Citation Nr: 21016155 Decision Date: 03/20/21 Archive Date: 03/20/21 DOCKET NO. 15-25 318 DATE: March 20, 2021 REMANDED Entitlement to service connection for left hip disability, to include a secondary to a back disability, is remanded. Entitlement to service connection for hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1970 to December 1996. The Board most recently remanded the claims in January 2020. There has not been substantial compliance with the Board’s remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for left hip disability, to include a secondary to a back disability, is remanded. At the hearing before the undersigned the Veteran contended that his left hip disability is due to physical activity in service and/or his back disability. The Veteran was afforded VA examinations regarding the etiology of his left hip disability in April 2019 and December 2020. The examination report in April 2019 indicates that the Veteran had an active life and had only minor arthritis in the left hip. In December 2020 the examiner noted in the medical history that the onset date was prior to 1997 while in service. The Veteran started to notice pain in his left hip which he related to his low back pain. He was able to continue physical training and manage the pain at that time. However, although the examiners addressed whether the Veteran’s left hip disability was related to or aggravated by his service-connected back disability, the examiners did not comment on whether the Veteran’s left hip disability was directly related to his active service, including the Veteran’s physical activity in service. Therefore, the issue must be remanded for another VA medical opinion. 2. Entitlement to service connection for hearing loss is remanded. In a January 2020 Board remand, the prior VA examination of the Veteran’s hearing loss disability was found to be inadequate. The basis of the negative nexus opinion was the absence of hearing loss in service and no showing of hearing loss on a November 2011 VA examination. However, the examiner did address the significance of normal hearing at both separation from service and at the November 2011 VA examination many years after service. Thereafter, the Veteran was afforded a VA examination in December 2020. The examiner provided a negative nexus opinion, noting there was no significant permanent shift in hearing thresholds beyond test variability from entrance to separation, which is objective evidence of no permanent auditory damage on active duty from conceded noise. There was no report of complaint/treatment for hearing decrease in service treatment records or at separation. Although noise exposure was conceded and the relationship of noise, auditory damage and hearing loss was well-established, auditory damage and hearing loss are not conceded based on noise alone. There must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology. The Board finds that the December 2020 medical opinion is not adequate. The examiner identifies no permanent shift in hearing threshold during service and relies upon this finding to indicate an absence of hearing loss in service. Although the examiner stated that there was no report of complaint/treatment for hearing decrease in service, the examiner did not address the significance, if any, of an in-service report of mild hearing loss. A December 1977 audiogram shows a hearing threshold of 50 decibels at 4000 Hertz in the left ear, and the Veteran’s reports that he first had hearing loss in service. Although the examiner indicated that there is a relationship between noise, auditory damage, and hearing loss, and that auditory damage and hearing loss are not conceded based on noise alone, the examiner did not identify any potential cause. In addition, the examiner does not discuss the significance of the Veteran’s normal hearing at both separation from service and the November 2011 VA examination report many years after service. Therefore, the issue must be remanded for another VA medical opinion. The Veteran receives consistent treatment from VA. Treatment records dated since December 2020 have not been associated with the claims file. On remand, attempts must be made to obtain and associate with the claims file all VA treatment records regarding the Veteran dated since December 2020. Review of the claims file shows that the Veteran underwent an audiogram in September 2013 and that the results were available in the Audiogram Display. However, the results have not been associated with the claims file. On remand, attempts must be made to obtain and associate with the claims file all scanned treatment records, including the September 2013 audiogram. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from December 2020 to the present. 2. Take all appropriate action to obtain and associate with the claims file all treatment records regarding the Veteran that are scanned into CPRS and VISTA Imaging. 3. Thereafter, forward copies of all pertinent records to a VA clinician to obtain a medical opinion regarding the etiology of the Veteran’s left hip disability. If examination is deemed necessary to respond to the questions presented, one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner must answer the following questions: Is left hip disability at least as likely as not (i.e., 50 percent or greater probability) related to service, including physical activity in service? Provide a rationale to support the opinion(s). 4. Thereafter, forward copies of all pertinent records to a VA clinician to obtain a medical opinion regarding the etiology of the Veteran’s hearing loss disability. If examination is deemed necessary to respond to the questions presented, one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner must answer the following questions: Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran’s hearing loss disability is related to the Veteran’s service, to include the Veteran’s conceded noise exposure? In rendering the opinion the examiner must comment on the in-service notations of hearing loss and a hearing threshold of 50 decibels at 4000 Hertz in the left ear, the Veteran’s reports of first having hearing loss in service, the examination opinions of record, discuss any significance of the Veteran’s normal hearing at both separation from service and the November 2011 VA examination report many years after service. A complete rationale should be provided for any opinion. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, evidence would permit such an opinion to be made. M.E. LARKIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert J. Burriesci, 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.