Citation Nr: 21003372 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 15-18 485 DATE: January 21, 2021 REMANDED Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from August 1966 to August 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned at a hearing in December 2017. The Board remanded this matter in July 2018, October 2019, and September 2020 for additional development. The matter is now returned to the Board for further appellate review. This appeal is advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c) (2019); 38 U.S.C. § 7107 (a)(2) (2012). As a preliminary matter, VA has conceded in-service noise exposure based on the Veteran’s Military Occupational Specialty of “Infantry Unit Commander” and his multiple decorations for combat. 1. Entitlement to service connection for hearing loss is remanded. In September 2020, the Board remanded the Veteran’s claim of service connection for bilateral hearing loss, finding the December 2019 opinion of record to be inadequate. VA provided a subsequent medical opinion in October 2020, at which time the examiner opined the Veteran’s bilateral hearing loss was less likely than not incurred in or caused by the Veteran’s active duty service. Unfortunately, this opinion is inadequate to adjudicate the Veteran’s claim. The Veteran contends his exposure to rifle and artillery fire while serving as an infantry commander in the Republic of Vietnam caused his bilateral hearing loss. The October 2020 VA examiner relied, in part, on a 2005 Institute of Medicine (IOM) report concerning delayed on set hearing loss. In McCray v. Wilkie, 31 Vet. App. 243 (2019), the US Court of Appeals for Veterans Claims highlighted the contradictory findings regarding delayed-onset hearing loss in the IOM report. Specifically, the VA medical opinion noted that the IOM report concluded, in part, that there is no sufficient scientific basis for the existence of delayed-onset hearing loss. However, the IOM report also indicates 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.” Any future opinion predicated on the IOM reports’ findings regarding delayed onset hearing loss must address these inconsistencies. Consequently, the Board finds that a remand is necessary in order to obtain an addendum opinion as to whether the Veteran's bilateral hearing loss is related to his military service, to include his in-service noise exposure, in light of the examiner's consideration of the IOM opinion without addressing its contradictory findings. 2. Entitlement to service connection for tinnitus is remanded. In September 2020, the Board remanded the Veteran’s claim of service connection for tinnitus, finding the December 2019 opinion of record inadequate. VA provided a subsequent medical opinion in October 2020, at which time the examiner opined the Veteran’s tinnitus was less likely than not incurred in or caused by the Veteran’s active duty service. Unfortunately, this opinion is inadequate to adjudicate the Veteran’s claim. The Veteran contends his exposure to rifle and artillery fire while serving as an infantry commander in the Republic of Vietnam caused his tinnitus. The October 2020 examiner again relied on the 2005 IOM report, in part, when rendering a negative nexus opinion. Specifically, the examiner noted the report states there is a possibility of a delay in onset of tinnitus due to noise exposure, but "…as the interval between a noise exposure and the onset of tinnitus lengthens, the possibility that tinnitus will be triggered by other factors increases. A more complete understanding of the mechanisms by which tinnitus is generated will be needed before the existence of delayed onset of noise-induced tinnitus can be confirmed or rejected." The examiner did not explain why Veteran’s tinnitus is not the delayed onset type nor explain how the other factors that could have triggered the Veteran’s tinnitus. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide an examination, it must provide an adequate one). The matters are REMANDED for the following action: Obtain an opinion regarding the Veteran’s claim for service connection for bilateral hearing loss and tinnitus. If the selected clinician determines that an examination is necessary to respond to this request, such examination should be scheduled. After review of the claims file, and examination of the Veteran if deemed necessary, the clinician should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current bilateral hearing loss and tinnitus began in or are otherwise related to his service, to include conceded in-service noise exposure from combat. The clinician should address the Veteran’s 2011 contention that he was told “years ago” that he had “combat hearing loss”, a statement suggesting his hearing loss manifested much earlier. The clinician should also address the Veteran’s competent and credible statement that after service he was employed in white collar jobs that did not involve significant noise exposure. The Veteran’s report of symptoms capable of lay observation may not be disregarded solely on the basis that they are not recorded in contemporaneous medical treatment records. The clinician is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the clinician rejects the Veteran’s reports, he or she must provide a reason for doing so. If the clinician relies on findings from the 2005 IOM study to support a negative opinion, the clinician must provide a complete rationale as to why the IOM study conclusions apply to this particular Veteran, given the contradictory findings within the study noted by the Court in the McCray case. Finally, if the clinician finds that the Veteran’s current hearing loss and/or tinnitus is due to post-service factors, the examiner must provide a rationale for why the Veteran’s hearing loss and/or tinnitus would be more likely due to post-service factors. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zachery S.C. Luce, 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.