Citation Nr: 21030486 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-42 152 DATE: May 19, 2021 REMANDED Entitlement to service connection for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from January 1987 to October 1991. This case comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed disagreement with this determination, and the present appeal ensued. In a June 2020 Board decision, the Board remanded the Veteran's claim for right ear hearing loss to provide an adequate examination for the Veteran's disability. The case has now been returned to the Board for further adjudication Entitlement to service connection for right ear hearing loss is remanded. The Board notes that the Veteran's VA medical examinations have found that the Veteran has right ear hearing loss for VA purposes. 38 C.F.R. § 3.385. The Veteran was provided with a VA medical examination in October 2020. The Board notes that the examiner diagnosed the Veteran with right ear hearing loss for VA purposes. However, the VA examiner failed to adequately address the etiology of the Veteran's hearing loss and relied on a lack of hearing loss and threshold shift during service to conclude that the Veteran's right ear hearing loss was not caused by service. The opinion is therefore inadequate for the purpose of readjudicating the Veteran's appeal. The absence of in-service evidence of a hearing disability during service (i.e., one meeting the requirements of 38 C.F.R. § 3.385) is not fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service (as opposed to intercurrent causes). See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). In Training Letter 10-02 (issued in March 2010) regarding the adjudication of claims for hearing loss and tinnitus, the Director of the VA Compensation and Pension Service indicated that the two most common causes of sensorineural hearing loss are presbycusis (age-related hearing loss) and noise-induced hearing loss (caused by chronic exposure to excessive noise). It was also noted that the presence of a notch (of decreased hearing) that may be seen on audiograms generally at frequencies of 3000, 4000, or 6000 Hertz with a return toward normal at 8000 Hertz may be indicative of noise-induced hearing loss. It was noted that delayed-onset hearing loss and tinnitus must be considered. See Training Letter 10-02 (issued in March 2010). The Board concludes that October 2020 examiner provided an inadequate opinion for adjudicating the issue before the Board. The rationale for the examiner's unfavorable opinion is contrary to the Court's holding in Hensley and VA Training Letter 10-02, that the Veteran's claims of experiencing symptoms cannot be dismissed because of a lack of contemporaneous evidence especially in cases involving delayed-onset hearing loss. In light of above, the record for review by the Board remains inadequate for the purpose of readjudicating the Veteran's appeal. Thus, a remand is necessary to obtain an adequate nexus opinion. 38 C.F.R. § 3.159(c)(4); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The matters are REMANDED for the following action: Obtain an addendum opinion to determine the etiology of the Veteran's right ear hearing loss. The complete file must be made available to the examiner for review in conjunction with the examination. The examiner is asked to address the following: Provide an opinion concerning whether the Veteran's right ear hearing loss is at least as likely as not proximately due to or the result of the Veteran's in-service noise exposure. The examiner is reminded that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The examiner should provide a complete rationale for all opinions rendered. The examiner should specifically discuss the pertinent evidence of record, to include the Veteran's assertions described in this remand. If the examiner finds that he or she cannot provide any opinion without resorting to speculation, the examiner must explain why he or she is unable to provide an opinion without speculation, and sufficiently explain the reasons for that inability. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. W. Morgan, Associate 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.