Citation Nr: 18159596 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 13-21 180 DATE: December 20, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1979 to November 1982. He also served in the United States Army Reserve and was discharged in May 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2011 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Seattle, Washington. The Veteran testified at a hearing before the undersigned Veterans Law Judge in September 2016. A transcript is of record. The Board remanded the case for further development in September 2017. The case has since been returned to the Board for appellate review. The Board notes the Veteran’s appeal originally included the issue of entitlement to service connection for tinnitus. However, in an August 2018 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for that disability. Therefore, the issue is no longer on appeal. The Veteran was afforded a VA examination in connection with his claim in October 2010. The examiner found that he did not have current bilateral hearing loss as defined by VA. The examiner also noted the Veteran’s post-service noise exposure. Nevertheless, she later concluded in the report that it is less likely than not that hearing loss is related to the Veteran’s military noise exposure. In so doing, she indicated that the hearing loss is not the shape of a noise-induced hearing loss and that the Veteran has a history of ear infections, which seemed to be a more likely cause of his hearing problems. However, she did not address the October 1982 service treatment record indicating that the Veteran had ear pain after firing a weapon and ringing in his left ear diagnosed as a possible ear infection or the other service treatment records documenting symptoms, such as ear pain and otitis media and externa. The Veteran was afforded another VA examination in February 2013 at which time he was diagnosed with bilateral hearing loss. The examiner opined that it was not at least as likely as not that his hearing loss was related to his military service. In so doing, she acknowledged the report of military noise exposure, but also observed that there was no hearing loss as of three years ago. Instead, she found that the current hearing loss was mild and most likely due to the natural aging process. She also noted that there was a strong history of ear infections. However, the Board again notes that the examiner did not address the symptomatology documented in the Veteran’s service treatment records. The Veteran was subsequently provided a VA examination in December 2015. Given his middle ear issues and lack of hearing loss shown within a reasonable time after service, the examiner opined that the Veteran’s hearing loss was not at least as likely as not caused by or a result of his military service. In particular, she noted that the previous recent testing had shown minimal loss in both ears. However, she still did not address the symptomatology documented in the Veteran’s service treatment records. Following, the September 2017 remand, the Veteran was afforded another VA examination in November 2017. The examiner indicated that she was unable to determine if hearing loss was present during the examination due to inconsistent testing. Nevertheless, she opined that, if hearing loss is present, it is less than likely due to noise exposure in service and more likely due to outer and middle ear pathology. She noted that the Veteran had normal hearing in 2010 and that the patterns of hearing loss in 2013 and 2015 are inconsistent with noise-induced hearing loss. However, the examiner did not address the service treatment records documenting ear infections and otitis externa and media. Thus, it is still unclear as to whether any current hearing loss may be related to outer and middle ear pathology that was present in service. Therefore, the Board finds than additional medical opinion is needed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his bilateral hearing loss. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims files. The AOJ should also secure any outstanding VA treatment records. 2. After completing the foregoing development, a VA medical opinion should be obtained to determine the nature and etiology of any hearing loss that may be present. An examination should be performed if deemed necessary by the individual providing the opinion. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions or statements by the Veteran. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s bilateral hearing loss is related to his military service, to include any noise exposure and symptomatology therein. The examiner should specifically address the service treatment records documenting symptomatology such as ear pain, ringing in the left ear, ear infections, and otitis externa and media. In rendering his or her opinion, the examiner should discuss medically known or theoretical causes of hearing loss and describe how hearing loss which results from noise exposure generally presents or develops in most cases, as distinguished from how hearing loss develops from other causes, in determining the likelihood that the disorders were caused by noise exposure in service as opposed to some other cause. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing these actions, the AOJ should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.M. Walker, Associate Counsel