Citation Nr: 21029259 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-47 888 DATE: May 13, 2021 REMANDED Entitlement to an initial compensable disability rating for inguinal hernia is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for right leg shin splints is remanded. Entitlement to service connection for left leg shin splints is remanded. Entitlement to service connection for top left foot disability is remanded. Entitlement to service connection for vision loss is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for allergies is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1990 to June 1991. These matters come to the Board of Veterans' Appeals (Board) from an October 2014 rating decision which granted service connection for inguinal hernia, evaluated as noncompensable, effective December 12, 2013, and denied service connection for a bilateral knee disability, bilateral shin splints, top left foot disability, vision loss, bilateral hearing loss, tinnitus, allergies, and headaches. In February 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board videoconference hearing. A copy of the transcript is of record. The claims of entitlement to an initial compensable disability rating for inguinal hernia and the claims of entitlement to service connection for a bilateral knee disability, bilateral shin splints, top left foot disability, vision loss, bilateral hearing loss, tinnitus, allergies, and headaches, are remanded. As it pertains to all claims, during the February 2020 Board hearing, the Veteran identified relevant outstanding private treatment records. Specifically, he indicated that he had a private primary care physician, Dr. K., from whom he has sought treatment for many of his disabilities. While the Veteran provided VA Form 21-4142 (Authorization and Consent to Release Information to the Department of Veterans Affairs (VA)) in November 2013 for Drs. K. and W., only records relevant to the Veteran's bilateral knee disability were requested and obtained. A remand is required to allow VA to obtain authorization and request these records. Additionally, the Veteran indicated during the February 2020 Board hearing that he intended to submit additional evidence in support of his claims, to include buddy statements and a headache log. To date, these have not been associated with the record. The Veteran is invited to submit these documents on remand. Inguinal hernia The Veteran was last afforded a VA examination in May 2018. The evidence of record, including an October 2018 private treatment record and the Veteran's testimony during the February 2020 Board hearing, reflect the Veteran's inguinal hernia may have increased in severity since the Veteran was last examined by VA. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his service-connected inguinal hernia. Bilateral knee disability The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a bilateral knee disability because no VA examiner has opined whether the Veteran has a bilateral knee disability that was incurred in or is otherwise related to service, to include the rigors of service. Bilateral shin splints The Board cannot make a fully-informed decision on the issue of entitlement to service connection for bilateral shin splints because no VA examiner has opined whether the Veteran has a bilateral shin splint disability that was incurred in or is otherwise related to service, to include the rigors of service. Top left foot disability The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a top left foot disability because no VA examiner has opined whether the Veteran has a top left foot disability that was incurred in or is otherwise related to service, to include the rigors of service. Vision loss and headaches The Board cannot make a fully-informed decision on the issue of entitlement to service connection for vision loss because no VA examiner has opined whether the Veteran has a vision disability that was incurred in or is otherwise related to service, to include hits to his head during an in-service altercation. As it pertains to headaches, while the Veteran was afforded a VA examination and medical opinion in September 2014, the Board finds the opinion inadequate. Specifically, the examiner opined that the Veteran's tension headaches were not etiologically related to an in-service altercation but did not provide a rationale or basis for the opinion. Therefore, the Board finds that a remand for a new VA examination and medical opinion is warranted. Allergies The Board cannot make a fully-informed decision on the issue of entitlement to service connection for allergies because no VA examiner has opined whether the Veteran has allergies that were incurred in or are otherwise related to service, to include being stationed in Alaska. Bilateral hearing loss and tinnitus The Board cannot make a fully-informed decision on the issue of entitlement to service connection for bilateral hearing loss and tinnitus at this time. While the Veteran was afforded a VA examination and medical opinion in September 2014, the Board finds the examination and medical opinion are inadequate. Specifically, the examiner indicated that use of speech discrimination scores, which showed a hearing loss disability for VA purposes, were not appropriate for this Veteran as the scores were inconsistent with his puretone thresholds. However, the examiner did not provide a rationale or basis for why application of puretone thresholds was more appropriate in determining that the Veteran did not have hearing loss such that a diagnosis could be rendered. A remand for a new VA examination and medical opinion is warranted. The matters are REMANDED for the following actions: 1. Obtain the Veteran's VA treatment records from April 2018 to present. 2. Ask the Veteran to complete a VA Form 21-4142 for Dr. K. and any other physician/facility from which he has sought treatment for his claimed disabilities. Make two requests for the authorized records from the identified providers unless it is clear after the first request that a second request would be futile. 3. Invite the Veteran to submit additional evidence in support of his claim, including buddy statements and a headache log. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected inguinal hernia. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 5. Schedule the Veteran for a VA examination for his bilateral knee 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 it at least as likely as not that a right and/or left knee disability (1) began during active service, to include related to the rigors of service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinion(s). Although a complete review of the claims file is required, the examiner's attention is drawn to a March 2006 treatment record in which the Veteran reported he had always had soreness in the anterior aspect of his knees bilaterally and a March 2006 MRI showing a possible old ACL injury. In providing the requested opinion, consider the Veteran's description of his in-service injury 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 injury and 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 align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 6. Schedule the Veteran for a VA examination for his bilateral shin splints. 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 it at least as likely as not that right and/or left shin splints (1) began during active service, to include related to the rigors of service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of his in-service injury 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 injury and 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 align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 7. Schedule the Veteran for a VA examination for his top left foot 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 it at least as likely as not that a top left foot disability (1) began during active service, to include related to the rigors of service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinion(s). Although a complete review of the claims file is required, the examiner's attention is drawn to an October 2013 treatment record in which the Veteran reported he had always had a great toe deformity and a finding of significant osteoarthritis in the first MTP joint with spurring. In providing the requested opinion, consider the Veteran's description of his in-service injury 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 injury and 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 align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 8. Schedule the Veteran for a VA examination for his claimed headache and vision loss disabilities. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is it at least as likely as not that the Veteran has headaches or additional vision loss that (1) began during active service, to include related to hits to his head during in-service altercations, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinion(s). Although a complete review of the claims file is required, the examiner's attention is drawn to a January 1991 emergency record in which the Veteran sought treatment after he was involved in an altercation and was struck in the mouth and left side of his head near his eye. In providing the requested opinion, consider the Veteran's description of his in-service injury 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 injury and symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 9. Schedule the Veteran for a VA examination for his allergies. The examiner must review the claims file. The examiner is asked to provide a response to the following: Are the Veteran's allergies at least as likely as not related to service, including his lay statements that they developed while stationed in Alaska? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of his in-service injury 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 injury and 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 align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 10. Schedule the Veteran for a VA examination for his hearing disability, including hearing loss and tinnitus. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is it at least as likely as not that the Veteran's hearing loss and/or tinnitus (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinion(s). If use of puretone thresholds or speech discrimination scores are inappropriate for this Veteran, or if puretone thresholds are inconsistent with speech discrimination scores, the examiner should explain why this is so. In providing the requested opinion, consider the Veteran's description of his in-service injury 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 injury and 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 align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 11. After completing the above, and any other development as may be indicated, the Veteran's claims should be readjudicated based on the entirety of the evidence. If the claims remain denied, the Veteran and his representative should be issued a supplemental statement of the case (SSOC). An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Owen, 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.