Citation Nr: 21064705 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 18-29 305 DATE: October 21, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1966 to January 1970, and from August 1990 to September 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified, sitting in Chattanooga, Tennessee, before the undersigned via a videoconference hearing. A transcript of the hearing has been associated with the virtual file and reviewed. This issue was most recently before the Board in March 2020, at which time it was remanded for further development, as discussed below. The Board finds that the remand directives were not substantially complied with and thus another remand is warranted. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board also remanded the issues of entitlement to service connection for back pain and skin/nerve damage. A January 2021 rating decision granted service connection for degenerative arthritis and lumbosacral strain, effective September 25, 2014. And, an August 2021 rating decision granted service connection for scar, post basal cell carcinoma treatment with actinic keratosis, effective December 24, 2013, the date of the Veteran's claim for skin/nerve damage. Since the service connection benefit sought has been granted in full, these issues are no longer on appeal before the Board. Entitlement to service connection for bilateral hearing loss is remanded. The March 2020 Board decision noted that, after the December 2015 VA examiner opined that the Veteran's hearing loss is less likely than not related to his active service, the Veteran submitted a summary of a medical study suggesting that jet fuel exposure, in combination with noise exposure, may increase the likelihood of hearing loss, as well as a document regarding the noise levels of various jets, with frequencies recorded in decibels. The Board decision remanded the claim for the Agency of Original Jurisdiction (AOJ) to obtain a medical opinion that addresses whether it is as likely as not that the Veteran's bilateral hearing loss manifested during or is otherwise related to his period of active service. Additionally, the clinician was directed to consider the medical literature regarding the relationship between jet fuel exposure and hearing loss, as well as the documents provided by the Veteran regarding the level of noise, in decibels, of various jet engines that he worked with during his periods of active service. 03/03/2020, BVA Decision. An April 2021 VA medical opinion noted that the Veteran's hearing was within normal limits during his first period of active duty. The clinician opined that the Veteran's bilateral hearing loss is less likely than not related to his active service. The clinician acknowledged limited studies on animals regarding jet fuel and noise exposure. However, the clinician indicated that there is no peer reviewed evidence for late onset of hearing loss for humans due to jet fuel exposure. The clinician also relied on a 2006 Institute of Medicine (IOM) study regarding delayed onset of hearing loss. The clinician further opined that significant threshold shifts that occurred between 1970 and 1977. The clinician also noted evidence suggesting an aggravation of the Veteran's hearing loss between 1977 and 2002. 05/11/2020, C&P Exam. In a separate April 2021 addendum VA medical opinion, the clinician noted that the Veteran had normal hearing before his first period of active service. However, the clinician did not provide an opinion as to whether the Veteran's hearing loss was aggravated during his second period of active service from August 1990 to September 1990. 04/28/2021, C&P Exam. The Board finds the opinion and rationale to be incomplete as the examiner overly relied on the Veteran's hearing loss not occurring immediately in service. In this regard, the Board notes that the U.S. Court of Appeals for Veterans Claims (CAVC) has held that where there is no evidence of the Veteran's claimed hearing disability until many years after separation from service, if the evidence "demonstrate[s] a medical relationship between the [V]eteran's in-service exposure to loud noise and his current disability, it would follow that the [V]eteran incurred an injury in service...." Hensley v. Brown, 5 Vet. App. 155, 160 (1993); see also McCray v. Wilkie, 31 Vet. App. 243, 249, 257 (2019) (discussing the IOM report contained unfavorable findings as well as apparently contradictory findings regarding delayed-onset hearing loss). Furthermore, although the clinician acknowledges that the Veteran's hearing loss may have been aggravated between 1977 and 2002, none of the medical opinion address whether the Veteran's hearing loss was aggravated during his second period of active service from August 1990 to September 1990. Additionally, the clinician opined that the onset of the Veteran's bilateral hearing loss may have occurred as early as 1970, but did not opine as to whether the hearing loss manifested within one year after discharge from the Veteran's first period of active service in January 1970. As such, the Board finds that prior Board remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. This matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. Additionally, request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. After completing directive # 1, obtain a medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's bilateral hearing loss. The clinician is to review the virtual file, including a copy of this Remand. (a) The clinician is to provide an opinion as to whether any current bilateral hearing loss diagnosis is at least as likely as not related to an in-service injury, event, or disease. **In doing so, the clinician is to consider the medical literature regarding the relationship between jet fuel exposure and hearing loss. Also, the clinician is to consider the documents provided by the Veteran regarding the level of noise, in decibels, of various jet engines that he worked with during his periods of active service.** (b) The clinician is to provide an opinion as to whether the Veteran's bilateral hearing loss was at least as likely as not aggravated during his second period of active service from August 1990 to September 1990. (c) The clinician is to also provide an opinion as to whether is at least as likely that any current bilateral hearing loss diagnosis manifested within one year after discharge from the Veteran's first period of active service in January 1970. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David Han 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.