Citation Nr: 18149805 Decision Date: 11/14/18 Archive Date: 11/13/18 DOCKET NO. 16-35 701 DATE: November 14, 2018 REMANDED The claim of entitlement to service connection for bilateral hearing loss is remanded. The claim of entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran had active service from August 1966 to August 1968. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Veteran contends that his current bilateral hearing loss and tinnitus are a result of his active service. The Veteran’s service treatment records are negative for hearing loss. Specifically, the Veteran’s June 1968 separation examination shows normal hearing and in a June 1968 report of medical history, the Veteran denied “hearing loss.” However, in the June 1968 report of medical history, the Veteran did report a history of “ear, nose, or throat trouble.” The earliest evidence of hearing loss/tinnitus currently in the claims file is the Veteran’s May 2013 claim for service connection. In connection with the claim, the Veteran was afforded a VA audiological examination in March 2014. Significantly, this examination shows that the Veteran has bilateral hearing loss for VA purposes as well as tinnitus. However, the examiner opined that the Veteran’s hearing loss and tinnitus were less likely than not caused by in-service acoustic trauma and were more likely than not caused by post-service noise exposure. In reaching this conclusion, the examiner relied in part on findings from a March 2010 audiology examination, and the Veteran’s statements during that examination, which is not of record. VA treatment notes from 2015, when the Veteran was fitted with hearing aids, also reference the 2010 pure tone thresholds, which are not of record. In his substantive appeal, the Veteran argued that the post-service noise exposure he experienced was only that of an acoustic guitar and mandolin, and he believes those could not cause the hearing loss and/or tinnitus he experiences. Additionally, the Veteran argued that the March 2014 VA examination was not adequate due to a lack of sufficient consideration and detailed discussion of his noise exposure during service as an infantryman. A remand is necessary to obtain and incorporate any outstanding medical records, to include the 2010 audiological examination referenced in the March 2014 VA opinion. Additionally, on remand, VA must obtain a medical opinion considering the acoustic trauma the Veteran described both in training and as an infantryman. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. Contact the Veteran to determine whether there are any additional relevant private treatment records and obtain any necessary authorizations for such records. 2. Return the claims file, to include a copy of this remand, to the examiner who conducted the March 2014 VA audiological examiner to render an opinion on the etiology of the Veteran’s hearing loss and tinnitus. If that examiner is no longer available, make the claims file available to another qualified examiner. The examiner should review the claims file and indicate such on the examination report. The Veteran may be recalled for examination if deemed necessary. The following questions should be addressed: Is at least as likely as not that the Veteran’s hearing loss and tinnitus are related to his military service in the context of his pertinent history. For purposes of presenting this opinion, the examiner is to assume as true the Veteran’s reported history of repeated exposure to the noise of small arms and hand grenades while stationed at the Korean DMZ (demilitarized zone). A complete rationale for any opinion expressed must be provided. An examiner’s report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide the opinion is based on the limits of medical knowledge. (Continued on the next page)   2. Readjudicate the appeal. APRIL MADDOX Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.E. Lee, Associate Counsel