Citation Nr: A21020518 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 210621-167069 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 had active service from December 1963 to December 1967. In April 2021, the Agency of Original Jurisdiction denied service connection for both bilateral hearing loss and tinnitus. In the June 2021 Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, the Veteran elected the Direct Review docket. Therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the April 2021 Agency of Original Jurisdiction decision on appeal. 38 C.F.R. § 20.301. Entitlement to service connection for bilateral hearing loss and tinnitus is remanded. The Veteran contends that service connection for bilateral hearing loss and tinnitus is warranted as the claimed disabilities are a result of his military noise exposure. The Department of Veterans Affairs' (VA) duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The United States Court of Appeals for Veterans Claims has stated that when an audiological opinion relies on the 2005 Institute of Medicine report entitled Noise and Military Service: Implications for Hearing Loss and Tinnitus, he Board must assess the underlying medical text evidence when it may affect the probative value and adequacy of the medical opinion. McCray v. Wilkie, 31 Vet. App. 243 (2019). The report states there was 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. The report of an April 2021 VA audiological examination states that the Veteran was diagnosed with bilateral sensorineural hearing loss and tinnitus. The examiner concluded "the Veteran's hearing loss and tinnitus are less likely as not (less than 50/50 probability) caused by or a result of noise exposure in the military for both ears." In support of her conclusion, she cited the 2005 Institute of Medicine report, an inconclusive study, to give an opinion regarding etiology. Given this deficiency, the Board finds that the examination report is of limited probative value and further VA audiological evaluation is need. That is a pre-decisional error. The matters are REMANDED for the following action: Schedule the Veteran for a VA audiological examination to assist in determining the nature and etiology of any identified hearing loss and tinnitus and any relationship to active service. A rationale for all opinions should be provided. The examiner should: (a.) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hearing loss disability, had its onset during active service or is related to any incident of service, to include conceded military noise exposure. (b.) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified tinnitus had its onset during active service or is related to any incident of service, to include conceded military noise exposure. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Emily A. Kotroco 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.