Citation Nr: A21016291 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 181130-937 DATE: October 4, 2021 REMANDED Service connection for tinnitus is remanded. Service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served in the United States Army from July 1966 to July 1968. A rating decision was issued under the legacy system in December 2016. In August 2018, the Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the Higher-Level Review Option. The Agency of Original Jurisdiction (AOJ) issued an AMA rating decision pursuant to RAMP in October 2018, which is the decision on appeal. In a November 2018 RAMP selection to appeal to the Board of Veterans' Appeals (Board), the Veteran elected the Hearing option. However, in June 2021, he withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the August 2018 RAMP opt-in and any evidence submitted by the Veteran or his representative within 90 days of the June 2021 withdrawal. Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is remanding the claims for further development, this additional evidence will be considered by the AOJ in the adjudication of those claims. The Veteran alleges that his hearing loss and tinnitus are related to exposure to loudspeakers blasting music, propaganda, and from the sounds of jet airplanes landing, taking off, and flying overhead while he was stationed in the DMZ in Korea. He said he was not provided with ear protective equipment during that time. VA concedes that the Veteran was exposed to loud noises during his service. In a December 2016 Notice of Disagreement, and in multiple VA medical treatment records, the Veteran states that he first noticed hearing loss and tinnitus symptoms, including intermittent bilateral ear fullness and ringing sounds, while in the military. In December 2016, the Veteran was afforded a VA examination for hearing loss and tinnitus, including audiogram testing. His hearing loss met the criteria to be considered a disability for VA purposes as set forth in 38 C.F.R. § 3.385. He also had tinnitus. The examiner opined that his hearing loss was not caused by or the result of military service. The rationale states, "comparison of STRs at enlistment and discharge reveal no significant threshold shifts." The examiner also noted a 2006 Institute of Medicine study which found that "is unlikely that permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure." See Institute of Medicine. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press, 2006. Regarding tinnitus, the examiner also opined that it was not related to military service and in the rationale cited lack of evidence in STRs of a diagnosis of or treatment for service. If VA provides an examination when developing a service-connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). While the VA examination report briefly notes the Veteran's comments that he became aware of tinnitus in March or April 1967, it fails to list or address any other records in the file, including medical treatment records which note repeated references to the Veteran's lay statements that his hearing problems, including sensations of bilateral ear fullness and ringing, began in 1967 during active duty. Nor did the examiner address the Veteran's lay statements in his NOD or note or discuss in any detail the effects of the Veteran's noise exposure during service or reasons, if any, he did not report his symptoms during service. The Board regrets the additional delay in this case. But it finds that the 2016 VA examination was inadequate, and a fully informed decision cannot be made without an opinion to determine the etiology of the Veteran's current hearing loss and tinnitus and nexus to his military service. This duty to assist error occurred prior to the AOJ determination on appeal and therefore a remand is appropriate. The matters are therefore REMANDED for the following action: 1. Provide the Veteran's claims file to a clinician to provide an addendum opinion to determine the nature and etiology of the Veteran's current hearing loss and tinnitus. The clinician should review the entire claim file and a copy of this remand. A new examination of the Veteran is only necessary if deemed so by the clinician. The clinician must opine whether it is at least likely as not (a 50 percent or greater probability) that the Veteran's current hearing loss was incurred in service; or is otherwise related to an in-service event, injury or illness; or began within one year of separation from service. The examiner must also opine whether it is at least likely as not (a 50 percent or greater probability) that the Veteran's current tinnitus was incurred in service; or is otherwise related to an in-service event, injury or illness; or began within one year of separation from service. Particular attention is directed to the Veteran's lay statements in his December 2016 NOD, and to December 2016 VA medical records, which indicate that intermittent bilateral ear fullness and ringing symptoms began in 1967. A complete, detailed rationale must be provided for all opinions rendered. If the examiner cannot provide opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kathleen M. Fiorillo, 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.