Citation Nr: 22017308 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 18-18 418 DATE: March 24, 2022 REMANDED Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1994 to August 2002 and from March 2003 to March 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2021, the Veteran testified at a hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. The undersigned agreed to keep the record open for 60 days to allow the Veteran additional time to submit evidence to support his claims. See October 2021 Hearing Transcript, pages 10-11. Additional evidence, to include private treatment records, was received in December 2021. See December 2021 Medical Treatment Record Non-Government Facility. 1. Entitlement to an initial rating in excess of 30 percent for PTSD is remanded. The Veteran last underwent a VA examination for PTSD in March 2016. The examiner diagnosed the Veteran with PTSD, which was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with routine behavior, self-care, and conversation. During the examination, the Veteran reported that he was in the process of obtaining medical retirement from his previous employer. In addition, he indicated that he lived alone but spent "a lot" of time with his girlfriend and was in frequent contact with his two children. The examiner noted the following symptoms: anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, difficulty in establishing and maintaining effective work and social relationships, occasional flashbacks, and occasional inability to experience positive emotions. The examiner noted that the Veteran was neatly dressed and groomed, cooperative, and in good contact. He was also found to be alert and fully oriented, with no significant clinical cognitive or memory deficits. The examiner found that the Veteran appeared moderately anxious and depressed throughout the examination and was tearful at times, and his affect was found to be constricted but appropriate to thought content. In addition, no evidence of formal thought disorders, delusions, hallucinations, overdetermined content, pressure of speech, or suicidal or homicidal ideation was found. See March 2016 C&P examination. In an April 2016 letter, K.S., a licensed master social worker at the Veteran's Center (Vet Center) in Concord, California, noted that the Veteran's symptoms included severe anxiety attacks, near constant anxiety causing social and occupational impairment, intrusive memories, avoidance of crowds, frequent headaches, and chronic sleep impairment. Serna further noted that the Veteran's PTSD caused social impairment; to this end, she explained that he had been married and divorced twice and had difficulty forming friendships. See April 2016 Medical Treatment Record Government Facility. During the October 2021 Board hearing, the Veteran testified that his service-connected PTSD had been progressively worsening since 2015. To this end, he endorsed constant anxiety, nightmares, chronic sleep impairment, and self-isolation. The Veteran further reported that his service-connected PTSD strained his relationships with his wife, children and co-workers. See October 2021 Hearing Transcript, pages 2-6. The Board notes that the abovementioned symptoms indicate that the severity of the Veteran's service-connected PTSD has worsened since the March 2016 VA examination and may cause occupational and social impairment that is manifested by more than an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Evidence of a change in the condition or allegation of worsening of the condition renders an examination inadequate for rating purposes. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Thus, because there are reports of worsening, which appear to be supported by the evidence of record, a remand is necessary to obtain a VA examination to determine the current severity of the Veteran's service-connected PTSD. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In addition, during the October 2021 Board hearing, the Veteran testified that he had been receiving counseling at the Vet Center in Concord, California since 2015. See October 2021 Hearing Transcript, pages 3-5. However, with the exception of letters dated in January 2016 and April 2016, no treatment records from the Vet Center have not been associated with the claims file. As such, the Board finds that a remand is also required to obtain these records. 2. Entitlement to service connection for bilateral hearing loss is remanded. During the October 2021 Board hearing, the Veteran testified that his bilateral hearing loss disability manifested after he was exposed to loud noise from aircraft and auxiliary power units during service. He also stated that he was exposed to loud gunfire, explosions, and explosive ordinance devices during his deployments. See October 2021 Hearing Transcript, pages 6-8. A review of the Veteran's service treatment records (STRs) shows a November 1993 enlistment report of medical examination that notes his ears and drums to be normal, and an audiogram obtained in connection with the examination revealed the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 5 0 5 5 0 Left 0 0 0 10 0 The Veteran indicated that he intended to