Citation Nr: 22019166 Decision Date: 03/31/22 Archive Date: 03/31/22 DOCKET NO. 20-29 937 DATE: March 31, 2022 ORDER Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for lower back pain is remanded. Entitlement to service connection for a right forearm condition, to include right musculocutaneous neuropathy is remanded. Entitlement to service connection for a right shoulder condition is remanded. Entitlement an evaluation for greater than 10 percent right ulnar neuropathy is remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his tinnitus began during active service. CONCLUSION OF LAW The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Air Force from August 1954 to November 1965. These matters are on appeal from an April 2018 rating decision. In May 2021, the Veteran testified at a Board hearing before the undersigned. A transcript of the proceeding is associated with the record. 1. Entitlement to service connection for tinnitus. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran was afforded a VA hearing loss and tinnitus examination in March 2018. The VA examiner indicated that the Veteran did not have a diagnosis of tinnitus. In April 2018, the Veteran was granted service connection for a bilateral hearing loss disability. In May 2021, the Veteran testified he worked near the flight line and trained extensively with firearms. He did not use hearing protection and noticed ringing in his ears during service. The ringing in his ear worsened after he left service. The Veteran's Form DD 214 indicates that he received the small arms expert marksmanship ribbon. On balance, the Board will resolve reasonable doubt in the Veteran's favor. His statements that his tinnitus began during active service are competent and credible. Because tinnitus is a presumptive disease (organic disease of the nervous system), this evidence showing a continuity of symptomatology since service establishes the nexus requirement. See 38 C.F.R. § 3.303 (b); Fountain v. McDonald, 27 Vet. App. 258, 271 (2015). Accordingly, all material elements of the claim are in equipoise. Therefore, the claim is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). REASONS FOR REMAND 1. Entitlement to service connection for lower back pain is remanded. 2. Entitlement to service connection for a right forearm condition, to include right musculocutaneous neuropathy is remanded. 3. Entitlement to service connection for a right shoulder condition is remanded. In May 2021, the Veteran testified that his lower back, right forearm, and right shoulder disabilities were caused by an in-service motor vehicle accident. The Veteran's service treatment records indicate that he was involved in a motor vehicle accident and a motorcycle accident during active service. His service treatment records include complaints of right shoulder, right forearm, right clavicle, and low back pain. Additionally, imaging studies performed during the Veteran's active service show right wrist fracture and right shoulder cuff calcification In July 2020, the Veteran was afforded VA examinations to determine the nature and etiology of his claimed right forearm, right shoulder, and low back disabilities. The VA examination reports indicate that the Veteran does not have current lower back, right forearm condition, and right shoulder disabilities. However, private treatment records indicate that the Veteran has moderate lower thoracic and moderate to severe lumbar degenerative disc disease and spondylosis. He also has degenerative changes of the elbow. Additionally, VA treatment records reflect diagnoses of osteoarthritis of the right shoulder and impingement syndrome of the right shoulder. A remand is required to afford the Veteran contemporaneous examinations and to obtain adequate etiological opinions. 4. Entitlement an evaluation for greater than 10 percent right ulnar neuropathy is remanded. In July 2020, the Veteran underwent his most recent VA nerve examination. The Veteran testified that he experienced right arm pain and restricted range of motion of his right arm. He was unable to grip with his right hand and dropped things. He indicated that his right ulnar neuropathy had worsened since his July 2020 VA examination. A remand is required to afford the Veteran a contemporaneous examination. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA examination for his lower back, right shoulder, and right forearm disabilities. The examiner must review the claims file. 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 below. The examiner is asked to provide a response to the following: Are the Veteran's lower back, right shoulder, and right forearm disabilities at least as likely as not related to service, including his in-service motor vehicle accident, motor accident and/or reports of low back, right elbow, and right shoulder pain? In rendering the opinion, the VA examiner is asked to address the Veteran's lay statements regarding back, right elbow, and right shoulder pain since active service and his diagnoses of moderate lower thoracic and moderate to severe lumbar degenerative disc disease and spondylosis, right elbow degenerative changes, osteoarthritis and impingement syndrome of the right shoulder. The VA examiner is asked to comment on imaging studies performed during the Veteran's active service show right wrist fracture and right shoulder cuff calcification Provide a rationale to support the opinion. 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? 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right ulnar neuropathy. 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. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.R. Watkins, 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.