Citation Nr: 1322663	
Decision Date: 07/16/13    Archive Date: 07/24/13

DOCKET NO.  05-25 695	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas


THE ISSUE


Entitlement to service connection for bilateral hearing loss.


REPRESENTATION

Appellant represented by:	The American Legion


ATTORNEY FOR THE BOARD

D. Schechter, Counsel



INTRODUCTION

The issue of entitlement to an increased initial rating for service-connected post-traumatic stress disorder to include a total rating based on individual unemployability (TDIU) being referred has been raised by the record in the April 2013 Written Brief Presentation, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ).  Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action.  

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

Reason for remand:  To attempt to obtain an April 1983 Audiological examination report from the Topeka VAMC and to obtain another medical opinion.

In previous remands, the Board neglected to specifically request that the RO/AMC attempt to obtain an April 1983 Audiological examination report from the Topeka VAMC, and consequently the RO/AMC did not attempt specifically to obtain that report.  The Board regrets the oversight but feels the report, if obtained, may have a bearing on the outcome of the claim for service connection for bilateral hearing loss.

Whether or not the April 1983 Audiological examination report is obtained, the Board has determined that another medical opinion is needed in this case, although it may not be necessary to call the Veteran for another examination, but instead the clinician or audiologist may be able to render the opinion needed based on review of the medical records in this case.

Accordingly, the case is REMANDED for the following action:

1.  Attempt to obtain an April 1983 Audiological examination report from the Topeka VAMC or, if such a report has been archived, from the appropriate repository for such archived records.  In an April 1983 VA Form 21-4138, the Veteran noted that he had had an Audio examination at the Topeka VAMC on April 7, 1983.  Attempts should be made to obtain this report of examination with the Audiogram results from testing.

2.  Whether or not the April 1983 report is obtained, send the claims file for review by the VA examiner.  If the examiner feels that the Veteran must be examined in order to render the opinions requested, schedule the Veteran for an examination; otherwise, the examiner should base opinions and conclusions on review of the records in the claims file, particularly the records summarized below.

The examiner should note the following facts as shown by the service treatment records and post-service records in rendering the opinion:

Upon authorized audiological evaluations in service, pure tone thresholds, in decibels, were as follows:

(NOTE: Prior to November 1967, audiometric results were reported in standards set forth by the American Standards Association (ASA). Those are the figures on the left of each column and are not in parentheses. Since November 1, 1967, those standards have been set by the International Standards Organization (ISO)-American National Standards Institute  (ANSI).  In order to facilitate data comparison, the ASA standards have been converted to ISO-ANSI standards and are represented by the figures in parentheses.) 







HERTZ




500
1000
2000
3000
4000
Service entrance examination October 1965
RIGHT
0 (15)
0 (10)
-5 (5)

5 (10)

LEFT
15 (30)
0 (10)
5 (15)

0 (5)
October 1966
RIGHT
0 (15)
5 (15)
5 (15)
5 (15)
0 (5)

LEFT
0 (15)
0 (10)
5 (15)
10 (20)
10 (15)
January 1967
RIGHT
0 (15)
0 (10)
0 (10)
0 (10)
5 (10)

LEFT
10 (25)
0 (10)
0 (10)
0 (10)
0 (5)
December 1967
RIGHT
5 
10 
10 
5
15

LEFT
5 
10
10 
5
15
April 1968
RIGHT
-5
0
0
0
15

LEFT
0
0
10
10
10
March 1969
RIGHT
0
0
0
0
10

LEFT
5
5
5
5
5

* Veteran's DD 214 shows his specialty in service was aircraft maintenance specialist.
* Hearing conservation data reports reflect that the Veteran was exposed to noise in service, and his hearing was periodically tested.
* VA has awarded service connection for tinnitus in this case and noise exposure in service is conceded.
* October 1965 Enlistment examination reflected Veteran's occupation as "musician".
* a February 1966 record had a notation of "ears clear except for external otitis (mild)." 
* December 1967 Audiometric data reflects pure tone threshold of 45 in the left ear and 25 in the right ear at 6000 Hz.
* In March 1969, Veteran was discharged from service.
* In June 1973, Dr. Song P. Lee, ENT, noted, "Ears: Normal."
* An April 1974 private record of a Pre-Employment Physical reflects a finding of "Ears: Hearing 100%." 
* On October 1974 VA examination, Auroscopy was negative and box was checked "no" under "Hearing loss noted."
* A March 1979 VA Hospital Summary reflects, "Examination of the head, eyes, ears, nose and throat was essentially within normal limits except for an old perforated tympanic membrane on the left and a loss of high-pitch hearing on the left."
* An August 1979 VA C&P examination report reflected that "hearing is normal to crude tests with the left ear, with high tone hearing impairment in the right ear, and well-preserved medium and low-pitched hearing in the right ear."
* In April 1983, the Veteran stated that he had an Audio exam at Topeka VAMC; VBA will attempt to obtain a copy of that examination on remand.
* Please also review VA Audio examinations in May 2009, with Addendum in May 2010, and in May 2012.

In considering the facts above, the examiner should render an opinion as to

(1) whether it is at least as likely that bilateral (or left or right ear) hearing loss had its onset in service between October 1965 and March 1969 as opposed to having had its onset at some other time; and, in the alternative,
(2) whether it is at least as likely that current hearing loss is the result of noise exposure in service as it is the result of some other cause or factor.  If the examiner believes that noise exposure in service was "less likely" the cause of the hearing loss, the examiner should specifically state what those "other" causes or factors might have been and why those causes or factors are believed more likely to have resulted in the Veteran's hearing loss than the noise exposure he experienced in service.

In rendering these opinions, the examiner should note that the VA examiner stated in the May 2010 Addendum that the December 1967 audiogram in service indicated left ear hearing loss was present at 6000 Hz but that this was most likely a "temporary threshold shift which recovered on subsequent hearing tests."  Regarding this, the examiner should specifically explain what factors may have caused such a "temporary" threshold shift.

(3)  After undertaking any other developmental action deemed necessary, the RO/AMC should readjudicate the issue remaining on appeal.  If the benefit sought on appeal is not granted in full the RO should issue a supplemental statement of the case, and should provide the Veteran and his representative an opportunity to respond.

After the Veteran and her representative have been given an opportunity to respond to the supplemental statement of the case and the period for submission of additional information or evidence set forth in 38 U.S.C.A. § 5103(b) (West 2002) has expired, if applicable, the case should be returned to the Board for further appellate consideration, if otherwise in order.  By this remand, the Board intimates no opinion as to any final outcome warranted.  

The appellant has the right to submit additional evidence and argument on the matter or 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).



_________________________________________________
KATHLEEN K. GALLAGHER
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).