Citation Nr: 21030786 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-36 795 DATE: May 19, 2021 ORDER Service connection for bilateral tinnitus is granted. REMANDED Service connection for hearing loss is remanded. Service connection for pseudofolliculitis barbae, hair loss, or keloids is remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, the Veteran's bilateral tinnitus began during active service. CONCLUSION OF LAW The criteria for service connection for bilateral tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July to December 1983 and from February to July 1991. The Veteran also had inactive and active duty for training during reserve service from June 1983 and February 2010, including in July and August 1999, when the Veteran incurred a service-connected left ankle fracture in the line of duty. These matters come before the Board of Veterans' Appeals (Board) from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript is of record. Service connection for bilateral tinnitus is granted. The Veteran contends that tinnitus began during active service. The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). March 2021 private treatment records show the Veteran has a current diagnosis of bilateral tinnitus. Thus, the question becomes whether the current disability is related to service. On this question there is evidence in favor of and against the claim. The evidence against the claim includes a June 2015 VA examination. The examiner opined that the Veteran's reported tinnitus was less likely than not (less than 50 percent probability) caused by or a result of military noise exposure. The VA examiner offered as rationale: "Not due to noise exposure while active duty. More likely than not due to excessive noise exposure while in the Reserves." The Board gives this opinion no weight. In order to be entitled to probative weight, a medical opinion must contain not only clear conclusions with supporting data, but also a reasoned explanation connecting the two. Nieves-Rodriguez, 22 Vet. App. at 301. A medical opinion is not entitled to any weight in a service-connection or rating context if it contains only data and conclusions. Here, the VA examiner's opinion is only conclusion, without any explanation. The evidence in favor of the claim includes the Veteran's February 2021 Board hearing testimony and March 2021 private treatment notes. In February 2021, the Veteran testified tinnitus symptoms began during active duty service and has been present ever since. The Veteran testified that the symptoms have become more "consistent" over time. The Veteran testified to being issued hearing protection, but "sometimes those things get knocked off." The Veteran testified to being told by private audiologists that the tinnitus symptoms were due to noise exposure as an Air Force mechanic. The Veteran denied tinnitus symptoms prior to active duty service. The Veteran testified to working as an airplane mechanic as a civilian too, but was a cabin mechanic, explaining his civilian work duties were performed inside the aircraft and not outside near the engines on the flight line. The Veteran testified to wearing hearing protection at the civilian worksite because of screw guns. A review of the military personnel records and service treatment records corroborate parts of the Veteran's testimony and the Board has no reason to doubt the rest. The Veteran indeed served as an aircraft mechanic in an aircraft maintenance squadron of the United States Air Force. These records confirm that the Veteran's work duties were performed in a "high noise environment." The Veteran's reserve records confirm a standard threshold shift in 2003 and the Veteran began wearing double hearing protection. The Veteran denied tinnitus symptoms in October 1997 and April 2004, but he testified in February 2021 that he did not understand what was going on or what tinnitus was until a doctor later explained it to him. In March 2021, the Veteran reported to a private audiologist "tonal tinnitus bilaterally shortly after serving in the military during the 80's" and the audiologist diagnosed "bilateral tinnitus." The Board finds the Veteran's lay statement credible because they were made during medical treatment. Upon review of the record, the Board finds the evidence to be at least even as to whether the Veteran's current bilateral tinnitus arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral tinnitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted. REASONS FOR REMAND 1. Service connection for hearing loss is remanded. The Board cannot make a fully informed decision on the issue of service connection for hearing loss because no VA examiner has considered the Veteran's February 2021 hearing testimony. Once VA undertakes to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In June 2015, a VA examiner opined that the Veteran's hearing loss was not at least as likely as not (50 percent probability or greater) caused by or a result of an event in military service. The VA examiner explained that the Veteran had "normal" hearing while the Veteran was active duty and while other hearing examinations showed slight fluctuations in the reserves, the Veteran's last examinations from 2009 all showed "normal" hearing. The opinion does not consider all the relevant evidence of record, including lay statements. Nieves-Rodriguez, 22 Vet. App. 295; Dalton, 21 Vet. App. 23. The VA examiner remarked that the Veteran "was only active duty in 1991." This is not true. The Veteran also served on active duty in 1983. The Veteran also had inactive and active duty for training during reserve service from June 1983 and February 2010, including in July and August 1999, when the Veteran incurred a service-connected left ankle fracture in the line of duty. Since the June 2015 VA examination, the Veteran testified before the Board. In February 2021, the Veteran testified that hearing problems began during active duty service and has had them ever since. The Veteran testified to being issued hearing protection, but "sometimes those things get knocked off." The Veteran testified to being told by private audiologist that the hearing loss was due to noise exposure as an Air Force mechanic. The Veteran denied hearing problems prior to active duty service. The Veteran testified to working as an airplane mechanic as a civilian too, but as a cabin mechanic, performing duties inside the aircraft and not outside near the engines or on the flight line. The Veteran testified to wearing hearing protection at the civilian worksite because of screw guns. The VA examiner did not benefit from this additional lay evidence added to record later. An addendum VA medical opinion addressing this evidence is warranted. 