Citation Nr: 20046589 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 17-21 786 DATE: July 13, 2020 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from August 1958 to May 1961. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in May 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). The hearing transcript is associated with the claims file and reflects the record was held open for 30 days from the date of the hearing to allow the Veteran to submit additional evidence. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that his hearing loss disability is a result of in-service noise exposure while serving as a light weapons infantryman. During the May 2019 Board hearing, the Veteran testified that he was the number two crewmember on the howitzer and that he loaded and fired howitzer rounds. He further explained that he did not wear hearing protection while working on the howitzer because he could not hear commands given to him. Additionally, he reported that after working on the howitzer he could not hear and that this hearing loss lasted for a half day up to a full day after he had stopped working on the howitzer. See Correspondence, received by VA in May 2019. The Veteran was afforded a VA examination in January 2016. The examiner found that the Veteran had bilateral sensorineural hearing loss. The examiner opined that the Veteran’s bilateral hearing loss was less likely than not caused by or a result of an event in military service. The examiner noted the Veteran’s service treatment records revealed normal whisper test results at enlistment and hearing sensitivity within normal limits at separation of military service. The examiner stated there was no evidence in the record to indicate that the Veteran sustained noise injuries based on in-service audiograms. The examiner cited the Institute of Medicine’s 2006 report which found that based on current understanding of auditory physiology, hearing loss from noise injuries occurs immediately following exposure. Citing the Institute of Medicine’s 2006 report, the examiner concluded that there is no scientific basis on which to conclude that the current hearing loss was caused or the result of military service, to include military noise exposure. The examiner did not address the Veteran’s assertions that he could not hear for up to a day after working on the howitzer. Moreover, the examiner did address the possibility of delayed-onset hearing loss. In that regard, the absence of in-service evidence of a hearing disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385) is not always fatal to a service connection claim. See Leford v. Derwinski, 3 Vet. App. 87, 89 (1992); Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Based on the foregoing, the Board finds an additional medical opinion is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for a new VA examination to determine the nature and etiology of his bilateral hearing loss. The claims folder and a copy of this remand should be reviewed by the examiner. The examiner should take as a fact for the purposes of the opinion, that the Veteran was exposed to hazardous noise from the artillery due to his work as a cannon crewmember who loaded and fired howitzer rounds without ear protection. The examiner should opine whether it is at least a likely as not (50 percent or greater probability) that the Veteran’s current bilateral hearing loss may be attributed to his exposure to hazardous noise in service. The examiner is asked to specifically address the Veteran’s assertion that he could not hear for up to a day after working on the howitzer. It should be noted that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss when there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements of a hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. The examiner should specifically address whether there was any threshold shift or notch at higher frequencies during service or shortly thereafter that may be indicative of acoustic trauma. The examiner should also comment on the likelihood that loud noises experienced resulted in damage to auditory hair cells even though findings may or may not suggest a recovered temporary threshold shift in service. If the examiner finds auditory hair cell damage to be a likely result of military noise exposure, please comment on the likelihood that such damaged hair cells would result in a greater permanent hearing loss than otherwise would be manifest. The examiner should discuss the medically known or theoretical causes of hearing loss and describe how hearing loss which results from noise exposure generally presents or develops in most cases, as distinguished from how hearing loss develops from other causes, in determining the likelihood that current hearing loss was caused by noise exposure in service as opposed to some other cause. A full rationale must be provided for any opinion offered and a thorough explanation would be helpful for the Board. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity for an examination. If a VA examination proves not feasible for any reason, including the Veteran not appearing for an examination, the claims file should still be reviewed by an appropriate professional for the purpose of providing the requested opinions. 2. When the above development has been completed, readjudicate the issues on appeal. If any benefit sought on appeal remains denied, provide an additional supplemental statement of the case to the Veteran and his representative, and afford the Veteran and his representative an adequate opportunity to respond, prior to returning the issue to the Board for appellate review. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fairlie, 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.