Citation Nr: 21065314 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 17-66 791 DATE: October 25, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran had active military service from March 1968 to March 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision by the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a hearing in February 2020. A transcript of the hearing has been associated with the claims file. By way of background, in June 2020 the Board remanded the issue on appeal for further evidentiary development and adjudication. As discussed below, the Board finds the AOJ did not substantially comply with the June 2020 remand and as such another remand is required. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for bilateral hearing loss is remanded. At the outset, the Board notes that the Veteran has a current diagnosis of bilateral hearing loss that meets the criteria of 38 C.F.R. § 3.385. The Board also concedes that the Veteran was exposed to hazardous noise. The Veteran was afforded a VA examination in April 2016 with addendum opinions in September 2020 and November 2020. In the April 2016 VA examination, the examiner opined that the Veteran's bilateral hearing loss is not at least as likely as not caused by or a result of an event in service. The examiner explained that the March 1968 audiometric data was barely legible but the results that could be read appeared to be within normal limits for the bilateral ears. Additionally, there was no hearing loss in the December 1971 separation examination. In further support of her opinion, the examiner referenced The Institute of Medicine (2006) (IOM) wherein a study found that there is insufficient scientific basis to conclude that permanent hearing loss directly attributable to noise exposure will develop long after noise exposure. The IOM panel concluded that based on their current understanding of auditory physiology a prolonged delay in the onset of noise-induced hearing loss was 'unlikely.' Based on the objective evidence (i.e., audiograms), the examiner determined that there is no evidence on which to conclude that the Veteran's current bilateral hearing loss was caused by or a result of the Veteran's service, including noise exposure. In the September 2020 addendum opinion, the examiner opined that it is less likely than not his hearing loss incurred in or was caused by the claimed in-service injury, event, or illness. The examiner explained that the March 1968 entrance examination showed high frequency hearing loss in the left ear at 40 dB at 4000 Hz and 25 dB at 6000 Hz (ASA standards) whereas the right ear showed 10 dB at 4000 Hz and 15 dB at 6000 Hz (ASA standards). In order to convert to ISO standards, 10 dB should be added to the thresholds reported above. The actual Rudmose audiometry tracings were included in the STRs and are considered the most valid record of the entrance level of hearing in each ear. The September 1970 and September 1971 audiogram showed no further increase in threshold levels in either ear. Both hearing conservation forms reported results reflected in ISO 1964 standards. The December 1971 separation examination revealed bilateral normal hearing. The September 1971 hearing conservation audiogram more accurately reflects the Veteran's hearing near the time of discharge. The overall pattern of audiometric tests suggests preexisting high frequency hearing loss in the left ear than showed no significant decrease during service. The preexisting high frequency hearing loss pattern is consistent with noise exposure. Although noise exposure is conceded, the periodic hearing conservation audiograms indicated that ear protection was worn in the Veteran's primary work area. As such, the current hearing loss is less likely as not related to the Veteran's military noise exposure. Due to several discrepancies in the September 2020 addendum opinion, the RO requested a new medical opinion. In the November 2020 addendum opinion, the examiner opined it is less likely as not that the Veteran's hearing loss is related to military noise exposure. The examiner explained that there is no new evidence to refute previous negative opinions. There is no permanent significant shift in hearing thresholds from March 1968 to the 1971 separation examination at all frequencies. Further, there is no significant permanent shift in hearing thresholds at 3000 and 6000 Hz from May 1968 to the 1971 separation examination. This is indicative of no permanent auditory damage in service from conceded military noise. There is no hearing loss or hearing decrease in the STRs. There is no continuity of care for or chronicity of hearing loss since separation. Although hazardous noise exposure is conceded damage from that noise is not conceded based on noise alone. There must be a nexus of auditory damage to relate current hearing loss to military noise and not another possible etiology. The evidence is against a nexus of auditory damage in service. The Board finds that an addendum medical opinion is warranted to obtain further clarification. Specifically, after converting the March 1968 audiometric ASA units to International Standards Organization-American National Standards Institute (ISO-ANSI) units and comparing it to the December 1971 audiometric (ISO units), it appears that there is a shift of 10 dB for the right ear at the 3000 Hz and 4000 Hz and a shift of 15 dB for the left ear at the 3000 Hz. Further, when comparing the March 1968 audiometric data to the September 1971 audiometric data there are shifts in the right ear at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, and 6000 Hz and shifts in the left ear at 500 Hz, 1000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz. The November 2020 examiner did not address these shifts, or explain their significance, if any. Accordingly, the Board finds that a remand is warranted. The matter is REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records. 2. Thereafter, obtain an addendum medical opinion from an appropriately qualified examiner to determine the nature and etiology of the Veteran's bilateral hearing loss. The claims file, including a copy of this remand, must be made available to be reviewed by the examiner. For any diagnosed bilateral hearing loss, provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in service or is otherwise etiologically related to service. The examiner is reminded that exposure to hazardous noise in service has been conceded. The examiner must address the March 1968, May 1968, September 1970, September 1971, and December 1971 audiometric data and convert the data to ISO-ANSI units. Thereafter, the examiner should address whether there was any significant threshold shift in the Veteran's hearing in service. The examiner should consider that after converting the May 1968 audiometric ASA units to ISO-ANSI units and comparing it to the December 1971 audiometric (ISO units), it appears that there is a shift of 10 dB for the right ear at the 3000 Hz and 4000 Hz and a shift of 15 dB for the left ear at the 3000 Hz. Further, when comparing the March 1968 audiometric data to the September 1971 audiometric data there appear to be shifts in the right ear at 500 Hz (difference of 10 dB), 1000 Hz (difference of 10 dB), 2000 Hz (difference of 10 dB), 3000 Hz (difference of 10 dB), and 6000 Hz (difference of 10 dB) and shifts in the left ear at 500 Hz (difference of 20 dB), 1000 Hz (difference of 15 dB), 3000 Hz (difference of 30 dB), 4000 Hz (difference of 25 dB), and 6000 Hz (difference of 10 dB). The examiner is asked to explain what constitutes a significant threshold shift. Additionally, it would be beneficial to the Board if the examiner can explain how the Veteran's hearing appeared to have decreased in September 1970 and September 1971 but then improved in December 1971. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Noh, 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.