Citation Nr: 22013182 Decision Date: 03/08/22 Archive Date: 03/08/22 DOCKET NO. 18-01 498 DATE: March 8, 2022 REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to an initial rating higher than 0 percent for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1963 to June 1967. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the matters for further development in February 2020. In a January 2021 decision, the Board denied service connection for left ear hearing loss and a higher initial rating for right ear loss. In a November 2021 Order, the United States Court of Appeals for Veterans Claims (Court) granted a joint motion for remand (JMR) and vacated the Board's January 2021 decision. It remanded the matters for action consistent with the terms of the JMR. The Veteran testified at a hearing before the undersigned Veterans Law Judge in January 2020. A transcript of the hearing is of record. 1. Entitlement to service connection for left ear hearing loss is remanded. 2. Entitlement to an initial rating higher than 0 percent for right ear hearing loss is remanded. The JMR found that there has not been substantial compliance with the Board's February 2020 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In its remand, the Board instructed that the Veteran's outstanding VA treatment records dated since December 2017 must be added to the file. The Board added that any VA audiometric testing results not in the CAPRI file that must be separately accessed through CPRS Tools/Audiogram Display should also be uploaded to the file. The JMR points out that a November 2018 VA audiology treatment record reflects that testing of the Veteran's hearing was conducted, and that the audiometric summary is available in "CPRS via Tools/Audiogram Edit." However, the November 2018 testing results are not in the file. Accordingly, there has not been substantial compliance with the Board's remand directives. The JMR instructs that the November 2018 audiometric summary must be obtained. In its January 2021 decision, the Board found the March 2020 VA opinion on the issue of service connection for left ear hearing loss to be adequate. Nevertheless, it has considered the Veteran's November 2021 written arguments regarding the adequacy of that opinion. In particular, the Board has considered the fact that an excerpt from an article previously quoted by him may support the possibility of a delayed onset of hearing loss following noise exposure, as discussed in its January 2021 decision. The article is titled "Adding Insult to Injury: Cochlear Nerve Degeneration After 'Temporary' Noise-Induced Hearing Loss," and was not addressed in the March 2020 VA medical opinion. On remand, the opportunity should be taken to obtain a new VA medical opinion that considers that article. The opinion should also consider the fact that the audiometric testing results during service may have been recorded in American Standard Association (ASA) units rather than units established by the International Standards Organization (ISO)-American National Standards Institute (ANSI), which represent the current standard. The examiner should thus consider the converted results as well in formulating the opinion. The matters are REMANDED for the following action: 1. Add to the file a copy of the November 19, 2018 VA audiometric summary, which can be accessed in CPRS via Tools/Audiogram Edit. 2. Add to the file any outstanding VA treatment records pertaining to the Veteran dated since October 2020. Ensure that any audiometric testing results that are not in CAPRI and must be separately accessed are also obtained and added to the file. 3. Obtain a new VA medical opinion regarding the likelihood that the Veteran's hearing loss may be linked to his established in-service noise exposure. In the opinion, the examiner must consider and address the following: (a.) The article titled "Adding Insult to Injury: Cochlear Nerve Degeneration After 'Temporary' Noise-Induced Hearing Loss," The Journal of Neuroscience, November 11, 2009, S. Kujawa and M. C. Liberman. The article states, in part: "The present results . . . [show] that reversibility of noise-induced threshold shifts masks progressive underlying neuropathology that likely has profound long-term consequences on auditory processing." (b.) The Veteran's in-service audiometric testing results may have been recorded in ASA units, rather than ISO-ANSI units. The examiner should thus consider the results when converted to ISO-ANSI units. The conversion is accomplished by adding 15 decibels (dB) at 500 Hertz (Hz), 10 dB at 1000 Hz, 2000 Hz, and 3000 Hz, and 5 dB at 4000 Hz. The converted results are provided here as follows. 1. When converted to ISO units, the July 1963 enlistment audiogram shows puretone thresholds for the left ear of 15 dB at 500 Hz, 10 dB at 1000 Hz, 10 dB at 2000 Hertz, 10 dB at 3000 Hz, and 5 dB at 4000 Hz. 2. The April 1967 separation audiogram, when converted to ISO units, shows puretone thresholds for the left ear of 25 dB at 500 Hz, 20 dB at 1000 Hz, 15 dB at 2000 Hz, 15 dB at 3000 Hz, and 10 dB at 4000 Hz. The post-conversion threshold of 25 db at 500 Hz would indicate some hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Rutkin, 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.