Citation Nr: 21065805 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 17-28 344 DATE: October 27, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from September 1960 to August 1964. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing. A transcript of the hearing is of record. This case was initially before the Board in February 2019, at which time the Board denied entitlement to service connection for bilateral hearing loss. The Veteran appealed the February 2019 decision to the United States Court of Appeals for Veterans Claims (Court). In a November 2019 Order, the Court granted a Joint Motion for Remand (JMR), vacating the Board's February 2019 decision and remanding the case for further action consistent with the terms of the JMR. The Board has since remanded this case in May 2020, December 2020, April 2021, and July 2021 for additional development. Unfortunately, as discussed below, the Board is not satisfied that there has been substantial compliance with the most recent remand instructions; therefore, the matter must be remanded once again. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Entitlement to service connection for bilateral hearing loss is remanded. The Veteran seeks service connection for bilateral hearing loss, and the Board has previously conceded in-service noise exposure based on the Veteran's credible statements. In its July 2021 remand, the Board requested an addendum medical opinion addressing the nature and etiology of the Veteran's bilateral hearing loss. It emphasized that the opinion must consider and discuss specific medical articles that the Veteran submitted supporting the possibility of delayed onset hearing loss, including the March 2014 NIH Publication No. 14-423 "Noise Induced Hearing Loss" National Institution on Deafness and Other Communication Disorder, which the Veteran submitted in July 2020. In the September 2021 VA addendum opinion, the VA examiner did not consider or discuss this medical article in his opinion. Furthermore, the September 2021 VA examiner indicated that there was a lack of hearing "changes" during the Veteran's service, however the numerical values are not the same in the Veteran's September 1960 and July 1964 audiograms from his service treatment records (STRs), and the examiner did not state whether he was referring to significant threshold shifts or address whether he was referring to the Veteran's audiograms using American Standards Association (ASA) units or to International Standards Organization-American National Standards Institution (ISO-ANSI) units. The November 2019 JMR indicated that it was unclear whether the previous medical examiner considered if there were significant threshold shifts in the Veteran's hearing during service. It further noted that it was not clear whether the VA examiner converted the Veteran's in service audiometry results from ASA units to ISO-ANSI units and instructed that on remand the VA examiner should instruct whether such a conversion is necessary, and if so to do it and note it in the VA examination report. For the reasons stated above, the Veteran's service connection claim for bilateral hearing loss is remanded for another addendum VA medical opinion. The matter is REMANDED for the following action: 1. Forward the Veteran's claims file, including a copy of this REMAND, to a VA audiologist (who has not yet provided an opinion in this Veteran's case) to provide an addendum medical opinion addressing the nature and etiology of the Veteran's bilateral hearing loss. A full audiological examination should not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file in its entirety and the review should be noted in the examination report. Thereafter, the examiner is asked to provide a fully-articulated medical opinion with respect to the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's bilateral hearing loss had its onset during active service, within one year of separation, or is otherwise related to any in-service disease, event, or injury, to include conceded exposure to excessive military noise? 1. The examiner should address the Veteran's September 1960 and July 1964 audiograms, to include whether there were any significant threshold shifts, under both the ASA and ISO-ANSI standards. 2. The provided opinion must specifically consider and discuss the following evidence: a. November 2018 Private Medical Opinion provided by the Veteran's private doctor, D.W., M.D. b. July 2020 Correspondence in which the Veteran describes the nature and extent of his noise exposure during service, including his MOS duties, calculated flying time in the cargo hold of the C-130 aircraft, and the fact that he never wore hearing protection while working on the flight line or while flying on military aircraft. c. October 2018 Board hearing testimony in which the Veteran testified that he first noticed decreased hearing acuity shortly after separation from service when he enrolled in college and had trouble hearing his professors lecturing in class. (Continued on the next page) d. NIH Publication No 14-4233: "Noise-Induced Hearing Loss," National Institute on Deafness and Other Communication Disorder (March 2014), which details that noise-induced hearing loss may develop gradually over time and may not be noticeable until it becomes more pronounced. e. Katherine Fernandez, et al, "Aging after Noise Exposure: Acceleration of Cochlear Synaptopathy in 'Recovered' Ears," The Journal of Neuroscience (May 13, 2015), available at https://www.jneurosci.org/content/jneuro/35/19/7509.full.pdf. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ahuva D. Sunshine 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.