Citation Nr: 18146928 Decision Date: 11/02/18 Archive Date: 11/01/18 DOCKET NO. 16-15 402 DATE: November 2, 2018 REMANDED 1. Service connection for bilateral hearing loss is remanded. 2. Service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from January 13, 1976 through May 2, 1977. The Veteran’s DD Form 214 reflects that his military occupational specialty (MOS) was surface-to-air missile crewman, which is considered to have a high probability of noise exposure. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a February 2, 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete and accurate record upon which to decide the Veteran’s claims so that every possible consideration is afforded. The Board cannot make a fully-informed decision on the claim at this time because the record does not include an opinion that adequately addresses the facts and circumstances presented by the Veteran’s case. Service connection for bilateral hearing loss VA must provide a veteran with a medical examination and opinion when it is necessary to decide a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). Whenever VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). An adequate examination requires that the examiner be fully cognizant of a veteran’s past medical history. Id. Here, the VA examiner opined after a January 12, 2014 examination that the Veteran’s hearing loss was not the result of noise exposure during military service. The examiner also noted that service treatment records indicated the Veteran entered the military with a mild sensitivity loss at 1,000 Hz in the left ear (enough for the Army examiner to consider the Veteran’s hearing defective). The Veteran apparently exited the military with normal hearing at 1,000 Hz in the left ear, experiencing a 10 dHL hearing improvement through the course of his service. The examiner rationalized this apparent improvement by explaining the Veteran’s improved hearing was “likely in[sic] conductive or mixed hearing loss,” which she then further opined was not caused by acoustic trauma. This opinion does not provide the Board with the required information to adjudicate the claims. The opinion does not include an explanation (nor is data provided) as to why the examiner ruled out an in-service event, injury or disease other than exposure to acoustic trauma. Even assuming the Veteran was not exposed to requisite amounts of acoustic trauma, the examiner did not adequately explain the opinion that it was less likely than not that the Veteran’s hearing loss was caused by an in-service event, injury or disease. In addition, the examiner neglected to consider and opine on other potential causes of hearing loss that may have occurred during service. Notably, the examiner did not consider the Veteran’s statement that he experienced ear pain during a flight to Fort Bliss from Dallas, Texas for basic training. In reviewing the Veteran’s service records, the Board has found the Veteran’s service treatment records to indicate the following: Entrance Exam: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 15 N/A 15 LEFT 10 30 25 N/A 15 Exit Exam: HERTZ 500 1000 2000 3000 4000 RIGHT 30 15 15 N/A 25 LEFT 25 20 25 N/A 20 The Board acknowledges there is some discrepancy in interpreting the original service treatment records as to whether the Veteran presented with hearing at 15 dHL at the 4,000 HZ range or 25 dHL at the 4,000 HZ range during his 1977 exit exam. This is a result of the poor condition of the photocopy of the original document as well as the ambiguous handwriting of the original document. Given the Veteran’s MOS and likelihood of exposure to loud noise during service, the Board gives the Veteran the benefit of the doubt and resolves the audio test ambiguity in favor of the Veteran. To be clear, service treatment records indicate—and the VA examiner acknowledged—that the Veteran experienced at least some degree of hearing loss during service within low frequency ranges in both ears. The Board also finds that the Veteran arguably experienced a degree of hearing loss in the higher frequency range in both ears. Further, service treatment records note scarring on the Veteran’s left tympanic membrane was observed during a visit to the doctor on February 21, 1976—a fact which was never addressed in the 2014 VA examination. Given that several pertinent facts were not considered in the 2014 VA examination, the Board seeks to further clarify whether the Veteran’s current bilateral hearing loss is as likely as not related to an in-service injury, event, or disease. Service connection for tinnitus The VA examiner’s opinion with respect to the Veteran’s tinnitus is also problematic because it reflects only consideration of tinnitus as secondary to his bilateral hearing loss and, therefore, does not consider all theories of entitlement to service connection (such as whether tinnitus may be directly caused by service, not only whether it was caused or aggravated by hearing loss). See Combee v. Brown, 54 F.3d 1039, 1043-44 (Fed. Cir. 1999). Because a remand is required, the Board requests that any opinion that VA obtains also address this issue. Accordingly, a remand is necessary to obtain a new opinion. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and likely cause of the Veteran’s bilateral hearing loss and tinnitus. The entire claims file and a copy of this remand order must be made available to the examiner. The examiner must note in the report that the evidence in the claims file has been reviewed. (a.) Is it at least as likely as not that the Veteran’s current bilateral hearing loss is related to an in-service injury, event, or disease, taking into consideration the high likelihood of in-service acoustic trauma, the Veteran’s competent and credible report of ear pain while experiencing altitude change during air travel from Dallas, Texas to basic training at Fort Bliss, and the in-service treatment records noting scarring on his left tympanic membrane. (b.) Is it at least as likely as not that the Veteran’s current tinnitus is related to an in-service injury, event, or disease, taking into consideration the high likelihood of in-service acoustic trauma, the Veteran’s competent and credible report of ear pain while experiencing altitude change during air travel from Dallas, Texas to basic training at Fort Bliss, and the in-service treatment records noting scarring on his left tympanic membrane. Please note that the term “at least as likely as not” does not mean “within the realm of medical possibility.” Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor it as it is to find against it. [CONTINUED ON NEXT PAGE] A detailed explanation (rationale) is requested for all opinions provided. By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in further clarification being requested. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. B. Kucera, Associate Counsel