Citation Nr: 21012552 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 16-37 925 DATE: March 4, 2021 REMANDED Entitlement to service connection for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1959 to October 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the appeal was initially characterized as entitlement to service connection for bilateral hearing loss. However, in a September 2020 rating decision, the RO granted service connection for left ear hearing loss with a noncompensable evaluation effective October 10, 2013. As a full grant of benefits has resolved this issue, it is no longer in appellate status. AB v. Brown, 6 Vet. App. 35 (1993). Moreover, the issue in this decision has been recharacterized to reflect the grant. The Veteran testified at a videoconference hearing before the undersigned in July 2019. A transcript is of record. In July 2020 and November 2020, the claim was remanded for further development. 1. Entitlement to service connection for right ear hearing loss is remanded. Unfortunately, another remand is necessary for full compliance with the previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order). In its November 2020 Board remand, the Board specifically stated that the July 2020 VA medical addendum opinion failed to address the fact that post-service treatment records show that the Veteran still has a perforated right tympanic membrane. The Board referenced the April 2013 VA audiology consult, as well as the November 2017 and May 2019 treatment records. In addition, the Board expressed that the July 2020 VA examiner failed to address the Veteran’s contention that he has had a gradual onset of hearing loss since he ruptured his right eardrum and continues to get right ear infections if he gets in the water. The Veteran was afforded an addendum VA medical opinion by the same VA examiner in November 2020. However, the VA examiner offered an opinion that was merely a copy-and-paste of her July 2020 addendum opinion with some minor changes. The opinion is inadequate as the examiner failed to address the fact that post-service treatment records show that the Veteran still has a perforated right tympanic membrane and the Veteran’s assertion that he has had a gradual onset of hearing loss since he ruptured his right eardrum. Thus, an addendum opinion is required. The matters are REMANDED for the following action: 1. The AOJ should obtain a VA medical opinion from a different VA examiner to determine the nature and etiology of any right ear hearing loss that may be present. The examiner is requested to review all pertinent records associated with the claims file, including this REMAND, the Veteran’s service treatment records, post-service medical records, and assertions or statements by the Veteran. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. In addition, military personnel records, such as the DD 214, show that the Veteran served as an aircraft maintenance support during service, which has a high probability of hazardous noise exposure. As such, in-service hazardous noise exposure is conceded. The Board notes that the lack of hearing loss documented in service or at separation cannot, standing alone, serve as the basis for a negative etiology opinion. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s right ear hearing loss is related to his military service, to include any right ear tympanic membrane injury or noise exposure therein. The examiner must address Veteran assertions that he has had a gradual onset of hearing loss since he ruptured his right eardrum, and that he continues to get right ear infections if he gets water in his right ear. The examiner must also address post-service treatment records that show the Veteran still as a perforated right tympanic membrane. See April 2013 VA audiology consult. See also November 2017 and May 2019 private treatment records. If it is not found that the Veteran’s right ear hearing loss is caused by his service, the examiner should address how the etiology for hearing loss in his right ear might differ from that of his left ear. Additionally, the examiner should explain the significance, if any, that the Veteran did not have right ear hearing loss in service or for many years thereafter. In rendering his or her opinion, the examiner should discuss medically known or theoretical causes of hearing loss and describe how hearing loss which results from noise exposure generally presents or develops in most cases, as distinguished from how hearing loss develops from other causes, in determining the likelihood that the disorders were caused by noise exposure in service as opposed to some other cause. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. 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.