Citation Nr: 20060281 Decision Date: 09/14/20 Archive Date: 09/14/20 DOCKET NO. 14-24 408A DATE: September 14, 2020 REMANDED The claim of entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served active duty in the United States Army from August 1969 to March 1972. This matter comes to the Board of Veterans’ Appeals (Board) on appeal of a September 2012 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In May 2018 and December 2019, the Board remanded the issue on appeal for additional development, and the case has since been returned for further appellate review. The claim of entitlement to service connection for bilateral hearing loss is remanded. By way of history, the Veteran submitted an initial claim for service connection for bilateral hearing loss in September 2007. This claim was denied in a February 2008 rating decision as the evidence, at that time, did not show that the Veteran had hearing loss pursuant to 38 C.F.R. § 3.385 or that his current hearing loss was related to service. The Veteran attempted to reopen the previously denied claim in May 2011. In connection with this claim, he was afforded a VA audiological examination in April 2012. Significantly, the April 2012 VA examiner determined the Veteran suffered from hearing loss but would need to be examined by a specialist in order to determine whether the Veteran’s in-service ear infection contributed to his current condition. As such, the case was remanded in May 2018 for a new VA examination by an otolaryngologist to determine whether the Veteran’s claim that his in-service right ear infection may have contributed to his current hearing problems, as well as the Veteran’s belief that removal of a foreign substance in his ear in August of 1969 is related to his current condition. In May 2018, the Board reopened the previously denied claim of entitlement to service connection for bilateral hearing loss. Pursuant to the May 2018 Board remand, the Veteran received a VA examination by an otolaryngologist in January 2019. The examiner diagnosed the Veteran with bilateral sensorineural hearing loss, but opined that it was less likely than not that the Veteran’s hearing loss was worsened by an in-service ear infection caused by sand in the ear canal. The examiner, however, did not provide an opinion regarding whether or not the infection caused the Veteran’s diagnosed bilateral hearing loss. Additionally, the examiner noted that the Veteran experienced noise exposure in service, but did not provide an explanation of whether this exposure resulted in the Veteran’s current hearing loss. The examiner also failed to discuss the Veteran’s contention that the Veteran’s current bilateral hearing loss may have resulted from low cabin pressure in military flights as discussed in a September 2013 Statement in Support of Claim. Accordingly, the Board found the January 2019 VA examination to be inadequate and remanded the case for a new VA examination. Pursuant to the December 2019 Board remand, the Veteran was provided another VA examination in January 2020, with file review by an otolaryngologist in February 2020. The January 2020 VA audiologist performed an in-person examination and diagnosed the Veteran with bilateral sensorineural hearing loss but did not provide an opinion on the etiology or possible existence of a causal relationship to military service. The February 2020 VA otolaryngologist reviewed the Veteran’s records and opined that the Veteran’s hearing loss was less likely than not related to an in-service injury, event, or illness. Addressing the Veteran’s contention that an in-service ear infection worsened his condition, the otolaryngologist noted a lack of documentation that the incident caused hearing loss. The examiner also concluded that the in-service removal of a foreign substance and acoustic trauma were not shown to have caused hearing loss as the Veteran was not diagnosed with the condition until 2014. Similarly, he noted that the Veteran’s exposure to low cabin pressure may have caused him to experience temporary eustachian tube dysfunction but concluded it did not cause hearing loss because it was not documented in the record. Although the examiner noted the Veteran’s in-service condition as “acute” with “no evidence of chronicity of care,” no further analysis was provided. The Board finds the February 2020 medical opinion inadequate as it is based solely on the fact that the Veteran was not diagnosed with bilateral hearing loss until 2014 (actually 2012) and fails to discuss how the specified in-service events might have been related to the Veteran’s current diagnosis. The opinion also fails to consider the Veteran’s allegations of hearing loss as early as 2007. An adequate medical opinion must be accurate, fully descriptive, and must describe the disability in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994). Medical opinions must support its conclusions with an analysis that the Board can consider, as the probative value of a medical opinion comes from its reasoning. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). It is the medical examiner’s responsibility to provide a well-supported opinion so that the Board may carry out its duty to weigh the evidence of record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (noting that “a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two”). Accordingly, the Board finds remand is necessary for an adequate medical opinion on the etiology of the Veteran’s current disability given the specified in-service evidence noted from the record. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an otolaryngologist to determine the nature and etiology of the Veteran’s bilateral hearing loss. The examiner is asked to review the claims file and provide the following information: (a.) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hearing loss was incurred in or otherwise related to the Veteran’s service. (b.) If it is determined that there is another likely etiology for the Veteran’s hearing loss, that should be stated. (c.) In reaching the determinations requested, the examiner is asked to comment upon the Veteran’s contentions that the following in-service events contributed to his hearing loss: (1) severe right ear infection; (2) August 1969 removal of a foreign substance from his ear; (3) low cabin-pressure on military flights; and (4) traumatic noise exposure experienced as a tank mechanic. Significantly, the examiner should discuss how the specified in-service events might have been related to the Veteran’s current diagnosis as well as consider the Veteran’s allegations of hearing loss as early as 2007. The examination report must include a complete rationale for all opinions expressed. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. 2. Then, readjudicate the claim. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. April Maddox Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.N. Chapman, 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.