Citation Nr: A19001546 Decision Date: 09/26/19 Archive Date: 09/25/19 DOCKET NO. 190805-19168 DATE: September 26, 2019 REMANDED Entitlement to connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Board notes that the rating decision on appeal was issued in March 2018. In February 2019, the Veteran elected the modernized review system. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2(d)). The Veteran served on active duty from May 1966 to May 1969. His awards and decorations include the Combat Medical Badge. The Veteran selected the Higher-Level Review lane when he opted in to the Appeals Modernization Act (AMA) by submitting a Rapid Appeals Modernization Program (RAMP) election form. Accordingly, the March 2019 AMA rating decision considered the evidence of record as of the date VA received the RAMP election form. The Veteran timely appealed this rating decision to the Board and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ). Entitlement to service connection for bilateral hearing loss is remanded. The Board finds that a remand is necessary to correct a duty to assist error that occurred prior to the rating decision on appeal. In this regard, in a March 2018 VA medical opinion, the examiner opined that it was less likely than not that the Veteran’s bilateral hearing loss was caused by or a result of an event in service. However, the examiner did not address whether delayed-onset hearing loss could be related to service. Moreover, the Veteran’s service treatment records document that he was prescribed Darvon for headaches. However, the examiner did not address the Veteran’s contention regarding the relationship between sensorineural hearing loss and large doses of propoxyphene (Darvon) compounds. Therefore, a remand is necessary to obtain an additional VA medical opinion. The matters are REMANDED for the following action: 1. The AOJ should refer the Veteran’s claims file to a suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of the Veteran’s bilateral hearing loss. An additional examination should only 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. 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. It should also be noted that the absence of evidence of a hearing loss disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s bilateral hearing loss manifested in or is otherwise causally or etiologically related to his military service, to include his conceded noise exposure. In rendering this opinion, the examiner should address the Veteran’s assertion that a study showed sensorineural deafness has been reported following large doses of propoxyphene (Darvon) compounds. See February 2018 statement in support of claim. The examiner should also 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 current hearing loss was 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. J. Nichols Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Wulff, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.