Citation Nr: 18132011 Decision Date: 09/05/18 Archive Date: 09/05/18 DOCKET NO. 16-01 986 DATE: September 5, 2018 REMANDED Entitlement to service connection for right ear hearing loss is remanded. Entitlement to a compensable rating for left ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1973 to September 1973. He received the Marksmanship Badge Grenade and Marksmanship Badge M-16. Service Connection for Right Ear Hearing Loss In conjunction with his claim, the Veteran was afforded a VA examination in March 2015. In the examination report, the examiner opined that the Veteran’s hearing loss was unrelated to service based solely on the Veteran’s separation audiogram that did not demonstrate a significant threshold shift. The examiner, however, questioned the validity of the discharge examination thresholds, but added no further explanation in support of her negative nexus determination. See March 2015 VA Examination, p. 5; Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (finding that the probative value of a medical opinion comes from the factually accurate, fully articulated, and sound reasoning for the conclusion); cf. Hensely v. Brown, 5 Vet. App. 155, 159-60 (1993) (noting that service connection for a hearing disability is not precluded where hearing was within normal limits at separation). As such, there is no adequate medical opinion of record that specifically addresses whether the Veteran’s right ear hearing loss may have been caused by his in-service noise exposure, or consider whether the disability has been aggravated by his service-connected tinnitus. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (medical opinions must address the relevant facts). Thus, on remand the AOJ should obtain an opinion that considers the Veteran’s in-service noise exposure and whether his tinnitus aggravates his right-ear hearing loss. Increased Rating for Left Ear Hearing Loss The March 2015 VA examiner indicated that it was not appropriate to use the Veteran’s speech discrimination scores because of “language difficulties, cognitive problems, inconsistent word recognition scores, etc.” However, the predicate for such finding is not explained in the examination report, nor is readily clear in the file. In other words, it is not clear from the file or from the examination what language difficulties, cognitive problems, inconsistencies, or other issues that may be present that would interfere with the test. March 2015 VA Examination, p. 2. Consequently, it is unclear whether the use of Table VIa to evaluate the Veteran’s hearing impairment is appropriate in this case. See 38 C.F.R. § 4.85(c) (2017) (“Table VIa will be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc.”). Accordingly, on remand the Veteran should be afforded a new audiological examination to obtain both puretone threshold and speech discrimination values. If the examiner determines that speech discrimination testing is inaccurate or otherwise inappropriate, the examiner must provide a thorough explanation why. The matter is REMANDED for the following action: Schedule the Veteran for a VA audiological examination to determine whether the Veteran’s right ear hearing loss has been aggravated by his service-connected tinnitus, and to ascertain the severity of his left hearing loss. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report MUST include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion and a complete supporting rationale addressing the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s right ear hearing loss was caused or aggravated by his in-service noise exposure? In providing this opinion, the examiner must address the Veteran’s exposure to noise from grenades and as a wheeled vehicle mechanic. (b) Is it at least as likely as not that the Veteran’s right ear hearing loss has been aggravated by his service-connected tinnitus? (c) Administer the puretone audiometry test and Maryland CNC speech discrimination test. If the results of the speech discrimination test are not appropriate for use, please indicate the specific reason for such a determination. (Continued on the next page)   The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W.V. Walker, Associate Counsel