Citation Nr: 18160727 Decision Date: 12/28/18 Archive Date: 12/27/18 DOCKET NO. 17-22 126A DATE: December 28, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1962 to March 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Nashville, Tennessee. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2017). 38 U.S.C. § 7107(a)(2) (2012). 1. Entitlement to service connection for bilateral hearing loss is remanded. Unfortunately, a remand is required in this case. While the Board regrets the delay, the Veteran’s service connection claims for a bilateral hearing loss disability must be remanded for further development to ensure they are afforded every consideration. Specifically, the Board finds that a new VA audiological examination is necessary to fully address the nature and etiology of the Veteran’s claimed hearing loss. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (establishing that when the VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); D’Aries v. Peake, 22 Vet. App. 97, 104 (2008) (holding that an examination must be based on consideration of the claimant’s medical history and must describe the disability in sufficient detail so that the Board’s evaluation of the disability will be a fully informed one). See also 38 C.F.R. §§ 3.159 (c)(4), 3.326(a) (2017). The Veteran was provided a VA audiological examination for an etiological opinion regarding his bilateral hearing loss in August 2016; however, the audiological opinion provided is inadequate to decide this claim. The VA examiner’s opinion notes that the Veteran’s 1963 entrance examination indicated normal hearing sensitivity, bilaterally. However, the Veteran’s entrance examination was dated in November 1962 and contained no audiometric findings. Further, the VA examiner stated that at separation in 1968, the Veteran's puretone threshold audiogram indicated normal hearing sensitivity, bilaterally, which was unchanged from the entrance examination. However, it does not appear that March 1968 audiometric findings were converted from ASA units to ISO-ANSI units. Of note, VA policy has changed with regard to the conversion of in-service audiograms. Formerly, the results of audiometric testing (i.e. puretone thresholds at various frequencies) during active service dated after October 31, 1967 were assumed to have been provided in units of measurement established by the International Standards Organization (ISO)-American National Standards Institute (ANSI). Audiometric data prior to October 31, 1967 was assumed to have been recorded in American Standards Association (ASA) units, and thus had to be converted to ISO-ANSI units to enable data comparison and to bring them in line with VA regulation pertaining to hearing loss, which is based on ISO-ANSI units. However, VA policy now is to consider audiometric data dated between January 1, 1967 and December 31, 1970 using either ISO-ANSI or ASA units, whichever is more favorable to the claimant, unless the audiogram clearly indicates which standard was used. In this case, the Veteran’s separation audiogram is dated in March 1968, and thus falls within this date range, but it specifies that the ASA standard was used. Additional decibels must be added at the relevant frequencies. Specifically, 15 decibels must be added at 500 Hertz, 10 decibels at 1000, 2000, and 3000 Hertz, and 5 decibels at 4000 Hertz. In short, the August 2016 VA opinion turns, in part, on a finding that there was no threshold shift during service. However, audiometric findings were not reported on the November 1962 entrance examination and the March 1968 separation audiogram was not converted from ASA units to ISO-ANSI units. As such, remand is required for an additional medical opinion, as set forth below. Finally, as the claim is being remanded, the RO/AMC should also obtain any outstanding VA treatment records. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (c) (2017); see also Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Thereafter, schedule the Veteran for a VA audiological examination, to evaluate his bilateral hearing loss. The Veteran’s entire claims file, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must reflect that such a review was undertaken. The examiner must render an opinion as to the following: Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current bilateral hearing loss had its clinical onset during active service or is related to his conceded in-service noise exposure? In providing this opinion, the examiner is advised of the following: • VA law does not require hearing loss or a significant puretone threshold shift during service in order to establish an in-service disease or injury. Rather, the examiner must use his or her own independent medical judgment in determining how normal hearing during service or the lack of a significant puretone threshold shift may factor into the assessment as to whether current hearing loss is linked to in-service noise exposure. • The Veteran served on active duty from November 1962 to March 1968. • The November 1962 entrance examination contains no audiometric findings. Hearing was recorded as 15/15 bilaterally. • The examiner must assume that the March 1963 (annual), January 1964 (award of navigator rating), April 1964 (annual), April 1965 (annual), April 1967 (annual) and March 1968 (separation) audiograms were recorded in ASA units and thus consider the puretone thresholds as converted to ISO-ANSI units. This means adding to the recorded findings 15 decibels at 500 Hertz; 10 decibels at 1000, 2000, and 3000 Hertz; and 5 decibels at 4000 Hertz. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Sinckler, Associate Counsel