Citation Nr: 21015644 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 17-00 587 DATE: March 18, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1966 to November 1968. In September 2019, the Board remanded this case for additional development. The Board finds that there has not been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998). Initially, the appeal included the issue of entitlement to service connection for tinnitus. An August 2020 rating decision established service connection for tinnitus and assigned a 10 percent rating, effective January 16, 2015. The August 2020 decision represents a full grant of benefits sought. Thus, the issue of entitlement to service connection for tinnitus is no longer on appeal. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran asserts that bilateral hearing loss is the result of service. In September 2019, the Board remanded the claim, in part, because the April 2015 examination was incomplete. The April 2015 examiner did not consider the Veteran’s statements of continuity of symptomatology, and the examiner did not note threshold shifts in hearing acuity during active service. The Board requested a medical opinion which addressed the etiology of bilateral hearing loss and requested that the examiner “discuss the Veteran’s lay statements regarding the history and continuity of symptomatology…[and] specifically address any in-service threshold shifts.” The Board noted that the basis of the opinion should not be based on the fact that “hearing was normal at separation.” The Board the December 2019 medical opinion to be incomplete. The examiner opined that bilateral hearing loss was not the result of service. The examiner stated that when “directly asked” about hearing loss in service, the Veteran stated that hearing loss was “not until some years later.” While the examiner noted that “the Veteran seemed to have difficulty differentiating between the hearing loss and ringing in his ears,” the examiner did not discuss or reconcile the Veteran’s reports to the April 2015 reports that “he first noticed problems with his hearing in basic training.” The examiner stated that “[a] review of the C-file and service medical records revealed the Veteran to have normal hearing sensitivity at both the entrance and separation exams with no significant threshold shifts.” The Board notes that a significant threshold shift is defined as a 15 dB shift or more at any frequency of 500 Hertz to 4000 Hertz. The August 1968 audiogram shows a 15 dB threshold shift in the left ear at 3000 Hertz, when compared to the September 1966 audiogram. In addition to basing the opinion on normal hearing at separation, the examiner did not discuss the threshold shift in service. A remand confers on the Veteran the right to compliance with the terms of that remand. Stegall v. West, 11 Vet. App. 268 (1998). During the April 2015 VA examination, the Veteran reported that he had a “significant drop in hearing in his left ear last September or October. He stated that he was seen by an ENT in Columbia, TN and was given an injection in his left ear. He denied receiving a diagnosis at the time.” The relevancy of the reported left ear treatment was not discussed in the December 2019 report. Moreover, there is no record of the reported treatment. As that and other medical records regarding the ears or hearing loss may be relevant to the question of etiology, all relevant private medical records must be obtained. The Board notes that during the June 2019 Board hearing, the Veteran’s representative challenged the validity of the August 1968 separation audiogram. The representative asserted that the test was invalid because the Veteran’s hearing improved despite unprotected, hazardous noise exposure. This assertion was not addressed in the December 2019 VA examination. When VA obtains an examination or opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Remand is necessary for a VA examination and to obtain private medical records. The matter is REMANDED for the following action: 1. Ask the Veteran to identify all relevant private medical records, to include the treatment record of the left ear procedure reported during the April 2015 VA examination. After obtaining any necessary releases, obtain all relevant VA and private treatment records not already associated with the claims file. All attempts to locate records must be documented in the claims file. 2. Schedule the Veteran for a VA audiology examination to obtain an opinion on the etiology of bilateral hearing loss. The examiner must review the claims file, to include this Remand, and should note that review in the report. For the purposes of this analysis, VA concedes that the Veteran was exposed to acoustic trauma during service. The examiner must: (a) Opine whether it is at least as likely as not (50 percent probability or greater) that bilateral hearing loss had its onset during or is otherwise related to the conceded hazardous noise exposure during service. The examiner must provide sufficient rationale for the opinion explaining why any etiology for the hearing loss disability is more likely than another. The basis of the opinion cannot be solely that hearing was normal at separation. (b) Discuss the Veteran’s lay statements as to symptoms during and since service. (c) Discuss any significance of the threshold shift in service. (d) Discuss any significance of the improvement in hearing, as shown on the August 1968 audiogram. Specifically, the examiner should state whether that improvement, despite noted in-service noise exposure, is probable, or indicative of a flawed examination. The examiner should explain the opinion. (e) Discuss any significance of any post-service ear complaints, treatments, and diagnoses, to include a 2014 “significant drop in hearing” in the left ear, followed by a left ear “injection.” Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.O., 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.