Citation Nr: 21001768 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 16-62 980 DATE: January 11, 2021 REMANDED Entitlement to service connection for a right ear hearing loss disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to April 1975 with additional service in the United States Naval Reserve. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Board reopened the claim for entitlement to service connection for bilateral hearing loss and then remanded the claim to obtain an additional VA examination and medical opinion. The Veteran was afforded a VA examination in December 2019 at which time the examiner provided a positive nexus opinion regarding the Veteran’s left ear hearing loss and a negative nexus opinion regarding his right ear hearing loss. Consequently, in a May 2020 rating decision, the RO granted service connection for a left ear hearing loss disability and assigned an initial noncompensable evaluation effective from May 19, 2016, the date of the reopened claim. The RO contemporaneously issued a supplemental statement of the case (SSOC) regarding entitlement to service connection for a right ear hearing loss disability. As the RO granted in full the benefit sought by the Veteran regarding a left ear hearing loss disability, there is no remaining allegation of error of fact or law for appellate consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). However, the issue of entitlement to service connection for a right ear hearing loss disability remains in appellate status. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). 38 U.S.C. § 7107(b). Entitlement to service connection for right ear hearing loss is remanded. The Veteran has asserted that his right ear hearing loss is due to his military service. The Veteran underwent a VA hearing loss examination in December 2019 at which time he was diagnosed with sensorineural hearing loss in the right and left ears. At the examination, the Veteran’s puretone thresholds (air conduction) showed an average of 39 Hertz (Hz) in the right ear and average of 38 Hz in the left ear with 96 percent speech discrimination scores noted in both ears. The examiner addressed each ear separately and stated that there was not a permanent positive threshold shift greater than normal measurement variability at any frequency between 500 Hz and 6000 Hz in the right ear but there was in the left ear. She then opined that the Veteran’s right ear hearing loss was not at least as likely as not caused by or a result of an event in service but determined that his left ear hearing loss was related to service. The examiner provided a rationale for each ear in which she recited the same negative etiological opinion from the prior VA examination. However, in additional remarks that followed, she recognized the significance of the Veteran’s reported in-service noise exposure, limited post-service occupational noise exposure and absence of recreational noise exposure. In addition, she referenced a 1999 hearing test noting mild loss at 6000 Hz in the right ear and a moderate loss at 6000 Hz in the left ear. Thus, although the examiner acknowledged the Veteran’s in-service noise exposure and related his current left ear hearing loss disability to that exposure, it is unclear as to why she found the right ear hearing loss was not also related to the same noise exposure other than stating that a 1999 hearing test revealed mild hearing loss in the right ear versus moderate hearing loss in the left ear in a high frequency. Furthermore, a December 2015 private audiogram from Midwest Ear, Nose and Throat notes that the Veteran presented with a binaural, symmetrical, progressive mild to moderately severe degree of sensorineural hearing loss. These findings suggest that the Veteran’s bilateral hearing loss developed in a symmetrical and progressive manner thereby contradicting the December 2019’s examiner’s findings that the Veteran’s right ear hearing loss should be considered independent of his left ear hearing loss. Given the foregoing, remand is necessary for an addendum opinion as the December 2019 VA examiner did not adequately address whether the Veteran’s current right ear hearing loss disability is etiologically related to his conceded in-service noise exposure. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from April 2020 to the Present. 2. Obtain an addendum medical opinion to the December 2019 VA medical opinion that addressed the etiology of the Veteran’s right ear hearing loss from the same VA examiner, or another qualified clinician if unavailable. The claims file, to include a complete copy of this REMAND, must be reviewed by the examiner. The examiner must be advised that service connection for a left ear hearing loss disability has been established following the December 2019 examiner’s positive nexus opinion regarding the left ear only. (a.) The clinician must opine on whether it is at least as likely as not that the Veteran’s right ear hearing loss disability (1) began during active service, (2) manifested within one year after the Veteran's discharge from service, (3) was noted during service with continuity of the same symptomatology since service., or (4) any delayed onset right ear hearing loss is etiologically related to conceded in-service noise exposure and in doing so may not rely exclusively on the absence of in-service findings for hearing loss disability. (b.) The examiner is not required to accept the Veteran's theory that acoustic trauma during his active service caused his right ear hearing loss, or that he experienced hearing loss symptoms during and following service if found to be incongruous with the record or medical knowledge. However, the examiner must provide a full explanation for any medical history rejected. (c.) The opinion should include a discussion of the relevant or significant medical history, lay statements, medical knowledge or literature, and address the etiology and development of the Veteran’s service-connected left ear hearing loss as opposed to his right ear hearing loss and consider any clinical findings distinguishing the pattern of hearing loss between the right and left ears. The opinion should also reflect consideration of the December 2015 private audiogram and associated comment from Midwest Ear, Nose and Throat noting a binaural, symmetrical, progressive mild to moderately severe degree of sensorineural hearing loss. 3. Ensure that all VA medical opinions obtained include a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Krunic, 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.