Citation Nr: 18156589
Decision Date: 12/11/18	Archive Date: 12/10/18

DOCKET NO. 16-58 330
DATE:	December 11, 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 in the United States Marine Corps from November 1961 to March 1966.  The Board thanks the Veteran for his service.  
This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).
Medical Examination Sufficiency
In addition to the above required development, there is currently no adequate medical nexus opinion of record.  As indicated above, a VA examination was conducted in November 2015.  However, the examiner stated that she could not provide an etiology opinion because the Veteran’s service treatment records (STRs) were not associated with the claims file at the time of the exam.  Thus, although the objective findings that the Veteran currently has bilateral hearing loss and bilateral tinnitus are probative, the examination does not address a crucial element of service connection.  
An Addendum opinion was obtained in April 2016, after the STRs were obtained.  The April 2016 examiner concluded it was less likely than not that the Veteran’s current bilateral hearing loss and tinnitus were associated with conceded noise exposure in service.  The primary rationale for the opinions was that there were no complaints or diagnosis of hearing loss in service, or until approximately the time the Veteran filed his claims for service connection in 2015.  Additionally, the examiner found that there was clear and unmistakable evidence that the Veteran had a left ear hearing disability at the time he entered into service, and that there was no evidence that hearing in his left ear worsened during service or within a year after. The entrance Report of Medical Examination in the Veteran’s STRs shows that the Veteran had a 40-dB loss at 4000 Hz in his left ear, which constitutes a left ear hearing loss disability for service connection purposes.
However, the April 2016 examiner did not appear to consider or discuss the Veteran’s lay statements in his November 2015 examination estimating that he had experienced symptoms of hearing loss and tinnitus for several decades.  Thus, a new opinion must be obtained.
The matters are REMANDED for the following action:
1. Undertake appropriate development to obtain any outstanding VA and non-VA records pertinent to the Veteran’s claims.  In particular, an attempt should be made to obtain any prior hearing tests adequately identified by the Veteran. 
2. Obtain an addendum opinion by an appropriate clinician to determine whether it is at least as likely as not that the Veteran’s right ear hearing loss and/or tinnitus is causally related to active service.  
The clinician should consider the pertinent evidence of record, to include: a) The Veteran’s STRs, including the above referenced audiometry readings; b) the November 2015 C&P examination, including the history provided by the Veteran that he had experienced symptoms of hearing loss and tinnitus for several decades.  
A full rationale is to be provided for all stated medical opinions. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 
 
M. C. GRAHAM
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Anderson, Associate Counsel