Citation Nr: 18155289 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 14-35 362A DATE: December 4, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus, to include as secondary to bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1966 to May 1969 in the United States Air Force to include active duty service in the Republic of Vietnam. 1. Entitlement to service connection for hearing loss is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for bilateral hearing loss because no VA examiner has opined whether the Veteran clearly and unmistakeably had a hearing loss disability that preexisted active duty service. On the Veteran’s November 2011 VA examination the examiner checked the box indicating that the Veteran had hearing loss that existed prior to service. The examiner then stated that the Veteran’s entrance examination showed mild left ear hearing loss at the 6000Hz level and that hearing loss was not aggravated beyond its natural progression by active duty service, despite acknowledging the Veteran’s in-service noise exposure as a jet mechanic without the use of adequate hearing protection. The VA examiner contradicts this finding, however, by checking the “yes” box in response to the question of whether prexisiting left ear hearing loss was aggravated beyond its natural progression by service. Furthermore, the examiner offers no opinion as to whether the Veteran’s right ear hearing loss was etiologically related to active duty service. It’s unclear whether the examiner was reviewing the correct service examination when addressing a pre-existing hearing loss. The Veteran’s service treatment records (STRs) show that the 1966 entrance examination for active duty is silent for any hearing loss disability in the “Summary of defects and diagnoses” portion. The report of an April 1977 examination for “enlistment” in the Reserves includes audiometric findings that show some change from 1099, but again, no pertinent defects or diagnoses are noted. The burden is on VA to rebut the presumption of soundness by clear and unmistakable evidence that the Veteran’s left ear hearing loss both preexisted and was not aggravated by service. Wagner v. Principi, 370 F. 3d 1089 (Fed. Cir. 2004). Thus, a new medical opinion is needed. The Board acknowledges the positive private medical opinions of record. However, these opinions are contradictory. The first appears to acknowledge the existence of some left ear hearing impairment prior to active duty service but then, in an addendum, states that there was no history of hearing loss prior to active duty service. It is unclear what information the private physician is relying on to make these conclusions as the Veteran’s STRs are not referenced. The second opinion does not address whether hearing loss was preexisting and provides an opinion on direct service connection. While the Board acknowledges the probative value of these opinions the outstanding question of whether there was any preexisting hearing loss disability must be addressed to fully adjudicate the claim. 2. Entitlement to service connection for tinnitus is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to servicec connection for tinnitus because no VA examiner has opined whether the Veteran’s tinnitus is caused or aggravated by his bilateral hearing loss. Finally, because a decision on the remanded issue of service connection for bilateral hearing loss could significantly impact a decision on the issue of entitlement to service connection for tinnitus, to inlcude as secondary to hearing loss, the issues are inextricably intertwined. A remand of the claims for service connection for tinnitus is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hearing loss and tinnitus. The examiner must opine as to the following: (a) Did the Veteran’s hearing loss clearly and unmistakably (i.e., it is undebatable) exist prior to his active service that began in 1966? The examiner should consider and discuss as necessary the 1966 enlistment examination and related Report of Medical History. (b) If the answer to (a) is yes, does the evidence clearly and unmistakably show (i.e., it is undebatable) that the hearing loss was not aggravated by service or that any increase in disability was due to the natural progression of the condition? Please identify such evidence with specificity. (c) If the answer to either (a) or (b) is no, is it at least as likely as not that the Veteran’s hearing loss had its onset in service? (d) Is at least as likely as not that any currently diagnosed tinnitus has its onset in service? (e) If the answer to (d) is no, is it at least as likely as not that any diagnosed tinnitus is caused or aggravated by the Veteran’s hearing loss disability? The examiner is informed that aggravation here is defined as any increase in disability. The examiner must also comment on the private opinion of DR. SH that the Veteran’s tinnitus developed as a result of his bilateral hearing loss. See record dated 5/17/12. A complete rationale must be provided for any opinions offered. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.S. McLeod