Citation Nr: 21005657 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 14-25 834 DATE: February 2, 2021 REMANDED Entitlement to service connection for hearing loss, to include as secondary to service-connected tinnitus, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1973 to August 1980. The claim was most recently remanded by the Board of Veterans' Appeals (Board) in August 2020 for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). The claim is remanded again because the August 2020 VA opinion and November 2020 addendum report are inadequate as to whether the Veteran’s hearing loss was aggravated by tinnitus. The examiner offered a negative opinion on aggravation, but the rationale is internally inconsistent with regard to both aggravation and causation. In the August 2020 opinion, the examiner stated that “tinnitus and hearing loss can be associated,” but then noted that hearing loss “cannot cause” tinnitus and vice versa. In the November 2020 addendum, the examiner stated that tinnitus and hearing loss does “not cause or aggravate the other,” but then noted that tinnitus “can cause the individual to not hear as well due to distraction.” Both opinions used the incorrect standard of aggravation; that is beyond the natural progression. For secondary service connection, the standard for aggravation is any increase in disability, per 38 C.F.R. § 3.310. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an audiologist on the likely etiology of the Veteran’s diagnosed hearing loss. Copies of all pertinent records must be made available to the opinion provider for review. Based on a review of the record, the examiner must answer the following: Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed hearing loss has been aggravated by (defined as any increase in disability) the Veteran’s service-connected tinnitus? The examiner must address the (i) statement in the August 2019 opinion indicating that tinnitus “may interfere with the Veteran’s ability to hear” and (ii) July 2012 VA audiological examination. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. If the examiner refers to medical studies, the examiner must discuss the significance of the studies as they relate to the specific facts of this case. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner’s own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, Associate 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.