Citation Nr: 21061915 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-36 645 DATE: October 5, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from April 1961 to April 1964. He also had additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) in the Army Reserves, Air Force Reserves, Air Force National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this case in April 2019 for additional development. Unfortunately, as explained below, the Board is not satisfied that there was substantial compliance with its most recent remand. Therefore, the appeal must be remanded once again. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). Although the Board regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the claim so that the Veteran is afforded every possible consideration. 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran seeks service connection for bilateral hearing loss which he contends was incurred in or caused by exposure to excessive noise during service. In numerous statements to VA, the Veteran has outlined the extent of his military noise exposure. The Veteran asserts exposure to acoustic trauma from large and small weapons including artillery and jet engine noise. Moreover, he described further acoustic trauma incurred while serving as an aircraft mechanic during reserve service. As an initial matter, the Board notes that the Veteran is competent to describe the nature and extent of his in-service noise exposure. See C.F.R. § 3.159(a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Therefore, based on his lay statements, the Veteran's exposure to excessive military noise during service is conceded. In the April 2019 remand, the Board instructed the RO to obtain an opinion from an appropriate examiner to address whether the Veteran's current bilateral hearing loss may be related to or had its onset during a period of post-active service, in either active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). The examiner was instructed to cite to and discuss audiograms during periods of such service that demonstrate diminished hearing, specifically a February 1971 audiogram that showed hearing loss in the right ear that met the criteria for a hearing loss disability for VA purposes with a puretone threshold at 500 Hertz of 45 decibels and the March 1975 audiogram that showed hearing loss for VA purposes in the left ear with a puretone threshold at 4,000 Hertz of 45 decibels. See 38 C.F.R. § 3.385. The Board notes that on both occasions, the treating physician noted that the Veteran was experiencing hearing loss. Pursuant to the remand, an opinion was obtained by the RO in August 2021. The VA examiner opined that the Veteran's bilateral hearing loss is less likely than not related to military service. In making this determination, the examiner relied on the finding that the Veteran's hearing between enlistment and separation showed no significant threshold shifts and that current medical evidence does not support delayed-onset hearing loss due to noise exposure. However, the examiner did not address the Veteran's reserve service hazardous noise exposure or observed threshold shifts during periods of ACDUTRA and INACDUTRA as instructed in the April 2019 remand. Moreover, it is not clear whether the Veteran's complete records, including Reserve treatment records, were considered in this opinion. Therefore, the Board finds the August 2021 VA medical opinion to be inadequate as it was not responsive to the directives outlined by the Board in its April 2019 remand. In light of the above, the Board finds that the Veteran's claim must be remanded once again because the RO did not comply with the Board's prior remand directives to obtain an adequate medical opinion on the Veteran's behalf. See Stegall, 11 Vet. App. at 268. On remand, the RO must obtain an addendum medical opinion from a qualified medical professional that is adequate for the Board to make an informed decision on the Veteran's claim. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007); Douglas v. Shinseki, 23 Vet. App. 19, 26 (2009). Accordingly, the matter is REMANDED for the following action: 1. Forward the Veteran's claims file, including a copy of this REMAND, to a VA audiologist WHO HAS NOT YET PROVIDED AN OPINION IN THIS CASE to provide an addendum medical opinion addressing the nature and etiology of the Veteran's bilateral hearing loss. A full audiological examination need not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file in its entirety, to include a copy of this REMAND, and the review should be noted in the examination report. Thereafter, the examiner is asked to provide a fully articulated medical opinion with respect to the following: a. Is it is at least as likely as not (50 percent probability or more) that any current hearing loss was manifested in, caused by, or is otherwise etiologically related to service, to include any verified periods of ACDUTRA and/or INACDUTRA. The examiner should note that in-service noise exposure has been established. He/she should specifically discuss the threshold shifts shown on examination in February 1971 and March 1975 and the notation of hearing loss on both occasions. The examiner must specifically cite to and discuss audiograms during periods of such service that demonstrate diminished hearing. The examiner is reminded that the term "at least as likely as not" does not mean "within the realm of possibility." Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it. The examiner is further reminded that the absence of complaint or diagnosis of hearing loss during service cannot serve as the sole basis for a negative finding. The Veteran's lay statements and other evidence of record must be considered and weighed in making the determination as to whether a nexus exists between the Veteran's hearing loss disability and his military service. The examiner must set forth a complete rationale for any conclusion reached, citing to the examiner's clinical experience, medical expertise, and established medical principles, as well as evidence in the Veteran's claims file, as necessary. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so. The Board reminds the examiner that failure to comply with the examination directives outlined herein will render the medical opinion inadequate and will result in further remand of the Veteran's claim. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Rosenthal, Ariana 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.