Citation Nr: 1329384 Decision Date: 09/13/13 Archive Date: 09/20/13 DOCKET NO. 10-24 653 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for chronic tinnitus. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The Veteran served on active duty from October 1970 to February 1973. This case comes before the Board of Veterans' Appeals (Board) on appeal of a May 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. For reasons which will become apparent, this appeal is being REMANDED to the RO via the Appeals Management Center (AMC) in Washington, D.C. VA will notify you if further action is required on your part. REMAND A review of the record in this case raises some question as to the exact nature and etiology of the Veteran's hearing loss and tinnitus. In that regard, pertinent evidence of record is to the effect that, while in service, the Veteran served as an armor crewman, an occupation in which he may very well have been exposed to noise at hazardous levels. While at the time of a service separation examination in early February 1973, a physical examination of the Veteran's ears was within normal limits, the Veteran's hearing was, apparently, not tested. In point of fact, the earliest clinical indication of the presence of either hearing loss or tinnitus is revealed by private medical records dated in January 2009, almost 36 years following the Veteran's discharge from service. The Board observes that, following a VA audiometric examination in March 2010 (which examination, it should be noted, involved a full review of the Veteran's claims folder), it was the opinion of the examining audiologist that, given that the Veteran had been exposed to two years of artillery noise in the military, as well as 40 years of noise exposure from construction-type noise, and given the lack of evidence of hearing loss at the time of discharge or within one year of separation from service, it was "not possible to opine which noise event was the causative factor for (the Veteran's) present day hearing loss without resort to speculation." Significantly, the aforementioned opinion was offered notwithstanding the RO's request that the examiner provide a medical opinion regarding whether it was "likely, not likely, or at least as likely as not" that the Veteran's hearing loss and tinnitus were the result of noise exposure during military service. The Board recognizes the difficulty in determining the exact cause or causes responsible for the Veteran's current hearing loss and tinnitus. Nonetheless, given the request of the Veteran's accredited representative (see Informal Hearing dated August 15, 2013) for an additional, more "complete" VA examination, the Board is of the opinion that further development of the evidence would be appropriate prior to a final adjudication of the Veteran's current claims. Accordingly, in light of the aforementioned, the case is REMANDED to the AMC/RO for the following actions: 1. Any pertinent VA or other inpatient or outpatient treatment records, subsequent to March 2010, the date of the most recent VA examination of record, should be obtained and incorporated in the claims folder. The Veteran should be requested to sign the necessary authorization for release of any private medical records to the VA. All attempts to procure such records should be documented in the file. If the AMC/RO cannot obtain records identified by the Veteran, a notation to that effect should be included in the claims file. In addition, the Veteran and his representative should be informed of any such problem. 2. The Veteran's entire claims folder should then be furnished to the same VA audiologist who conducted the March 2010 VA audiometric examination. Should that examiner prove unavailable, the Veteran's entire claims folder should be furnished to another VA audiologist. Following a review of the Veteran's entire claims folder, the examiner should, to the extent possible, offer an opinion as to whether the Veteran's current hearing loss and tinnitus at least as likely as not (50 percent probability or greater) had their origin during, or are in some way the result of, the Veteran's inservice noise exposure, as opposed to his postservice construction noise exposure. If the type of hearing loss found is not normally found after acoustic trauma, that too should be noted, as should any other etiology such as advancing age or infection. A complete rationale must be provided for any opinion offered, and all information and opinions, once obtained, must be made a part of the Veteran's claims folder. If it is determined that no opinion can be reached without resort to speculation, it should be detailed why this is so, and it should be indicated whether there is any additional development to be undertaken which might allow an opinion to be entered. 3. The AMC/RO should then review the aforementioned report to ensure that it is in complete compliance with the directives of this REMAND, and that the examiner has documented his consideration of all records contained in Virtual VA. If the report is deficient in any manner, the AMC/RO must implement corrective procedures. 4. The AMC/RO should then readjudicate the Veteran's claims for service connection for bilateral hearing loss and tinnitus. Should the benefits sought on appeal remain denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case (SSOC). The SSOC must contain notice of all relevant action taken on the claims for benefits since the issuance of a Statement of the Case (SOC) in May 2010. An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome in this case. The Veteran need take no action unless otherwise notified. 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). _________________________________________________ MICHAEL D. LYON 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).