Citation Nr: 21029467 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 17-52 041 DATE: May 13, 2021 REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1984 to January 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In March 2021, the Veteran and his representative submitted additional private medical records with a waiver of RO consideration of that evidence. 1. Entitlement to service connection for a bilateral hearing loss disability is remanded. The Veteran contends that his hearing loss and tinnitus began in the early 1990s. See Hearing Transcript (February 2021) & VA Form 9 (September 2017). In his September 2017 substantive appeal, he reported excessive noise exposure from working near T-64 jet engines and helicopter engines when stationed at New River Air Station, North Carolina. Later, in February 2021, he testified that he was a jet engine mechanic in service and did not have hearing protection; and that, although he continued working as an airplane mechanic after service, he had hearing protection. The Board concludes that remand is required to obtain an addendum opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Notably, a central issue in determining probative value of a medical opinion is whether the examiner was informed of the relevant facts and that the opinion was based on an accurate factual premise with consideration of the Veteran's prior medical history. Ardison v. Brown, 6 Vet. App. 405, 407 (1994); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Here, a December 2015 VA examination was conducted. The examiner provided negative nexus opinions regarding hearing loss and tinnitus, noting no reports of hearing loss or tinnitus during service or at separation, and significant post-service noise exposure. In March 2021, however, the Veteran submitted a summary of private audiogram results dating from 1988 to 2020. Notably, left ear hearing loss for VA purposes (although not at the 10 percent level required for service connection, see 38 C.F.R. § 3.307(a)(3)) is shown in December 1988, within a year of service discharge. This is relevant information that was not considered by the 2015 VA medical opinion. Therefore, remand is necessary a medical professional to consider and address this relevant information. It is noted that the Board is prohibited from substituting its own medical opinion to support or deny a claim. Colvin v. Derwinski, 1 Vet. App. 171 (1991) (holding that the rating board cannot substitute its own medical judgment for that of medical professionals). In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding bilateral hearing loss and tinnitus. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with the diagnosed bilateral hearing loss and tinnitus. The opinion should, among other things, include a discussion of the Veteran's documented history and assertions. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician should provide an opinion, with supporting rationale, as to: Whether the Veteran's bilateral hearing loss and tinnitus at least as likely as not (1) had onset in service, (2) are otherwise related to an in-service injury, event, or disease; or (3) manifest within one year of service discharge. Consider whether symptoms described by the Veteran, such as hearing difficulty and ringing in the ears within a few years of discharge, at least as likely as not represent the onset of bilateral hearing loss or tinnitus in service and indicate whether such symptoms are more likely than not due to other causesexplain. Consider whether the diagnosis of left ear hearing loss within one year of service discharge, as shown by Premise Health Audiogram record dated December 1988 (received March 2021), at least as likely as not represents the onset of LEFT ear hearing loss in service and indicate whether such symptoms are more likely than not due to other causesexplain. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): If any medical history is rejected, a complete explanation is required. 2. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The 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; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.