Citation Nr: 22014266 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 17-44 030 DATE: March 12, 2022 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1966 to December 1969, with additional service in the Army National Guard from August 1982 to October 1988. These matters come to the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. The above captioned issues were previously remanded by the Board in November 2019 and again in September 2021 for additional development. Entitlement to service connection for bilateral hearing loss and tinnitus The Veteran seeks service connection for bilateral hearing loss and tinnitus and contends, essentially, that he developed both because of noise exposure in service. In particular, he reported experiencing repeated exposure to noise in association with his Military Occupational Specialty (MOS) as a radio operator. While the Veteran's auditory threshold for any of the frequencies of 500, 1000, 2000, 3000 and 4000 Hertz is not 40 decibels or greater nor does the record show auditory thresholds for at least three of those frequencies are 26 decibels or greater, the March 2020 VA examination did document speech recognition scores using the Maryland CNC Test of 92 percent in both ears. Therefore, the Veteran has a current diagnosis of bilateral hearing loss in accordance with 38 C.F.R. § 3.385 during the appeal period. Moreover, the record shows the Veteran has also been diagnosed with tinnitus. See March 2020 VA examination. Review of the claims file also shows that the Veteran's exposure to excessive noises during service has been conceded based on his duties performed. What is missing is competent medical evidence linking his current hearing loss disability and tinnitus to the excessive noise exposure in service. The Veteran's service treatment records (STRs) are silent for any complaints, findings, treatment, or diagnoses related to hearing loss. His post service treatment records are similarly silent for any opinions concerning the etiology of his bilateral hearing loss and tinnitus. The Veteran was afforded VA audiological examinations in August 2016 and again in April 2020. However, for reasons that were discussed in more detail in the September 2021 Board remand, neither examination adequately evaluated the Veteran's bilateral hearing loss and tinnitus claims. Accordingly, another VA audiological examination was performed in November 2021. The November 2021 VA examiner opined that the Veteran's current bilateral hearing loss and tinnitus were less likely than not incurred in or caused by his military service. The examiner noted for rationale that the Veteran's service entrance examination and separation examinations revealed hearing within normal limits and did not show a threshold shift, which was objective evidence of no permanent auditory damage on active duty from conceded noise. The examiner also noted there was no report of complaint or treatment for hearing decrease in the STRs, including at the time of the Veteran's separation from service. The examiner then stated that although noise exposure was conceded and the relationship of noise, auditory damage and hearing loss were well-established, auditory damage and hearing loss were not conceded based on noise alone. The examiner further stated that there must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology. In support of this rationale, the examiner also cited to the Institute of Medicine's "landmark study" on military noise exposure, which states, "There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure. Although the definitive studies to address this issue have not been performed, based on the anatomical and physiological data available on the recovery process following noise exposure, it is unlikely that such delayed effects occur." In light of this study, and based on the Veteran's hearing threshold levels at the time of separation from military service with no evidence of a permanent positive threshold shift during military service, the examiner concluded it was less likely than not that the Veteran developed a disability to a compensable degree within a year of service; that the evidence was against a nexus in this case; and therefore, it was less likely than not that the hearing loss was related to military noise exposure. See November 2021 VA examination. Pertaining to the Veteran's tinnitus, the November 2021 VA examiner reiterated that there was no permanent auditory damage on active duty from conceded noise based on the lack of a shift in hearing thresholds beyond test variability from entrance to separation. The examiner also noted the Veteran's report of tinnitus 5 years earlier, which was 48 years post-separation from exposure to recreational and/or occupational noise. The examiner stated that although noise exposure was conceded and relationship between noise, auditory damage and hearing loss were well documented, auditory damage and hearing loss were not conceded based on noise alone. Therefore, there was no evidence to support a nexus to relate current hearing loss to military noise and not another etiology and it was less likely as not that the current tinnitus was related to military noise exposure. See November 2021 VA examination. Unfortunately, the most recent VA examiner's opinions limited the consideration of the Veteran's military service to his active duty service from December 1965 to November 1969 and did not consider the noise that the Veteran was exposed to while serving in the Naval Reserves until August 1982 and then in the Army National Guard from August 1982 to October 1988. Significantly, the Board's September 2021 remand had instructed an examiner to consider the Veteran's exposure "to noise during weapons qualification and from the noise of trucks while in the National Guard." The examiner was also instructed to "address the articles regarding hearing loss that [the Veteran] submitted in April 2016 and October 2017." Yet, these articles were not specifically discussed. While the Board regrets the further delay in the adjudication of this claim, the RO did not substantially comply with the September 2021 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, an addendum VA medical opinion is necessary. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's bilateral hearing loss and tinnitus are at least as likely as not related to his military service. In so doing, the examiner is asked to specifically address the noise exposure from all of the Veteran's periods of military service, including his service in the Reserves and National Guard, as well as address the articles regarding hearing loss submitted in April 2016 and October 2017. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Churchwell, 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.