2. Service connection for pseudofolliculitis barbae, hair loss, or keloids is remanded. The Board cannot make a fully informed decision on the issue of service connection for pseudofolliculitis barbae, hair loss, or keloids because no VA examiner has opined whether it is at least as likely as not related to service. The VCAA, as part of the duty to assist, requires VA to obtain an exam or opinion in certain circumstances. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). A VA examination or opinion must be obtained in conjunction with a claim if there is: competent evidence of a current disability; evidence of an in-service event, injury or disease; an indication that the current disability may be (very low threshold) associated with the veteran's service or another serviceconnected disability; and there is otherwise insufficient competent medical evidence to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In February 2021, the Veteran testified to current skin problems, "raised keloids," on the back of the head. The Veteran denied skin problems before service. The Veteran testified that these problems began during basic training (1983) when his head was shaved and an "nicked." In 1987, the Veteran was treated by a military health care provided for pseudofolliculitis barbae. The Veteran testified that treatment did not help, and the Veteran was still required to keep his hair short for military service. By 1987, the Veteran testified to needing a haircut waiver because the problem continued. The Veteran denied that a certain hair length was required by the Veteran's civilian employer. There is no medical opinion about the cause of the Veteran's skin disorder in the record of evidence. A VA examination of the Veteran's skin disorder is warranted. The matters are REMANDED for the following actions: 1. In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 2. Obtain updated VA and/or private treatment records. If any identified records are unavailable, the Veteran's claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's hearing loss. The examiner must review the claims file, including a copy of this remand order and the February 2021 Board hearing transcript. The Veteran testified that hearing problems began during active duty service and has had them ever since. The Veteran testified that the symptoms have become more "consistent" over time. The Veteran testified to being issued hearing protection, but "sometimes those things get knocked off." The Veteran testified to being told by private audiologist that the hearing loss was due to noise exposure as an Air Force mechanic. The Veteran denied hearing problems prior to active duty service. The Veteran testified to working as an airplane mechanic as a civilian too, but as a cabin mechanic, explaining that the civilian work duties were performed inside the aircraft and not outside the aircraft near the engines or on the flight line. The Veteran testified to wearing hearing protection at the civilian worksite because of screw guns. The examiner is asked to provide a response to the following: Is hearing loss at least as likely as not related to service, including exposure to high levels of noise? The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. Provide a rationale to support the opinion. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). In providing the requested opinion, consider the Veteran's description of in-service injury and symptoms as well as 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 current disability, this should be noted. Stated another way, do the Veteran's reports about 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? 4. Schedule the Veteran for a VA examination for pseudofolliculitis barbae, hair loss, or keloids. The examiner must review the claims file, including a copy of the remand order and the February 2021 Board hearing testimony. The Veteran testified to current skin problems, "raised keloids," on the back of the head. The Veteran testified that these problems began during basic training when his head was shaved and an "nicked." By 1987, the Veteran testified to needing a haircut waiver because the problem continued. The Veteran testified that treatment did not help, and he was required to keep his hair short for military service. He denied skin problems before service. The Veteran denied that a certain hair length was required by his civilian employer. 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 below. The examiner is asked to provide a response to the following: Is pseudofolliculitis barbae, hair loss, or keloids at least as likely as not related to service, including treatment for pseudofolliculitis barbae? The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. Provide a rationale to support the opinion. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). In providing the requested opinion, consider the Veteran's description of in-service injury and symptoms as well as 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 current disability, this should be noted. Stated another way, do the Veteran's reports about 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? G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.