Citation Nr: 21070141 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 19-21 363 DATE: November 23, 2021 REMANDED Entitlement to service connection for bilateral hearing loss disability is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran had active military service from January 1965 to January 1968. In September 2021, the Veteran testified in support of these claims during a hearing at the local Regional Office (RO) before the undersigned Veterans Law Judge of the Board (Travel Board hearing). A transcript of the proceeding is of record. During the hearing, the Veteran was granted an additional 60 days to submit more evidence and/or argument in support of his claims, which he did. And, based on this additional evidence, the Board is further developing these claims, so remanding them back to the RO (Agency of Original Jurisdiction (AOJ)). 1. Entitlement to service connection for bilateral hearing loss disability is remanded. The claims file includes a January 2018 Disability Benefits Questionnaire (DBQ) opinion by the examiner that it is less likely than not the Veteran's hearing loss is related to his military service because there was not a significant change in his hearing acuity during his service. However, the claims file now includes a September 2021 opinion of Dr. J. R. (Northwest Audiology) indicating that, after reviewing the results of audiology testing in 2021 and the Veteran's history of noise exposure from 1965 (i.e., during his time in the military), it is highly like that his current hearing loss is a direct result of that loud noise exposure in 1965. But this opinion lacks significant probative value upon which to base a grant of service connection since this examiner failed to acknowledge or reconcile the Veteran's 1967 audiology report from his service noting his hearing was within normal limits. This examiner also failed to acknowledge or reconcile the Veteran's post-service noise exposure (a 2017 record indicates that, in addition to in-service noise exposure, he had additional exposure to equipment noise at his civilian job, a March 2007 private record reflecting that he worked with some type of floor waxing machine that reasonably can be expected to be noisy, and the 2018 DBQ explaining that the Veteran had worked in a shipyard for a few years after service, which also can reasonably be expected to have exposed him to noise). The Veteran's October 1967 Report of Medical Examination for separation purposes reflects normal hearing acuity upon audiology testing. He also denied hearing loss on his corresponding Report of Medical History. An October 2017 private audiology record reflects that the Veteran had been seen at Northwest Audiology in April 1998 when mild hearing loss was observed bilaterally. Records from April 1998 are not associated with the claims file but may be useful in adjudicating his claim. In providing a supplemental opinion, it may be helpful for the examiner to discuss whether there are human longitudinal studies of delayed-onset hearing loss, and if so, whether it supports the Veteran's assertion of current hearing loss due to service. 2. Entitlement to service connection for tinnitus also is remanded. As already noted, the Veteran separated from service in 1967. He alleges that, while in service, he had tinnitus after noise exposure, but that it went away "in a day or so". However, he alleges steady tinnitus started in 1980-1983 in one ear and then later in both. That would be more than a decade after his separation from service. The January 2018 VA examiner concluded that it is less likely than not the Veteran's current tinnitus is related to his service because it did not begin until after his service. The September 2021 clinician who since has additionally commented on the origins of the Veteran's tinnitus opined that it is the Veteran's claimed symptoms (pain and tinnitus) in service at the time of noise exposure that indicate permanent damage to his ear; and thus, his current tinnitus is related to his service. However, this examiner did not adequately discuss or reconcile the fact that the Veteran's symptoms went away in service and did not return until more than a decade later and only after post-service noise exposure. Thus, supplemental medical comment is needed before deciding the appeal of this claim. This claim of entitlement to service connection for tinnitus also is inextricably intertwined with the claim of entitlement to service connection for bilateral hearing loss partly since both claims are predicated on noise exposure during the Veteran's service as opposed to during the many years since his discharge. Accordingly, these claims are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Northwest Audiology (Ellensburg, WA) for all clinical records from April 22, 1998 and earlier. If he provides this necessary authorization, obtain these additional records. Document all requests for these records, as well as all responses, in the claims file and appropriately notify him and his representative if unable to obtain these additional records. 2. Thereafter, obtain a supplemental opinion to the January 2018 DBQ. The examiner is asked to provide more rationale for the opinion that it is less likely than not the Veteran's current hearing loss disability and tinnitus are related to his service. The examiner is asked to specifically consider: a) the Veteran's October 1967 Report of Medical History when he denied hearing loss; b) his October 1967 Report of Medical Examination audiology results; c) his current report of temporary tinnitus (lasting approximately a day) having initially occurred in service after noise exposure; d) his current report of the onset of steady tinnitus in approximately 1980-1983 for one ear and later in the other ear; and e) his post-service occupational exposure to noise as a civilian (e.g., working in a shipyard for a few years, operating floor waxing machinery). In providing this supplemental opinion, it may be helpful for the examiner to also discuss whether there are human longitudinal studies of "delayed-onset" hearing loss and, if there as, whether it supports the Veteran's assertion of his current hearing loss being due to his service. If upon further review of the file, the examiner changes the opinions from 2018 (i.e., finds that the Veteran's disabilities are as likely as not related to his service), this must be expressly stated, and adequate rationale provided. When responding, regardless of whether favorably or instead unfavorably, it is essential the examiner provide rationale preferably citing to evidence in the file supporting conclusions and/or citing to accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Wishard 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.