Citation Nr: 0810709 Decision Date: 04/01/08 Archive Date: 04/14/08 DOCKET NO. 06-30 452 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUE Entitlement to service connection for bilateral hearing loss. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL The veteran ATTORNEY FOR THE BOARD A. C. Mackenzie, Counsel INTRODUCTION The veteran served on active duty from May 1971 to May 1975, from November 1990 to August 1991, and from June 2004 to April 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2005 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The veteran also initiated an appeal of the denial of service connection for residuals of heatstroke but excluded this issue from his September 2006 Substantive Appeal. He appeared at a VA Travel Board hearing in August 2007. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the veteran if further action is required. REMAND The Board has reviewed the evidence of record and finds this evidence to be inconclusive as to the etiology of the veteran's currently diagnosed bilateral hearing loss. In this regard, the Board notes that an audiogram from a February 1988 Army National Guard enlistment examination report indicates pure tone thresholds at 4000 Hertz for both ears in excess of 40 decibels, consistent with the criteria for a bilateral hearing loss disability under 38 C.F.R. § 3.385. The examiner, however, did not render a diagnosis but instead stated "note audiometric result." No hearing loss testing was conducted at entry into the veteran's second period of active duty service, although an audiogram from an August 1991 outprocessing examination report reflects pure tone thresholds at or above 40 decibels at both the 3000 Hertz and 4000 Hertz levels. The veteran underwent a VA audiological examination in July 2005, with an examiner who reviewed the veteran's "medical records." The examiner noted that the veteran's hearing loss "is as likely as not related to military service." No rationale for this opinion was presented, however, and the examiner among other things did not comment on whether the veteran's hearing loss disability preexisted his second period of service or whether any worsening during that period of service represented anything other than a natural progression of the disorder. See 38 C.F.R. § 3.306 (2007). A more thorough VA audiological examination is thus "necessary" under 38 U.S.C.A. § 5103A (d). Accordingly, the case is REMANDED for the following action: 1. The veteran should be afforded a VA audiological examination to determine the nature and etiology of his claimed bilateral hearing loss disorder. The veteran's claims file should be made available to the examiner prior to the examination, and the examiner is requested to review the entire claims file in conjunction with the examination. All tests and studies deemed necessary by the examiner should be performed. Based on a review of the claims file and the clinical findings of the examination, the examiner is first requested to provide an opinion as to whether the veteran's bilateral hearing loss disorder clearly and unmistakably preexisted his period of service beginning in November 1990. If so, the examiner should provide an opinion as to whether it is at least as likely as not (e.g., a 50 percent or greater probability) that this hearing loss was etiologically related to the veteran's first period of service. If any hearing loss present in November 1990 was not related to the first period of service, then the examiner should then provide an opinion as to whether such disorder clearly and unmistakably did not worsen during the second period of service, or during his third period of service in 2004 and 2005. The examiner should further provide an opinion as to whether any worsening during service constituted only a natural progression of the disorder. If a bilateral hearing loss disorder is not found to have clearly and unmistakably preexisted the period of service beginning in November 1990, the examiner should provide an opinion as to whether it is at least as likely as not (e.g., a 50 percent or greater probability) that such disorder is etiologically related to the veteran's second period of active service. A complete rationale should be given for all opinions and conclusions expressed in a typewritten report. 2. After completion of the above development, the veteran's claim of service connection for bilateral hearing loss should be readjudicated. If the determination remains adverse to the veteran, he and his representative should be furnished with a Supplemental Statement of the Case and given an opportunity to respond. Then, if indicated, this case should be returned to the Board for the purpose of appellate disposition. The veteran has the right to submit additional evidence and argument on this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). (CONTINUED ON NEXT PAGE) This appeal must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2006). _________________________________________________ JOHN L. PRICHARD Acting Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (2007).