Citation Nr: 21015799 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-17 759 DATE: March 18, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from May 1976 to July 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board for further development in March 2019. In March 2019, the Board reopened the previously denied claim for entitlement to service connection for bilateral hearing loss. The matter returns to the Board for appellate consideration. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that his bilateral hearing loss is related to his military noise exposure. Although the Board regrets the delay, another remand is required before a decision can be made in this case. In the March 2019 remand, the Board directed the RO to obtain an addendum opinion regarding the etiology of the Veteran’s hearing loss. Specifically, the Board asked that the examiner address the Veteran’s lay statements and explain the impact, if any, of the Veteran’s noise exposure in the military due to his military occupational specialty (MOS). Additionally, in assessing the plausibility or non-plausibility of delayed onset hearing loss, the examiner was asked to discuss the Institute of Medicine (IOM) report on noise exposure in the military, considering IOM reports that it is “unlikely” that the onset of hearing loss begins years after noise exposure occurs, but that an “individual’s awareness of the effects of noise on hearing may be delayed considerably after the noise exposure.” In an August 2020 VA addendum report, a VA examiner opined that she could not provide a medical opinion regarding the etiology of the Veteran’s bilateral hearing loss without resorting to speculation. The examiner reasoned that review of the medical evidence shows no evidence of hearing loss or permanent significant changes to the Veteran’s hearing sensitivity during service, although the Veteran’s MOS has a moderate probability of noise exposure. In addition, the examiner noted the Veteran had significant noise exposure both during and after service, to include as a motorcycle and car mechanic, an in gas refineries, power plants, and steel mills. The examiner highlighted that the Veteran’s hearing loss does not have a noise notch but is rather consistent with age related presbycusis. Lastly, the examiner concluded that her opinion could not be based simply on the MOS and the Veteran’s reported history of noise exposure. The Board finds the August 2020 opinion is inadequate. First, the examiner’s opinion is not based on a definitive conclusion as she stated that her opinion could not be rendered without resorting to speculation. Second, the examiner did not consider the Veteran’s lay statements regarding his hearing loss. Third, the examiner did not consider the cited IOM report on noise exposure during military service. Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the Board confers the right to compliance with remand orders). The Board notes the Veteran submitted a statement in September 2020 further clarifying his military occupational noise exposure as a military policeman and his post service occupational noise exposure in more controlled environments. See September 2020 Statement in Support of Claim. As such, a remand is warranted to obtain another addendum opinion to determine the etiology of the Veteran’s bilateral hearing loss, considering his statements about noise exposure, onset of symptoms, the record of evidence, and accepted medical principles. The matter is REMANDED for the following action: Obtain an addendum opinion from the August 2020 VA examiner, or another qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must obtain a full history from the Veteran. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner must provide a fully reasoned explanation. The examiner must provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss disability was caused or aggravated by his active service, including noise exposure therein. In so doing, the examiner should discuss medically known or theoretical causes of hearing loss and describe how hearing loss that results from noise exposure generally presents or develops in most cases, in determining the likelihood that current hearing loss was caused by noise exposure in service as opposed to post service occupational exposures. The examiner MUST address the IOM report on noise exposure in the military, considering IOM reports that it is “unlikely” that the onset of hearing loss begins years after noise exposure occurs, but that an “individual’s awareness of the effects of noise on hearing may be delayed considerably after the noise exposure.” The examiner MUST address the Veteran’s most recent statements regarding his military noise exposure, to include decibel levels, compared to that of his post- service occupational noise exposure and the use of hearing protections during such time. If the examiner is unable to offer the requested opinion, 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. Signature on the next page DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Asfaw, 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.