Citation Nr: 21076522 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 18-00 356A DATE: December 27, 2021 REMANDED Entitlement to service connection for coronary artery disease (CAD), to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for prostate cancer residuals, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1965 to August 1969. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran testified at a hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. The undersigned agreed to keep the record open for 30 days to allow the Veteran additional time to submit nexus evidence to support his claims. See July 2021 Hearing Transcript, pages 24, 28. Additional evidence, including a private medical opinion, was received in August 2021. See August 2021 Medical Treatment Record Non-Government Facility. 1. Entitlement to service connection for CAD, to include as due to herbicide agent exposure, is remanded. 2. Entitlement to service connection for prostate cancer residuals, to include as due to herbicide agent exposure, is remanded. The Board finds that the Veteran's SPRs appear to be incomplete. In this regard, the Veteran reported that he was temporarily transferred to Japan for two 90 day tours of duty while he was assigned to Fleet Tactical Support Squadron 21 in Hawaii. To this end, he indicated that the plane transporting him to and from Japan landed in multiple locations, to include stops in the Republic of Vietnam, Guam, and the Philippines; notably, he testified that he deplaned in Da Nang for approximately six to eight hours per trip to help unload and reload his aircraft. See July 2021 Hearing Transcript, pages 10-13, 25-26; December 2016 VA Form 21-4138 Statement in Support of Claim; April 2017 Correspondence. In this regard, the Board notes that the Veteran submitted additional SPRs in April 2017, which were not included in the packet initially obtained by the RO. Specifically, the Veteran submitted orders dated in July 1967 and December 1967, which show that he was ordered to report to Atsugi, Japan via squadron aircraft for temporary additional duty in connection with maintenance support for periods of 90 days. See April 2017 Military Personnel Record. However, as these records were not included in any of the packets of SPRs obtained by the RO, additional development is required. 38 C.F.R. § 3.159(c). Based on the foregoing, the Board finds that a remand is required to obtain a complete copy of the Veteran's SPRs, to include all records reflecting the Veteran's duties, units, and assignments. 3. Entitlement to service connection for bilateral hearing loss is remanded. 4. Entitlement to service connection for recurrent tinnitus is remanded. The Veteran states that he had in-service traumatic noise exposure due to his military occupational specialty (MOS) as an aviation structural mechanic, which is supported by his DD-214. Specifically, the Veteran reported that his diagnosed bilateral hearing loss and tinnitus were caused by exposure to noise from airplane exhausts, jet engines, popping arresting cables, and support equipment. In this regard, the Veteran indicated that his duties included maintaining and servicing C-118 aircraft before and after flights and stated that he performed run-up testing, taxiing, and occasionally "stood fire" in proximity to aircraft exhausts without hearing protection. He also indicated that he was exposed to noise from firearms during basic training without hearing protection. In addition, the Veteran acknowledged that he was eventually issued and wore ear plugs during service but explained that they were insufficient to block out the noise. He also acknowledged that he later received earmuffs toward the end of his service. See July 2021 Hearing Transcript, pages 2-10; January 2021 Correspondence; December 2016 VA Form 21-4138 Statement in Support of Claim; September 1969 Certificate of Release or Discharge from Active Duty (e.g., DD 214, NOAA 56-16, PHS 1867). In support of his claim, the Veteran submitted a November 2019 article published in the Journal of the Acoustical Society of America, titled Noise of Military Weapons, Ground Vehicles, Planes and Ships. The article states that noisy equipment and processes are found throughout military operations and expose service members to potential hearing damage. The Veteran also submitted a field study on noise level from the Malaysian Journal of Public Health Medicine, titled Noise Exposure Among Maintenance Crews of C130H Aircraft Lead to the Hearing Impairment, dated in 2017. See August 2021 Correspondence. A July 1969 release from active duty report of medical examination notes the Veteran's ears and drums to be normal. The examiner performed a whispered speech test, which measured 15/15 bilaterally, but the audio section of the examination was left blank. The Board further notes that the RO has conceded in-service acoustic trauma based on the Veteran's MOS as an aviation structural mechanic. See December 2017 SOC. A review of the post-service treatment records shows that the Veteran underwent a private audiological evaluation in January 2013, which revealed the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 35 25 40 65 65 Left 35 25 45 65 65 Speech recognition scores were 100 percent for the right ear and 88 