Citation Nr: 20052943 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 19-27 457 DATE: August 10, 2020 REMANDED Service connection for hearing loss is remanded. Service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran had active service with the United States Navy from June 1955 to June 1959. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2017 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO) in Oakland, California. Service connection for hearing loss and tinnitus is remanded. The Veteran was afforded a VA examination in January 2017, in which he was diagnosed with left ear sensorineural hearing loss, right ear mixed hearing loss, right ear tinnitus and upon audiological testing, is considered to have a hearing loss disability for VA purposes. 38 C.F.R. § 3.385 (2019). However, the VA examiner was unable to provide a medical opinion regarding the etiology of the Veteran’s hearing loss and right ear tinnitus without resorting to speculation. The examiner indicated that as for the right ear, mixed hearing loss was likely partially due to noise exposure, but also due to perforated ear drum and recurrent Otitis Media. As for left ear hearing loss, the examiner reasoned that the Veteran was exposed to aircraft noise but worked in an office setting. The examiner reasoned that it was not possible to state why right ear tinnitus improved following surgery, and that if the etiology of tinnitus was due to noise exposure, it would likely remain following surgery. Before the Board can accept an examiner’s statement that an opinion cannot be provided without resort to speculation, it must be clear that this is predicated on a lack of knowledge among the medical community at large and not the insufficient knowledge of the specific examiner.” Sharp v. Shulkin, 29 Vet. App. 26 (2017); Jones v. Shinseki, 23 Vet. App. 382 (2010). While the VA examiner proffered rationale for the speculative opinions, it is not clear that this is based on a lack of knowledge amongst the medical community at large or the insufficient knowledge of the examiner themselves. Therefore, the Board finds that remand is necessary for VA addendum opinions with sufficient rationale prior to rendering a decision on the appeal. The matters are REMANDED for the following action: 1. The RO should refer the case for a VA addendum opinion to determine the nature and etiology of bilateral hearing loss and tinnitus. An examination of the Veteran is not required but may be so ordered by the VA examiner if he/she determines it necessary to render the below requested opinions. The VA examiner is requested to determine whether it is at least as likely as not (50 percent probability or greater) that diagnosed right ear mixed hearing loss, left ear sensorineural hearing loss and right ear tinnitus were incurred in or caused by active service. Additionally, as for left ear sensorineural hearing loss, determine whether it is at least as likely as not (50 percent probability or greater) that the Veteran experienced chronic symptoms of left ear hearing loss in service, with continuous symptoms since service separation. The term “at least as likely as not” does not mean “within the realm of medical possibility.” Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. The examiner must provide a complete explanation for his or her opinion(s), based on his or her clinical experience, medical expertise, and established medical principles. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and specifically explain whether there is any potentially available information that, if obtained, would allow for a non-speculative opinion to be provided. 2. The RO must ensure that the required actions have been accomplished to the extent possible in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, corrective action must be undertaken before the claims file is returned to the Board. Specifically, the RO should ensure that the VA medical opinions received are articulated in the language as requested by the Board. (Continued on next page) 3. After all the development has been completed, the AOJ should review the case again based on the additional evidence. If the benefits sought are not granted, the AOJ should furnish the Veteran and his representative with a supplemental statement of the case, and should give the Veteran a reasonable opportunity to respond before returning the record to the Board for further review. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. R. Woodarek 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.