Citation Nr: 21028252 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-27 077 DATE: May 10, 2021 ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for an acquired psychiatric disorder, claimed as major depressive disorder, to include as secondary to service connected disabilities. 3. Entitlement to service connection for bilateral hearing loss disability. ORDER Entitlement to service connection for hypertension is denied. The appeal on the issue of entitlement to service connection for an acquired psychiatric disorder, claimed as major depressive disorder, to include as secondary to service connected disabilities is dismissed. REMANDED Entitlement to service connection for bilateral hearing loss disability is remanded. FINDINGS OF FACT 1. Hypertension was not manifest in service or within one year of separation, and is not otherwise attributable to service. 2. A February 1, 2021 Rating decision granted service connection for major depressive disorder, claimed as depressive disorder; with a notation that this represented a full grant of the issue on appeal. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated by service, and cardiovascular renal disease may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 2. There remains for appellate consideration no case or controversy with respect to the claim for entitlement to service connection for an acquired psychiatric disorder, claimed as major depressive disorder, to include as secondary to service connected disabilities, over which the Board may exercise jurisdiction. 38 U.S.C. §§ 511, 5107, 7104 (2012); 38 C.F.R. §§ 19.4, 19.5, 20.101 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1985 to August 1989. His DD-214 shows his Military Occupational Specialty (MOS) as an F-14 system aircraft organization maintenance technician. This matter is before the Board of Veterans Appeals (Board) on appeal from June 2015 and May 2017 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) in January 2020. A copy of the hearing transcript has been associated with the claims file. In Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Court held that the scope of a mental health disability claim includes any mental health disability that could reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. The Board previously recharacterized the major depressive disorder appeal as encompassing the acquired psychiatric disorder issue on the title page. The Board observes that during the pendency of his appeal, an October 2018 Rating decision granted service connection for a right knee strain and continued the 10 percent evaluation for left knee degenerative joint disease with muscle atrophy. Next, a February 2020 Rating decision granted an increased rating for left knee degenerative joint disease with muscle atrophy, in addition to service connection for tension headaches, left knee instability, right knee limitation of extension, and several other disabilities. The Rating decision denied service connection for tinnitus. In June 2020, the Board favorably considered the Veteran's application to reopen the claim for service connection for bilateral hearing loss disability. The Veteran had testified at the hearing regarding a buzzing sound causing impairment, and that he worked around F14 jet launches. See January 2020 Hearing Transcript, pp. 8-9. The issues were ultimately remanded by the Board in June 2020. The Board also restored a 10 percent disability rating for left leg radiculopathy. Later, an October 2020 Rating decision implemented the restoration of a 10 percent disability rating for left leg radiculopathy based upon the Board's June 2020 Decision and Remand. Recently, a February 2021 Rating decision granted service connection for major depressive disorder, claimed as depressive disorder. The RO assigned an evaluation of 70 percent effective January 17, 2020. The RO explained, "An evaluation of 70 percent is assigned from January 17, 2020, the date your claim for headaches was received as your mental condition has been associated with your service connected headaches, which were not service connected until January 17, 2020. (38 C.F.R. § 3.400,38 C.F.R. § 3.310)." The same rating decision also granted service connection for tinnitus, allergic rhinitis, and Dependents' Educational Assistance. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). At the January 2020 hearing, the VLJ left the record open for 90 days for the submission of additional evidence. See January 2020 Hearing Transcript, p. 2. The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert denied, U.S.C. Oct. 3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection To establish service connection a Veteran must generally show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b). We note that hypertension is a chronic disease, and as such, additional presumptive theories of entitlement are relevant in addition to direct service connection. See 38 C.F.R. §§ 3.303, 3.307, 3.309. Under 38 C.F.R. § 3.303 (b), service connection may be established by demonstrating continuity of symptomatology. Continuity may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. The provisions of 38 C.F.R. § 3.303 (b) only apply to diseases