rating in excess of 10 percent for a bilateral hearing loss disability. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for a low back disability. In any case involving a finally denied claim, the Board must address whether new and material evidence has been received to reopen the claim before addressing the merits of the claim, regardless of whether or not the agency of original jurisdiction (AOJ) has already addressed the question. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001); Wakeford v. Brown, 8 Vet. App. 237, 239-40 (1995). The question of whether new and material evidence has been received to reopen such a claim must be addressed in the first instance by the Board, because the issue goes to the Board's jurisdiction to reach the underlying claim and adjudicate it on a de novo basis. See Jackson, 265 F.3d 1366; see also Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996), aff'g 8 Vet. App. 1 (1995). If the Board finds that new and material evidence has not been received, that is where the analysis must end; hence, what the RO may have determined in this regard is irrelevant. Jackson, 265 F.3d at 1369; Barnett, 83 F.3d at 1383. The Board has characterized the claims accordingly. New evidence is defined as existing evidence not previously submitted to VA, and material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a) (2018). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, consideration is not limited to whether the newly submitted evidence relates specifically to the reason the claim was last denied, but instead should include whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary's duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. Additionally, the United States Court of Appeals for the Federal Circuit has noted that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a claimant's injury or disability, even where it would not be enough to convince the Board to grant a claim. Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998). For the purpose of establishing whether new and material evidence has been received, the credibility of the evidence, but not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). However, VA is not bound to consider credible the patently incredible. Duran v. Brown, 7 Vet. App. 216 (1994). Turning to the evidence of record in the evaluation of this claim: In a June 2004 rating decision, the RO denied the Veteran's claim of entitlement to service connection for a low back condition. The RO found that the Veteran's service treatment records were silent regarding a low back condition. The first evidence of back pain was on a November 11, 1998 VA examination. No medical evidence showing a back disability related to service. See June 1, 2004 Rating Decision. The Veteran was notified of the June 2004 rating decision and of his appellate rights; however, he did not submit a Notice of Disagreement (NOD). In general, rating decisions that are not timely appealed are final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. There was also no new and material evidence received within one year of the issuance of the decision. Therefore, the June 2004 rating decision is final. The Veteran filed a claim to reopen his claim in August 2013. See August 23, 2013 VA Form 21-526EZ. In a May 2014 Rating decision, the RO continued to deny the claim on the ground that the evidence submitted was not new and material. See May 16, 2014 Rating Decision. In a subsequent supplemental statement of the case (SSOC), post remand, the RO re-adjudicated the claim on the merits and continued the denial. See September 21, 2020 SSOC. But despite the RO's determinations, in any case involving a finally denied claim, the Board must address whether new and material evidence has been received to reopen the claim before addressing the merits of the claim, regardless of whether or not the agency of original jurisdiction (AOJ) has already addressed the question. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001); Wakeford v. Brown, 8 Vet. App. 237, 239-40 (1995). Hence, this claim has been characterized accordingly. The Board notes that evidence received since the last June 2004 rating decision includes the Veteran's August 2013 claim to reopen; May 2016 correspondence from the Veteran regarding an accident he sustained while stationed Anchorage, Alaska; and October 2014 Private treatment records from Providence Family Physicians Citronelle which document a history of the Veteran's present illness, to include chronic back pain after a skiing accident while in the military years ago (fractured L.5). See October 20, 2014 Private treatment records; See also May 3, 2016 Veteran correspondence regarding back injury. For the purpose of establishing whether new and material evidence has been received, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513(1992). The Board finds that evidence received since the June 4, 2004 rating is new in that it is neither cumulative nor redundant of the evidence previously of record, and raises a reasonable possibility of substantiating the claim. The Board also finds that this evidence is material because the October 20, 2014 treatment discussed above, when considered with the previous evidence of record, addresses the underlying reason for the denial (no medical evidence that his low back disability is related to service), relates to an unestablished fact necessary to substantiate the claim. For the reasons stated above, the claim for a low back disability is reopened. 