Citation Nr: 21029869 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 15-23 986 DATE: May 17, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1967 to July 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Veteran testified, sitting in Montgomery, Alabama, before the undersigned via a videoconference hearing. A transcript of the hearing has been associated with the virtual file and reviewed. In May 2019, the Board most recently remanded for further development, as discussed below. The Board finds that the remand directives were not substantially complied with and thus another remand is warranted. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for bilateral hearing loss is remanded. A May 2019 Board decision remanded the claim of entitlement to service connection for a bilateral hearing loss. The Board acknowledged the February 2014 VA examination, which opined that the Veteran's bilateral hearing loss is less likely than not related to his active service due to a history of noise exposure after separation from service. However, the Board noted the Veteran's credible testimony at the September 2018 Board hearing indicating that he had persistent ear infections during service and continuously thereafter. The Board directed the Agency of Original Jurisdiction (AOJ) to obtain any outstanding VA treatment records and request that the Veteran provide authorization to obtain relevant private treatment records regarding the treatment of his ears. And, the AOJ was directed to obtain a VA examination to determine the nature and etiology of any hearing loss condition. The VA examiner was directed to consider the Veteran's statements regarding persistent ear infections. 05/07/2019, Remand BVA. Subsequently, relevant private treatment records were associated with the claims file. In particular, a February 2013 treatment note indicated that there may be a vascular source for the Veteran's hearing loss. 10/22/2019, Medical Treatment Record Non-Government Facility, at 30. The Board notes that the Veteran has asserted that older private treatment records from a retired physician may be available from a current clinician at the same medical provider. 10/30/2019, VA 21-0820. The AOJ did make an attempt to obtain additional records from this provider, but it is unclear as to whether the AOJ specifically requested the records of the retired clinician. 10/24/2019, VA 21-0820. A December 2019 VA examination noted a diagnosis of bilateral hearing loss. The examiner opined that the Veteran's hearing loss condition is less likely than not related to his period of active service. The examiner's rationale was largely based on the lack of contemporaneous service treatment records noting complaints or treatment of hearing loss during active service. However, the examiner did not explicitly consider Veteran's statements regarding persistent ear infections. 12/19/2019, C&P Exam. Subsequently, the Veteran further contended that the onset of his hearing loss may have been delayed and asserted that the VA examiner did not adequately address this theory in the medical opinion. 04/21/2021, Appellate Brief. The Board finds that the December 2019 VA examination does not provide a sufficient rationale regarding whether the Veteran's hearing loss condition is related to his active service. Specifically, the examiner did not explicitly consider Veteran's statements regarding persistent ear infections. Moreover, the examiner did not address whether the onset of the Veteran's hearing loss may have been delayed. As such, the Board finds that the remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. Specifically, the VA examination provided an insufficient rationale that did not consider the Veteran's persistent ear infections and whether the Veteran experienced a delayed onset of hearing loss. Accordingly, the Board finds the December 2019 VA examination to be incomplete and that an addendum opinion is necessary to determine the nature and etiology of the Veteran's bilateral hearing loss. This matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. Additionally, request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records, including records from his private physician regarding treatment of his ears. Specifically, ascertain whether treatment records from Dr. Birdsong may be obtained from Dr. Osula and whether treatment records from Dr. Simmons may be obtained from Dr. O'Neil. See 10/30/2019, VA 21-0820. 2. After completing directive # 1, obtain an addendum opinion from an appropriate clinician regarding nature and etiology of any bilateral hearing loss condition. An in-person examination is not required unless deemed necessary by the clinician. The clinician should review the virtual file, including a copy of this Remand. The examiner is to provide an opinion whether it is at least likely as not related to an in-service injury, event, or disease. The examiner is asked to review the claims file to become familiar with the relevant medical history related to the Veteran's ear condition, to include obtaining a full history from the Veteran, as well as the Veteran's statements regarding persistent ear infections. See 09/26/2019, Hearing Transcript. Moreover, the examiner is to address whether the Veteran experienced a delayed onset of hearing loss and an article showing that auditory damage can accelerate hearing loss in aging in some cases. See 04/21/2021, Appellate Brief, at 2. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David Han 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.