Citation Nr: 21001849 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 17-19 808 DATE: January 12, 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 in the United States Army from April 1966 to March 1968. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified before the undersigned Veterans Law Judge at a video conference hearing. The Board remanded these matters in November 2019 for additional development. Unfortunately, the Board is not satisfied that there was substantial compliance with its prior remand instructions; therefore, the appeal must be remanded once again. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Entitlement to service connection for bilateral hearing loss and tinnitus are remanded. The Veteran seeks entitlement to service connection for bilateral hearing loss and tinnitus, which he contends were incurred in or caused by military service. The Board notes that the Veteran’s military occupational specialty (MOS) was power generator equipment operator, an MOS that is considered highly probable for hazardous noise exposure. The Veteran has stated that he performed his military duties, which included maintaining and repairing diesel generators, without the use of hearing protection. The Veteran specifically testified at his August 2019 Board hearing that he noticed changes to his hearing acuity during service, particularly after finishing his daily shift working near the generators. In the November 2019 remand, the Board directed the RO to schedule the Veteran for a new VA audiology examination and to obtain a medical opinion from a qualified VA examiner to assess the nature and etiology of the Veteran’s hearing loss and tinnitus disabilities. Among other examination directives, the Board specifically requested that the VA examiner discuss an August 2019 private audiology opinion from Northwest Hearing in which the Veteran’s audiologist opined that his current bilateral hearing loss disability is due to exposure to loud noise. In providing this opinion, the private audiologist noted that the Veteran reported being exposed to high levels of noise during military service and denied any significant noise exposure after service. Pursuant to the remand, the Veteran under a VA audiology examination in January 2020. Upon examination, the VA examiner provided a negative nexus opinion for the disabilities on appeal. However, the Board notes that the examiner did not consider or address the favorable evidence contained in the August 2019 private opinion, as requested by the Board in the remand directives. Moreover, the examiner noted in the opinion that “the Veteran has a history of middle ear problems resulting in scar tissue,” however, failed to provide any context or further explanation for this observation. In light of the above, the Board finds that the January 2020 medical opinion did not fully respond to the Board’s remand directives and is therefore insufficient to fairly decide the Veteran’s claims. As such, the claim must be remanded once again because the RO did not comply with the Board’s prior remand directive to obtain an adequate medical opinion on the Veteran’s behalf. See Stegall, 11 Vet. App. at 268. On remand, an addendum medical opinion must be obtained that is adequate for the Board to make an informed decision on the Veteran’s claims. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007); Douglas v. Shinseki, 23 Vet. App. 19, 26 (2009). Accordingly, the matters are REMANDED for the following action: Return the Veteran’s claims file to the VA audiologist who examined the Veteran in January 2020 to provide an addendum medical opinion regarding the nature and etiology of the Veteran’s bilateral hearing loss and tinnitus. An in-person examination need not be scheduled unless deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file in its entirety, to include a copy of this REMAND, and the review should be noted in the examination report. Thereafter, the examiner is asked to provide an addendum opinion with respect to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss and/or tinnitus had its onset during active service, within one year of separation, or is otherwise related to an inservice disease, event, or injury, to include conceded military noise exposure? The requested opinion must adequately consider and discuss the relevance of the August 2019 private audiology opinion from Northwest Hearing, in which the audiologist opined that the Veterans’ current bilateral hearing loss disability is due to exposure to loud noise. It should be noted that the private audiologist provided this opinion in light of the Veteran’s reports that he was exposed to high levels of noise during military service and denied any significant noise exposure (occupational or otherwise) after service. The examiner is also requested to provide context and/or further explain her observation from the January 2020 opinion that “the veteran has a history of middle ear problems resulting in scar tissue.” If it is determined that there is another, more likely etiology for the Veteran’s bilateral hearing loss and/or tinnitus, that should be stated. The examiner must provide a complete rationale for any opinion expressed, citing to the examiner’s clinical experience, medical expertise, and established medical principles, as necessary. If the examiner is unable to provide an opinion without resorting to speculation, she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Melissa Barbee, 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.