Citation Nr: 20003741 Decision Date: 01/16/20 Archive Date: 01/15/20 DOCKET NO. 14-27 966A DATE: January 16, 2020 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1972 to July 1974. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled for a Board hearing by videoconference in September 2017. The record indicates that he cancelled the hearing. Thus, his request for a hearing before the Board is considered withdrawn. 38 C.F.R. § 20.704 (d) (2017). This matter was previously before the Board in May 2018, when it was remanded for further development. The matter now returns to the Board for appellate consideration. 1. Entitlement to service connection for bilateral hearing loss is remanded. The May 2018 Board Remand instructed the RO to obtain a VA addendum opinion to determine whether there was an increase in the Veteran’s hearing loss during service, and if so, whether it was clear that the increase was solely due to the natural progression of the disorder. The examiner was instructed to review a medical study from November 11, 2009 and discuss the significance, if any, of the findings of the study in relation to the questions posed above. A subsequent VA examination in July 2019 indicated that there were no permanent threshold shifts greater than normal variability at any frequency between 500Hz and 6000Hz in either ear during service. The examiner also opined that the Veteran’s hearing loss was not at least as likely as not caused by or the result of military service. The examiner noted the lack of threshold shifts from entrance examination in 1972 to separation examination in July 1973. The examiner also noted the Veteran’s report of decreased hearing after his final in-service examination in November 1973. The examiner then stated that although noise exposure is conceded and the relationship of noise, auditory damage, and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise alone. The examiner stated there must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology. The Board finds the examiner’s opinion inadequate for decision-making purposes. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board notes that the examiner did not adhere to the directives of the May 2018 Board remand, as he did not discuss the significance of the November 11, 2009 medical study. Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that if the Board proceeds with final disposition of an appeal, and the remand orders have not been complied with, the Board itself errs in failing to ensure compliance). Further, while the examiner stated there was no significant threshold shift from the 1972 enlistment examination as compared with the July 1973 separation examination, the Board notes that those examinations may not be congruent as the January 1972 examination report appears to indicate the results were reported in ISO units, while the July 1973 testing appears to have been reported using ANSI units. While the January 1972 induction medical examination report did not include findings at the 3000 Hz level in either ear, the attached January 1972 audiogram appeared to show a hearing threshold of 35 dB at 3000 Hz in the right ear and 30 dB at 3000 Hz in the left ear, while the July 1973 separation examination testing included hearing thresholds of 25 dB at 3000 Hz in the right ear and 35 dB at 3000 Hz in the left ear, indicative of some hearing loss. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Thus, the Veteran may not be presumed sound upon entry to service with regard to his hearing in each ear. The record also contains an October 2019 private medical opinion stating that it is at least as likely as not that the Veteran’s hearing loss is related to his military service. The examiner is asked to address and reconcile this conflicting opinion to the extent possible on remand. The matters are REMANDED for the following action: 1. Forward the record and a copy of this Remand to the examiner who provided the July 2019 audiological examination, or, if that examiner is unavailable, to another suitably qualified examiner for completion of an addendum opinion. The examiner must address the following: a) As the January 1972 examination report appears to indicate the results were reported in ISO units, while the July 1973 testing appears to have been reported using ANSI units, after converting the results of each examination to a congruent standard, opine whether it is at least as likely as not that there was an increase in the Veteran’s hearing loss that was noted upon entry during service, and if so whether the evidence is clear that the increase was due solely to the natural progress of the disorder. Rationale must be provided for the opinion proffered. In rendering the opinion, the examiner should review the study cited to in the May 2018 Informal Hearing Presentation “Adding Insult to Injury: Cochlear Nerve Degeneration after “Temporary” Noise-Induced Hearing Loss”, The Journal of Neuroscience, November 11, 2009 29(45):1407714085 14077 and discuss the significance, if any, of the findings of the study in relation to the question posed above. The examiner should discuss and reconcile his/her findings with the findings of the October 2019 private medical nexus opinion if they are in conflict with the opinion proffered. Consideration should be given to the Veteran’s in-service noise exposure, complaints of decreased hearing, and his report of an in-service head injury. The Board again notes that the Veteran reported a decrease in hearing ability and was told to use hearing protection after his last in-service audiogram. The examiner should explain the reasoning for any opinion provided as the Board is precluded from making medical findings. If an opinion cannot be offered without speculating, a clear explanation for why speculation would be required must be given. 2. After the development requested is completed, readjudicate the issue on appeal. If any benefit sought remains denied, then furnish the Veteran and his representative a supplemental statement of the case and a   reasonable period to respond, and then return the case to the Board. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Baker, 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.