Citation Nr: 21032562 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 17-51 726 DATE: May 27, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran had qualifying, active duty service from March 1966 to September 1966 (as active duty training in the Army National Guard) and from May 1968 to December 1969 (in the United States Army). This matter comes before the Board of Veterans' Appeals (Board) from a May 2017 rating decision issued the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for bilateral hearing loss is remanded. This matter was previously before the Board in November 2019, at which time it was denied. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In a December 2020 Joint Motion for Remand (JMR), the parties agreed that the Board erroneously failed to address the adequacy of a May 2017 VA examination and an August 2017 addendum opinion in light of the examiner's failure to apply the ASA to ISO-ANSI conversion policy in effect for audiograms performed between January 1967 and December 1970. The JMR also states that the Board failed to address which evidentiary standards and presumptions are applicable here given the combination of active duty for training (ACDUTRA) and regular active duty service. The JMR also states that a veteran is not precluded from service connection for a current hearing loss disability where hearing loss was within normal limits on audiometric testing at separation from service. Hensley v. Brown, 5 Vet. App. 155, 160 (1993). Finally, the JMR directs the Board to determine whether the VA examiner's reliance on the Institute of Medicine (IOM) report is proper in light of McCray v. Wilkie, 31 Vet. App. 243 (2019). The Veteran seeks entitlement to service connection for bilateral hearing loss. The Veteran was provided a VA examination as to his hearing disability in May 2017 and an addendum opinion was obtained in August 2017. VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, the May and August 2017 VA audiological opinions relating to the Veteran's bilateral hearing loss are inadequate for decision-making purposes because the examiners failed to consider American Standards Association (ASA) to International Standards Organization (ISO) unit conversion when discussing in-service threshold shift. The Veteran's separation audiological examination was conducted in November 1969 and it does not indicate which standard was used. For in-service audiograms conducted between January 1, 1967 and December 31, 1970, where the standard used is unclear, the data under both ASA and ISO-ANSI standards will be considered. Therefore, on remand the examiner should consider the data under both ASA and ISO-ANSI standards. The recorded metrics are considered under both standards, relying on the unit measurements most favorable to the Veteran's appeal. Converting from ASA standards to ISO-ANSI requires the following amounts be added to the recorded ASA audiological results: 15 dB at 500 Hz, 10 dB at 1000 Hz, 10 dB at 2000 Hz, 10 dB at 3000 Hz, and 5 dB at 4000 Hz. Additionally, the May 2017 examiner relied, in part, on a 2005 Institute of Medicine (IOM) report entitled Noise and Military Service: Implications for Hearing Loss and Tinnitus. The examiner stated that the study found that there was insufficient scientific basis for delayed or late onset noise-induced hearing loss. The Court has found that this study contains apparently contradictory findings as to delayed-onset hearing loss and may be inadequate to support a negative nexus opinion. See McCray v. Wilkie, 31 Vet. App. 243 (2019). In particular, the Court directed attention to the fact that, although the IOM report states "based on the anatomical and physiological data available on the recovery process following noise exposure, it is unlikely" that the onset of hearing loss begins years after noise exposure occurs (IOM report at 47), this statement does not reflect the full extent of the report's pertinent findings. Although a portion of the IOM report found there is no evidence of delayed onset hearing loss due to noise exposure, another portion of the same IOM Report found that "an individual's awareness of the effects of noise on hearing may be delayed considerably after the noise exposure." (IOM report at 203-04). Therefore, the Court noted that the IOM report's language may support a theory of service connection involving delayed onset of a Veteran's perception of hearing loss such that a VA examiner's citation of the report should contemplate to all of the pertinent aspects of its findings. Thus, on remand, any discussion of the 2005 IOM report regarding delayed onset of noise-induced hearing loss, both the positive and negative findings in the report must be discussed. Accordingly, an opinion with a complete rationale that considers ASA-ISO unit conversion and does not rely on the lack of documented in-service bilateral hearing loss is needed and must be obtained on remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion (schedule examination if necessary) regarding the current nature and etiology of the Veteran's bilateral hearing loss. Provide an opinion addressing the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral hearing loss disability is etiologically related to his service. In rendering the above opinion, the examiner must consider the conversion from ASA standards to ISO standards for the Veteran's November 1969 separation examination. If the examiner relies on the 2005 IOM report regarding delayed onset of noise-induced hearing loss, both the positive and negative findings in the report must be discussed. See McCray v. Wilkie, 31 Vet. App. 243 (2019). 2. Readjudicate the claim. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals J. Morgan, Attorney for the Board Department of Veterans Affairs 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.