Citation Nr: 21009792 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-43 201 DATE: February 23, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2000 to June 2000, October 2001 to September 2002, and September 2004 to December 2005. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this claim in May 2018 and September 2020. The most recent remand instructed the examiner to consider the Veteran’s lay assertions of inservice acoustic trauma and continuous symptomatology. In turn, the September 2020 post-remand VA examination report includes the annotation that the Veteran served on active duty from January 2000 to June 2000; October 2001 to September 2002, and September 2004 to December 2005 with an MOS (military occupational specialty) of BFVS Turret Mechanic and combat exposure in Iraq. Hazardous noise exposure was conceded. Additionally, the opinion reported, the Veteran’s service treatment records document normal hearing for VA purposes in 1998, 2004, and 2007, and that his records are negative for significant hearing thresholds shifts while in service. Instead, the examination reports the Veteran first complained of hearing loss in 2012. The examiner found that while the Veteran’s testimony is that hearing loss began with service with continued symptomatology, his testimony, alone, does not outweigh the objective evidence. Unfortunately, this opinion is based on an inaccurate factual background. The opinion cites to the finding that the Veteran first complained of hearing loss in 2012. Significantly, the Veteran’s VA medical records document that hearing loss was first reported in October 2010. At that time the Veteran reported he was interested in starting a claim for hearing loss. In that same month, a VA assessment and plan of care reported the Veteran had decreased hearing in his right ear. This record documents that hearing loss was present, at least in the right ear, sometime prior to October 2010. Furthermore, the examiner was directed to assume the Veteran was credible in reporting some hearing problems during active duty. To the extent that the rationale for the etiology opinion rests with the finding that hearing loss was not reported until 2012 it is inaccurate. Unfortunately, the Board has no way to determine what evidentiary value the examiner placed on this when formulating the opinion. Accordingly, a remand for an adequate decision is needed. The matters are REMANDED for the following action: 1. Obtain updated medical records, VA and private, and associate them with the file. Also ensure, all of the Veteran’s medical records from his reserve duty have been associated with the file. 2. Obtain an addendum opinion from a suitably qualified health care professional to determine the nature and etiology of the Veteran’s bilateral hearing loss. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The addendum opinion must include a notation that this record review took place. It is up to the discretion of the examiner as to whether a new examination of the Veteran is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary by the examiner, the VA examiner is asked to respond to the following inquiry: (a.) Is at least as likely as not (a 50 percent probability or greater) that his bilateral hearing loss is related to an in-service injury, event, or disease? The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. The examiner must specifically consider and discuss the Veteran’s lay statements and assume the Veteran is competent and credible to report that he experienced acoustic trauma during active duty and that he noticed hearing problems while on active duty and at the time of his separation. He is also competent to report the hearing loss symptomology continued until the present. The examiner must assume there was some level of hearing loss present during active duty based on the Veteran's reported history. For the requested opinion above, a comprehensive rationale for any opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.