Citation Nr: A21020533 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 211207-202445 DATE: December 27, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served active duty in the United States Army from July 1965 to April 1967. Historically, in January 2021, the Veteran's service connection claim for bilateral hearing loss was denied as the Department of Veterans Affairs (VA) Regional Office (RO) found there was no nexus between his claimed disability and military service. In April 2021, the Veteran filed a higher-level review claim. Following, in July 2021 in a higher-level review decision, the RO indicated that another VA examination was required. However, it conceded the Veteran had a moderate probability of military noise exposure as an amphibian engineer in service. In a September 2021 decision, the RO denied the claim once again. In response, the Veteran submitted a VA Form 10182, in November 2021, opting into the Appeals Modernization Act (AMA) system and disagreeing with the decision. He elected a direct review by a Veterans Law Judge. Upon review, the Board finds that the claim must be remanded to correct a pre-decisional duty to assist error. In an August 2021 VA medical opinion, the examiner found that it is less likely than not the Veteran's bilateral hearing loss was incurred in or caused by the claimed in-service injury, event, or illness. She noted that he had normal hearing at entrance and separation from service with no significant threshold shifts. Therefore, because he had normal hearing at separation and there was no significant threshold shifts during active duty, she determined there is no evidence the in-service noise exposure caused permanent noise injury affecting his hearing sensitivity. Nevertheless, it should also be noted that the absence of evidence of a hearing loss disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. Moreover, the examiner did not explain the significance of those facts related to the threshold shifts or address whether delayed-onset hearing loss could be related to his military service, regardless of the fact that the disorder did not manifest therein. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992); Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Therefore, the Board finds that an additional medical opinion is needed. The Board notes that additional evidence was associated with the claims file since the Agency of Original Jurisdiction's (AOJ) last adjudication of the claim. However, the evidence does not appear to be relevant to the Veteran's service connection claim for hearing loss. To the extent that it is, the AOJ should consider the evidence on remand. The matter is REMANDED for the following action: The Veteran should be afforded a VA examination to determine the nature and etiology of any hearing loss that may be present. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. As noted above, the examiner should consider that the absence of evidence of a hearing loss disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. The examiner should state whether it is at least as likely as not that the Veteran's hearing loss is related to his military service, to include any noise exposure therein. In rendering his or her opinion, the examiner should consider that VA has conceded the Veteran had noise exposure while serving in the military. Moreover, he or she should consider that the Veteran worked on boats with noise engine turbines with no hearing protection. Additionally, the examiner should discuss medically known or theoretical causes of hearing loss and describe how hearing loss which results from noise exposure generally presents or develops in most cases, as distinguished from how hearing loss develops from other causes, in determining the likelihood that the disorder was caused by noise exposure in service as opposed to some other cause. (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.) A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M. Walker 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.