Citation Nr: 21042590 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-41 573 DATE: July 13, 2021 REMANDED Entitlement to service connection for erectile dysfunction and urethra condition is remanded. Entitlement to service connection for a right hip condition is remanded. Entitlement to service connection for right lower extremity sciatica is remanded. Entitlement to an initial compensable rating for right ear hearing loss is remanded. Entitlement to an initial compensable rating for left knee osteoarthritis with meniscal tear status post-surgery with limitation of extension is remanded. Entitlement to an initial compensable rating for left hip strain with limitation of extension is remanded. Entitlement to an initial compensable rating for left hip strain with limitation of adduction, abduction, and rotation is remanded. Entitlement to an initial compensable rating for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1987 to May 2015. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2015 and a November 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, a hearing was held before the undersigned. A transcript of the hearing is of record. Entitlement to service connection for erectile dysfunction and urethra condition, right hip condition, and right lower extremity sciatica The Veteran's claims for service connection for erectile dysfunction and urethra condition, right hip condition, and right lower extremity sciatica were denied by the RO in the September and November 2015 rating decisions on the basis that the medical evidence failed to show that erectile dysfunction and a urethra condition, a right hip condition, and right lower extremity sciatica were clinically diagnosed. The claims file, however, contains VA treatment records from March 2017 which include a diagnosis of lumbago with sciatica and records from May 2017 indicating that the Veteran has been diagnosed with erectile dysfunction. The May 2017 VA treatment records also indicate that the Veteran underwent an MRI in 2016 and was assessed with mild posterior chondro labral separation tear and partial thickness chondrosis involving the superior/central aspect of the acetabulum. He was also assessed with right hip pain. The Board notes that pain is a disability when pain reaches the level of functional impairment that affects earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Given the above, and that service treatment records note that the Veteran had urethritis, right hip pain, and sciatica, as well as the Veteran's statements that these conditions are related to his active service; the Board finds that VA examinations and opinions regarding the etiology of the Veteran's conditions is warranted. Also, regarding the right hip and sciatica, the Veteran indicated at his February 2021 hearing that his conditions were also secondary to his service-connected back disability. As such, an opinion on secondary service connection should also be obtained. Entitlement to an increased rating for right ear hearing loss At his February 2021 hearing, the Veteran stated that he was told by doctors that his hearing was getting worse and that he was a candidate for a hearing aid. He also indicated that he underwent audiological testing around three years ago and went for a followup sometime in 2019. The Veteran last underwent a VA examination in February 2015, where he indicated difficulty understanding speech when spoken to in the presence of background noise. Given that the Veteran has also stated that he had been starting to talk loud to his wife without realizing he was doing so, the Board finds that there is evidence that the Veteran's disability may have worsened, and a new VA examination is needed. Also, the record reflects that there are VA treatment records associated with the claims file, but they are only up to May 2017. Given that the Veteran has stated that he underwent audiological testing around 2018 and 2019, remand is needed to obtain updated VA treatment records, including results of audiological testing. Entitlement to increased ratings for left knee osteoarthritis with meniscal tear, left hip strain with limitation of extension, and left hip strain with limitation of adduction, abduction, and rotation The record reflects that the Veteran last underwent VA examinations for his left knee and left hip disabilities in February 2015. At his February 2021 hearing, the Veteran indicated that his disabilities have worsened since 2015. Consequently, a new VA examination to determine the current severity of his left knee osteoarthritis with meniscal tear, left hip strain with limitation of extension, and left hip strain with limitation of adduction, abduction, and rotation is warranted. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Entitlement to an increased rating for hypertension At his February 2021 hearing, the Veteran stated that he was receiving treatment for hypertension through Tricare. The Veteran did submit some private treatment records in April 2021, which consisted of a list of some blood pressure readings and reports from December 2018 and March 2019. However, it appears that it is not the complete treatment records. Remand to obtain the complete treatment records is needed. The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for the complete Tricare treatment records and all other private treatment records concerning his treatment for his service-connected disabilities, including hypertension. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. Obtain all VA audiometric and speech discrimination test results from the VISTA system, for the period from May 207 to the present. Obtain any audiometry results from audiological testing during this time period. Results from this testing should be obtained and associated with the claims file. **If it is unclear from such results whether speech discrimination testing was done using the Maryland CNC word list, please seek clarification regarding what type of speech discrimination testing was used. 3. Obtain the Veteran's VA treatment records for the period from May 2017 to the present. 4. After completing the above development, schedule the Veteran for an in-person VA examination with an appropriate examiner to determine the nature and etiology of his erectile dysfunction and/or urethra condition. The electronic claims file must be made available to the examiner, and the examiner must specify in the opinion that the file has been reviewed. Following a review of the medical and lay evidence of record, the examiner is requested to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's erectile dysfunction and/or urethra condition had its onset in service or is related to any in-service disease, event, or injury. The Veteran must discuss the service treatment records, which note that the Veteran had urethritis, and his statements during his February 2021 hearing that he suffered a fractured urethra while stationed at Fort Bragg in 1998. A complete rationale for all opinions must be provided. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 5. Also schedule the Veteran for an in-person VA examination with an appropriate examiner to determine the nature and etiology of his right hip condition and right lower extremity sciatica. The electronic claims file must be made available to the examiner, and the examiner must specify in the opinion that the file has been reviewed. Following a review of the medical and lay evidence of record, the examiner is requested to provide opinions as to: a) Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's right hip condition and right lower extremity sciatica had its onset in service or is related to any in-service disease, event, or injury. The Veteran must discuss the service treatment records, which note that the Veteran had right hip pain and sciatica in service, and his statements during his February 2021 hearing that he suffered right hip problems in 2012 while stationed at Fort Irwin. b) Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's right hip condition and right lower extremity sciatica was caused by his service-connected thoracolumbar degenerative joint disease with intervertebral disc syndrome. c) Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's right hip condition and right lower extremity sciatica was aggravated (i.e., any worsening of the condition beyond its natural progression) by his service-connected thoracolumbar degenerative joint disease with intervertebral disc syndrome. The clinician is reminded that an adequate medical opinion regarding secondary service connection must address causation and aggravation separately. El-Amin v. Shinseki, 26 Vet. App. 136 (2013); 38 C.F.R. § 3.310(b). A complete rationale for all opinions must be provided. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right ear hearing loss. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. Audiometric testing and speech discrimination testing (using the Maryland CNC word list) should be completed. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee osteoarthritis with meniscal tear, left hip strain with limitation of extension, and left hip strain with limitation of adduction, abduction, and rotation. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bonnie Yoon, 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.