Citation Nr: 21028775 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 17-31 455 DATE: May 12, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1974 to August 1980. This matter comes before the Board of Veterans Appeals (Board) on appeal from a March 2016 decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran and his wife testified at videoconference hearing before the undersigned Veterans' Law Judge. The transcript of the hearing is associated with the claims file. The Board finds that a remand is necessary, as the VA examinations on record are inadequate to make a determination. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran underwent VA medical examinations for his bilateral hearing loss in February 2016 and February 2017. The February 2016 opinion stated that the Veteran "had a conductive hearing loss in the military which is not associated with his current audiogram," but does not explain how the examiner concluded that the Veteran's in-service conductive hearing loss and his current hearing loss are not related. The February 2016 opinion also did not explain its finding that there was no aggravation of the Veteran's hearing loss, stating only "there was a right ear moderate conductive hearing loss during his time in the military." The February 2017 VA examiner also opined that the Veteran's hearing loss was less likely than not related to in-service noise exposure. The February 2017 examiner gave conflicting answers on whether the Veteran had significant hearing threshold shifts between his entrance and separation examinations; when asked whether the Veteran had a permanent positive threshold shift in his left ear, the examiner checked the box for "yes," but then went on to say that "The Veteran's in-service hearing tests were within normal limits and significant threshold shifts were not noted." The VA examiner added that according to the Institute of Medicine, there was an insufficient scientific basis to conclude that noise-induced permanent hearing loss can develop a long time after noise exposure. The Board finds that both VA examiners provided an inadequate rationale for their opinions. First, the VA examiners primarily relied on a lack of evidence of findings of hearing loss in the Veteran's STRs as the basis of the opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992) (finding that a lack of documented hearing loss while in service is not fatal to a claim for service connection). Second, although the February 2017 VA examiner cited the Institute of Medicine's conclusion about prolonged delay in the onset of hearing loss long after noise exposure, the opinion does not identify the onset of the Veteran's hearing loss. The examiner seemingly presumed that the Veteran's hearing loss was "delayed" because of a purported lack of evidence that his hearing worsened during serviceor at least, that the worsening that did occur is related to the Veteran's current hearing loss. Without sufficient data to support this determination, the VA examiner's rationale is inadequate to support their opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2009). Finally, the Board notes the February 2017 examiner's findings on tinnitus seem inconsistent with the findings on hearing loss. The examiner found that the Veteran's tinnitus (for which he has since been granted service connection) was at least as likely as not related to military service, offering the following rationale: The Veteran reports regular exposure to high impact sounds during his deployment to Vietnam. His tinnitus is at least as likely as not a result of military noise exposure. This finding is supported by abnormal acoustic reflex thresholds which indicate cochlea damage. The examiner never explains why this "cochlea damage" is unrelated to the Veteran's current hearing loss, despite apparently being related to his tinnitus. As a general matter, once VA undertakes to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Because the VA examination opinions are inadequate in this case, a remand is necessary. Id. The matters are REMANDED for the following action: Obtain an addendum medical opinion from a clinician regarding the etiology of the Veteran's hearing loss. If a new examination is deemed necessary to respond to the questions presented, one should be scheduled. After a complete review of the claims file, the examiner should answer the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's current hearing loss was caused by his conceded noise exposure in service? The examiner should specifically address the Veteran's assertions that he has experienced hearing loss since service, that his post-service ear surgery was ineffective, and that his pre-service ear surgery was not, in fact, related to hearing loss. The examiner should also address whether the Veteran's hearing loss is of the same etiological origin as his service-connected tinnitus. (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran's current hearing loss was aggravated by his military service? (c) Is it at least as likely as not (50 percent or greater probability) that the Veteran's current hearing loss was caused or aggravated by his service-connected tinnitus? (d) If the Veteran's hearing loss is unrelated to service/tinnitus, what is the likely cause of the disorder? A clear and complete rationale must be provided for all opinions, citing all evidence used in making a determination. If the examiner is unable to provide an opinion without resorting to mere speculation, the examiner must explain why. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shermila Sundquist 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.