Citation Nr: 21001642 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 17-22 134 DATE: January 11, 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 January 1958 to January 1961. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a June 2016 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The claims were previously remanded by the Board in April 2019 and September 2020. 1. Entitlement to service connection for bilateral hearing loss remanded. Unfortunately, the report of the September 2020 VA examination does not comply with the prior remand instructions. The examiner found that the Veteran’s bilateral hearing loss was not related to service. It was reasoned that there were no entrance or separation examinations and, while noise exposure was conceded, the examiner could not render an etiology opinion without resort to mere speculation. The examiner found no evidence of hearing loss during active duty. The examiner also found that other actors such as presbycusis and civilian noise exposure could just as likely have caused the claimed hearing loss. The remand instructions directed that, if the examiner could not provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner was directed to explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). The examiner did not address this instruction when finding he could not render an opinion without resorting to speculation. A remand is required to obtain the evidence. 2. Entitlement to service connection for tinnitus is remanded. As the claim of entitlement to service connection for hearing loss is being remanded, the claim of entitlement to service connection for tinnitus is found to be inextricably intertwined. As such, it also is remanded. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the VA examiner who conducted the September 2020 VA examination and request that he explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 2. If the examiner who conducted the September 2020 VA examination is not available, obtain and addendum opinion from a suitably qualified health care professional as to the etiology of the Veteran's hearing loss. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The addendum opinion must include a notation that this record review took place. It is up to the discretion of the examiner as to whether a new examination of the Veteran is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary by the examiner, the VA examiner is asked to respond to the following inquiries: (a.) Is at least as likely as not (a 50 percent probability or greater) that any current bilateral hearing loss for VA purposes is related to an in-service injury, event, or disease, including conceded noise exposure? In answering this question, discuss the Veteran’s testimony before the Board describing the several ways in which he was exposed to loud noises during service (corroborated by service personnel records). Also discuss his lay evidence regarding hearing acuity following service. Accept his lay descriptions regarding noises and symptoms during service. This is particularly important in this matter because STRs are unavailable. (Continued on the next page)   For each requested opinion above, a comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), or the record (additional facts are required). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.