Citation Nr: 21066572 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 18-07 136 DATE: November 1, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1988 to January 1992. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision. In October 2021, the Veteran testified at a videoconference Board hearing before the undersigned Veterans Law Judge. 1. Entitlement to service connection for bilateral hearing loss is remanded. 2. Entitlement to service connection for tinnitus is remanded. The Veteran contends that his bilateral hearing loss and tinnitus are the result of in-service hazardous noise exposure from tank engine and weapon fire while serving in Operation Desert Storm. During the October 2021 Board hearing, the Veteran testified that he served on board a M1 tank and participated in numerous live fire while deployed during the Gulf war for 7 months. In July 2016, the Veteran was afforded a VA examination for hearing loss and tinnitus. The examiner indicated that the Veteran's bilateral hearing loss was not at least as likely as not caused by or the result of an event in military service. The rationale provided was that all military audiograms from enlistment to separation showed normal hearing, and there were no significant threshold shifts at any frequency during the service. This reasoning, alone, is not a sufficient rationale for a negative opinion. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). As a result of the inadequate rationale for the expressed opinion, the Board finds that an addendum opinion is required to address the nature and etiology of the Veteran's bilateral hearing loss disability. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Hence, on remand, the Veteran must be afforded another VA examination to determine the etiology of his present bilateral hearing loss, taking into account his statements about noise exposure, onset of symptoms, the record evidence, and accepted medical principles. As to tinnitus, the examiner indicated that it is likely that the tinnitus has the same etiology as the high frequency hearing loss and thus is less than likely related to military noise exposure. As the issue of entitlement to service connection for the Veteran's tinnitus is inextricably intertwined with his claim for service connection for bilateral hearing loss, the Board will remand this issue for Agency of Original Jurisdiction (AOJ) consideration and issuance of a supplemental statement of the case if any claim remains denied. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (finding two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA examination to determine the etiology of his present bilateral hearing loss. The electronic claims file and a copy of this Remand must be made available to and be reviewed by the examiner in conjunction with the examination. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements; the examiner must indicate on the examination report that such review was undertaken. The audiometry examination must include a speech recognition test using the Maryland CNC wordlist and a pure tone audiometry test. Any and all studies, tests, and evaluations deemed necessary by the examiner should also be performed. The examiner must obtain a full history from the Veteran. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology and in-service noise exposure. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner must provide a fully reasoned explanation. The examiner must provide an opinion on whether it is at least as likely as not (50 percent or greater probability) that the Veteran's present bilateral hearing loss disability was caused or aggravated by his active service, including noise exposure therein. In so doing, the examiner should discuss medically known or theoretical causes of hearing loss and describe how hearing loss that results from noise exposure generally presents or develops in most cases, in determining the likelihood that current hearing loss was caused by noise exposure in service as opposed to some other cause. A thorough explanation for any opinion must be provided. The examiner should note that the absence of evidence of a hearing loss disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. In rendering the opinion, the examiner should not resort to mere speculation, but rather should consider that the phrase "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. 2. After completing the above action and any other development as may be indicated by any response received as a consequence of the action taken in the paragraph above, the claims must be readjudicated. If the claims remain denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. J. In, 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.