Citation Nr: 22004404 Decision Date: 01/27/22 Archive Date: 01/27/22 DOCKET NO. 19-05 766A DATE: January 27, 2022 ORDER The previously denied claim of entitlement to service connection for an acquired psychiatric disorder is reconsidered The previously denied claim of entitlement to service connection for sarcoidosis is reopened. The previously denied claim of entitlement to service connection for bilateral hearing loss is reopened. REMANDED Entitlement to service connection for a bilateral wrist disorder is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. Entitlement to service connection for pulmonary embolism is remanded. Entitlement to service connection for a psychiatric disorder is remanded. Entitlement to service connection for sarcoidosis is remanded. Entitlement to service connection for bilateral hearing loss, to include an ear disorder with symptoms of hearing loss, impacted cerumen, and recurrent ear infections, is remanded. Entitlement to service connection for eczema is remanded. FINDINGS OF FACT 1. A January 2010 rating decision denied entitlement to service connection for an acquired psychiatric disorder, hearing loss, and sarcoidosis. The Veteran did not appeal that decision and no new or material evidence was received within one year. 2. After the January 2010 decision, new service department records were added to the claims file that were relevant to the previously denied claim of entitlement to service connection for an acquired psychiatric disorder. 3. After the January 2010 decision, new evidence was received that relates to unestablished facts necessary to substantiate the claims of entitlement to service connection for sarcoidosis and hearing loss. CONCLUSIONS OF LAW 1. The January 2010 rating decision is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.156(b), 20.302, 20.1103. 2. The criteria for reconsideration of the previously denied claim of entitlement to service connection for an acquired psychiatric disorder are met. 38 U.S.C. §§ 5107, 5108 (2012); 38 C.F.R. § 3.156. 3. The criteria for reopening the previously denied claim of entitlement to service connection for hearing loss are met. 38 U.S.C. §§ 5107, 5108 (2012); 38 C.F.R. § 3.156. 4. The criteria for reopening the previously denied claim of entitlement to service connection for sarcoidosis are met. 38 U.S.C. §§ 5107, 5108 (2012); 38 C.F.R. § 3.156 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from February 1984 to June 1987. This matter comes to the Board of Veterans' Appeals (Board) on appeal from March 2018 and July 2018 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge and a transcript of the proceeding is of record. Some of the Veteran's claims on appeal have been recharacterized to fully contemplate the symptoms described by the Veteran. When a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Thus, the Board has broadly construed the Veteran's claims as reflected on the title page of this document. Additional and relevant VA treatment records were added to claims file after the most recent statement of the case. Generally, the Veteran is entitled to have newly received evidence reviewed by the Agency of Original Jurisdiction (AOJ) in the first instance. The issues on appeal are either granted or remanded and there is no prejudice to Veteran from the Board's initial consideration of the evidence. The AOJ will have opportunity to review the new VA records on remand. New and Material Evidence - Service Connection In general, decisions of the RO and the Board that are not appealed in the prescribed time period are final. 38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. §§ 3.104, 20.1100, 20.1103. A finally disallowed claim, however, may be reopened when new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108 (2012). Regardless of the action taken by the RO, the Board must determine whether new and material evidence has been received subsequent to an unappealed RO denial. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). As part of this review, the Board considers evidence of record at the time of the previous final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim, and evidence submitted since a prior final disallowance. Evans v. Brown, 9 Vet. App. 273, 285-86 (1996). New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156. For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, to include by triggering the Secretary's duty to assist or consideration of a new theory of entitlement. Shade, 24 Vet. App. at 117-18. Additionally, new and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). Furthermore, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed but were not associated with the claims file when VA first decided the claim, VA will reconsider the claim, rather than requiring new and material evidence. 38 C.F.R. § 3.156(c)(1). A claim is not reconsidered, however, where VA could not have obtained the records when it initially decided the claim because the records did not exist at that time, or because the claimant failed to provide sufficient information to identify and obtain the records from the respective service department, the Joint Services Records Research Center, or any other official source. 