Citation Nr: 20021101 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 17-65 075 DATE: March 24, 2020 REMANDED Entitlement to service connection for left ear mixed hearing loss disability is remanded. Entitlement to service connection for right ear sensorineural hearing loss disability is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1953 to April 1955 and from December 1990 to May 1991. The Board remanded the Veteran’s claims in November 2019, and the directives were complied with. 1. Entitlement to service connection for left ear mixed hearing loss disability is remanded. 2. Entitlement to service connection for right ear sensorineural hearing loss disability is remanded. 3. Entitlement to service connection for tinnitus is remanded. The Board previously remanded the Veteran’s claims in order to obtain new medical opinions that were supported by adequate rationale. Such opinions were obtained and were not favorable to the Veteran’s claims. See December 2019 VA examination report. With regard to hearing loss, the examiner noted hearing loss was not found until 2016, many years after service. The examiner explained that medical literature doesn’t support a relationship between acoustic trauma and delayed onset hearing loss. The examiner similarly noted that complaints of tinnitus were not located in the record until 2016, despite the Veteran’s belief that “ringing began when he was deployed.” See December 2019 VA examination report, page 5. The Board notes that during a May 2016 VA examination the Veteran reported tinnitus began a few years prior to the examination. The Veteran’s representative has provided argument in conflict with the VA examiner’s rationales. In a March 2020 brief, the representative cited medical literature supporting delayed onset hearing loss. “Therefore, normal hearing thresholds may mask neural degeneration. In other words, hearing damage resulting in degeneration years later may occur, despite ‘normal’ hearing shortly post-exposure.” See March 2020 brief, page 2. Literature that may support the same for tinnitus was also cited. Although the Veteran’s representative has provided support for the idea of delayed onset hearing loss and tinnitus, no clinician has attributed such a delayed onset to the Veteran’s hearing loss and tinnitus. Furthermore, the Veteran has offered conflicting evidence regarding the timing of such onset. Additionally, with regard to the Veteran’s left ear hearing loss, the December 2019 examiner concluded the rationale section by stating the Veteran has left ear mixed hearing loss and “it may be helpful to have that ear examined by a physician.” It is not clear from this statement if a physician would be better suited to evaluate the etiology of the Veteran’s mixed hearing loss, or if a physician would be helpful in treating the Veteran’s mixed hearing loss. Therefore, remand to clarify this statement and possibly obtain an opinion from a physician is warranted. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left ear mixed hearing loss disability and right ear sensorineural hearing loss disability are at least as likely as not related to an in-service injury or disease, to include reported noise exposure. The clinician should consider the literature cited by the Veteran’s representative in the March 2020 brief. The clinician should state whether an opinion or examination by a physician would be beneficial in evaluating the etiology of the Veteran’s left ear mixed hearing loss disability. If so, such an examination should be scheduled or opinion obtained.   2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s tinnitus is at least as likely as not related to an in-service injury or disease, to include reported noise exposure. The clinician should consider the literature cited by the Veteran’s representative in the March 2020 brief. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.