Citation Nr: 21032726 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-50 736 DATE: May 27, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a neck disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 2008 to July 2009 with additional Reserve service. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in February 2021. A transcript of that hearing is of record. 1. Entitlement to service connection for bilateral hearing loss is remanded. Although the January 2014 examination implies a negative nexus opinion by stating that there was no permanent threshold shift greater than normal measurement variability at any frequency between 500 and 6000 Hertz for the right ear, it does not clearly provide a nexus opinion. Upon remand, a new addendum opinion should be obtained that clearly discusses the etiology of the Veteran's right-ear hearing loss supported by a complete rationale. 2. Entitlement to service connection for a neck disability is remanded. The Board cannot make a fully-informed decision on this issue because no VA examiner has opined whether the Veteran has a neck disability caused by wearing heavy Kevlar during service, or is proximately due to or aggravated by service-connected lumbar spine disability. During the February 2021 hearing, the Veteran identified relevant outstanding private treatment records. A remand is required to allow VA to obtain authorization and request these records. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for the private physician who treats her neck disability, as referenced in the February 2021 hearing. Make two requests for the authorized records from any physician so identified, unless it is clear after the first request that a second request would be futile. 2. After completing the above, schedule the Veteran for a VA examination for her neck disability. The examiner must review the claims file. (a.) Does the Veteran have a neck disability that is at least as likely as not (50 percent or greater probability) related to service, to include wearing heavy Kevlar? The clinician is advised that the Veteran testified in her February 2021 hearing that she had neck pain in service, and that she reported swollen, stiff or painful joints in a June 2009 post-deployment examination. (b.) If the answer to the first question is no, does the Veteran have a neck disability that is at least as likely as not (50 percent or greater probability) proximately due to or aggravated (defined as any increase in disability) by her service-connected lumbar spine disability? Each opinion offered must be supported by a complete rationale. 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 opinions. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's right ear hearing loss is at least as likely as not (50 percent or greater probability) related to exposure to the loud noise of gunfire during service. The clinician is asked to reconcile his or her opinion with the February 2021 private medical opinion finding that the Veteran's hearing loss is more likely due to her military experience of gunfire in Iraq and Panama, and with the 5-decibel downward shift at 1000k noted in a June 2009 service treatment record (STR). The opinion offered must be supported by a complete rationale. 4. The AOJ must confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Budd, 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.