Citation Nr: 22017209 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-00 587 DATE: March 24, 2022 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1966 to November 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record. In August 2021, the Board remanded this case for additional development. The Board finds that there has not been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for bilateral hearing loss is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claim of entitlement to service connection for bilateral hearing loss. VA's statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The Veteran contends that a current bilateral hearing loss disability is the result of noise exposure in service. Noise exposure in service has been conceded by VA. At a December 2021 VA examination, the examiner opined that the Veteran's current hearing loss was likely as not (less than 50 percent probability) caused by or a result of service noise exposure. The examiner explained that review of the records showed no significant threshold shifts having occurred during active-duty service as indicated by the normal hearing thresholds at enlistment and separation. In addition, there was no evidence that noise exposure in service caused permanent noise injury affecting hearing sensitivity. The examiner also noted acoustic trauma was not evident during service. The examiner stated that current research did not support the claim of long-term delayed onset of pure tone threshold shifts following noise exposure, there, the Veteran's current hearing loss cannot be correlated with military noise exposure. Per the work of Metidieri et all in "Noise-Induced Hearing Loss: literature review with a focus on occupational medicine" (Int Arch Otorhinolaryngol, 2013 17 (2): 208-212), "The progression ceases when the exposure to intense noise ends." Based on those studies, the examiner found that the Veteran's hearing test at the time of service separation represented the effects of any hazardous noise exposure the Veteran sustained during active service, noting the Veteran had normal thresholds at separation. As the December 2021 VA examiner relied on the absence of symptoms or treatment in service for the negative opinion concerning the demonstrated hearing disability, the Board finds that the opinion is incomplete. Thus, remand is necessary for an adequate etiology opinion regarding bilateral hearing loss. Importantly, the Board notes that VA attention has been directed to an Institute of Medicine (IOM) report on delayed onset hearing loss, submitted by the Veteran. As such, the examiner should include review of the IOM; specifically, to the portion discussing "an individual's awareness of the effects of noise on hearing may be delayed considerably after the noise exposure." Comm. on Noise-Induced Hearing Loss and Tinnitus Assoc'd with Military Service from World War II to the Present, Inst. of Medicine, Noise and Military Serv.: Implications for Hearing Loss and Tinnitus, at 203-04 (Larry E. Humes, Lois M. Joellenbeck, and Jane S. Durch eds., 2005). Therefore, the IOM report's language may support a theory of service connection involving delayed onset of a Veteran's perception of hearing loss such that a VA examiner's citation of the report should contemplate all of the pertinent aspects of its findings. Lemmons v. McDonald, No. 15-3043, 2016 LEXIS 1646 (Vet. App. October 28, 2016) (non-precedential). The Veteran is notified that it is his responsibility to report for any scheduled examination and to cooperate in the development of these claims. The consequences or failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. § 3.655. The matters are REMANDED for the following action: 1. Request the Veteran identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who provided treatment for all claimed disabilities. After securing the necessary releases, attempt to obtain all copies of pertinent treatment records identified by the Veteran that are not currently of record. 2. Then, schedule the Veteran for a VA audiology examination, with an examiner who has not previously examined the Veteran, to diagnose and obtain an opinion regarding the etiology of any right or left ear hearing loss disability. The examiner must review the claims file, to include this Remand in its entirety; the September 2019, March 2021, and August 2021 Remands; the Veteran's lay statements, including hearing testimony, concerning noise exposure in service and hearing loss symptoms during and since service; the service separation examination where the Veteran indicated in the medical history that he had ear, nose, or throat trouble; the previous VA examinations, including the April 2015 examination where the Veteran stated he first noticed problems with hearing in basic training; and the IOM report concerning an individual's delayed awareness on the effects on hearing from noise, and the onset of current symptomatology, and should indicate review of the file in the examination report. The examiner must opine as to whether it is at least as likely as not (50 percent probability or greater) that any portion of the Veteran's hearing loss is etiologically related to active service or any event, disease, or injury during service, including whether any hearing disability (1) began during active service, (2) was noted during service with continuity of the same symptomatology since service, (3) was caused by the service-connected disabilities or treatment for the service-connected disabilities, to specifically include tinnitus, or (4) has been aggravated (increased in severity beyond the natural progress of the disorder) by the service-connected disabilities or treatment for the service-connected disabilities, to specifically include tinnitus. The examiner should specifically consider the findings at entrance to service and at separation from service and should explain why those findings do or do not represent a finding of hearing loss during service. The examiner is advised that VA has conceded noise exposure in service and a current hearing loss diagnosis. The examiner is further advised that the Veteran is competent to report his symptoms during and since service and that those reports must be acknowledged and considered in formulating any opinion. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. The examiner must consider and discuss those lay statements and should reconcile the opinion with any previous opinions of record. A clearly stated rationale for any opinion offered should be provided and must not be based on the lack of any in-service records of hearing loss. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sonya S. Tsao, 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.