Citation Nr: 21067272 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 18-32 304 DATE: November 3, 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 in the U.S. Marine Corps from January 1966 to January 1968. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled to appear at a hearing before the Board in October 2021; however, the hearing was cancelled. 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 current hearing loss and tinnitus are a result of inservice noise exposure. He has reported: I was assigned a 3516 MOS which is motor transport. When I got to El Toro Base, California I did not go into the motor pool but was sent to an overhaul shop in an aircraft hangar. The other part of the hangar was aircraft maintenance. People in that department were required to wear hearing protection most of the time in there. My side of the hangar had none and never was told about the noise level in there. When the shop was running an engine in, they were required to wear hearing protection. I was at this duty station for 20 months and was exposed to all levels of noise, from aircrafts coming in and out with their engines on loud, clanking from working on the engines, and the aircrafts taking off on the runway next to my hangar. When I would get off from work my ears were still ringing from the noise when I walked into my house and would subside for after almost 2 hours. The Veteran was provided a VA examination and medical opinion in July 2016. However, the medical opinion rendered did not provide an adequate rationale regarding whether the Veteran's bilateral hearing loss and tinnitus had onset in service or are otherwise related to service. In this regard, the VA audiologist opined that the claimed condition was less likely than not (less than 50 percent probability) caused by or a result of an event in military service. The audiologist's rationale noted that review of the Veteran's service treatment records (STRs) revealed hearing sensitivity thresholds within normal limits bilaterally at entrance and on exit from service. The examiner stated that "no threshold shifts were noted." The Board notes that it is unclear whether the May 1965 (pre-induction), October 1965 (induction), and December 1967 (separation) evaluations used American Standards Association (ASA) units or International Standards Organization-American National Standards Institute (ISO-ANSI) units. There is no indication that the examiner considered the metrics most favorable to the Veteran or acknowledged that different standards might have been used in opining that there was no threshold shift in service. To facilitate data comparison for VA purposes, including under 38 C.F.R. § 3.385, audiometric data originally recorded using ASA standards has been converted to ISO-ANSI standard by the Board. The converted data is included below for the purpose of facilitating review by the examiner. On the authorized audiological evaluation in May 1965, pure tone thresholds (ISO or ANSI units after conversion are in parentheses), in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0(15) 0(10) 0 (10) x (x) 0 (5) LEFT 0 (15) 5(15) 5 (15) x (x) 0 (5) On the authorized audiological evaluation in October 1965, pure tone thresholds (ISO or ANSI units after conversion are in parentheses), in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 (15) 0 (10) 0 (10) x (x) 0 (5) LEFT 0 (15) 0 (10) 5 (15) x (x) 0 (5) On the authorized discharge audiological evaluation in December 1967, pure tone thresholds, in decibels, were as follows: HERTZ (ISO) 500 1000 2000 3000 4000 RIGHT -5 (10) -5 (5) 0 (10) 0 (10) 0 (5) LEFT -5 (10) -5 (5) 0 (10) 0 (10) -5 (0) In addition, the audiologist noted that the Institute of Medicine's (IOM) 2006 report entitled "Noise and Military Service: Implications for Hearing Loss and Tinnitus" does not support the concept of delayed onset noise-induced hearing loss years following exposure to noise. Taking those two pieces of evidence in combination led to the audiologist's conclusion. The reliance on the IOM report addressing military noise exposure and hearing loss is misplaced because the study is ultimately inconclusive as to the onset of hearing loss. See McCray v. Wilkie, 31 Vet. App. 243 (2019). Additionally, the reliance on the absence of abnormalities in hearing sensitivity thresholds in service is misplaced as well, as it is well settled that the absence of a hearing disability in service is not fatal to a claim of entitlement to service connection for hearing loss. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). As such, the examiner's rationale is not adequate, and the Board finds that an addendum opinion is required. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's current bilateral hearing loss and tinnitus is at least as likely as not etiologically related to noise exposure during service. A fully explained rationale is required. In formulating the opinion, the examiner should consider the significance, if any, of any auditory threshold shifts during service, to include between the 1965 and 1967 audiological evaluations. The in-service audiometric data originally recorded using ASA standards has been converted to ISO-ANSI standard by the Board in the above Remand for the purpose of facilitating review by the examiner. Further, if the examiner relies on the IOM study, he or she must provide an explanation as to why the IOM study conclusions apply this particular Veteran, given the contradictory findings within the study. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Mazzucchelli, 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.