Citation Nr: 21063633 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 16-01 713 DATE: October 15, 2021 ORDER Entitlement to service connection for left-ear otitis media is denied. REMANDED Entitlement to service connection for left-ear hearing loss is remanded. FINDING OF FACT The evidence is insufficient to establish that the Veteran's left-ear otitis media is related to service. CONCLUSION OF LAW The criteria for service connection for left-ear otitis media have not been met. 38 U.S.C. §§ 1111, 1131; 38 C.F.R. §§ 3.303, 3.304(b). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1975 to October 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2021, the Board remanded the claims for addendum etiology opinions. 1. Left-Ear Otitis Media The Veteran appeals the denial of service connection for left-ear otitis media. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the claimed in-service event, injury, or disease and the present injury or disease. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A Veteran is considered to have been in sound medical condition at the time of entrance to service except where otherwise noted. Only conditions recorded in an examination report are considered to be noted. Where a preexisting condition is noted at the time of entrance, service connection is warranted where the evidence establishes that the preexisting disability was aggravated by service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Where a preexisting condition is not noted at the time of entrance, service connection, the Veteran is presumed sound, and the presumption is rebutted only where there is clear and unmistakable evidence that (1) a disability existed prior to service and (2) the preexisting disability was not aggravated during service. If these two elements are shown, service connection cannot be granted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). In this case, Medical Board proceedings during service resulted in the Veteran's discharge in October 1975 by reason of having been "enlisted in error, failure to meet enlistment physical standards." The Medical Board report listed diagnoses of "otitis media right ear" and "deafness, bilateral," detailing that "according to [the Veteran's] own statement, lifelong ear problems; treated numerous times by civ[ilian] physicians; he revealed this before but it wasn't considered disqualifying. AFEES exam does document marked hearing loss in right ear and mild hearing deficiency in left. Presented to medical care during initial phase of training with complaint of draining from right ear. . . . Examination of the right ear discloses serous drainage as well as a markedly scarred and erythematous ear drum." The Veteran's June 1975 enlistment examination noted defects of cerumen in the ears and defective hearing bilaterally; his report of medical history noted "gets water in ear [with] swimming." After review of the evidence, the Board finds that service connection is not warranted. As a preliminary matter, the Board finds that the Veteran is presumed to have been in sound health with respect to left-ear otitis media at his enlistment, and that the presumption has not been rebutted. The Board does not find that the notations on the June 1975 entrance examination support a finding of preexisting otitis media at that time, and the Board does not find that the evidence of record clearly and unmistakably shows otherwise. The September 1975 Medical Board report and surrounding evidence specifically identifies right-ear otitis media only. The Board acknowledges VA opinions in October 2020 and June 2021 that opined that the Veteran's left-ear otitis media did preexist his service; however, these opinions simply referenced the 1975 Medical Board report, without reconciling the fact that the report and ultimate discharge was based specifically on right-ear otitis media. Thus, the Veteran is presumed sound as to left-ear otitis media at the time of his entrance to service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). In turn, in order to establish entitlement to service connection, the evidence must show that the Veteran's current disabilities are etiologically related to service. 38 U.S.C. § 1131. On this element, the Board finds that the evidence is insufficient. In the October 2020 and June 2021 opinions, both clinicians opined that the Veteran's left ear otitis media was not incurred in service and is not related to his service, based on rationale including a hearing examination in 1975 with results interpreted as normal. Elsewhere in the record, there is not sufficient competent evidence linking the Veteran's current left-ear otitis to any in-service injury, disease, or event. See 38 C.F.R. § 3.303. Thus, because the evidence is insufficient to establish that the Veteran's left-ear otitis media is related to his time in service, service connection for left-ear otitis media is denied. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS FOR REMAND 2. Left-Ear Hearing Loss The Board's previous April 2021 decision directed for an addendum opinion, but one was not provided on appeal. Though an examination was provided, the clinician was unable to test the Veteran's hearing, on which basis she stated she could not offer an opinion without speculating. An explanation was not given, however, as to why current audiometric testing would be needed in order to provide an etiology opinion regarding the Veteran's established hearing loss during the appeal period. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). The matter is REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the Veteran's left-ear hearing loss. A new examination is not required unless the clinician states that one is needed. The clinician is asked to opine whether the Veteran's left-ear hearing loss (as found in June 2014 VA audiology notes) at least as likely as not is related to his active-duty service from September 1975 to October 1975. In rendering his or her opinion, the clinician may consider and discuss the reasoning already of record, to include in the November 2020 C&P opinion. The clinician must, however, acknowledge the Veteran's reported exposure to noise from grenade explosions and loud yelling; his contention that he has had hearing loss ever since then; and, the fact that his medical discharge was in part due to a diagnosis of bilateral deafness. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, 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.