Citation Nr: 18152853
Decision Date: 11/27/18	Archive Date: 11/26/18

DOCKET NO. 12-33 338
DATE:	November 27, 2018
REMANDED
The issue of service connection for bilateral hearing loss is remanded.
REASONS FOR REMAND
Service connection for bilateral hearing loss is remanded.
In November 2017, the Board remanded this issue for a VA medical opinion that considered the implications of a worsening in hearing loss from the November 1968 pre-induction examination to the October 1970 separation examination when converted from American Standards Association (ASA) to International Standards Organization – American National Standards Institute (ISO) units.  In the January 2018 examination, the examiner wrote: 
VBA has issued guidance to assume all audios prior to 10/31/67 are ASA and to consider both ASA and ISO for any exam prior to 1969 in which no designation is made. VBA states safe to assume any exam after 1969 would be ISO. Following this guideline that 1968 exam would be ASA, as it is designated, and the 1970 exam is ISO.
In March 2017, the Board issued guidance which states that unless a standard is clearly indicated, when considering service department audiograms conducted prior to January 1, 1967 assume the use of ASA standards, between January 1, 1967 and December 31, 1970 consider both ASA and ISO standards, after December 31, 1970 assume the use of ISO standards. Based on the Board’s most-recent guidance, the Veteran’s October 1970 examination cannot be assumed to be in ISO or ASA standards.  The examiner’s rationale is inadequate to comply with the Board’s prior remand directives and the current guidance.  Remand is needed for an addendum opinion consistent with the Board’s directives.  If the examiner cannot determine which unit was used in the October 1970 examination, 
the examiner should assume ASA standards were used and convert the evaluation to ISO units as this outcome shows a worsening in hearing and is more favorable to the Veteran.
The matter is REMANDED for the following action:
Obtain an addendum medical opinion for the Veteran’s hearing loss claim.  An appropriate examiner should review this remand and the Veteran’s claims file and address the following:
Is the Veteran’s hearing loss at least as likely as not related to his established in-service noise exposure?
**When considering all pertinent lay and medical evidence, review the October 1970 audiological examination, if you can determine from the records whether ASA or ISO standards were used, explain how.  If you cannot determine which standards were used, then assume the evaluation used ASA standards and convert to ISO.  Additionally, consider the Veteran’s statements that hearing problems began at the time of service.**  
All opinions must be supported by a comprehensive rationale.  If the opinion cannot be provided without resort to speculation, the examiner should explain why and state whether the inability is due to the absence of evidence or limits of scientific or medical knowledge.
 
Paul Sorisio
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A.P. Armstrong