Citation Nr: 18158546 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 17-03 114 DATE: December 18, 2018 REMANDED Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran contends that his tinnitus is related to service. In July 2016, a VA audiologist opined that it was less likely as not that the Veteran’s tinnitus was directly related to service because the Veteran had reported that his tinnitus onset many years after service. The examiner further opined, however, that the tinnitus was likely related to his hearing loss. Notably, in the same opinion, the examiner concluded that the Veteran’s hearing loss was related to service based on the Veteran’s military noise exposure, which included howitzers, as well as the lack of post-service noise exposure. This opinion was offered without the examiner having access to the Veteran’s service treatment records and so an addendum opinion was subsequently obtained. In a September 2016 addendum, following a review of service treatment records, the same audiologist concluded that because a November 1966 pre-induction audiogram and a May 1969 separation audiogram revealed zero decibels at all tested frequencies, there was no threshold shift, hearing loss was therefore not related to service and, by extension, neither was tinnitus. The separation audiogram appears to show, however, that at 4,000 Hertz in the left ear, the result was 10 decibels, not zero. Moreover, neither audiogram indicates whether the testing was conducted according to American Standards Association (ASA) standards or International Standards Organization – American National Standards Institute (ISO-ANSI). Current Board policy provides that where, as here, it is not clear which standard was used in an audiogram dated prior to January 1, 1967, the assumption is that ASA standards were used. Where, as here, it is not clear which standard was applied to an audiogram dated between January 1, 1967 and December 31, 1970, the results should be considered under both ASA and ISO-ANSI standards. The unit measurements most favorable to the Veteran’s appeal will then be applied. In light of the above, and where necessary to facilitate data comparison for VA purposes in the decision below, audiometric data originally recorded using ASA standards will be converted to ISO-ANSI standard by adding between 5 and 15 decibels to the recorded data as follows: Hertz 250 500 1000 2000 3000 4000 6000 8000 add 15 15 10 10 10 5 10 10 In sum, therefore, because the evidence indicates that the Veteran’s tinnitus is related to his hearing loss, the question of whether his hearing loss is related to service must be answered before the Board can determine whether tinnitus is related to service. Because the audiologist’s opinion in this regard was inadequate, a clarifying addendum opinion must be obtained. The matter is REMANDED for the following action: 1. Forward the entire claims file in electronic records and a copy of this remand to the author of the July and September 2016 opinions for an addendum opinion addressing the etiology of the Veteran’s tinnitus. If examination is indicated, it should be scheduled in accordance with applicable procedures. The examiner should indicate whether it is as least as likely as not (50 percent probability or more) that tinnitus is related to the Veteran’s active duty service, to include the theory that the Veteran’s active service gave rise to his hearing loss which gave rise to his tinnitus. In answering this question, the examiner should consider the information discussed above, to include (i) the appropriate (and most favorable) conversion from ISO-ANSI to ASA standards and (ii) the May 1969 left ear result at 4,000 Hertz which appears to be 10 decibels. The rationale for all opinions expressed must be provided. 2. After completion of the above, readjudicate the claim. If any benefit requested on appeal is not granted to the Veteran’s satisfaction, the appellant should be furnished a supplemental statement of the case, and provided an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if in order. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Matthew Schlickenmaier, Counsel