Citation Nr: 21008438 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 14-20 142A DATE: February 17, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1965 to September 1967, including in the Republic of Vietnam. He received the Combat Infantryman Badge, the Vietnam Service Medal, and the Republic of Vietnam Campaign Medal, among other decorations. The Board sincerely thanks him for his honorable military service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA), and has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107. The Veteran and his spouse appeared before the undersigned Veterans Law Judge during a Travel Board hearing in January 2018. A transcript of the hearing is of record. In July 2018, the Board remanded this matter to obtain a VA examination and medical opinion. The Veteran underwent a VA audiological examination in September 2020. Regrettably, the Board finds that further clarification is needed before a decision may be made on the merits. See Stegall v. West, 11 Vet. App. 268, 271 (2011) (holding that the Board errs as a matter of law when it fails to ensure substantial compliance with its own remand directives). The Veteran’s representative submitted an informal hearing presentation in January 2021. He asserted that the examiner did not sufficiently consider the question of delayed-onset hearing loss, and included citations to medical evidence to support his contentions. Specifically, he provided a link to a website from the National Institutes of Health, National Institute on Deafness and Other Communications Disorders, indicating that noise induced hearing loss can be immediate or it can take a long time to be noticeable. He also included a citation to an article from the Journal of Neuroscience from May 2015 purporting to show that a single synaptic exposure to traumatic noise can accelerate cochlear aging. As such, the Board finds that a clarifying medical opinion should be obtained considering the evidence and contentions raised by the representative. This matter is REMANDED for the following action: 1. Please obtain an addendum medical opinion from the September 2020 VA examiner, if available, or any other qualified clinician. ONLY IF the clinician believes that a VA examination is necessary to answer the question below should one be scheduled. The clinician is asked to review the claims file and to opine on the following: (a) Is it at least as likely as not that the Veteran’s hearing loss had its onset during or is etiologically related to military service, to include as a delayed-onset reaction to hazardous noise exposure? A complete rationale should be provided for all opinions. The clinician is asked to consider and discuss relevant lay and medical evidence, to specifically include: • The informal hearing presentation submitted by the Veteran’s representative in January 2021, including contentions that the Veteran’s hearing loss is a delayed-onset reaction to hazardous noise exposure during military service • The NIH website cited by the Veteran’s representative, located at the following link: https://www.nidcd.nih.gov/health/noise-induced-hearing-loss#1 • The study from the Journal of Neuroscience in May 2015, located at the following link: https://www.jneurosci.org/content/jneuro/35/19/7509.full.pdf The clinician is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.