Citation Nr: 21009553 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 09-47 515 DATE: February 22, 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 September 1961 until September 1964 and August 1967 until April 1969, to include active service in the Republic of Vietnam. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (c). 38 U.S.C. § 7107 (a)(2). This matter has been before the Board on several prior occasions. Most recently in December 2019, the claim was remanded for an addendum medical opinion. Unfortunately, there has not been substantial compliance with the Board’s prior remand directives, and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for right ear hearing loss is remanded. The Veteran contends that his right ear hearing loss is etiologically related to service. The Veteran’s representative argues that the January 2020 VA opinion obtained after the most recent remand is inadequate. The Board agrees and the claim must be remanded again. In providing the negative nexus opinion, the opinion provider relied solely upon a 2005 report from the Institute of Medicine (IOM) entitled Noise and Military Service in which the IOM noted an insufficient scientific basis for the existence of delayed-onset hearing loss. The rationale is inadequate, because it relies on a qualifying or contradictory aspect of a medical text. See McCray v. Wilkie, 31 Vet. App. 243 (2018). Furthermore, the opinion is inadequate because it fails to address the Veteran’s contention that his hearing loss is the result of an otosclerosis caused by a stress fracture of the stapes bone. The Veteran contends the stress fracture developed from traumatic head injury (THI) and concussions suffered in service. The addendum opinion is also inadequate because it fails to address the medical treatise evidence, including conflicting medical evidence, submitted by the Veteran in his December 2019 informal hearing presentation. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right ear hearing loss is at least as likely as not (50 percent or greater probability) related to the Veteran’s claimed in-service traumatic head injury (THI), concussions, and blasts and conceded in-service military noise exposure. The AOJ must confirm that copies of all pertinent records (including those noted within the directives below) are made available to the opinion provider for review. The examiner must specifically address the following contentions: a. The Veteran’s statement that improvement of his hearing after the 1985 surgery was “noticeable” rather than “significant,” but diminished over a five to seven-year period. b. The multiple possible risk factors for otosclerosis, of which the Veteran contends he only has to (race and age) and no family history of hearing loss. c. The Veteran’s contention that stress fracture of the stapes bones from traumatic head injury (THI), concussions, and blasts is a cause of otosclerosis and that his direct exposure to tank artillery, small arms and machine gun fire, and a December 1968 rocket propelled grenade direct attack on his tank is sufficient to cause this type of injury. d. The medical literature the Veteran’s representative cited in the December 2019 informal hearing presentation. All provided opinions must be supported by complete rationale. If the opinion provider determines a requested opinion cannot be provided without resort to speculation, they should say why. 2. The agency of original jurisdiction must ensure compliance with this remand and review an obtained medical opinion for adequacy prior to readjudicating the claim. If necessary, after readjudication, return the matter to the Board for further appellate review. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.