Citation Nr: 21041593 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 16-25 060 DATE: July 9, 2021 REMANDED Service connection for bilateral hearing loss is remanded. Service connection for patent ductus arteriosus, claimed as a heart condition is remanded. REASONS FOR REMAND The Veteran served in the Marine Corps Reserve; he had a period of initial active duty for training (IADT) from June 2007 to December 2007 and he served on active duty from May 2009 to June 2010. The Veteran testified before the undersigned Veterans Law Judge during a July 2019 hearing. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO) dated October 2013, November 2015, and January 2016. In November 2019, the Board remanded the case to obtain medical examinations and opinions; unfortunately additional remand is required. Specifically, in January 2021 VA examinations of the Veteran were conducted. With respect to the claim for service connection for hearing loss an audiology examination was conducted. However, the examiner indicated that the opinions requested touched on medical matters requiring examination and review by an otolaryngologist. Additional examination and review of the record by such a medical doctor did not occur. With respect to the claim for service connection for patent ductus arteriosus, claimed as a heart condition patent ductus arteriosus, claimed as a heart condition, examination was conducted using the artery and vein conditions Disability Benefits Questionnaire (DBQ). However, the examiner in the medical opinion indicated that an examination using the Cardiac DBQ was more appropriate but was never conducted. Remand for the proper examinations and opinions is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA Ears examination with an otolaryngologist to assess the nature and cause of the Veteran's his claimed hearing loss and ear disabilities. (a.) The examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent of greater probability) that the Veteran's ear disabilities began in service, were caused by service, or are otherwise related to the Veteran's period of active military service. (b.) The examiner is requested to please clarify whether the disability constitutes a congenital "disease" or "defect." (c.) For any congenital "disease" identified, assess whether such disease clearly and unmistakably preexisted service. (d.) If such disease is found to have preexisted service, determine whether any such disease was not aggravated during active military service, including the Veteran's complaints of hearing difficulties, and later developed bilateral hearing loss. Here, aggravation means an increase in disability beyond the natural progression. (e.) If bilateral hearing loss is not deemed an aggravation of the Veteran's ear disabilities, the examiner should state whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral hearing loss incurred in, or was aggravated by active military service, including the Veteran's accepted history of in-service noise exposure. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. 2. Then, afford the Veteran a VA Cardiac DBQ examination, by an appropriate specialist, to determine the nature and cause of the Veteran's claimed heart condition. The claims folder must be made available to the examiner(s) prior to the examination and the examiner should acknowledge such review in the examination report. All indicated studies should be performed and all manifestations of current disability should be described in detail. The examiner should address the following: (a.) Does the Veteran have any current, chronic disorder(s) of the heart and if so, what is the nature of this disorder? (b.) The examiner should specify whether any heart disorder noted is congenital in nature. (c.) For any identified disorder determined to be congenital or developmental in nature, that may have preexisted service, the examiner should offer an opinion as to whether it is at least as likely as not that: 1. such disorder was aggravated (worsened), as the result of some incident of active service, or 2. whether any such disorder is due to the natural progression of a disease. (d.) If the Veteran's service aggravated or contributed to or accelerated any pathologic process of a preexisting heart condition, the examiner must state to what extent did it so contribute as compared to the natural progress of the disability itself. (e.) Is it at least as likely as not (a 50 percent or greater probability) that any or all of the Veteran's service-connected disabilities (including any medications taken for the service-connected disabilities) caused or aggravated the Veteran's obesity/being overweight including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (f.) If yes, is it at least as likely as not (a 50 percent or greater probability) that the obesity/being overweight caused or aggravated the Veteran's claimed cardiac disability including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. The examiner must provide a comprehensive report including complete rationales for all conclusions reached. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Havelka, 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.