Citation Nr: 18142310 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 18-20 689 DATE: October 15, 2018 REMANDED The issue of entitlement to service connection for bilateral hearing loss is remanded. The issue of entitlement to service connection for tinnitus is remanded. The issue of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to April 1971. This matter is before the Board following his appeal of February 2015 and April 2018 rating decisions. Although the Board regrets the delay, additional development is necessary prior to adjudication of the Veteran’s claims of entitlement to service connection for bilateral hearing loss and tinnitus, and a TDIU. 1. The issues of entitlement to service connection for bilateral hearing loss and tinnitus are remanded. Here, a November 2014 VA examiner diagnosed the Veteran with bilateral hearing loss for VA purposes but concluded that the hearing loss was less likely than not caused by or a result of the Veteran’s in-service noise exposure. In support of that conclusion, the examiner cited, in part, the “clinically normal hearing” documented in the Veteran’s December 1970 Medical Evaluation Board examination report. However, the Board observes that the December 1970 examination report shows pure tone thresholds of 25 decibels in the right and left ears at 4000 Hertz, which is indicative of some degree of hearing loss. Indeed, in December 1970, there was a 10-decibel shift at 4000 Hertz in the right ear when compared to the Veteran’s February 1969 pre-induction examination. Moreover, hearing loss need not be shown in service for service connection to be established; rather, service connection may be established for a current hearing disability with evidence that the current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 160 (1993); see also 38 C.F.R. § 3.303(d). The November 2014 examiner also cited to other potential causes for the Veteran’s hearing loss, including hereditary factors and post-service noise exposure. However, the examiner did not identify any history of post-service noise exposure or familial hearing loss. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (“The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion.”). In view of the foregoing deficiencies, the Board finds that an additional VA examination is needed on remand. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (once VA undertakes the effort to provide an examination when developing a service-connection claim, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). In finding that an additional VA examination is needed, the Board acknowledges that the record also includes an August 2018 statement from a private physician, who stated that the Veteran had complained of earaches, hearing loss, and tinnitus since service, and asserted that the Veteran’s “SENSORIAL…DISORDERS ARE MORE PROBABLE THAN NOT SECONDARY TO HIS MILITARY SERVICE PERFORMANCE.” However, the physician did not explain why he reached that conclusion, or address the clinical evidence showing routine denials of tinnitus. Thus, his statement does not form a sufficient basis on which to grant service connection for hearing loss or tinnitus, and a remand is still required. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). The Board also observes that there are outstanding VA treatment notes, including those related to the Veteran’s initial audiology visit at VA. Thus, all relevant treatment records should be obtained on remand. 2. The issue of entitlement to a TDIU is remanded. As the outcome of the Veteran’s pending service connection claims may affect the outcome of his claim of entitlement to a TDIU, a final decision on the TDIU claim would, at this point, be premature. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). Thus, the issue of entitlement to a TDIU must also be remanded. The matter is REMANDED for the following action: 1. Obtain (1) any outstanding relevant VA treatment notes dated since service and prior to April 2011; (2) any relevant records viewable in Tools/Audiogram Display, Vista Imaging, or any similar viewing tool, to specifically include the full results of the audiograms conducted during VA treatment since service; and, (3) any outstanding VA treatment records (including any relevant records available via the above viewing tools) dated since July 2018. 2. Schedule the Veteran for a VA audiological examination. The claims file must be reviewed by the audiologist in conjunction with the examination. Any tests or studies deemed necessary should be conducted and the results reported in detail. The audiologist should consider both ASA values and values converted from ASA to ISO-ANSI units for the February 1969 in-service audiogram. Following review of the claims file and examination of the Veteran, the audiologist should respond to the following: (a) Is it at least as likely as not (50 percent probability or more) that the Veteran’s bilateral hearing loss or tinnitus began during or is otherwise related to his period of active duty service, to include his conceded in-service acoustic trauma, or that a hearing loss or disability or tinnitus manifested within a year of his separation from service? Please explain why or why not, specifically addressing whether the STRs support an overall decline in hearing loss in service, even if they do not show a hearing loss disability for VA purposes. (b) If bilateral hearing loss is found to be related to service, please state whether the Veteran’s tinnitus is at least as likely as not a symptom of his hearing loss disability. Please note that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. (Continued on the next page)   A complete rationale for the opinion rendered must be provided. If you cannot provide the requested opinion without resorting to speculation, please expressly indicate this and explain why that is so. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Fagan, Counsel