Citation Nr: 21071090 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 17-18 306 DATE: November 29, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the U.S. Air Force from March 1971 until March 1975. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The matter was previously remanded by the Board in January 2019 and August 2021. 1. Entitlement to service connection for bilateral hearing loss is remanded. Unfortunately, remand is again required to obtain an adequate medical examination that address the lay testimony and all theories of entitlement. See McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016) ("the VA examiner's failure to consider [a veteran's] testimony when formulating her opinion renders that opinion inadequate."). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). The Veteran asserts that he sustained acoustic trauma in service due to noise exposure on an airbase flight line from jet engines. See May 2015 statement. He reported that he would experience ear pain and ringing after the exposure, and the long-term effect was progressive hearing loss. He said the sound was so loud his teeth rattled, and he was not given hearing protection in service. He also reported post-service occupational noise exposure as a forester, but he regularly used hearing protection. In his December 2015 notice of disagreement, he wrote that although hearing loss had not manifested at the time of separation from service, the in-service exposure affected his hearing later in life. Essentially, the Veteran asserts that the in-service noise exposure caused a delayed onset hearing loss disability. VA obtained a medical examination and opinion in October 2019 with a September 2021 addendum. The October 2019 examiner opined that right ear hearing loss existed prior to service and was not aggravated beyond its normal progression. The examiner explained that the enlistment examination showed a mild, preexisting hearing loss at 4000 Hertz in the right ear. A January 1973 audiogram indicated normal hearing thresholds, and the Veteran's hearing was normal at the February 1975 separation exam. The examiner stated there was no significant decrease in hearing thresholds, defined as a decrease of greater than 10 dB, from enlistment to discharge; however, the examiner did note there was a mild hearing loss disability at 6000 Hertz at separation. The examiner noted the Veteran had post-service occupational noise exposure but did not address the Veteran's report of wearing hearing protection in his civilian career as opposed to not using hearing protection in service. Thus, the examiner concluded the current right loss hearing disability was not related to the military noise exposure. For the left ear, the examiner did not find a preexisting hearing loss disability but reached the same conclusion that the current left ear hearing loss disability was not etiologically related to the in-service exposure to hazardous noise. The examiner again explained that there were no significant threshold shifts from entrance to separation, and the Veteran's left ear hearing was normal during his period of active duty. In the September 2021 addendum, the examiner stated that they did not refute the Veteran's testimony regarding hearing protection and taking it into account, the October 2019 opinion was unchanged. The examination report and opinion did not contain discussion of the Veteran's previously reported in-service ear symptoms of ear pain and ringing which renders the examiner's conclusion the Veteran did not sustain acoustic trauma in service inadequate. The examiner also failed to address the contention that the Veteran experienced a delayed onset hearing loss that is nevertheless due to the in-service acoustic trauma. On remand, the examiner is requested to comment on the severity of the exposure as described by the Veteran (sounds so loud his teeth rattled), the competent and credible testimony of in-service symptoms of ear pain and ringing after exposure to hazardous noise, and the theory of entitlement based on delayed onset hearing loss despite the absence of a hearing loss disability in service. Remand is also necessary to attempt to obtain outstanding and relevant private treatment records. The Veteran submitted an April 2014 private audiology evaluation, however no other records from that facility are in the claims file. On remand VA should undertake reasonable efforts to obtain the outstanding private records. 38 C.F.R. § 3.159(c)(1). The matters are REMANDED for the following action: 1. Contact the Veteran and request the necessary authorization to obtain medical records from Sanford Bemidji Medical Center or audiologist LS., or any other relevant private medical facility. After securing the proper authorizations, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file. If, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 2. After any additional records are associated with the claims file, obtain an addendum opinion regarding the etiology of the bilateral hearing loss from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that a hearing loss disability is caused or aggravated by conceded in-service exposure to hazardous noise. (b.) The examiner is requested to comment on the severity of the exposure as described by the Veteran (sounds so loud his teeth rattled), the competent testimony of in-service symptoms of ear pain and ringing after exposure to hazardous noise, the lay testimony regarding hearing protection, and the theory of entitlement based on delayed onset hearing loss despite the absence of a hearing loss disability in service. (c.) The examiner is remined that service connection for tinnitus is in effect and it is legally conceded that tinnitus was incurred in service. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Smith, 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.