Citation Nr: 18159510 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-32 868 DATE: December 20, 2018 REMANDED ISSUE The Veteran served on active duty in the United States Army from August 1966 to August 1969. He contends that his bilateral hearing loss is a direct result of noise exposure experienced during his military service; in the alternative, he asserts that his hearing loss is related to or aggravated beyond its natural course by his service-connected otitis externa condition. In September 2015, the Veteran underwent a VA hearing loss examination. At that time, the audiologist opined that the Veteran’s bilateral hearing loss was not due to his military service. As rationale, she explained that the Veteran’s hearing was normal at the time of his separation. However, hearing loss need not be shown in service for service connection to be established; rather, service connection may be established for a current hearing disability with evidence that the current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 157 (1993); see also Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Additionally, the examiner failed to explain why remote onset hearing loss could not have been caused by in-service noise exposure, or the significance, if any, of a threshold shift in the Veteran’s hearing acuity between entrance and separation. Importantly, the issue of an association between the Veteran’s service-connected otitis externa and current bilateral hearing loss has not been addressed. Thus, the Board finds that an additional opinion is necessary. The record shows that, as of December 11, 2018, the Veteran has a pending request for a VA audiological examination to assess his service-connected otitis externa. It is reasonable to conclude that any such upcoming examination could contain information and evidence relevant to the adjudication of the current appeal, and a copy of the resulting examination report should be associated with the record prior to its return to the September 2015 VA examiner. Further, if the questions set forth below are addressed by the examiner assigned to the upcoming examination, the file should be returned to the Board for further action. The matter is REMANDED for the following action: 1. Associate all outstanding VA audiological examination reports, completed since December 11, 2018, with the record. If those reports adequately address the requested findings below, return the appeal to the Board for further review. 2. If the post-December 11, 2018 audiological reports do not address the below findings, return the record to the VA examiner who conducted the Veteran’s September 2015 audiological examination. The record, to include any post-December 11, 2018 audiological examination reports, and a copy of this Remand, must be made available to the examiner. If the September 2015 VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the entire record, to include the Veteran’s lay statements concerning onset and continuity of symptomatology, the examiner should opine as to the following: a) whether it is at least as likely as not (i.e., a 50 percent probability or greater) that the Veteran’s bilateral hearing loss is related to his military service. The opinion provided must not be based solely on the lack of any evidence of hearing loss in the Veteran’s service treatment records. Furthermore, the examiner should specifically comment upon the significance, if any, of the threshold shift in the Veteran’s hearing acuity between his August 1966 entrance and August 1969 separation from service. b) whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s bilateral ear hearing loss was caused or aggravated by his service-connected otitis externa. Both causation and aggravation must be addressed. If aggravation is found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. A complete rationale must be provided for all opinions provided. (CONTINUED ON NEXT PAGE) JEREMY J. OLSEN Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. M. Hitchcock