Citation Nr: 20072872 Decision Date: 11/12/20 Archive Date: 11/12/20 DOCKET NO. 16-12 439 DATE: November 12, 2020 REMANDED Service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1963 to June 1967, with periods of additional service in the United States Air Force Reserves from June 1967 to June 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In April 2019, the Board denied the claim for service connection for bilateral hearing loss. Thereafter, the Veteran appealed the Board’s denial of this claim with the United States Court of Appeal for Veterans Claims (CAVC). In a February 2020 joint motion for remand (JMR), the parties stipulated that the Board erred by failing to ensure that VA satisfied its duty to assist by obtaining a pertinent hearing evaluation that was conducted by the Veteran’s former employer; and also, by failing to provide adequate reasons or bases for its decision, by relying, in part, on an inadequate 2016 VA compensation and pension examination (VA examination). In a February 2020 Order, CAVC vacated and remanded the April 2019 Board decision for further additional developments. Thus, the Board regrets further delay, as additional developments, consistent with the February 2020 JMR and CAVC Order, are necessary before a decision may be rendered on this issue on appeal. In a February 2019 statement in support of claim, the veteran further asserted that a March 2016 VA opinion, which rendered a negative etiological opinion on his bilateral hearing loss, was inadequate and that recent medical studies show that the onset of hearing loss can be delayed for years after the exposure to noise has ended. Specifically, in support of this assertion, the Veteran has cited to “Adding Insult to Injury: Cochlear Nerve Degeneration after Temporary Noise Induced Hearing Loss”, Sharon G. Kujawa, et al., 29 (45) J. Neuroscience 14077, 14078 – 79 (2009). In the March 2016 VA opinion, a VA examiner opined that the Veteran’s bilateral hearing loss was not at least as likely as not caused by or a result of an event in military service. As part of the rationale for this opinion, the VA examiner reasoned that that the Veteran had normal pure tone threshold hearing sensitivity at enlistment into the USAF in 1963 and normal pure tone threshold hearing sensitivity at separation from the USAF in 1967. However, this opinion is inadequate, as it is based on an inaccurate factual premise because the Veteran’s enlistment examination does not include an audiogram. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (Holding that a medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (“If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely”) (citing Reonal). Thus, in summary, a remand is required or a new VA examination and opinion on the etiology of the Veteran’s bilateral hearing loss, with an adequate opinion that considers the Veteran’s assertions and medical citation on delayed onset hearing loss. Additionally, on remand, the RO must obtain all outstanding medical records and associate them with the claims file, specifically including and not limited to, a 2009 hearing evaluation from the Veteran’s former employer, Royal Mouldings. The matters are REMANDED for the following action: 1. Obtain the requisite authorization and release from the Veteran and obtain all outstanding private and/or VA medical records, specifically including and not limited to, a 2009 audiology report from the Veteran’s former employer, Royal Mouldings. 2. After obtaining all outstanding medical treatment records and associating them with the claims file, schedule the Veteran for a new VA examination with an audiologist (VA examiner) to determine the etiology of the Veteran’s bilateral hearing loss. The VA examiner must review the claims file and must note that review in the report. A copy of this REMAND must be made available to the VA examiner. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral hearing loss was incurred in service; is the result of an in-service illness, injury, disease, or event; and/or is otherwise related to his active service. b. In rendering an opinion, consider all lay statements by the Veteran about onset, continuity, and symptomatology. c. In rendering an opinion, also consider all medical literature, submitted by the Veteran, in the claims file. Specifically, discuss and address the medical literature the Veteran has cited to, Adding Insult to Injury: Cochlear Nerve Degeneration after Temporary Noise Induced Hearing Loss”, Sharon G. Kujawa, et al., 29 (45) J. Neuroscience 14077, 14078 – 79 (2009), regarding delayed onset of hearing loss, after exposure to noise and/or acoustic trauma. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Vanessa-Nola Pratt 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.