Citation Nr: 20007340 Decision Date: 01/29/20 Archive Date: 01/28/20 DOCKET NO. 17-27 574 DATE: January 29, 2020 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1966 to April 1968. In January 2020, the Veteran testified in front of the undersigned Veterans Law Judge. This decision is being made under the “one-touch” program. A transcript of the hearing will be associated with the claims file at a later time. 1. Bilateral hearing loss The Board of Veterans’ Appeals (Board) finds a remand is warranted because the medical evidence currently of record is insufficient to resolve the claims for service connection because there are outstanding questions pertaining to whether there exists a medical nexus between the Veteran’s current bilateral hearing loss and service. Outstanding Medical Records The Board finds a remand is warranted to obtain additional medical records. During the January 2020 Board hearing, the Veteran testified that he worked at General Motors immediately following service and a medical examination confirmed that he had hearing loss. These records have not been associated with the record. The Veteran also asserted that he was prescribed hearing aids in 1970 by an Audiologist and that he has had hearing aids since 1970. The Veteran’s VA treatment records confirm that he requested hearing aids during a September 2012 VA Audiology Consult. See September 2012 VA Audiology Consult in CAPRI received October 2015. As such, there is a question regarding the onset of the Veteran’s hearing loss. Because such records, if obtained, might contain information bearing on the Veteran’s appeal, efforts should be made to procure them. See 38 U.S.C. § 5103A (2002); 38 C.F.R. § 3.159(c)(2018). Accordingly, on remand the Regional Office (RO) should obtain these records with the Veteran’s assistance. New VA Medical Opinion Although, the Veteran submitted a private medical opinion from Dr. D.D.Z. from Red Cedar ENT & Audiology, P.L.L.C. dated August 2014., the Board requires additional information to decide the claim. See Private Medical Opinion from Dr. D.D.Z. Dr. D.D.Z. opined that the Veteran’s hearing loss and tinnitus were at least as likely as not related to his military noise exposure. However, Dr. D.D.Z. did not address what type of noise exposure caused the Veteran’s current hearing loss or whether she reviewed the claims file in rendering her opinion. Therefore, the private DBQ does not provide sufficient information to decide the claim. Accordingly, the Board finds a VA examination would be helpful in deciding this claim. In November 2015, the Veteran was provided a VA examination for his hearing loss and tinnitus claims. See November 2015 VA Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ). The examiner diagnosed the Veteran with bilateral SNHL and opined that the Veteran’s hearing loss was less likely than not related to active service. Id. The examiner reasoned that the Veteran’s audiograms were normal at the time of entrance and separation, and that there was no significant threshold shift during that time. The examiner also noted that the Veteran’s military occupation specialty (MOS) as a Projector Repairman had a low probability of hazardous noise exposure. Id. The Board finds this opinion is inadequate because the examiner failed to address whether the Veteran’s in-service treatment and complaints of ear problems including being medevaced in 1967 for an ear infection and was treated for otitis media. Specifically, in July 1967, the Veteran was seen for an ear, nose, and throat (ENT) consultation for complaint of otitis media and left ear discharge. See July 1967 Consultation Sheet in Service Treatment Records-Medical. He was assessed with a left ear cyst on canal wall. Id. During the January 2020 Board hearing, the Veteran reported that although his MOS was Projector Repairman, he rarely worked in his MOS, instead he helped build compounds. He also testified that he was exposed to cement mixers and nail guns to build a compound. The Veteran also reported such noise exposure to the November 2015 VA examiner; however, the examiner did not address the Veteran’s lay statements regarding his exposure to noise from cement mixers and nail guns in providing a negative nexus opinion. See Dalton v. Nicholson, 21 Vet. App. 23, 27, 39 (2007) (finding that an examiner improperly failed to discuss the Veteran’s lay statements). Thus, on remand the RO should arrange to obtain an addendum opinion addressing the etiology of the Veteran’s bilateral hearing loss. 2. Tinnitus The Board finds that a remand is also warranted for the Veteran’s claim for tinnitus because the November 2015 VA examiner did not address the Veteran’s lay statements regarding noise exposure from cement mixers and nail guns as well as the Veteran’s service records reflecting treatment for otitis media and ear infection. Regarding the Veteran’s tinnitus, the examiner opined that the tinnitus was at least as likely not a symptom associated with hearing loss. Id. However, he opined that the Veteran’s tinnitus was less likely than not related to military noise exposure when considering the Veteran’s normal hearing at his separation, and because of his MOS. Id. Thus, because the examiner did not address all of the Veteran’s lay statements and in-service treatment for ear complaints, the Board finds this opinion is inadequate. Because the Veteran’s hearing loss claim is being remanded and the November 2015 VA examiner has opined that the Veteran’s tinnitus is a symptom of hearing loss. The Board also finds that tinnitus claim is inextribably intertwined with the Veteran’s hearing loss claim. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). A grant of service connection for hearing loss would have a significant impact on his tinnitus claim. Thus, a remand is necessary to determine the nature and etiology of the Veteran’s tinnitus. On remand, the VA examiner should also provide an opinion on whether the Veteran’s tinnitus was caused or aggravated by the Veteran’s hearing loss or is otherwise related to active service. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated since January 2015 last received in CAPRI in November 2015 and associate with the claims file. 2. Ask the Veteran to provide any outstanding private audiogram reports, in particular from General Motors and the 1970 private treatment record prescribing hearing aids, or complete a VA Form 21-4142 so that VA may obtain the outstanding records on his behalf. If the Veteran submits the appropriate authorization, make two requests for the authorized records unless it is clear after the first request that a second request would be futile. All efforts to obtain treatment records or negative responses should be documented in the claims file. If records are obtained, such should be associated with the claims file. 3. After the foregoing development has been completed, obtain an addendum VA medical opinion for the Veteran’s hearing loss and tinnitus by a medical professional with appropriate expertise. The examiner should review the Veteran’s claims file, including a copy of this remand. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the reviewer must address the following. The examiner is requested to provide the following information: (a.) The examiner should convert ASA to ISO-ANSI standards in evaluating the results of the in-service audiograms. (b.) Whether it is at least as likely as not (50 percent probability or more) that the bilateral hearing loss disability began in service or is causally and etiologically related to service, or manifested to a compensable degree within one year of April 1968? (c.) In providing the requested opinion, the examiner is asked to specifically illicit from the Veteran a history of his military noise exposure and address whether the Veteran’s exposure to noise including from cement mixers and nail guns is sufficient to cause acoustic trauma or be considered military noise exposure and whether such exposure caused or is related to the Veteran’s current hearing loss. The examiner is to specifically address all lay statements and assume the Veteran is competent and credible to report on military noise he was exposed to during active duty and of any hearing loss and tinnitus symptomology he experienced at that time and thereafter. (d.) Opine whether the Veteran’s in-service treatment for complaints of ear infection and otitis media including the July 1967 treatment for left ear cyst on canal wall is related to or caused the Veteran’s current hearing loss disability. The examiner must specifically address the July 21, 1967 service entry. (e.) Provide an opinion whether the Veteran’s tinnitus is it at least as likely as not (50 percent or greater probability) that tinnitus manifested during, is otherwise related to the Veteran’s period of active service, or manifested to a compensable degree within one year of April 1968? (f.) Provide an opinion whether the Veteran’s tinnitus is a symptom of hearing loss or is otherwise caused by or aggravated beyond the natural progression by the Veteran’s hearing loss. The examination report must include a complete rationale for all opinions expressed. If medical literature is relied upon in rendering this determination, the VA examiner should specifically cite each reference material utilized. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010). 4. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Gunella Lilly, 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.