Citation Nr: 21029002 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 17-15 243 DATE: May 12, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from October 1975 to October 1978. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a January 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran provided testimony before the undersigned Veterans Law Judge (VLJ) at a July 2020 Board hearing. A copy of the transcript has been associated with the claims file. 1. Service connection for bilateral hearing loss is remanded. 2. Service connection for tinnitus is remanded. The Veteran contends that his current bilateral hearing loss and tinnitus is a result of hazardous noise exposure in service. Specifically, the Veteran argues that his hearing loss and tinnitus disabilities are due to acoustic trauma related to his military occupational specialty (MOS) duties. See Hearing Transcript (July 2020). The record shows that the Veteran's MOS was a power generator equipment operations mechanic. See VA Form DD214. The Veteran asserts that he spent 8 hours a day in the motor pool. His duties involved running large generators for a long period of time and being in the field firing weapons. He contends that he was not exposed to any hazardous noise after service. See Hearing Transcript (July 2020). In December 2015, the Veteran was afforded a VA examination. The Veteran was found to have bilateral sensorineural hearing loss and tinnitus. The examiner concluded that the Veteran's bilateral hearing loss were less likely as not caused by or a result of an event in military service. For rationale the examiner noted the Veteran's enlistment and separation examination reports and stated that both examinations indicated normal hearing and showed no permanent positive threshold shifts during active duty. The examiner further noted that the Veteran served as a generator mechanic in a motor pool in the Army, and that the Veteran reported exposure to noise from artillery with the use of hearing protective devices. Further, the examiner noted that after separation the Veteran reported only doing "odd jobs" for employment, such as jobs in lawn care and as a mechanic. As for tinnitus, the examiner concluded that the Veteran's tinnitus is at least as likely as not a symptom of his hearing loss. However, the examiner opined that the Veteran's tinnitus was less likely as not caused by or a result of military noise exposure. For rationale, the examiner noted that the Veteran did not relate the onset of tinnitus to a time or incident while on active duty. Additionally, the examiner referenced the Veteran's inability to identify the onset of his tinnitus. The Board finds the December 2015 VA examination inadequate for the following reasons. First, the December 2015 examiner did not account for the delayed onset of the Veteran's bilateral hearing loss and tinnitus. The Veteran contends that both his bilateral hearing loss and tinnitus began a few years after service, however the examiner did not address this. Additionally, the examiner did not adequately consider whether the Veteran's bilateral hearing loss and tinnitus are etiologically related to the Veterans reports of working on large scale generators and engines, being present in the motor pool for 8 hours a day, lack of hearing protection, as well as noise exposure from firing weapons. See Hearing Transcript (July 2020). See McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016) ("the VA examiner's failure to consider [the Veteran's] testimony when formulating her opinion renders that opinion inadequate."). Second, the VA examiner relied on the absence of evidence of hearing loss and tinnitus complaints in the Veteran's STR and concluded that there was no objective in-service noise injury, without adequate consideration of the Veteran's lay statements and circumstances of his service. Additionally, the examiner's emphasis on the Veteran's post service lawn care as a job as a source of noise exposure appears questionable given the Veteran's hearing testimony that this involved lawncare around his own home. See Hearing Transcript (July 2020). Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). In general, an adequate medical opinion must support its conclusion with analysis that can be weighed against contrary opinions and be based upon prior medical history and examinations. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision"). Here, the Veteran's reports of noise exposure during in service are consistent with the circumstances of his service. The examiner, however, made no attempt to explain why the claimed in-service noise exposure did not cause or contribute to the Veteran's bilateral hearing loss and tinnitus disabilities. Third, the absence of in-service evidence of a hearing loss disability is not fatal to the Veteran's claim for service connection for a hearing loss disability. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. Hensley v. Brown, 5 Vet. App. 155 (1993). It is also noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007). A "medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board cannot make a fully-informed decision on the issue of bilateral hearing loss and tinnitus because the December 2015 VA medical opinion is inadequate, with respect to addressing the realtionship between the Veteran's claimed in-service noise exposure and his current bilateral hearing loss and tinnitus. Due to the foregoing, a remand is necessary to obtain an adequate VA examination and medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Finally, the Board notes that in correspondence received in September 2020, the Veteran, through his representative, stated he had a hearing examination recently at the VA hospital in Birmingham and requested this examination be associated with the claims file. On remand, the AOJ should attempt to obtain and associate with the file a copy of this examination. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records, including a hearing examination administered in approximately September 2020 at the VA hospital in Birmingham, and associate them with the claims file. 2. Schedule the Veteran for a VA examination for his bilateral hearing loss and tinnitus. The examiner must review the electronic claims file, including a copy of this remand, the VA examiner is requested to opine as to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hearing loss had onset during military service, within a year following service, or is otherwise related to service, including in-service noise exposure? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's tinnitus had onset during military service, within a year following service, or is otherwise related to service, including in-service noise exposure? In providing the requested opinion, consider the Veteran's description of his in-service noise exposure as well as his post-service noise exposure. Additionally, the examiner must consider the Veteran's lay statements including the onset of the Veteran's bilateral hearing loss and tinnitus. The examiner must provide a complete and fully articulated explanatory rationale for any opinion expressed that is based on the examiner's clinical experience and medical expertise; established medical principles; and the evidence in the electronic claims file. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Law Clerk for the Board N. Jamordee 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.