Citation Nr: 21025139 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-10 285 DATE: April 27, 2021 REMANDED The issue of an increased rating for left ear hearing loss is remanded. The issue of service connection for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from May 2002 to May 2006 and from September 2008 to September 2009. These matters come before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision. The Veteran testified before the Board at a hearing in June 2019. A transcript of the hearing has been associated with the claims file. In a November 2019 decision, the Board remanded these claims to obtain a new VA examination, which was provided in January 2020. During this examination, the examiner attempted to administer two hearing tests, including a test evaluating the Veteran's pure tone thresholds in decibels and a speech discrimination test using the Maryland CNC word list; however, the examiner concluded that the Veteran could not be tested due to inconsistent responses. The examiner opined that it is less likely than not that that the Veteran's right ear hearing loss was incurred in or caused by service. In support of this opinion, the examiner stated that although Veteran's military occupational specialty (MOS) indicates a high probability of noise exposure, the Veteran’s hearing was normal upon enlistment in May 2002 and also at separation in March 2006 with no significant permanent threshold shifts. Further, the examiner stated that the Veteran has conceded in-service noise exposure and that the relationship between noise auditory damage and hearing loss is well-established; however, auditory damage and hearing loss are not conceded based on noise alone. The examiner concluded that although the results of the audiological evaluation performed during the VA examination were inconsistent, the Veteran has previously documented audiograms and VA examinations available for review and this evidence is against a positive nexus opinion. Because the examiner did not discuss the results of these previous audiological evaluations or provide a reasoned medical explanation regarding how the cited medical evidence precluded a positive nexus opinion, another opinion is indicated. In addition, the examiner did not discuss the Veteran’s lay reports regarding his symptomatology, which the Board had requested in its 2019 remand. Lastly, a private audiological evaluation performed in April 2019 indicates that the Veteran has right ear hearing loss for VA purposes at a level worse than was reflected in a 2014 evaluation. As this seems to fit a pattern of decreasing hearing acuity over the years since the Veteran initially entered service in May 2002, some discussion of this private report in the context of the Veteran’s claim should occur. In view of the foregoing, another examination of the Veteran should be scheduled, and a medical opinion obtained concerning the etiology of his right ear hearing loss. With respect to the Veteran’s left ear, since the outcome of its evaluation could be impacted by the outcome of the service connection question, a final determination may not yet be entered. Further, since the Veteran’s contention remains that it has worsened since last evaluated, another examination should be scheduled. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of his right ear hearing loss and assess the current severity of his service-connected left ear hearing loss. The claims folder must be made available to and be reviewed by the examiner. With respect to the right ear, the examiner should address whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right ear hearing loss had its onset during service or is otherwise related to service? In offering the opinion, the examiner should discuss the Veteran’s in-service audiological evaluations, the report dated between periods of service, as well as VA and private audiological evaluations dated after September 2009, which together appear to reflect a gradual decline in hearing acuity after May 2002. Any significance to what appears to be the right ear auditory threshold of 30 decibels at 6000 Hertz recorded in May 2002, also should be discussed. (Continued on the next page)   In providing the requested opinion, the examiner should consider and discuss all pertinent medical and lay evidence of record, to include the Veteran’s competent assertions as to the nature, onset, and continuity of such problems since service. Notably, the absence of documented evidence of a diagnosis or associated symptoms during and shortly after service should not, alone, serve as the sole basis for a negative opinion. A rationale for all opinions is to be provided. If the examiner cannot provide any of the requested opinions without resorting to speculation, he or she should provide an explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Page-Nelson, 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.