Citation Nr: 21040511 Decision Date: 07/05/21 Archive Date: 07/05/21 DOCKET NO. 15-32 739 DATE: July 5, 2021 REMANDED Entitlement to service connection for tinnitus is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1987 to October 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2012 by a Department of Veterans Affairs (VA) Regional Office. In February 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In July 2019, September 2020, and March 2021, the Board remanded this case for additional development and it now returns for further appellate review. 1. Entitlement to service connection for tinnitus. As noted previously, the Board has remanded the matter several times, most recently in March 2021, in order to obtain an addendum opinion addressing whether it is at least as likely as not that the Veteran's tinnitus is related to his military service, to include his in-service noise exposure (resulting in his service-connected left ear hearing loss) and/or his in-service treatment for impacted cerumen of the left ear. In offering such opinion, the examiner was directed to consider, as relevant, the Veteran's report that he experienced tinnitus during and since service, but such became more prominent and distracting after his 2008 impacted cerumen extraction. However, as there has not been substantial compliance with such directive, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In this regard, pursuant to the March 2021 remand, addendum opinions were obtained in March 2021 and April 2021, in which the December 2020 VA examiner again offered unfavorable opinions. However, in her March 2021 addendum opinion, the VA examiner simply reiterated her December 2020 opinion, and again failed to consider or discuss the Veteran's report that his tinnitus initially manifested in, and had recurred since, service. Additionally, she repeated her statement that the Veteran's military occupational specialty in Functional Support and Administration had a low probability of noise exposure, even though it was noted the Veteran is service-connected for left ear hearing loss due to in-service noise exposure. In this regard, the Board also notes the Veteran's service personnel records reflect that his duties included those of an A-7 plane captain, in which he was assigned to the maintenance department and responsible for the launch/recovery, fueling/defueling, daily/turnaround and special inspections on the A-7 version aircraft. Such duties are consistent with the Veteran's April 2021 statement in which he contends his tinnitus is due to four years of being surrounded by, and launching, naval jets. Further, while the examiner had previously indicated in her December 2020 opinion that there was "no documented reason for cerumen to cause tinnitus," in her April 2021 addendum opinion she stated that "although cerumen impaction can case tinnitus in some instances, it is not the case with this Veteran, as he himself clarified in the December 2019 examination that the tinnitus began in or around 2010 and was unrelated to the 2008 cerumen impaction removal." However, the Board notes the examiner was directed to consider the Veteran's report that he experienced tinnitus during and since service, but such worsened after his 2008 impacted cerumen extraction. Therefore, a remand is necessary in order to obtain an addendum opinion which considers the Veteran's report of initially experiencing tinnitus during service, to include as due to his acknowledged noise-exposure, as well as the potential association between his tinnitus and his impacted cerumen. 2. Entitlement to a TDIU. As the Veteran asserts that he has been rendered unemployable as a result of his left ear hearing loss and tinnitus, adjudication of his TDIU claim must be deferred pending the development and readjudication of his claim for service connection for tinnitus. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc). The matters are REMANDED for the following action: Forward the record, to include a copy of this Remand, to an appropriate clinician other than the December 2020/March 2021/April 2021 VA examiner, if possible, so as to obtain an addendum opinion addressing the etiology of the Veteran's tinnitus. After a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's tinnitus is related to his military service, to include his in-service noise exposure (resulting in his service-connected left ear hearing loss) and/or his in-service treatment for impacted cerumen of the left ear. When rendering this opinion, the clinician is requested to specifically consider and comment on the following evidence: (a.) The Veteran's report that he experienced tinnitus during and since service, but such became more prominent and distracting after his 2008 impacted cerumen extraction. (b.) The Veteran's only history of acoustic trauma occurred during service (resulting in his service-connected left ear hearing loss), as he reports no significant post-service occupational or recreational noise exposure. (c.) The Veteran was not noted to have any ear abnormalities when examined during his enlistment medical examination, thereby triggering the legal presumption that no ear abnormalities existed prior to service. (d.) During service, the Veteran was noted to have cerumen blocking his tympanic membranes in October 1988, and he was treated for impacted cerumen in December 1988 and January 1990. (e.) Post-service VA treatment records reflect the Veteran's treatment for impacted cerumen in April 2003 (at which time his cerumen was noted to be "profound") and, in October 2008, after which time he reports a significant increase in his tinnitus. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M. Kelly, 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.