Citation Nr: 21062094 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 15-07 641 DATE: October 6, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1972 to November 1975. This case has been before the Board multiple times, most recently in July 2021 when it was remanded for additional development. There has not been substantial compliance with the Board's previous remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for bilateral hearing loss is remanded. The claim must be remanded again because the August 2021 VA opinion is inadequate. The August 2021 VA examiner offered a negative nexus opinion based upon the presence of mild hearing loss in his right ear on his 1972 service enlistment examination, no evidence of hearing loss during service, and an Institute of Medicine (IOM) study to refute the theory of delayed onset hearing loss. The November 1972 enlistment examination included some audiometric thresholds 20 decibels or higher, but no specific defect was noted. See Hensley v. Brown, 5 Vet. App. 155 (1993). On the PULHES profile system, the Veteran's hearing ("H") was assigned a "1," reflecting a high level of fitness. See Odiorne v. Principi, 3 Vet. App. 456 (1992). Since no hearing defect was noted on enlistment examination, the Veteran is presumed sound. There is no record of a separation examination. Additionally, the absence of evidence of hearing loss in service is not a bar to service connection for hearing loss. See Hensley v. Brown, 5 Vet. App. 155 (1993). Further, as identified by the Board in the July 2021 remand, The IOM report includes inconsistencies. McCray v. Wilkie, 31 Vet. App. 243 (2019). The August 2021 VA examiner did not discuss the IOM study beyond the reference to it; there was no discussion of the qualifying findings within that report. Accordingly, a new opinion is necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the VA examiner who provided the August 2021 VA opinion, (or another appropriate provider if that provider is unavailable) to determine the nature and etiology of the Veteran's bilateral hearing loss. Copies of all pertinent records, including this remand, must be made available to the examiner for review. Based on the review of the record, the examiner should answer the following: (a.) Did a hearing loss disability clearly and unmistakably (i.e., it is undebatable) exist prior to his active service? The examiner should consider and discuss as necessary the November 1972 enlistment examination which did not show any hearing defect or related diagnosis. (b.) If the answer to (a) is yes, does the evidence clearly and unmistakably show (i.e., it is undebatable) that the hearing loss was not aggravated by service or that any increase in disability was due to the natural progression of the condition? Please identify such evidence with specificity. (c.) If the answer to either (a) or (b) is no, is at least as likely as not related to conceded in-service noise exposure. Why or why not? Should the examiner rely to any extent upon the IOM study, noted above, the examiner must (a) identify the medical text's qualifying or contradictory aspects (i.e. "There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure"); and (b) explain why the examiner found the contradictory aspects or conclusions in the IOM study to be less persuasive in this Veteran's case as to the question of whether delayed onset hearing loss is as likely as not etiologically related to conceded in-service noise exposure. The examiner may discuss this Veteran's documented complaints and clinical history in support thereof, but must not reject medical history unless otherwise incongruous with the record and explaining why any history is rejected. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why this is so. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Eric Struening 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.