Citation Nr: 18152223 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-45 062 DATE: November 21, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1971 to April 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. 1. Entitlement to service connection for bilateral hearing loss is remanded. A review of the record reflects that further development of this claim is necessary prior to appellate consideration. Where, as here, VA undertakes to provide an examination or obtain an opinion when developing a claim, even if not statutorily obligated to do so, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bolton v. Brown, 8 Vet. App. 185, 191 (1995) (emphasizing the Board’s duty to return an inadequate examination report “if further evidence or clarification of the evidence... is essential for a proper appellate decision”). The Veteran was provided with a VA audiological examination in February 2016. Report of the February 2016 VA examination reflects, in pertinent part, a notation by the examiner that he could not read Veteran’s military occupational specialty (MOS), but the examiner noted his military decorations include a combat action ribbon. The Veteran reported significant noise exposure as a result of the ships cannons and engines. The Veteran was diagnosed with bilateral sensorineural hearing loss. The examiner opined that it is not at least as likely as not that the Veteran’s bilateral hearing loss is caused by or a result of service. In doing so, the examiner indicated that the Veteran’s MOS is low-risk for noise exposure, and that there is no documentation for significant threshold shift in service. He noted a history of kidney disease, diabetes mellitus, and tobacco use. He also noted a family medical history of hearing loss. The examiner opined that the Veteran’s hearing loss is more likely than not a result of his current physical condition. No further opinion or rationale was provided. The examiner who prepared the February 2016 VA examination provided an addendum medical opinion in August 2016. The examiner noted that in-service noise exposure is conceded in light of the Veteran’s combat action ribbon. Notwithstanding, the examiner opined that the Veteran’s bilateral hearing loss is less likely than not incurred in or caused by noise exposure in service. In doing so, the examiner noted that the Veteran’s service treatment records (STRs) did not note any audiological findings from which to determine a threshold shift. Thus, the nexus between the Veteran’s current bilateral hearing loss and service cannot be made at this time. First, the examiner’s statement that “the nexus between the Veteran’s current bilateral hearing loss and service cannot be made at this time” creates ambiguity (even when considering the report as a whole) as to whether any additional evidence would permit such an opinion to be made. Additionally, it creates ambiguity as to whether the examiner is retracting his prior opinion that the Veteran’s hearing loss is more likely than not a result of his current physical condition. Under the surrounding circumstances, the VA examiner’s failure to provide an adequate rationale for any of the opinions offered is significant. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Here, the Board is strained to make assumptions and draw inferences as to the examiners’ reasoning. Second, the examiner’s apparent focus on the lack of audiological data at separation tends to disregard all of the available evidence of record, including post-service medical treatment records dated between December 1993 and February 2016 establishing a medical history. See generally Bolton, 8 Vet. App. at 191. For instance, medical treatment records dated in November 1994 reflects the Veteran’s hearing is “good.” Medical treatment records dated in November 2001 reflect the Veteran’s hearing is within normal limits. The first evidence of hearing impairment, other than the Veteran’s statements, is medical treatment records dated in January 2004 reflecting “decreased hearing.” The Board finds that a medical examination and opinion adequately commenting on the evidence of record is necessary in order to adjudicate the claim. The matter is REMANDED for the following action: 1. Obtain all relevant outstanding post-service medical treatment records from VA treatment facilities. 2. Thereafter, arrange for the examiner who prepared the February 2016 VA examiner, if available, to prepare an addendum opinion as to the nature and etiology of the Veteran’s diagnosed bilateral hearing loss, and if deemed necessary, conduct a new examination of the Veteran. The electronic claims file must be made accessible to the examiner for review, and such review should be noted in the examination report. Following a review of the claims file and medical history, the VA examiner must offer an opinion as to the following: (a.) Whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s bilateral hearing loss is caused by or a result of the Veteran’s military service. The Board notes that the Veteran has been awarded a combat action ribbon. As such, the Veteran’s in-service noise exposure is conceded. Any opinion rendered should reflect consideration of the Veteran’s statements regarding symptomatology, the Veteran’s pertinent medical history, and discuss the February 2016 medical opinion. The examiner must provide a rationale for all opinions provided. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. (Continued on the next page)   3. Thereafter, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, issue a supplemental statement of the case (SSOC) and provide the Veteran and his representative with an opportunity to respond. Then return the case to the Board, if otherwise in order. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Kalolwala, Associate Counsel