Citation Nr: 21007522 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 15-00 787 DATE: February 9, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from June 1967 to June 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in May 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the Veteran’s electronic claims file. The Board remanded the case for further development in December 2018 and September 2020. This case has since been returned to the Board for appellate review. When this issue was last before the Board in September 2020, it was remanded to obtain an addendum medical opinion to determine whether the Veteran’s current hearing loss was related to his active service because the rationale provided in the January 2020 VA audiology examination medical opinion was found to be inadequate. The rationale provided by the January 2020 VA examiner was that there was no evidence of hearing loss during the Veteran’s military service and that the pure tone threshold evaluation completed as part of the Veteran’s separation examination indicated normal hearing and no threshold shift. The remand instructed the examiner providing the addendum opinion to note that the absence of in-service evidence is not always fatal to a service-connection claim. It further instructed that the examiner should accept as true that the Veteran experienced an in-service acoustic trauma. If the examiner opined that it was less likely that the Veteran’s current hearing loss disability was related to his period of active service, he or she was then instructed to discuss why this was the case, with full consideration of the Veteran’s own reported history. Pursuant to the September 2020 Board remand, an addendum medical opinion was obtained in September 2020. The September 2020 VA examiner opined that the Veteran’s bilateral hearing loss was less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event, or illness. The examiner first conceded that the Veteran had a current diagnosis of hearing loss; that the claimant believed that the current presence and severity of his hearing loss was caused uniquely and exclusively by noise exposure sustained during and related to military service; and that the claimant was exposed to hazardous noise during and related to military service. He then noted that the Veteran had normal hearing at the time of separation from service with no significant threshold shifts. He cited the Institute of Medicine’s 2006 report which found that based on current understanding of auditory physiology, hearing loss from noise injuries occurs immediately following exposure. Citing the Institute of Medicine’s 2006 report, the examiner concluded that if it was caused by military noise exposure, hearing loss would have had its onset during service and/or would have been present at separation from service. The examiner did not address the Veteran’s assertions that he first noticed significant loss of hearing when he was stationed in Vietnam in 1968/1969. See Hearing Transcript, received by VA in May 2017. Moreover, the examiner did address the possibility of delayed-onset hearing loss. In that regard, the absence of in-service evidence of a hearing disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385) is not always fatal to a service connection claim. See Leford v. Derwinski, 3 Vet. App. 87, 89 (1992); Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The matters are REMANDED for the following action: 1. Forward the claims file to a qualified medical professional to obtain an addendum opinion as to the nature and etiology of the Veteran’s bilateral hearing loss disability. All pertinent evidence of record must be made available to and reviewed by the examiner. If the examiner determines that an examination is necessary, one should be scheduled. After reviewing the record, the examiner is asked to determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss disability is related to his period of active duty service? In providing an answer to this question, the examiner should accept as true that the Veteran experienced in-service acoustic trauma. It should be noted that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss when there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements of a hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. The examiner should specifically address whether there was any threshold shift or notch at higher frequencies during service or shortly thereafter that may be indicative of acoustic trauma. The examiner should also comment on the likelihood that loud noises experienced resulted in damage to auditory hair cells even though findings may or may not suggest a recovered temporary threshold shift in service. If the examiner finds auditory hair cell damage to be a likely result of military noise exposure, please comment on the likelihood that such damaged hair cells would result in a greater permanent hearing loss than otherwise would be manifest. The examiner should discuss the medically known or theoretical causes of hearing loss and describe how hearing loss which results from noise exposure generally presents or develops in most cases, as distinguished from how hearing loss develops from other causes, in determining the likelihood that current hearing loss was caused by noise exposure in service as opposed to some other cause. Finally, the examiner should address the Veteran’s assertions that he first noticed significant loss of hearing when he was stationed in Vietnam in 1968/1969. A full rationale must be provided for any opinion offered and a thorough explanation would be helpful for the Board. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity for an examination if an examination is deemed necessary. If a VA examination proves not feasible for any reason, the claims file should still be reviewed by an appropriate professional for the purpose of providing the requested opinions. 2. After completing the above development, and any other development deemed necessary, readjudicate the issue on appeal. If any benefit sought on appeal remains denied, provide an additional supplemental statement of the case to the Veteran and his representative, and return the appeal to the Board for appellate review, after the Veteran and his representative have had an adequate opportunity to respond. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fairlie, 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.