Citation Nr: 21032759 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-10 018 DATE: May 27, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1972 to July 1974. In October 2019 the Veteran testified at a video conference hearing before the undersigned. The issue was remanded in December 2019 for an addendum opinion. As will be discussed further, the Board finds that the RO did not fully comply with the remand instructions and that another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for bilateral hearing loss is remanded. Although further delay is regrettable, the Board finds that additional development is necessary. The Veteran asserts that his bilateral hearing loss had its onset in service as a result of exposure to acoustic trauma during basic training. Specifically, the Veteran states that he was exposed to loud noise from hand grenades and M60s during his eight weeks of basic training. In support of his claim, the Veteran testified at his October 2019 Board hearing that the hearing protection during basic training was inadequate and he often had to use his hands to cover his ears in addition to the ear plugs he was provided. The Veteran also submitted medical journal articles regarding the acceleration of age-related hearing loss by early noise exposure and the relationship between hearing loss and tinnitus, indicating, in pertinent part, that tinnitus is accompanied by hearing loss. The Veteran underwent a hearing loss and tinnitus VA examination in January 2015. While the examiner determined that the Veteran's tinnitus had onset in service, unfortunately the examiner was unable to provide an opinion on the Veteran's diagnosed bilateral hearing loss, noting that the audiological results on the Veteran's March 1974 service evaluation were illegible. Given that the January 2015 VA opinion was inadequate, the Board, in December 2019, remanded the issue for an addendum opinion. A March 2020 VA examiner opined the Veteran's hearing loss was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was that the Veteran had hearing with normal limits on entrance and separation from service and therefore any hearing loss developed after military service and is unrelated to military service. The examiner also stated that medical literature does not support such a delayed onset of hearing loss. Unfortunately, the Board finds the March 2020 VA opinion to be inadequate. The main reason for the negative opinion is that hearing loss was not shown in service. However, in the December 2019 Board remand, the examiner was reminded that VA law and regulations do not preclude service connection for post-service hearing loss just because hearing was within normal limits at the time of separation from service. Additionally, if the examiner determined the Veteran's bilateral hearing loss was not related to in-service noise exposure, an explanation must be provided to fully explain why the current symptoms are not consistent with the in-service noise exposure or why such exposure is not at least a "contributing factor." The March 2020 VA examiner did not address this at all. The audiologist was also asked to discuss the likelihood that the Veteran's current hearing loss is due to post-service intercurrent causes wholly unrelated to his military service, such as post-service employment. This was also not addressed by the examiner. Lastly, the medical journal articles submitted by the Veteran and included in the claim file, discuss the acceleration of age-related hearing loss by early noise exposure, as well as a relationship between tinnitus, which the Veteran is service connected for, and hearing loss. It is not clear from the opinion that the audiologist reviewed the medical journal articles. Accordingly, the Board finds that remand is again necessary to obtain an addendum opinion in order to be in compliance with the prior remand. Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: Return the claims file to the VA examiner who conducted the March 2020 examiner, or to a qualified medical professional if the examiner is unavailable. The electronic claims file must be made accessible to the examiner. After reviewing the record, including this Remand, the examiner should address the following: (a) The examiner should offer an opinion as to whether it is at least as likely as not, i.e., a 50 percent probability or greater, that the Veteran's hearing loss is causally related to his military service. (b) If it is the opinion of the examiner that the Veteran's bilateral hearing loss is not related to in-service noise exposure: i. an explanation must be provided to fully explain why the current symptoms are not consistent with the in-service noise exposure or why such exposure is not at least a "contributing factor." ii. The audiologist should discuss the likelihood that the Veteran's current hearing loss is due to post-service intercurrent causes wholly unrelated to his military service, such as post-service employment. iii. In providing the opinion, the examiner must review the medical journal articles and discuss in the opinion. If the examiner cannot render an opinion without resorting to mere speculation, a full and complete explanation for why an opinion cannot be rendered should be provided. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Mitchell, 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.