Citation Nr: 21039787 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-63 289 DATE: July 1, 2021 ORDER Entitlement to service connection for diabetes mellitus type II is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The most probative evidence does not reach the level of equipoise as to whether the Veteran's diabetes mellitus type II had its onset during or is etiologically related to active military service. 2. The most probative evidence does not reach the level of equipoise as to whether the Veteran's GERD had its onset during or is etiologically related to active military service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for diabetes mellitus type II have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for GERD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 1966 to January 1968. These matters come before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). Legal Criteria Service Connection Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for diabetes mellitus type II The Board finds that the most probative evidence does not reach the level of equipoise in the claim of entitlement to service connection for diabetes mellitus type II. Therefore, the claim may not be granted. The Veteran has a current diagnosis of diabetes mellitus type II. See CAPRI, January 2021. He did not serve in Vietnam and has not asserted that he was exposed to herbicide agents during service. Therefore, the questions for the Board are (1) whether there exists an in-service event, injury, or disease relevant to diabetes mellitus type II and (2) whether there exists an etiological nexus between any such occurrence during service and current diabetes mellitus type II. Service medical records are silent for any complaints, symptoms, treatment, or diagnoses of diabetes. The Veteran's separation examination did not document any diabetes, and there is no indication in the record of such symptoms manifesting within a year of the Veteran's discharge. The Veteran has not explained why he believes his current diabetes mellitus type II is related to his remote military service. In February 2017, his prior representative indicated "we have no evidence linking his diabetes...to his active duty service." Considering the foregoing, the Board finds that the most probative evidence does not show an in-service event, injury, or disease relevant to diabetes or a nexus between any current diabetes and military service. 38 C.F.R. § 3.303. Accordingly, the claim of service connection for diabetes mellitus type II must be denied. See 38 U.S.C. § 5107(a) ("[A] claimant has the responsibility to present and support a claim for benefits...."). 2. Entitlement to service connection for GERD The Board finds that the most probative evidence does not reach the level of equipoise in the claim of entitlement to service connection for GERD. Therefore, the claim may not be granted. The Veteran has a current diagnosis of GERD. See CAPRI, January 2021. The questions for the Board are (1) whether there exists an in-service event, injury, or disease relevant to GERD and (2) whether there exists an etiological nexus between any such occurrence during service and current GERD. Service medical records are silent for any complaints, symptoms, treatment, or diagnoses of GERD. The Veteran's separation examination did not document any GERD. The Veteran has not explained why he believes his current GERD is related to his remote military service. In February 2017, his prior representative indicated "we have no evidence linking... his GERD to his active duty service." Considering the foregoing, the Board finds that the most probative evidence does not show an in-service event, injury, or disease relevant to GERD or a nexus between any current GERD and remote military service. 38 C.F.R. § 3.303. Therefore, the claim of service connection for GERD must be denied. REASONS FOR REMAND 3. Entitlement to service connection for bilateral hearing loss The Board finds that the above claim must be remanded for an addendum medical opinion addressing the possibility of delayed-onset hearing loss. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran contends that his current bilateral hearing loss is related to hazardous noise exposure during his military occupation as a Hercules missile crewman. See VA Form 646, February 2017. In June 2015, a VA medical examiner concluded that it is less likely than not that hearing loss originated in service because the Veteran's audiograms were within normal limits at entrance and separation from service. However, she did not address whether hearing loss could be a delayed-onset reaction to hazardous noise exposure during military service. Therefore, an addendum opinion is necessary. The matter is REMANDED for the following actions: 1. Please secure for the record copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorder on appeal. 2. Obtain an addendum medical opinion addressing the nature and etiology of the Veteran's bilateral hearing loss. The clinician is asked to review the claims file and to opine on the following: (a) Is it at least as likely as not that the Veteran's bilateral hearing loss had its onset during or is etiologically related to military service, to include as a delayed-onset reaction to hazardous noise exposure? (b) Is it at least as likely as not that the Veteran's bilateral hearing loss is proximately due to, a result of, or aggravated beyond its natural progression by service-connected tinnitus? A complete rationale should be provided for all opinions. The clinician is asked to consider and discuss relevant lay and medical evidence, to specifically include: VA examinations in June 2015 and August 2020 The Veteran's contentions that his current hearing loss is a result of a delayed-onset reaction to hazardous noise exposure during military service The Veteran's post-service employment history as a machine operator, bus driver, and factory worker, as documented in an October 1999 VA Form 21-6796, and a VA social worker note in October 2002 The clinician is reminded that the term "at least as likely as not," does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Reed, Associate 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.