Citation Nr: 21072169 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-24 827 DATE: December 2, 2021 REMANDED Entitlement to service connection for a vestibular schwannoma is remanded. Entitlement to service connection for left ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1980 to June 1984. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran and a witness testified at a hearing before the undersigned Veterans Law Judge (VLJ) in August 2021. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for a vestibular schwannoma is remanded. 2. Entitlement to service connection for left ear hearing loss is remanded. The Veteran claims entitlement to service connection for a vestibular schwannoma and left ear hearing loss which she claims began during active duty. The Veteran's vestibular schwannoma was diagnosed in May 2013 and was resected in July 2013. A January 2015 letter from Dr. J.O., the Veteran's neurosurgeon, indicates that the tumor measured 31mm x 28 mm x 21 mm on a May 2013 MRI and that the "natural history" of these types of tumors is that they grow 1-2 mm per year. The Veteran submitted an article in January 2015 indicating that one of the first symptoms of a vestibular schwannoma is unilateral hearing loss, often accompanied by ringing in that ear. A July 2013 medical record indicates that the Veteran reported "at least" 5 years of decreased hearing and tinnitus and tinnitus in the left ear. A June 2011 VA treatment record indicates that she noticed hearing loss in both her left and right ear during active duty since being around airplanes and noticed that she had asymmetric hearing loss about 9 or 10 years before, or in approximately 2001. The Veteran also testified that she noticed hearing loss during service, in addition to dizziness, a dry eye, facial numbness, and weakness. The Veteran also testified that she was unable to obtain a nexus letter from her physician because he did a lot of surgeries for the VA. The Veteran has not undergone a VA examination for her vestibular schwannoma. The Board finds that the Veteran's reports of symptoms during service, combined with the January 2015 letter from Dr. J.O. indicate that her vestibular schwannoma may be related to her military service, and therefore a VA exam is required before this matter can be adjudicated. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Veteran has also alleged that she was exposed to radiation from aircraft radar equipment. She believes that her vestibular schwannoma is related to the alleged radiation exposure. In cases where a veteran claims that exposure to radiation during service caused a disease which did not manifest during an applicable presumptive period, "an assessment will be made as to the size and nature of the radiation dose or doses." 38 C.F.R. § 3.311(a)(1). In this case, vestibular schwannoma is not specifically enumerated as a radiogenic disease in 38 C.F.R. § 3.311(b)(2). Therefore, no presumptive period applies, and VA must obtain an assessment as to the size and nature of any in-service radiation exposure to the Veteran from the Under Secretary for Health. 38 C.F.R. § 3.311(a)(2)(iii). Regarding the Veteran's left ear hearing loss, the Veteran reports that she was exposed to loud noises during service, and that her hearing loss began during service. The Veteran has undergone two VA examinations for hearing loss. Unfortunately, although the Veteran is service connected for hearing for right ear hearing loss and tinnitus, no VA examiner has offered a nexus opinion regarding the Veteran's left ear hearing loss. Therefore, a VA examination is necessary regarding the Veteran's left ear hearing loss before this matter can be adjudicated. The matters are REMANDED for the following action: 1. Obtain any additional records that may contain information pertaining to the Veteran's radiation exposure during service. Thereafter, refer the claims file to the Under Secretary for Health for a radiation dose assessment pursuant to 38 C.F.R. § 3.311. Document all development with respect to this directive in the claims file. 2. Schedule the Veteran for a VA examination for her left ear hearing loss. The examiner must review the claims file. The examiner is asked to provide a response to the following: a) Is the Veteran's left ear hearing loss at least as likely as not related to service, including noise exposure during service? Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran's description of her in-service reports of noise exposure and hearing loss symptoms as well as her post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported noise exposure and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? b) Is it at least as likely as not that the Veteran's left ear hearing loss (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? 3. Schedule the Veteran for a VA examination for her vestibular schwannoma. The examiner must review the claims file. The examiner is asked to provide a response to the following: a) Is the Veteran's left vestibular schwannoma at least as likely as not related to service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of her in-service hearing loss, dizziness, a dry eye, facial numbness, and weakness as well as her post-service symptoms. The examiner should also address the Veteran's post-service medical records, including the January 2015 letter from Dr. J.O. and the article submitted by the Veteran in January 2015. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Boal, 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.