recognized by VA as "chronic." See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303 (b), 3.309(a). Chronic diseases that become manifest to a degree of 10 percent or more within one year of termination of active duty may be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. The Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc. Id. Further, a negative inference may be drawn from the absence of complaints for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 1. Entitlement to service connection for hypertension The Board incorporates its discussion from the sections above by reference. We note that hypertension is a recognized chronic disease, and as such, additional presumptive theories of entitlement are relevant in addition to direct service connection. See 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). "Hypertension" refers to persistently high arterial blood pressure. Medical authorities have suggested various thresholds ranging from 140 mm Hg systolic and 90 mm Hg diastolic to as high as 200 mm Hg systolic and 110 mm Hg diastolic as reflective of hypertension. See Dorland's Illustrated Medical Dictionary, 896 (32nd ed. 2012). Similarly, for VA rating purposes, the term "hypertension" means that the diastolic blood pressure is predominantly 90 mm Hg or greater. The term "isolated systolic hypertension" means that the systolic blood pressure is predominantly 160 mm Hg or greater with a diastolic blood pressure of less than 90 mm Hg. See 38 C.F.R. § 4.104, DC 7101, Note (1). For VA purposes, hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. By way of background, the Service Treatment Records (STRs) include a July 1989 Report of Medical Examination from separation. It disclosed a clinically normal evaluation of the heart and vascular system. In the related Report of Medical History, the Veteran denied high or low blood pressure. He wrote that he was in good health and not taking any medication. Years later, ongoing VA treatment records show remote impressions of hypertension. A May 5, 2011 VA Primary Care Nursing Note reads in part, "No history of Diabetes, No history of Hypertension, No history of Congestive Heart Failure." Months later, a July 14, 2011 VA Primary Care Nursing Note shows, "SCREEN FOR CARDIAC HISTORY Screen results: No chest pain, No hx of irregular heart beat, No hx of CHF, No Hx of hypertension, No hx of MI or angina." Later, on November 17, 2011, the Veteran was advised regarding lifestyle changes to improve control of hypertension based upon a blood pressure reading of 144/98. By October 2, 2013, hypertension had been identified. A VA treatment record shows: The pt.'s BP was checked X2; the readings remain to be high. The pt. is asymptomatic (denies tinnitus, headache, blurry vision or flushing) The pt. states that he took his BP medication. The pt. was advised to get the BP rechecked after his visit with the Provider. The pt.'s BP history was reviewed and it was found to have a hx of HTN. Pt.is on antihypertensive. Additional VA treatment records show impressions of benign essential hypertension. The Veteran later filed his service connection claim for hypertension by way of a February 2017 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. Next, at the January 2020 hearing, the Veteran testified regarding hypertension. He reported that he was diagnosed with hypertension in service, but treatment providers did not give him any medication. See January 2020 Hearing Transcript, p. 16. His representative highlighted "maybe two or three diastolic high readings" in service. Id. A few years ago, he began taking related medication. It is now under control, but even with the medication, "it reaches pretty high sometimes." Id. at p. 17. When the Veteran was first out of the Navy, he had good insurance, and so did not immediately use VA healthcare. He began care with VA in 2011, and was prescribed medication. He did not go to the doctor in service unless he got sick. Id. at 19. Ongoing VA treatment records show prescriptions for lisinopril. The Board found in June 2020 that a VA examination with medical opinion was necessary. Next, the Veteran was afforded a January 2021 VA hypertension examination with Disability Benefits Questionnaire (DBQ). The VA examiner elicited a lay history from the Veteran, reviewed the entire claims file, and performed a physical examination. The VA examiner identified hypertension with a date of diagnosis of 2021. Next, the VA examiner rendered a negative nexus opinion for all theories of direct and presumptive service connection. The VA examiner concluded: After reviewing medical records dated 09/05/1985. 03/19/1986. 03/19/1986. 08/05/1988.02/03/1989. 08/29/2013. 11/26/2013.07/28/2015. 