Citation Nr: 21065848 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 16-04 090 DATE: October 27, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on in the South Carolina Army National Guard from May 1975 until his honorable retirement in March 1996. During his service, he served on active duty for training from August 1975 until his honorable discharge in December 1975 and had numerous other periods of active duty for training and inactive duty for training. See DPRIS Response. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision by the Regional Office of the United States Department of Veterans Affairs (VA). In January 2021, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the record on appeal. In March 2021, the Board remanded the case to the Regional Office for further development. Specifically, the Board directed the Regional Office to obtain complete copies of his military personnel record and an updated VA examination. 1. Entitlement to service connection for bilateral hearing loss. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue of the nature and etiology of the Veteran's bilateral hearing loss. For the reasons set forth below, additional development is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran has had three VA examinations for his hearing loss, in July 2015, May 2019, and August 2021. These examinations are inadequate. The July 2015 examiner opined that the Veteran's hearing loss is less likely than not (less than 50 percent probability) caused by or a result of an event in military service because records show [hearing] loss prior to service and [his hearing loss] has fluctuated over time, sometimes worse, sometimes better; and there is no evidence to indicate that it is at least as likely as not caused by or exacerbated by military service. However, the VA examiner only included the conclusory statement that "there is no evidence to indicate that it is at least as likely as not caused by or exacerbated by military service," which is inadequate. Again, the Board notes that the Veteran provided a June 2018 private provider opinion that diagnosed bilateral moderate sensorineural hearing loss. Unfortunately, the private provider hearing evaluation was not tested under the criteria required for VA rating purposes and is therefore inadequate and not probative. Specifically, although the private provider included a "Discrimination in Quiet" score, that is not a Maryland CNC word recognition test which is required. Furthermore, the private provider provided a nexus opinion that the Appellant's bilateral hearing loss is at least as likely as not (50 percent probability or greater) occurred while he was on active duty but does not provide any rationale nor consideration that the Appellant's service was entirely in the South Carolina Army National Guard nor the Appellant's preexisting bilateral hearing loss. The May 2019 examiner opined: Veteran had hearing loss upon enlistment into service 05-07-75; hearing thresholds were within normal limits for all frequencies tested upon release from active duty audio 11-25-75 (significant negative threshold shifts), therefore no permanent positive threshold shifts occurred during active duty. The Veteran's post-service employment at Michellin Tire Plant was positive for noise exposure, with initial 12-15 years of employment prior to routine use of hearing protection in industrial settings; he continued to show bilateral shifts in hearing during his post-service employment, as evidenced by [several] Reserves audiograms. There is nothing in the evidence to support hearing loss due to military service. Therefore, it is less likely than not (less than 505 probability) the Veteran's hearing loss is caused by or the result of an event in military service. See April 2019 VA Examination. However, the post remand DPRIS response shows that the Veteran had active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) throughout his time in the reserves. Any adequate VA medical examination must address whether his hearing loss could have been from that activity. Finally, the most recent examination states "Veteran was active duty Army less than 4 months in 1975 (Aug 15 - Dec 3). Although he was exposed to generators, rifles and grenades, his hearing was normal on Nov 1975 audiogram. The literature does not support delayed onset hearing loss from noise exposure" And then stated, "Hearing loss resolved on Nov 1975 audiogram" in response to whether service aggravated hearing loss. There has not been an adequate VA examination opinion on the various ACDUTRA or INACDUTRA periods. The examiner must consider and address service connection for the Veteran's hearing loss during all included periods of service (Field Wireman prior to September 1992 and MSE Transmission System Operator from September 1992); and including aggravated beyond its natural progression by his active duty for training and/or other Federal service (and specifically excluding inactive service and other non-Federal service) with consideration for the his duties during all included periods of service (Field Wireman prior to September 1992 and MSE Transmission System Operator from September 1992). The March 2021 DPRIS response outlines that Veteran's various ACDUTRA and INACDUTRA dates of service, which must be addressed by the examiner in determining if service caused or aggravated the Veteran's hearing loss. The Regional Office must ensure that the VA examiner addresses each period of ACDUTRA service and whether his hearing loss was aggravated beyond its natural progression. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's bilateral hearing loss is at least as likely as not related to his active duty for training and/or other Federal service (and specifically excluding inactive service and other non-Federal service) with consideration for his duties during all included periods of service (Field Wireman prior to September 1992 and MSE Transmission System Operator from September 1992); and including aggravated beyond its natural progression by his active duty for training and/or other Federal service (and specifically excluding inactive service and other non-Federal service) with consideration for the his duties during all included periods of service (Field Wireman prior to September 1992 and MSE Transmission System Operator from September 1992). See March 2021 DPRIS Response. An in person examination may be held if the examiner deems it necessary. The examiner must provide a detailed rationale, including an explanation relating to the Veteran's active duty for training service and/or other Federal service (and specifically excluding inactive service and other non-Federal service). 2. After, readjudicate the Veteran's claim. If the claim remains denied, send the Veteran and his representative a supplemental statement of the case (SSOC), and allow them an appropriate time to respond before returning the issue to the Board for further appellate consideration. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Johnston, Associate 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.