Citation Nr: 21011323 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 15-44 973 DATE: March 1, 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 June 1973 to June 1976, from January 1977 to January 1980, and from October 1981 to October 1984. He also served on active duty in the United States Navy from November 1985 to December 1995. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office. The Board remanded the appeal in August 2018 and April 2020. In the most recent remand, the Board requested an addendum opinion addressing the etiology of the Veteran’s hearing loss, and instructed the examiner to discuss the possibility of delayed onset hearing loss. In May 2020, a VA audiologist opined against the claim, noting a 2016 Military Medical Research article by Yong and Wang that does not support “a years-delayed onset noise-induced hearing loss.” Notably, this report indicates that noise can induce several hearing symptoms such as tinnitus, and that “these symptoms are typically insidious and most patients with noise induced hearing loss may not notice their deficiency until it starts to affect their communication.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455974/ (last accessed February 25, 2021). Here, the Veteran is service-connected for tinnitus (in other words, he had in-service signs of noise inducted hearing problems) and the quoted portion from the Yong and Wang article seems to supports a theory of delayed onset hearing loss, requiring clarification from the VA examiner on remand. See McCray v. Wilkie, 31 Vet. App. 243 (2019). The matter is REMANDED for the following action: Obtain an addendum opinion from the May 2020 VA audiologist. No additional examination of the Veteran is necessary unless the examiner deems otherwise. The examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral hearing loss: (a.) is related to the Veteran’s active service, to include as a result of conceded noise exposure therein, on the basis of a delayed onset theory. In addressing this question, please discuss the following: (1) the Yong and Wang article’s (relied upon in your prior opinion) statement that noise can induce several hearing symptoms such as tinnitus, that the tinnitus pitch match is associated with the frequency spectrum of hearing loss, and fact that the Veteran is service-connected for tinnitus that was present during active duty; and (2) the Yong and Wang article’s statement that hearing loss “symptoms are typically insidious and most patients with noise induced hearing loss may not notice their deficiency until it starts to affect their communication.” Please explain why this statement is not supportive of a delayed onset hearing loss. (3) If you rely upon the 2005 Institute of Medicine study regarding delayed onset hearing loss, please address the portion of the report noting “[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after the cessation of that noise exposure” and that “definitive studies to address this issue have not been performed.” (b.) is proximately due to tinnitus; or (c.) is aggravated (worsened beyond natural progression) by his service-connected tinnitus. If you are unable to opine on any of these questions without resorting to speculation, please provide a basis for your conclusion. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. J. Rogers, 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.