Citation Nr: 21009197 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 17-08 848 DATE: February 19, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1954 to December 1956. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico, which determined that new and material evidence had not been received to reopen a previously denied final claim of service connection for bilateral hearing loss. In a November 2017 decision, the Board found that new and material evidence had been received to warrant reopening of the claim of service connection for bilateral hearing loss. The Board remanded the underlying claim for additional evidentiary development. This matter was most recently before the Board in November 2018. At that time, the Board again remanded the claim for further evidentiary development, to include an addendum medical opinion. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that his current bilateral hearing loss is causally related to in-service noise exposure. Although the Board’s November 2018 remand instructions directed the RO to obtain an addendum medical opinion, the Veteran was afforded a VA examination in May 2019. The examiner noted a diagnosis of bilateral sensorineural hearing loss. After examination of the Veteran and review of the claims file, the examiner rendered a negative etiological opinion regarding the Veteran’s bilateral hearing loss. The examiner opined, Current VA evaluation found unreliable response in the audiological evaluation. The Veteran was re-instructed several times due to the inconsistent responses and overall Veteran’s behavior during suggests exaggerated responses. Audiological evaluations found in the electronic C-file show normal whisper test at separation audio exam (12/3/1956). No other evidence of audio evaluation was found until private sector audio evaluation in the year of 2011. Further VA audiological evaluations evidenced bilateral mild to severe sensorineural hearing loss. Veteran brought today recent audio evaluation from March 2019 which suggest[s] bilateral moderate severe to severe sensorineural hearing loss. However, Veteran’s pure tone responses in today’s audiological evaluation suggest profound sensorineural hearing loss. In addition, the speech reception thresholds are not compatible with the pure tone audiometry. Based on the current audiological evaluation and the unreliable voluntary responses from the Veteran, hearing loss could not be estimated with any certainty. It is reasonable to conclude that the bilateral hearing loss is less likely as not related to the military service. The Board finds that the VA examination is inadequate. In that regard, in the November 2018 remand, noted above, the examiner was directed to discuss the Veteran’s lay statement contending that he was exposed to daily artillery and gunfire, as well as the Veteran’s particular MOS. However, the examiner failed to consider such in her rationale. Additionally, the examiner appears to consider the Veteran’s separation hearing examination whisper voice test as medical evidence that the Veteran had normal hearing acuity at separation. As the Board noted in the November 2018 remand, whisper voice tests are not sensitive to high frequency hearing loss, which is the type of hearing loss most commonly caused by noise exposure. Therefore, the Veteran’s separation results are not considered reliable evidence of normal hearing or hearing impairment. More importantly, the absence of in-service evidence of a hearing disability is not fatal to a claim of service connection for hearing loss. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Rather, 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 where, as here, there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). While the Board greatly regrets further delay, additional remand is required for full compliance with the Board’s previous remand instructions. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). Accordingly, the matter is REMANDED for the following action: 1. Obtain an addendum medical opinion for the purpose of ascertaining the nature and etiology of the Veteran’s current bilateral hearing loss. The entire claims file should be made available to and be reviewed by the examiner, and it should be confirmed that such records were available for review. After reviewing the record, the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s current bilateral hearing loss is causally related to his active service or any incident therein, including established acoustic trauma. The examiner must address all of the Veteran’s lay statements, including his contention in his VA Form 9 dated February 2017 that he was exposed to daily artillery and gunfire, and the relevant medical evidence of record. The Veteran’s MOS was “Flight AAA Fire Control Crewman” and his December 1956 military separation examination indicates that only whisper voice testing was performed. The Board notes that whisper voice testing is not reliable for determining high frequency hearing loss. The examiner should also discuss the Veteran’s contention that his hearing loss was of delayed onset years after his exposure to in-service acoustic trauma. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ruddy, 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.