Citation Nr: 20052973 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 10-20 974 DATE: August 10, 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 Air Force from March 1973 to March 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York. In May 2011, the Veteran and his wife testified before the undersigned Veterans Law Judge during a Board hearing held at the RO. A copy of the hearing transcript has been associated with the record. By way of history, the Board denied the claim for service connection for bilateral hearing loss in November 2016. The Veteran appealed this denial to the Court of Appeals for Veterans Claims (Court). In May 2017 the Court granted a Joint Motion for Remand (JMR), vacating the Board’s November 2016 decision and remanding the claim to the Board for further adjudication. In August 2017, the Board remanded the Veteran’s claim for additional development. In March 2018, the Board requested a medical opinion from a specialist in the employ of the Veteran’s Health Administration (VHA). A VHA opinion dated May 2018 was subsequently associated with the file. In a September 2018 decision, the Board denied service connection for bilateral hearing loss. The Veteran appealed this denial to the Court. In April 2019 the Court granted a March 2019 JMR, vacating the Board’s September 2018 decision and remanding the claim to the Board for further adjudication. In September 2019 the Board remanded the Veteran’s claim provide a new VA exam and VA opinion in compliance with the March 2019 JMR. A VA examination and opinion of December 2019 have been added to the record. Unfortunately, as will be discussed below, another remand is required. 1. Entitlement to service connection for bilateral hearing loss is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). A recent VA examiner’s opinion from December 2019 addressed the isues raised by the March 2019 JMR. However, in June 2020 the Veteran’s representative submitted a brief that both explicitly challenged the competency and qualifications of the December 2019 VA examiner and provided citations to relevant medical literature which has not been discussed in any previous VA or provate opinion. An addendum opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claims. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). This matter is REMANDED for the following action: 1. Contact the examiner who conducted the December 2019 VA examination and request that they provide a copy of their resume/CV. Upon receipt of such, associate it with the record and provide the Veteran and his representative a copy thereof. If the requested resume/CV is not obtainable, the Veteran should be so advised and the reasons for such should be noted in the record. 2. Obtain an addendum opinion from an appropriate medical professional to determine the nature and etiology of the Veteran’s bilateral hearing loss. The Veteran’s claims file must be made available to and reviewed by the examiner. After review of the service and post service medical evidence of record, and the lay statements and testimony of record, the examiner must provide an opinion as to whether the Veteran’s bilateral sensorineural hearing loss is at least as likely as not(i.e. 50 percent probability or more) etiologically related to his period of active military service, to include his conceded military noise exposure. The examiner must also consider and address the Veteran’s lay statements and testimony regarding the symptoms that he experienced during service and continuously since service discharge. The examiner must specifically address the 1985 private treatment note indicating that the Veteran had been seen in 1978 for various complaints, to include a decrease in hearing. The examiner must specifically consider and address the additional findings of the 2006 IOM report regarding young adults with slight noise-induced high-frequency hearing loss, which according to the definition provided in the report, the Veteran manifested at discharge from service. The examiner’s opinion must specifically address the arguments in the Veteran’s June 2020 brief and the medical literature cited therein including the following: a. Le TN, Straatman LV, Lea J, Westerberg B. Current insights in noise-induced hearing loss: a literature review of the underlying mechanism, pathophysiology, asymmetry, and management options. J Otolaryngol Head Neck Surg. 2017;46(1):41. Published 2017 May 23. doi:10.1186/s40463-017-0219-x. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442866/ (last visited August 7, 2020). b. Kujawa S G, Liberman M C, Adding Insult to Injury: Cochlear Nerve Degeneration after “Temporary” Noise-Induced Hearing Loss. Journal of Neuroscience. 11 November 2009, 29 (45) 14077-14085; doi: 10.1523/JNEUROSCI.2845-09.2009. Available online at https://www.jneurosci.org/content/29/45/14077 (last visited August 7, 2020). c. Tetsuro Wada, Hajime Sano, Shin-ya Nishio, Ryosuke Kitoh, Tetsuo Ikezono, Satoshi Iwasaki, Kimitaka Kaga, Atsushi Matsubara, Tatsuo Matsunaga, Takaaki Murata, Yasushi Naito, Mikio Suzuki, Haruo Takahashi, Testuya Tono, Hiroshi Yamashita, Akira Hara & Shin-ichi Usami (2017) Differences between acoustic trauma and other types of acute noise-induced hearing loss in terms of treatment and hearing prognosis, Acta Oto-Laryngologica, 137:sup565, S48-S52, doi: 10.1080/00016489.2017.1297899. Available online at https://www.tandfonline.com/doi/full/10.1080/00016489.2017.1297899 (last visited August 7, 2020). d. Dodd-Murphy J, Community Outreach Following an Industrial Explosion, American Speech-Language-Hearing Association Website, March 2014. Available online at https://www.asha.org/Articles/Auditory-Effects-of-Blast-Exposure/ (last visited August 7, 2020) e. Jensen JB, Lysaght AC, Liberman MC, Qvortrup K, Stankovic KM (2015) Immediate and Delayed Cochlear Neuropathy after Noise Exposure in Pubescent Mice. PLoS ONE 10(5): e0125160. Available online at https://doi.org/10.1371/journal.pone.0125160 (last visited August 7, 2020). f. Borg E. Delayed effects of noise on the ear. Hear Res. 1983;9(3):247-254. doi:10.1016/0378-5955(83)90029-1. Available online at https://pubmed.ncbi.nlm.nih.gov/6841281/ (last visited August 7, 2020) In rendering the requested opinion and rationale, the examiner must note the fact that the service treatment records do not document hearing loss disability for VA purposes is not fatal to the Veteran’s claim and cannot be the only basis by which to reject a possible nexus to service. All opinions must be supported by a complete and thorough rationale. If the examiner providing the requested addendum opinion is not the December 2019 examiner, request that the current examiner provide a copy of their resume/CV. Upon receipt of such, associate it with the record and provide the Veteran and his representative a copy thereof. If the requested resume/CV is not obtainable, the Veteran should be so advised and the reasons for such should be noted in the record. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Zimmerman 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.