Citation Nr: 18155496 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 15-04 999 DATE: December 4, 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 on active duty from September 1971 to September 1975, September 1975 to September 1977, and October 1980 to October 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. 1. Entitlement to service connection for bilateral hearing loss is remanded. 2. Entitlement to service connection for tinnitus is remanded. The Veteran underwent a VA audiological examination in October 2012. The examiner report shows a hearing loss disability in both ears, as well as tinnitus. The examiner reported that the Veteran gave a history of recurrent tinnitus that had its onset approximately 20 years before and was bilateral and constant. The examiner provided an opinion later in October 2012, in which the examiner concluded that the Veteran’s bilateral hearing loss and tinnitus were less likely as not related to noise exposure during military service. The only explanation was that “cited evidence” did not show findings related to hearing loss or tinnitus. The “cited evidence” consisted of audiograms at entrance and separation in 1980 and 1983, respectively, that were found to be within normal limits. This explanation is not sufficient to make an informed decision. The sole stated basis of the examiner’s opinion was that the entrance and separation audiograms for the last period of the Veteran’s active-duty service revealed hearing thresholds that were within normal limits. The examiner did not consider whether the Veteran’s in-service noise exposure, which has already been established, may have caused hearing loss and/or tinnitus to develop after service, or provide an explanation as to why normal audiograms supported the conclusion that the Veteran’s hearing loss and tinnitus were less likely than not related to service noise exposure. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993), Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). In this regard, service connection can be granted for a disability that is first diagnosed after service, upon proper proof. See 38 C.F.R. § 3.303(d). Moreover, “a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The VA medical opinion clearly does not satisfy that requirement. The VA examination also was inadequate because the opinion did not address the numerous other audiograms from the three periods of the Veteran’s active-duty service that were on file. Upward puretone threshold shifts are shown on some of these audiograms as compared with readings for the same ear in the same frequency on the next-previous audiogram. These upward threshold shifts were usually by 10 or 15 dB but sometimes were by more. Of note are three audiograms. One taken in May 1972 reveals a reading of 30 dB for the left ear in the 500 Hz frequency, which represents an upward shift by 15 dB as compared with the reading for the left ear in that frequency on a January 1972 audiogram that was taken to qualify the Veteran for the MOS of air controller. Another taken in September 1975 for the Veteran’s re-enlistment in the Marines (after a hiatus of less than one month) reveals a reading of 30 dB for the left ear in that frequency on a July 1975 separation audiogram. A third taken on the Veteran’s July 1977 separation shows a dB level of 25 for the left ear in the same frequency, indicating a continuing elevated puretone threshold. The puretone threshold for normal hearing is from 0 to 20 dB, and higher puretone threshold levels indicate some degree of hearing loss. Hensley, 5 Vet. App. at 157 (citing Current Medical Diagnosis & Treatment 110-11 (Stephen A. Schroeder et al. eds. 1988)). The Board therefore finds that a remand is required to obtain a new medical opinion addressing the question of whether the Veteran’s hearing loss and tinnitus are linked to in-service noise exposure. See 38 U.S.C. § 5103(d) (2012); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board notes that there is no separation examination for the Veteran in the file, to include any audiometric findings dated in 1983. However, the VA examiner cited to a 1983 audiogram in his October 2012 opinion. The agency of original jurisdiction (AOJ) should make another effort to obtain any outstanding service treatment records, to include any separation examination report for the Veteran’s last period of active service. Accordingly, this case is REMANDED for the following action: 1. Submit a request to the National Personnel Records Center (NPRC) for the Veteran’s 1983 separation examination report, and any other service treatment records (STRs) that may be outstanding. The Veteran should also be informed that a separation examination for his last period of service (October 1980 to October 1983), is not in the file. 2. Add to the file any outstanding VA treatment records for the Veteran dated since May 2017. 3. Then, obtain a new medical opinion from a VA audiologist regarding service connection for the Veteran’s bilateral hearing loss and tinnitus, as specified below. Hearing loss: The examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss is related to established in-service noise exposure. The examiner should consider any puretone threshold shifts during the Veteran’s periods of service in the 1970’s. If the examiner finds that the Veteran’s audiograms during service weighs against a relationship between his current hearing loss and his in-service noise exposure, a complete explanation must be provided. Tinnitus: The examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tinnitus is related to established in-service noise exposure. The examiner must provide a complete explanation in support of the conclusion reached. J. Rutkin Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Pitts, Associate Counsel