Citation Nr: 18148659 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 12-30 668A DATE: November 8, 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 in the United States Air Force from April 1971 to April 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In September 2016, the Veteran withdrew his Board hearing request. 38 C.F.R. § 20.704(e). In December 2016, the Board remanded the claims for further development. 1. Entitlement to service connection for bilateral hearing loss is remanded. 2. Entitlement to service connection for tinnitus is remanded. Remand is necessary because the January 2017 VA examiner’s opinion is inadequate. The examiner opined that is it less likely than not that the Veteran’s bilateral hearing loss was caused by or a result of his military service. In support of her opinion, she relied on the presence of normal hearing at service separation with no significant threshold shifts. However, she did not address the Veteran’s in-service noise exposure due to his military occupational specialty in relation to his current hearing loss, relevant service treatment records, or the Veteran’s reports of hearing loss since service. Moreover, the examiner refuted the medical plausibility of delayed onset hearing loss based on an Institute of Medicine (IOM) study in 2005, indicating “that there was no scientific support for delayed onset noise- induced hearing loss,” and the United States Court of Appeals for Veterans Claims recently indicated that medical opinions citing this IOM report in this manner appear to misstate or incompletely contemplate the IOM report’s pertinent conclusions. See, e.g., Lemmons v. McDonald, No. 15-3043, 2016 LEXIS 1646 (Vet. App. October 28, 2016) (non-precedential); Bethea v. Derwinski, 2 Vet. App. 252 (1992) (single-judge memorandum decisions may be cited or relied upon for any persuasiveness or reasoning they contain). Thus, an addendum opinion is warranted on remand. Moreover, as the examiner has attributed the Veteran’s tinnitus to his hearing loss, action on this intertwined claim is deferred. The matter is REMANDED for the following action: Refer the claims file to an audiologist for preparation of an addendum opinion. The entire claims file should be made available to, and reviewed by the examiner. No additional examination is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current bilateral hearing loss had its onset in, or is otherwise related to service, to include as a result of conceded noise exposure therein. In addressing this question, please discuss: (a) any threshold shifts among the audiograms (see February 1976, October 1979, September 1984, and December 1990 service treatment records) and the December 1990 report of loss of hearing in his left ear; (b) conceded in-service noise exposure and the Veteran’s statements as to first noticing hearing loss during active duty; and (c) the IOM Report on noise exposure in the military (cited as authority in the January 2017 VA examination report), which states that it is “unlikely” that the onset of hearing loss begins years after noise exposure, but also states that “an individual’s awareness of the effects of noise on hearing may be delayed considerably after the noise exposure.” (Emphasis added). Please note that the absence of hearing loss pursuant to 38 C.F.R. § 3.385 during service cannot, standing alone, serve as a basis of a negative opinion. A complete rationale should be given for all opinions and conclusions expressed. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.S. Mahoney, Associate Counsel