Citation Nr: 20042347 Decision Date: 06/23/20 Archive Date: 06/23/20 DOCKET NO. 17-66 380 DATE: June 23, 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 March 1970 to March 1990. In a July 2019 decision the Board remanded the appeal to cure defects found in a July 2014 VA examination report. 1. Entitlement to service connection for bilateral hearing loss is remanded. As to the hearing loss evaluation, the Board directives required conversion of the September 1969 entrance examination hearing threshold measurements from American Standards Association (ASA) standards to American National Standard Institute (ISO-ANSI) standards. For the VA examination on November 2019, the examiner properly converted the readings, with one small caveat. The examiner interpreted the exit audiogram the right ear at 500 Hz as 20. A close examination of the service treatment record reveals that rather than “+20” this cell actually reads “+10.” The zero in the cell underneath crosses into the space to make it easy to misinterpret as the loop of a “2” but the Board finds the value is actually “+10” in this cell. Applying the conversion of +15 for 500 Hz, the converted right ear score is 25, not 35 as found by the examiner. This alone is not sufficient reason to remand, as the lower reading is still consistent with the examiner’s opinion that there was no significant threshold shift in service. However, remand is required because the opinion did not address the two medical treatises the Veteran supplied with his Form 9 in December 2017 (on Cochlear Nerve degeneration after acoustic trauma and neural degeneration in acquired hearing loss). The examiner needs to discuss them and explain any potential contradiction with his rationale. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). 2. Entitlement to service connection for tinnitus is remanded. The Board’s directives relating to the tinnitus claim instructed: The examiner must also specifically consider and discuss the Veteran’s lay statement that he experienced tinnitus shortly after he retired from the Air Force . . . The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. The November 2019 VA examiner did not acknowledge the Veteran’s lay evidence at all. The Veteran has a right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, a remand is necessary for a new opinion that complies with these directives. Beyond the Veteran’s lay statements, service personnel records confirm that the Veteran started his career as a jet engine technician and was ultimately promoted to crew chief, to include responsibilities for fighter aircraft, as he progressed through his career. Remand is necessary to address the Veteran’s contentions and the evidence in the claims file that supports those contentions. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate examiner to determine the nature and etiology of the Veteran’s bilateral hearing loss and tinnitus. The claims file (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. Prior to rendering the above opinion, the examiner must accurately convert the September 1969 entrance examination audiometric results from ASA to ISO-ANSI standards. Please accept that the September 1969 separation examination has a value of “+10” for 500 Hz in the right ear. The examiner must also specifically consider and discuss the Veteran’s lay statements that he experienced tinnitus shortly after he retired from the Air Force and that he has lost hearing from working on the flight line for 20 years. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran’s reports in this area are discounted, the examiner should provide a reason. The examiner must also specifically consider and discuss the two medical treatises provided by the Veteran in December 2017 with his Form 9 substantive appeal. The medical opinion should discuss why the proffered research studies were found to be persuasive or unpersuasive in the context of any medical connection between his current hearing condition and service. If the research materials and results are discounted, the examiner should provide a reason for doing so. The examiner must provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that: a) the Veteran’s bilateral hearing loss had its onset in service. b) the Veteran’s bilateral hearing loss is related to his active duty service, to include his noise exposure from his military occupation as a tactical aircraft maintenance technician and crew chief for 20 years. c) sensorineural hearing loss manifested by March 1991. d) the Veteran’s tinnitus had its onset in service. e) the Veteran’s tinnitus is related to his active duty service, to include his noise exposure from his military occupation as a tactical aircraft maintenance technician and crew chief for 20 years. f) tinnitus manifested by March 1991. (Continued on the next page)   A full and complete explanatory rationale must be provided for any opinion offered. If any requested opinion cannot be answered 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 to offer an opinion. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Allen M. Kerpan 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.