Citation Nr: 18154316
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 17-32 609
DATE:	November 29, 2018
REMANDED
1. Entitlement to service connection for bilateral hearing loss is remanded.
2. Entitlement to service connection for tinnitus is remanded.
REASONS FOR REMAND
The Veteran served on active duty from October 1966 to December 1969.
The Veteran is seeking service connection for hearing loss and tinnitus which he believes are the result of his military noise exposure.  The Veteran wrote that during service he flew many air medevac missions and otherwise spent a tremendous amount of time on the flight line without adequate hearing protection.  On multiple occasions immediately following certain air medevac missions, he recalled experiencing a temporary total hearing loss that would last for two to three days.  He recalled speaking to his commanding officer and a medical officer about this, but nothing appears to have been documented. 
At his separation physical in December 1969, audiometric testing showed normal hearing.  After service, the Veteran worked in a hospital setting of cardiological care unit and has not engaged in any recreational activities that would expose him to loud noises.  
In June 2016, the Veteran underwent a VA examination to determine the nature and etiology of the Veteran’s hearing loss and tinnitus.  The examiner confirmed bilateral sensorineural hearing loss disability for VA purposes, but noting no positive permanent threshold shift in his hearing acuity during service and the absence of hearing loss until later years, the examiner concluded that the Veteran’s bilateral hearing loss was less likely than not related to service.
However, based on the pattern of audiogram, speech discrimination scores, and stapedial reflex results, the audiologist opined that the Veteran may have Meniere’s Syndrome and recommended an evaluation for it.  Unfortunately, this does not appear to have been done.
The matters are REMANDED for the following action:
1. Schedule the Veteran for a VA examination.  The examiner should determine whether the Veteran has Meniere’s disease and if so should answer the following questions:
a)	Is it at least as likely as not (50 percent or greater) that the Veteran’s Meniere’s disease either began during or was otherwise caused by his military service, to include as a result of military noise exposure therein?  Why or why not? 
b)	Is it at least as likely as not (50 percent or greater) that the Veteran’s Meniere’s disease caused his hearing loss?  Why or why not? 
c)	Is it at least as likely as not (50 percent or greater) that the Veteran’s Meniere’s disease aggravated (made worse) his hearing loss?  Why or why not? 
If aggravation is found, the examiner should identify a baseline level of severity of the hearing loss by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the hearing loss. If such cannot be done, it should be explained why.
d)	Is it at least as likely as not (50 percent or greater) that the Veteran’s Meniere’s disease caused his tinnitus?  Why or why not? 
e)	Is it at least as likely as not (50 percent or greater) that the Veteran’s Meniere’s disease aggravated (made worse) his tinnitus?  Why or why not? 
 
MATTHEW W. BLACKWELDER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Bardin, Associate Counsel