Citation Nr: 21031647 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-40 448 DATE: May 24, 2021 REMANDED Entitlement to an initial compensable prior to June 20, 2016 and in excess of 20 percent thereafter for left shoulder degenerative joint disease (claimed as rotator cuff tear) is remanded. Entitlement to an initial compensable rating prior to December 1, 2014 and in excess of 10 percent thereafter for gastroesophageal reflux (GERD) (claimed as gastroenteritis and fatty liver) is remanded. Entitlement to an initial compensable rating for back scars, status post laminectomy and right shoulder scars, residual of rotator cuff repair (surgery scars) remanded. Entitlement to an initial compensable rating for hypertension is remanded. Entitlement to an initial compensable rating for allergic rhinitis. Entitlement to an initial compensable rating for dermatophytosis (claimed as onychomycosis toenails, tinea corporis multiple locations) is remanded. Entitlement to an initial compensable rating for herpes is remanded. Service connection for right knee condition is remanded. Service connection for left knee condition is remanded. Service connection for right hip condition (claimed as bursitis trochanteric) is remanded. Service connection for right ankle condition (claimed as osteoarthritis and pain) is remanded. Service connection for bilateral Eustachian tube blockage is remanded. Service connection for testicle condition is remanded. Service connection for headaches is remanded. Service connection for glaucoma (now claimed as vitreous floaters left eye with scarring) is remanded. Service connection for asthma is remanded. Service connection for dizziness is remanded. REASONS FOR REMAND The Veteran had active duty in the Air Force from March 1987 to March 2013. The issues are on appeal from a June 2013 rating decision. In a June 2016 rating decision, the regional office (RO) granted increased ratings for left shoulder degenerative joint disease to 20 percent disabling, effective June 3, 2016; and for GERD to 10 percent disabling, effective December 1, 2014. However, as these increased do not represent a total grant of the benefits sought on appeal, the issues of an increased rating for left shoulder degenerative joint disease and GERD remain before the Board of Veterans' Appeals (Board). AB v. Brown, 6 Vet. App. 35 (1993). The Veteran testified before the undersigned in a March 2021 hearing. A copy of the hearing transcript is associated with the claims file. 1. Entitlement to an initial compensable prior to June 20, 2016 and in excess of 20 percent thereafter for left shoulder degenerative joint disease (claimed as rotator cuff tear) is remanded. 2. Entitlement to an initial compensable rating prior to December 1, 2014 and in excess of 10 percent thereafter for gastroesophageal reflux (GERD) (claimed as gastroenteritis and fatty liver) is remanded. 3. Entitlement to an initial compensable rating for back scars, status post laminectomy and right shoulder scars, residual of rotator cuff repair (surgery scars) remanded. 4. Entitlement to an initial compensable rating for hypertension is remanded. 5. Entitlement to an initial compensable rating for allergic rhinitis. 6. Entitlement to an initial compensable rating for dermatophytosis (claimed as onychomycosis toenails, tinea corporis multiple locations) is remanded. 7. Entitlement to an initial compensable rating for herpes is remanded. 8. Service connection for right knee condition is remanded. 9. Service connection for left knee condition is remanded. 10. Service connection for right hip condition is remanded. 11. Service connection for right ankle condition is remanded. 12. Service connection for bilateral Eustachian tube blockage is remanded. 13. Service connection for testicle condition is remanded. 14. Service connection for headaches is remanded. 15. Service connection for glaucoma (left eye condition) is remanded. 16. Service connection for asthma is remanded. 17. Service connection for dizziness is remanded. Initially, his March 2021 hearing, the Veteran testified that he had received recent treatment from Joint Base Charleston, formerly Charleston Air Force Base, and that these medical records are not associated with his claims file. On remand, the RO should obtain any missing medical records. Regarding his increased rating claims, the Veteran asserted that his service-connected left shoulder degenerative joint disease, GERD, surgery scars, hypertension, allergic rhinitis, dermatophytosis, and herpes have worsened in severity since the Veteran was last examined by VA in June 2016. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of these disabilities. The Board notes that a revised criterion for rating musculoskeletal claims pursuant to 38 C.F.R. § 4.71(a) came into effect February 7, 2021. As the Veteran's claims for his left shoulder degenerative joint disease is rated under Diagnostic Codes 5003-5201, which in part has been revised, the current severity of his left shoulder degenerative joint disease should be evaluated under the revised regulation. Regarding his service connection claims, readjudication should occur after all missing medical records have been associated with the claims file. The Board acknowledges that the Veteran was afforded VA examinations for his left eye, ear, headaches, male reproductive system, asthma, right hip, bilateral knees, and right ankle in March 2013. However, the examiner noted that she did not have access to his claims file, nor did she provide any etiology opinions on these issues. Therefore, the Board finds these VA examinations are not sufficient for adjudication purposes. The Veteran was afforded an additional VA examination in June 2016 for his asthma. The examiner opined the Veteran did not have a current disability of asthma, but rather pulmonary sarcoidosis, as there is only one note in his service treatment records diagnosing asthma and his pulmonary function tests during active duty had normal results. The examiner opined that neither asthma nor his current pulmonary sarcoidosis is due to the Veteran's active duty. Again, the Board finds this VA examination as insufficient for adjudication purposes. The Veteran was noted to have asthma as an "active medical problem" throughout his active duty tenure, and on his retirement medical evaluation, the assessor noted as such. Furthermore, the assessor referred the Veteran for annual asthma testing because of asthma. When VA undertakes to provide a VA examination or obtain a VA opinion it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, the Board finds that new VA examinations and etiology opinions are necessary. 