Citation Nr: 21071669 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-26 284 DATE: December 1, 2021 REMANDED Entitlement to bilateral hearing loss is remanded. Entitlement to tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from February 1976 to February 1979. These matters come before the Board of Veterans' Appeals (Board) from a March 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans' Law Judge at a Board virtual hearing in August 2021. A transcript of the hearing has been associated with the claims file. Hearing Loss and Tinnitus The Veteran contends that service connection is warranted for his bilateral hearing loss and tinnitus disabilities caused by high levels of noise from artillery. Service personnel records show that the Veteran served as an artilleryman with service in Germany. Service treatment records include an enlistment physical examination in February 1976 with audiometric testing showing normal hearing acuity and no reported hearing loss or ear abnormalities. Although the report of a discharge physical examination in November 1978 showed no results of hearing acuity testing, a copy of an audiogram dated in December 1978 contained handwritten marks suggesting thresholds at 30 and 35 decibels at multiple frequencies in both ears. In September 2015, a VA outpatient primary care clinician referred the Veteran for a hearing examination after he reported hearing loss since active duty. He underwent testing in November 2015, but the examiner found that the results were inconsistent and ordered another test. In February 2016, an audiologist noted only that there were consistent responses "this time" and diagnosed bilateral sensorineural hearing loss normal sloping to moderate. Test results were not place in the record. The audiologist ordered hearing aids. In October 2016, the Veteran was afforded a VA hearing loss and tinnitus examination. However, the audiologist found that a medical opinion could not be provided. The testing for puretone thresholds showed hearing loss that met the VA criteria for disability, but speech discrimination scores were 98 percent bilaterally. The examiner noted, "Pure-tone responses are not considered to represent true auditory thresholds and should not be used for rating purposes." The examiner also noted, "Civilian occupational history is positive for long-time noise exposure." For these reasons, the examiner could not provide an opinion on the etiology of any hearing or tinnitus disorder, and the examiner considered the testing not valid. In August 2021, the Veteran attended a virtual hearing. The Veteran testified that while in-service and stationed in Germany he was a gunner on a 110 Howitzer. See August 2021 Hearing Transcript, p.3. The Veteran discussed his position on the gun crew and the loud noise during firing. He could not wear earplugs since he would not have been able to hear the mission directions. The Veteran further testified that his right ear was injured from gun recoil on his right side, and that his left ear was injured by the noise. He also trained with a rifle and hand grenades in basic training. See August 2021 Hearing Transcript, p.3-4. The Veteran reported that he currently wore hearing aids, and his wife would yell at him to put his hearing aids in, when tired of repeating herself. He stated that he could not communicate, and others thought he was trying to be stupid or close minded when he could not actually hear them. The Veteran stated that the ringing in his ears was constant and all of his regular damage was from shell shock. The Veteran testified that he first noticed his hearing loss of tinnitus when he was deaf while stationed in Germany but thought it was a normal thing to have. However, he did not pay attention to it or get medical attention, since he thought it was a part of the job. The Veteran further noted that hearing loss and tinnitus continued even after he was no longer exposed to noise. The Veteran indicated that he first sought treatment after service in 2010 and received hearing aids two years prior to the hearing. The Veteran also testified that his civilian job after service at a tire shop could not have caused his hearing issues because he had to wear earplugs and safety glasses. See August 2021 Hearing Transcript, p.5-8. The Veteran's spouse testified that she also had been wearing hearing aids since her birth, so she knew it was something wrong with his hearing when he would ask her what was being said on television. She further testified that the Veteran's hearing was much better when he began having treatment. The Veteran further noted that hearing loss and tinnitus continued even after he was no longer exposed to noise. The Board finds that additional VA outpatient treatment records must be obtained as the Veteran reported on-going VA treatment that included testing and issuance of hearing aids. A new VA examination and opinion is warranted for adequate hearing loss measurements and to fully address the Veteran's claims for entitlement to service connection for hearing loss and tinnitus as to direct and presumptive service connection. The matters are REMANDED for the following action: 1. Request all records of VA outpatient treatment since January 2016 to include the results of audiometric testing conducted at a VA clinic and reported in February 2016 record. Associate any records received with the claims file. 2. Schedule the Veteran for a VA audiometric examination to determine the severity of hearing loss. Obtain a new opinion from an appropriate clinician regarding the Veteran's bilateral hearing loss tinnitus and whether: (a.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's current bilateral hearing loss and tinnitus was caused by an in-service injury, event, or disease, including in-service noise exposure? (b.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's bilateral hearing loss and tinnitus (1) began during active service, (2) manifested within the applicable presumptive period after discharge from service, or (3) was noted during service with continuity of the same symptomology since service? Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The Board notes the Veteran served as a gunner in-service; therefore, hazardous noise exposure has been conceded. Attention is invited to the VA examination in October 2016 noting that the Veteran's bilateral hearing loss and tinnitus. The examiner noted a medical opinion could not be provided without speculation because the test results were inconsistent and invalid. In addition, attention is invited to the Veteran's lay statements, the service treatment records that included the handwritten audiometric test in December 1978, and August 2021 testimony noting a worsening of his bilateral hearing loss and tinnitus that worsened over time since service. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Long-Ellis, 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.