Citation Nr: 20036767 Decision Date: 05/28/20 Archive Date: 05/28/20 DOCKET NO. 17-20 082 DATE: May 28, 2020 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from September 1963 to June 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran asserts that his current hearing loss had its onset during his active duty service, was caused by his exposure to acoustic trauma while working on flight lines and his exposure to jet fuels and continued from his active duty service to the present. See March 2013 Veteran lay statement, July 2014 Notice of Disagreement, and April 2017 VA Form 9. The Veteran has a current diagnosis of hearing loss for VA purposes. See August 2013 and March 2017 VA examination reports. The Veteran’s military occupation specialty was aircraft painter. He reported he worked on the flight deck of his ship continuously for 6 months during a deployment; thus, the Veteran has an in-service injury or acoustic trauma. The Board also notes the Veteran asserts that his bilateral hearing loss is due to his exposure to aircraft fuels and exhaust. The Board concedes the Veteran’s acoustic trauma and his exposure to chemicals, including jet fuel, as being consistent with the places, types, and circumstances of his service. 38 U.S.C. § 1154(a). Both the August 2013 and March 2017 VA examiners opined that as the Veteran’s hearing was within normal limits at the time of his separation from active duty, his current hearing loss was less likely than not related to his in-service acoustic trauma. Although the examiners addressed conceded in-service noise exposure, they did not address the possibility of delayed-onset hearing loss and are accordingly of no probative value. Hensley v. Brown, 5 Vet. App. 155, 159. Additionally, neither examiner addressed the Veteran’s assertion that his hearing loss was also caused by his exposure to jet fuels in service. In this regard, the RO submitted into evidence an article published in March 2014 at VA Currents, Research News from the U.S. Department of Veterans Affairs entitled “Exposure to jet fuel, not just noise, contributes to hearing problems.” Available at https://www.research.va.gov/currents/spring2014/spring2014-11.cfm, last accessed May 27, 2020. In the article, Dr. O’Neil Guthrie states regarding jet fuel that “even at subtoxic levels, the exposure is affecting the brain and resulting in auditory processing dysfunctions.” Accordingly, as the examiners did not consider this alternative theory of entitlement or the above-cited article associated with the record, the opinions are also inadequate in this regard. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Finally, the August 2017 examiner also relied on a lack of significant threshold shifts during the Veteran’s active duty service in denying service connection. The Veteran had an audiological evaluation at his time of entry in August 1963 and at the time of his separation in June 1967, at which time auditory thresholds were recorded. Prior to January 1, 1967, the American Standards Association (ASA) standards are presumed to have been utilized by US military branches and between January 1, 1967 and December 31, 1970, consideration should be given under both ASA and the more recent International Standards Organization – American National Standards Institute (ISO-ANSI) standards. Accordingly, the enlistment examination is presumed to be under ASA standards and the exit examination must be considered under both standards, relying on the unit measurements most favorable to the Veteran’s appeal. As the August 2017 examiner failed to discuss these shifting standards that were occurring at the time of the Veteran’s in-service audiograms, the lack of any identifying standards used on the audiograms, and the examiner’s reliance on a lack of significant threshold shift in forming his negative opinion, the Board finds the August 2017 VA medical opinion to be inadequate in this regard as well. Accordingly, any adequate addendum opinion must also take into account the changing audiological standards that occurred during the Veteran’s enlistment. Thus, an addendum opinion is warranted on remand. Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding private treatment records. If any records are unavailable, notify the Veteran pursuant to 38 C.F.R. § 3.159(e). 3. Then, request an addendum opinion addressing the etiology of the Veteran’s bilateral hearing loss. The claims file, including a copy of this remand, must be made available to the examiner for review. No additional examination of the Veteran is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner should address whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss had its onset in service or is otherwise related to service, to include as a result of conceded in-service acoustic trauma; and the Veteran’s conceded exposure to jet fuel coincident with his MOS as an aircraft painter. In answering the above question, the examiner must address the following: (a.) The enlistment audiogram and the separation audiogram to include any threshold shifts that may or may not have been appropriately recorded due to a shift from the use of ASA standards to ISO-ANSI standards during the Veteran’s active duty service and addressing what effect this may have had on considering an in-service shift; (b.) the Veteran’s conceded in-service exposure to jet fuels and the above cited research indicating that exposure to jet fuel, not just noise, contributes to hearing problems; (Available at https://www.research.va.gov/currents/spring2014/spring2014-11.cfm, last accessed May 27, 2020) (c.) whether the Veteran’s conceded in-service acoustic trauma resulted in delayed-onset hearing loss; and (d.) the Veteran assertions that his current hearing loss had its onset during his active duty service and continued from his active duty service to the present. See March 2013 Veteran lay statement, July 2014 Notice of Disagreement, and April 2017 VA Form 9. In addressing the Veteran’s statements, the examiner must assume this statement as true, even despite the absence of “objective documentation.” (e.) Please state whether the Veteran’s hearing loss is medically consistent with the symptomatology reported by the Veteran and his wife in sub-part (d) above. In the event you rely on the 2006 IOM report finding that “there is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after the cessation of that noise exposure” to support a negative rationale, please also address the fact that “definitive studies to address this issue have not been performed.” Any failure to do so will render the opinion inadequate. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Rouse, 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.