Citation Nr: 18140300 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 16-11 973 DATE: October 2, 2018 REMANDED Entitlement to service connection for hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1972 to November 1974. He alleges that his hearing loss is a result of in-service noise exposure. This matter is the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, TN, which denied service connection for hearing loss because the record does not show a current hearing disability. The Veteran filed a notice of disagreement within the one-year appellate period, thus, the rating decision did not become final. In February 2016, the VA issued a Statement of the Case denying the claim, the Veteran timely appealed. In June 10, 2016, the Veteran withdrew his appeal for entitlement to service connection for tinnitus. 1. Entitlement to service connection for hearing loss is remanded. VA’s duty to assist includes providing an adequate examination when such an examination is indicated. See Sefl v. Nicholson, 21 Vet. App. 120, 123 (2007). An examination is adequate if it “takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one.” Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991)). An examination must be based upon consideration of the Veteran’s past prior history and examinations. Stefl, 21 Vet. App. at 123. The Veteran was afforded a VA examination in December 2014 to address the nature and etiology of his hearing loss. The examiner offered a negative opinion finding that the Veteran had normal hearing. The Board finds the examination is incomplete for VA rating purposes. The examiner indicated that that the Veteran’s measured responses were inconsistent with observed communication skills, even after re-instruction and re-testing threshold several times. Therefore, the Veteran’s voluntary puretone stimuli responses were considered unreliable. Likewise, the examiner found that a Maryland CNC word list score was not appropriate for the Veteran because language difficulties and cognitive problems rendered inconsistent word recognition scores. The examiner indicated that review of the claims file revealed stable hearing (within 10 dB) from entrance exam in in 1972 to separation in 1974. The examiner’s conclusions regarding the etiology of the claimed hearing loss did not adequately address the threshold shift in the Veteran’s hearing as evidenced by the February 1972 induction and the October 1974 separation audiological examinations as there appears to be more than a 10 dB shift at several auditory thresholds. In addition, at the time of the separation examination, several threshold levels were higher than 20 dB. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (finding the threshold for normal hearing is from 0 to 20 dB, and higher threshold levels indicate some degree of hearing loss). Accordingly, an additional examination is needed prior to adjudication of the claim for service connection for bilateral hearing loss. The matter is REMANDED for the following action: 1. Obtain all of the Veteran’s VA medical records and associate them with the record, including the fee-based audiology evaluation at Bridgewater Balance Hearing. See 38 C.F.R. § 3.159 (c). All actions to obtain the records should be documented. Any negative results should be noted in the record and communicated to the Veteran pursuant to 38 U.S.C. § 5103A(b) and 38 C.F.R. § 3.159(e)(1). 2. After the development directed in paragraph 1 has been completed to the extent possible, schedule the Veteran for an examination, with an examiner other than the one who conducted the prior examination, to determine the nature and etiology of the claimed hearing loss. The examiner should obtain a complete, pertinent history from the Veteran and review the claims file in conjunction with the examination, giving particular attention to his VA treatment records, lay assertions, and the pertinent medical evidence. The complete claims folder should be provided to the examiner, and the examiner should specifically state that the complete folder has been reviewed. In formulating the requested opinions, the examiner is asked to specifically consider and address the Veteran’s service treatment records including audiometric findings dated in February 1972 and October 1974 demonstrating a puretone threshold shift from time of enlistment to time of separation, and consider the fee-based audiological evaluation dated August 2014. The examiner is advised that the Veteran is competent to report symptoms and treatment and that his reports, including his reports as to the onset and chronic nature of his symptoms, must be considered, along with the other evidence of record, in formulating the requested opinions. The examiner should note also that the requirements for service connection for hearing loss pursuant to 38 C.F.R. § 3.385 need not be shown by audiometric testing during a claimant’s period of active duty in order for the claim to be granted. Ledford v. Derwinski, 3 Vet. App. 87 (1992). Rather, service connection may be granted where there is credible evidence of acoustic trauma due to 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, as opposed to intercurrent causes. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Based on the examination and review of the record, the examiner is asked to provide an opinion whether it is at least as likely as not (i.e. a 50 percent probability or greater) that hearing loss was incurred in service, or is otherwise attributable to the Veteran’s service. Any evaluations, studies, or tests deemed necessary by the examiner should be accomplished and any such results must be included in the examination report. (Continued on the next page)   A complete rationale for any opinion expressed must be provided. If the examiner is unable to reach an opinion without resort to speculation, he or she should explain the reasons for this inability and comment on whether any further tests, evidence or information would be useful in rendering an opinion. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Steele, Associate Counsel