Citation Nr: 21022964 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 18-31 681 DATE: April 19, 2021 REMANDED The claim for service connection for bilateral hearing loss is remanded. The claim for service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1961 to May 1964. The claim was remanded by the Board in March 2019 and July 2020. Unfortunately, there has not yet been substantial compliance with the remand orders. 1. Entitlement to service connection for bilateral hearing loss The Veteran’s representative has asserted that the Veteran’s hearing loss was a case of delayed onset hearing loss, that his ears were damaged by noise exposure during service, and has continued to deteriorate to the point that he now has hearing loss according to VA regulation. The examiner pointed to a 2006 Institute of Medicine study, which found that the most profound auditory effects of noise exposure occur immediately following exposure, as evidence supporting that the Veteran’s hearing loss is not etiologically. However, first, the Board notes that the examiner’s assertion is that “most profound” auditory effects of noise exposure occur immediately after such exposure. However, the impact on hearing must not be “profound” to lead to a service-connectable hearing loss. Moreover, as the Veteran’s representative has noted, the 2006 IOM study is not considered wholly determinative as to the etiology of hearing loss. Therefore, an opinion specific to the facts of this Veteran’s case, including his lay statements regarding the onset and course of his symptoms, and an opinion considering whether delayed onset hearing loss is possible without wholly relying on the 2006 IOM report is required. 2. Entitlement to service connection for tinnitus The VA opinion obtained pursuant to the July 2020 Board remand is inadequate for the purpose of determining the etiology of the Veteran’s tinnitus. The examiner concluded that since hearing loss preexisted the diagnosis of tinnitus, that his tinnitus could not have been aggravated by hearing loss. However, the standard applied in this opinion is incorrect. The preexistence of hearing loss does not mean that hearing loss could not have caused tinnitus and does not determinative of whether as to whether tinnitus was aggravated by bilateral hearing loss. The order of diagnoses in this case are not determinative of proximate service connection. As such, a new opinion must be obtained. The matters are REMANDED for the following action: 1. Forward the claim and this remand to the examiner who provided the July 2020 VA opinion, if available, or to an equally qualified audiologist, to obtain the following opinions pursuant to this remand. The examiner should opine as to the following: a) Did the Veteran’s hearing loss and tinnitus at least as likely as not have its onset during service or are otherwise related to service? The opinion should include consideration of the Veteran’s exposure to loud noises during service. The clinician is advised that an unfavorable opinion is not acceptable if it is based solely on the fact that the shift did not meet VA’s definition of a hearing loss disability during service. The examiner is advised that the rationale may not rest solely on the 2006 IOM report but rather must specifically consider the facts of this Veteran’s case and consider the Veteran’s contentions regarding delayed onset hearing loss. b) Was the Veteran’s tinnitus at least as likely as not (i) caused or (ii) aggravated by his hearing loss? Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Bordewyk, Alicia R. 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.