38 U.S.C. § 5108 38 C.F.R. § 3.156. To this limited extent only, the claim is granted. Entitlement to service connection for a low back disability is remanded. The Veteran contends that he should be service connected for a low back disability. He has repeatedly contended that he suffered an in-service injury (skiing accident) in 1960 while he was stationed in Alaska. The Veteran contends that he was treated at the Air Force Base Hospital in Fairbanks, Alaska for this injury for a period of 30 days. See May 3, 2016 Correspondence. As referenced above in this decision, the Board also notes that Veteran has submitted private treatment records from Providence Family Physicians that show treatment for back pain, a diagnosis of marked degenerative disc disease at L3-4 and L5-S1, with documentation of chronic back pain resulting from a skiing accident while in the military years ago, fracture at L5. See October 20, 2014 treatment records (Providence Family Physicians Citronelle: History of Present Illness.); See also, October 20, 2014 Radiology Associates of Mobile, P.C. The Veteran's service treatment records do not document any in-service low back injury, and the first post-service indication of a low back condition is dated in 1998, more than three decades after separation from service. See November 27, 1998 VA Examination re: back condition as secondary service connection claim. In seeking treatment for his low back disability, however, the Veteran has referenced an old service injury in providing his medical history and has reported trouble with his low back since his military service. The Board is cognizant that generally speaking, people are credibly forthcoming when seeking medical attention, and their statements usually can be found credible. See Harvey v. Brown, 6 Vet. App. 390, 39394 (1994) (drawing a credibility distinction between statements made for the purpose of receiving treatment and those made for the purpose of seeking compensation). In this case, private treatment records reflect reports of pain, and treatment for a chronic low back condition, that the Veteran has asserted to be related to an injury in service. See October 20, 2014 treatment records (Providence Family Physicians Citronelle: History of Present Illness.); See also, April 12, 2021, Appellant's Post-Remand Brief, pgs. 1-2. Thus, the question remains whether the Veteran's current low back condition is consistent with his assertions of what happened in service and since service. The Board is cognizant that no examiner has opined on the etiology of this Veteran's condition on a direct service basis. See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (holding that the Board must consider only independent medical evidence to support its findings rather than provide its own medical judgment). Given the lack of sufficient medical evidence to make a decision on this matter, the Board finds that the Veteran should be afforded a VA examination to address the complete nature and etiology of his low back disability. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The Board also finds that attempts should be made to obtain any personnel or in-patient hospitalization records that may be pertinent to this Veteran's service connection claim to ensure that there is a complete record upon which to decide the Veteran's low back disability claim and to afford him very possible consideration. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A (2012); 38 C.F.R. § 3.159 (c) (2018). Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. The Veteran asserts that his service-connected disabilities render him so helpless as to warrant SMC based on being homebound or for the need for regular aid and attendance. See January 6, 2016 VA Form 21-2680 re: chronic back pain. Because a decision on the remanded issue entitlement to service connection for a low back disability could significantly impact a decision on the issue of entitlement to SMC, the issues are inextricably intertwined. A remand of the claims for entitlement to SMC based on the need for aid and attendance is required. Accordingly, these matters are REMANDED for the following action: 1. Send the Veteran and his representative a letter requesting that the Veteran provide sufficient information, and if necessary, authorization in order to obtain any additional private treatment records pertinent to the claim on appeal that is not currently of record. After the Veteran has signed the appropriate releases, those records not already on file should be obtained and associated with the claims folder. 2. The AOJ should verify whether all service personnel records (including from Anchorage, Alaska) have been obtained and associated with the claims file. If additional records exist, take all indicated action to contact the appropriate authorities and attempt to secure the Veteran's complete service personnel records. If no additional records are available, that fact should be documented, in writing, in the record, and the Veteran should be provided notice of that fact. 38 C.F.R. § 3.159 (e). 3. In addition, take all appropriate action to obtain records of any in-patient hospitalization during service, to include the U.S. Air Force Base Hospital in Fairbanks, Alaska. If any record identified cannot be obtained, the Veteran and his representative should be notified of this in writing, to include all efforts taken by VA to attempt to obtain any such record. The Veteran should also be offered the option to provide any such record himself. 38 C.F.R. § 3.159 (e). Please document all efforts to obtain these records in the virtual benefits file. 4. After the above development is completed, arrange for a spine disorders examination of the Veteran to determine the nature and likely etiology of any low back disability he may have. The examiner is requested to acknowledge review of the Veteran's record. The examiner is also invited to review October 20, 2014 treatment records from Providence Family Physicians Citronelle re: complaints of chronic low back pain, reference to accident while in military, L5 fracture (Document type: Medical Treatment Records, Receipt Date, January 13, 2015). Please acknowledge review of these treatment records. The VA examiner is requested to respond to the following: Identify by diagnosis each low back disability found (or shown by the record during the pendency of the claim). Identify the likely etiology of each low back disability diagnosed; opine whether it (i) began during active service, (ii) manifested as arthritis within one year after discharge from service, or (for arthritis) was manifested by continuing symptoms since service, (iii) or became manifest subsequent to service, but is related to activities (skiing accident) ot injuries therein, such as he describes. Note: If any low back disability diagnosed is found to not be related to the Veteran's service and activities/injuries therein, identify the etiology for the disability considered to be more likely (and explain why that is so). 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to service connection for a low back disability and entitlement to SMC based on the need for aid and attendance. If the benefit sought is not granted to the Veteran's satisfaction, send him and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.