Citation Nr: 22017592 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 17-57 169 DATE: March 25, 2022 REMANDED The claim of entitlement to service connection for bilateral hearing loss is remanded. The claim of entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Air Force from February 1969 to January 1973. 1. The claim of entitlement to service connection for bilateral hearing loss is remanded. The Veteran's service treatment records are silent regarding complaints of or treatment for bilateral hearing loss. The Veteran's pre-induction physical examination reflected pure tone thresholds, in decibels, as follows: Nov. 1968 HERTZ 500 1000 2000 3000 4000 6000 RIGHT 10 5 -5 10 LEFT -5 -5 0 25 The Veteran's separation physical examination reflected pure tone thresholds, in decibels, as follows: Dec. 1972 HERTZ 500 1000 2000 3000 4000 6000 RIGHT 20 20 20 10 20 10 LEFT 25 20 25 20 20 20 The June 2016 VA examiner opined that the Veteran's bilateral hearing loss was less likely than not incurred in or caused by service. The rationale was that there was no significant threshold shift from enlistment to separation. The Board finds that the September 2016 VA medical opinion is inadequate for adjudication purposes. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The Board finds that the unfavorable opinion was based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (medical opinion based on inaccurate factual basis not probative). Specifically, the Board notes significant threshold shifts in both ears when comparing the November 1968 pre-induction audiogram and the December 1972 separation examination. Accordingly, a remand is required to obtain another medical opinion. The Board further notes that audiometric test results dated prior to January 1, 1967, are presumed to have been reported in units pursuant to standards set forth by the American Standards Association (ASA), unless otherwise indicated. Since November 1, 1967, those standards have been set by the International Standards Organization (ISO)-American National Standards Institute (ANSI). During the pendency of the Veteran's appeal, the policy was changed so that for audiograms conducted between January 1, 1967, and December 31, 1970, the Board will consider the data under both ASA and ISO-ANSI standards unless it is clearly indicated which units were used. When rendering the opinion, the examiner should consider the Veteran's pre-induction audiogram results under both ASA and ISO-ANSI standards. 2. The claim of entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. The Veteran asserts that his bilateral lower extremity peripheral neuropathy is related to various in-service exposures, including Agent Orange and jet fuel. In a May 2018 statement, he described an incident in which his feet were soaked in Agent Orange for 13 hours when a monsoon washed Agent Orange off the plane and onto his feet. He also reported exposure to jet fuels and solvents while working as an aircrewman. Exposure to Agent Orange is conceded based on the Veteran's service history. The claim was previously denied, however, because early onset peripheral neuropathy is presumed to be due to exposure to Agent Orange. There has been no evidence associated with the file to suggest that the Veteran suffers from what early-onset peripheral neuropathy as defined by VA. The Veteran has not been afforded a VA examination with respect to his claim for service connection for a bilateral lower extremity peripheral neuropathy. Generally, VA must provide a medical examination or obtain a medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2), 38 C.F.R. § 3.159 (c)(4)(i). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, disease or injury is a low threshold. McLendon, 20 Vet. App. at 83. Based on the above, the Board finds the low threshold necessary to provide an examination has been established in this case. The matters are REMANDED for the following action: 1. The AOJ should undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claim. If the AOJ deems the records do not exist or that any additional attempts to obtain these records would be futile, the record should be annotated to reflect such and the Veteran should be notified in accordance with 38 C.F.R. § § § 3.159 (e) 2. Then, the AOJ should obtain an addendum medical opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's bilateral hearing loss. All pertinent evidence of record must be made available to and reviewed by the examiner. Following a review of the relevant records and lay statements, the appropriate clinician is requested to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the disorder is etiologically related to the Veteran's active service. In so opining, the examiner must consider and discuss the upward threshold shifts documented during the Veteran's active service. The examiner should also consider the February 1969 enlistment audiogram results under both ASA and ISO-ANSI standards and use the results most favorable to the Veteran when rendering the opinion. The rationale for all opinions expressed must also be provided. If the examiner is unable to provide any required opinion, he or she should explain why. If an opinion cannot be provided without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, examiner should identify the additional information that is needed. 3. Thereafter, the AOJ should afford the Veteran a VA examination by a physician with sufficient expertise, to determine the nature and etiology of the Veteran's bilateral lower extremity peripheral neuropathy. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated tests and studies should be accomplished. The examiner should state an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's bilateral lower extremity peripheral neuropathy is etiologically related to the Veteran's active service, to include Agent Orange, jet fuel, and solvents. The rationale for all opinions expressed must also be provided. If the examiner is unable to provide any required opinion, he or she should explain why. If an opinion cannot be provided without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, examiner should identify the additional information that is needed. 4. Then, the AOJ should readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran's satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. N. McKinley, 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.