Citation Nr: 21023401 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-39 541 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 August 1990 to August 1994 in the United States Navy. The appeal was previously before the Board in July 2018 and was denied. The Veteran timely appealed the denial to the United States Court of Appeals for Veterans Claims (Court). The Court vacated the July 2018 decision and remanded the appeal to the Board. See March 2020 Memorandum decision. Entitlement to service connection for bilateral hearing loss is remanded. The claim is remanded to obtain a medical opinion that addresses whether the Veteran’s left ear hearing loss is etiologically related to active duty service and whether the Veteran’s pre-existing right ear hearing loss was aggravated by active duing service. The April 2014 VA opinion needs clarification. See 38 C.F.R. §4.2. During service, the Veteran was mostly stationed at sea and alleged exposure to aircraft noise in his “workplace, sleeping quarters, and dining area.” As noted by the Court, his records show hearing loss that occurred throughout his time in service had “more than doubled in dB thresholds by April 2014.” The April 2014 VA examination did not consider the Veteran’s contentions of in-service noise expsosure or explain why the shifts in the dB thresholds were not significant. That opinion is furher inadequate because the examiner did not offer any rationale for concluding that it was more likely that the Veteran’s hearing loss was due to his “life after service” and not his in-service noise exposure. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician on the likely etiology of the diagnosed hearing loss disability. Copies of all pertinent records must be made available to the examiner for review. The examiner is asked to provide a response to the following, with clearly stated rationale: a) Is it at least as likely as not that the left ear hearing loss is related to service, including the Veteran’s direct exposure to jet aircraft noise in workplace, sleeping quarters, and dining area? In providing the requested opinion, specifically address the following (i) consider the Veteran’s description of his in-service noise exposure and left ear threshold shifts as well as his post-service left ear hearing loss development and severity of noise exposure. If there is any medical reason to accept or reject the proposition that the Veteran’s reported noise exposure in service and threshold shifts represented the onset of his current left ear hearing loss, this should be noted. (ii) If the threshold shifts are not deemed significant this should be adequately explained. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? (iii) If post-service noise exposure is the more likely etiology the examiner must explain why this noise exposure is more significant. (iv) What is the significance of the records showing the Veteran’s hearing loss that occurred in service more than doubled in dB thresholds by April 2014? b) Did the Veteran’s right ear hearing loss, which existed prior to service, at least as likely as not increase in severity during service? If so, was the increase in severity clearly and unmistakably (undebatable) due to the natural progress of the disease? What is the significance of the records showing the Veteran’s hearing loss that occurred in service more than doubled in dB thresholds by April 2014? The examiner must specifically address the characterization of the Veteran’s right ear hearing loss at separation (mild to moderate at 4000 to 6000 Hz). M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.S. McLeod 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.