Citation Nr: 21005054 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 19-20 465 DATE: January 28, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1953 to April 1957, and from February 1958 to October 1973. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2018 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). This issue was previously before the Board in August 2019 and October 2020, each time remanded for further development. That development was completed, and the case has since been returned to the Board for appellate review. The Board finds there was substantial compliance with the October 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Nonetheless, for the reasons stated below, remand is again required. Entitlement to service connection for bilateral hearing loss Remand is required for an addendum opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The RO obtained an addendum in October 2020. The examiner provided a negative nexus opinion, acknowledging the Veteran’s lay statements regarding in-service noise exposure from ships, aircraft, machinery and small arms fire. The examiner, however, explained that in-service hearing evaluations showed normal thresholds, and that although the Veteran may have noticed some slight changes, they did not decrease into hearing loss range nor did they constitute significant shifts by VA standards. The examiner stated that threshold sensitivity is the gold standard for quantifying noise damage in humans, and the audiogram is the objective standard for noise injury. The examiner also provided thorough reasoning explaining why there was not delayed onset hearing loss. Noting studies in rodents that suggest a delayed onset of neural central or cochlear changes due to noise exposure, the examiner explained that there are genetic and physiologic differences between humans and rodents. Further, the examiner cited a 2006 Institute of Medicine report that found while there is not sufficient evidence from longitudinal studies to determine whether permanent noise-induced hearing loss can develop much later in life, based on the anatomical and physiological data available, it is unlikely that such delayed effects occur, and human subject research has produced mostly negative results. The examiner stated that current literature supports the conclusion that the most pronounced effects of noise exposure on pure-tone thresholds are measurable immediately following exposure. The examiner explained that animal study research is speculative and does not provide conclusive evidence that these studies definitely apply to humans, and there is no objective evidence that the Veteran experienced any neurodegeneration noise-induced damage in service. In a December 2020 addendum VA medical opinion, the examiner addressed the July 1970 service treatment record (STR) entry which included a notation of high frequency hearing loss. The examiner explained that no audiogram, hearing thresholds, or further explanation were included, and that his hearing was found to be within normal limits bilaterally upon discharge three years later. Despite the thoroughness of the above opinions, this examiner provided the July 2020 addendum VA medical opinion. There, the examiner provided a negative nexus opinion stating that the threshold changes while in service did not shift into hearing loss range, and that they did not constitute significant shifts by VA standards. However, the examiner also noted that the hearing levels decreased at a rate greater than normal age progression during the Veteran’s military career. These statements appear to be contradictory, and need to be addressed. Accordingly, remand is required for an addendum VA medical opinion. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the bilateral hearing loss from the same VA examiner who provided the July 2020 addendum opinion, if possible. Otherwise, another VA examiner is sufficient. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must reconcile the two contradictory statements in the July 2020 VA opinion. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rogos 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.