38 C.F.R. § 3.156(c)(2). To establish service connection, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called nexus requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 1. The previously denied claim of entitlement to service connection for an acquired psychiatric disorder is reconsidered. A January 2010 rating decision denied entitlement to a psychiatric disorder, claimed as depression and a nervous condition, on the grounds that the evidence did not show a psychiatric condition in service, or that the Veteran's current complaints of insomnia with anxiety and stress were otherwise related to his military service. The Veteran did not appeal that decision and no new or material evidence was received within one year. At the time of that decision, the Veteran's service personnel records had not been associated with the claims file although VA was on notice of their existence. Those documents included the Veteran's record of assignments that is relevant to his claim for a psychiatric disorder in light of his testimony regarding in-service stressful and traumatic events. A June 2014 rating decision found that no new and material evidence had been submitted to reopen the previously denied claim of entitlement to service connection for a psychiatric disorder. That decision never became final, however, because the Veteran was not properly notified of his appellate rights. VA sent the notification letter in November 2015, but it was returned as undeliverable. VA failed to make any follow up attempt to verify the Veteran's address. Thus, the June 2014 decision never became final. A November 2017 rating decision also found that no new and material evidence had been submitted to reopen the previously denied claim of entitlement to service connection for a psychiatric disorder. The Veteran did not appeal that decision, but he did submit a statement in December 2017 describing traumatic events in service that constituted new and material evidence. Thus, the November 2017 rating decision also did not become final. As a result, the January 2010 rating decision is the prior final denial. Because new and relevant service department records were received in August 2013, the claim of entitlement to service connection for a psychiatric disorder is reconsidered. 2. The previously denied claim of entitlement to service connection for sarcoidosis is reopened. In a January 2010 rating decision, the RO denied service connection for sarcoidosis because the evidence did not show that sarcoidosis had onset during the Veteran's period of active duty. The Veteran did not appeal that decision nor submit new and material evidence within one year. The rating decision is thus final based on the evidence then of record. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Although the Veteran's record of duty assignments was added to the claims file after the January 2010 decision, that record was not relevant to the Veteran's claim for sarcoidosis because it did not tend to prove or disprove a fact necessary to establish the claim. The June 2014 rating decision determined that new and material evidence had not been submitted sufficient to reopen the previously denied claim of entitlement to sarcoidosis. As discussed, the June 2014 decision never became final because the Veteran was not properly notified. Thus, January 2010 is the last final denial of the claim. The evidence of record at the time of the January 2010 decision included the Veteran's claim and lay testimony, private treatment records, and the Veteran's service treatment records (STRs). The STRs do not show a diagnosis of sarcoidosis in service and the private treatment records show that sarcoidosis was first noted in 1996. Thus, the evidence did not show that sarcoidosis had onset in service. The evidence submitted after the January 2010 decision includes additional private treatment records, VA treatment records, and additional lay testimony. At the July 2021 hearing, the Veteran testified that he first noticed symptoms of shortness of breath on exertion in service, that those symptoms were chronic and worsened over time, and that sarcoidosis was related to in-service exposure to certain chemicals and fumes in service. The Board finds that new and material evidence has been presented. The hearing testimony is new because it was not previously submitted to VA. The evidence is material because it relates to unestablished facts necessary to establish the claim - evidence of in-service respiratory symptoms and an indication that sarcoidosis may be related to exposure to chemicals and fumes in service. See 38 C.F.R. § 3.303(a); Shedden, 381 F.3d at 1167. Additionally, the evidence is neither cumulative nor redundant as that evidence was not of record at the time of the prior denial. See 38 C.F.R. § 3.156(a). The evidence is presumed credible for purposes of deciding whether a previously denied claim may be reopened. Justus, 3 Vet. App. at 513. When considering the new evidence in conjunction with the evidence already of record, it raises a reasonable possibility of substantiating the claim. Shade, 24 Vet. App. at 117. Accordingly, the claim is reopened. 3. The previously denied claim of entitlement to service connection for hearing loss is reopened. In a January 2010 rating decision, the RO denied service connection for hearing loss because the evidence did not show a current hearing loss disability. The Veteran did not appeal that decision nor submit new and material evidence within one year. The rating decision is thus final based on the evidence then of record. