Citation Nr: 21031714 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 19-31 272 DATE: May 24, 2021 REMANDED Entitlement to a compensable rating for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1964 until his honorable discharge in June 1966, with additional service in the United States Naval Reserve. The Board of Veterans' Appeals (Board) thanks the Veteran for his service to our country. This matter comes before the Board on appeal from a November 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2021, the Veteran presented sworn testimony during a video-conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. Entitlement to a compensable rating for bilateral hearing loss. A remand for a contemporaneous evaluation is necessary because the Veteran has testified and reported that his hearing loss is more severe than his currently rated noncompensable (zero percent) disability and the medical evidence in the record appears to corroborate with a greater impairment. Furthermore, the Veteran's last compensation and pension (C&P) examination in conjunction with this appeal was conducted in November 2017, approximately four years ago. Because the evidence suggests a material worsening of the Veteran's condition since his last VA examination, reexamination is necessary. See 38 C.F.R. §§ 3.326, 3.327; Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Although the Veteran has had multiple subsequent hearing examinations, these examinations do not meet the legal requirements for VA compensation purposes because the required speech discrimination test, the Maryland CNC test, was not used. 38 C.F.R. § 4.85. For example, the October 2020 private audiological examination from Dr. S.A. used the WRS/SRS 1 speech discrimination test, and the February 2021 private audiological examination from Dr. J.O. used the CID W-22 List 1A speech discrimination test. Therefore, remand is needed for further development. Savage v. Shinseki, 24 Vet. App. 259, 267 (2011). Additionally, a review of the electronic claims file reveals relevant VA-generated evidence remains outstanding. A review of the electronic claims file reveals that relevant audiograms are missing from the available VA treatment records. In conjunction with his Notice of Disagreement, the Veteran submitted an August 2016 audiogram from Dr. C.J. However, the audiogram is not legible. On his VA Form 9, the Veteran stated the August 2016 audiogram was conducted on referral through the VA Choice Program, and the results should be available at the New Mexico, VA Healthcare System. The audiogram must be obtained and associated with the claims file. A January 2016 VA audiological consultation record shows the Veteran complained of reduced bilateral hearing and reduced bilateral speech discrimination. The treatment record from this visit notes, "[p]lease see CPRS note dated March 1, 2013 for complete case history. Please use "Audiogram Display" Tool to view pure tone results. To see speech audiometry and immittance data, click "View" then "Table." An August 2018 VA Community Care-Consult record notes, "VistA Imaging Scanned Document: Audiometry." Because the Board is unable to ascertain whether the Veteran underwent VA audiometric testing, a remand is needed to obtain all available VA audiometric testing conducted during the appellate period. See Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should afford the Veteran an opportunity to submit or identify any outstanding pertinent evidence not already associated with the claims file. The AOJ should then attempt to obtain those records if the appropriate authorization is provided. 2. The AOJ must contact the private audiologist who conducted the October 2020 audiological examination and request clarification of the report. Specifically, the audiologist should be asked to: (1) provide the audiometric examination results in a numerical report, as opposed to a graphed report, and (2) state whether the Maryland CNC word list was used during audiometric testing. The AOJ must document all efforts made to obtain this clarification. 3. The AOJ must contact the private audiologist who conducted the February 2021 audiological examination and request clarification of the report. Specifically, the audiologist should be asked to: (1) provide the audiometric examination results in a numerical report, as opposed to a graphed report, and (2) state whether the Maryland CNC word list was used during audiometric testing. The AOJ must document all efforts made to obtain this clarification. 4. The AOJ should ensure all outstanding VA treatment records are associated with the claims file, to include updated VA treatment records since September 2019. 5. Obtain and associate with the electronic claims file a legible copy of the August 2016 audiometric testing submitted by the Veteran. As noted above, the audiogram was a referral through the VA Choice Program and the results should be available at the New Mexico, VA Healthcare System. If it is not clear that the word recognition testing was conducted using the Maryland CNC word list, the AOJ should seek clarification from the facility/audiologist as to whether the Maryland CNC word list was utilized. 6. Obtain and associate with the electronic claims file a copy of all VA audiological evaluations conducted during the appellate period. If it is not clear that the word recognition testing was conducted using the Maryland CNC word list, the AOJ should seek clarification from the facility/audiologist as to whether the Maryland CNC word list was utilized. 7. After completion of the above, schedule the Veteran for an audiological examination to determine the current level of severity of his service-connected bilateral hearing loss disability. The examination should include the required speech discrimination score (Maryland CNC word list). The examiner should elicit from the Veteran a detailed history regarding the progression, frequency, and severity of relevant symptoms. Any associated functional impairment should be described in detail. The Veteran's entire record must be reviewed by the examiner, and all indicated tests and studies must be completed. 8. For the AOJ: Under 38 C.F.R. § 4.86(a), when the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels (dB) or more, the rating specialist will determine the Roman numeral impairment from either Table VI or Table VIa, whichever results in the higher numeral. For example, if it is determined the above-mentioned October 2020 audiology consult did not use the Maryland CNC test, it appears that the average puretone reading for each ear (73.75 dB for the right ear and 81.25 dB for the left ear) could be applied, resulting in a VI (right ear) and VII (left ear) Roman numeral designation. Applying both designations to Table VII, it would appear to result in a minimum 30 percent disability. If it is determined the above-mentioned February 2021 audiology consult did not use the Maryland CNC test, it appears that the average puretone reading for each ear (63.75 dB for the right ear and 80 dB for the left ear) could be applied, resulting in a V (right ear) and VII (left ear) Roman numeral designation. Applying both designations to Table VII, it would appear to result in a minimum 30 percent disability. Of course, the Veteran should be afforded a higher rating if it is dictated by the evidence resulting from the ordered (C&P) audiological examination or additional development of the record. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Grace Johnk, 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.