Citation Nr: 21004726 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 16-31 113 DATE: January 28, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from May 1969 to November 1971. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision. In October 2018, this case was remanded for additional development. Entitlement to service connection for bilateral hearing loss. The Veteran contends that he has bilateral hearing loss due to noise trauma in service. His military occupational specialty (MOS) was a food inspector (which of itself does not suggest exposure to hazardous levels of noise). He reported exposure to rifle fire, grenade, and infiltration noise in service. The agency of original jurisdiction conceded he was exposed to some level of noise in service and granted service connection for tinnitus (the Veteran cited to the apparent inconsistency). Postservice, he has worked as a farmer. In support of his claim, the Veteran submitted a December 2015 private audiologist’s statement noting that audiometry showed a bilateral sensorineural hearing loss (SNHL) disability and attributing that disability (and the Veteran’s tinnitus to noise in service). The audiometry reported is not shown to have been in accordance with 38 C.F.R.§ 4.85 (and is inadequate for rating purposes). The matter was subsequently remanded, and the Veteran was afforded a VA examination to confirm he has bilateral hearing loss disability, and if so, ascertain its etiology. On August 2019 examination pursuant to the Board remand, the examiner noted that there was no significant permanent shift in hearing thresholds (beyond test variability) from service entrance to separation. The provider explained that according to literature, one can expect a threshold change to vary as much as 10 dB from test to test. Therefore, for a threshold shift to be considered significant, the change must be more than 10 dB. The examiner opined that since the Veteran's hearing did not worsen more than 10 dB during military service, it was not likely that his current right and left hearing loss is related to military noise exposure. The August 2019 test results also showed significant improvement compared to December 2015 private audiology evaluation; in particular, the December 2015 testing showed a moderate sloping to profound SNHL, bilaterally, with poor speech recognition, bilaterally. The August 2019 testing showed a mild to moderate mid to high frequency SNHL, bilaterally, with good speech recognition bilaterally. The examiner disagreed with the December 2015 private audiologist’s conclusion that the Veteran’s hearing loss was likely caused by his exposure to noise in the military. The Board finds the August 2019 opinion inadequate for rating purposes because the provider did not (as was requested) identify an alternate non-service related (considered to be more likely) etiology for the Veteran’s bilateral hearing loss, and although the provider expressed disagreement with the December 2015 private opinion, rationale for the disagreement was not included. Therefore, the opinion is less than substantially compliant with the remand directives (See Stegall v. West, 11 Vet. App. 268, 271 (1998)), and development for an addendum medical advisory opinion is necessary. The matter is REMANDED for the following: (a) Secure for the record all updated-to-the present records of VA treatment the Veteran has received for bilateral hearing loss (any not already in the record), specifically including any such records since June 2020. (b) After the above development is completed, arrange for the Veteran's claims file to be returned to the August 2019 VA examiner for review and an addendum opinion. [If that provider is unavailable, arrange for another appropriate clinician to review the record, and provide the clarifying opinion sought. (c) The consulting provider should provide an opinion identifying the likely etiology of the Veteran’s bilateral hearing loss disability, and expressing, including rationale, agreement or disagreement with the December 2015 private audiologist’s opinion. If the hearing loss is determined to be unrelated to (the Veteran’s AOJ-acknowledged) exposure to noise in service, an alternate (considered more likely) nonservice-related etiology must be identified, with explanation why that is so. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Fabian Lokenauth, 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.