Citation Nr: 1802125 Decision Date: 01/11/18 Archive Date: 01/23/18 DOCKET NO. 14-07 608 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for bilateral hearing loss. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD B. Kuczynski, Associate Counsel INTRODUCTION The Veteran served on active duty from May 1968 to September 1969 and from June 1971 to September 1989. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. This appeal was processed using the Veterans Benefits Management System (VBMS). Accordingly, any future consideration of this case should take into consideration the existence of these records. The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ). VA will notify the appellant if further action is required. REMAND The Veteran's service treatment records show that he had aerosinusitis in service, and private medical records later show that he required a myringotomy with pressure equalization tubes in June 2007. He is currently service-connected for sinusitis and allergic rhinitis, and a July 2012 VA examiner noted the Veteran's report of having sinus congestion with fluid in his ears for over 30 years. Moreover, the post-service records indicate that he has been experiencing hearing loss with other ear complaints. For example, the Veteran was seen in June 2009 with complaints of bleeding from his left ear, as well as draining and muffled hearing on that side. He later sought treatment in April 2012 with complaints of worsening left ear drainage, as well as popping, bleeding, and severe left ear hearing loss. Although the Veteran has not specifically raised the theory of secondary service connection, the evidence suggests that there could be a relationship between those disorders. However, the medical opinions of record only address whether his current hearing loss is related to any military noise exposure. Therefore, the Board finds that a medical opinion is needed to address that theory of entitlement. Accordingly, the case is REMANDED for the following action: 1. The AOJ should send the Veteran an additional notice letter in connection with his claim for service connection for bilateral hearing loss. The letter should (1) inform him of the information and evidence that is necessary to substantiate the claim; (2) inform him about the information and evidence that VA will seek to provide; and, (3) inform him about the information and evidence he is expected to provide. The letter should also explain how disability ratings and effective dates are determined. Specifically, the letter should notify the Veteran of the evidence necessary to substantiate the claim on both a direct and secondary basis. 2. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for hearing loss and his ears. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA medical records. 3. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any hearing loss that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should also note that the absence of evidence of a hearing loss disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. The examiner should state whether it is at least as likely as not that the Veteran's hearing loss is causally or etiologically related to his military service, including any noise exposure and aerosinusitis therein. The examiner should also opine as to whether it is at least as likely as not that the Veteran's current bilateral hearing loss is either caused by or aggravated by his service-connected rhinitis and sinusitis. In rendering his or her opinion, the examiner should discuss medically known or theoretical causes of hearing loss and describe how hearing loss which results from noise exposure generally presents or develops in most cases, as distinguished from how hearing loss develops from other causes, in determining the likelihood that current hearing loss was caused by noise exposure in service as opposed to some other cause. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the Veteran's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. After completing the above actions and any other necessary development as may be indicated as a consequence of the action taken in the preceding paragraph, the claim should be readjudicated. If the benefit sought is not granted, the Veteran and his representative should be furnished a supplemental statement of the case (SSOC) and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. This SSOC should set forth the provisions of 38 C.F.R. § 3.310. 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. §§ 5109B, 7112 (2012). _________________________________________________ J.W. ZISSIMOS Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C. § 7252 (2012), 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) (2017).