Citation Nr: 18161202 Decision Date: 12/31/18 Archive Date: 12/28/18 DOCKET NO. 16-62 879 DATE: December 31, 2018 REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to service connection for right ear hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1964 to January 1968, to include service in Vietnam. 1. Entitlement to Service Connection for Left Ear Hearing Loss 2. Entitlement to Service Connection for Right Ear Hearing Loss The Veteran contends he is entitled to service connection for a right and left ear hearing loss disability, as a result of in-service noise exposure. Service personnel records and the Veteran’s testimony during a September 2018 Board hearing establish that the Veteran performed duties as a radio/Morse Code intercept operator working extended hours listening to signals and static using headsets. The Veteran underwent an audiological test during his January 1964 entrance examination. Pure tone thresholds, in decibels using ASA standards, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 -10 -10 -10 -10 LEFT 0 -5 -5 -10 -5 The audiological evaluation performed at his December 1967 separation examination reflected pure tone thresholds, in decibels using ASA standards, as shown below: HERTZ 500 1000 2000 3000 4000 RIGHT -5 -5 -5 -5 5 LEFT -5 -5 -5 -5 0 The Veteran underwent a private audiometric and organic ear examination in July and December 2012. The July testing did not include a Maryland CNC speech discrimination examination. Puretone threshold at 4000 Hz was 40 decibels in the right ear and 30 decibels in the left ear. Other frequencies were normal. In the December 2012 report, a nurse practitioner noted the Veteran’s report of an onset of ringing sounds in both ears three months earlier. There were no organic ear deficits. In June 2013, the Veteran submitted a statement from his spouse who noted observing the Veteran’s sleep difficulty and annoyance from constant ringing in his ears for the past 45 years. VA examination and opinion was obtained in November 2013. The examination showed puretone thresholds at substantially the same levels as measured in 2012 with normal Maryland CNC speech discrimination. The provided opinion by a VA audiologist stated that the Veteran’s hearing was normal bilaterally per enlistment and separation audiograms. Therefore, there was no objective evidence of hearing loss or acoustic trauma in either ear, and the Veteran’s hearing loss was likely attributable to civilian noise exposure, presbycusis, or some other etiology. The rationale relied, at least in part, on a lack of in-service documentation of a bilateral hearing loss disability. The absence of in-service evidence of a hearing disability during service (i.e., one meeting the requirements of 38 C.F.R. § 3.385), however, is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87 (1992). The Court stated in Hensley v. Brown, 5 Vet. App. 155 (1993) that “when audiometric test results at a veteran’s separation from service do not meet the regulatory requirements for establishing a ‘disability’ at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service.” The examiner also did not address the several very mild threshold shifts reflected from January 1964 to December 1967 and comment whether that does or does not represent some hearing acuity loss due to noise exposure. In a November 2016 letter, a private otolaryngologist provided a record of a recent audiometric test that showed puretone thresholds at 40 decibels or greater in both ears indicating worsening acuity. The speech discrimination test was not noted as a Maryland CNC test. The physician noted the Veteran’s report of tinnitus while in service associated with “high amplitude noise” such as from interpreting Morse Code patterns while wearing headphones. The physician did not comment on the testing in service or the private and VA testing and opinion and provided no rationale other than to repeat the Veteran’s contentions. The November 2013 VA opinion and the November 2016 private opinions are accordingly insufficient and remand is therefore required for a new VA examination and opinion. See Barr v. Nicholson, 21 Vet. App. 303 (2007). 3. Entitlement to Service Connection for Tinnitus The Veteran contends service connection for tinnitus is warranted and because a decision on the remanded issue of service connection for bilateral hearing loss could significantly impact a decision on the issue of service connection for tinnitus, these issues are inextricably intertwined. As such a remand is warranted. Furthermore, the Veteran submitted a private medical opinion in November 2016, which reported that the Veteran experienced tinnitus while in service and provided testimony on this contention during the September 2018 Board hearing. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination with respect to his right and left hearing loss disability and tinnitus claims. Request that an audiometric examination be performed to determine the current level of hearing acuity and an assessment of the Veteran’s reported tinnitus and its onset and continuity. Request that an audiologist provide an opinion addressing whether it is at least as likely as not (i.e. 50 percent probability or greater) that a right and left hearing loss disability and tinnitus had its onset during active service or is caused or aggravated by any in-service disease or injury including the Veteran’s duties as a Morse intercept operator. The examiner’s attention is invited to the testing during service, private testing in 2012 and 2016, VA testing in 2013, and the two opinions offered by the VA audiologist in 2013 and the private specialist in 2016. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The examiner should also address the in-service threshold shifts in hearing between the Veteran’s entrance and separation examinations. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Fitzgerald, Associate Counsel