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Although the Veteran's record of duty assignments was added to the claims file after the January 2010 decision, that record was not relevant to the Veteran's claim for hearing loss because it did not tend to prove or disprove a fact necessary to establish the claim. The June 2014 rating decision determined that new and material evidence had not been submitted sufficient to reopen the previously denied claim of entitlement to hearing loss. The June 2014 decision never became final because the Veteran was not properly notified. Thus, January 2010 is the last final denial of the claim. The evidence of record at the time of the January 2010 decision included the Veteran's claim and lay testimony, private treatment records, and the Veteran's service treatment records (STRs). Those records did not show a current hearing loss disability for VA purposes despite the Veteran's complaints of hearing loss in service. Since then, the Veteran testified at the July 2021 hearing that his hearing had worsened over time. The Board finds that new and material evidence has been presented. The hearing testimony is new because it was not previously submitted to VA. The evidence is material because it relates to unestablished facts necessary to establish the claim - evidence that the Veteran's hearing impairment may have progressed to a disability for VA purposes. See 38 C.F.R. § 3.303(a), 3.385; Shedden, 381 F.3d at 1167. Additionally, the evidence is neither cumulative nor redundant as that evidence was not of record at the time of the prior denial. See 38 C.F.R. § 3.156(a). The evidence is also presumed credible. Justus, 3 Vet. App. at 513. When considering the new evidence in conjunction with the evidence already of record, combined with VA assistance including an examination, it raises a reasonable possibility of substantiating the claim. Shade, 24 Vet. App. at 117. Accordingly, the claim is reopened. REASONS FOR REMAND 1. Entitlement to service connection for a bilateral wrist disorder is remanded. This issue is remanded to obtain a VA examination and opinion. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159. VA's duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). The evidence shows forearm symptoms in service, a current diagnosis, and an indication of chronic wrist symptoms since and in-service onset. The STRs document that in March 1984 the Veteran had left forearm pain and weakness with prolonged use. Examination showed a tender ulnar contusion. July 2019 VA treatment records show the Veteran reported a history of carpal tunnel syndrome and was given wrist splints. At the July 2021 hearing, the Veteran reported he had chronic bilateral wrist pain that progressively worsened since service. He attributed the pain to overuse during physical training and his regular duties. Thus, remand for an examination is required. The VA treatment records discussing carpal tunnel syndrome are sparse, and the Veteran appears to receive regular medical care outside of VA. On remand, VA should undertake reasonable efforts to obtain any outstanding treatment records pertaining to the Veteran's claimed bilateral wrist disorder. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159(c). 2. Entitlement to service connection for a gastrointestinal disorder is remanded. This issue is also remanded to obtain a VA examination and opinion. McLendon, 20 Vet. App. at 83-86. The STRs show the Veteran was treated for gastroenteritis in April 1985 and April 1987, and he may have reported stomach problems on the separation report of medical history because both boxes are marked. Private records document symptoms of reflux disorder as early as the 1990s. VA and private treatment records also show a current diagnosis of gastroesophageal reflux disorder. Thus, remand for an examination is necessary. The Veteran also testified that his reflux disorder was caused by steroid medication used to treat sarcoidosis. Thus, the claim of entitlement to service connection for a gastrointestinal disorder is also inextricably intertwined with the pending claim of entitlement to service connection for sarcoidosis. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). 3. Entitlement to service connection for pulmonary embolism is remanded. Entitlement to service-connection for a pulmonary embolism is inextricably intertwined with the issue of entitlement to service connection for sarcoidosis. The lay and medical evidence shows that the Veteran had a pulmonary embolism in 2015 and is required to take anticoagulation medication to prevent future episodes. At the July 2021 hearing, the Veteran essentially testified that the pulmonary embolism was a progression of the sarcoidosis. Thus, the issue is inextricably intertwined with a pending claim on appeal and remand is required. Harris, 1 Vet. App. 180. 4. Entitlement to service connection for a psychiatric disorder is remanded. This issue is remanded to obtain an adequate examination and opinion that takes into consideration the lay testimony of record. When a Veteran has provided competent lay statements of an in-service injury or symptoms, the examiner must consider and address them when developing his rationale. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that when the Veteran has provided lay testimony of an in-service injury, an examiner cannot ignore that lay evidence and base his or her opinion that there is no relationship to service on the absence of in-service corroborating medical records). The Veteran underwent a VA examination in June 2018. The examiner documented the Veteran's testimony that he was near an explosion caused by a militia group during his time in Germany, that he was physically assaulted by his supervisor on 2 occasions, and that he was falsely accused of theft by a superior and believed there was a racial component to the charge. That examiner found the Veteran's symptoms did not meet the diagnostic criteria for posttraumatic stress disorder (PTSD) under the DSM-5 criteria. The examiner did state that the gas station incident could constitute a stressor related to the Veteran's fear of hostile military or terrorist activity if the militia group described by the Veteran was a terrorist group. Nevertheless, the Veteran did not meet other diagnostic criteria for a diagnosis of PTSD. The examiner instead found the Veteran's symptoms met the criteria for unspecified depressive disorder and that the Veteran had no other mental disorder. The examiner opined that the unspecified depressive condition was not