06/08/2020 and performing physical exam, it is less likely than not that the veteran's hypertension condition is related to military service as there are no medical records showing diagnosis, treatment for the hypertension condition during active duty. The Veteran contends that he is entitled to service connection for hypertension. The Veteran's central theory of entitlement is that he had untreated hypertension in service and after separation, until it was later re-identified and he was prescribed medication. The Veteran is competent to provide evidence of that which he experiences, including his symptomatology and medical history. Layno v. Brown, 6 Vet. App. 465, 469 (1994). More specifically, the Veteran is competent to report going to a healthcare provider and taking medication. The Veteran is competent to relate what he has been told by a professional. He is competent to report when he began receiving treatment for hypertension, and when it was first identified by physicians. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran's own lay opinions as to the diagnosis and cause of a hypertension disability are not probative evidence, although the Veteran's observed symptoms described may be useful to an expert in evaluating whether the Veteran has a disability and in determining the etiology thereof. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Because the record does not indicate that the Veteran has medical expertise, the Veteran's lay opinion beyond a description of his symptoms is of limited probative value. The most probative evidence is the contemporaneous treatment records, including the STRs, and the opinion of the January 2021 VA examiner. First, the separation examination is clinically normal for the heart and vascular system. The Veteran denied high or low blood pressure. He did not report any medications. Decades later, and consistent with his own lay history, the Veteran was diagnosed by VA with hypertension. Thus, the first documentation of the Veteran having a hypertension was around late 2011. He was advised of other lifestyle risk factors associated with hypertension. By 2013 VA identified a history of hypertension and related medication. The Board assigns substantial probative weight to the contemporaneous treatment records. Second, the Board also assigns substantial probative weight to the negative nexus opinion of the January 2021 VA examiner. The VA examiner reviewed the entire claims file, including blood pressure readings, and provided reasons and bases citing to evidence in the claims file. The VA examiner ultimately rendered a negative nexus opinion implicitly encompassing all theories of direct and presumptive service connection. The VA examiner repeated that service treatment records do not show hypertension. We note that if the medical evidence of record is insufficient, or, in the opinion of the Board, of doubtful weight or credibility, the Board is always free to supplement the record by seeking an advisory opinion, ordering a medical examination or citing recognized medical treatises in its decisions that clearly support its ultimate conclusions. However, it is not free to substitute its own judgment for that of such an expert. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Therefore, the Board assigns substantial probative weight to the findings of the January 2021 VA examiner. Here, regarding direct or presumptive service connection, we find that the Veteran did not have the characteristic manifestations necessary to identify the disease entity in service. Hypertension was not manifest in service or within one year from separation, and is not attributable to service. There is no probative evidence to the contrary. In addition, the Board finds that while competent to report what he has been told by his physician and to report taking blood pressure medication, the Veteran's own lay opinion regarding identifying a potential chronic disease entity, such as hypertension, pales in probative weight when compared to the objective medical evidence of record. The Veteran's theory of entitlement is largely based upon conclusory statements about a past diagnosis in service. The STRs from separation failed to show chronic high blood pressure or any related medication. Furthermore, we note that a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In short, the most probative evidence is the clinically normal STRs upon discharge and January 2021 VA examination with medical opinion. The most probative evidence establishes a remote onset of hypertension several years after discharge. Additionally, we have specifically considered that Saunders clarified that evidence of pain alone which results in functional impairment, even if there is no identified underlying diagnosis, can constitute a disability. See Saunders v. Wilkie, 886 F.3d 1356 (2018). Even assuming historical cardiovascular pathology were identified, though we do not concede this, there is still no link to service (nexus). The Veteran's lay history of hypertension is outweighed by the contemporaneous treatment records and negative nexus opinion. Consequently, service connection for hypertension is not warranted. 2. Entitlement to service connection for an acquired psychiatric disorder, claimed as major depressive disorder, to include as secondary to service connected disabilities The Board incorporates its discussion from the sections above by reference. The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided. 38 C.F.R. § 4.14. The Secretary shall decide all questions of law and fact necessary to a decision by the Secretary under a law that affects the provision of benefits by the Secretary to Veterans or the dependents or survivors of Veterans. 