Citation Nr: 21005908 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 14-31 793A DATE: February 2, 2021 REMANDED The issue of service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1976 to June 1985. This matter is on appeal from a November 2013 rating decision. In August 2018, the Board remanded this matter for further evidentiary development. Pursuant to the August 2018 Board remand, the Veteran underwent a VA examination in September 2019. The examiner indicated that the Veteran’s bilateral hearing loss was not at least as likely as not caused by or a result of an event in military service. In support of his opinion, the examiner, in part, referred to a study by the Institute of Medicine (IOM), which found that there was no sufficient scientific basis for the existence of delayed-onset hearing loss. Given the above, and in light of a decision of the Court of Appeals for Veterans Claims (Court), the Board finds that remand is necessary. See McCray v. Wilkie, 31 Vet. App. 243 (2019). This Court decision addressed the Board’s dependence on a negative VA medical opinion that relied on a medical text containing unfavorable findings as well as unaddressed contradictory findings regarding delayed-onset hearing loss. The Court held that a medical text’s qualifying or contradictory aspects may affect the probative value and adequacy of any ensuing medical opinion that relies on the text. The text involved in the Court decision was the IOM report relied on by the September 2019 VA examiner. Therefore, the Board finds that the medical opinion is inadequate and must be returned for an addendum that asks the examiner to identify the medical text’s qualifying or contradictory aspects and to explain why the examiner found the contradictory aspects or conclusions in the IOM study to be less persuasive in this Veteran’s case as to the question of whether delayed onset hearing loss and/or tinnitus are as likely as not etiologically related to in-service noise exposure. The matters are REMANDED for the following action: Obtain an addendum opinion to the September 2019 VA medical opinion regarding whether any delayed onset bilateral hearing loss in this Veteran is at least as likely as not related to in-service noise exposure. In formulating a negative medical opinion, if relying to any extent upon the IOM study, noted above, the examiner must (a) identify the medical text’s qualifying or contradictory aspects (i.e., that there is 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 (b) explain why the examiner found the contradictory aspects or conclusions in the IOM study to be less persuasive in this Veteran’s case as to the question of whether delayed onset bilateral hearing loss is as likely as not etiologically related to in-service noise exposure. The examiner may discuss this Veteran’s clinical history in support thereof but must not reject medical history unless otherwise incongruous with the record and explaining why any history is rejected. A complete rationale is required. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Griffith 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.