seek VA disability benefits for decreased hearing on a May 1998 report of medical assessment, and a subsequent June 1998 report of hearing evaluation noted the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 10 10 10 10 10 Left 5 10 15 20 10 In addition, the Veteran underwent a reference audiogram in October 1999. The examiner noted that the Veteran's last noise exposure was 15 hours prior to the evaluation, and recorded the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 5 0 5 0 10 Left 0 -5 0 10 0 Thereafter, a master workplace exposure data summary, dated in November 2000, shows that personnel in the Veteran's squadron performed various types of industrial work to augment for training purposes. To this end, it further shows that personnel were exposed to hazardous materials, noise, radiofrequency (RF) radiation, ionizing radiation, and thermal stress. In addition, the summary shows that all members of the Veteran's squadron were exposed to noise from various noise producing equipment and were involved in the hearing conservation program. Thereafter, hearing conservation evaluations, dated in September 2000, September 2001, and June 2002, confirm that the Veteran was routinely exposed to noise during service. See December 2015 STR Medical. A review of the post-service treatment records shows that the Veteran underwent a VA examination for hearing loss and tinnitus in February 2016. The examiner noted the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 25 25 35 30 45 Left 25 40 45 45 55 Speech recognition scores were 100 percent for the right ear and 96 percent for the left ear. Following the examination, the examiner diagnosed the Veteran with bilateral sensorineural hearing loss in the frequency range of 500 Hz to 4,000 Hz. After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's bilateral hearing loss was caused by or a result of an event in service. In support of her opinion, the examiner noted that all of the Veteran's hearing examinations were within normal limits through July 2004. To this end, the examiner acknowledged that the Veteran served in the Air Force Reserve until 2013 but was not deployed during that time. She also found that his Air Force Specialty Code (AFSC) had a low probability for noise exposure. See February 2016 C&P examination. After a review of the evidence of record, the Board finds that a remand is required to obtain an addendum medical opinion. To this end, the Board finds that the February 2016 VA examiner based her opinion, at least in part, on the finding that the Veteran's AFSC had a low probability for noise exposure. However, the Board notes that a November 2000 master workplace exposure data summary shows that personnel in the Veteran's squadron performed various types of industrial work to augment for training purposes and were exposed to hazardous noise, and hearing conservation data evaluations dated in September 2000, September 2001, and June 2002 confirm that the Veteran was routinely exposed to hazardous noise. See December 2015 STR Medical. Thus, the Board finds that the February 2016 medical opinion is based, at least in part, on an incomplete factual premise, and as such, is inadequate to adjudicate the issue on appeal. See Reonal v. Brown, 5 Vet. 458, 461 (1993) (medical opinions based on an incomplete or inaccurate factual premise are not probative). Lastly, during the October 2021 Board hearing, the Veteran testified that he received medical treatment through Kaiser Permanente. See October 2021 Hearing Transcript, pages 4, 8-10. However, treatment records from Kaiser Permanente have not been associated with the claims file. As such, the Board finds that a remand is also required to obtain these records. The matters are REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran's VA treatment facilities, and all private treatment records from the Veteran not already associated with the file, to include all medical records from the Veteran Center in Concord, California dated from 2015 to the present and any private treatment records from Kaiser Permanente. 2. After completion of the above development, schedule the Veteran for a VA examination to determine the current nature and severity of his service-connected PTSD. The examiner should review pertinent documents in the Veteran's claims file in connection with the examination. The examiner should identify the nature and severity of all current manifestations of the Veteran's service-connected PTSD, as well as the impact that such has on his social and occupational functioning. 3. After completion of the development in #1, obtain an addendum opinion by an appropriate examiner to determine the nature and etiology of the Veteran's diagnosed bilateral hearing loss. The examiner should provide the following opinion: Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed bilateral hearing loss is etiologically related to his periods of service, to include as due to exposure to loud noise from aircraft, auxiliary power units, gunfire, explosions, and explosive ordinance devices? Please explain why or why not. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, 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.