Citation Nr: 21010540 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 20-01 776 DATE: February 25, 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 Army from February 1961 to November 1963. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA), and has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107. The Veteran testified before the undersigned Veterans Law Judge during a hearing in January 2021. A transcript of the hearing is associated with the claims file. The Board finds that this matter must be remanded for an addendum VA medical opinion discussing the etiology of the Veteran’s bilateral hearing loss. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA provides a medical opinion, it must be adequate for decisional purposes). The Veteran underwent a VA examination in June 2018. The examiner diagnosed bilateral sensorineural hearing loss, and opined that it was not “at least as likely as not” caused by military service. Nevertheless, he clarified that he “was forced to answer the above question either yes or no. However, the correct answer is that it cannot be determined in that the enlistment hearing test was performed by a whispered voice test which is not frequency specific. Frequency specific audiometric data is needed at enlistment and discharge to determine if hearing changed while in the military. The exit hearing test documented normal hearing bilaterally. Therefore, it is this examiner’s opinion that the noise exposure from the military is less likely than not a cause of his present hearing loss.” The Veteran submitted a medical opinion from V.M.F., Au.D., dated January 2021. V.M.F. stated that she was unable to review service medical records because the Veteran reported that he did not have them. She found, among other things, that a hearing impairment due to previous noise exposure during military service cannot be ruled out. She indicated that the Veteran would like to obtain his separation examination with audiometric testing information to determine the etiology of his hearing loss, but suggested that without this information, she was unable to provide a conclusive medical opinion as to the etiology of his hearing loss. Considering the above, the Board finds that further clarification of the medical evidence is necessary before a decision may be made on the merits. Initially, the examiners did not consider the possibility of delayed-onset hearing loss, which may not necessarily require a finding of a hearing threshold shift during service. See e.g. McCray v. Wilkie, 966 F.3d 616 (Fed. Cir. 2020). Also, the Board is aware that VA treatment records show a report of a physical examination in October 2001, where the Veteran was found to have impacted cerumen, but “good” hearing. This evidence tends to suggest that his hearing loss had its onset after October 2001, and the report should be addressed by the VA opinion provider on remand. The Board further notes that V.M.F. stated that she was unable to review relevant service medical records. However, the Veteran was provided with a copy of his entire claims file after a Privacy Act request was completed in October 2020. Therefore, VA has apparently provided him with a copy of his service medical records, and, should he wish to provide such records to his private audiologist, he remains free to do so. Lastly, the Veteran is service-connected for tinnitus, but previous nexus opinions have not discussed a potential relationship between his bilateral hearing loss and tinnitus on a secondary basis. 38 C.F.R. § 3.310. On remand, the examiner should consider this theory. The matter is REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorder on appeal. 2. Thereafter, obtain a VA medical opinion from a suitably qualified clinician regarding the etiology of the Veteran’s bilateral hearing loss. ONLY IF the clinician believes that a VA examination is necessary to answer the question below should one be scheduled. The clinician is asked to review the claims file and to opine as follows: (a) Is it at least as likely as not that the Veteran’s bilateral hearing loss had its onset during or is etiologically related to military service, to include as due to a delayed-onset reaction from hazardous noise exposure? (b) Is it at least as likely as not that the Veteran’s bilateral hearing loss is proximately due to, a result of, or aggravated by his service-connected tinnitus? A complete rationale should be provided for all opinions. The clinician is asked to consider and discuss relevant lay and medical evidence, to specifically include: • VA treatment records showing a finding of “good” hearing during a physical examination in October 2001 • The VA examination report in June 2018 • The medical opinion submitted by V.M.F., Au.D., in January 2021 • The Veteran’s lay contentions that his current hearing loss is related to military service, to include as due to a delayed-onset reaction to hazardous noise exposure The clinician is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the clinician’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.