Citation Nr: 21071921 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 15-11 856 DATE: December 1, 2021 REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to service connection for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2003 to April 2004. Evidence affiliated with the claims file also indicates that the Veteran served on active duty from March 2002 to June 2002 and that he served in the Reserve from December 2001 to December 2009. This matter again comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The Veteran testified before the undersigned Veterans Law Judge (VLJ) via a virtual hearing in February 2021; a transcript is of record. The Board previously remanded this matter in April 2021. As noted above, there is evidence associated with the claims file indicating that the Veteran served on active duty both from January 2003 to April 2004 and March 2002 to June 2002 in addition to serving in the Reserve from December 2001 to December 2009. See February 2019 Information Report (labeled Service Record (SR)). There are also military personnel records reflecting that the Veteran continued to serve beyond that time. See January 2010 NCO Evaluation Report (received in an October 2018 DPRIS Response). Even though there are service medical records and service personnel records associated with the claims file revealing the Veteran's education, performance, assignments, points, and awards, the precise dates of all periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) are not available. On remand, the RO should confirm the Veteran's periods of ACDUTRA and INACDUTRA. The Veteran's Reserve service medical records, if outstanding, should also be obtained if available. Furthermore, the Board requests that the Veteran's updated VA and/or private medical records related to his hearing loss, if available, be obtained and associated with the claims file. The Board also acknowledges that the Veteran was examined in September 2021 to determine the nature and etiology of his bilateral hearing loss. However, this examination is inadequate, as the examiner did not determine the most likely etiology of the Veteran's hearing loss. Additionally, although the examiner noted review of an examination from January 2015 which reflected normal hearing, the Board notes that there is no such examination in the claims file; however, the numeric dates corresponding to said examination match the Veteran's in-service examination from December 2001, the time at which he began his Reserve service. As such, the Board finds that the September 2021 opinion is based on an inaccurate factual premise and is therefore inadequate to determine the merits of this claim. See Reonal v. Brown, 5 Vet. App. 458 (1993); Monzingo v. Shinseki, 26 Vet. App. 97 (2012). Moreover, the examiner did not address two very important diagnoses from when the Veteran was serving in the Reserve: eustachian tube dysfunction (diagnosed in September 2003); and otitis media (diagnosed in January 2005). See September 2003 Progress Note; January 2005 VA Nursing Outpatient E&M Note; January 2005 VA Otolaryngology Note; January 2005 Attending Emergency Department Note. As the examiner did not discuss these findings, and thus all relevant, pertinent evidence of record, the September 2021 opinion is inadequate. Finally, as the Board acknowledges the possibility that the Veteran's Reserve medical records, if outstanding and obtained, could reflect changes in the Veteran's hearing during ACDUTRA and/or INACDUTRA, the Board finds that an opinion should be obtained as to whether the Veteran's current bilateral hearing loss is causally related to his Reserve service. Therefore, the Board requests that the RO obtain an adequate opinion as to the nature and etiology of the Veteran's bilateral hearing loss. The matters are REMANDED for the following action: 1. The RO should determine the specific dates of when the Veteran served on ACDUTRA and/or INACDUTRA. In this regard a report detailing the Veteran's award of Reserve retirement points will NOT represent compliance with this instruction. Rather, each and every date of active duty, ACDUTRA, and INACDUTRA must be verified. Then, issue a memorandum for inclusion in the claims file detailing each period of verified active military service, whether on active duty, ACDUTRA, or INACDUTRA. All outstanding medical treatment records associated with the Veteran's Reserve service, if available, should also be obtained and associated with the claims file. 2. The RO should request the Veteran to identify any and all outstanding and/or updated VA and/or private medical records related to his bilateral hearing loss. Appropriate efforts must be made to obtain these records if he has adequately identified them and authorized their release (with respect to any private medical records). He should also be invited to submit these records himself. All actions to obtain the requested records should be fully documented in the claims file. If they cannot be located or no such records exist, the Veteran and his representative should be so notified in writing. 3. After completing the foregoing development, forward the claims file, including a copy of this remand, to an appropriate clinician who has not previously provided an opinion in this case to determine the nature and etiology of the Veteran's bilateral hearing loss. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be obtained. The clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's bilateral hearing loss manifested during, or is the result of, his active duty service, ACDUTRA, and/or INACDUTRA, including as due to the previously conceded in-service noise exposure and/or to Reserve service diagnoses of eustachian tube dysfunction and otitis media. In formulating his or her opinion, the clinician should consider and address the competent medical and lay evidence of record, including, but not limited to: (i) The Veteran's available service treatment records, including any and all in-service audiological examinations, September 2003 Progress Note, January 2005 VA Nursing Outpatient E&M Note, January 2005 VA Otolaryngology Note, January 2005 Attending Emergency Department Note; (ii) The Veteran's VA and private medical records; and (iii) The Veteran's competent and credible lay statements, including September 2016 correspondence and February 2021 hearing testimony, as to the onset and continuity of his symptomatology. If the clinician determines that the Veteran's bilateral hearing loss is less likely than not due to his active duty service, ACDUTRA, and/or INACDUTRA, the clinician should discuss what other factor(s) caused the disorder. In other words, the clinician should ascertain the most likely etiology of the Veteran's bilateral hearing loss. The clinician must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoffman 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.