Citation Nr: 21023362 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 13-20 506 DATE: April 20, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1962 to June 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). This matter was previously before the Board in April 2015, June 2017, and August 2019. Entitlement to service connection for bilateral hearing loss is remanded. Unfortunately, further remand is necessary to obtain a VA medical center (VAMC) record and VA medical opinions. First, a June 2020 VA medical opinion cited October 2, 2018, VAMC audiogram results that have not been associated with the claims file. The audiogram results should be obtained on remand. Second, the June 2020 VA medical opinion indicated that “Any opinion needed related to Otitis Media requires the Veteran to be seen by a medical provider.” Because otitis media of the left ear was noted in the June 1962 entrance examination, the presumption of soundness does not apply. Potential symptoms of otitis media were referenced in service treatment records (STRs), however. An October 1963 STR noted that the Veteran had an “Ear ache in left ear of 1-2 days duration . . . [with] mild coryza.” In a January 1965 STR, the Veteran “Complain[ed] of stuffiness in ears, on and off for past month.” This was followed by complaints in February 1965 of “loss of hearing in L ear,” for which the Veteran was sent “To ENT [ear, nose, and throat]” clinic. The next day, the ENT clinic noted “? [decreased] hearing on L.” Considering this information, a VA medical opinion is necessary to determine whether the left ear otitis media worsened in service (beyond the natural progress of the disease) and, if so, whether that affected his hearing loss. Finally, an additional VA medical opinion is needed to address hearing loss. Several statements in the June 2020 VA medical opinion were contradictory on their face. Specifically, one statement indicated that when compared to the June 1962 entrance audiogram, the puretone thresholds at 3000 Hertz in a January 23, 2013 audiogram had “improved.” Another reported that “an improvement of thresholds was observed in subsequent audiograms in 1965, 2013 and 2015” relative to the June 1962 entrance audiogram. These statements are inconsistent with the results of the cited audiograms. In the 1960s, the military changed its standard of measuring hearing acuity, replacing American Standards Association (ASA) units with the current International Standards Organization (ISO) units. Prior to January 1, 1967, service departments are assumed to have used ASA units. To convert ASA units to ISO units, the Board added 15 decibels to 500 Hz, 10 decibels to 1000 Hz, 10 decibels to 2000 Hz, 10 decibels to 3000 Hz, and 5 decibels to 4000 Hz. The Board notes that the June 1962 entrance examination audiogram testing results (when converted from ASA units to ISO units) listed the following results: June 1962 HERTZ 500 1000 2000 3000 4000 RIGHT 35 40 30 30 25 LEFT 35 30 30 20 25 Additionally, a January 2002 private audiological evaluation noted “all life” next to the entry for “Onset” of bilateral hearing loss. Based on this evidence, the Board finds that bilateral hearing loss preexisted service and the new VA medical opinion should focus on in-service aggravation of the condition. The matter is REMANDED for the following action: 1. Obtain the Veteran’s October 2, 2018 ,VAMC audiogram results from the “audiogram display,” as noted in the corresponding VAMC Audiology note. Any applicable VISTA imaging should be produced. 2. Obtain an addendum opinion from an appropriate clinician. The clinician must review the claims file, then determine whether it is at least as likely as not that the Veteran’s bilateral hearing loss, which existed prior to service, increased in severity during service. If so, determine whether the increase in severity was clearly and unmistakably (undebatable) due to the natural progress of the disease. Prior to rendering an opinion, the clinician must convert all of the Veteran’s in-service audiograms to ISO units, including those recorded in February 1965 and May 1965. When providing the requested opinions, the clinician must address the evidence and arguments presented in the Veteran’s representative’s March 2019 brief, to include the information taken from WebMD, journal articles, and excerpts from 29 C.F.R. § 1910.95 (discussing hearing protection and acceptable levels of occupational noise for purposes of the Occupational Safety and Health Administration). 3. Obtain a VA medical opinion for otitis media. The clinician must review the claims file, then determine whether it is at least as likely as not that the Veteran’s left ear otitis media, which existed prior to service, increased in severity during service. If so, determine whether the increase in severity was clearly and unmistakably (undebatable) due to the natural progress of the disease. If left ear otitis media did increase in service and that increase was not due to the natural progress of the disease, determine whether that left ear otitis media aggravated the Veteran’s left and/or right ear hearing loss in service. 4. Then, readjudicate the claim. If the benefit sought remains denied, issue a supplemental statement of the case and, after appropriate time for response, return the matter to the Board if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Ripplinger, 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.