Citation Nr: 1320744 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 10-03 851 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for tinnitus. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD L. J. N. Driever INTRODUCTION The Veteran had active service from May 1960 to May 1962 and from August 1962 to August 1968. These claims come before the Board of Veterans' Appeals (Board) on appeal of a June 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Virtual VA paperless claims processing system (Virtual VA) reveals no additional pertinent documents for consideration in support of these claims. This 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 Veteran seeks service connection for bilateral hearing loss and tinnitus. He claims that he developed these conditions secondary to his exposure to noise while serving on two aircraft carriers and a seaplane tender in the United States Navy. Allegedly, when he served on these vessels, he worked as a postal clerk, which required him to deliver and retrieve mail from the flight decks four times daily without the benefit of hearing protection. On the decks, aircraft reportedly approached and landed, causing very loud noise. The Veteran claims that the hearing loss and ringing in his ears initially manifested "almost right after discharge" and progressively worsened from that point forward. Prior to adjudication of these claims, additional development is required. See 38 C.F.R. § 19.9 (2012). Reports of VA examinations conducted in June 2008 and May 2009 confirm that the Veteran has bilateral hearing loss by VA standards. The former report also confirms that the Veteran has tinnitus. Service personnel records establish that the Veteran served in the capacity alleged and on naval vessels. VA assisted the Veteran in support of these claims by seeking an opinion of one of the VA examiners regarding whether the hearing loss and tinnitus are related to the Veteran's active service, including the alleged noise exposure. Unfortunately, that VA examiner's report, dated May 2009, is inadequate to decide these claims. The VA examiner refrained from discussing the etiology of the Veteran's tinnitus on the basis that the Veteran did not report tinnitus on examination when asked to describe his current ear symptoms. However, there is other medical evidence of record - the June 2008 VA examination report - establishing that the Veteran has tinnitus so its presence is not at issue. The question of its etiology remains. The examiner also noted that scientific research shows that hearing loss due to noise does not progress beyond age-related changes once the exposure to noise is discontinued. She also noted that the Veteran's bilateral hearing loss could be related to aging, military and non-military noise exposure and other factors not yet identified. She concluded, however, that she could not resolve the issue without resort to mere speculation. She did not indicate whether there is additional outstanding evidence that would aid her in providing such an opinion. The VA examiner's finding in this regard constitutes an insufficient basis for ruling out a relationship between any current disability and the Veteran's active service. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010) (holding that an examiner's conclusion that a diagnosis or etiology opinion is not possible without resort to speculation is a medical conclusion just as much as a firm diagnosis or conclusive opinion, but a bald statement that it would be speculative to render an opinion on etiology or diagnosis is fraught with ambiguity). Another opinion is thus needed and, given that the Veteran had mumps as a child, the opinion should contemplate this history. The Board REMANDS these claims for the following action: 1. Obtain an addendum opinion from the VA examiner who evaluated the Veteran in May 2009. Forward the claims file to the examiner for review of all pertinent documents and ask the examiner to confirm in his written report that he conducted such a review. Remind the examiner that certain symptoms, including difficulty hearing and ringing ears, are capable of lay observation and therefore competent and that any opinion provided on etiology should contemplate such symptoms. Ask the examiner to proceed with the following instructions following review of the claims file: a. Note the Veteran's history (reported previously) of childhood mumps, in-service noise exposure (delivering and retrieving mail from the flight decks four times daily without the benefit of hearing protection), post-service noise exposure (occasional use of power tools, chainsaws and gas-powered lawn equipment), and initial manifestation of hearing loss and tinnitus "almost right after discharge"; b. Assuming the Veteran experienced the noise exposure, difficulty hearing and ringing in his ears as described, opine whether his bilateral hearing loss and/or tinnitus more likely than not is/are related to his active service, including the in-service noise exposure; c. Provide detailed rationale, with specific references to the record, for the opinions expressed; and d. If an opinion cannot be expressed without resort to speculation, discuss why such is the case and whether there is additional evidence that would aid in providing such opinion. IN ALL OPINIONS, THE EXAMINER MUST PROVIDE A FULLY REASONED EXPLANATION FOR HIS OR HER RESPONSES, INCLUDING BOTH THE FACTUAL AND MEDICAL BASES FOR THE OPINIONS REACHED. 2. Review the addendum opinion to ensure that it complies with these remand instructions and includes all requested information and, if not, return it to the examiner for correction. 3. Readjudicate these claims based on all of the evidence of record. If either benefit sought on appeal is not granted to the Veteran's satisfaction, issue a supplemental statement of the case. List the additional evidence the RO considered and identify the relevant actions the RO took and the evidence and applicable law and regulations it considered in support of the appeal. Allow an appropriate period of time for a response. Thereafter and subject to current appellate procedure, return this case to the Board for further consideration. The Board intimates no opinion as to the ultimate outcome in this case, but advises the Veteran that he has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ Vito A. Clementi 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).