Citation Nr: 21025685 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 16-49 897 DATE: April 28, 2021 ORDER Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT Tinnitus has been shown to have originated during active service. CONCLUSION OF LAW The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1965 to November 1967. He served in the Republic of Vietnam. The Veteran appeared at a January 2021 virtual hearing before the undersigned Veterans Law Judge. The hearing transcript is of record. Service Connection for Tinnitus Service connection may be established for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The service medical records do not refer to tinnitus or ringing of the ears. The service personnel records show that the Veteran was an artillery repairman in the Republic of Vietnam. Because of that service, the Board of Veterans’ Appeals (Board) acknowledges that the Veteran was exposed to artillery fire noise during service. The report of a July 2016 Department of Veterans Affairs (VA) auditory examination states that the Veteran presented a history of recurrent tinnitus of “25 to 30 years or longer.” The Veteran was diagnosed with tinnitus. At the January 2021 Board hearing, the Veteran testified that he was in close proximity to firing artillery guns on a daily basis while performing service duties in the Republic of Vietnam and experienced ringing and impaired hearing after the artillery firing operations. The Board finds that the evidence is in at least equipoise as to whether the diagnosed tinnitus arose during active service. The Veteran served as an artillery repairman in the Republic of Vietnam; was exposed to firing artillery guns on a daily basis; reported experiencing tinnitus during active service after such noise exposure; and has been diagnosed with tinnitus on VA examination. The Veteran is competent to report that tinnitus was present in service and that it has existed from service to the present. 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Charles v. Principi, 16 Vet. App. 370 (2002). Resolving all reasonable doubt in the Veteran’s favor, the Board concludes that service connection is warranted for tinnitus. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to service connection for bilateral hearing loss is remanded. The Veteran asserts that service connection for bilateral hearing loss is warranted as the result of the significant artillery related noise exposure he experienced as an artillery repairman in the Republic of Vietnam. At the January 2021 Board hearing, the Veteran testified that he was in close proximity to firing artillery guns without hearing protection on a daily basis in the Republic of Vietnam. He experienced impaired hearing after the guns fired. The Veteran stated that he had sought treatment for impaired hearing shortly after service separation. Clinical documentation of the cited private treatment is not of record. VA clinical documentation dated after July 2016 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran’s claim. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The service medical records do not refer to hearing loss disability. The October 1967 physical examination for service separation indicates that the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 - 0 LEFT 0 0 0 - 0 The report of the July 2016 VA audiology examination states that the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 35 35 45 55 LEFT 30 35 40 55 60 Speech audiometry found speech recognition ability was not reported as “the use of the word recognition score is not appropriate for this Veteran because of language difficulties, cognitive problems, inconsistent word recognition scores, etc., that make combined use of pure tone average and word recognition scores inappropriate.” The Veteran was diagnosed with bilateral sensorineural hearing loss. The examiner concluded that “given that the Veteran’s hearing thresholds in both ears were within normal limits at time of his separation exam with no standard threshold shift evident in comparison to entrance thresholds, there is no evidence on which to conclude that any hearing loss that the Veteran may presently have in either ear, is caused by, or a result of, military noise exposure” and “based on this evidence, examiner concludes Veteran’s bilateral hearing loss is less likely than not caused by or a result of military noise exposure.” The examiner did not note or otherwise address the Veteran’s competent testimony that he experienced recurrent impaired hearing during and immediately following active service. Because of such deficiency and as the Veteran’s speech recognition ability was not reported, the Board finds that the examination report is of limited probative value. VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). When VA obtains an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, further VA audiology evaluation is needed. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated him for any hearing loss disability. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA clinical documentation not already of record, including treatment records dated after July 2016. 3. Schedule the Veteran for a VA audiology examination to assist in determining the nature of bilateral hearing loss and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all hearing loss disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hearing loss disability had its onset during active service or is related to any incident of service, including conceded artillery-related noise exposure in service and competent testimony as to having experienced impaired hearing during and following active service. The rationale for the opinion cannot be solely that hearing was normal at separation. The Veteran’s lay statements regarding symptoms during and since service should be considered. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. T. Hutcheson, 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.