Citation Nr: 21077478 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 14-01 403 DATE: December 29, 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 Army from April 1969 to March 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Board remanded this claim for development in January 2016. The Board denied this claim in February 2018, and the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In November 2018, the Court granted a Joint Motion for Remand (JMR) in which the parties agreed to vacate the February 2018 decision and remand the matter to the Board. The Board remanded the claim for development in April 2019. In October 2020, the Board again denied the claim and after the Veteran appealed to the Court, an April 2021 JMR was issued where the parties agreed to vacate the October 2020 decision and remand the matter to the Board. The Board remanded the claim for development in August 2021, and it has now returned for further appellate review. 1. Service Connection for Right Ear Hearing Loss is Remanded. The Veteran contends that his right ear hearing loss was due to his active duty service, to include as due to in-service noise exposure. Alternatively, he asserts that his right ear hearing loss is secondary to his service-connected left ear hearing loss and tinnitus. Consistent with the April 2021 JMR, the Board remanded this claim in August 2021 to obtain an addendum VA medical opinion that addresses direct and secondary service connection, and if these theories of entitlement are not in the Veteran's favor, for the examiner to determine the etiology of the right ear hearing loss. Taking each in turn, an addendum medical opinion was obtained in August 2021 where the examiner opined that while the Veteran's MOS as a light weapons infantry was highly probable for hazardous noise exposure, his right ear hearing loss is not attributable to service as his hearing was normal at separation. The examiner supported the opinion by citing to the 2006 report on military hearing loss published by the Institute of Medicine (IOM). The Board finds that this opinion is inadequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007). In that regard, while the examiner acknowledged that the Veteran may have been exposed to hazardous noise exposure, the examiner did not provide an adequate explanation to address whether the Veteran's right ear hearing loss was due to such exposure. Further, the examiner based the opinion on normal hearing at separation which is inconsistent with the November 2018 JMR where the parties cited Hensley v. Brown, 5 Vet. App. 155 (1993) finding 38 C.F.R. § 3.385 does not preclude service connection when the Veteran's hearing was within normal limits on audiometric testing at separation. Secondly, while the examiner cited the audiometric testing results during the Veteran's service, the examiner failed properly address the threshold shifts in hearing between enlistment and separation. Lastly, the examiner cited to the IOM but ignored the Board's remand directive which states that if the examiner relies on the IOM report, the examiner should explain how the qualifying and contradictory statements in the IOM report impact on the ultimate conclusion. An explanation was not provided. With regards to the opinion addressing secondary service connection, the examiner opined that evaluation of the Veteran's hearing during his examination in September 2012, October 2013, February 2016, March 2016, and November 2019 appears to show that his hearing loss is due to combined etiologies such as genetics, post service noise exposure, side effects to medication, and presbycusis. However, the examiner does not provide an adequate explanation as to whether his right ear hearing loss is due to his service-connected left ear hearing loss or tinnitus. Lastly, the opinion provided was limited to aggravation; an opinion addressing causation was not given. Based on the foregoing, the Board finds that an addendum VA medical opinion should be obtained. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: The claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current right ear hearing loss disability arose during service or is otherwise related to service, to include as due to noise exposure. The examiner should assume the Veteran was exposed to acoustic trauma during his service in his MOS of light weapons infantryman. The examiner should also address whether the current right ear hearing loss disability is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected left ear hearing loss and service-connected tinnitus. If for an opinion provided it is indicated that reliance was placed on medical literature/treatise, such should be specifically cited. If reliance is placed on the 2006 IOM report "Noise and Military Service: Implications for Hearing Loss and Tinnitus," explain how the qualifying and contradictory statements in the IOM report impact on the ultimate conclusion. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.