Citation Nr: 21002635 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 18-52 871 DATE: January 14, 2021 REMANDED Service connection for hearing loss. Service connection for tinnitus. REASONS FOR REMAND The Veteran served on active duty from January 1958 to July 1961. The case is on appeal from an August 2017 rating decision. In October 2019, the Veteran testified at a Board hearing. The claim was last before the Board in October 2019. At that time, the Board reopened the claim of service connection for hearing loss and tinnitus and remanded the same for further development. 1. Service connection for hearing loss. 2. Service connection for tinnitus. The Veteran underwent a VA audiology examination in June 2017, which reflected a diagnosis of tinnitus and hearing impairment for VA purposes under 38 C.F.R. § 3.385. Despite these results, the examiner opined that the Veteran’s hearing loss and tinnitus were less likely as not due to military noise exposure. The rationale was limited to a discussion of the Veteran separating from the military in 1961, then working as a barber for 26 years and an optician for 20 years, and only hearing ringing in his ears when he lifts weights. Lack of noise exposure post service was not addressed by the examiner. As provided in the Board’s October 2019 remand, in-service noise exposure is established for the claim as exposure to loud acoustic noise is consistent with his military duties of being around loud construction equipment and vehicles and going through combat training without hearing protection. The Board remand further noted June 2018 private treatment records including audiogram results revealing bilateral tinnitus and mid to high level frequency severe sensorineural hearing loss. The private examiner indicated that “although his noise exposure history during his time in the Navy is likely a contributing factor, [he could] not state with certainty that this was the cause.” See Eastside ENT Specialists treatment records dated in June 2018. Also mentioned in the remand was the Veteran’s October 2019 Board hearing testimony, in which he described his daily duties in construction and how continuous noise exposure had an effect on his hearing, especially since he was not provided hearing protection. He also mentioned that he never underwent hearing tests during service to determine whether noise exposure was having any effect on his hearing. Given the Veteran’s statements regarding his in-service noise exposure, post-service occupation history suggesting little to no noise exposure, and the insufficiency of medical evidence of record, the Board remanded the claims in October 2019, requesting the Veteran be scheduled for a new medical examination and opinion addressing the etiology of the Veteran’s hearing loss and tinnitus, specifically taking into consideration this evidence. To ensure competency of the opinion, the RO was also directed to schedule the examination with a VA otolaryngologist (ENT). Although the Veteran was provided with a new VA examination in January 2020, with the examiner again finding the Veteran has tinnitus and hearing loss for VA purposes, the examiner failed to consider the evidence of record, including the Veteran’s in-service noise exposure given his military duties, post-service occupation history having little to no noise exposure, and private medical records. Rather, the examiner concluded that the Veteran’s hearing loss and tinnitus are less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner noted that, for hearing loss, that his whisper test at separation was normal and that hearing loss was not documented until June 2017. As rationale regarding the tinnitus claim, the examiner noted simply that it was not documented until 55 years after separation and only occurred when he lifts weights. The Board finds the opinion regarding tinnitus was not based on a complete review of the record, as the Veteran’s October 2019 Board hearing testimony provides he also hears ringing in his ears when it is quiet and when he is eating. Accordingly, remand is warranted at this time such that a proper medical opinion may be obtained, and, if necessary, a VA examination, that follows the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The Board also finds the January 2020 examination medical opinion inadequate, as it relied on a mere absence of evidence in the service and post-service treatment records to provide a negative opinion. Dalton v. Nicholson, 21 Vet. App. 23 (2007). On remand, an additional medical opinion based on full consideration of the Veteran’s documented medical history and all lay assertions, and supported by a complete, clearly stated rationale is needed to resolve the claim. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or to obtain a VA opinion, it must ensure that the examination or opinion is adequate). In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain outstanding VA treatment records dated since June 2020. 2. Thereafter, obtain from an ENT specialist an addendum opinion addressing the etiology of the Veteran’s current bilateral hearing loss and tinnitus. Only arrange for the Veteran to undergo further VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) by an appropriate medical professional if deemed necessary in the judgment of the individual designated to provide the addendum opinion. The ENT specialist should then provide an opinion as to whether it is at least as likely as not (i.e., at least equally probable) that the Veteran’s hearing loss and/or tinnitus had its onset during, or is otherwise related to, his military service. Consideration should be given to: (1) the in-service noise exposure as a construction worker being around loud construction vehicles and equipment for 10 hours daily without hearing protection and being exposed to loud acoustic noise during combat skills training without hearing protection; (2) the Veteran’s statements as to his post-service occupational history suggesting little or no exposure to loud noises; and (3) the Eastside ENT examiner’s statements as to the noise exposure history during his time in the Navy as a likely contributing factor. A complete rationale should be provided for any opinion expressed. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becton, 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.