Citation Nr: 21041273 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 19-06 919 DATE: July 8, 2021 REMANDED Entitlement to service connection for a bilateral hearing loss disability, including as secondary to posttraumatic stress disorder (PTSD), is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1968 to April 1969. The Veteran served in the Republic of Vietnam and is presumed to have been exposed to tactical herbicide agents. The issue of entitlement to service connection for bilateral hearing loss was previously before the Board in June 2019, at which time the Board issued a decision that denied the Veteran's claim for entitlement to service connection for bilateral hearing loss and granted service connection for tinnitus. Following the Board's decision, the Veteran timely appealed the Board's denial of service connection for bilateral hearing loss to the U.S. Court of Appeals for Veterans Claims (CAVC or the Court). In July 2020, the Court granted an Order for a partial remand consistent with the terms set forth in a Joint Motion for Partial Remand (JMPR). The July 2020 JMPR vacated the issue of entitlement to service connection for bilateral hearing loss. The Court noted that the portion of the Board's decision to grant entitlement to service connection for tinnitus was a favorable determination not to be disturbed on appeal. Therefore, the June 2019 Board decision to grant entitlement to service connection for tinnitus was not disturbed by the JMPR. Following the return of the appeal to the Board, in December 2020 the Board remanded the issues on appeal for further development. At that time, the Board also granted service connection for type II diabetes mellitus, and denied service connection for sleep apnea and an increased rating for PTSD. As such, those issues are no longer on appeal. 38 C.F.R. § 20.1100; see Ab v. Brown, 6 Vet. App. 35 (1993).In addition, in December 2020 decision also remanded the issues of entitlement to service connection for gastroesophageal reflux disease (GERD), hypertension, and hypothyroidism. However, in a May 2021 rating decision, the RO granted service connection for GERD, hypertension and hypothyroidism. As this represents a full grant of the benefits sought as it pertains to these claims, the issues are no longer before the Board. Ab, 6 Vet. App. 35. 1. Entitlement to service connection for bilateral hearing loss. In the above-mentioned July 2020 JMPR, the parties agreed that the Board erred by not providing an adequate statement of reasons and bases by not responding to arguments and treatise evidence presented by the Veteran, including an article regarding age-related hearing loss and early noise exposure. In December 2020 the Board remanded the claim for an addendum medical opinion to determine the nature and etiology of the Veteran's bilateral hearing loss, to include as secondary to his PTSD. The VA examiner was specifically directed to consider articles the Veteran submitted in May 2016 and June 2016 indicating that early noise exposure makes "the inner ears significantly more vulnerable to aging," and that PTSD can impact physical health. The Veteran was provided with a February 2021 VA hearing loss examination where the VA examiner opined that the Veteran's hearing loss was not proximately due to or aggravated beyond its natural progression by his PTSD. The examiner noted that she was "not able to locate the specific article 'PTSD and Physical Health' in the Veteran's E-file." Upon review of the record, the Board notes that the article "PTSD and Physical Health" was submitted by the Veteran on June 17, 2016, and is labeled as "Exhibit 6," located on page 14 of the document. Since the article was in fact associated with the record at the time of the opinion, and as the Board specifically requested that the article be addressed as part of any opinion concerning secondary service connection, the Board finds that the February 2021 opinion does not substantially comply with the Board's December 2020 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, the Board finds that an addendum opinion that considers this article is required prior to adjudication of this claim. 2. Entitlement to a TDIU. Concerning entitlement to a TDIU, the Board finds that any determinations with respect to the remanded claim would materially affect a determination concerning a TDIU. As such, it is inextricably intertwined with the service connection claim being remanded and must therefore be remanded as well. Harris v. Derwinski, 1 Vet. App. 180 (1991) The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the following: a) Is it at least as likely as not (a fifty percent probability or greater) that the bilateral hearing loss disability was caused by the service-connected PTSD? b) If not, is it at least as likely as not (a fifty percent probability or greater) that the bilateral hearing loss disability was aggravated (worsened) by the PTSD? In so opining, the examiner must consider and discuss the article "PTSD: National Center for PTSD: PTSD and Physical Health" (labelled "Web / HTML Documents" pg. 14 uploaded 6/17/16). A detailed rationale for the opinion must be provided. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. CHRISTOPHER A. WENDELL Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Morrad, Shabnam 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.