Citation Nr: 21001478 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 16-22 013 DATE: January 8, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1978 to October 1981. He also had additional inactive service. These matters were previously before the Board in August 2020 whereupon the Board remanded them for the Regional Office (RO) to obtain another VA audiological opinion regarding the etiology of the Veteran’s current bilateral hearing loss and tinnitus. In this remand, the examiner was specifically requested to address the following: (1.) The medical significance, if any, of changes in the Veteran’s active duty audiometric data where it appears to worsen from his September 1978 enlistment hearing test to the August 1980 hearing test, and then appears to improve from the August 1980 hearing test to the October 1981 separation hearing test. (2.) Whether, from a medical standpoint, the Veteran’s audiometric data from his September 1978 enlistment hearing test, August 1980 in-service hearing test, and October 1981 separation hearing test is consistent or inconsistent with the Veteran’s contention that during the October 1981 separation hearing test, he deliberately reported he could hear various tones when in fact he could not in order to avoid further testing. The examiner should indicate whether or not the audiometric data corroborates the Veteran’s contention; however, the examiner’s opinion must not contain any determinations regarding the credibility of any statements made by the Veteran. The examiner was further requested to consider the following: the Veteran’s October 1981 pre-separation Report of Medical History (showing the Veteran endorsed hearing loss); his conceded in-service noise exposure from his military occupational specialty as a boiler technician; his competent reports of continuous hearing loss and tinnitus symptoms since active service; and his competent reports of no significant post-active service noise exposure. Subsequently, VA medical opinions were rendered on September 2020. The examiner found that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran’s September 1977 entrance examination and his October 1981 separation examination indicated hearing within normal limits with no significant threshold shift. The examiner noted that there was no further evidence to consider. In the absence of any further audiometric data, it is less likely than not that the Veteran’s hearing loss was caused by or a result of noise exposure during military service. The examiner further noted in a separate opinion rendered on this same date that May 2015 and December 2019 VA examinations were the first documentation of hearing loss. The examiner noted that noise exposure was conceded. However, as there was no hearing loss, or evidence of permanent threshold shift, that occurred during military service, it is less likely than not the Veteran’s hearing loss was caused by or the result of an incident in military service. Additionally, the examiner noted on another opinion rendered on this same date that the Veteran had 3 hearing tests administered during military service in September 1978, March 1979, and October 1981. There were minor thresholds shifts, not considered clinically significant at 2000 and 4000 Hertz in the left ear only. There was no loss of hearing at separation, and there were no significant thresholds shifts present at separation. There is no indication that there were any false positive responses provided on testing completed on October 1981. As there was no significant threshold shift during military service which would indicate acoustic damage, it is less likely than not that the Veteran’s tinnitus was caused by military noise exposure. Unfortunately, the Board finds these opinions did not address the pertinent evidence identified in the August 2020 remand. Specifically, it was requested that the examiner discuss the medical significance of changes in the audiometric data recorded in September 1978, August 1980, and October 1981. However, the September 2020 VA examiner failed to discuss the August 1980 hearing test in the provided opinions. Moreover, the examiner did not discuss or indicate that that she considered the Veteran’s October 1981 pre-separation Report of Medical History (showing the Veteran endorsed hearing loss); his competent reports of continuous hearing loss and tinnitus symptoms since active service; and his competent reports of no significant post-active service noise exposure. The Board finds that the Veteran’s reports of continuous symptomatology and a lack of post-service noise exposure would be significant evidence to consider in rendering an etiological opinion on these matters. Accordingly, a new VA opinion must be obtained. The matters are REMANDED for the following action: Return the claims file to the VA examiner who provided the September 2020 VA opinions so that an addendum opinion may be obtained. If the same examiner is not available, an opinion should be provided by a similarly qualified VA examiner. The examiner should opine as to whether it at least as likely as not (50 percent probability or greater) that the Veteran’s current bilateral hearing loss OR his tinnitus is related to active service. The examiner is specifically requested to address the following: (a) The medical significance, if any, of changes in the Veteran’s active duty audiometric data where it appears to worsen from his September 1978 enlistment hearing test to the August 1980 hearing test, and then appears to improve from the August 1980 hearing test to the October 1981 separation hearing test. (b) Whether, from a medical standpoint, the Veteran’s audiometric data from his September 1978 enlistment hearing test, August 1980 in-service hearing test, and October 1981 separation hearing test is consistent or inconsistent with the Veteran’s contention that during the October 1981 separation hearing test, he deliberately reported he could hear various tones when in fact he could not in order to avoid further testing. The examiner should indicate whether or not the audiometric data corroborates the Veteran’s contention; however, the examiner’s opinion must not contain any determinations regarding the credibility of any statements made by the Veteran. The examiner also must consider: the Veteran’s October 1981 pre-separation Report of Medical History (showing the Veteran endorsed hearing loss); his conceded in-service noise exposure from his military occupational specialty as a boiler technician; his competent reports of continuous hearing loss and tinnitus symptoms since active service; and his competent reports of no significant post-active service noise exposure. If additional examination is needed to render the above-requested opinions, such should be provided. The examiner must provide a rationale for all opinions. If the examiner cannot provide an opinion without resorting to mere speculation, then he or she shall explain whether additional information is needed or that he or she has exhausted the limits of current medical knowledge. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Durham, 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.