Citation Nr: 18149877 Decision Date: 11/14/18 Archive Date: 11/13/18 DOCKET NO. 16-49 750 DATE: November 14, 2018 REMANDED Entitlement to service connection for right ear hearing loss is remanded. Entitlement to an initial disability rating in excess of 10 percent for service-connected left ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1967 to August 1969. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). The RO denied service connection for hearing loss in the right ear on the basis that the Veteran’s VA audiological examination results did not demonstrate hearing loss for VA compensation purposes under 38 C.F.R. § 3.385. Likewise, the RO determined that the Veteran’s VA audiological examination results showed left ear hearing loss no worse than contemplated by a 10 percent disability rating under 38 C.F.R. § 4.85. The Veteran filed a timely notice of disagreement challenging these determinations. Initially, the Veteran argues that “a few years ago for disability, the VA said I had twenty percent loss in my left ear.” See October 2016 substantive appeal. It appears that the Veteran mistakenly believes that the 20 percent speech discrimination score recorded in the left ear at the August 2015 VA audiological examination automatically equates to a 20 percent disability rating. However, determining a schedular rating assigned to a hearing loss disability involves more than just the speech discrimination score. The Veteran stated in the October 2016 substantive appeal that his hearing in both the left and right ears has worsened in severity. When a veteran asserts that the severity of a disability has increased since the most recent rating examination, another examination may be required. VAOPGCPREC 11-95 (April 7, 1995); see also Snuffer v. Gober, 10 Vet. App. 400 (1997). A new VA examination may provide favorable evidence demonstrating hearing loss under 38 C.F.R. § 3.385 in the right ear to assist in evaluating entitlement to service connection; or more severe audiological findings in the left ear to warrant a higher disability rating under 38 C.F.R. § 4.85. In light of the Veteran’s statements expressing a subjective worsening of his disability, and given that it has been more than two years since his last examination, a remand for a new VA examination is warranted. Currently, the appellate record contains VA treatment records from July 2014 to September 2015, but do not include copies of the audiograms conducted at VA audiology visits in July 2014 and September 2015. These records note “See SPECIALTY APPLICATIONS under TOOLS, then AUDIOLOGY, then AUDIOGRAM DISPLAY,” but the audiograms themselves, and the Veteran’s puretone thresholds, are not visible. The RO is instructed to obtain this additional information, as well as any updated VA treatment records from September 2015 to present, including audiograms. The Board also observes that the September 2015 rating decision indicates that the RO reviewed and considered VA treatment records from the VA Medical Center Loma Linda (Jerry Pettis) facility dated from December 2011 through July 2015, yet the earliest VA treatments records in the electronic claims file are dated from July 2014. These missing VA treatment records must be obtained and reassociated with the electronic claims file upon remand. Additionally, there is a notation in the VA treatment records suggesting the Veteran’s healthcare is co-managed by Kaiser Permanente. The RO is requested to clarify with the Veteran whether he receives any relevant audiological treatment from Kaiser, and if so, the Veteran should be requested to provide the necessary authorizations to allow VA to obtain these private treatment records. The matters are REMANDED for the following action: 1. Reassociate with the electronic claims file the missing VA treatment records from the VA Medical Center Loma Linda (Jerry Pettis) facility dated from December 2011 to July 2015. 2. Obtain and associate with the electronic claims file the Veteran’s VA treatment records for the period of September 2015 to the present, including audiograms found under “SPECIALTY APPLICATIONS under TOOLS, then AUDIOLOGY, then AUDIOGRAM DISPLAY”. 3. Obtain and associate with the electronic claims file a copy of the July 2014 and September 2015 audiograms referenced in the Veteran’s VA treatment records. These records can be found under “SPECIALTY APPLICATIONS under TOOLS, then AUDIOLOGY, then AUDIOGRAM DISPLAY”. 4. Contact the Veteran and clarify whether he receives audiological treatment at Kaiser Permanente. If so, ask the Veteran to complete a VA Form 21-4142 for this provider. If the necessary authorization is received, make two requests for the authorized records from Kaiser Permanente unless it is clear after the first request that a second request would be futile. 5. Schedule the Veteran for a VA audiological examination to assess the current degree of hearing loss the Veteran experiences in both ears. ONLY IF hearing loss for a VA compensation purposes is found to exist in the Veteran’s right ear, should the examiner be requested to issue a medical nexus opinion on whether the Veteran’s right ear hearing loss is at least as likely as not (50 percent or greater probability) caused by, or otherwise etiologically related to, his active duty service. The examiner must provide a complete rationale for any opinion expressed that is based on the examiner’s clinical experience, medical expertise, established medical principles, and the evidence in the electronic claims file. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Galante, Associate Counsel