Citation Nr: 21076735 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 14-34 176A DATE: December 27, 2021 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 November 1971 to November 1974. The Veteran appeared before the Board of Veterans' Appeals (Board) and the undersigned Veterans Law Judge in June 2016. The matters were denied by the Board of Veterans' Appeals (Board) in a March 2018 decision. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a January 2020 Memorandum Decision, the Court affirmed the March 2018 Board decision. The United States Court of Appeals for the Federal Circuit (Federal Circuit) recently issued a decision in Euzebio V. McDonough, 989 F.3d 1305 (Fed. Cir. 2021) as to the constructive possession doctrine. The Federal Circuit decision reversed the Court's prior decision in Euzebio v. Wilkie, 31 Vet. App. 394 (2019). Accordingly, the Court issued a joint motion for remand in September 2021 which vacated the March 2018 Board decision, and remanded it back to the Board. The Veteran waived regional office review of new evidence in November 2021. In June 2019, the Court held that the Board must address a medical text that serves as the basis for a medical opinion which contains apparent qualifiers or contradictions to explain whether those aspects of the medical text diminish the probative value of the medical opinion. See McCray v. Wilkie, 31 Vet. App. 243 (2019). The Court provided that the Board may seek clarification from the medical professional if assistance in understanding or interpreting the underlying the medical text evidence is required. See id. The March 2013 VA negative opinion relied on the same medical study discussed by the Court in McCray. Thus, the Noise and Military Service-Implications for Hearing Loss and Tinnitus, Institute of Medicine, National Academy of Sciences, 2006 (IOM) report requires clarification as it contains contradicting information on how there is insufficient evidence from definitive studies to support the lack of a causal link between one's delayed hearing loss and prior noise exposure. The Board concludes that it is necessary for the Agency of Original Jurisdiction (AOJ) to obtain another addendum opinion by an appropriate medical professional to clarify the IOM report in order to appropriately evaluate the probative value of the March 2013 VA medical opinion. As the March 2013 examiner's opinion provided a negative nexus as to tinnitus that appears to be based, in part, on hearing loss not being related to service, this issue is intertwined and must also be remanded. The matters are REMANDED for the following action: Obtain an addendum medical opinion to determine the etiology of any diagnosed bilateral hearing loss and tinnitus. The examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that any diagnosed bilateral hearing loss and tinnitus are related to the Veteran's active service. If the examiner cites to the 2006 IOM study on delayed onset hearing loss, they must address any qualifying or contradictory statements relied upon in the medical text: the IOM study found that "based on current knowledge of cochlear physiology there was no sufficient scientific basis for the existence of delayed-onset hearing loss." However, the IOM report also indicated that "[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure" and that "definitive studies to address this issue have not been performed. All opinions must be supported by a rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. N. Quarles, 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.