Citation Nr: 21041804 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 17-43 151 DATE: July 10, 2021 ORDER Entitlement to service connection for bilateral hearing loss is denied. REMANDED Entitlement to service connection for Pseudofolliculitis Barbae (PFB). Entitlement to service connection for left knee disability. Entitlement to service connection for right knee disability. Entitlement to service connection for sleep apnea. Entitlement to service connection for irritable bowel syndrome (IBS). Entitlement to service connection for acid reflux disability. Entitlement to service connection for hemorrhoids. Entitlement to service connection for low back disability. Entitlement to service connection for left hip disability, to include as secondary to low back disability. Entitlement to service connection for right hip disability, to include as secondary to low back disability. Entitlement to service connection for pes planus. Entitlement to service connection for left foot disability, to include as secondary to pes planus. Entitlement to service connection for right foot disability, to include as secondary to pes planus. Entitlement to service connection for left ankle disability, to include as secondary to pes planus. Entitlement to service connection for right ankle disability, to include as secondary to pes planus. Entitlement to service connection for headaches, to include as secondary to service-connected disability. FINDING OF FACT Hearing loss for VA purposes has not been shown. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1999 to March 2003. The case is on appeal from rating decisions issued in January 2014, July 2014, April 2015, August 2016, February 2018, and February 2019. The Veteran offered testimony before the undersigned at a Board hearing in February 2021. Subsequent to the Board hearing the Veteran, through his attorney, submitted evidence indicating that a timely appeal had been submitted for the issues of entitlement to service connection for low back disability and sleep apnea. Thus, the issues on appeal are as listed above. Laws and regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for bilateral hearing loss. Hearing loss is a disability when the threshold level in any of the frequencies 500, 1000, 2000, 3000 and 4000 Hertz is 40 decibels or greater; or the thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores are less than 94 percent. 38 C.F.R. § 3.385. Although the Veteran underwent audiological testing during service, that testing did not result in hearing loss for VA purposes. The Board also finds that there is not a current left ear or right ear hearing loss disability. At no point do the medical records demonstrate hearing loss for VA purposes, to include the November 2017 and October 2020 VA examinations. 38 C.F.R. § 3.385. The existence of a current disability is the cornerstone of a claim for VA disability compensation. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As such, service connection for bilateral hearing loss is not warranted. REASONS FOR REMAND 2. Entitlement to service connection for PFB. 3. Entitlement to service connection for left knee disability. 4. Entitlement to service connection for right knee disability. 5. Entitlement to service connection for sleep apnea. Where VA provides the veteran with an examination, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Although the Veteran underwent VA examinations for these disabilities in February 2014, the examiner did not provide any opinions of etiology. As such, medical opinions must be obtained. 6. Entitlement to service connection for IBS. 7. Entitlement to service connection for acid reflux disability. 8. Entitlement to service connection for hemorrhoids. In November 2017 the Veteran underwent a VA intestinal conditions examination that was to address the medical matters raised by his service connection for gastrointestinal disability claims. The examiner appeared to indicate that it was unclear if the Veteran had a diagnosis of IBS, and seemed to suggest that further testing was necessary. Based on the foregoing, and in light of the Veteran's Board hearing testimony, his inservice diagnosis of infectious colitis, and current VA medications list (noting medication for acid reflux), the Board finds that a new VA gastrointestinal examination should be undertaken. 9. Entitlement to service connection for low back disability. 10. Entitlement to service connection for left hip disability. 11. Entitlement to service connection for right hip disability. In July 2014 a VA examiner provide a negative opinion concerning the etiology the Veteran's low back disability claim. In doing so, however, it appears that the opinion was not based on all the pertinent evidence of record. In this regard, there was no mention of post-service MRI studies (including in December 2013 that noted an "anular tear" at L4-L5) that showed lumbar spine disc disease, a disability not noted on the February 2014 VA back examination. Although a favorable opinion of etiology was submitted by the Veteran in March 2021 (from his private chiropractor), the opinion contained an essentially generic rationale and did not note the Veteran's multiple reserves records containing essentially negative low back findings subsequent to the Veteran's period of active service. Based on the foregoing, the Board finds that a medical opinion is necessary prior to adjudicating the low back claim. As for the left and right hip claims, the Veteran has indicated that these are related to his low back, and the Board will thereby defer adjudication of the hip claims at this time. 12. Entitlement to service connection for pes planus. 