Citation Nr: 18142735 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 16-31 263 DATE: October 17, 2018 REMANDED Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to an evaluation in excess of 70 percent for service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from October 1981 to October 1985. A May 2016 statement of the case (SOC) denied the issues of service connection for hearing loss, service connection for tinnitus, and entitlement to a rating in excess of 70 percent for service-connected PTSD. The June 2016 VA Form 9 indicated the Veteran was only appealing the issues of service connection for tinnitus and hearing loss, but stated in the remarks section that he was entitled to a higher rating and discussed the severity of his PTSD. The RO certified all three issues to the Board, including the issue of entitlement to an increased rating for PTSD. See September 2016 VA Form 8. The Board finds the RO properly certified this issue to the Board under the circumstances. 1. Service connection for tinnitus 2. Service connection for bilateral hearing loss The Veteran contends his tinnitus and hearing loss are secondary to his service-connected PTSD. See November 2015 notice of disagreement (NOD) and June 2016 VA Form 9. The Veteran submitted medical articles supporting a relationship between PTSD and tinnitus. A medical opinion is needed to adequately address the Veteran’s contentions and supporting medical articles. In addition, the June 2014 VA examination found only right ear hearing loss disability. The claims file supports that the Veteran’s hearing loss has worsened bilaterally since the June 2014 examination. An audiological examination is needed to determine the severity of the Veteran’s hearing loss. 3. Entitlement to a rating in excess of 70 percent for PTSD Since the issuance of the May 2016 SOC, additional VA treatment records, additional Social Security Administration (SSA) records, and a January 2017 VA examination were added to the claims file. When additional evidence is received by the RO prior to transfer of records to the Board, an SSOC will be furnished unless the additional evidence received duplicates evidence previously of record or the additional evidence is not relevant to the issue on appeal. 38 C.F.R. §§ 19.31(b)(1), 19.37(a). VA treatment records received in August 2016 were received prior to the September 2016 transfer to the Board. The VA treatment records were relevant and not duplicative. In addition, there was no waiver of RO review for the VA treatment records, SSA records, and January 2017 VA examination received after transfer to the Board. Accordingly, a remand is appropriate for the issuance of a SSOC addressing the relevant evidence received after the issuance of the May 2016 SOC. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his tinnitus and bilateral hearing loss. The results of audiological testing must include, in numeric decibels, the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz and must provide speech recognition scores using the Maryland CNC test. The examiner must opine: (a.) Is it at least as likely as not (a 50 percent or greater probability) the Veteran’s tinnitus is (i) proximately due to or (ii) aggravated beyond its natural progression by his service-connected PTSD? (b.) Is it at least as likely as not the Veteran’s hearing loss is (i) proximately due to or (ii) aggravated beyond its natural progression by his service-connected PTSD? (c.) Is it at least as likely as not the Veteran’s hearing loss is (i) proximately due to or (ii) aggravated beyond its natural progression by his tinnitus? The examiner must address the Veteran’s contentions that increased stress causes his tinnitus to worsen, which causes his hearing loss to worsen. See November 2015 NOD and June 2016 VA Form 9. The examiner must also address the medical articles submitted by the Veteran in June 2016, “PTSD plus Tinnitus Make Everyday Noise Tough to Take,” “The Association between Tinnitus and PTSD,” “Questions and Answers About Tinnitus,” and “Multisensory impairment reported by veterans with and without mild traumatic brain injury impairment.” The examiner must provide a detailed rationale for any opinion expressed. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Readjudicate the issue of entitlement to a rating in excess of 70 percent for service-connected PTSD that considers the relevant evidence added to the claims file since the May 2016 SOC, to include updated VA treatment records, updated SSA records, and the January 2017 VA examination. Issue a SSOC and provide the Veteran with an opportunity to respond. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Winkler, Associate Counsel