Citation Nr: 21007783 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 16-44 971 DATE: February 10, 2021 REMANDED Entitlement to service connection for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1972 to June 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2016 rating decision issued by a Department of Veterans Appeals (VA) regional office. This matter was previously remanded by the Board in December 2019. Entitlement to service connection for right ear hearing loss is remanded. The Board regrets the delay associated with this remand, particularly as this matter is the subject of a prior remand. However, based on a review of the evidence of record, the Board finds that another remand is necessary to allow the Agency of Original Jurisdiction (AOJ) to obtain an adequate opinion regarding the etiology of the Veteran’s right ear hearing loss. In January 2020, a VA opinion was obtained, without examination, in which the audiologist opined that the Veteran’s right ear hearing loss was less likely as not caused by or a result of military noise exposure. In support of this opinion, the examiner noted that the Veteran suffered no permanent shift in hearing for the worse during service and that his hearing was still normal from 500 hertz (Hz) to 3000 Hz. See January 2020 VA Medical Opinion Disability Benefits Questionnaire (DBQ). However, the Veteran’s medical records indicate that he has right ear hearing loss at 500 Hz, where it is noted to be 40 decibels. See Minneapolis VA Medical Center (VAMC) records, received December 2019 in CAPRI. As such, the January 2020 opinion appears to be based, in part, on inaccurate factual premises and, therefore, is inadequate. See Reonal v. Brown, 4 Vet. App. 458 (1993). Further, an opinion is inadequate when, as indicated here, the examiner fails to consider the Veteran’s prior medical history. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). For these reasons, the Board finds the January 2020 opinion to be inadequate for adjudication purposes. As such, a remand is necessary to obtain an adequate opinion regarding the etiology of the Veteran’s right ear hearing loss. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, the matter is REMANDED for the following action: 1. With the Veteran’s assistance as appropriate, obtain and associate with the electronic claims file any outstanding pertinent medical records, whether VA or private, including records relating to treatment at Minneapolis VAMC from November 2019 to current. Pursuant to 38 C.F.R. § 3.159(e), any efforts to secure these records MUST be documented in the electronic claims file, and the Veteran MUST be informed if any of these records are unable to be secured. 2. The Board recognizes the potential practical difficulties in scheduling an examination in light of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran any warranted examination. 3. After completing the development above, and any additional development warranted by record, schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of his claimed right ear hearing loss. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated tests, studies, or evaluations should be performed. The examiner is asked to: (a.) Obtain the Veteran’s detailed lay history, including employment, noise exposure, and onset and progression of symptomatology. (b.) Opine as to whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran’s right ear hearing loss is related to his military service, to include conceded noise exposure. (c.) In formulating the requested opinion, the examiner is instructed to consider and address the Veteran’s service-connected left ear hearing loss and tinnitus. • Any opinion expressed by the examiner must contain not only clear conclusions with supporting data but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). • If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. • The examiner is reminded that noting that a hearing condition did not manifest in service as the sole basis for forming a negative nexus opinion, without additional explanation, will not be adequate. • The examiner is also reminded that, if an opinion is based on the Institute of Medicine’s 2006 report, titled “Noise and Military Service: Implications for Hearing Loss and Tinnitus,” the apparently contradictory findings therein must be addressed. 4. The AOJ must review the claims file and ensure that the foregoing development action hs been completed in full. If any development action is incomplete, the appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. T. Martin III, 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.