Citation Nr: 21074204 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-05 633 DATE: December 14, 2021 REMANDED Entitlement to service connection for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from May 1969 to May 1971. This matter comes before the Board of Veterans' Appeals (Board) from a September 2019 decision by VA Regional Office (RO) in New Orleans, Louisiana. The Board remanded this claim in January 2019 and July 2021 for an adequate medical opinion. 1. Entitlement to service connection for right ear hearing loss is remanded. The Veteran contends that his right ear hearing loss is due to service. Specifically, he states that if one ear is service connected, the other should also be service connected. See September 2021 VA 21-4138 Statement in Support of Claim. In the August 2021 VA examination, the examiner opined that the Veteran's right ear hearing loss was less likely than not due to his service. The examiner noted review of a prior October 2019 VA examination and medical opinion that also concluded that the Veteran's right ear hearing loss was less likely than not due to his service. The October 2019 examiner indicated that the Veteran had no significant shift in hearing thresholds from entrance to separation and no complaints or treatment for hearing loss during service. The October 2019 examiner found that although noise exposure is conceded and "the relationship of noise, auditory damage and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise alone". By way of rationale, that examiner stated "[t]here must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology". However, in citing the findings of the October 2019 examination, the August 2021 examiner does not identify another likely cause or why those other etiologies are the more likely explanation of his hearing loss. The examiner also explained that "[t]he first audiogram I have after active duty is from 2019", contrary to the examiner's statement, there is a VA examination from February 2016 demonstrating right ear hearing loss. See VA Hearing Loss and Tinnitus Disability Benefits Questionnaire, submitted February 2, 2016. The Board finds this VA examination and opinion is inadequate for adjudicative purposes. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Here the rationale does not clearly support the conclusion. It relies, in part, on the fact that the Veteran had no complaints in service. This, however, does not alone foreclose a grant of service connection for subsequently demonstrated hearing loss. Evidence of current hearing disability and a medically sound basis for attributing that disability to service may provide a basis for a grant of service connection for hearing loss. Hensley v. Brown, 5 Vet. App. 155 (1993). Moreover, the examiner partially based his opinion on an inaccurate factual premise when he found that the first evidence of right ear hearing loss was in 2019, contrary to the record. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion is only as good and credible as the history on which it was based, and if based on an inaccurate factual premise it has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely") (citing Reonal). As the opinion is inadequate, the Board remands this matter for the issuance of a new addendum VA medical opinion. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician to determine whether the Veteran's current right ear hearing loss is at least as likely as not (50 percent or greater probability) a) had its onset in service; b) otherwise incurred in service to specifically include the conceded in-service noise exposure; or c) manifested to a compensable degree within one year of service. The examiner is also asked to identify the type of hearing loss the Veteran has and the recognized causes of such a loss. The opinion should identify rationale for why one cause might be as likely as or less likely than any of the other causes. (Continued on the next page) The examination report must include a complete rationale for any opinion provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. A. MARSH II Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kelsey Love, 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.