Citation Nr: 21003344 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-30 600 DATE: January 21, 2021 REMANDED Service connection for hearing loss is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from November 1997 to April 1998 and April 1999 to September 1999. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision appealed in a timely May 2015 notice of disagreement (NOD) and perfected by a timely July 2016 substantive appeal in response to a May 2016 statement of the case (SOC). In June 2019, a hearing was held before the undersigned; a transcript is of record. The Board remanded this claim in July 2019. 1. Service connection for hearing loss is remanded. The December 2019 VA examination obtained on remand indicated that no medical opinion could be provided without resorting to mere speculation because the pure tone thresholds obtained on audiometric testing were inconsistent with speech recognition scores. Specifically, the examiner noted that “[s]peech discrimination test results are good at or below pure tone average thresholds, suggesting unreliable pure tone average” and the examiner felt “[i]f the pure tone averages were reliable, the spondees could not be heard at the speech recognition threshold levels obtained.” Speech audiometry results, however, “show[ed] speech reception thresholds and speech discrimination results in agreement and indicate speech frequencies within normal limits.” The Board cannot rely on the pure tone thresholds in determining whether a current disability exists. Moreover, the examiner’s opinion seems to indicate simultaneously that the speech recognition scores are valid (in which case they indicate a hearing loss disability warranting a substantive answer to the etiological questions posed in the prior remand) and indicate “speech frequencies within normal limits.” Further clarification is needed. Moreover, the Veteran’s June 2019 hearing testimony indicated he had an audiological evaluation sometime around 2017 (as he said his last hearing examination at the time had been two years prior). It does not appear that any record of such an evaluation is in the Veteran’s file even after the Board’s prior remand ordered obtaining all pertinent medical records not already of record. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disabilities remaining on appeal, TO SPECIFICALLY INCLUDE (BUT NOT LIMITED TO) any private OR VA audiological evaluations circa 2017 that are not already of record. 2. Schedule the Veteran for an in-person or telehealth (whichever is appropriate) examination by an audiologist to determine the nature and cause of his alleged hearing loss. The Veteran MUST BE NOTIFIED of the date and time of the examination AND informed that his cooperation in obtaining accurate audiometric test results is crucial to adjudicating his claim. Furthermore, the inability to conduct reliable audiometric studies may result in adjudication of the claim based on the evidence already of record. Based on a review of the record, examination of the Veteran (INCLUDING A COMPLETE SUBJECTIVE HISTORY AND REPORT DESCRIBING ONSET, COURSE, AND PROGRESSION OF HIS SYMPTOMS), and any tests or studies deemed necessary, the examiner must respond to the following: (a.) Does the Veteran have a current hearing loss disability as defined in 38 C.F.R. § 3.385? (b.) If so, is it AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such disability is related to the Veteran’s military service, to include his conceded noise exposure or the documented threshold shifts therein? If the examiner determines that the noted threshold shifts in service were not meaningful or otherwise insignificant, they MUST explain why, remembering that a normal separation audiogram alone is insufficient to disprove a nexus to service, and including an explanation of the normal variability range for threshold shifts. (CONTINUED ON NEXT PAGE)   All opinions must include a detailed rationale considering all pertinent medical evidence AND competent lay reports. Providing an opinion without enough explanation will delay processing of the claim and require further clarification. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yuan, 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.