Citation Nr: A21020685 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 211018-191801 DATE: December 30, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1963 to May 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal from October 2021 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The rating decision on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the October 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38C.F.R. § 20.301. 1. Entitlement to service connection bilateral hearing loss is remanded. The Veteran seeks service connection for bilateral hearing loss. Specifically, in his October 2021 notice of disagreement, the Veteran maintained that his hearing loss developed as a result of his exposure to hazardous noise from being a Naval pilot. He also maintained that his bilateral hearing loss started in service and still exists today. It is noteworthy that the RO has conceded that the Veteran had hearing loss for VA purposes as reflected in a July 2020 VA examination. In the October 2021 rating decision, the RO found the following favorable findings: that there is a qualifying event, injury, or disease that had its onset in service; specifically, given the Veteran's Military Occupation Specialty as a Pilot, he was exposed to hazardous noise during service. The RO also conceded a current diagnosis of bilateral hearing loss, that the claimed bilateral hearing loss is a chronic disease which may be presumptively linked to military service, and the Veteran also has sufficient service to meet the minimum requirement for presumptive service connection based on dates served. The Board is bound by these findings. In October 2021, the Veteran reported for an audiology VA examination where the examiner performed an in-person examination, reviewed the pertinent records, and provided an opinion. The examiner opined that the Veteran's bilateral hearing loss is less likely than not (less than 50 percent) caused by or a result of an event in military service. To support this opinion, the examiner explained that there is no report of complaint or treatment for hearing decrease in STRs or at separation. However, the Board finds that a remand is necessary because the VA etiology opinion of record is inadequate. The October 2021 examiner opined that is it less likely than not that the Veteran's bilateral hearing loss was caused by or a result of his military service. In support of her opinion, the examiner relied on the presence of normal hearing at service separation with no significant threshold shifts. However, examiner did not address the Veteran's in-service noise exposure due to his military occupational specialty in relation to his current hearing loss, relevant service treatment records, or the Veteran's reports of hearing loss since service. As such, the Board finds that a remand is necessary in order to obtain an addendum opinion regarding the etiology of the Veteran's bilateral hearing loss. McCray v. Wilkie, 31 Vet. App. 243 (2019). The failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error. The matters are REMANDED for the following action: Refer the claims file to an audiologist for preparation of an addendum opinion. The entire claims file should be made available to and reviewed by the examiner, to include a copy of this Remand. The need for further in-person examination is left to the discretion of the examiner. Following a review of the claims file, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current bilateral hearing loss had its onset in, or is otherwise related to service, to include as a result of conceded noise exposure therein. In addressing this question, please discuss conceded in-service noise exposure. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. T. Berry Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Suzie S. Gaston 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.