08-30 962, 08-30 962

Veteran served Aug 1972–Sep 1975 and is currently incarcerated.
Initial RO denial (Apr 2008) for service connection for bilateral hearing loss and depression; RO later granted service connection for major depressive disorder with noncompensable rating effective Aug 23, 2007 (Feb 2013).
Board previously remanded in Jan 2011 and Jun 2014 for VA examinations; VA exam scheduling was hindered by the prison lacking audiology equipment and refusing transport for non-emergent care.
Claims file contains a November 2007 private audiogram of unclear format and Maryland CNC word-list use; May 2012 telemedicine mental exam may have been incomplete and the Veteran reported suicidal ideation and worsened symptoms not captured in that exam.
RO has not documented exhaustive efforts per M21-1 and VBA Fast Letter 11-22 to secure in-prison or transported examinations or fee-basis/VA examiners at the Veteran’s current facility.
Board remanded both claims for renewed attempts to obtain appropriate VA audiological and psychiatric examinations (or, if impossible, detailed documentation of attempts and medical opinions based on records), and for readjudication thereafter.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Entitlement to service connection for bilateral hearing loss	Veteran claims in-service onset (firing range, helicopter noise) and continuous hearing loss since service; contends lack of adequate VA exam blocked decision	RO/VA contends transportation/resources and prison limitations prevented examination; referenced prior attempts and facility constraints	Remanded: RO must follow M21-1/VBA procedures to schedule in-prison or transported VA/fee exams, document exhaustive efforts, or obtain an opinion based on records; clarify Nov 2007 audiogram and Maryland CNC use
Entitlement to an increased (compensable) rating for major depressive disorder	Veteran reports suicidal ideation, occupational/social impairment, irritability, and relationship problems not captured in May 2012 exam; requests evaluation of current severity since Aug 2007	RO relied on prior noncompensable rating and May 2012 telemedicine exam (which may be incomplete)	Remanded: RO must obtain a new psychiatric exam (or telemedicine alternative) per incarcerated-veteran procedures; examiner to reconcile prior records and opine on severity since Aug 2007 with rationale

Stegall v. West, 11 Vet. App. 268 (1998) (Board must ensure RO compliance with remand directives)
Wood v. Derwinski, 1 Vet. App. 190 (1991) (VA duty to assist tailored for incarcerated veterans)
Bolton v. Brown, 8 Vet. App. 185 (1995) (VA must attempt various methods to obtain examinations for incarcerated claimants)
Snuffer v. Gober, 10 Vet. App. 400 (1997) (procedural guidance on VA examinations and evidence for VA claims)
Caffrey v. Brown, 6 Vet. App. 377 (1994) (VA evidentiary and procedural considerations in disability adjudication)
Kutscherousky v. West, 12 Vet. App. 369 (1999) (claimant may submit additional evidence after remand)