Citation Nr: 20021312 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 17-33 260 DATE: March 25, 2020 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1959 to October 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in March 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for bilateral hearing loss. As noted in the February 2019 remand, the evidence demonstrates that the Veteran has a current diagnosis of bilateral hearing loss as defined by VA regulations. See March 2017 VA examination. Furthermore, while his service treatment records are negative for any complaints, treatment, or diagnosis referable to bilateral hearing loss, the Board found that he was exposed to excessive noise from helicopters, mortars, pistols, and grenades while serving in the Republic of Vietnam. Thus, the remaining question is whether the Veteran’s bilateral hearing loss is related to such in-service noise exposure. In this regard, the February 2019 remand found that a March 2017 VA opinion that found that that it was less likely than not that the Veteran’s hearing loss was caused by or a result of an event in military service to be inadequate to decide the claim. In support of such opinion, she noted that the Veteran’s service treatment records were silent for any complaints of hearing loss, his July 1979 separation examination revealed normal hearing, and his military occupational specialty (MOS) had a low probability of noise exposure. The examiner also observed that there was a lack of continuity of care as it was over 36 years between his separation from service and his first hearing examination, and he claimed that he had only had problems hearing for the past 10 years. Finally, she referenced a 2002 position paper from the American College of Occupational and Environmental Medicine and a 2006 report from the Institute of Medicine in support of the principle that there is no delayed onset hearing loss. However, the Board determined that such opinion was inadequate as it did not consider the nature of the Veteran’s in-service noise exposure to helicopters, mortars, pistols, and grenades while serving in the Republic of Vietnam; his May 2017 statement that, while in service, he had exposure to continuous loud noises, problems with people speaking in mumbled or slurred tones, feeling of being off-balance/dizzy, problems following conversations at daily briefings, and sensation of a buzzing in both ears; and a line of research conducted by Dr. Sharon G. Kujawa that discusses the possibility of delayed-onset hearing loss. Consequently, the Board remanded the case in February 2019 in order to obtain an addendum opinion addressing whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s bilateral hearing loss had its onset in, or is otherwise related to, his military service, to include noise exposure therein, or manifested within one year of his service discharge in October 1979, i.e., by October 1980. In September 2019, the March 2017 VA examiner essentially reiterated her prior opinion that it was less likely than not that the Veteran’s hearing loss is related to his military noise exposure, relied on the same rationale, and discounted the line of research conducted by Dr. Sharon G. Kujawa. However, she did not address the nature of the Veteran’s in-service noise exposure or his reported in-service symptomatology as requested in the February 2019 remand or offer an opinion as to whether the Veteran’s bilateral hearing loss manifested within one year of his service discharge in October 1979, i.e., by October 1980. Therefore, another remand is necessary in order to obtain an addendum opinion that complies with the February 2019 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: 1. Forward the record to an appropriate clinician other than the March 2017/September 2019 VA examiner, if possible, for an addendum opinion addressing the etiology of the Veteran’s bilateral hearing loss. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a full review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s bilateral hearing loss had its onset in, or is otherwise related to, his military service, to include his acknowledged noise exposure therein, or manifested within one year of his service discharge in October 1979, i.e., by October 1980. In offering such opinion, the examiner should consider and discuss (1) the nature of the Veteran’s in-service noise exposure to helicopters, mortars, pistols, and grenades while serving in the Republic of Vietnam, which the Board has found to be consistent with the nature of his in-service duties, and (2) his May 2017 statement that, while in service, he had exposure to continuous loud noises, problems with people speaking in mumbled or slurred tones, feeling of being off-balance/dizzy, problems following conversations at daily briefings, and sensation of a buzzing in both ears. The examiner is advised that the lack of medical records reflecting in-service complaints of hearing loss, or demonstrating a continuity of care after service, cannot form the sole basis of a negative opinion. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Northcutt, 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.