Citation Nr: 21026600 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 18-46 988 DATE: May 3, 2021 REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1957 to July 1961. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO) which denied service connection for a bilateral hearing loss disability. In March 2020, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Entitlement to service connection for a bilateral hearing loss disability is remanded. This appeal was previously before the Board in October 2020, at which time the Board, once again, remanded the appeal for additional evidentiary development. Specifically, the Board requested an addendum opinion regarding the etiology of the Veteran's hearing loss disability. The remand instructions specifically requested the RO to obtain an opinion from an otolaryngologist as to whether the Veteran's in-service noise exposure resulted in delayed onset hearing loss. Upon remand, the RO obtained an opinion from a consultant, Dr. C.B.A., who opined that she could not provide a medical opinion regarding the etiology of the Veteran's hearing loss without resorting to speculation. In so finding, Dr. C.B.A. noted that the Veteran's enlistment and separation exams used the "whisper" test, which is not considered to be a good indicator of hearing loss as it is not frequency specific. And it is virtually impossible to know if a hearing loss existed, developed, or progressed during service based on a "whisper" test. Further, Dr. C.B.A. reported that the institute of medicine's report on "Noise and Military Service: Implications for Hearing Loss and Tinnitus" (2006) concluded that, based on current knowledge, noise induced hearing loss (NIHL) occurs immediately, and there is no evidence to support delayed onset of NIHL years after exposure. Also, the recent studies on delayed onset of hearing loss are based on animal models and simply speculation in human subjects. Lastly, Dr. C.B.A. opined that one must consider presbycusis due to Veteran's age and the fact that Veteran had post military noise exposure through employment, but she could not determine the etiology of the Veteran's hearing loss based on the evidence provided. In any event, the Board can take judicial notice that Dr. C.B.A. is an audiologist and not an otolaryngologist as instructed by the Board. The matters are REMANDED for the following action: 1. Obtain VA updated VA treatment records and associate them with the claims file. 2. Provide the Veteran with another opportunity to identify any outstanding private treatment records relevant to his claim, i.e. the discussed 2017 audiological examination. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained. 3. Forward the claims folder to an otolaryngologist for opinion as to whether the Veteran's in-service noise exposure resulted in delayed onset hearing loss. Following review of the claims folder, please provide opinion on the following question: (a.) Whether it is at least as likely as not that the Veteran's bilateral sensorineural hearing loss is causally related to events in service, to include his reported history of noise exposure during service? The expert is asked to specifically comment on the concept of a delayed onset hearing loss (i.e., does absence of pertinent complaints and normal audiometry/whispered voice test at separation preclude a nexus between the current disability and exposure to noise trauma in service). If feasible, the otolaryngologist is asked to cite to medical literature supporting the responses to the questions posed. The otolaryngologist should also discuss the findings of the medical treatise provided by the Veteran ("AHRF Researchers Believe Damage from Noise Occurs Long Before Hearing Loss is Perceived). In rendering the above opinions, the examiner must specifically consider and discuss the April 2020 VA Medical opinion from Dr. N.D., where he concedes that the Veteran may have developed some high frequency hearing loss during service. As well as, the October 2016 VA 21-4138 Statement in Support of Claim, where the Veteran's wife described the Veteran experiencing hearing difficulties in 1966. 4. Thereafter, readjudicate the claim. If any benefit sought on appeal remans denied, furnish the Veteran and his representative a Supplemental Statement of the Case and an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Patrick C. Brady, Attorney Advisor 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.