13. Entitlement to service connection for left foot disability. 14. Entitlement to service connection for right foot disability. 15. Entitlement to service connection for left ankle disability. 16. Entitlement to service connection for right ankle disability. The Board finds that the medical evidence of record is insufficient to decide the pes planus claim. Pes planus was noted upon the Veteran's entry to service. At his Board hearing, the Veteran stated that he had significant problems of the feet related to his service boots, and a May 2001 STR notes that the Veteran was seen for callouses of the feet related to his boots. Based on the foregoing, a VA examination is necessary to adequately address the Veteran's pes planus and bilateral foot and ankle disorder claims. 17. Entitlement to service connection for headaches. At his Board hearing the Veteran stated that he had experienced headaches about once a week during service, but also stated that his headaches were currently triggered by his service-connected vertigo and PTSD. The medical evidence of record is insufficient to address this claim, and an examination with medical opinion should be obtained. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment on and after March 1, 2021. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant non-VA medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. 3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination or examinations to determine the etiology of his PFB, sleep apnea, and headaches. The entire claims file must be made available to and be reviewed by the examiner. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran's PFB, sleep apnea, or headaches had its onset in, or is otherwise caused by, the Veteran's military service. The examiner is also asked to state whether it is at least as likely as not that the Veteran's headaches are proximately due to or aggravated by service-connected disability PTSD or vertigo. A rationale for any opinion reached must be provided. The examiner must consider the evidence of record, to include the Veteran's lay statements. 4. Provide the Veteran with an appropriate examination to determine the etiology of his claimed IBS, acid reflux, and hemorrhoids. The entire claims file must be made available to and be reviewed by the examiner. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran's IBS, acid reflux, or hemorrhoids had its onset in, or is otherwise caused by, the Veteran's military service, to include the January 2001 STRs noting treatment for infectious colitis. A rationale for any opinion reached must be provided. The examiner must consider the evidence of record, to include the Veteran's lay statements. 5. Provide the Veteran with an appropriate examination to address the medical matters related to the Veteran's pes planus (and related disability of the feet claims). The entire claims file must be made available to and be reviewed by the examiner. The examiner must answer the following questions: (a) Is it at least as likely as not that the Veteran's pes planus was worsened in severity beyond its natural progression during his period of active service? (b) If (a) is answered in the positive, is it at least as likely as not that the Veteran's pes planus caused or aggravated any disability of the Veteran's ankles or feet? (c) Regardless of the answer to question (a), is it at least as likely as not that any of the Veteran's disability of the knees, ankles, or feet (other than pes planus) had its onset in, or is otherwise caused by, the Veteran's military service. A rationale for any opinion reached must be provided. The examiner must consider the evidence of record, to include the Veteran's lay statements. 6. Provide the Veteran with an appropriate examination to determine the etiology of his claimed low back disability. The entire claims file must be made available to and be reviewed by the examiner. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran's low back disability had its onset in, or is otherwise caused by, the Veteran's military service, to include the September 2001 and November 2001 STRs noting treatment for low back complaints. In rendering the above opinions, the examiner must consider and specifically address the March 2021 opinion from the Veteran's private chiropractor. If it is determined that the Veteran's low back disability is related to service, the examiner is asked to state whether it is at least as likely as not any left hip or right hip disability were caused or aggravated by the low back disability. A rationale for any opinion reached must be provided. The examiner must consider the evidence of record, to include the Veteran's lay statements. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Nelson 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.