Citation Nr: 21002217 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 16-53 954 DATE: January 13, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from July 1961 to July 1965. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. In July 2019, the Board remanded the matter for an addendum opinion regarding the etiology of the Veteran’s bilateral hearing loss. An addendum opinion was obtained in January 2020, with additional clarification to the opinion obtained in August 2020 from the same audiologist. The January and August 2020 examiner opined that it was less likely than not that the Veteran’s hearing loss was caused by service. Unfortunately, as the January and August 2020 negative nexus opinions are supported by inadequate rationales, remand is necessary to obtain another addendum opinion. The July 2019 Board remand instructed the examiner to not rely on the fact that the Veteran had “normal” hearing at separation and to discuss the possibility of delayed-onset hearing loss. In addition, the July 2019 Board remand requested the examiner to discuss the Veteran’s “October 1964 and June 1965 audiogram results converted from ASA to ISO-ANSI units;” the Veteran’s conceded in-service noise exposure; and his April 2019 testimony regarding lack of post-service hazardous noise exposure. In providing a negative nexus, the January 2020/August 2020 VA examiner opined that it was less likely than not that the Veteran’s bilateral hearing loss was caused by service because he “was afforded a frequency specific hearing test upon separation that showed hearing to be well within the normal range at all frequencies tested.” Although the examiner was instructed to concede in-service noise exposure, the examiner stated that “[n]oise exposure around loud aircraft does not mean an auditory injury took place.” The examiner also states that the Veteran’s “[s]ervice record evidence refutes a claim of auditory injury during military service since the evidence shows no auditory injury to the ears during military service.” The examiner also says that delayed-onset hearing loss is not based “on current science” and cites the Institute of Medicine (IOM) for the proposition that hearing loss can only be attributed to service if it was noted upon separation. This proposition, however, cannot be relied upon to deny a claim for service connection. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993) (holding that a Veteran may establish service connection, despite testing within normal hearing limits at the time of separation from service). In August 2020, the same examiner added that the Veteran’s post-service occupational history in low-noise environments does not mean his hearing loss was caused by service. In support of this opinion, the examiner again relied on the fact that the Veteran’s separation audiograms were “normal,” delayed-onset hearing loss is not supported by “current science,” and there are other etiologies of hearing loss. However, the examiner does not explain why those other etiologies are the more likely explanation of his hearing loss. The January and August 2020 negative nexus opinions are inadequate because the examiner’s primary rationale was that the Veteran’s audio tests in service and upon separation revealed no hearing loss. The examiner also relied on the IOM to state that “current science” does not support the existence of delayed-onset hearing loss, despite the IOM reporting in a 2006 study that “[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after the cessation of that noise exposure” and that “definitive studies to address this issue have not been performed.” See McCray v. Wilkie, 31 Vet. App. 243, 256 (2019). Thus, per the IOM, while delayed-onset hearing loss may not be supported by “current science,” it is also not refuted by it either. Furthermore, it is not clear whether the examiner converted the Veteran’s pre-1967 audiometric results from ASA to ISO-ANSI units as instructed to do in the July 2019 Board remand. The examiner simply said that “the separation exam ends up being well within the normal limits despite either calibration;” however, the examiner did not produce the results of that conversion. Accordingly, the Board finds the January and August 2020 etiology opinions and their supporting rationale to be inadequate. As a result, remand is, unfortunately, necessary yet again to obtain an addendum opinion to ensure the VA fulfills its statutory obligation to assist the Veteran. The matters are REMANDED for the following action: Provide the claims file to an audiologist other than the January/August 2020 audiologist for preparation of an addendum opinion. No additional examination is necessary unless the examiner determines otherwise. Following review of the claims file, the audiologist should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current bilateral hearing loss had its onset in or is otherwise related to his period of active duty service, to include as a result of conceded noise exposure therein. Please consider the following in addressing this question: (a.) do not rely solely on the fact that the Veteran had “normal” hearing at separation from service or in service to support the opinion; (b.) discuss the possibility of delayed-onset hearing loss, and if you rely on the IOM, please address the 2006 IOM statement that “[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after the cessation of that noise exposure” and that “definitive studies to address this issue have not been performed;” (c.) concede the fact that the Veteran sustained acoustic trauma from in-service noise exposure, to include as a result of his military occupational specialty as a photographer often stationed in close proximity to the flight line, and determine whether a nexus to service is “medically plausible” based on the same; (d.) convert the Veteran’s October 1964 and June 1965 audiogram results from ASA to ISO-ANSI units, and produce the results of that conversion in your opinion; (e.) discuss the lack of post-service hazardous noise exposure as a result of the Veteran’s post-service employment in low noise environments as he described in his April 2019 hearing testimony; (f.) discuss and concede the Veteran’s lay accounts of his bilateral hearing loss beginning shortly after leaving service (see April 2019 lay statement; April 2019 hearing transcript at 4; October 2016 VA Form 9; February 2015 Notice of Disagreement) and determine whether a nexus is “medically plausible” based on the same; and (g.) if you attribute the Veteran’s hearing loss to other etiologies, to include aging or genetics, please explain why those other etiologies are more likely than in-service hazardous noise exposure to have caused the Veteran’s hearing loss. A complete rationale must be provided for all opinions expressed or the opinion will be returned as inadequate. If unable to provide a medical opinion without resorting to speculation, the examiner should provide a statement as to whether there is any 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. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. deBruyn, 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.