Citation Nr: 21077439 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 19-37 067 DATE: December 29, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran had active service from July 1955 to July 1959. This matter comes before the Board of Veterans' Appeals (Board) from a July 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, the Veteran provided testimony via videoconference equipment before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. The Board remanded this matter in December 2020, June 2021, and August 2021 for additional development, which has been substantially completed. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for bilateral hearing loss is remanded. In prior remands, the Board pointed out that service treatment records included audiometric testing from April 1958 and June 1959, and that the test results, when converted from American Standards Association (ASA) to International Standards Organization (ISO) or American National Standards Institute (ANSI) values, showed thresholds above 20 decibels in both ears and showed a worsening of the Veteran's hearing acuity between the two tests. Thresholds for normal hearing are between 0 and 20 decibels, and higher thresholds show some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). While the Veteran had a VA examination in June 2018, the examiner did not address the significance of the test results documented during service. In the December 2020 remand order, the Board requested an addendum opinion and asked the examiner to (1) consider the converted ASA to ISO-ANSI standards in evaluating the results of the in-service audiograms from 1958 and 1959; (2) explain the significance of the absence or presence of threshold shifts; and (3) consider statements from the Veteran regarding the onset and continuity of symptomatology. The Board directed that the examiner must not rely solely on the fact that the Veteran's hearing was within normal limits for VA purposes at the time of separation from service, as the basis for any opinion provided. In a December 2020 addendum opinion, the examiner provided a negative nexus opinion based on the lack of a hearing loss disability shown at separation from service. The examiner did not discuss the 1958 and 1959 audiograms, the notation of a 25 dB value at 500 Hz and/or 1000 Hz, or the Veteran's lay statements. In June 2021, the Board remanded the matter for compliance with the Board's prior remand directives. In a June 2021 addendum opinion, the examiner provided a negative nexus opinion based on the lack of hearing loss disability shown at separation from service. The examiner stated that there was no documented threshold shift during service; however, he did not address the 1958 and 1959 audiograms as requested in the June 2021 Board directives. The examiner also did not address the Veteran's lay statements regarding continuity of symptomatology. In August 2021 argument, the Veteran's representative noted a study indicating that despite a temporary return to normal hearing measurements after noise exposure, there is primary degeneration of cochlear neurons after noise exposure. Therefore, normal hearing thresholds may mask neural degeneration. See "Adding Insult to Injury: Cochlear Nerve Degeneration after 'Temporary' Noise-Induced Hearing Loss," 29 (45) J. Neuroscience 14077, 14078-79 (2009). The Board remanded this matter in August 2021 for an addendum opinion, which was received in October 2021. However, since that date, the Veteran has submitted additional argument and evidence in support of his claim. Specifically, in November 2021, the Veteran cited to numerous studies, including a 2017 article, "Current insights in noise-induced hearing loss: a literature revie of the underlying mechanism, pathophysiology, asymmetry, and management options." Significantly, this article notes that there may be instances of "hidden hearing loss" resulting in reduced speech perception in noise event when pure tone thresholds are still preserved. On remand, an updated addendum opinion should be obtained that considers the research articles noted in the November 2021 correspondence. The matter is REMANDED for the following actions: 1. Associate with the electronic claims file updated VA treatment records, if any. 2. Ask the June 2018/December 2020/June 2021 examiner or another qualified clinician to provide an addendum opinion addressing the etiology of the Veteran's bilateral hearing loss. The examiner must be provided access to the electronic claims file and a copy of this remand, and he or she should indicate review of the file in the opinion report. The examiner must provide an opinion indicating whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral hearing loss manifested during service or is otherwise related to service, to include exposure to noise during service. In providing the opinion, the examiner should consider the converted ASA to ISO-ANSI standards in evaluating/comparing the results of the in-service audiograms from 1958 and 1959 and indicate whether these audiograms show a threshold shift or a worsening of the Veteran's hearing acuity during service. The examiner must also address the statements from the Veteran regarding the onset and continuity of symptomatology. Finally, the examiner must address the articles cited in the Veteran's November 2021 argument. The examiner must not rely solely on the fact that the Veteran's hearing was within normal limits for VA purposes at the time of separation from service, as the basis for any opinion provided. 3. Then, readjudicate the Veteran's claim on appeal. If the benefit sought on appeal remains denied, provide the Veteran and his representative a supplemental statement of the case and allow an appropriate period for response. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. G. Alderman, 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.