Citation Nr: 18154195
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 18-15 945
DATE:	November 29, 2018
ORDER
New and material evidence having been submitted, the claim for service connection for hearing loss is reopened.   
New and material evidence having been submitted, the claim for service connection for incontinence is reopened.   
REMANDED
Service connection for hearing loss is remanded.
Service connection for incontinence is remanded.
An increased rating for alopecia, temples of the head, is remanded.
FINDINGS OF FACT
1.  An October 2010 rating decision denied service connection for hearing loss.  The decision was not appealed and became final.  
2. An October 2010 rating decision denied service connection for incontinence.  The decision was not appealed and became final.  
3. Evidence received since the October 2010 rating decision relates to unestablished facts necessary to substantiate the claims of entitlement to service connection for hearing loss and service connection for incontinence. 
CONCLUSIONS OF LAW
1.  Evidence received since the October 2010 rating decision is new and material, and the claim of entitlement to service connection for hearing loss is reopened.  38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a).
2.  Evidence received since the October 2010 rating decision is new and material, and the claim of entitlement to service connection for incontinence is reopened.  38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran had active duty service from March 1986 to May 2009.  
1. Whether new and material evidence has been received to reopen service connection for hearing loss
2. Whether new and material evidence has been received to reopen service connection for incontinence
Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. 
New evidence is defined as evidence not previously submitted to agency decision-makers.  Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim.  New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim.  See 38 C.F.R. § 3.156 (a). 
The October 2010 rating decision denied service connection for hearing loss based on the absence of a current hearing loss disability for VA purposes.  Evidence received since the October 2010 rating decision includes an April 2017 VA examination and a private audiological evaluation dated in April 2018.  The VA examination noted normal hearing for VA purposes.  The private audiogram reflects elevated audiometric thresholds compared to the VA examination.  Thus, the new records are material to the issue of the existence of a current hearing loss disability.  Accordingly, the claim for service connection for hearing loss is reopened.  
The October 2010 rating decision denied service connection for incontinence based on the absence of evidence that incontinence was related to service or a service-connected disability.  The decision indicated that an April 2009 VA examination did not relate the Veteran’s incontinence to her service-connected lumbar spine disability.  Evidence received since the October 2010 rating decision is material, as it relates to possible etiologies of incontinence.  Accordingly, the claim for service connection for incontinence is reopened. 
REASONS FOR REMAND
1.  Service connection for hearing loss is remanded.
A VA examination in April 2017 showed normal hearing bilaterally.  The Veteran submitted a private audiological report in April 2018, which indicated a shift in her hearing since the last VA examination.  The claim is being remanded for a new VA examination to ascertain whether the Veteran has a current hearing loss disability for VA purposes.  

2.  Service connection for incontinence is remanded.
An April 2009 VA examination reflects that the Veteran reported incontinence.  The examination did not provide a medical opinion regarding the etiology of incontinence.  A May 2017 VA treatment record noted a history of bladder sling repair in 2010 at a private hospital.  A physician noted that causes of incontinence include heavy lifting, childbirth, and obesity.  The claim is being remanded for a VA examination and to obtain medical records pertaining to the Veteran’s bladder sling repair procedure.  
3.  An increased rating for alopecia, temples of the head, is remanded.
The Veteran’s alopecia is currently rated according to Diagnostic Code 7831, pertaining to alopecia areata.  Diagnostic Code 7830 is used to rate scarring alopecia.  DC 7830 provides that a 10 percent rating is warranted for scarring alopecia affecting 10 to 20 percent of the scalp.  A 40 percent rating is assignable for scarring alopecia affecting more than 40 percent of the scalp.  
The Veteran submitted photographs in April 2017, which show hair loss affecting the scalp.  VA examinations in September 2010 and April 2017 did not describe the percentage of the scalp affected by hair loss.  The claim is being remanded for a new VA examination to ascertain the percentage of the scalp affected by alopecia.  
The matters are REMANDED for the following action:
1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hearing loss.  The examiner must indicate whether the Veteran has current hearing loss for VA purposes.   If hearing loss is present, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease.  
2. Ask the Veteran to complete a VA Form 21-4142 for treatment records from Pinehurst Surgical pertaining to bladder sling repair surgery.  Make two requests for the authorized records from Pinehurst Surgical, unless it is clear after the first request that a second request would be futile.
3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any incontinence.  The examiner must indicate whether incontinence is at least as likely as not related to service, including the birth of the Veteran’s child in 1987.
The examiner must indicate whether incontinence is at least as likely as not (1) proximately due to service-connected lumbar strain, or (2) aggravated beyond its natural progression by lumbar strain.  
3.  Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her alopecia.  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.  The examiner must indicate the percentage of the scalp affected by alopecia.


 
JENNIFER HWA
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Catherine Cykowski 

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