Citation Nr: 21076667 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 17-54 847 DATE: December 27, 2021 REMANDED Entitlement to accrued benefits is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1962 to July 1965. The Veteran died in February 2016. In August 2021, the Board remanded the case for further development. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to accrued benefits is remanded. The Board remanded this case in August 2021 for an addendum opinion discussing the etiology of bilateral hearing loss. In October 2021 the examiner opined hearing loss was less likely than not caused by or a result of noise exposure in service. The examiner relied on the absence of complaints of difficulty hearing and a normal hearing test at separation. In addition, the examiner noted that there are no specific incidents of noise exposure either military or civilian presented; thus, hearing loss is likely due to the aging process. The Board finds this opinion inadequate for adjudication. The examiner relies on no specific incidents of excessive noise exposure during the military to support the conclusion that hearing loss is age related. However, while the Veteran may not have reported a specific incident in service, noise exposure is conceded based on his military occupational specialty in the field artillery unit which was not considered or addressed by the examiner. As such, the Board finds the VA medical opinion is inadequate as it is based on a factually incomplete premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise has no probative value). Therefore, a remand is necessary to obtain an addendum opinion that contains clear conclusions with supporting data and a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. Based on a review of the record, the examiner must address the following: Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's bilateral hearing loss and/or tinnitus was related to his active service or was caused by or aggravated by military service. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran was competent to report his symptoms of bilateral hearing loss and tinnitus. The examiner should consider and discuss the Veteran's prior statements that hearing loss occurred gradually and without a specific incident to cause it. The examiner is advised noise exposure is conceded and should be considered. The examiner is advised that normal hearing at separation is not sufficient to serve as a rationale as 38C.F.R. §3.385 establishes that service connection for a current hearing disability is not precluded where hearing was within normal limits at separation. (Continued on the next page) If a negative opinion is offered based primarily on the length of time between separation and the current diagnosis the examiner should explain the medical significance of this fact, i.e., why this is indicative that any current hearing loss and/or tinnitus was not related to service. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s) G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Prinsen 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.