Citation Nr: 18159187
Decision Date: 12/19/18	Archive Date: 12/18/18

DOCKET NO. 17-02 723
DATE:	December 19, 2018
REMANDED
Entitlement to service connection for bilateral hearing loss is remanded.
REASONS FOR REMAND
The appellant is a Veteran who served on active duty from February 1969 to February 1971. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision.
Service connection for bilateral hearing loss is remanded.
The Veteran served in combat (and was awarded a Combat Infantryman Badge); he is assumed to have been exposed in service to the excessive levels of noise associated with combat.  VA examination found that he has a hearing loss disability.  He was afforded the July 2014 VA examination in part to determine the likely etiology of his bilateral hearing loss.  In finding that the Veteran’s hearing loss is unrelated to his service, the examiner pointed to normal hearing at separation (suggesting that the Veteran’s hearing improved during service). It is well-established in caselaw that a finding of normal hearing at separation does not preclude a finding of service connection for hearing loss disability.  Notably, the examiner did not identify the non-service related etiology for the hearing loss considered more likely. A remand for an addendum medical advisory opinion is necessary.
The matter is REMANDED for the following:
Arrange for the Veteran’s record to be forwarded to an audiologist for review and an addendum medical advisory opinion regarding the etiology for the Veteran’s hearing loss disability (and specifically whether it may be related to the Veteran’s exposure to noise in service). On review of the record (to include this remand) the consulting audiologist should provide an opinion that responds to the following:
Noting that the absence of hearing loss disability at separation cannot be the sole basis for a finding that a hearing loss disability is unrelated to service, please identify the most likely etiology for the Veteran’s hearing loss disability? Specifically, is it at least as likely as not (a 50% or better probability) that the hearing loss was incurred in service/is due to his exposure to combat noise therein?   
If the hearing loss disability is determined to be unrelated to service, identify the etiology for the hearing loss considered more likely (and explain why that is so). 
Any discussion of puretone thresholds in service should include comment on the validity of the separation audiometry (in that all puretone thresholds on separation were 0 decibels-at all frequencies), and the medical plausibility of such an improvement in hearing acuity during service - following the acknowledged exposure to noise therein (and if found not implausible, there should be citation to supporting medical texts or studies).  


All opinions must include rationale. 
 
GEORGE R. SENYK
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. Robert Cordingley, Associate Counsel