Citation Nr: 20004040 Decision Date: 01/16/20 Archive Date: 01/16/20 DOCKET NO. 18-13 341 DATE: January 16, 2020 REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1963 to June 1966. This appeal comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In the March 2018 Form 9, the Veteran requested a live videoconference hearing before the Board. In October 2018, the Veteran withdrew his request for a Board hearing. As such, the Veteran’s hearing request is withdrawn. 38 C.F.R. § 20.704(e). Entitlement to service connection for a bilateral hearing loss disability is remanded. The Veteran, and his representative, contends that his current bilateral hearing loss disability is due to in-service acoustic trauma. Specifically, the Veteran argues that his hearing loss stems from his duties as a paratrooper in which he was exposed to loud noises from aircraft, gun fire, and artillery fire without hearing protection. See Form 9 (March 2018). For reasons discussed below, the Board finds that remand is necessary. As an initial matter, the Board notes that a bilateral hearing loss disability as defined at 38 C.F.R. § 3.385 is shown. The Veteran’s service personnel records reflect that he was a qualified Army paratrooper. It is also noted that the absence of in-service evidence of hearing loss disability is not fatal to a claim for service connection for hearing loss disability. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. See Hensley v. Brown, 5 Vet. App. 155 (1993). It has also been established that the threshold for normal hearing is from 0 to 20 decibels. Id. Service treatment records reflect no complaints or findings for hearing loss. An April 1966 separation examination report reflects audiometric findings within normal limits. The first documented complaints and findings for hearing loss are in 2015, decades after discharge from active service. A February 2016 VA examination report reflects hearing loss disability for VA purposes in each ear, the examiner opined that the Veteran’s bilateral hearing loss was less likely than not etiologically related to service. In support of this conclusion, the examiner stated that the Veteran’s hearing examination done at separation revealed hearing within normal limits and that it was more likely that his current hearing loss was the result of acoustic trauma after military service. The Board finds the VA medical opinion is inadequate because it does not directly answer the question of whether the Veteran’s current hearing loss disability is as likely as not related to in-service injury, claimed as noise exposure. The Veteran’s noise exposure is consistent with the circumstances of his service. The examiner, in this case, made no attempt to explain why the Veteran’s delayed onset hearing loss was not caused by the claimed in-service noise exposure. Additionally, as stated above, the absence of in-service evidence of a hearing loss disability is not fatal to the Veteran’s claim for service connection for a hearing loss disability. See Ledford, 3 Vet. App. at 89. It is also noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25. A “medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Of which, the medical opinion is deficient. Because the February 2016 VA medical opinion is incomplete with regards to addressing the claimed in-service noise exposure to the current hearing loss disability, remand is necessary. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from November 2017 to the Present. 2. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for his hearing loss symptoms since service discharge. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 3. Obtain VA medical opinion from an otolaryngologist on the nature and etiology of the Veteran’s bilateral hearing loss disability. The clinician must opine on whether it is at least as likely as not that the Veteran’s claimed bilateral hearing loss disability (a) began during active service, (b) manifested within one year after the Veteran’s discharge from service, or (c) was noted during service with continuity of the same symptomatology since service. Additionally, the clinician must opine on whether any delayed onset hearing loss is etiologically related to conceded in-service noise exposure – and in doing so may not rely exclusively on the absence of in-service findings for hearing loss. The examiner is not required to accept the Veteran’s theory that his military service caused his hearing loss, or that he had symptoms associated with the disability during or following military service if this is incongruous with the record; however, the examiner is required to fully explain why he or she disagrees with the Veteran’s theory of causation, and provide a discussion of the relevant or significant medical history, clinical findings, medical knowledge or literature, etc., that support the negative medical opinion or conclusion(s). If another etiology is the more likely cause, the clinician must provide a complete explanation of his or her reasoning. 4. Ensure that all VA medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffey, 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.