Citation Nr: 21067713 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 17-57 248 DATE: November 5, 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 October 1969 to March 1972. This case is before the Board of Veterans' Appeals (Board) on appeal from a May 2017 Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement to service connection for bilateral hearing loss and tinnitus. The Veteran's notice of disagreement (NOD) was received in September 2017. The RO issued a statement of the case (SOC) in October 2017. The Veteran's VA Form 9, substantive appeal to the Board, was received in November 2017. In September 2020, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of the testimony is associated with the claims file. In April 2021, the Board remanded the case to the RO for further development and adjudicative action. 1. Entitlement to service for bilateral hearing loss. 2. Entitlement to service connection for tinnitus. In April 2021, the Board remanded the claims to obtain a VA medical opinion regarding whether the Veteran's pre-existing right ear hearing loss disability was aggravated (increased in severity) beyond the natural progression of the disability as the result of exposure to acoustic trauma during the Veteran's active duty service, whether the Veteran's left ear hearing loss disability is related to active military service to include any acoustic trauma, and whether the Veteran's tinnitus had its onset in or is otherwise related to active military service to include acoustic trauma. An April 2021 VA examiner provided a negative opinion with respect to these questions. However, the examiner's rationale was based on the incorrect determination that the audiograms conducted in March 1971 were part of the Veteran's separation examination. However, the Veteran underwent a separation examination, which included the results of an audiogram, in February 1972. The examiner did not address or discuss this audiogram and it is unclear that the examiner reviewed this audiogram prior to forming the negative medical opinions. Accordingly, an addendum medical opinion is necessary prior to adjudicating the claims on appeal. The matters are REMANDED for the following action: Obtain a VA medical opinion by an authorized audiologist or ENT with respect to the Veteran's service connection claims for bilateral hearing loss and tinnitus. Only arrange for an examination if deemed necessary by the medical specialist. The claims file, including a copy of this REMAND, must be made available to the medical expert, and the opinion should reflect that the claims file was reviewed. After reviewing the record to include the service treatment records (as well as the audiological evaluations dated in August 1969, March 1971, and February 1972) and VA examinations conducted in April 2017 and April 2021, the medical specialist should offer an opinion as to the following: 1. Whether it is it at least as likely as not that the Veteran's pre-existing right ear hearing loss disability was aggravated (increased in severity) beyond the natural progression of the disability as the result of exposure to acoustic trauma during the Veteran's active duty service. The medical specialist should provide an explanation for all conclusions reached based on the evidence of record and medical principles. The medical specialist is specifically requested to address any shifts in puretone thresholds during active military service and that the Veteran was exposed to jet engine noise daily for one year, with inadequate hearing protection. The medical specialist should also consider and discuss the lay statements of record to include the onset and continuous nature of his hearing loss and that he thought his hearing was normal when he entered active duty service, and he thought the audiometric results from the entrance examination were inaccurate. If lay assertions in any regard are discounted, the medical specialist should clearly so state, and explain why. 2. Whether the Veteran's current left ear hearing loss disorder is at least as likely as not (i.e., a fifty percent or greater probability) etiologically related to active military service to include any acoustic trauma. The medical specialist must provide an explanation for all conclusions reached based on the evidence of record and medical principles. The medical specialist is specifically requested to address any shifts in puretone thresholds during active military service and that the Veteran was exposed to jet engine noise daily with inadequate hearing protection. The medical specialist should also consider and discuss the lay statements of record to include the onset and continuous nature of his hearing of his hearing loss. If lay assertions in any regard are discounted, the medical specialist should clearly so state, and explain why. 3. Whether it is at least as likely as not that the Veteran's tinnitus had its onset in or is otherwise related to active military service to include acoustic trauma. The medical specialist must provide an explanation for all conclusions reached based on the evidence of record and medical principles. The medical specialist is specifically requested to consider and discuss the lay statements of record to include the onset and continuous nature of the Veteran's tinnitus. In providing the requested opinions, the audiologist or ENT should consider the Veteran's reported injury and symptoms in service and thereafter, including the nature of his reported injury and the onset, progression and severity of his reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms, including his belief that the findings from the entrance hearing examination weren't accurate, align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Berry, 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.