Citation Nr: 19123731 Decision Date: 03/29/19 Archive Date: 03/29/19 DOCKET NO. 18-55 668 DATE: March 29, 2019 REMANDED Service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran honorably served in the U.S. Army from June 1951 to May 1953. This matter is before the Board of Veterans’ Appeals on appeal from a November 2017 decision of the Department of Veterans Affairs (VA) Regional Office in Buffalo, New York. 1. Service connection for tinnitus is remanded. In November 2017, the Veteran received a VA examination concerning his tinnitus. The examiner noted that the Veteran denied experiencing any ringing or any other noises in his ears. Id. The examiner concluded that the Veteran does not experience recurrent tinnitus and therefore the examiner did not provide an opinion about a causal link (nexus) between tinnitus and service. Id. In his November 2018 VA Form 9, the Veteran explained that he misunderstood the examiner and thought he was asking if the Veteran was experiencing tinnitus at that moment. Id. The Veteran explained that he experiences intermittent tinnitus but was not experiencing it at the time of the November 2017 examination. Id. The Veteran has already been service connected for hearing loss and in-service noise exposure has been established. See November 2017 Rating Decision. The Veteran has not been provided with an adequate examination because the November 2017 examiner’s conclusion that the Veteran does not have tinnitus was based on an inaccurate factual premise. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (medical opinion is inadequate when based on an inaccurate factual premise). Therefore, an examination and opinion are required to obtain medical evidence about whether the Veteran’s tinnitus is related to his service or service-connected hearing loss. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (VA must provide a medical examination when there is insufficient medical evidence to decide the claim but there is evidence of a current disability, an in-service injury, and an “indication” of a potential causal link (nexus) to service); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (whenever VA provides an examination or obtains a medical opinion, it must ensure that the examination or opinion is adequate). The matter is REMANDED for the following action: 1. Obtain outstanding VA treatment records concerning the Veteran’s tinnitus. 2. Schedule the Veteran for a VA examination with a qualified examiner to determine the likely cause of the Veteran’s tinnitus. The examiner should elicit from the Veteran a detailed history regarding the onset, progression, frequency, and severity of relevant symptoms. Any associated functional impairment should be described in detail. The Veteran's entire record must be reviewed by the examiner. Based on the clinical examination and the lay and medical evidence of record, the examiner is asked to answer the following questions: a. Is it as least as likely as not (a 50 percent or better probability) that the Veteran’s tinnitus was incurred in or is otherwise related to the Veteran’s service, to include the Veteran’s established in-service noise exposure? b. Is it as least as likely as not (a 50 percent or better probability) that the Veteran’s tinnitus was CAUSED by the Veteran’s service-connected hearing loss? c. Is it as least as likely as not (a 50 percent or better probability) that the Veteran’s tinnitus was AGGRAVATED by the Veteran’s service-connected hearing loss? [CONTINUED ON NEXT PAGE] A detailed explanation (rationale) is required for all opinions provided and is very much appreciated. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Bryant, Law Clerk