Citation Nr: 21041104 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 15-46 331 DATE: July 8, 2021 REMANDED Entitlement to service connection for bilateral hearing loss, including as secondary to service-connected Parry Romberg Syndrome, is remanded. REASONS FOR REMAND The Veteran had active service from July 1977 to December 1981. This case comes to the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed timely disagreement with the AOJ's determination, and the present appeal ensued. The Veteran's claim has previously been before the Board on two occasions. In March 2019 the Veteran's claim for entitlement to service connection for bilateral hearing loss was remanded as it was inextricably intertwined with the Veteran's claim for entitlement to service connection for Parry Romberg Syndrome. After the Veteran was granted entitlement to service connection for Parry Romberg Syndrome, the Veteran's bilateral hearing loss claim was again remanded in June 2020, to obtain missing records and provide the Veteran with a VA medical examination. The required development has been completed, and the Veteran's claim has now been returned to the Board for further adjudication. The Board notes that there are outstanding Privacy Act requests, submitted by the Veteran via his representative, however, those requests are not germane to the matter currently before the Board. Nonetheless, as will be explained below, a remand is necessary to ensure that the VA fulfills its duty to assist the Veteran in substantiating his appeal. Entitlement to service connection for bilateral hearing loss, including as secondary to service-connected Parry Romberg Syndrome The Board notes that the Veteran's previous VA medical examination includes a diagnosis of bilateral hearing loss for VA purposes. 38 C.F.R. § 3.385. The Veteran was provided with a VA audiological examination in January 2021, and with an otolaryngology examination in March 2021. The Board notes that while January 2021 examiner diagnosed the Veteran with bilateral hearing loss for VA purposes, the VA examiner failed to adequately address the etiology of the Veteran's hearing loss and relied on a lack of hearing loss and threshold shift during service to conclude that the Veteran's bilateral hearing loss was not caused by service. The March 2021 examiner stated that the possibility of delayed onset hearing loss was not an accepted position. Therefore, the opinions provided are inadequate for the purpose of readjudicating the Veteran's appeal. The absence of in-service evidence of a hearing disability during service (i.e., one meeting the requirements of 38 C.F.R. § 3.385) is not fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service (as opposed to intercurrent causes). See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). In Training Letter 10-02 (issued in March 2010) regarding the adjudication of claims for hearing loss and tinnitus, the Director of the VA Compensation and Pension Service indicated that the two most common causes of sensorineural hearing loss are presbycusis (age-related hearing loss) and noise-induced hearing loss (caused by chronic exposure to excessive noise). It was also noted that the presence of a notch (of decreased hearing) that may be seen on audiograms generally at frequencies of 3000, 4000, or 6000 Hertz with a return toward normal at 8000 Hertz may be indicative of noise-induced hearing loss. It was noted that delayed-onset hearing loss and tinnitus must be considered. See Training Letter 10-02 (issued in March 2010). The Board concludes that medical opinion provided in January 2021 by the VA audiologist, and the opinion provided in March 2021 by the VA otolaryngologist are not adequate for adjudicating the issue before the Board. The rationale for both unfavorable opinions is contrary to the Court's holding in Hensley and VA Training Letter 10-02, that the Veteran's claims of experiencing symptoms cannot be dismissed because of a lack of contemporaneous evidence especially in cases involving delayed-onset hearing loss. In light of above, the record for review by the Board remains inadequate for the purpose of readjudicating the Veteran's appeal. Thus, a remand is necessary to obtain an adequate nexus opinion. 38 C.F.R. § 3.159(c)(4); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate examiner to determine the etiology of the Veteran's bilateral hearing loss. The complete file must be made available to the examiner for review in conjunction with the examination. The examiner is asked to address the following: Provide an opinion as to whether the Veteran's bilateral hearing loss is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's in-service noise exposure. 2. Obtain an addendum opinion from an appropriate examiner to determine whether the Veteran's service-connected Parry Romberg Syndrome has caused or aggravated the Veteran's bilateral hearing loss. The complete file must be made available to the examiner for review in conjunction with the examination. The examiner is asked to address the following: (a). Provide an opinion as to whether the Veteran's bilateral hearing loss is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's Parry Romberg Syndrome. (b). Provide an opinion as to whether the Veteran's bilateral hearing loss is at least as likely or not (50 percent or greater probability) aggravated by the Veteran's service-connected Parry Romberg Syndrome. 3. The examiners are reminded that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). 4. Both examiners should provide complete rationales for all opinions rendered. The examiners should specifically discuss the pertinent evidence of record, to include the Veteran's assertions described in this remand. If the examiners find that they cannot provide any opinion without resorting to speculation, the examiners must explain why they are unable to provide an opinion without speculation, and sufficiently explain the reasons for that inability. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. W. Morgan, 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.