Citation Nr: 21012718 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-41 480 DATE: March 5, 2021 REMANDED Entitlement to service connection for left ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from November 2008 to June 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the matter in September 2019 and October 2020 for further development. The Veteran and a witness testified at a hearing before the undersigned in February 2019. A transcript of the hearing is of record. Entitlement to service connection for left ear hearing loss is remanded. The Board regrets the delay in rendering a decision on this claim, but finds that a new examination and opinion are warranted to make an informed decision. In accordance with the Board’s prior remand directives, a VA opinion was obtained in November 2020 to reconcile the wide disparity in the audiometric test results recorded in the June 2013 and December 2019 VA examination report with regard to the left ear. The June 2013 VA examination report reflects puretone thresholds of 35 decibels at 35 Hertz, 40 decibels at 1000 Hertz, and 45 decibels from 2000 through 4000 Hertz. The examiner found the results to be valid. By contrast, the December 2019 VA examination report reflects puretone thresholds of 10 decibels from 500 Hertz through 3000 Hertz, and 20 decibels at 4000 Hertz. The puretone thresholds in the June 2013 VA examination report satisfy the criteria for a hearing loss disability, while the puretone thresholds in the December 2019 VA examination report show normal hearing. See 38 C.F.R. § 3.385; Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Board noted in its October 2020 remand that if a current sensorineural hearing loss disability manifested during the pendency of the claim (regardless of whether it subsequently resolved), service connection might be established on a presumptive basis for a chronic disease pursuant to 38 C.F.R. § 3.303(b). In the November 2020 VA medical opinion, the examiner stated that the June 2013 VA examination results represented either a “transient sensorineural hearing loss, or more likely inconsistent results given the note of a positive Stenger at 500 Hz in the left ear.” With regard to the Veteran’s in-service hearing loss, which was noted in conjunction with symptoms of left ear pain and pressure and an eventual diagnosis of otitis media with a spontaneous ear drum rupture, and which also followed surgical repair (tympanoplasty) of a tympanic membrane perforation, the VA examiner stated that the hearing loss would have been conductive in nature, rather than sensorineural, as hearing loss resulting from surgical repair of the left ear drum is conductive. The examiner added that the Board’s prior remand stated that the Veteran’s in-service hearing loss was sensorineural, but that as bone conduction thresholds during service were not reported, there was no way to determine the nature of the Veteran’s hearing loss in service. The November 2020 medical opinion does not account for pertinent evidence in the file, and thus is not sufficient to make an informed decision. With regard to the nature of the Veteran’s in-service hearing loss, the service treatment records themselves reflect diagnoses of “sensorineural hearing loss.” The opinion must account for that diagnosis. Moreover, the Veteran reported “decreased hearing acuity” in August 2009, years prior to the 2011 tympanoplasty procedure. With regard to the June 2013 VA examination report, the November 2020 examiner noted the positive Stenger finding at 500 Hertz, but does not account for the fact that the June 2013 examiner otherwise found the results to be consistent and valid. At this juncture, the Board finds that a new VA examination should be conducted in an effort to reconcile the conflicting findings in the June 2013 and December 2019 VA examination reports as to the presence of left ear hearing loss. A new VA medical opinion must also be obtained that addresses the diagnoses of sensorineural hearing loss in service, and accounts for the decrease in hearing that occurred prior to the tympanoplasty procedure. The matters are REMANDED for the following action: 1. Add to the file any outstanding VA treatment records dated since December 2020. 2. Request the Veteran to identify and authorize the release of any recent private treatment records pertaining to hearing loss. He should also be invited to submit the records himself. 3. When considered safe, arrange for a VA audiological examination to determine whether the Veteran has a current left ear hearing loss disability, and whether it may be related to service. If testing results establish a current left ear hearing loss disability, the examiner is asked to render an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left ear hearing loss is related to his hearing loss in service, and/or to in-service noise exposure, and/or his left ear otitis media with ear drum rupture and subsequent tympanoplasty. The examiner is advised that although the November 2020 VA medical opinion notes that a bone conduction threshold study was not performed in service to rule out conductive hearing loss, the service treatment records reflect diagnoses of sensorineural hearing loss. The examiner must also take into account the Veteran’s decreased hearing prior to the tympanoplasty procedure. If current testing results do not establish a hearing loss disability, the examiner should address the validity of the findings of hearing loss in the June 2013 VA examination report. The examiner must provide a complete explanation in support of the conclusion reached. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rutkin, 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.