Citation Nr: 21031452 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 20-02 472 DATE: May 21, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from November 1966 to October 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO); this case is in legacy appeals system. The Veteran testified at a November 2020 Board hearing before the undersigned; a transcript is associated with the claims file. 1. Entitlement to service connection for bilateral hearing loss is remanded. Although VA has provided two examinations to determine the cause of the Veteran's diagnosed bilateral hearing loss, both opinions provided are inadequate to support a decision by the Board. In January 2019 and in March 2021 VA examiners opined that from the Veteran's February 1966 enlistment exam to his August 1968 separation exam there was no "significant threshold shift" or "permanent positive threshold shift (worse than reference threshold) greater than normal measurement variability at any frequency between 500 and 6000 Hz." The Veteran has alleged that there was a significant threshold shift between these two exams. The record shows that the results of the exams were not identical, and the record contains no explanation of what amount of threshold shift would qualify as "significant." A remand is required to obtain a new opinion with a supporting rationale. The Veteran has pointed out that his entrance and separation exams do not contain results at the 3000 Hz frequency. He argues that this should prevent a finding that he did not have significant threshold shift, at least in the 3000 Hz frequency. Neither VA examiner discussed this evidence. A remand is required obtain a new opinion which explicitly considers this evidence. Finally, the Veteran has made lay statements, including in testimony at his November 2020 Board hearing, that his hearing loss symptoms began during service or shortly after. No VA examiner has opined on the issue of whether the Veteran's hearing loss began during active service, manifested within one year after discharge from service, or was noted during service with continuity of the same symptomatology since service. A remand is required to obtain a new opinion that addresses the Veteran's lay statements. The matters are REMANDED for the following action: 1. Provide the Veteran's claims file to an appropriate medical professional. The examiner must review the claims file. The examiner is asked to provide a response to the following for each ear: Is the Veteran's hearing loss at least as likely as not related to service, including exposure to gunfire and engine sounds? If the Veteran is diagnosed with sensorineural hearing loss, is it at least as likely as not that his hearing loss (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinions. The examiner's rationale must address the following: (a.) The Veteran's lay statements regarding his exposure to hazardous levels of noise during service and the onset of his hearing loss symptoms. Note that while Veteran is not competent offer a diagnosis or opine as to the cause of his symptoms, but he is competent to report his own experiences, including his experience of lay-observable symptoms. (b.) What is the definition of a "significant threshold shift?" A "permanent positive threshold shift (worse than reference threshold) greater than normal measurement variability at any frequency between 500 and 6000 HZ?" Do the Veteran's service treatment records show evidence of either one of these? (c.) What is the significance of the Veteran's February 1966 entrance examination and August 1968 exit examination both listing no result at 3000 Hz? Discuss the audiogram graph printout dated February 2, 1966 and the audiogram graph printout dated August 22, 1967. Is the available evidence sufficient to determine whether the Veteran's hearing was withing normal limits when he left active service in October 1968, or for the following year? In providing the requested opinions, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an appropriate in-person examination. 2. Readjudicate the Veteran's appeal. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zimmerman, Micah 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.