Citation Nr: 21006241 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-59 708 DATE: February 3, 2021 REMANDED Service connection for left ear sensorineural hearing loss is remanded. Service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active duty service from June 1970 to January 1972. The instant case is on appeal from a Department of Veterans Affairs (VA) Regional Office (RO) rating decision that denied service connection for bilateral sensorineural hearing loss and tinnitus. The case has been before the Board of Veterans’ Appeals (Board) previously. In January 2019, the Board denied the appeal for service connection for bilateral sensorineural hearing loss and tinnitus. The Veteran appealed the Board decision denying left ear sensorineural hearing loss and tinnitus to the United States Court of Appeals for Veterans Claims (Court). The Veteran did not appeal the denial of service connection for right ear sensorineural hearing loss. See June 2020 Court Memorandum Decision (Memorandum Decision). In the Memorandum Decision, the Court vacated and remanded the Board decision. 1. Service Connection for Left Ear Sensorineural Hearing Loss 2. Service Connection for Tinnitus The Board is remanding the appeals for service connection for left ear sensorineural hearing loss and tinnitus for a new nexus opinion. The VA examiner is to note that the Veteran sustained very loud noise exposure during service as an infantryman and through artillery work. See November 2016 Statement of the Case (stating that in-service exposure to hazardous artillery noises is conceded due to work as a light weapons infantryman). The VA examiner is also to note that the Veteran worked as a truck driver after service, which resulted in some loud noise exposure. In keeping with the Memorandum Decision, the VA examiner is to address the 2006 Institute of Medicine report related to delayed-onset hearing loss. This will include the discussion that the current understanding of auditory physiology indicates that a prolonged delay in the onset of noise-induced hearing loss is “unlikely.” This will also include the discussion that there is not sufficient evidence from longitudinal studies 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 the issue has not been performed. The VA examiner is not restricted to these two aspects of the 2006 Institute of Medicine report, but these two should be addressed. The Veteran has previously provided a medical study that relates tinnitus and hearing loss. The VA examiner is requested to address the study provided by the Veteran: Satar B, Kapkin O, Ozkaptan Y., Evaluation of Cochlear Function in Patients with Normal Hearing and Tinnitus: a Distortion Product Otoacoustic Emission Study, J. of Ear, Nose, & Throat (May 2003). In reaching an opinion, the VA examiner is to treat the case as if a service separation examination did not occur. The Board notes that the audiometric readings at the time of service separation were zeros across the board. Such results, when considered with all the evidence of record, are highly unlikely and may have been the product of “gun decking,” which means simply filling in the boxes without actually conducting an audiometric examination. This is particularly likely here when the Veteran reports no audiometric examination happened and when there is no audiogram linked to the claims file for the service separation but there is one for pre-induction. Additionally, at pre-induction, the Veteran’s hearing had some variability (e.g., 500 Hertz was 30 decibels bilaterally), which would have had to improve. Current medical understanding is that sensorineural hearing loss does not improve. See Fountain v. McDonald, 27 Vet. App. 258 (2015). For these reasons, the Board finds that there was no service separation examination and that the VA examiner should treat the case as if a service separation examination was not in fact conducted during service. If the VA examiner relates the left ear sensorineural hearing loss to noise exposure, the examiner should offer an opinion as to the most likely source of that loud noise exposure, namely, whether the in-service noise or post-service noise is the most likely cause, or whether both sources of noise are equally as likely to be the cause of the current hearing loss and tinnitus. Concerning tinnitus, a prior VA examiner opined that the tinnitus “is at least as likely as not…a symptom associated with hearing loss, as tinnitus is known to be a symptom associated with hearing loss.” On remand, the new VA examiner is to address the etiology of tinnitus, including whether it is related to (secondary to) the hearing loss. This can include a secondary theory, whether by secondary causation or aggravation (worsening in severity). The matters are REMANDED for the following action: 1. After a review of the file and the pertinent medical studies, the VA examiner is to give the following opinions: (a.) Is it at least as likely as not (50 percent or higher degree of probability) that the left ear sensorineural hearing loss was caused by, or related to, military service, to include in-service noise exposure? Discuss the relative in-service and post-service noise exposures. (b.) Is it at least as likely as not (50 percent or higher degree of probability) that the tinnitus was caused by, or related to, military service? (c.) If the answer to (a) is a positive nexus, is the tinnitus caused by or worsened in severity by the left ear sensorineural hearing loss? When answering these questions, the VA examiner should assume the following facts: • the Veteran was exposed to very loud noises during service as an infantryman and through artillery work, and after service experienced loud noise exposure as a truck driver • a service separation examination did not occur (notwithstanding the purported service separation audiometric report) The rationale should address the following: • A 2006 Institute of Medicine report related to delayed-onset hearing loss – both the section that indicates that a prolonged delay in the onset of noise-induced hearing loss is “unlikely,” and the section discussing that there is not sufficient evidence from longitudinal studies 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 the issue have not been performed. • The study provided by the Veteran: Satar B, Kapkin O, Ozkaptan Y., Evaluation of Cochlear Function in Patients with Normal Hearing and Tinnitus: a Distortion Product Otoacoustic Emission Study, J. of Ear, Nose, & Throat (May 2003). 2. Readjudicate the claims for service connection for left ear sensorineural hearing loss and tinnitus. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, 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.