Citation Nr: 21005156 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 14-35 229 DATE: January 29, 2021 REMANDED Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1954 to March 1957 and from March 1959 to August 1963. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in November 2018 and September 2020 when it was remanded for further development. Entitlement to service connection for tinnitus is remanded. Although the delay is regrettable, the Board finds an additional remand is required before a decision can be made on the Veteran’s claim. In September 2020, a VA examiner opined that the Veteran’s tinnitus was not aggravated by any diagnosed conditions, including medications taken for the conditions. The examiner also noted that the Veteran’s tinnitus is a symptom associated with hearing loss so there was no indication of aggravation through any other conditions or medications. In an October 2020 addendum opinion, the examiner indicated that current literature does not support tinnitus being secondary to or aggravated by the Veteran’s service-connected PTSD, lower back issues, left tibia and fibula, and right eye issues and/or medications related to the conditions. However, the Board finds the opinion inadequate as the examiner failed to provide adequate rationale to support the opinion. Although the examiner referenced medical literature, she makes no mention of any specific articles that support the opinion. In addition, the examiner failed to specifically address any medications the Veteran takes for his service-connected conditions, so it is not entirely clear whether the effects of each medication the Veteran is prescribed was adequately considered. Consequently, remand for a new medical opinion is required. The matter is REMANDED for the following action: Obtain an addendum opinion from a VA examiner other than the September 2020 examiner. The Veteran’s electronic claims file must be made available to the examiner for review. An examination should only be scheduled if the examiner deems one is necessary for providing the requested opinions. Following a review of the claims file, the examiner is asked to provide an opinion on the following: (a) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s tinnitus was caused by any service-connected disability, to include any medication prescribed to treat the service-connected disability. (b) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s tinnitus was aggravated (i.e., worsened beyond natural progression) by any service-connected disability, to include any medication prescribed to treat the service-connected disability.  The examiner is advised that the Veteran is currently service-connected for the following disabilities: (i) right eye choroid scars and anterior uveitis with recent oculotoxoplasmosis, (ii) posttraumatic stress disorder (PTSD), (iii) low back disability, and (iv) malunion of fracture of left tibia and fibula shortening with some ankle disability. The examiner should individually address whether each of these disabilities (and any medications prescribed to treat the disabilities) caused or aggravated the Veteran’s tinnitus. The examiner is also advised the Veteran indicated his belief that his tinnitus was caused by medications prescribed to treat his PTSD, as noted in his testimony at the May 2014 hearing with a Decision Review Officer. As the record indicated the Veteran was prescribed Seroquel and Citalopram Hydrobromide for treatment, the examiner should specifically address whether these medications caused or aggravated the Veteran’s tinnitus. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be   rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Jiggetts 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.