Citation Nr: 21030070 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 19-00 766A DATE: May 17, 2021 REMANDED Entitlement to service connection for bilateral pes planus is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1964 to June 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO) which denied the claims on appeal. While further delay is regrettable, the Board finds that remand of the appeal is required for further evidentiary development. Bilateral Pes Planus The Veteran is seeking service connection for his bilateral pes planus disability. Notably, the April 1964 service entrance examination noted pes planus upon entrance into service. A pre-existing injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless clear and unmistakable evidence shows that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. There is a presumption of sound condition upon entrance into service unless a defect is "noted" on the entrance examination; and a presumption of aggravation of a preexisting condition if the preexisting condition worsens in severity during service. Clear and unmistakable evidence is required to rebut the presumption of aggravation, to include a specific finding that the increase is due to the natural progress of the disease. 38 U.S.C. §§ 1111, 1153; 38 C.F.R. §§ 3.304, 3.306. In July 2016, the Veteran was afforded a VA examination to determine the nature and etiology of his pes planus disability. Upon review of the record and examination of the Veteran, the examiner found that the Veteran's pre-existing pes planus was less likely as not aggravated beyond its natural progression during service. In so finding, the examiner noted that the current evidence in the claims file did not suggest aggravation of the Veteran's flat feet due to service. However, the examiner did not provide adequate rationale or discuss the specific facts of the Veteran's case to support the conclusory statement that the Veteran's feet were not aggravated by service. As a result, the Board finds that remand is required to obtain an adequate opinion based on the theory of aggravation. Bilateral Hearing Loss The Veteran claims service connection for bilateral hearing loss, which he states is secondary to his in-service noise exposure. As a preliminary matter, the Veteran's military occupational specialty (MOS) was auto repairman; the Board notes that general vehicle mechanics have a moderate level of noise exposure during service. The Board also notes that upon discharge from service, the Veteran demonstrated some degree of threshold shifts in hearing acuity at 4000 Hz and 6000 Hz. See Reports of Medical Examination dated April 11, 1964 and March 5, 1968. In July 2016, the Veteran was afforded a VA audiological examination to determine the nature and etiology of his bilateral hearing loss and tinnitus. In finding that the Veteran's tinnitus was related to service, the examiner noted the Veteran's in-service duties as a mechanic and found that noise levels associated with military vehicles were known to exceed safe levels. Contrarily, the examiner found that the Veteran's hearing loss was less likely than not caused by service. In so finding, the examiner found that the Veteran did not have a permanent positive threshold shift during service at any frequency and reasoned that the Veteran had normal hearing during service. Based on this examination, the Board finds that remand is required to obtain another nexus opinion. As previously noted, the Veteran's service treatment records reflect some degree of a threshold shift in the Veteran's hearing acuity at 4000 and 6000 Hz from the time of entrance into service to discharge from service. In addition, the examiner acknowledged the Veteran's exposure to loud noise during service and his resulting acoustic trauma. However, the examiner did not take this into account when rendering the opinion. As a result, remand is required to obtain an adequate opinion regarding the Veteran's hearing loss. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriate examiner to determine the nature and etiology of his bilateral pes planus. The claims file must be made available for review by examiner. The examiner must opine whether pes planus was at least as likely as not aggravated (non-temporary increase in severity) by service and, if so, whether any increase in severity was clearly and unmistakably (undebatable) due to its natural progression. The examiner should also determine whether pes planus is at least as likely as not aggravated beyond its natural progression by any service-connected disabilities. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state what, if any, additional evidence would permit such an opinion to be made. 2. Schedule the Veteran for a VA audiological examination by an appropriate examiner to determine the nature and etiology of the Veteran's bilateral hearing loss. The claims file must be made available for review by examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran's bilateral hearing loss had its onset in service or is otherwise etiologically related to service, to include the Veteran's conceded moderate noise exposure. The examiner must discuss the documented decrease in the Veteran's audiological test results between the entrance and separation examinations at 4000 Hz and 6000 Hz and explain why the Veteran's hearing loss is not otherwise related to his noise exposure during service. The examiner should specifically explain the standard from what is considered a positive permanent threshold shift (worse than reference threshold) which is considered greater than normal measurement variability, and whether the Veteran demonstrated a permanent threshold shift indicative of acoustic trauma and/or hearing loss during service. The examiner should also comment on the concept of a delayed onset hearing loss (i.e., does absence of pertinent complaints and normal audiometry at separation preclude a nexus between the current disability and exposure to noise trauma in service). A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state what, if any, additional evidence would permit such an opinion to be made. J. Komperda Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Orie, 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.