Citation Nr: 1317950 Decision Date: 06/03/13 Archive Date: 06/11/13 DOCKET NO. 11-14 456 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to service connection for hearing loss. 2. Entitlement to service connection for tinnitus. REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD Scott Shoreman, Counsel INTRODUCTION The Veteran had active service from July 1945 to August 1946 and from November 1950 to August 1951. This matter comes before the Board of Veterans' Appeals (Board) from a June 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Notice of Separation from the Veteran's first period of active duty states that he served as a motor machinist's mate and served on the USS Frost and USS Nueces. The DD Form 214 from his second period of active service does not list his military occupational specialty and indicates that he served on the USS Redstart. The Veteran wrote in a February 2010 statement that during his first tour of duty he was on watch in the engine room for long periods without hearing protection and that the noise was overwhelming. During his second tour of duty he was an engineman 3rd class and was subjected to loud engine noise on a daily basis while on watch. He also was subjected to noise from large guns, and hearing protection was not used. Therefore, the record shows that the Veteran was exposed to acoustic trauma in service. In a December 2012 statement the Veteran wrote that the noise exposure from his employment before his first period of service was minimal. His later civilian employment was as a parts man at car dealership and as a real estate broker for over 40 years without noise exposure. Private treatment from December 2001 showed mild to moderately severe sensorineural hearing loss at 1500 to 8000 Hertz (Hz.) in the left ear and mild to moderately severe sensorineural hearing loss at 2000 to 8000 Hz. in the right ear. In October 2010 the Veteran had an examination arranged through VA QTC Services. The examination report notes that the Veteran had no pre- or post-military occupational or recreational noise exposure and that during service he was exposed to noise from gunfire, explosions, loud machinery, and constant engine noise. The Veteran reported that the onset of tinnitus was in 1945. On audiological testing , pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 35 35 55 75 80 LEFT 35 40 65 75 80 Speech audiometry revealed speech recognition ability of 88 percent in the right ear and of 88 percent in the left ear. The examiner diagnosed the Veteran with mild to severe sensorineural hearing loss with good speech discrimination in the right ear and mild to profound sensorineural hearing loss with good speech discrimination in the left ear. The examiner opined that the Veteran's hearing loss and tinnitus were less likely as not caused by or a result of military noise exposure. The rationale was the limited exposure to noise and no evidence of hearing loss during service. The examiner also noted that the service treatment records do not include a separation examination, which left a small probability that the Veteran suffered from hearing loss and tinnitus during service. However, the examiner also wrote that the current hearing loss was likely much more severe than any loss that was sustained during service. A private physician wrote in May 2011 that he evaluated the Veteran and that an audiogram showed symmetrical mid and high frequency sensorineural hearing loss compatible with noise exposure and presbycusis (age related hearing loss). The physician felt that a significant portion of the Veteran's hearing loss is likely from noise exposure from Naval service. This, however, was not explained. Once VA undertakes the effort to provide an examination, it must obtain a fully adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Probative value cannot be given to the opinion from the October 2010 examiner because of the contradictory reasoning of the rationale. "...[M]ost of the probative value of a medical opinion comes from its reasoning" and the Board "must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The opinion of the October 2010 examiner appears to contain contradictory reasoning. While she felt it was less likely that the hearing loss and tinnitus are related to service, in also writing that current hearing loss was more severe than hearing loss sustained during service, she seemed to be stating that there was hearing loss sustained during service. Furthermore, the examiner wrote that the Veteran had limited exposure to noise during service, and, as discussed above, the record shows that the Veteran was exposed to acoustic trauma during service. No rationale was offered for the opinion regarding tinnitus. Therefore, a new opinion must be obtained before the claim can be decided on the merits. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. The file should be returned to the audiologist who conducted the October 2010 examination of the Veteran, or to another qualified person. The examiner should offer an opinion as to whether it is at least as likely as not that the Veteran's bilateral hearing loss and tinnitus are etiologically related to service. In rendering this opinion, the examiner should note that the exposure to in-service acoustic trauma has been conceded. A complete rationale for any opinion expressed should be provided, including with respect to hearing loss, a description of the manner in which noise induced hearing loss presents in a patient, and how this Veteran does or does not reflect a history consistent with that. If the examiner determines that a medically sound opinion cannot be reached, it is requested that an explanation as to why that is so be included. 2. Readjudicate the Veteran's claims. If the benefits sought on appeal are not granted in full, the RO should issue the Veteran and his representative a supplemental statement of the case and provide an opportunity to respond before the case is returned to the Board. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim 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. 2012). _________________________________________________ MICHAEL E. KILCOYNE 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) (2012).