Citation Nr: 20055893 Decision Date: 08/24/20 Archive Date: 08/24/20 DOCKET NO. 11-05 837 DATE: August 24, 2020 REMANDED Service connection for bilateral hearing loss is remanded. Service connection for tinnitus is remanded. Service connection for a chronic headache disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1989 to April 1992. A portion of his service was in Southwest Asia. This matter is on appeal from November 2010 and May 2014 (notice was sent in June 2014) rating decisions. In July 2018, the Veteran testified at a video hearing before the undersigned. The Board of Veterans’ Appeals (Board) granted three issues initially included in this matter in January 2019. The three remaining issues comprising it, listed above, were remanded for additional development at that time. Bilateral Hearing Loss and Tinnitus Unfortunately, the Board finds that another remand for additional development is needed prior to adjudicating service connection for bilateral hearing loss and for tinnitus. The January 2020 VA medical examination, conducted in compliance with the prior remand, confirms that the Veteran has bilateral hearing loss. Yet the opinion that his bilateral hearing loss is not related to his service is deficient for several reasons. First, it rests partially on his hearing being normal upon his separation from service. Hearing loss during service is not required, however. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). What is required is a medically sound basis (for example, a significant pure tone threshold shift) for attributing current hearing loss to loud noise exposure during service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). No such basis was discussed in the opinion. The opinion secondly rests on the Veteran’s denial of hearing loss on November 9, 2010. However, there is no relevant treatment record with this date. The only document dated then is a rating decision. Service connection for bilateral hearing loss were denied in it, but not because the Veteran himself denied having it. The opinion finally does not address important aspects of the Veteran’s medical history. No mention was made of his service treatment records, which reflect ear problems (popping, soreness, pressure). His statements and testimony, supported somewhat by statements from his wife and mother, that his hearing loss began during service and has continued ever since also were not discussed as required. Miller v Wilkie, 32 Vet. App. 249, 257-260 (2020). A new medical opinion, in sum, should be obtained. For tinnitus, the same is true. The deficiencies in this paragraph indeed also apply to it. It additionally was opined to be a symptom of bilateral hearing loss, so a determination cannot be made until bilateral hearing loss has been adjudicated. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Chronic Headache Disorder The Board also finds that another remand for additional development is needed prior to adjudicating service connection for a chronic headache disorder. In compliance with the prior remand, the December 2019 VA medical examination included an opinion that the Veteran’s chronic headache disorder was not caused or aggravated by his service-connected cervical strain. It is deficient for several reasons. First, it rests partially on him having “non-descript neck stiffness and soreness in service without known trauma” and partially on there being no documentation of chronic neck problems until 2013. Yet why this matters is unclear since the Veteran is seeking service connection for headaches secondary to his already service-connected cervical strain. The trauma, in any event, is known. Service connection indeed was granted as a result of repeated parachute jumps. Finally, the opinion did not separately address causation and aggravation as required. Atencio v. O’Rourke, 30 Vet. App. 74, 90 (2018). A new medical opinion, in sum, should be obtained. This matter is REMANDED for the following action: 1. Follow established procedure for obtaining any updated VA treatment records concerning the Veteran and any outstanding private treatment records identified as pertaining to his bilateral hearing loss, tinnitus, or chronic headache disorder. 2. Next, arrange for a qualified clinician to review the claims file, including this remand, and render an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral hearing loss is related to his loud noise exposure during service. An opinion as to whether it is at least as likely as not that the Veteran’s tinnitus is related to his loud noise exposure during service or is a symptom associated with his bilateral hearing loss also must be rendered. A detailed explanation is required to support each opinion. This means that relevant medical principles and/or literature should be discussed as it relates specifically to the Veteran. In this regard, comment must be made on his ear problems during service and his reports of symptoms which began during service and have continued ever since. 3. Also arrange for a qualified clinician to review the claims file, including this remand, and render an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s chronic headache disorder was caused by his service-connected cervical strain. A separate opinion as to whether it is at least as likely as not that his chronic headache disorder was aggravated (worsened) by his service-connected cervical strain also must be rendered. A detailed explanation is required to support each opinion. This means that relevant medical principles and/or literature should be discussed as it relates specifically to the Veteran. In this regard, comment must be made on his reports concerning the onset and course of his relevant symptoms. 4. Lastly, readjudicate this matter. Follow established procedure for returning any issue that remains denied to the Board. Thomas H. O’Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becker 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.