Citation Nr: 18153679 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 14-14 844 DATE: November 28, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served in the Army from January 1988 to June 1994. This matter comes before the Board of Veterans Appeals (Board) through an appeal of the September 2012 rating decision by the Regional Office (RO). Previously, the Board remanded these issues to the RO in October 2015 for a new VA examination to provide an etiological opinion of the bilateral hearing loss and tinnitus and to issue a supplemental statement of the case. Since the October 2015 decision, the RO has obtained a new VA examination and issued a new supplemental statement of the case which considered the new evidence. As discussed further below, the Board finds the November 2015 VA examination to be inadequate. 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that her hearing loss was aggravated in service because she was exposed to hazardous noise from working as an animal care specialist. See VA 21-4138 dated November 2015. She asserts that even though her military occupational specialty (MOS) is considered to have low hazardous noise levels, her duty responsibilities included increased noise exposure due to the loud sounds and piercing noises made by the dogs, pigs, sheep, and monkeys that she studied as part of her research. She further asserts that she only wore protective gear on occasion and that it did not filter out 100 percent of the noise. See VA 21-4138 dated July 2011; VA 21-4138 dated November 2015; Letter from the Veteran dated December 2014. The Veteran underwent a VA examination in November 2015. The examiner reviewed the evidence in the claims file and addressed the Veteran’s lay statements. See VA Examination dated November 2015. The examiner opined that the Veteran’s hearing loss was not within normal limits at the entrance examination and that there were no permanent, positive, standard threshold shifts bilaterally. The examiner further opined that there is no objective evidence of acoustic trauma and that the Veteran’s MOS was of “low probability” of hazardous noise exposure under the Duty MOS Noise Exposure Listing. The examiner further stated that while the Veteran reported noise exposure in the kennels, hearing protection was provided and worn in the kennels. Therefore, the VA examiner opined that the Veteran’s bilateral hearing loss was less likely than not caused by service. The Veteran’s entrance examination in January 1988 noted mild hearing loss with pure tone threshold, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 30 30 20 LEFT 10 10 25 30 15 The Veteran’s separation examination indicates a change in her hearing, albeit a small change. See Service Treatment Records dated March 1994. In March 1994, the audiometer examination noted mild hearing loss with pure tone threshold, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 30 30 25 LEFT 15 15 20 30 10 The Veteran’s audiogram readings from the entrance examination and the separation examination indicate a change in the Veteran’s hearing. However, the November 2015 VA examiner did not provide an adequate explanation as to why this change does or does not support a claim for service connection for bilateral hearing loss. Therefore, the Board finds that the VA examination is inadequate and that an addendum opinion is necessary to address the shift in the Veteran’s hearing. 2. Entitlement to service connection for tinnitus is remanded. The Veteran contends that her tinnitus developed through her work in service as an animal care specialist. She asserts that her MOS contributed to her developing tinnitus because it exposed her to hazardous noises in the performance of her daily duties. See VSO IHP dated October 2018. The Board finds that the claim for service connection for tinnitus is inextricably intertwined with the above claim because the examiner for the November 2015 VA examination opined that the Veteran’s tinnitus was at least as likely as not a symptom of the Veteran’s hearing loss. See VA Examination dated November 2015; Anglin v. West, 11 Vet. App. 361, 367 (1998). Therefore, this matter is remanded. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA treatment records dating, as well as any pertinent, outstanding private treatment records and associate them with the file. 2. After associating any outstanding records, obtain an addendum opinion regarding the Veteran’s bilateral hearing loss and tinnitus. The claims file and a copy of this REMAND must be made available to the reviewing examiner, and the examiner shall indicate in the addendum report that the claims file was reviewed. The examiner must opine as to whether there is clear and unmistakable evidence that any bilateral hearing loss preexisted service and, if so, whether there is clear and unmistakable evidence that it was not aggravated by service. In rendering the opinion, the examiner must address the shift in the Veteran’s hearing loss from the entrance examination to the separation examination. Specifically, the examiner must indicate whether any preexisting hearing loss was aggravated beyond its natural progression by service. The examiner must include consideration of the Veteran’s lay statements and MOS. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If any opinion and supporting rationale cannot be provided without resorting to speculation, please state the reason why speculation would be required (e.g., if the requested determination is beyond the scope of current medical knowledge, actual causation cannot be selected from multiple potential causes, etc.). 3. Thereafter, readjudicate the issues on appeal. If the benefits sought remain denied, furnish to the Veteran and her representative a Supplemental Statement of the Case and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Bognar, Associate Counsel