Citation Nr: 21010552 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 15-35 256A DATE: February 25, 2021 REMANDED Entitlement to service connection for peripheral neuropathy, each lower extremity (LE), is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran had active service from August 1965 to August 1967. His service included a tour in the Republic of Vietnam (RVN). On initial review of this case the Board reopened the hearing loss claim and remanded it and the peripheral neuropathy claims to the Agency of Original Jurisdiction (AOJ) for additional development. See 07/23/2019 BVA Decision. On further review, the Board finds that additional development is still needed. 1. Entitlement to service connection for peripheral neuropathy, each LE, is remanded. The AOJ arranged for an examination of the Veteran and a nexus opinion as directed in the July 2019 remand. The examination reports (12/31/2020 C&P Exam, 1st and 2nd Entries), however, reflect that the nexus opinions are inadequate for appellate review purposes. The nurse practitioner (NP) examiner opined that it is not at least as likely as not (at least a 50 percent probability) that the Veteran manifested with either early onset peripheral neuropathy of the LEs within one year of his active service, or any other type peripheral neuropathy within one year of his active service. The examiner based their rationale on the fact that the claims file is silent for any chronic complaints of neuropathy symptoms until 2014. Id. P. 2. The examiner noted the evidence of the Veteran’s lay testimony that he noticed leg numbness within 3 months of his return from RVN and separation from active service, but she did not address or analyze the significance, if any, of his lay reported symptoms, which the Board deems credible. Hence, the opinion is not supported by an adequate rationale, and additional explanation is needed. See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). 2. Entitlement to service connection for bilateral hearing loss is remanded. In the audio addendum to the examination report (11/22/2019 C&P Exam) it was found not at least as likely as not that the Veteran’s hearing loss had its onset (manifested to a compensable degree) in each ear within one year of his separation from service. In her rationale the audiologist discussed the prospect of a temporary hearing loss due to acoustic trauma, but she opined that there was no evidence to support a delayed onset of permanent hearing loss. In the discussion of her rationale she cited the findings of the Institute of Medicine (IOM), which is the health branch of the National Academy of Sciences (NAS). The IOM had found that although there were no definitive studies, based on anatomical and physiological data, it was unlikely that there would be a delayed onset of a chronic sensorineural hearing loss following acoustic trauma. Id. P. 2. Although the IOM study was not the sole basis for her negative nexus opinion, see McCray v. Wilkie, 31 Vet. App. 243 (2019), the Board finds that a matter raised by the Veteran’s representative in the Brief filed on the Veteran’s behalf should be addressed. The Brief cites a medical study that posits that temporary noise damage can have dramatic long-term consequences on the acceleration of age-related sensorineural hearing loss. See 02/01/2021 Appellate Brief, P. 2. The Board is aware the general presumption of competence includes a presumption that medical professionals remain up to date on medical knowledge and current medical studies related to their particular field. See Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012). This means that the audiologist is presumed to have had knowledge of the study cited in the representative’s brief. Nonetheless, the Board finds that the audiologist should comment on whether the cited study impacts her opinion on the etiology of the Veteran’s loss, especially in light of her discussion of a temporary hearing loss due to acoustic trauma. The matters are REMANDED for the following action: 1. Send the claims file to the examiner who conducted the neurological December 2020 neurological examination and rendered the negative nexus opinions. Inform the examiner that the impact or significance, if any, of the Veteran’s written submission and sworn testimony that he experienced symptoms of numbness in his legs within 3 months of departure from RVN and his separation from active service must be assessed and analyzed. As noted in the prior remand, the Board finds the Veteran credible. The examiner must explain how the Veteran’s credible reports factored into her opinion. If the examiner who conducted the December 2020 examination is no longer available, send the claims file to an equally or better qualified examiner for a medical nexus review. 2. Send the claims file to the audiologist who conducted the November 2019 hearing examination and rendered the negative nexus opinion. Refer the audiologist to the study cited in the Appellate Brief and ask the audiologist to provide an addendum wherein she discusses whether the study changes her prior opinion in any way. Please provide a full discussion of why the cited study does or does not impact her prior opinion. If the audiologist who rendered the November 2019 opinion is no longer available, send the claims file to an equally or better qualified audiologist. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. T. Snyder 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.