Citation Nr: 22016705 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 16-42 087 DATE: March 23, 2022 REMANDED Service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1967 to June 1969, including service in the Republic of Vietnam. The appeal was previously remanded in July 2021 for additional development. The claim has since been returned to the Board for further appellate review. 1. Service connection for bilateral hearing loss is remanded. Additional development is required prior to adjudicating the claim for bilateral hearing loss. Remand is required for an adequate VA opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In August 2021, the Veteran was afforded a VA examination. The examiner opined the Veteran's bilateral hearing loss was less likely than not caused by or the result of service. The Board finds the examiner's opinion is not adequate because the examiner failed to address the Veteran's contention regarding delayed onset. Instead, the examiner materially relied on finding of no report of complaint or treatment for hearing impairment in service. Even if no hearing loss is present during service, 38 C.F.R. § 3.385 does not preclude an award of service connection for hearing loss established by post-service audiometric and speech-recognition scores, even when hearing was found to be within normal limits at the time of separation from service. Hensley v. Brown, 5 Vet. App. 155, 157 (1993); Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). The VA examiner impermissibly relied on an absence of documented symptoms during service without explaining why, as a medical matter, the Veteran would have sought treatment or complained of the condition during service, or why an absence of treatment as opposed to symptoms was otherwise medically significant. See McKinney v. McDonald, 28 Vet. App. 15, 30 (2016); Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015); Buczynski v. Shinseki, 24 Vet. App. 221, 223-24 (2011). Moreover, in the July 2021 remand the Board directed the examiner to specifically address the lay and medical evidence of delayed onset including acknowledging and discussing the fact sheet from the National Institute on Deafness and Other Communication Disorders (NID). Regarding the article the examiner simply stated, "this article reports progression of noise induced hearing loss; however, this is reported as a result of long-term exposure." The examiner's statement regarding the article suggest delayed onset only occurs because of long-term exposure; however, the article states "sometimes exposure to impulse or continuous loud noise causes a temporary hearing loss that disappears 16 to 48 hours later. Recent research suggests, however, that although the loss of hearing seems to disappear, there may be residual long-term damage to your hearing." Thus, the article indicates that delayed onset may occur as result of more than just "long-term exposure." Therefore, the Board finds the examiner's opinion fails to adequately address the Veteran's contention regarding delayed onset and the NID fact sheet submitted in support his contention. Accordingly, remand is required. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disability on appeal. 2. Following the receipt of any outstanding records, obtain an addendum opinion regarding the etiology of hearing loss from a qualified clinician. The Veteran's entire claims file, to include a copy of this remand, should be provided to the examiner. If an examination is deemed necessary, it shall be provided. Following a complete review of the record, the examiner is asked to provide the following opinion: Whether it is at least as likely as not (50 percent or greater probability) that the hearing loss had onset in or is otherwise related to active service, including noise exposure or injuries during service. 3. The examiner should not rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptom(s) did not occur, including why the fact would have normally been recorded if present, or (b) why the absence of medical records is medically significant. (Continued on the next page) 4. In addressing the above, the examiner must consider and discuss all pertinent medical and lay evidence of record, to include competent, lay assertions as to the nature, onset, and continuity of symptoms. If lay assertions in any regard are discounted, the examiner should clearly state, and explain why. All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Braxton, 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.