38 U.S.C. § 511 (a); 38 C.F.R. § 20.101 (a). One of the principal functions of the Board is to make determinations of appellate jurisdiction. 38 C.F.R. § 19.4. The Board may address questions pertaining to its jurisdictional authority to review a particular case or issue. 38 C.F.R. § 20.101 (d). By way of background, at the January 2020 hearing, the Veteran testified regarding major depressive disorder. Sometimes he gets up in the morning and he can't do certain things. See January 2020 Hearing Transcript, p. 14. That was and is very depressing. He has been on medication twice, but sometimes the medication is worse than the problem he is having. Id. He has never been hospitalized because of depression. He explained that the pain and struggles include not being able to bathe directly and function. He testified that he has been to counseling, and has been diagnosed with major depressive disorder. See January 2020 Hearing Transcript, p. 16. The issue was expanded to include a theory of secondary service connection. Next, the February 2021 Rating decision granted service connection for major depressive disorder, claimed as depressive disorder. The RO assigned an evaluation of 70 percent effective January 17, 2020. The RO explained, "An evaluation of 70 percent is assigned from January 17, 2020, the date your claim for headaches was received as your mental condition has been associated with your service connected headaches, which were not service connected until January 17, 2020. (38 C.F.R. § 3.400,38 C.F.R. § 3.310)." The Rating decision concludes, "NOTE: The grant of service connection for major depressive disorder fully resolves your appeal on this issue. THIS DECISION CONSTITUTES A FULL GRANT OF THE BENEFITSOUGHT ON APPEAL. SINCE THE BENEFIT CLAIMED HAS BEEN GRANTED, THEAPPEAL ON THIS ISSUE HAS BEEN WITHDRAWN." (capitalization in original). This extinguished the appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). Mistakenly, in the February 2021 Supplemental Statement of the Case (SSOC), the RO re-certified to the Board an issue of "Entitlement to service connection from February 22, 2017 to January 17, 2020 for major depressive disorder." This is incorrect as the complete benefit sought had already been granted. There is no other earlier effective date claim. In this regard, the SSOC went so far as to address that the current effective date is the earliest possible date because it is the date of claim that headaches were received, as the Veteran's theory of entitlement is depression secondary to service-connected headaches. There no longer remains any case or controversy pending before the Board as contemplated by 38 U.S.C. §§ 7104, 7105 and 38 C.F.R. § 19.4. In the absence of any justiciable question, the appeal as to this service connection claim must be dismissed. See Sabonis v. Brown, 6 Vet. App. 426 (1994). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In reaching these conclusions, the Board finds that the preponderance of the evidence is against the claims. As such, the benefit of the doubt rule is not for application, and the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Although the Board regrets any possible delay, a remand is necessary to ensure that the Veteran is afforded due process, and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. 1. Entitlement to service connection for bilateral hearing loss disability is remanded. The Board incorporates its discussion from the sections above by reference. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). VA regulations do not preclude service connection for a hearing loss which first met VA's definition of disability after service. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The determination of whether a Veteran has a hearing loss disability is governed by 38 C.F.R. § 3.385. By way of history, the January 2015 Rating decision conceded acoustic trauma in service based upon the Veteran's MOS, in addition to current hearing loss for VA purposes. This was based upon a contemporaneous VA examination and the Veteran's DD-214. The issue remained a nexus. Years later, the Veteran testified at the January 2020 hearing regarding a buzzing sound causing hearing impairment, and that he worked around F14 jet launching. See January 2020 Hearing Transcript, pp. 8-9. His Military Occupational Specialty (MOS) was an aircraft electrician. Id. at p. 9. He spent a lot of time on the flight line. The cable that comes back from the aircraft carrier following launch is very loud. He testified since then, "I have a problem hearing certain pitches in, in conversations. I hear a buzzing sound sometimes, it's --and when I'm --when that happens, I can't barely hear." Id. at pp. 9-10. He explained that although he worked on aircraft after separation, he wasn't working on turning around the aircraft, he was wiring them. So he did not have loud exposure after separation other than in the carrier setting in service. Id. at p. 11. One month later, in February 2020, the Veteran was afforded a new VA audiological examination. Unfortunately, the VA examiner indicated that test results were not valid for rating purposes. She explained: