Citation Nr: 20003131 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 15-39 974 DATE: January 14, 2020 REMANDED Entitlement to service connection for bilateral sensorineural hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1970 to July 1972. This appeal comes before the Board of Veterans’ Appeals (Board) from a June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), in Atlanta, Georgia. In December 2018, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. 1. Entitlement to service connection for bilateral sensorineural hearing loss is remanded. The Veteran contends that service connection is warranted for his bilateral hearing loss. In June 2014, a VA examiner opined that the Veteran’s current hearing loss disability was most likely not due to military acoustic trauma, citing to normal audiological results at the Veteran’s discharge from service and a hearing loss pattern which was not consistent with noise-induced hearing loss. The Veteran was diagnosed with sensorineural hearing loss of the right ear, and mixed (conductive and sensorineural) hearing loss of the left ear. The examiner stated that: Although the Veteran reported a history of hazardous noise exposure during military service, today’s audiological evaluation revealed a bilateral, gradually sloping OR FLAT sensorineural hearing loss at all frequencies, which is not a typical noise-induced audiometric configuration. According to Feldmann, 1971; Penner, et.Al., 1981, noise-induced sensorineural hearing loss is typically greatest in the highest frequencies and least evident in the lower frequencies, often with a reasonably sharp transitional region between the affected and unaffected frequency regions. The configuration and type of hearing loss discovered today are not that of noise-induced etiology. Therefore, this Veteran’s hearing loss is not at least likely as not due to military noise exposure, but more likely due to presbycusis and/or contributory medical history, etc. Unfortunately, the examiner did not explain the significance, if any, of threshold shifts for either ear measured from the time of entrance until separation. The threshold for normal hearing is from 0 to 20 decibels, and puretone thresholds above 20 decibels may demonstrate hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The separation examination reflected that the left ear demonstrated puretone thresholds of 25 decibels and 30 decibels at 3000 and 6000 Hertz, respectively. The Board finds that additional opinion is necessary. 2. Entitlement to service connection for tinnitus is remanded. The Veteran was afforded a VA audiological examination in June 2014 where the examiner noted that the Veteran reported recurrent tinnitus and alleged it had its onset approximately 20 years prior to the examination for the left ear, and 304 years prior to the examination for the right ear. The examiner also stated The Veteran has a diagnosis of clinical hearing loss, and his or her tinnitus is at least as likely as not (50% probability or greater) a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. The Veteran’s report of a delayed-onset tinnitus (10 or more years after the service) due to military acoustic trauma is inconsistent with research and textbooks regarding noise-induced tinnitus and hearing loss. Research studies have shown that hazardous noise exposure has an immediate effect on hearing, and it is usually temporary at first. It does not have a delayed-onset, nor is it progressive or cumulative. It usually takes many incidents of temporary noise-induced hearing loss and tinnitus before it becomes permanent. References: 1. Otolaryngology, Volume II, 3rdEdition, Paparella &Shumrick, WB Saunders Co. 1991, p. 1639. 2. 2005finding from the Institute of Medicine's landmark study: Noise & Military Service: 3. NOISE MANUAL, (Fifth Edition, edited by Berger et al., AIHA Press 2000, p.459). Therefore, the Veteran's presence of tinnitus is less likely as not caused by military acoustic trauma… In spite of normal hearing at separation, the excessive noise exposure may have been a precursor to tinnitus at that time. As the VA audiology examiner indicated that tinnitus may be a symptom of hearing loss, the claim seeking service connection for tinnitus is inextricably intertwined with the hearing loss claim, and the Board will remand the tinnitus claim for adjudication at the same time as the hearing loss claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Identify and obtain any outstanding, pertinent, VA and private treatment records and associate them with the claims file. 2. After completing the above to the extent possible, forward the entire claims file to the June 2014 VA audiological examiner (or another appropriate individual if that examiner is not available) for an addendum report as to the cause of the Veteran’s hearing loss. The examiner should respond to the following: Whether it is at least as likely as not (probability of 50 percent or more) that the Veteran’s a) current left ear conductive hearing loss, b) left ear sensorineural hearing loss and/or c) right ear sensorineural hearing loss had its onset in service or was incurred as a result of disease or injury (including noise exposure) in service? In providing the opinion regarding hearing loss, the examiner is requested to specifically discuss the significance, if any, of the threshold shifts demonstrated on the service separation examination. If the examiner is unable to provide any requested opinion without resort to speculation, the examiner should explain whether the inability to provide the needed opinion is due to the limits of the examiner’s medical knowledge; the limits of the knowledge of the medical profession in general; or whether there is specific additional evidence, which if obtained, would enable the examiner to provide the needed opinion. (continued on the next page) 3. Thereafter undertake any other indicated development. Then readjudicate the issue on appeal. If the benefit sought on appeal is not granted to the Veteran’s satisfaction, she and any representative must be furnished a Supplemental Statement of the Case and afforded an opportunity to respond. Thereafter, if in order, the case should be returned to the Board for further appellate action. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael J. O'Connor 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.