Citation Nr: 21004054 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 14-44 239 DATE: January 25, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1984 to September 1987. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in March 2013 by a Department of Veterans Affairs (VA) Regional Office. While the Veteran requested a Board hearing in his December 2014 substantive appeal, he later withdrew such request in January 2015. 38 C.F.R. § 20.704(e). In May 2018, the Board remanded the appeal for additional development and it now returns for further appellate review. Entitlement to service connection for bilateral hearing loss. In the May 2018 remand, the Board observed that, as the Veteran’s military occupational specialty was rifleman, his in-service noise exposure had been acknowledged, and a February 2013 VA examination revealed a diagnosis of bilateral hearing loss for VA purposes. It was further noted that the Veteran reported experiencing hearing loss since his military service and his spouse, a primary care physician assistant, indicated that he had hearing loss at an abnormally young age, to include since she had met him. However, as the etiological opinion offered by the February 2013 VA examiner was inadequate to decide the claim as she did not address the Veteran’s or his spouse’s lay statements regarding pertinent symptomatology since service, the possibility of delayed onset hearing loss, or the appropriate legal standard for determining whether the Veteran’s left ear hearing loss was aggravated in service, the Board remanded the matter in order to afford him a new VA examination so as to address the etiology of his bilateral hearing loss. Thereafter, the Veteran was afforded a VA examination in October 2019. At such time, the examiner opined that his right ear hearing loss was at least as likely as not caused by or a result of an event in military service. However, her rationale was based on an inaccurate factual premise as she noted that there was a documented decrease in hearing during service based on a finding that he entered military service with normal hearing in August 1982 and his hearing acuity was measured at 30 decibels at 4000 Hertz in July 1986, which decreased to 35 decibels at 4000 Hertz at separation in August 1987. However, the Veteran’s service entrance examination was performed in May 1984, rather than August 1982, and audiometric testing in August 1987 reflects 25, rather than 35, decibels at 4000 Hertz, thereby suggesting improvement in his hearing. The examiner also opined that the Veteran’s pre-existing left ear hearing loss was not aggravated beyond normal progression during his military service as there was no shift in his hearing acuity therein. In support of such determination, she noted that his hearing acuity was measured at 35 decibels at 4000 Hertz at his entrance and separation examinations. However, such is inaccurate as audiometric findings reflect that there was a downward shift in the Veteran’s left ear hearing acuity from his entrance examination, which reflected 20 decibels at 4000 Hertz, to his separation examination, which reflected 35 decibels at 4000 Hertz. In January 2020, the Veteran underwent another VA examination, at which time the examiner opined that his right ear hearing loss was not at least as likely as not caused by or a result of an event in military service as the audiograms conducted at his entrance and separation from service showed hearing within normal limits, and his current thresholds were significantly worse and, therefore, more likely than not due to events/factors encountered since military service. She also noted that there was no evidence that noise exposure during military service lead to delayed onset of hearing loss. However, hearing loss need not be shown in service for service connection to be established. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The examiner further opined that the Veteran’s pre-existing left ear hearing loss was not aggravated beyond normal progression in military service as he entered military service with a hearing loss at the single frequency of 4000 Hertz, which was unchanged at the time of his separation. However, such is inaccurate as the Veteran’s left ear hearing loss was diagnosed by the decibel level at 3000, rather than 4000 Hertz, at his entrance examination, and she did not account for the downward shift that occurred at 4000 Hertz from entrance to separation. Furthermore, in addition to the deficiencies previously noted, neither the October 2019 nor January 2020 VA examiner addressed the Veteran’s or his spouse’s lay statements regarding pertinent symptomatology since service, and did not address the downward shifts in the Veteran’s hearing acuity from his May 1984 entrance examination to his August 1987 separation examination at 1000 and 2000 Hertz in his right ear and at 1000 and 4000 Hertz in his left ear. Therefore, the Board finds that another remand is necessary to obtain an addendum opinion that addresses such concerns. The matters are REMANDED for the following action: Return the record, to include a copy of this Remand, to the January 2020 VA audiological examiner. If she is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. Following a review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s right ear hearing loss had its onset during, or is otherwise related to, his military service, to include his acknowledged in-service noise exposure? (B) Did the Veteran’s right ear hearing loss manifest within one year of his separation from service in September 1987, i.e., by September 1988? If so, describe the manifestations. (C) Did the Veteran’s left ear hearing loss increase in severity in service? If so, is there clear and unmistakable evidence that such increase in severity is due to the natural progress of the condition? In offering the foregoing opinions, the examiner must consider and discuss the significance, if any, of the downward shift in the Veteran’s hearing acuity from his May 1984 induction examination to his August 1987 separation examination at 1000 and 2000 Hertz in his right ear and 1000 and 4000 Hertz in his left ear, and his and his spouse’s lay statements regarding pertinent symptomatology since service. The examiner is further advised that the basis for a negative opinion must not be based solely on the lack of evidence of hearing loss in the Veteran’s service treatment records or a lack of medical records demonstrating a continuity of care after service. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Clark, 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.