Citation Nr: 21008486 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 19-20 673 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 Air Force from September 1962 to September 1966. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2019 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Salt Lake City, Utah. The Board notes that in a September 2020 VA Form 27-0820 Report of General Information, the Veteran withdrew his hearing request. No additional request for a hearing has been made. Thus, the Veteran’s hearing request is considered to be withdrawn. This case was most recently before the Board in October 2020, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the Board directed the RO to obtain the Veteran’s updated VA treatment records and obtain a VA etiology opinion with regard to the Veteran’s claim. On remand, the RO obtained updated VA treatment records and such VA etiology opinion. Thus, the RO substantially complied with the October 2020 Board remand directives. See 38 U.S.C. § 5103A (b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). The case has now been returned to the Board for appellate action. Service Connection – Bilateral Hearing Loss In the October 2020 remand, the Board found that the January 2019 VA opinion did not give appropriate consideration to the Veteran’s statements regarding the onset and continuity of his symptoms. In that regard, the Board noted that the Veteran has submitted various statements indicating he had hearing loss during active service as a result of hazardous noise exposure sustained during service. Additionally, the October 2020 Board noted that the Veteran submitted a May 2019 opinion from Dr. V. B., a private ENT specialist, who recommended that the Veteran be granted service connection to get proper hearing aids and noted that the Veteran had significant noise exposure during service. However, this opinion was provided without a rationale and was not sufficient to support a grant of service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Accordingly, the Board found an additional VA examination was necessary in order to adjudicate the claim. The Veteran was afforded the directed VA examination for his claimed bilateral hearing loss in December 2020. At that time, the examiner opined that the Veteran’s bilateral hearing loss was less likely than not as a result of his active service. Specifically, the examiner noted that the Veteran’s separation examination from July 1966 was silent for hearing loss and noted the Veteran’s reported noise exposure due to firearms during active service without proper hearing protection but stated that while hearing loss due to shooting a firearm without proper protection can occur, this cannot directly link the Veteran’s current bilateral hearing loss to his active service. In this regard, the examiner noted that if acoustic trauma occurred, it would cause immediate and permanent damage to hearing; and in addition, hearing loss would likely be more severe in one ear, causing an asymmetrical hearing loss in the opposite ear from which the Veteran shoots. Here, the Veteran had symmetrical hearing within normal limits at separation, except at 500 Hz, which is not a frequency affected by noise exposure. Additionally, the December 2020 examiner noted that the Veteran reported aircraft noise exposure while transporting people and supplies to and from the flight line. The examiner noted that while being close to or on the flight line without hearing protection could cause hazardous noise exposure, the Veteran would need to be exposed for at least one or two hours at a time in order for this noise exposure to cause permanent damage. In that regard, the examiner found that trips to and from the flight line to transport people and items are not likely to cause acoustic trauma, as the Veteran would not have been exposed to the noise for a significant amount of time to cause damage and permanent hearing loss. In a February 2021 Informal Hearing Presentation, the Veteran’s representative argued that the December 2020 VA examiner did not consider whether the Veteran had delayed onset hearing loss. Specifically, that the Veteran had delayed onset of bilateral hearing loss due to the hazardous noise exposure sustained in active service; and notes an article published in the Journal of Neuroscience showing that auditory damage can accelerate hearing loss in aging, to include a single synaptopathic exposure (traumatic event) can accelerate cochlear aging. The Board notes the December 2020 VA opinion did not address whether the Veteran had delayed onset bilateral hearing loss, to include as due to a single traumatic event or accelerated cochlear aging. As a result, the Board concludes that an additional addendum opinion should be obtained to address the new contentions of the Veteran as well as the medical journal article that was referenced in the February 2021 Informal Hearing Presentation. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, an addendum opinion should be obtained to determine the nature and etiology of the Veteran’s bilateral hearing loss. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for further examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss had delayed onset of bilateral hearing loss due to the hazardous noise exposure sustained in active service, specifically any delayed onset hearing loss? The examiner should discuss the significance, if any, of the article published in the Journal of Neuroscience showing that auditory damage can accelerate hearing loss in aging, to include a single synaptopathic exposure (traumatic event) can accelerate cochlear aging. The examiner should discuss the significance, if any, of the Veteran’s military occupational specialty as a vehicle operator and his reports that he did not use noise protection during service. In offering such opinions, the examiner should consider the Veteran’s statements regarding in-service noise exposure and a continuity of symptoms since service. The examiner must provide a complete rationale for all opinions and conclusions reached. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.