Citation Nr: 18149940
Decision Date: 11/14/18	Archive Date: 11/14/18

DOCKET NO. 15-42 810A
DATE:	November 14, 2018
REMANDED
Entitlement to service connection for tinnitus is remanded.
REASONS FOR REMAND
The appellant is a Veteran who served on active duty from February 1952 to February 1956.  This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 Department of Veterans’ Affairs (VA) rating decision.
Service connection for tinnitus is remanded.
The Veteran contends that he has tinnitus due to exposure to noise in service or secondary to his service connected bilateral hearing loss. His military occupational specialty (MOS) was as a clerk; however, he reported exposure to hazardous level noise in service during a construction course therein.  The course is noted on his DD Form-214, and his exposure to such noise may reasonably be conceded.  
Tinnitus was not noted in service or clinically noted for decades after service.  On multiple occasions (including on November 2009 private examination and on several VA examinations, most recently in May 2015) the Veteran denied having tinnitus (he has since indicated in a statement that he did not know what tinnitus was).  Notably, he has not identified when he first noted any tinnitus.  He claims that his tinnitus is secondary to his hearing loss.  He has established service connection for hearing loss.  While, he had denied having tinnitus in the past, given that he now reports having tinnitus (and that the diagnosis of tinnitus is based on self-reports), he may now reasonably be conceded that he has such disability.  Whether a disability such as tinnitus is etiologically related to (was caused or aggravated by) another disability such as hearing loss is a medical question.  There is no medical opinion in the record that addresses that question (as previously the Veteran had denied that tinnitus was a problem).  Under such circumstances VA’s duty to assist requires development for a medical opinion that addresses the unresolved medical question.  
The matter is REMANDED for the following:
Arrange for the Veteran’s record to be forwarded to an appropriate clinician (audiologist or otologist) for review and a medical advisory opinion of his reported tinnitus.  [If further examination or interview of the Veteran is deemed necessary, such should be arranged.]  The consulting provider should respond to the following:  
Please identify the likely etiology for the Veteran’s reported tinnitus.  Is it at least as likely as not that it is etiologically related to his service (to include as due to exposure to noise during a construction course therein)?  If not, is it at least as likely as not that it is secondary to (was caused or aggravated by) the Veteran’s service-connected bilateral hearing loss disability.
Please include complete rationale with the opinion offered.  If the opinion is to the effect that the tinnitus was not incurred in service and not caused or aggravated by a service-connected disability, please identify the etiology considered more likely, and include some discussion of the basis for dissociating the tinnitus from the service-connected hearing loss. 
 
GEORGE R. SENYK
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. Robert Cordingley, Associate Counsel