Citation Nr: 21006599 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 18-00 242 DATE: February 4, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to December 1970. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision of the Department of Veteran Affairs (VA) Regional Office in Cleveland, Ohio. The Veteran provided testimony at a hearing in February 2020 before the undersigned Veterans Law Judge. In a November 2020 rating decision, service connection for a bilateral knee disorder was granted. This represents a full grant of the benefits sought, and the issue is no longer in appellate status. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). The record contains no indication that the Veteran has disagreed with the initial rating or effective date assigned, thus, those matters are not in appellate status. See Grantham, 114 F. 3d at 1158 (holding that a separate notice of disagreement must be filed to initiate appellate review of “downstream” elements such as the disability rating or effective date assigned). 1. Entitlement to service connection for bilateral hearing loss is remanded. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The examiner should consider and directly address any shifts of acuity thresholds found in the service treatment records even if the shifts do not amount to a hearing loss disability under 38 C.F.R. § 3.385. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board is also obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. The Veteran was provided with a VA examination in August 2020. The examiner determined that the Veteran’s hearing loss was less likely than not related to service as the Veteran’s hearing was within normal limits at induction and separation, with no shifts in threshold. The examiner stated that the Veteran’s current pattern of thresholds for hearing did not reflect hearing loss due to noise exposure. The Board finds this opinion inadequate. The examiner was specifically directed in the May 2020 Board decision, to address the fact that the Veteran’s hearing acuity shifted five to 10 decibels at every measured frequency between the October 1968 induction examination and the September 1970 STR. The examiner instead stated that there was no shift in thresholds. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the hearing loss from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must opine whether it is as least as likely as not (50 percent probability or more) that the Veteran’s claimed bilateral hearing loss: (i) had its onset during service; (ii) manifested to a compensable degree within one year after his separation from service; or (iii) is etiologically related to an in-service injury, event, or disease. The examiner must address the following: 1) the acuity shifts in hearing between the October 1968 entrance examination and the September 1970 STR; 2) the March 2015 VA examination; and 3) the Veteran’s lay statements regarding the excessive noise exposure he experienced in service in the February 2020 Board hearing transcript. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board AYK 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.