Citation Nr: 21070925 Decision Date: 11/27/21 Archive Date: 11/27/21 DOCKET NO. 15-31 409 DATE: November 27, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1961 to September 1964. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2018, the Veteran testified at a videoconference hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. By way of background, the Board initially denied the Veteran's claim of entitlement to service connection for bilateral hearing loss in January 2019. See January 2019 BVA Decision. The Veteran appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court), and in December 2019, the Court granted the parties' Joint Motion for Remand (JMR), which vacated the Board's January 2019 decision and remanded the matter for additional development and readjudication. See December 2019 CAVC Decision. This matter was also before the Board in April 2020, September 2020, and July 2021 when it was remanded for additional development. See April 2020 BVA Decision; September 2020 BVA Decision; July 2021 BVA Decision. Entitlement to service connection for bilateral hearing loss is remanded. In July 2021, the Board remanded the Veteran's claim to obtain an advisory opinion from an independent medical expert to determine the nature and etiology of the Veteran's diagnosed bilateral hearing loss. Specifically, the Board indicated that the Agency of Original Jurisdiction (AOJ) must follow its established procedures for requesting an advisory opinion furnished by a medical school, university, or clinic, pursuant to 38 U.S.C. § 5109. In this regard, the Board asked the examiner to proffer an opinion as to whether the Veteran's bilateral hearing loss was causally or etiologically related to his service, to include as due to loud noise exposure and to his military occupational specialty (MOS) as a Boiler Repairman. In addition, the Board stated that if the examiner relied, to any extent, on the 2005/2006 IOM study, they had to identify the medical text's qualifying or contradictory aspects and explain why the contradictory aspects or conclusions in the IOM study were less persuasive as to the question of whether it was at least as likely as not that the Veteran's delayed onset hearing loss was etiologically related to any in-service noise exposure. In addition, the Board asked the expert to specifically address the May 2015 article cited by the Veteran's representative, Aging after Noise Exposure: Acceleration of Cochlear Synaptopathy in "Recovered" Ears, which indicates that initially reversible noise damage can have dramatic long-term consequences in amplifying age-related sensorineural hearing loss and that a single synaptopathic exposure has effects on the aging ear which continue long after the damaging noise has stopped. See July 2021 BVA Decision. After a review of the evidence of record, the Board notes that the Veteran underwent a VA contract examination in September 2021, and the VA contract examiner provided a medical opinion in connection with the examination. See September 2021 C&P examination. The Board further notes that, in the November 2021 appellate brief, the Veteran's representative cited an August 2020 military hearing loss study from the University of Cambridge, titled Diagnosis and quantification of military noise-induced hearing loss, which found that the diagnosis and quantification of noise-induced hearing loss in a medico-legal context were usually based on the pattern of hearing loss that is typically associated with long-term exposure to steady broadband noises. However, the study also found that that pattern was not typical for hearing loss produced by intense impulsive sounds of the type that military personnel are exposed to. See November 2021 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief). The Board notes that none of the medical opinions of record have considered the article cited by the Veteran's representative. Thus, the Board finds that the examiner should consider the article cited by the Veteran's representative on remand. The matter is REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran's VA treatment facilities, and all private treatment records from the Veteran not already associated with the file. 2. After completion of the above development, obtain an opinion regarding the nature and etiology of the Veteran's diagnosed bilateral hearing loss. The examiner should provide the following opinion: The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the bilateral hearing loss is causally or etiologically related to his service, to include as due to loud noise exposure and to his military occupational specialty (MOS) as a Boiler Repairman. If relying to any extent upon the 2005/2006 IOM study, the examiner must (a) identify the medical text's qualifying or contradictory aspects (i.e. there is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure); and (b) explain why the contradictory aspects or conclusions in the IOM study are less persuasive as to the question of whether it is at least as likely as not that the Veteran's delayed onset hearing loss is etiologically related to any in-service noise exposure, to include as due to his MOS as a boiler repairman. The examiner should also specifically address the May 2015 article cited by the Veteran's representative, Aging after Noise Exposure: Acceleration of Cochlear Synaptopathy in "Recovered" Ears, which indicates that initially reversible noise damage can have dramatic long-term consequences in amplifying age-related sensorineural hearing loss and that a single synaptopathic exposure has effects on the aging ear which continue long after the damaging noise has stopped, as well as the August 2020 military hearing loss study from the University of Cambridge, titled Diagnosis and quantification of military noise-induced hearing loss, which found that the diagnosis and quantification of noise-induced hearing loss in a medico-legal context were usually based on the pattern of hearing loss that is typically associated with long-term exposure to steady broadband noises but that that pattern is not typical for hearing loss produced by intense impulsive sounds of the type that military personnel are exposed to. If the examiner relies upon treatise or medical literature for support, citations to such must also be provided. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The examiner should review pertinent documents in the Veteran's claims file in connection with the examination, including this Remand. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, Associate 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.