percent for the left ear, however, the private audiologist also indicated that speech recognition testing had been conducted using the NU-6 monosyllabic word list rather than the Maryland CNC word list. See December 2016 Medical Treatment Record Non-Government Facility. In support of his claim, the Veteran submitted a letter from a clinical audiologist, Dr. Anna Ellis, dated in February 2016. Dr. Ellis noted that she had been helping the Veteran with his hearing since January 2013 and indicated that he had bilateral mild to moderate sensorineural hearing loss and intermittent tinnitus. See December 2016 Medical Treatment Record Non-Government Facility. A private audiogram dated in August 2016 revealed the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 40 30 45 65 60 Left 40 25 45 65 55 Speech recognition scores were 100 percent for the right ear and 96 percent for the left ear, however, it is unclear whether speech recognition testing was conducted using the Maryland CNC word list. See December 2016 Medical Treatment Record Non-Government Facility. The Veteran initially underwent a VA examination for hearing loss and tinnitus in March 2017. During the examination, the Veteran reported that he performed "start-up's" on prop aircraft and worked 100 yards away from jet aircraft during service. He further stated that he was exposed to noise from auxiliary power units and tested and repaired ground support equipment next to the jet engine shop. In addition, the Veteran reported that he maintained prop engines while he was stationed in Japan and indicated that he worked underneath arresting cables and slept underneath the catapult while he was stationed aboard the USS Constellation. The Veteran also acknowledged that he worked at a lawn mower shop performing repairs and as a service station mechanic at a gas station after he was discharged from active duty service but denied associated occupational noise exposure in either position. However, he also noted that he worked in a sheet metal industry in the field and shop installing equipment without ear protection and described the occupation as noisy. On audiometric examination, the examiner noted the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 30 20 35 65 55 Left 25 20 40 65 60 Speech recognition scores were 96 percent bilaterally. Following the examination, the examiner diagnosed the Veteran with bilateral sensorineural hearing loss in the frequency range of 500 Hz to 4,000 Hz. After performing and examination and reviewing the evidence of record, the examiner indicated that they could not proffer a medical opinion regarding the etiology of the Veteran's bilateral hearing loss without resorting to speculation. In this regard, the examiner further noted that whispered voice tests were used to measure the Veteran's hearing but indicated that such evidence could not be considered as reliable evidence of whether hearing loss did or did not occur. The examiner further noted that there was no documentation of calibrated audiometry in the Veteran's STRs. Thus, the examiner opined that, given the Veteran's reported history of significant noise exposure during and after service, it was not possible to determine if his hearing loss was a result of military noise exposure without resorting to mere speculation. The March 2017 VA examiner also diagnosed the Veteran with recurrent tinnitus. During the examination, the Veteran reported that he had been experiencing tinnitus for "quite awhile[,]" and indicated that he was unaware of anything triggering the onset of his symptoms. After performing an examination and reviewing the evidence of record, the examiner reported that she could not proffer an opinion regarding the etiology of the Veteran's tinnitus without resorting to speculation. In this regard, the examiner reported that there was no documentation of tinnitus in the Veteran's STRs. As such, the examiner found that, given the Veteran's reported history of significant noise exposure during and after service, it was not possible to determine if his diagnosed tinnitus was the result of military noise exposure without resorting to mere speculation. See March 2017 C&P examination. In support of his claim, the Veteran submitted a private audiological evaluation report and medical opinion from Dr. Marvin Lewis, dated in April 2021. During the evaluation, the Veteran reported that he was exposed to noise from weapons, to include firearms, during basic training. He also reported that he was exposed to hazardous noise from the following sources: propeller engines at a distance of approximately two feet for 20 to 30 minutes at least once per day; turboprop engines at a distance of approximately five feet for 1 to 20 minutes per day; Auxiliary Power Unit (APU) small turbo jets at a distance of approximately five feet for 5 to 30 minutes bimonthly; and aircraft "catch" cables located on the deck above for 20 seconds approximately thirty times per day during service. He also endorsed bilateral tinnitus and reported that he was not provided with hearing protection devices during service. The Veteran further reported that he had been approved and fitted for hearing aids by VA, which Dr. Lewis indicated implied that VA recognized that the Veteran's hearing loss was caused during his