Citation Nr: 21012234 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 15-28 502 DATE: March 3, 2021 REMANDED Service connection for bilateral hearing loss is remanded. Service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran had active service from June 1983 to June 1992. In a January 2019 decision, the Board of Veterans’ Appeals (Board) denied service connection for bilateral hearing loss and tinnitus. The Veteran filed a timely appeal to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a June 2020 Memorandum Decision and Order, the Board’s decision was vacated and remanded for action consistent with the decision. The Veteran has reported that he is in receipt of disability benefits from the Social Security Administration (SSA); such records should be obtained. Additionally, the Veteran asserts that during an in-service live-fire exercise, he suddenly lost his hearing and began having difficulty maintaining his balance. He asserts that he sought treatment and was told that his right ear drum had burst due to the time he was spending on the firing line. He asserts that his ear drum burst again two weeks later. Since that time, he reports that his hearing has gotten worse, and he reports that ringing comes and goes. See 05/19/2014 VA 21-4138 Statement in Support of Claim. Service treatment records do not contain any complaints or diagnosis of tinnitus or ringing of the ears, nor any specific treatment for a ruptured eardrum. On an October 1989 Report of Medical History, the Veteran checked the ‘Yes’ box for ‘hearing loss’ and reported a ruptured right membrane. 12/17/2014 Medical Treatment Record-Government Facility at 29. There was no complaint of tinnitus. His ears were clinically evaluated as normal in October 1989 and May 1992. Id. at 8, 26. The record establishes, and the Board concedes, that the Veteran had noise exposure in service and has current tinnitus. A September 2014 audiological examination reflects normal hearing for VA purposes, to include 100 percent speech discrimination scores. See 38 C.F.R. § 3.385. The Veteran reported to the examiner that unilateral intermittent tinnitus began in his right ear in 1987 or 1988 following several right ear drum perforations. The examiner was unable to provide an etiological opinion regarding tinnitus without resorting to speculation. In May 2015, a VA examiner opined that it was less likely as not that the Veteran’s tinnitus was due to service. The examiner noted that the Veteran reported to the audiology examiner the onset of right intermittent tinnitus beginning in 1987 or 1988 following several right ear drum perforations. There is no treatment record demonstrating hearing loss or treatment of any ear conditions. The examiner stated that given a lack of evidence that the Veteran in fact had a tympanic membrane perforation, it is difficult to opine that this would cause tinnitus. More commonly tinnitus occurs in the setting of sensorineural hearing loss. There has been a great deal of research into the etiology of tinnitus, but there is much that we do not yet understand regarding the etiology of this disease. The examiner stated that the Veteran more likely is suffering from idiopathic unilateral tinnitus, which would not be the result of disease, injury, or noise exposure in service. In July 2015, the May 2015 VA examiner offered an addendum opinion in consideration of the Veteran’s reported tympanic membrane perforation. The examiner stated that while there is self-reported evidence of tympanic membrane perforation (which is not substantiated by actual physical examination documentation by medical personnel but still possibly occurred) the Veteran is without a sensorineural hearing loss, which would be typical of tinnitus. The examiner opined, after review of service treatment records, audiograms, history obtained from review of documentation, and prior opinions for this issue, that his tinnitus is consistent with idiopathic unilateral tinnitus and is less likely than so (less than 50% probability) to be related to his military service or reported history of tympanic membrane perforation. The examiner noted review of the conflicting medical evidence and opined that while there is a history of tympanic membrane perforation noted on exit exam where there was not one on his entrance examination, the opinion is based on the Veteran’s audiograms, which do not support a typical cause of tinnitus. The examiner noted review of service treatment records and the Veteran’s statement in support of his claim describing his chronology of events and symptoms. The Veteran submitted an August 2020 private audiological evaluation, which reflects audiometric findings in graph format and may show hearing loss in the right ear. The Veteran should be afforded a C&P examination to assess whether he has hearing loss and the etiology of any diagnosed hearing loss. Further opinion should be sought from a C&P examiner addressing the etiology of the Veteran’s tinnitus, to include consideration of the asserted in-service tympanic membrane perforation and the Veteran’s lay assertions that his tinnitus began in 1987 or 1988. The matters are REMANDED for the following actions: 1. Associate the Veteran’s SSA records with the claims folder. If such efforts, prove unsuccessful, documentation to that effect should be added to the claims folder. 2. Associate updated VA treatment records for the period from March 7, 2019. 3. Schedule the Veteran for an examination with a clinician with appropriate expertise to assess the nature and etiology of his claimed bilateral hearing loss and tinnitus. The Veteran should review the claims folder and offer an opinion as to the following: a) Does the Veteran have hearing loss in the right or left ear in accordance with 38 C.F.R. § 3.385? b) Is it at least as likely as not (a 50 percent or higher degree of probability) that hearing loss of the right ear had its onset during his period of service or is otherwise related to the Veteran’s period of service, including conceded in-service noise exposure and tympanic membrane perforation? c) Is it at least as likely as not (a 50 percent or higher degree of probability) that hearing loss of the left ear had its onset during his period of service or is otherwise related to the Veteran’s period of service, including conceded in-service noise exposure and tympanic membrane perforation? d) Is it at least as likely as not (a 50 percent or higher degree of probability) that tinnitus had its onset during his period of service or is otherwise related to the Veteran’s period of service, including conceded in-service noise exposure and tympanic membrane perforation. The examiner is advised that the Veteran is competent to report his symptoms and history and that his reports must be considered in formulating the requested opinions. The examiner must provide a comprehensive rationale for all opinions offered. If any requested opinions cannot be provided without resort to speculation, the examiner should explain why this is so; and whether the inability to provide the necessary opinion is due to the limits of medical and scientific knowledge or is due to the absence of specific evidence. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.W. Kreindler, 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.