Citation Nr: 20005019 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 19-13 793 DATE: January 22, 2020 REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1984 to September 1991. Entitlement to service connection for a bilateral hearing loss disability is remanded. The Veteran claims entitlement to service connection for a bilateral hearing loss disability. Specifically, the Veteran contends that his bilateral hearing loss is related to his service-connected tinnitus and ear pain condition, as well as his in-service exposure to loud noise. Unlike tinnitus, establishing a diagnosis and nexus for hearing loss is an inherently medical question, that requires specific testing by qualified medical professionals. To that end, the Veteran last had an audiology examination in November 2017. As to bilateral hearing loss, the November 2017 examiner diagnosed sensorineural hearing loss based on audiometric testing of puretone thresholds and speech discrimination scores. The examiner opined that it was less likely than not that the Veteran’s hearing loss was related to service. The examiner noted that the Veteran’s hearing thresholds at the time of entrance and separation were within normal limits. The Board finds the November 2017 examiner’s opinion to be inadequate because the opinion relied on the absence of evidence in the Veteran’s service treatment records. Specifically, the November 2017 examiner’s opinion relied on a lack of documented hearing loss noted on the Veteran’s separation exam. Generally, the lack of diagnosed hearing loss in service cannot serve as the sole basis for a negative finding. Additionally, it is not clear if the examiner fully considered the Veteran’s in-service treatment for ear pain and diagnosis of otitis noted in his service treatment records. Furthermore, the examiner’s opinion did not address the Veteran’s contention that his current hearing loss was caused or aggravated by his service-connected disabilities, specifically his tinnitus and service-connected bilateral ear pain condition. As a result, remand is necessary to address whether the Veteran’s current bilateral hearing loss condition was caused or aggravated by his service-connected disabilities. The matters are REMANDED for the following action: Obtain an addendum medical opinion from a qualified VA medical professional to determine the nature and etiology of any current hearing loss disability. The examiner should review the claims folder, and then respond to the following: Is it at least as likely as not (i.e., probability of 50 percent or greater) that a hearing loss disability is related to the Veteran’s active duty service? In answering this question, review and consider the lay assertions of record, to include the Veteran’s statements military noise exposure while in service. Additionally, consider the Veteran’s in-service treatment for ear pain and diagnosis of otitis, noted in his service treatment records. See VBMS, document labeled STR - Medical, receipt date 04/26/2007, pages 6-8, 17, and 26. Also, note that the Veteran is competent to describe any symptoms he may have experienced since service discharge, particularly symptoms of hearing loss. Notwithstanding the above, is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s hearing loss was caused by his service-connected disabilities, to include his tinnitus and bilateral ear pain? Notwithstanding the above, is it at least as likely as not (50 percent or greater probability) that the Veteran’s hearing loss is aggravated by his service-connected disabilities, to include his tinnitus and bilateral ear pain? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and also by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner should note that the lack of diagnosed hearing loss in service cannot serve as the sole basis for a negative finding. Lay contentions must be considered and weighed in making the determination as to whether a nexus exists. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David M. Sebstead, 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.