military service. An audiogram obtained in connection with the evaluation noted the following audiometric testing results: HERTZ 500 1000 2000 3000 4000 Right 35 35 50 60 60 Left 35 35 50 60 60 After performing the audiological evaluation, Dr. Lewis opined that it was highly likely that the Veteran's hearing loss was caused by his repeated and prolonged exposure to dangerous noise levels without the benefit of hearing protection. In support of his opinion, Dr. Lewis referenced an article published in Military Medical Research, titled Impact of Noise on Hearing in the Military, which indicated that pilots were at risk for exposure to dangerous sound levels and experienced hearing loss as a result of the exposure. In this regard, Dr. Lewis noted that the pilots mentioned in the article were in the cockpit area, approximately 18 feet away from plane engines and wearing communication headphones, which would help to decrease engine noise. To this end, Dr. Lewis explained that, if the engines were loud enough to cause hearing loss at that distance, then they could certainly cause hearing loss in an individual that was two to five feet away without hearing protection or headphones. Dr. Lewis also cited an article published in the Journal of the Acoustical Society of America, titled Noise of Military Weapons, Ground Vehicles, Planes and Ships, and an article published in the Malaysian Journal of Public Health Medicine, titled Noise Exposure Among Maintenance Crews of c130H Aircraft Lead to the Hearing Impairment. See August 2021 Medical Treatment Record Non-Government Facility. Following a review of the evidence of record, the Board finds that a remand is warranted to obtain an addendum medical opinion. The Board finds the February 2016 private medical opinion from Dr. Ellis and the April 2021 private medical opinion from Dr. Lewis speculative as they appear to be based primarily, if not entirely, upon the Veteran's lay statements. To this end, the Board notes that neither Dr. Ellis nor Dr. Lewis addressed the absence of complaints or treatment for hearing loss or tinnitus in the Veteran's STRs, and there is no indication that Dr. Ellis or Dr. Lewis reviewed the Veteran's STRs prior to proffering their medical opinions. Moreover, it is not clear whether either had access to all of the post-service medical evidence when they proffered their opinions. The Board further notes that neither Dr. Ellis nor Dr. Lewis explained the significance, if any, of the 44 year gap between the Veteran's discharge from active duty and his initial bilateral hearing loss diagnosis or of his post-service traumatic noise exposure. See December 2016 Medical Treatment Record Non-Government Facility; March 2017 VA examination. The Board further notes that the Veteran reported that he initially underwent a physical examination at the VA Medical Center (VAMC) in Portland, Oregon in or around the mid-1970s. See July 2021 Hearing Transcript, pages 20-22. However, the Board notes that the earliest VA treatment records currently associated with the Veteran's claims file are dated in June 2013 and that no unavailable records response has been received. As such, the Board finds that a remand is also required to obtain these records. The matters are REMANDED for the following action: 1. Request the Veteran's complete service personnel records, to include all records dated from October 1965 to August 1969, to include all records reflecting the Veteran's duties, units, and assignments. All requests and responses received from each contacted entity should be associated with the claims file. If the requested service treatment records are unavailable, issue a formal finding of unavailability and notify the Veteran and allow him the opportunity to submit any medical records in his possession. 2. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran's VA treatment facilities, and all private treatment records from the Veteran not already associated with the file, to include any outstanding treatment records from the VAMC in Portland, Oregon dated in or around the mid-1970s. 3. After completion of the above development, obtain an addendum opinion by an appropriate examiner to determine the nature and etiology of the Veteran's diagnosed bilateral hearing loss and tinnitus. The examiner should provide the following opinions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed bilateral hearing loss is etiologically related to his period of service, to include as due to his presumed in-service acoustic trauma? Please explain why or why not. (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed tinnitus is etiologically related to his period of service, to include as due to his presumed in-service acoustic trauma? Please explain why or why not. The examiner should specifically consider the articles submitted by the Veteran, Dr. Ellis's February 2016 private medical opinion, and Dr. Lewis's January 2021 private medical opinion as well as the medical articles and studies cited therein. The Veteran's claims file, to include a copy of this remand, must be made available to and be reviewed by the examiner in conjunction with the examination. Reasons should be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, 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.