Citation Nr: 21053059 Decision Date: 08/26/21 Archive Date: 08/26/21 DOCKET NO. 16-33 156 DATE: August 26, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to February 1986 and from November 1990 to May 1991. In November 2018, the Veteran testified at a Board hearing before a Veterans Law Judge (VLJ) who is no longer with the Board. A copy of the hearing transcript has been associated with the claims file. In June 2021, the Veteran was informed that the VLJ who held the November 2018 hearing was no longer with the Board and that he could have an additional hearing if he chose. The letter also explained that if the Veteran did not respond within 30 days of the letter, the Board will assume he did not want an additional hearing and proceed with the appeal. In July 2021, the Veteran responded that he did not wish another Board hearing and requested that his appeal proceed based on the evidence of record. In June 2019 and November 2020, the Board remanded the case to the RO for additional development. The case is once again before the Board. Unfortunately, another remand is required for a more comprehensive and fully informed medical opinion regarding the etiology of the Veteran's bilateral hearing loss. 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that he has a bilateral hearing loss disability, which can be attributed to his exposure to loud noise from his military occupational specialty as a fuel truck driver. Specifically, the Veteran testified to the effect that he occasionally drove near the front line and was subsequently exposed to the daily noise from the trucks during his first period of service. He related that he was exposed to the noise from trucks, explosions, airplanes, and helicopters throughout the duration of his second period of service. He recalled that he noticed difficulty with his hearing upon discharge from his second period of service, that he noticed that within one year following discharge from service, and that he also began to have frequent ear infections. Additionally, the Veteran testified that following service, he was exposed to noise but was provided earplugs. At the outset, the record evidence reflects that the Veteran's MOS was that of a Construction Equipment Operator, which is highly probable for noise exposure. See DD Form 214. The Veteran was found to have normal hearing upon enlistment in June 1985. The service treatment records reflect in October 1985, the Veteran was seen by the audiology clinic and was issued two fitted earplugs with one case. On separation from his second period of active duty, the Veteran was noted to have 25 dB at 4000 Hz in his left ear. The Veteran's right ear hearing was normal. See April 1991 Separation Examination. Subsequent to separation, the Veteran has had four VA hearing examinations. In August 2014, the Veteran was found to have normal hearing in his right ear and conductive hearing loss in his left ear. The examiner noted fluid in the middle ear bilaterally due to allergic rhinitis. The examiner opined that the Veteran's hearing loss is less likely than not service connected because the Veteran's hearing was within normal limits at enlistment and at separation and that "a noise induced hearing loss will not progress once it has stopped." The Veteran was afforded a second hearing examination in October 2014. The pure tone thresholds, in decibels, revealed a disability manifested by hearing loss in both ears for VA purposes, which the examiner diagnosed as conductive hearing loss in the right and left ears. However, the examiner did not address whether the Veteran's current bilateral hearing disability, as VA defines it, was causally related to military noise exposure. A third VA hearing examination was conducted in November 2019. This examination found no hearing loss disability for VA purposes, and that the Veteran's hearing had improved in both ears and returned to normal range. Based on these findings, the examiner did not provide an opinion as to the etiology of any previously hearing loss disability during the pendency of the appeal. Finally, a VA examination conducted in April 2021 reflects an auditory threshold in the frequency of 3000 of 40 decibels or greater in both ears. The examiner distinguished between conductive and sensorineural hearing loss. He noted that the Veteran's bilateral conductive hearing loss was due to the many bouts of otitis media that the Veteran had had over the years, and that it had resolved with ear tubes and tympanostomy. The examiner also diagnosed bilateral sensorineural hearing loss. He opined that the Veteran's right ear sensorineural hearing loss "is less likely than not a result of hazardous military noise exposure." He stated that "sensorineural hearing loss does not have a delayed onset." The examiner did not provide an etiology opinion with respect to the left ear sensorineural hearing loss. There is conflicting evidence as to whether the Veteran meets the criteria for bilateral hearing loss pursuant to 38 C.F.R. § 3.385. However, a current disability for the purposes of establishing service connection includes any diagnosis during the period on appeal. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that current disability requirement is satisfied when a claimant "has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim."). As the October 2014 and April 2021 VA examinations found a diagnosis of bilateral hearing loss, there is evidence to establish a current hearing loss disability under McClain. The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). As the Veteran's separation examination revealed a reading of 25 decibels in the left ear, the Veteran was considered to have some degree of hearing loss; however, none of the VA examiners noted or accounted for that in their opinions. In addition, none of the VA examiners addressed the Veteran's testimony that he noticed hearing loss shortly after his May 1991 discharge from service. Therefore, due to the discrepancy between the facts and the medical opinions, an addendum opinion to determine the etiology of any hearing loss during the period on appeal must be obtained. The matter is REMANDED for the following action: Obtain an addendum opinion from the April 21 audiologist (if available) to determine the etiology of the Veteran's bilateral hearing loss. A new VA examination is not warranted unless deemed so by the VA examiner. The claims file should be made available to and reviewed by the VA examiner. The VA examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hearing loss is related to his military noise exposure, to include the threshold shift in the April 1991 separation audiogram. A negative opinion may not be based solely on the absence of documented hearing loss during or at separation from service. (Continued on the next page) The examiner must consider the Veteran's testimony that he noticed hearing loss shortly after his May 1991 discharge. Regardless of the characterization of the Veteran's hearing loss as conductive or sensorineural, the examiner must provide a complete rationale for the opinion given. The rationale must contain a reasoned medical explanation connecting the examiner's conclusion with supporting data. The basis for any distinction made between conductive versus sensorineural hearing loss must be set forth. However, if the requested opinion cannot be provided without resort to speculation, the examiner should so state and explain why an opinion cannot be provided without resort to speculation. REBECCA N. POULSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael J. O'Connor, 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.