Citation Nr: 21063671 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 18-27 565 DATE: October 15, 2021 REMANDED The issue of service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1968 to December 1969, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019 and February 2020, the Board remanded the appeal for additional development. The issue of service connection for bilateral hearing loss is remanded. The Veteran claims that his bilateral hearing loss is related to his in-service noise exposure. Specifically, he asserts that he was exposed to loud weapons during service. See VA examination report (August 2021). The Veteran has current bilateral hearing loss for VA purposes. See VA examination report (October 2015). The Veteran's DD Form 214 and service records shows that his military occupational specialty (MOS) was a field wireman; he served in the Republic of Vietnam and was awarded the Sharpshooter (rifle) badge. Thus, the Veteran's in-service noise exposure is conceded based on the circumstances of his service. The Veteran's October 1967 pre-induction examination report contains an audiometer chart that suggests that he had bilateral hearing loss for VA purposes, as his right and left ear pure tone thresholds at 3,000 Hertz was recorded as 10 and at 4,000 Hertz was recorded as 45 decibels in each ear. This evaluation occurred prior to January 1, 1971, and since it is unclear whether such thresholds were recorded using American Standards Association (ASA) units or International Standards Organization-American National Standards Institute (ISO-ANSI) units, the thresholds are to be considered under both ASA and ISO-ANSI standards. Audiometric data originally recorded using ASA standards will be converted to the ISO-ANSI standard by adding between 5 and 15 decibels to the recorded data. Converting the audiometric data recorded during the Veteran's October 1967 pre-induction examination to the ISO-ANSI standard indicates that the pure tone thresholds were, at least, 15 to 20 decibels at 3,000 Hertz and 50 decibels at 4,000 Hertz. The Board points out that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Veteran's November 1969 separation audiometer report reflects that the pure tone thresholds were either 0 or 5 decibels. Notably, pure tone thresholds at 3,000 Hertz were not recorded, as there is a slash through the 3,000 Hertz. In February 2020, the Board remanded the appeal to obtain a VA opinion to address whether the Veteran's bilateral hearing loss was related to his military service and for an examiner to address the October 2019 VA examiner's findings that the Veteran's induction hearing examination was questionable. Pursuant to the February 2020 remand, an August 2021 opinion was obtained. The VA examiner provided a negative nexus opinion between the Veteran's bilateral hearing loss and his military service, on the basis that the Veteran had preexisting hearing loss due to presbycusis and that the Veteran did not have hearing loss until 2016. Notably, the examiner indicated that the claims file did not contain a separation report and found that the Veteran's preexisting hearing loss was not aggravated beyond normal progression during his military service. The August 2021 opinion is problematic for several reasons. For instance, the August 2021 examiner suggested that the Veteran had preexisting hearing loss on his pre-induction examination due to presbycusis. To that end, the examiner provided no explantation as to how he arrived at the finding that the Veteran had hearing loss on his pre-induction examination due to presbycusis. Such lack of rationale does not sufficiently inform the Board of a medical expert's judgment. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-06 (2012). This is particularly so as presbycusis was not noted on the Veteran's pre-induction examination. Additionally, the August 2021 examiner's rationale was based on an inaccurate factual basis. For example, the examiner indicated that the Veteran's claims file did not contain a separation report; however, the Veteran's service treatment record (STRs) includes a separation report. Lastly, the examiner indicated that the Veteran did not have hearing loss complaints until 2016; however, the evidence shows that as early as 2010, the Veteran was diagnosed as having bilateral hearing loss. See VA examination report (October 2015). See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise is not probative). As the August 2021 opinion is flawed, a remand is necessary to obtain a VA opinion to address the Veteran's claim of service connection for bilateral hearing loss and to ensure compliance with the Board's prior remand directives. The matter is REMANDED for the following action: 1. Refer the claims file to an audiologist to determine the etiology of the Veteran's bilateral hearing loss. The audiologist must provide opinions addressing the following: a. Whether the Veteran had bilateral hearing loss (pursuant to 38 C.F.R. § 3.385) that clearly and unmistakably existed prior to his military service entrance. In addressing the above, the audiologist must consider and address the following: i. The Veteran's pre-induction examination report that occurred prior to January 1, 1971. It is unclear whether such thresholds were recorded using American Standards Association (ASA) units or International Standards Organization-American National Standards Institute (ISO-ANSI) units. The audiometric data originally recorded using ASA standards should be converted to the ISO-ANSI standard by adding between 5 and 15 decibels to the recorded data. ii. The October 2019 VA examiner's note that the results from the Veteran's induction hearing examination were "questionable." iii. The August 2021 VA examiner's findings that that the Veteran had hearing loss on his pre-induction examination due to presbycusis. The examiner must clearly identify the evidence supporting a finding of that the Veteran's hearing loss clearly and unmistakably existed prior to his military service entrance. b. If the answer to (a) is yes, then the audiologist must address whether the Veteran's bilateral hearing loss was clearly and unmistakably NOT aggravated (i.e., made worse) during or as a result of service. c. Regardless of the answers to the above questions, is it at least as likely as not (50 percent or greater probability) that the Veteran's bilateral hearing loss had its onset during service, manifested to a compensable degree within one year following his separation from service, or is related to his military service, to include as due to his in-service noise exposure. The audiologist must provide a rationale for each opinion given. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Castillo, 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.