Citation Nr: 18140621 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 15-24 095 DATE: October 3, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1965 to May 1969. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for bilateral hearing loss is remanded. Unfortunately, the Board finds that the Veteran’s claims must be remanded prior to adjudication. The Veteran claims he is entitled to service connection for bilateral hearing loss as his hearing loss is at least partially related to in-service noise exposure. The Veteran was provided VA examinations for his claimed conditions in June 2014 and March 2015. The Veteran was diagnosed with hearing loss for VA purposes. However, the VA examiner in June 2014 opined that the Veteran’s hearing loss was less likely than not related to his service as he had not complained of difficulty hearing when separated from service or the years after, and that the examination was his first complaint of hearing loss since service. Similarly, the March 2015 VA examiner opined that it was “difficult to establish a causal relationship” between hearing loss and military service because it was first reported 45 years after service, he had changing puretone threshold measurements from the June 2014 exam to the March 2015 exam, and the configuration of hearing loss in the left ear which did not reflect a noise-induced pattern. In an August 2014 statement, the Veteran argued that his hearing loss has been getting worse for over 40 years, and got exceptionally worse after an aneurysm surgery in July 2013, and that he believed it was from his time in the boiler/engine room on ships with no hearing protection for 12 to 16 hours per day. In a September 2017 statement, the Veteran argued that his March 2015 VA examination was inadequate as the VA examiner “did not know what [he] was telling her” when the Veteran explained his in-service acoustic trauma. When VA undertakes to provide a VA examination or to obtain a VA opinion, it must ensure that the examination or opinion is adequate. Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (stating that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Neither the June 2014 nor March 2015 VA examiners considered the Veteran’s credible statements that he was exposed to loud noise in the engine/boiler/machinery space on ships for 12 to 16 hours per day with no hearing protection during his military service. Additionally, the examiners did not consider his statements that he started to notice difficulty hearing more than 40 years prior to 2014. As such, the Board finds both nexus opinions to be inadequate for failing to consider the Veteran’s lay statements and his in-service acoustic trauma; therefore, a new opinion should be obtained upon remand. 2. Entitlement to service connection for tinnitus is remanded. The Veteran’s claim for service connection for tinnitus must also be remanded for further development. Both the June 2014 and March 2015 VA examiners noted that the Veteran had a current diagnosis of tinnitus, but that it was most likely related to the Veteran’s claimed bilateral hearing loss, and as bilateral hearing loss was found not related to service, tinnitus was also not related to service. As the issue of bilateral hearing loss is being remanded and it could have a direct and material impact on whether entitlement to service connection for tinnitus is warranted, the issues are inextricably intertwined, and the claim for service connection for tinnitus must also be remanded. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated); see also Rice v. Shinseki, 22 Vet. App. 447 (2009). As the Veteran is in receipt of VA treatment for his claimed conditions, updated treatment records should be obtained on remand. The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records from April 2018 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of bilateral hearing loss and tinnitus. The clinician must opine on the following questions: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss is related to an in-service injury, event, or disease, including in-service acoustic trauma during his time in the boiler/machine room on Navy ships without hearing protection? b) Is it at least as likely as not that the Veteran’s tinnitus is related to in-service acoustic trauma? c) Is it at least as likely as not that the Veteran’s tinnitus is caused or aggravated by (where aggravation is any increase in severity beyond the natural progress of the disability) his claimed bilateral hearing loss? For purposes of providing opinions on the above questions, the clinician must consider the Veteran’s statements regarding acoustic trauma in service and symptoms of hearing loss and tinnitus after service. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD LM Stallings, Associate Counsel