related to military trauma or military service. In support of that opinion, the examiner stated the STRs and post-military history was absent for routine treatment for depression that would help establish a temporal relationship to service. In providing that opinion, the examiner failed to address relevant lay testimony and medical evidence. Although the Veteran did not begin to receive regular treatment for mental health symptoms until June 2009, the June 2009 VA treatment notes document chronic symptoms of PTSD and long-term issues with "wracking and tormenting" memories. October 2017 VA treatment notes document the Veteran experienced racism and unfair treatment in service, that he began to have issues with worrying and trusting others in service, and that those symptoms were chronic since service. Although the Veteran did not seek treatment for a mental health condition until many years after separation, he reported his symptoms negatively affected his relationships with his former wife and children. That provider diagnosed unspecified depressive disorder and unspecified anxiety disorder. In short, the 2018 VA examiner failed to adequately comment on the lay and medical evidence indicating chronic mental health symptoms since service. Also, new records have been received that require additional comment. At the July 2021 hearing, the Veteran explained there was a stigma against reporting mental health symptoms in service, and that he was hesitant to report the symptoms after separation because he did not want to go a mental institution. Also, since the June 2018 examination, a March 2019 VA mental health provider has diagnosed PTSD due to traumatic experiences in the military. At that appointment the Veteran had described traumatic experiences associated with racism and racial bullying. On remand, a VA examiner should consider the lay testimony regarding hesitancy reporting symptoms and the March 2019 VA treatment note when providing their updated opinion. The Veteran's service personnel records also seem incomplete. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim, which includes making as many requests as are necessary to obtain relevant records from a Federal department or agency. 38 C.F.R. § 3.159(c)(2). The Veteran has described disciplinary actions in service that he attributes to racial targeting, but those records are not included in the available military personnel records. On remand, VA must ensure that all service department records are associated with the claims file. Last, the Veteran reported stressors on a December 2017 statement in support of claim for PTSD and it does not appear that VA attempted to verify those stressors. On remand VA should undertake appropriate development regarding the Veteran's reported PTSD stressors. 5. Entitlement to service connection for sarcoidosis is remanded. This issue is remanded to obtain a VA examination and opinion. McLendon, 20 Vet. App. at 83-86. The STRs show that in December 1986 the Veteran was treated for left sided pain that radiated through the chest that was exacerbated by deep breathing. The assessment was probable pleurisy. Private records show that sarcoidosis was first diagnosed in May 1996, however by the time it was diagnosed the Veteran already had extensive air space disease. At the July 2021 hearing, the Veteran described symptoms of worsening shortness of breath during physical training as his time in service progressed. He also testified that those symptoms were chronic since the in-service onset. Thus, the evidence indicates symptoms of sarcoidosis may have first manifested in service or within a relevant presumptive period and remand for an examination and opinion are required. 6. Entitlement to service connection for hearing loss, to include an ear disorder with symptoms of hearing loss, impacted cerumen, and recurrent ear infections, is remanded. This issue is remanded to obtain a VA examination and opinion to assess whether the Veteran has a current hearing loss disability for VA purposes that is etiologically related to his period of service. The Veteran was most recently examined in March 2018, and that examiner found that the results were not valid for rating purposes due to inconsistent speech to puretone crosscheck. The Veteran was also unable to perform acoustic reflex testing at that time due to ear pain. The Veteran indicated worsening symptoms at the July 2021 hearing, and additional examination is warranted to attempt to assess the severity of the Veteran's hearing loss. On remand, the examiner is also requested to clarify whether an ear disorder characterized by recurrent ear infections, cerumen build up, and intermittent hearing loss is etiologically related to service. The STRs show the Veteran was treated for symptoms of ear pain, ear canal bleeding, and hearing loss on multiple occasions. He was regularly found to have impacted cerumen that required removal. On the March 1987 report of medical history, the Veteran endorsed symptoms of hearing loss and ear trouble. At the July 2021 hearing, the Veteran testified that he first began to have ear symptoms with associated hearing loss in service, and that he had ongoing symptoms of hearing loss and chronic ear infections. He also competently and credibly described exposure to hazardous noise in service. The Veteran's hearing testimony indicates the ear symptoms first noted in service have been chronic since separation and remand for a medical opinion is necessary. 