Veteran provided inconsistent responses to pure tone stimuli. He was re-instructed to push the button as soon as he heard a tone, but results are thought to reflect supra-threshold levels. I spoke to the veteran using the talk forward function of the audiometer at a level of 62dBSPL and he was able to hear and respond to questions. This would not be possible if his true hearing thresholds were based on test results he gave at today's evaluation, showing a moderate to severe hearing loss. Additionally, his SRT at 30dBHL was much better than his original PTA. Later that year, in June 2020, the Board remanded the issue to afford the Veteran a new VA audiological examination. The Board observed that the February 2020 VA audiological examination with medical opinion is phrased in terms of one specific incident of exposure to a loud noise. The Veteran's theory of entitlement is based upon his MOS and innumerable incidents of noise exposure in service for several years. Next, the Veteran was afforded a December 2020 VA audiological examination, uploaded to the claims file along with a series of examinations in January 2021. The word discrimination score was not available for either ear. The VA examiner indicated a diagnosis of sensorineural hearing loss in the right ear and normal hearing in the left ear. The VA examiner ultimately indicated negative nexus opinions for both ears. The rationale for the right ear reads: Veteran's MOS listed as aircraft maintenance technician concedes hazardous noise exposure. STRs are silent for hearing loss from enlistment to separation period, pure tone thresholds are within normal limits bilaterally from enlistment to separation exam dated 08/21/1985 and 07/19/1989 respectively without a significant shift in thresholds in either ear. It is less likely than not that the veterans hearing loss was caused by a result of military noise exposure. For the left ear, the VA examiner concluded, "Pure tone thresholds are within normal limits today for the left ear." For this issue, VA regulations do not preclude service connection for a hearing loss which first met VA's definition of disability after service. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Veteran is competent to provide evidence of that which he experienced, including a history of noise exposure in service and difficulty hearing. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The most recent December 2020 VA audiological examination is incomplete. It does not include a speech discrimination score. The medical opinion does not fully explain the negative nexus opinion in light of conceded hazardous noise exposure, Hensley, and diagnosed sensorineural hearing loss in the right ear. Indeed, a medical opinion is adequate when it is based upon consideration of the Veteran's prior medical history and examinations, and also describes the disability in sufficient detail so that the Board's "evaluation of the claimed disability will be a fully informed one." Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991)). Once VA undertakes the effort to provide an examination, it must obtain a fully adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Recently, in Miller v. Wilkie, No. 18-2796, the United States Court of Appeals for Veterans Claims (Court) held that when a VA examiner fails to address relevant lay evidence, and the Board fails to find the veteran not credible or not competent to offer that lay evidence, the proper remedy is for VA to obtain a new examination. Therefore, and in light of the Veteran's testimony regarding conceded noise exposure and impairment, the Board finds that a remand for supplemental VA audiological examination with medical opinion is warranted. In addition, the entire claims file, including the hearing transcript, should be made available to the VA examiner for review. The matters are REMANDED for the following action: 1. If the Veteran identifies other evidence, obtain updated copies of the Veteran's VA treatment records, and associate them with the Veteran's claims folder. 2. Please schedule the Veteran for an examination by an appropriate clinician to determine the nature, etiology, and severity of the Veteran's claimed bilateral hearing loss disability. Any audiometric testing results from the examination should be associated with the claims file. For each claimed disability, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including work as an aircraft electrician. Attention is invited to the January 2020 Hearing testimony, which must be specifically considered by the VA examiner. VA regulations do not preclude service connection for a hearing loss which first met VA's definition of disability after service. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). (Continued on the next page.) 3. After completing the above, and any other necessary development, the claims remaining on appeal must be readjudicated in light of all pertinent evidence and legal authority. If any benefits sought are not granted, issue the Veteran and his representative an appropriate supplemental statement of the case (SSOC). Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Bodi, 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.