Citation Nr: 21066904 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 16-17 406 DATE: November 2, 2021 REMANDED The claim for service connection for bilateral hearing loss is remanded. The claim for service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1960 to March 1964 and from October 1965 to October 1981. The Veteran died in June 2016. The Appellant is the Veteran's surviving spouse and properly substituted in this appeal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The claims for service connection for hearing loss and tinnitus were previously before the Board in October 2018 when they were denied. The Veteran appealed the denial of his claims to the Court of Appeals for Veterans Claims (Court). In May 2020, the Court issued a memorandum decision setting aside the Board's October 2018 decision and remanding the matter for further development and readjudication. In December 2020, the Board also remanded the claims for hearing loss and tinnitus to allow for the procurement of an addendum medical opinion. The case has now returned to the Board for additional appellate action. 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for tinnitus. The Board regrets further delay in this case, but finds that a remand is again necessary to comply with the Court's May 2020 memorandum decision. In its decision, the Court found that a February 2012 VA medical opinion was inadequate for evaluation purposes. The Court also remanded the claims for the Board to seek clarification regarding the relative importance of the Veteran's in-service hearing threshold shift compared to the absence of in-service complaints about his hearing. In accordance with the Court's instructions, the Board remanded the claims in December 2020 to procure an addendum VA medical opinion addressing the etiology of the claimed hearing loss and tinnitus. An opinion was received in July 2021; unfortunately, this opinion is inadequate as it is based on inaccurate facts. Information provided to the examiner from the RO states that the Veteran served on active duty for only five months: from June 1966 to November 1966. This is the time period the Veteran served on active duty in Thailandhis total active military service stretches from 1960 to 1981. The misinformation provided the examiner had a demonstrable impact on the examiner's medical opinion, which found that the Veteran's five month period of active service and noise exposure was not the cause of his current hearing loss and tinnitus. The July 2021 VA addendum medical opinion is facially inadequate, and another remand is therefore required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hearing loss and tinnitus are at least as likely as not related to his in-service noise exposure or had their onset within one year of the Veteran's service discharge. The examiner should specifically address the February 2012 VA medical opinion and clarify why the Veteran's in-service audiogram threshold shift is outweighed by a lack of in-service complaints about hearing. In answering this question the examiner should (i) explain the significance of the Veteran's in-service hearing threshold shift and whether it indicates the Veteran's in-service noise exposure is a cause of his bilateral hearing loss and tinnitus, and (ii) address theories of delayed/latent onset of hearing loss as they pertain to the Veteran's case. The Veteran served on active duty from March 1960 to March 1964 and from October 1965 to October 1981. His military occupational specialty was a jet engine mechanic, and his in-service noise exposure is therefore presumed. Service records contain multiple in-service audiograms dating from April 1960 to the Veteran's retirement examination in August 1981 (some likely utilizing the American Standard Associates (ASA) scale); these audiograms demonstrate a negative threshold shift during active duty, but still show normal hearing for VA purposes. The Veteran also worked as a jet mechanic after service with McDonnell Douglas for approximately 20 years. He contends that his hearing loss and tinnitus began during military service, that he was not provided hearing protection during active duty, but he did utilize hearing protection in his civilian work. The earliest post-service evidence of hearing loss dates from October 2013 when the Veteran was seen for an ears, nose, and throat consultation at the VA Medical Center (VAMC). At that time, he reported experiencing hearing loss and tinnitus and seeing a private audiologist. An October 2013 medical opinion report from the private audiologist identified a relationship between the Veteran's hearing loss and tinnitus and in-service noise exposure that was later worsened by civilian noise exposure. Notably, the private audiologist did not review the Veteran's service records. In April 2014 at the VAMC, the Veteran reported that he experienced the sudden onset of hearing loss in 2003 that was accompanied by constant left ear tinnitus. He never sought treatment for this sudden loss of hearing. This history regarding hearing loss is at odds with the Veteran's other reports that his hearing loss and tinnitus began during active service. K. Conner Veterans Law Judge Board of Veterans' Appeals M. Riley, Attorney for the Board Department of Veterans Affairs 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.