Citation Nr: 21015788 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 20-11 515 DATE: March 18, 2021 THE ISSUE Entitlement to service connection for a left ear hearing loss disability. REMANDED Entitlement to service connection for a left ear hearing loss disability is remanded. REASONS FOR REMAND The Veteran had active service from September 1980 to August 1983. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2019 rating determination by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for a left ear hearing loss disability is remanded. The Veteran contends that he has a left hearing loss disability as a result of his exposure to acoustic trauma in service. In order to determine the nature and etiology of the Veteran’s hearing loss disability, he was afforded a VA audiological examination in January 2019. The examiner found that the Veteran currently had left ear hearing loss for VA purposes and acknowledged the Veteran’s in-service acoustic trauma. However, the examiner found that the Veteran’s hearing was less likely than not related to, caused, or aggravated by his service. In explanation, the examiner found that there were stable auditory thresholds during service. Additionally, the examiner found there was preexisting hearing loss in the left ear upon entry into service. Specifically, the examiner cited auditory thresholds “at 3000 and 4000Hz were 25dB and 55dB at 6000Hz for the left ear” in his October 1980 enlistment examination. The report went on to explain that the preexisting hearing loss was not aggravated beyond normal progression during military service, and again cited a lack of significant change in auditory thresholds, noting audiometric data from the October 1980 entrance examination and September 1983 separation examination, which were the same as the entrance examination. The Board notes that the audiometric data cited by the VA examiner does not accurately correspond to the audiometric data contained in the Veteran’s service treatment records (STRs). Specifically, while the audiometric data from the entrance examination is accurately reflected in the January 2019 VA examination report, the examiner does not provide accurate measurements for the exit examination and does not address a finding of “high freq[uency] hearing loss” cited in that report. Additionally, STRs from June 1983 contain a mention of a potential left ear injury which was not addressed by the January 2019 VA examiner. When VA undertakes to provide an examination or opinion, it must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). For the reasons listed above, the Board finds that the VA nexus opinion is not adequate for determining the etiology of the Veteran's claimed left ear hearing loss, as it is not based upon an accurate reading of the Veteran’s medical records and does not address a possible in-service ear injury. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based upon an inaccurate factual premise has no probative value). The Board finds that a remand is necessary to afford the Veteran a VA addendum opinion to determine the nature and etiology of his claimed left ear hearing loss. The matters are REMANDED for the following action: 1. Provide an addendum medical opinion from an appropriate medical professional to determine the etiology of the Veteran's left ear hearing loss. The electronic claims file, to include the Veteran's service treatment records, statements, and treatment records, must be reviewed by the examiner. After reviewing the claims file and examining the Veteran, the examiner should answer the following: did the Veteran's left ear hearing loss clearly and unmistakably (undebatable) preexist the Veteran's service. If the examiner finds it did clearly and unmistakably preexist service, the examiner must opine whether it was clearly and unmistakably not aggravated by service. If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, to include as due to the conceded in-service acoustic trauma. The examiner's attention is directed to the Veteran’s service treatment records which note a possible left ear injury in June 1983 and record “high frequency hearing loss” upon exit examination. The Veteran's assertions as to his in-service acoustic trauma and his symptoms should be noted and addressed by the VA examiner. Finally, the examiner is asked to address the medical articles submitted by the Veteran’s attorney. A rationale for the opinion must be provided. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. If the examiner is unable to offer the requested opinions, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). 2. The RO should then review the record and readjudicate the claim. If it remains denied, the RO should issue an appropriate supplemental statement of the case (SSOC) and afford the Veteran and his attorney the opportunity to respond. The case should then be returned to the Board, if in order, for further review. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. E. Geary, 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.