Citation Nr: 21026724 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 14-41 358 DATE: May 3, 2021 REMANDED Entitlement to service connection for bilateral hearing loss, to include as secondary to service-connected mycosis fungoides, is remanded. Entitlement to service connection for bilateral tinnitus, to include as secondary to service-connected mycosis fungoides, is remanded. REASONS FOR REMAND The Veteran had active duty service from January 1968 to January 1970. The Veteran initially appealed an adverse rating decision from December 2013 issued by a Regional Office (RO). The case then came to the Board wherein the Board remanded the issues for further development in November 2018. The case has been returned to the Board of Veterans' Appeals (Board) for further appellate review. 1. Entitlement to service connection for bilateral hearing loss, to include as secondary to service-connected mycosis fungoides, is remanded. In this case both an audiologist and an ENT issued medical opinions as to the claims at issue. The audiologist issued her opinion in October 2019 and the ENT issued his opinion in July 2020. The examiners were asked to address the nature and etiology of the disability and determine whether it is at least likely as not that the disabilities were related to service and whether the disabilities were at least likely as not caused or aggravated by the already service-connected mycosis fungoides. In providing the opinion, the audiologist stated that the "Separation exam dated 10/23/69 also showed normal hearing, presumed ISO-ANSI standards as not documented otherwise". On the separation exam it is not documented which standard was used, American Standards Association (ASA) units or International Standards Organization-American National Standards Institute (ISO-ANSI) units. As to the ENT's opinion, he noted that "Audiometric testing at separation was normal;" however, it is not documented whether the ENT used ASA and ISO-ANSI standards to make that opinion. Under VA policy, prior to January 1, 1967, the ASA standard is assumed to have been used. Between January 1, 1967 and December 31, 1970, the data should be considered under both ASA and ISO-ANSI standards. After December 31, 1970, the ISO-ANSI standard is assumed to have been used. Since this Veteran was discharged in October 1969, the ASA and ISO-ANSI standards should have been considered. In light of the above, and where necessary to facilitate data comparison for VA purposes in the decision below, including under 38 C.F.R. § 3.385, audiometric data originally recorded using ASA standards will be converted to ISO-ANSI standard by adding between 5 and 15 decibels to the recorded data as follows: Hertz 250 500 1000 2000 3000 4000 6000 8000 add 15 15 10 10 10 5 10 10 Therefore, an addendum opinion is necessary with consideration of the separation audiogram findings under both ASA and ISO-ANSI. At the time of the separation examination, the Veteran's puretone thresholds in dB were as follows: HERTZ 500 1000 2000 3000 4000 Right Ear 5 10 10 -- 15 Left Ear 5 10 10 -- 10 The separation examination was ASA, then the conversion to ISO results in the following puretone thresholds: HERTZ 500 1000 2000 3000 4000 Right Ear 20 20 20 -- 20 Left Ear 20 20 20 -- 15 An addendum opinion is necessary to consider the ASA and ISO-ANSI converted puretone threshold. 2. Entitlement to service connection for bilateral tinnitus is remanded. Please see the analysis in Section 1, above. The matters are REMANDED for the following action: Obtain an addendum opinion from the ENT examiner regarding whether the Veteran's hearing loss or tinnitus at least as likely as not first manifested during active service or are causally related to his noise exposure during active service. The examiner should specifically address the October 1969 audiogram using both ASA and ISO-ANSI standards as noted above. The examiner should consider any findings of hearing loss and whether they reflect any threshold shift between 1968 and 1970 using both the ASA and ISO-ANSI standards. If the examiner is not available, provide the claims file to an ENT for an opinion regarding the above. A complete rationale must be provided for all opinions offered. If any opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence would potentially allow for a more definitive opinion. If an additional examination is required for the examiner to sufficiently address the above questions, then a new examination should be afforded. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Wilson, Bronwyn I. 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.