Citation Nr: 21061810 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-04 620A DATE: October 5, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served in the United States Army on active duty from October 1973 to March 1974, and in the Army National Guard from June 1976 to March 1989. The case comes to the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision of the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran submitted a timely substantive appeal in February 2016. The appeal was previously before the Board in January 2019, when the Board remanded the appeal for further development. The RO issued a supplemental statement of the case in June 2020. The appeal has now been returned to the Board for further appellate review. The Board notes that the Veteran requested a Travel Board hearing in a statement received in June 2017. However, by correspondence of September 2021, the Veteran has withdrawn his request for a Board hearing. Thus, the Board will proceed with appellate review. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that his current bilateral hearing loss is the result of his active service. In the Veteran's February 2016 Notice of Disagreement, the Veteran stated that his hearing loss was likely caused by his military occupational specialty (MOS). The Veteran also explained in a May 2016 Statement in Support of Claim that his hearing loss was caused by his exposure to continuous firing from tank ranges as a Range Officer for 11 years with the Army National Guard of New Jersey. Per the January 2019 Board remand, a VA hearing loss addendum opinion was obtained in September 2019. The examiner noted that potential noise injury is indicated if the automatic results meet the criteria that the military defines as a standard threshold shift. Additionally, she noted that it was unlikely that significant threshold shifts meeting these criteria occurred during the active duty service since thresholds on the exit exam in 1974 were well within normal limits. She also noted that there were audiograms dated April 3, 1976 and July 19, 1980 during the Veteran's National Guard service also showing normal hearing. Therefore, there was no objective evidence (i.e. service audiometric results) to support claim of military related noise injury, even though noise exposure was reported. Also, available service treatment records are silent for any complaint, diagnosis, or treatment of claimed condition. However, the examiner concluded by saying that it should be noted that when comparing the available National Guard exams (4/3/76, 7/19/80, and 8/27/80), a gradual decrease in high frequency hearing was noted. The examiner noted the available National Guard hearing exams and the gradual decrease in high frequency, but did not provide an opinion as to whether those decreases were related to in-service noise exposure. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As such, the examiner's addendum opinion is not adequate, as the changes in hearing levels during the Veteran's National Guard service were not addresses. Additionally, the Veteran had more active-duty service than that considered by the examiner. Lastly, all outstanding National Guard treatment records should be obtained to ensure the examiner has a complete record to base their opinion on. The matters are REMANDED for the following action: 1. Ensure all outstanding National Guard records are obtained from the appropriate source and associate them with the record. 2. After performing the development directed above, obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file, including a copy of this remand. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: Is it at least as likely as not (50 percent or greater likelihood) that the Veteran's bilateral hearing loss began during service or is etiologically related to exposure to excessive noise during active duty, active duty for training, or inactive duty for training service, specifically noise exposure the Veteran experienced in the course of his duties as an armor crewman? The Veteran was in the Army National Guard from June 1976 to March 1989, with the specific dates listed in the April 2015 Military Personnel Record. Additionally, review and address the National Guard audio exams on April 3, 1976, July 19, 1980, August 27, 1980, and any additionally examinations performed during that time. Address all decreases/threshold shifts in the Veteran's hearing. The examiner must acknowledge the Veteran's conceded exposure to excessive noise in service. The examiner must address the Veteran's self-reported hearing loss history in formulating the etiology opinion. If there is a medical basis to support or doubt the statements provided by the Veteran, the examiner should provide a fully reasoned explanation addressing this. Additionally, please review the July 2015 and September 2019 VA examination reports. The examiner is advised that the term "as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is medically sound to find in favor of conclusion as it is to find against it. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). (Continued on the next page) After completing the requested actions, and any additional action deemed warranted, readjudicate the claim on appeal. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Temple, 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.