Citation Nr: 22012803 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 17-29 719 DATE: March 7, 2022 REMANDED Entitlement to a compensable rating for left ear hearing loss is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for atopic dermatitis is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is remanded. Entitlement to service connection for posttraumatic stress disorder, also claimed as anxiety, is remanded. Entitlement to service connection for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1968 to February 1971, to include service in Vietnam. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in March 2014 by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared for a hearing before the undersigned Veterans Law Judge in April 2021. A transcript of the hearing is of record. 1. Entitlement to a compensable rating for left ear hearing loss is remanded. The Veteran asserts he is entitled to a compensable rating for his left ear hearing loss. The most recent VA examination of record for the Veteran's left ear hearing loss occurred in March 2014. Due to the length of time that has passed since the Veteran's last VA examination, a new examination is warranted to obtain the current level of severity of the Veteran's disability. 2. 3. & 4. Entitlement to service connection for hypertension, atopic dermatitis, and peripheral neuropathy is remanded. The Veteran asserts he is entitled to service connection for hypertension, atopic dermatitis, and peripheral neuropathy due to herbicide exposure. Evidence of record documents the Veteran's service in Vietnam and his exposure to herbicides, as well as a diagnosis of the aforementioned disabilities. However, the Board cannot make a fully informed decision on the issue of entitlement to service connection for hypertension, atopic dermatitis, or peripheral neuropathy because no VA examiner has opined as to whether the Veteran's disabilities are related to his military service, to include exposure to herbicides. Thus, a remand is warranted. 5. Entitlement to service connection for posttraumatic stress disorder, also claimed as anxiety is remanded. The Veteran asserts he is entitled to service connection for PTSD. The Veteran testified during his April 2021 Board hearing that he has had sleep disturbances since the 1970's due to in-service stressors. During the Veteran's March 2014 VA examination, the examiner stated that the Veteran had an in-service stressor event sufficient enough for a DSM-V diagnosis of PTSD. However, the examiner stated that the Veteran's current symptoms, except for his dreams, do not relate directly to his military service. The Board finds the March 2014 VA examination to be insufficient for rating purposes. First, the examiner did not provide medical reasons and bases for the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Second, the examiner focused primarily on post-service stressors instead of providing an opinion the longterm effects the Veteran's military service has had on him (to include his nightmares). As such, the March 2014 VA medical opinion is insufficient and a remand is warranted to obtain a new VA medical examination and opinion. 6. Entitlement to service connection for right ear hearing loss is remanded. The Veteran asserts he is entitled to service connection for right ear hearing loss. During his April 2021 Board hearing, the Veteran testified that he did not wear hearing protection during service. The Veteran underwent an audiological examination in March 2014 to determine the nature and etiology of his right ear hearing loss. The examiner noted that the Veteran had a permanent positive threshold shift for his right ear during service, however, opined that the Veteran's current hearing loss was not related to his military service. The examiner then noted the Veteran's occupational and recreational noise exposure post-service (stating that the Veteran had hearing protection when necessary), and referenced his in-service audiograms. The Board finds the March 2014 VA medical opinion to be inadequate. In this regard, the while the examiner noted a permanent positive threshold shift during service, the examiner did not provide medical reasons and bases as to why the permanent positive threshold shift was not related to his current right ear hearing loss. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Thus, a new VA examination and opinion is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left ear hearing loss, and to determine whether the Veteran's right ear hearing loss is related to his active service. For the right ear hearing loss issue, the examiner is to state whether it is at least as likely as not that the Veteran's hearing loss is related to his active service. In answering this question, the examiner must address the positive threshold shift during the Veteran's active service (as identified by the previous VA examiner), as well as his contentions regarding his noise exposure in service. For the increased rating claim for the Veteran's left ear, the examiner is to provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 2. Schedule the Veteran for a VA examination for hypertension. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the Veteran's hypertension at least as likely as not related to in-service exposure to herbicide agents? Does the Veteran suffer from any other cardiac disability other than hypertension? In answering these questions, the examiner must address the recent Agent Orange Update regarding the relationship between hypertension and herbicide agent exposure. The examiner is advised that a negative opinion cannot be based solely on the fact that hypertension is not on the list of diseases that are presumptively associated with exposure to herbicide agents. 3. Schedule the Veteran for a VA examination for his atopic dermatitis. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the Veteran's atopic dermatitis at least as likely as not related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that atopic dermatitis is not on the list of diseases that are presumptively associated with exposure to herbicide agents. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. 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? 4. Schedule the Veteran for a VA examination for peripheral neuropathy. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the Veteran's peripheral neuropathy at least as likely as not related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that peripheral neuropathy is not on the list of diseases that are presumptively associated with exposure to herbicide agents. 5. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any posttraumatic stress disorder (PTSD) or any other identified psychiatric disorder. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor, to include fear of hostile military or terrorist activity. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease. A complete rationale must be provided for all requested opinions. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. K. Hall, 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.