Citation Nr: 21065022 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 16-25 848 DATE: October 22, 2021 REMANDED The issue of entitlement to service connection for bilateral tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1963 to July 1967. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. Jurisdiction is currently with the RO in Chicago, Illinois. Entitlement to service connection for bilateral tinnitus is remanded. The Veteran contends that he developed bilateral tinnitus as a result of acoustic trauma he sustained in service related to his Military Occupational Specialty (MOS) as Air Policeman. Specifically, he contends that while guarding F-14 Aircrafts he was exposed to engine, M16, and mortar noise without hearing protection. In this regard, an October 2013 VA examiner opined that the Veteran's tinnitus was less likely than not related to military noise exposure. The examiner reasoned that the Veteran's tinnitus first started many years post discharge; the Veteran reported that his tinnitus began about 10-15 years ago, which is over 35 years post discharge. The examiner cited to the Institute of Medicine (IOM) study, indicating that as the interval between a noise exposure and the onset of tinnitus lengthens, the possibility that tinnitus will be triggered by other factors increases. In light of a recent decision of the United States Court of Appeals for Veterans Claims (Court), the Board finds that remand is necessary. See McCray v. Wilkie, 31 Vet. App. 243 (2019). This Court decision highlighted the contradictory findings regarding delayed onset hearing loss in the IOM report. Specifically, the VA medical opinion noted that the IOM report concluded, in part, that based on the anatomical and physiological data available on the recovery process following noise exposure, it was unlikely that delayed effects occurred. However, the IOM report also indicates that "[t]here 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 that "definitive studies to address this issue have not been performed." Any future opinion predicated on the IOM report's findings regarding delayed onset hearing loss must address these inconsistencies. As the October 2013 VA examiner relied on this IOM study without addressing these inconsistencies, the Board finds the opinion inadequate and a remand for an addendum opinion is necessary. The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Return the claims file to the audiologist who provided the October 2013 addendum opinion, if available. If that audiologist is not available, send the claims file to another audiologist. The claims file and this remand should be made available to the examiner and review of the file should be noted in the requested report. After reviewing the claims file the audiologist should respond to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that tinnitus had its onset in, or is related to any in-service disease, event, or injury, including noise exposure, including on a delayed onset theory of causation? The audiologist should specifically address the Veteran's contention that he was exposed to acoustic trauma (engine, M16, and mortar noise without hearing protection) in relation to his MOS of Air Policeman and his contention that he was not exposed to any occupational or recreational noise post-service. Please note that the RO has conceded hazardous in-service noise exposure based on the Veteran's MOS. The audiologist shoulder also specifically address evidence that the Veteran's tinnitus had onset earlier than reported during the September 2013 VA audiological examination. See VA-Form 21-526 on which the Veteran indicated onset of tinnitus in 1990. (b.) In formulating a medical opinion, if relying to any extent upon the IOM study noted above, the examiner must (a) identify the medical text's qualifying or contradictory aspects; 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 tinnitus is as likely as not etiologically related to in-service noise exposure. (c.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.