Citation Nr: 18158069 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 17-00 266 DATE: December 14, 2018 ORDER Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s tinnitus is a result of noise exposure in service. CONCLUSION OF LAW The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from September 1976 to September 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Bay Pines, Florida. Entitlement to service connection for tinnitus Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Analysis In this case, the Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran’s service treatment records (STRs) do not document any evidence of tinnitus or ringing in the ears. Tinnitus is readily observable by laypersons and does not require medical expertise to establish its existence. See Charles v. Principi, 16 Vet. App. 370 (2002). The Veteran is competent to describe his tinnitus symptomatology, which he has called “high pitched ringing in my ears,” and such subjective complaints have been documented by the medical evidence of record, including by the June 2014 VA examiner. As a result, the Board finds that the Veteran has a current diagnosis of tinnitus. The Veteran is also competent to describe his in-service noise exposure, which he indicates was from exposure to aircraft engines, generators, aircraft communication equipment, aircraft navigation equipment, and various other noise exposures without proper hearing protection. The Veteran’s descriptions reflect noise exposure consistent with his military service in the Air Force, as documented in his service personnel records. The June 2014 examiner reported that the Veteran indicated his tinnitus had “started in the service.” The examiner opined that the Veteran’s tinnitus was less likely than not caused by or a result of military noise exposure. The rationale provided for that opinion was that there were “calibrated audiometrics without significant change during [the Veteran’s] military service bilaterally…” However, the Veteran has consistently stated that he began to hear ringing in his ears while stationed in Hahn Air Force Base (AB), Germany. In a September 2013 statement in support of his claim, the Veteran reported that the ringing in his ears began while he was stationed in Hahn AB. In a September 2014 notice of disagreement (NOD), and in a statement attached to his NOD, the Veteran reported experiencing ringing in his ears a short time after being assigned to Hahn AB. In the Veteran’s December 2016, VA Form 9 he once again reported that the ringing in his ears began while stationed at Hahn AB. Additionally, the VA examiner noted that he did not review any records the claims file and did not discuss the Veteran’s credible statements addressing his in-service noise exposure or when he first noticed the ringing in his ears. For these reasons, the Board questions the adequacy of the June 2014 VA opinion. In light of the above analysis, the Board determines that the evidence, both in favor of and against a relationship between the Veteran’s tinnitus and his military service, is at least in equipoise. Therefore, the Board affords the benefit of the doubt to the Veteran, and service connection for tinnitus is granted. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss is remanded. Although the Board sincerely regrets the additional delay, a remand is required to ensure proper development of the Veteran’s claim of entitlement to service connection for bilateral hearing loss, prior to adjudication by the Board. When VA undertakes to provide an examination or opinion, it must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Veteran underwent a VA examination in June 2014. The examiner noted that he did not review the claims file as part of the examination. The examiner concluded that the Veteran’s bilateral hearing loss was less likely than not caused by or related to his military service. The rationale provided for the conclusion was “calibrated audiometrics without significant change during military service bilaterally 04-06-1976; 06-03-1980; 01-26-1982; 03-19-1982.” The Board finds the examiner’s medical opinion inadequate. Specifically, the Board notes the examiner failed to consider and discuss the Veteran’s credible statements about the frequency and duration of noise exposure that the Veteran experienced, as well as the lack of hearing protection afforded to him, during his active duty service. Additionally, the VA examiner should have reviewed the claims file including the Veteran’s credible lay statements. As such, a remand is necessary to obtain an adequate medical opinion that complies with the Board’s directives. On remand all relevant ongoing medical records should be obtained. 38 U.S.C. § 5103A (c) (2014); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). The matter is REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims. If it is deemed any pertinent records do not exist, or that additional attempts to obtain these records would be futile, the record should be annotated to reflect such, to specifically include a formal finding of unavailability, and the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). 2. Then, refer the claims file to a physician with sufficient expertise to render the requested opinion. Upon a review of the record, the physician should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hearing loss originated in service, to include as being consequentially related to his reports of noise exposure and lack of hearing protection and all other credible statements made by the Veteran whereby he referenced experiencing hearing loss while in service. A complete rationale must be provided for any opinion or conclusion expressed. If the examiner is unable to provide any required opinion he/she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner must provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. (Continued on the next page)   3. Finally, readjudicate the issue on appeal. If the benefit sought on appeal is not granted to the Veteran’s satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Gresham