Citation Nr: 21010056 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 11-18 171 DATE: February 24, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from August 1983 to December 1983 and from October 1984 to April 1988. This case is before the Board of Veterans’ Appeals (Board) on appeal from June 2015 and October 2016 Department of Veterans Affairs (VA) rating decisions. In October 2017 the Veteran withdrew her Board videoconference hearing request. The Board remanded the case to the agency of original jurisdiction (AOJ) in October 2015, June 2016, October 2017, April 2019, August 2019, November 2019, and June 2020, for additional evidentiary and due process development of the claims. Entitlement to service connection for bilateral hearing loss and tinnitus In June 2020, the Board remanded the claims for an addendum opinion by the otolaryngologist who provided an opinion in December 2019, because that opinion was not responsive to all queries of the Board’s November 2019 remand. (It was formerly noted that the Board was seeking an opinion from a specialist other than an audiologist, regarding the etiology of the Veteran’s current bilateral hearing loss and tinnitus, because in the prior opinions of August 2016, November 2017, and August 2019 the audiologist suggested that an “otologic process” not related to acoustic trauma may have led to the claimed disabilities.) Unfortunately, the addendum opinion likewise is insufficient, and the Board has no recourse but to remand the case again for an opinion that does comply with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The September 2020 opinion is deficient because it does not appear that the opinion on a May 2010 VA audiology record was reviewed (or even recorded in the relevant evidence section). Also, it states there is no nexus between military noise exposure and current hearing loss and tinnitus, which is not responsive to whether the current disabilities were related to her active duty service period, and not merely to noise exposure or acoustic trauma therein. Further, the opinion states the only otologic process during service was an acute hearing loss that resolved within two weeks; however, it also acknowledges, without full explanation, that there were threshold shifts greater than 10 decibels at certain Hertz levels in comparing entrance and separation audiograms. As to such shifts, it merely states that hearing levels “remained within VA limits of normal hearing,” which does not explain the cause of such shifts or indicate whether they are of any particular significance. That is, it does not appear to rule out the possibility of some degree of hearing loss during service or that some unacknowledged otologic process began in service. (The Veteran is not precluded from establishing service connection for a current hearing disability where hearing was within normal limits on audiometric testing at separation from service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993).) In additional comments, the otolaryngologist asserts that the Veteran’s current hearing loss at low, mid, and high frequencies was not consistent with noise-induced hearing loss; such an assessment does not preclude the possibility of an otologic process that began in service, as possibly demonstrated by threshold shifts between enlistment and separation. The matters are REMANDED for the following action: 1. Arrange for the claims file to be reviewed by an ear disease clinician (an ENT physician, not an audiologist) other than the provider who furnished opinions in December 2019 and September 2020, for an advisory medical opinion regarding the etiology of the Veteran’s bilateral hearing loss and tinnitus. If an examination of the Veteran is deemed necessary, it should be arranged. The consulting provider is asked to: (a). Opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s current bilateral hearing loss and tinnitus were incurred in, or are otherwise etiologically related to, her (August 1983 to December 1983 and October 1984 to April 1988) periods of active duty service. Of particular concern is any likelihood that an “otologic process” manifesting in hearing loss and tinnitus (as suggested by one VA audiologist) had onset during service. (b). Review the medical opinions (1) on a VA audiology clinic visit in May 2010; (2) on VA examination in June 2015; (3) by a VA consulting audiologist in August 2016, November 2017, and August 2019; and (4) by a VA consulting otolaryngologist in December 2019 and September 2020. Express agreement or disagreement as to the presence of an “otologic process” not related to acoustic trauma (and explain the rationale for the agreement or disagreement). (c). Address the significance, if any, of (a) puretone threshold shifts from service enlistment examinations to the service separation examination (e.g., whether they were within the range of acceptable test variability or were evidence of some “otologic process”); (b) the documented findings of hearing loss in service in a May 1987 report and a June 1987 audiogram (whether they reflect onset of long-term damage, even though it appears to have disappeared by the separation examination, when audiogram findings were within normal limits); and (c) the August 2019 VA examiner’s remarks, in explaining why audiology findings showed hearing loss during service (in June 1987) but not at separation (in April 1988), that the “difference in these test results and normal results on a later date could be due to a non-organic etiology, an otologic process that causes fluctuating hearing loss, or temporary threshold shifts due to noise exposure.” All opinions must include complete rationale, that cites to supporting factual data and, to the extent possible, pertinent medical literature. 2. Then, ensure that the furnished opinion is responsive to all of the requested directives of #1 (above). If not, return the opinion for a supplemental opinion before adjudicating the issues of service connection for bilateral hearing loss and tinnitus. George R. Senyk Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Debbie Breitbeil, 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.