Citation Nr: 21073641 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 16-18 316 DATE: December 9, 2021 REMANDED Entitlement to service connection bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from November 1965 to February 1969. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision from Department of Veterans Affairs (VA) Regional Office (RO). This issue was recently before the Board in July 2021, at which time it was remanded for additional evidentiary development. Specifically, the Board sought to obtain an addendum opinion regarding whether the Veteran's hearing loss was either caused or aggravated by service. The case has now been returned to the Board for appellate consideration. For the following reasons, the Board finds that additional remand is required for further consideration. As was previously noted by the Board in June 2021, the Veteran's representative asserted that any preexisting hearing loss the Veteran may have had prior to service was plausibly aggravated as a result of military noise exposure. In the September 2021 VA addendum opinion, the examiner provided negative nexus opinions based on the objective medical information documented in the service treatment records. The examiner conceded in-service noise exposure and acknowledged that the Veteran did participate in a hearing conservation program in June 1967. The negative nexus opinion appears to be based, in part, on the fact that there was no objective evidence of any treatment, complaints, or manifestations of hearing loss either during service or shortly thereafter. However, it appears that the examiner did not discuss the Veteran's lay statements regarding onset and progression. Accordingly, the Board finds that remand is warranted for adequate consideration of the lay evidence of record. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an otolaryngologist or other similarly qualified examiner to determine the nature and etiology of the Veteran's bilateral hearing loss. The record must be made available to the examiner for review, including a copy of this remand, and the examiner should indicate that the record was reviewed in connection with the examination. The examiner should elicit a detailed history from the Veteran regarding onset and progression of his hearing loss. Based on review of the record and examination of the Veteran, the examiner should address: (a.) Whether a bilateral hearing loss disability clearly and unmistakably (obvious, manifest, undebatable) existed prior to the Veteran's period of active service. (b.) If the examiner determines that there is clear and unmistakable evidence that the Veteran's bilateral hearing loss preexisted active duty service, is there clear and unmistakable evidence that the preexisting bilateral hearing loss was NOT aggravated in service beyond the natural progression of such disorder during such service. (c.) If there is no clear and unmistakable evidence that the Veteran had bilateral hearing loss that preexisted active duty service and was not aggravated in active duty service, then opine as to whether it is at least as likely as not (50 percent or greater probability) that bilateral hearing loss manifested during active duty service, that sensorineural hearing loss was manifest to a compensable degree within one year of active duty service, or that it is otherwise causally or etiologically related to a period of active duty service. In rendering the opinions, the examiner must consider and discuss the statements of the Veteran regarding onset and continuity of the symptoms of his bilateral hearing loss. The examiner must consider and discuss the objective medical evidence, including but not limited to: VA has conceded the Veteran's exposure to hazardous noise during service. The October 1965 enlistment examination report. August 9, 1966: Veteran was put on physical profile for high frequency hearing loss. The January 1969 separation examination report. February 1970: treatment medical record documents "mild hearing decrease" in the right ear. The examiner must consider and discuss the medical research cited by the Veteran's representative, including the study from the University of Cambridge, research from the Columbia University Irving Medical Center, the National Institute of Health, National Institute on Deafness and Other Communication Disorders (NIDCD), and the Journal of Neuroscience. See June 2021 and November 2021 Appellate Briefs. The examiner should note that the absence of an in-service hearing loss disability is not fatal to the claim. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and medically sound basis for attributing that disability to service may serve as a basis for the grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meet the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The examiner should provide a complete rationale for all opinions expressed and conclusions reached, including a discussion of the facts and medical principles involve. The examiner is advised that a negative opinion cannot be based solely on a lack of documentation of a chronic disability or continuous treatment. T. Berry Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Orie, 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.