7. Entitlement to service connection for eczema is remanded. The Board notes that the issue on appeal is properly characterized as entitlement to service connection for eczema because the June 2014 rating decision did not become final. The Veteran filed a timely notice of disagreement to the March 2018 rating decision's finding that no new or material evidence had been received sufficient to reopen the previously denied claim of entitlement to service connection for eczema. A remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. Ensure that the complete service personnel records, to include all records of disciplinary actions, are associated with the claims file. 2. Undertake appropriate development to verify the stressors reported by the Veteran on his December 2017 statement in support of claim for PTSD. 3. Ask the Veteran to complete a VA Form 21-4142 for any private treatment providers he has seen for a bilateral wrist condition. Make two requests for any authorized records unless it is clear after the first request that a second request would be futile. 4. Schedule the Veteran for a VA examination for the claimed bilateral wrist disorder. The examiner must review the claims file. The examiner is asked to provide a response to the following: (a.) 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 opinion(s) below. (b.) Does the Veteran have a bilateral wrist disorder that is etiologically related to his period of service? (c.) A rationale for all opinions expressed must be provided. The examiner's attention is directed to the STRs showing a complaint of left forearm pain and ulnar swelling in March 1984, and the July 2019 VA treatment notes indicating a current diagnosis of carpal tunnel syndrome. In providing the requested opinion, consider the Veteran's description of bilateral wrist symptoms in service and his testimony of progressively worsening wrist pain since an in-service onset. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 5. Schedule the Veteran for a VA examination for the claimed gastrointestinal disorder. The examiner must review the claims file. The examiner is asked to provide a response to the following: (a.) Does the Veteran have a gastrointestinal disorder that is etiologically related to his period of service? (b.) A rationale for all opinions expressed must be provided. The examiner's attention is directed to the STRs showing treatment for gastroenteritis on 2 occasions in service, and the private and VA treatment records showing a history of gastroesophageal reflux disorder since the 1990s. 6. After the Veteran's reported stressors have been developed and additional records have been associated with the claims file, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any posttraumatic stress disorder (PTSD) or other diagnosed acquired psychiatric disorder. (a.) If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is related to a verified in-service stressor. (b.) If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is related to an in-service event or had onset in service. (c.) For the purposes of this opinion, the examiner is instructed to find the Veteran credible with regard to his reports of racial harassment in service. The examiner must address the lay testimony of chronic symptoms since service, and the testimony that the Veteran did not seek treatment for a mental health condition in service or shortly after separation due to the stigma associated with mental illness. The examiner's attention is also directed to the June 2009, October 2017, and March 2019 VA treatment notes. 7. Schedule the Veteran for a VA examination for his claimed sarcoidosis. The examiner must review the claims file. The examiner is asked to provide a response to the following: (a.) Is sarcoidosis etiologically related to the Veteran's period of service, to include exposure to chemicals used to kill rabbits and exhaust fumes? (b.) Did sarcoidosis (1) begin during active service, (2) manifest within one year after discharge from service, or (3) was sarcoidosis noted during service with continuity of the same symptomatology since service? (c.) Provide a rationale to support the opinion(s). (d.) In providing the requested opinion, consider the Veteran's description of in-service symptoms of progressively worsening shortness of breath and chronic symptoms after separation. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 8. Schedule the Veteran for a VA examination for his claimed bilateral hearing loss or other ear disorder. The examiner must review the claims file and if necessary, all relevant disability benefit questionnaires must be utilized. The examiner is asked to provide a response to the following: (a.) Clarify whether the Veteran has an ear disorder characterized by hearing loss, impacted cerumen, and recurrent ear infections. (b.) Is a hearing loss disability or ear disorder characterized by hearing loss, impacted cerumen, and recurrent ear infections etiologically related to the Veteran's period of service? (c.) Did sensorineural hearing loss (1) begin during active service, (2) manifest within one year after discharge from service, or (3) was sensorineural hearing loss noted during service with continuity of the same symptomatology since service? (d.) Provide a rationale to support the opinion(s). (e.) In providing the requested opinion, consider the STRs showing the Veteran was treated for symptoms of ear pain, ear canal bleeding, and hearing loss on multiple occasions. Also consider the lay testimony that ear symptoms with associated hearing loss first began in service and existed chronically since that time. The examiner is also instructed to find that the Veteran was exposed to hazardous noise in service. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 9. Issue a statement of the case regarding the issue of entitlement to service connection for eczema. If the Veteran perfects an appeal as to that issue, return the appeal to the Board for further action. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Smith, 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.