Citation Nr: 21013055 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 15-40 875 DATE: March 8, 2021 REMANDED Entitlement to service connection for bilateral hearing loss, to include as secondary to service-connected tinnitus, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1971 to June 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018 and August 2020, the Board remanded the Veteran’s claim for additional development. The case is once again before the Board. Entitlement to service connection for bilateral hearing loss, to include as secondary to service-connected tinnitus, is remanded. The Board must discuss a theory of entitlement raised by the Veteran or by the evidence of record. Robinson v. Peake, 21 Vet. App. 545, 553 (2008). In the November 2015 Substantive Appeal, the Veteran reported that he began having hearing loss not long after his tinnitus was service-connected. This reasonably raised the theory of secondary service connection. Recognizing this, the Board remanded the Veteran’s claim, directing that he be scheduled for an examination and asking the examiner to opine on the issue of direct and secondary service connection. At the following examination, the examiner could not test the Veteran’s hearing acuity. Even so, she opined that the Veteran’s hearing loss was not related to his service and that tinnitus does not cause hearing loss. The opinion did not address whether tinnitus could have aggravated the Veteran’s hearing loss. In August 2020, the Board found the examination inadequate and remanded for a new one. Unfortunately, the remand did not ask for another secondary service connection opinion. Once VA undertakes to provide an examination or obtain a medical opinion, it must ensure that it is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). To be adequate, a secondary service connection examination must answer two questions: whether the Veteran’s service-connected tinnitus (1) caused or (2) aggravated his hearing loss. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). Here, the July 2019 VA examiner only answered the first question. The Board regrets the delay associated with this remand, especially considering that this matter was the subject of two previous remands. However, another remand is necessary to ensure that the Veteran is afforded full compliance with the statutory duty to assist. Finally, as the case is being remanded for additional development, any outstanding VA treatment records should be associated with the claims file. See Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (per curiam). The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Then, arrange for an appropriate healthcare provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hearing loss was (A) caused or (B) aggravated beyond its normal progression by the Veteran’s service-connected tinnitus. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability before aggravation by the service-connected disability. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. 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. 3. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran’s pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Canedy, 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.