Citation Nr: 21013093 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 15-32 739 DATE: March 8, 2021 REMANDED Entitlement to service connection for tinnitus is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1987 to October 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in November 2012 by a Department of Veterans Affairs (VA) Regional Office. In February 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In July 2019 and September 2020, the Board remanded this case for additional development and it now returns for further appellate review. The Board notes that, subsequent to the issuance of the most recent supplemental statement of the case in January 2021, additional VA treatment records was associated with the record. However, as the Veteran’s appeal is being remanded, the newly received evidence will be considered in the readjudication of the claims. 1. Entitlement to service connection for tinnitus. As noted previously, the Board remanded the matter in September 2020 in order to obtain an addendum opinion addressing whether it is at least as likely as not that the Veteran’s tinnitus is related to his military service, to include his in-service noise exposure (resulting in his service-connected left ear hearing loss) and/or his in-service treatment for impacted cerumen of the left ear. In offering such opinion, the examiner was directed to consider, as relevant, the Veteran’s report that he experienced tinnitus during and since service, but such became more prominent and distracting after his 2008 impacted cerumen extraction. However, as there has not been substantial compliance with such directive, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In December 2020, the Veteran underwent a VA examination, at which time the examiner opined that it was less likely than not that his tinnitus was incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, she reported that, although the Veteran entered into his military service with mild hearing loss in the left ear, a significant threshold shift could not be established from the audiometric data that was available. The examiner further reported that, during his January 2012 VA examination, the Veteran indicated that he experienced tinnitus since his cerumen removal in 2008, but, at the current examination, he indicated that such was incorrect, and, during his December 2019 VA examination, he indicated that such began in approximately 2010. Here, she noted that tinnitus was not reported during military service in either account. Additionally, the examiner essentially reiterated a May 2020 VA opinion that the Veteran’s military occupational specialty of functional support/administration had a low probability of hazardous noise exposure and, thus, his hearing loss was less likely than not a result of such noise exposure; tinnitus did not occur 18 years following hazardous noise exposure, and there was no reason for cerumen removal to cause tinnitus. However, the December 2020 VA examiner did not consider the Veteran’s report that his tinnitus initially manifested in, and had recurred since, service. Also, as noted in the September 2020 Board remand, while the examiner indicated that there was “no documented reason for cerumen to cause tinnitus,” a simple internet search revealed numerous articles addressing the correlation between cerumen impaction and tinnitus. Furthermore, the examiner relied, in part, on a determination that the Veteran’s hearing loss was not related to his in-service noise exposure; however, he is service-connected for left ear hearing loss due to such in-service noise exposure. Therefore, a remand is necessary in order to obtain an addendum opinion which considers the Veteran’s report of initially experiencing tinnitus during service, as well as the potential association between his tinnitus and his impacted cerumen. 2. Entitlement to a TDIU. As the Veteran asserts that he has been rendered unemployable as a result of his left ear hearing loss and tinnitus, adjudication of his TDIU claim must be deferred pending the development and readjudication of his claim for service connection for tinnitus. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc). The matters are REMANDED for the following action: Forward the record, to include a copy of this Remand, to an appropriate clinician so as to obtain an addendum opinion addressing the etiology of the Veteran’s tinnitus. After a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s tinnitus is related to his military service, to include his in-service noise exposure (resulting in his service-connected left ear hearing loss) and/or his in-service treatment for impacted cerumen of the left ear. When rendering this opinion, the clinician is requested to specifically consider and comment on the following evidence: (a.) The Veteran’s report that he experienced tinnitus during and since service, but such became more prominent and distracting after his 2008 impacted cerumen extraction. (b.) The Veteran’s only history of acoustic trauma occurred during service (resulting in his service-connected left ear hearing loss), as he reports no significant post-service occupational or recreational noise exposure. (c.) The Veteran was not noted to have any ear abnormalities when examined during his enlistment medical examination, thereby triggering the legal presumption that no ear abnormalities existed prior to service. (d.) During service, the Veteran was noted to have cerumen blocking his tympanic membranes in October 1988, and he was treated for impacted cerumen in December 1988 and January 1990. (e.) Post-service VA treatment records reflect the Veteran’s treatment for impacted cerumen in April 2003 (at which time his cerumen was noted to be “profound”) and, in October 2008, after which time he reports a significant increase in his tinnitus. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, 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.