Citation Nr: 21040872 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 19-17 392 DATE: July 7, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to January 1971. He has a combined VA disability rating of 100 percent from January 23, 2020 and has been awarded special monthly compensation under 38 U.S.C. 1114(k) due to of loss of use of a creative organ from April 26, 2017. This appeal comes before the Board of Veterans' Appeals (Board) from a December 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that, as a combat medic, he was exposed to extensive noise during service, including being in close proximity to weapons fire, detonating mortar shells and helicopters. See Form 9 (June 2019). He also stated that he began to have difficulty hearing at the time of his discharge and has had it since. Id. To ensure that VA has met its duty to assist, remand is necessary. VA obtained a November 2017 VA medical examination and opinion on whether the Veteran has a hearing loss disability caused by or the result of in-service noise exposure, which concluded that it was not at least as likely as not that it was caused by or the result of in-service noise exposure. The rationale was that: Veteran's hearing thresholds at time of entrance and separation were within normal limits. According to the American College of Occupational Medicine Noise and Hearing Conservation Committee that "a noise induced hearing loss will not progress once it is stopped. The Board finds that the November 2017 medical opinion is inadequate to deicide the appeal for the following reasons. First, the opinion relied on the absence of findings for hearing loss at service entrance and separation and did not address the etiology of delayed onset hearing loss. See Hensley v. Brown, 5 Vet. App. 155 (1993) ("[W]hen audiometric test results at a Veteran's separation from service do not meet the regulatory requirements for establishing a 'disability' at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service."). Second, opinion relied on medical literature indicating that "a noise induced hearing loss will not progress once it is stopped." However, again, the Board observes that the absence of in-service evidence of hearing loss disability is not fatal to a claim for service connection for hearing loss disability. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. See Hensley, supra. Further, it is noted that in McCray v. Wilkie, 31 Vet. App. 243, 249 (2019), the Court of Appeals for Veterans Claims held that "a medical text's qualifying or contradictory aspects may affect the probative value and adequacy of any ensuing medical opinion that relies on the text." Here, the opinion does not acknowledge any contradictory aspects of the study. Also, reliance only on medical literature without discussing the Veteran specific facts renders an opinion inadequate. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018). "[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board finds that another VA medical opinion is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate specialist regarding the etiology of Veteran's hearing loss and tinnitus. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the examiner. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion(s). The examiner must opine on: Whether the Veteran's hearing loss disability of either ear at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) (even if of delayed onset) is related to an in-service injury, event, or disease, to include in-service noise exposure. Consider the Veteran's documented relevant history and assertions, to include that he was exposed to extensive noise during service, including being in close proximity to weapons fire, detonating mortar shells and helicopters, and that he began to have difficulty hearing at the time of his discharge and has had it since. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of in-service complaints, findings, or diagnosis. NOTE (2): The Veteran is competent to report diminished hearing acuity during active service and progressively worsening symptoms since service. The clinician is not required to accept the Veteran's history or theory of entitlement (e.g. that his military service caused his hearing loss) if this is incongruous with the record or otherwise implausible; however, the clinician is required to fully explain why he or she rejects any history shown or disagrees with the Veteran's theory of causation. NOTE (3): An adequate medical opinion may not rely on a medical texts or treatise material to support a negative medical opinion without (a) addressing apparent qualifiers or contradictions or (b) discussion it vis-à-vis facts specific to this Veteran. 2. Ensure that the VA medical opinions obtained include a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. M. Pesin 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.