38 C.F.R. § 4.2. The Board notes that specifically for the Veteran's service connection claim for left eye conditions, the Veteran asserts that he had a pre-existing disability. His October 1986 enlistment report of medical evaluation and report of medical history demonstrate having had surgery as a child in his left eye due to hematoma. The Veteran's service treatment records also reflect consistent reporting of his childhood left eye surgery and diagnoses of various left eye conditions including glaucoma. His retirement medical assessment also notes the Veteran's continued struggles with left eye glaucoma. In addition to an etiology opinion for direct service connection, as directed above, an etiology opinion is needed discussing whether the Veteran's left eye condition is a preexisting condition, and if so, whether the preexisting condition was permanently aggravated during service and whether there is clear and unmistakable evidence that such aggravation was due to the natural progress of the disease. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Additionally, regarding the Veteran's claims for right hip and dizziness, the Veteran has asserted possible secondary service connection links for each. The Veteran states that his dizziness could be caused due to his bilateral Eustachian tube blockage or his service-connected hypertension. As for his right hip, he asserts having a strange gait pattern, and believes the disability could be caused by his right ankle condition or service-connected left ankle osteoarthritis. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). To prevail on a claim for secondary service connection, the record must show (1) current disability, (2) a service-connected disability, and (3) medical nexus evidence establishing a connection between the current and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition to an etiology opinion for direct service connection, as directed above, an etiology opinion discussing whether the Veteran's dizziness is proximately due to or worsened beyond natural progression by his service-connected conditions, specifically bilateral Eustachian tube blockage (if service-connected after readjudication) or his hypertension, should be obtained. An etiology opinion discussing whether the Veteran's right hip condition is proximately due to or worsened beyond natural progression by his service-connected conditions, specifically right ankle condition (if service-connected after readjudication) or his left ankle osteoarthritis, should be obtained. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records from Joint Base Charleston. 2. After all missing medical records have been retrieved and associated with the claims file, schedule the Veteran for VA examinations to assess the current nature and manifestations of his service-connected left shoulder, surgery scars, hypertension, allergic rhinitis, dermatophytosis, GERD, and herpes. 3. Schedule the Veteran for VA examinations to assess the current nature of his bilateral knee condition, bilateral Eustachian tube blockage, testicle condition, right hip condition, headaches, right ankle condition, left eye condition, asthma, and dizziness. (a) The examiner should opine whether his bilateral knees, ear condition, testicle condition, right hip condition, headaches, right ankle condition, left eye condition, asthma, or dizziness are at least as likely as not (i.e. 50 percent or greater) due to active duty. (b) In addition to a direct etiology opinion, the examiner must opine whether the Veteran has a preexisting left eye condition. (i) If a preexisting left eye condition is found, the examiner should provide opinion as to (1) whether the preexisting left eye condition was permanently aggravated during service, and (2) if so, whether there is clear and unmistakable evidence that such aggravation was due to the natural progress of the disease. (c) In addition to a direct etiology opinion, the examiner must opine whether the Veteran's dizziness is at least as likely as not (i.e. 50 percent or greater) proximately due to his service-connected conditions, specifically bilateral Eustachian tube blockage (if service-connected after readjudication) or hypertension. (d) In addition to a direct etiology opinion, the examiner must opine whether the Veteran's dizziness is at least as likely as not (i.e. 50 percent or greater) worsened beyond its natural progression by his service-connected conditions, specifically bilateral Eustachian tube (if service-connected after readjudication) or hypertension. (e) In addition to a direct etiology opinion, the examiner must opine whether the Veteran's right hip condition is at least as likely as not (i.e. 50 percent or greater) proximately due to his service-connected conditions, specifically right ankle condition (if service-connected after readjudication) or left ankle osteoarthritis. (f) In addition to a direct etiology opinion, the examiner must opine whether the Veteran's right hip condition is at least as likely as not (i.e. 50 percent or greater) proximately due to his service-connected conditions, specifically right ankle condition (if service-connected after readjudication) or left ankle osteoarthritis. Any opinions provided must include thorough review of the record, consideration of the Veteran's lay statements, and sufficient rationale. If the examiner(s) cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 4. Readjudicate the appeals. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee 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.