BVA9502384 DOCKET NO. 93-10 580 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES 1. Entitlement to service connection for right ear hearing loss, residuals of a left hand fracture, residuals of fractures of the feet, residuals of dehydration, dermatophytosis of the feet, and urticaria and angioneurotic edema. 2. Entitlement to an increased rating for residuals of a right inguinal herniorrhaphy, currently rated as 10 percent disabling. 3. Entitlement to increased (compensable) ratings for residuals of a left inguinal herniorrhaphy, postoperative residuals of an umbilical hernia, left ear hearing loss, and residuals of a fracture of a right second metacarpal. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Joseph P. Gervasio, Jr., Counsel INTRODUCTION The veteran served on active duty from June 1960 to March 1980. This case comes to the Board of Veterans' Appeals (Board) on appeal of a February 1992 rating decision of the Muskogee, Oklahoma, Regional Office (RO) of the Department of Veterans Affairs (VA), which denied entitlement to service connection for right ear hearing loss, a left hand fracture, fractures of the feet, residuals of dehydration, urticaria and angioneurotic edema, and dermatophytosis of the feet; denied a compensable evaluation for left inguinal herniorrhaphy residuals, umbilical herniorrhaphy residuals, left ear hearing loss, and right second metacarpal fracture residuals; and denied a rating in excess of 10 percent for right inguinal herniorrhaphy residuals. The main portion of the current Board decision only addresses the issue of service connection for right ear hearing loss. Other issues on appeal are either the subject of the remand at the end of the decision, or Board action is being deferred on such issues until completion of the remand development. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his right ear hearing loss had its onset during service. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports the claim for service connection for right ear hearing loss. FINDINGS OF FACT Hearing loss of the right ear had its onset during service. CONCLUSION OF LAW Right ear hearing loss was incurred during service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 1991); 38 C.F.R. §§ 3.303, 3.385 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION It is initially noted that the veteran's claim for service connection for right ear hearing loss is well grounded; that is, it is not inherently implausible. 38 U.S.C.A. § 5107(a). It is also found that the facts relevant to this issue have been properly developed and the statutory obligation of the VA to assist the veteran in the development of his claim has been satisfied. Id. On a June 1960 examination for entry into active duty, hearing in the right ear was 15/15 (normal) by whispered voice testing. Service medical records show no complaints of hearing loss. On examination for retirement from service, in January 1980, audiometric testing of the right ear showed decibel threshold levels of 20 or less in all tested frequencies except at 4,000 hertz where a level of 25 decibels was noted. An audiometric examination was performed by the VA in December 1991. The results of right ear testing included decibel thresholds of 20, 15, 5, 30, and 35 at respective frequencies of 500, 1,000, 2,000, 3,000, and 4,000 hertz; speech discrimination was 92 percent correct. At his July 1992 RO hearing, the veteran said he was not sure whether he had right ear hearing loss in service, although he recounted that he was exposed to loud noise from naval artillery. In order to establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. The veteran's hearing was shown to be normal at the time he entered service. On examination in 1980 for separation from active duty, a level of 25 decibels was noted at 4,000 hertz. According to some medical authorities, the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet.App. 155, 157 (1993). Thus some degree of hearing loss in the right ear is demonstrated at the time the veteran left service, even if minimal. Audiometric test results at the 1991 VA examination, particularly the 92 percent correct speech discrimination score, indicate a current right ear hearing disability for service connection purposes, under 38 C.F.R. § 3.385. Even if diminished hearing in the right ear did not amount to a hearing disability, within the meaning of 38 C.F.R. § 3.385, during the time of service, this does not preclude service connection if the current disability can be linked to service. Ledford v. Derwinski, 3 Vet.App. 87 (1992). Evidence in favor of service connection includes the minimal findings of hearing loss at the service retirement examination, and the veteran's history of acoustic trauma in service. Evidence against the claim includes the absence of medical records documenting a continuity of symptoms since service. After a review of the entire record, the Board finds an approximate balance of the evidence for and against service connection, and under such circumstances the benefit of the doubt is given to the veteran. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). The Board holds that right ear hearing loss was incurred in service, and service connection for hearing loss in the right ear is granted. ORDER Service connection for right ear hearing loss is granted. REMAND One of the remaining issues on appeal is entitlement to a compensable evaluation for left ear hearing loss. As service connection for hearing loss in the right ear has now been granted, the bilateral condition must now be evaluated. See 38 C.F.R. § 4.85. This claim is well grounded, meaning plausible, and inasmuch as the last VA examination is over three years old, it is the judgment of the Board that the duty to assist the veteran requires a current audiometric evaluation. 38 U.S.C.A. § 5107(a); Caffrey v. Brown, 6 Vet.App. 377 (1994). Therefore, this claim requires additional action by the RO. After a review of the record, including the veteran's hearing testimony, it is also the decision of the Board that further development is warranted with regard to pending claims for service connection for residuals of fractures of the feet and for skin conditions. The service medical records from March and May 1970 show that the veteran injured the second toe of his right foot and that X-ray studies showed that he may have sustained a fracture. The possibility that he may have residual disability from this injury was not investigated on the most recent VA examination, and in the judgment of the Board another examination is warranted. Service medical records also show that he received extensive treatment for variously diagnosed skin disorders, including dermatophytosis of the feet, urticaria and angioneurotic edema. With regard to urticaria (hives) in particular, the service records note a preservice history of the condition, including preservice hospital treatment. Any preservice and post-service treatment records should be obtained. While the veteran was examined by a VA dermatologist in December 1991, the examiner stated that he was not certain of the veteran's history and that it would be helpful to examine records of past treatment. Another examination, taking into account the historical records, is warranted. Green v. Derwinski, 1 Vet.App. 121 (1991). In view of the foregoing, the case is REMANDED for the following: 1. The RO should instruct the veteran to prepare a detailed list of all treatment received for any skin disorder both prior and subsequent to service. Names and addresses of medical providers and dates of treatment should be listed by the veteran. The RO should then obtain copies of all treatment records, not already on file, in accordance with 38 C.F.R. § 3.159. 2. Thereafter, the RO should have the veteran undergo a special dermatological examination to ascertain the existence and etiology of all skin disorders, including, but not limited to, claimed dermatophytosis of the feet, and urticaria and angioneurotic edema. The claims folder must be made available to and reviewed by the examiner prior to the examination. The doctor should correlate current findings with historical records, including service medical records, and should offer an opinion on whether past and present skin disorders are etiologically related. 3. The RO should have the veteran undergo a VA orthopedic examination to ascertain whether there are any residuals of a right foot fracture or other injury. The claims folder should be made available to and reviewed by the examiner. The examination should include all indicated studies, including X-rays. 4. The RO should also have the veteran undergo VA audiometric testing to evaluate the severity of service-connected bilateral hearing loss. When this action is completed, the RO should review the claims for service connection for residuals of foot fractures, service connection for a skin disorder (including dermatophytosis of the feet, and urticaria and angioneurotic edema), and an increased rating for bilateral hearing loss. If the claims are denied, the veteran and his representative should be furnished a supplemental statement of the case and afforded an opportunity to respond. Thereafter, the case should be returned to this Board for further appellate consideration. L. W. TOBIN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).