Citation Nr: 18143130 Decision Date: 10/18/18 Archive Date: 10/17/18 DOCKET NO. 15-04 262 DATE: October 18, 2018 REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran had active duty service in the U.S. Air Force from November 1972 to November 1976. Entitlement to service connection for left ear hearing loss and/or tinnitus. The Veteran seeks entitlement to service connection for left ear hearing loss and/or tinnitus. Essentially, he claims that he was exposed to in service acoustic trauma, which ultimately resulted in his hearing loss and tinnitus. For the purpose of applying the laws administered by the VA, impaired hearing is considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000 or 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 decibels or greater; or when speech recognition scores utilizing the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2017). The Board observes that the Veteran’s military occupational specialty is listed as Electronic Communications and Crypto Equipment Repairman. The Veteran’s September 1972 entrance examination revealed the following results: Frequency 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz Left 10 5 0 - 10 Right 15 5 5 - 0 The Veteran’s December 1975 separation examination revealed the following results: Frequency 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz Left 10 5 5 10 10 Right 20 5 5 10 10 The Veteran’s service treatment records are otherwise silent as to any audiological problems. The Veteran received a VA examination for hearing loss and tinnitus in September 2012. Audiological testing revealed the following results: Frequency 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz Left 15 15 10 20 40 Right 15 15 10 10 25 Additionally, Maryland CNC Speech Discrimination testing yielded scores of 96 percent for the left ear and 94 percent for the right ear. The VA examiner diagnosed the Veteran with left ear hearing loss and tinnitus. A negative etiological opinion was provided. However, the VA examiner noted that she did not have access to the Veteran’s service treatment records. An addendum opinion was obtained in March 2013. The VA examiner noted that he had reviewed the entirety of the Veteran’s electronic claims file. Curiously, the VA examiner diagnosed the Veteran with bilateral hearing loss, despite the results of the September 2012 VA examination, which only show hearing loss for VA purposes in the left ear. See 38 C.F.R. § 3.385. Nevertheless, the VA examiner noted that the Veteran’s service treatment records show no significant decrement in hearing between his entrance and separation examinations. The examiner opined that it is less likely than not that the Veteran’s hearing loss and tinnitus are related to military service and referenced a report from The Institute of Medicine in support of his rationale. The Board observes a July 2013 report from the Veteran’s private provider, Dr. Weinstock. In the report, Dr. Weinstock stated that the Veteran reported a history of bilateral tinnitus which began prior to him leaving the military, with associated hearing loss. In a September 2018 Informal Hearing Presentation, the Veteran and his representative challenged the adequacy of the previous VA examinations and opinions. Given the Veteran’s statements and the significant time period since the Veteran’s previous VA examination, the Board finds that a new VA audiological examination would be of considerable assistance in determining his claim. The Board notes it is unclear whether the Veteran has received ongoing medical treatment for his claimed hearing loss and tinnitus. Notably, the latest available or pertinent treatment records are from a long time ago. Any outstanding treatment records for the Veteran’s claimed disability would help shed light on his claim. Therefore, VA should obtain all relevant treatment records. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. With the assistance of the Veteran as necessary, identify and obtain any outstanding, relevant treatment records and associate them with the Veteran’s electronic claims file. If the Agency of Original Jurisdiction (AOJ) cannot locate or obtain such records, it must specifically document the attempts that were made to locate or obtain them, and explain in writing why further attempts to locate or obtain any government records would be futile. The AOJ must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. All attempts to obtain records should be documented in the Veteran’s electronic claims file. 2. Then, after pertinent records are obtained, but whether or not records are obtained, schedule the Veteran for a VA examination with an audiologist to determine the nature and etiology of the Veteran’s claimed hearing loss and tinnitus. The audiologist is to be provided access to the Veteran’s electronic claims file. The audiologist is requested to review all pertinent records associated with the claims file, the Veteran’s service treatment records, post-service medical records, and the Veteran’s own assertions. Any indicated diagnostic tests and studies should also be accomplished. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology and in-service noise exposure. If there is a medical basis to support or doubt the history provided by the Veteran, the audiologist should provide a fully reasoned explanation. The VA audiologist must opine whether it is at least as likely as not, i.e., is there a 50/50 chance, that any hearing loss and/or tinnitus manifested in-service or is otherwise causally or etiologically related to his military service, to potential in-service noise exposure. The significance, if any between recorded findings on entrance and separation should be discussed, even though the hearing was essentially normal at separation. It should be indicated whether the recorded change suggests the early onset of hearing loss. It should also be indicated whether any hearing loss found and/or tinnitus is the type typically seen in cases of acoustic trauma, or is more likely due to advancing age, infection, or other cause. All prior reports (including the July 2013 report from Dr. Weinstock) should be reconciled, as necessary. 3. After the development requested has been completed, the AOJ should review any report to ensure that it is in complete compliance with the directives of this remand.   If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Miller, Associate Counsel