Citation Nr: 18156940 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 17-29 916 DATE: December 11, 2018 REMANDED Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1955 to July 1959. Entitlement to service connection for tinnitus is remanded. In an October 2017 decision, the Board denied the Veteran’s claim of entitlement to service connection for tinnitus. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In April 2018, the Veteran and the Secretary of VA (parties) filed a Joint Motion for Remand (JMR) with respect to the claim on appeal and remanded the claim back to the Board, which was granted by the Court. The parties agreed that the Board erred in failing to ensure compliance with the duty to assist, specifically with regard to providing an adequate VA medical examination. The parties agreed that the Board erred in relying on an inadequate October 2016 VA medical examination. Specifically, the examiner did not adequately discuss whether in-service noise exposure could have caused the Veteran’s tinnitus after service and an adequate rationale for an opinion was not provided since a simple recitation of facts was not reasoned analysis. Furthermore, the parties agreed that the examiner’s opinion on whether the Veteran’s service-connected hearing loss could have been related to his tinnitus was unclear because the examiner stated that “it is less likely than not” that the Veteran’s tinnitus is related to his hearing loss, but then stated that “it would be speculation to know what is causing his present complaint of tinnitus.” As a result, the parties agreed that a remand is warranted for a new VA opinion as to the etiology of the Veteran’s claimed tinnitus. The matter is REMANDED for the following action: Seek a qualified medical professional to provide an opinion for the Veteran’s claimed tinnitus. If the examiner finds that an examination is necessary, then schedule an examination. If an examination is scheduled, any indicated evaluations, studies, and tests deemed to be necessary by the examiner should be performed. The VA examiner’s attention is drawn to the following: • The Veteran served on active duty from November 1955 to July 1959. • The Veteran is currently service connected for bilateral hearing loss disability. • The Veteran asserts that his tinnitus was due to working on a carrier flight deck during service. The Veteran explained that there are AD5’s, AD5N’s and jets on the flight deck and that his main duties were inspections of the planes on the flight deck without hearing protection. He also stated that he had been in the plane when 50 cal. ammunition and rockets were fired. See (1) VBMS entry with document type, “VA 21-526EZ, Fully Developed Claim (Compensation),” receipt date 09/26/2016, on p. 3; (2) VBMS entry with document type, “C&P Exam,” receipt date 10/25/2016, on p. 6; (3) VBMS entry with document type, “Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief,” receipt date 11/14/2018. • The Veteran also asserts that he is currently service connected for hearing loss due to in-service acoustic trauma and that it should follow that his tinnitus is a result of the same traumatic event. Research by the Mayo Clinic which the Veteran contends reveals that hearing loss can also cause tinnitus and an article by Dr. Tyler about tinnitus are referenced in a September 2017 appellant’s brief. See VBMS entry with document type, “Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief),” receipt date 09/22/2017. • The Veteran indicated that he could not remember the onset of his tinnitus but described his symptoms as recurring on and off for years and lasting 10 to 30 to 60 seconds. See VBMS entry with document type, “C&P Exam,” receipt date 10/25/2016, on p. 6. • Of record is the Veteran’s July 1959 Report of Medical Examination at separation from service, which reflects a normal clinical evaluation of “ears-general.” See VBMS entry with document type, “STR - Medical,” receipt date 12/24/2013, on p. 20. • In a January 2003 VA treatment record, the Veteran reported experiencing hearing loss in service but that he did not have tinnitus at the time. See VBMS entry with document type, “CAPRI,” receipt date 07/21/2014, on p. 217. • The Veteran also denied tinnitus in December 1997 and December 2003 VA medical records and July 2012 and July 2014 VA examinations. See VBMS entry with document type, “CAPRI,” receipt date 07/21/2014, on p. 6, 42, 211, and 220. • Of record are the October 2016 VA medical opinions for the claimed tinnitus. See VBMS entry with document type, “C&P Examination,” receipt date 10/25/2016. While the Board has provided some of the relevant facts above, an attempt has been made to obtain additional potentially relevant medical records which may have now been added to the file, the examiner is to review the entire record to include any newly associated records, examine the Veteran if determined necessary, and then answer the following questions: a) It is at least as likely as not (50 percent probability or more) that the claimed tinnitus is caused by or otherwise related to service, to specifically include working on a carrier flight deck during service? In answering this question, the examiner is to also discuss whether in-service noise exposure caused his tinnitus after service. b) Is the claimed tinnitus at least as likely as not (50 percent or greater likelihood) caused by or related to the service-connected bilateral hearing loss disability? c) Please specifically address research by the Mayo Clinic and the article “Tinnitus” by Dr. Tyler, referenced by the Veteran in the September 2017 appellant’s brief. (Location of these records is described above). Please explain your answers by citing to supporting clinical data and/or medical literature, as deemed appropriate. A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Cheng, Associate Counsel