Citation Nr: 18159237 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 17-09 457 DATE: December 18, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1966 to January 1970. The Veteran appeals a September 2015 rating decision by the Agency of Original Jurisdiction (AOJ). The Veteran was afforded a VA examination in August 2015 to assess the etiology of his bilateral hearing loss. However, the Board finds that the clinician’s opinion is inadequate for adjudication purposes. See Barr v. Nicholson, 21 Vet. App. 302, 312 (2007). The VA clinician found the Veteran’s entrance and separation hearing tests were within normal limits with no significant changes. However, the clinician did not discuss whether the American Standards Association (ASA) or International Standards Organization American National Standards Institute (ISO-ANSI) standard was used in determining whether there was a threshold shift in service. The Veteran’s August 1969 separation audiogram chart is noted with “ISO”. However, the Veteran’s February 1966 entrance audiogram chart has no such specification. The Board emphasizes that a correct evaluation of service audiometric findings requires that the ASA standard be converted to the ISO-ANSI standard. Such conversion could impact whether the Veteran had bilateral hearing loss or a significant threshold shift in service. Therefore, as it is unclear which standard the clinician used during either audiometric reading, and the VA clinician did not explain whether conversion to ISO-ANSI standards would indicate a significant threshold shift, the August 2015 VA opinion is inadequate and a new etiology opinion must be obtained. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records relevant to treatment the Veteran received for his bilateral hearing loss that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified and the record clearly documented. 2. Obtain an opinion from an appropriately qualified VA clinician to determine the nature and etiology of the Veteran’s bilateral hearing loss. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician is asked to respond to the following inquiry: Is it at least as likely as not that the Veteran’s bilateral hearing loss was incurred in, or is otherwise related, to his time on active service? In rendering this opinion, the clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. Further, the clinician is to discuss the February 1966 and August 1969 audiometer and audiogram charts. Specifically, the clinician is to discuss which standard (ASA or ISO-ANSI) was used and make the appropriate conversions in rending the opinion. If it is unclear which standards were used, the data is to be considered under both ASA and ISO-ANSI standards, and the clinician should discuss whether the Veteran had hearing loss or significant threshold shifts in service under both standards. The clinician is also to discuss the August 1969 note in the service treatment records stating the Veteran thinks his hearing is getting worse. For the purposes of this opinion, the clinician is to assume the Veteran is credible as to the facts surrounding his bilateral hearing loss. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Zheng, Associate Counsel