Citation Nr: 21021438 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 17-67 268 DATE: April 13, 2021 REMANDED Entitlement to service connection for hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1960 to June 1965. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). The Board most recently remanded the claim in January 2021 for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran asserts that his bilateral hearing loss began during service and has existed since that time and is related to in-service flight line noise exposure. The Board is unable to make a final decision on the claim because the January 2021 medical opinion is inadequate. The examiner opined that the Veteran’s bilateral hearing loss was less likely than not related to service, to include conceded in-service noise exposure. The basis of the opinion was a lack of evidence of hearing loss at the time of separation and a 2005 IOM report ("Noise and Military Service: Implications for Hearing Loss and Tinnitus") that was referenced to refute the theory of delayed onset hearing loss. However, the examiner did not address the qualifying or contradictory findings in that report. McCray v. Wilkie, 31 Vet. App. 243 (2019). Furthermore, the examiner did not consider the Veteran’s 2006 National Institutes of Health report (“Noise and Military Service”), or his October 2020 Board hearing. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician on the likely etiology of the Veteran’s hearing loss. Copies of all pertinent records must be made available to the examiner for review. Based on a review of the record, the examiner must answer the following: Is it at least as likely as not (50 percent probability) that the Veteran’s hearing loss disability was incurred in or is otherwise related to service, to include conceded in-service noise exposure to active flight line? In providing the opinion, the examiner must specifically consider and address (i) the National Institutes of Health, Noise and Military Service (2006); (ii) Journal of Occupational and Environmental Medicine, Effects of Concurrent Noise and Jet Fuel Exposure on Hearing Loss (2005); (iii) Veteran's Correspondence received October 2, 2017; (iv) March 2017 Buddy Statements from J.S.,P.M.,L.R., B.R., R.S., R.M., M.R., and M.J.; and (v) October 2020 BVA Hearing. Should the examiner rely to any extent upon the IOM study, noted above, the examiner must (i) identify the medical text’s qualifying or contradictory aspects (“There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure ); and (ii) explain why the examiner found the contradictory aspects or conclusions in the IOM study to be less persuasive in this Veteran’s case as to the question of whether delayed onset hearing loss is as likely as not etiologically related to in-service noise exposure. The examiner may discuss this Veteran's documented complaints and clinical history in support thereof, but must not reject medical history unless otherwise incongruous with the record and explaining why any history is rejected. The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state why. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.