Citation Nr: 22017257 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-46 778 DATE: March 24, 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 from September 1974 to January 1977. This matter again comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in May 2019. 1. Bilateral Hearing Loss 2. Tinnitus The Board acknowledges receipt of July 2020 and August 2020 opinions; however, these opinions are inadequate. The clinician who provided the July 2020 and August 2020 opinions stated that the Veteran's claimed condition "clearly and unmistakably existed prior to service," but then indicated that there was no evidence that the Veteran's hearing loss and/or tinnitus existed prior to his enlistment. See July 2020 and August 2020 VA Medical Opinions. This internal inconsistency calls into question the adequacy of the opinions received on remand. Additionally, the clinician providing the July 2020 and August 2020 opinions found that the Veteran's post-separation noise exposure in a factory for approximately 37 years was the most likely etiology of his conditions. However, the clinician did not provide a rationale explaining this conclusion. See July 2020 and August 2020 VA Medical Opinions; Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Therefore, these opinions are inadequate, and the Board finds that a new remand is warranted for adequate opinions regarding the natures and etiologies of the Veteran's bilateral hearing loss and tinnitus. The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate clinician who has not previously provided an opinion in this case to determine the natures and etiologies of the Veteran's bilateral hearing loss and tinnitus. If the clinician finds that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. If an examination is provided, the clinician should elicit from the Veteran his history of noise exposure before, during, and after his military service. (a) The clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's bilateral hearing loss manifested during, or is the result of, his active duty service. (b) The clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's tinnitus manifested during, or is the result of, his active duty service. (c) The clinician should opine as to whether there is clear and unmistakable (i.e., medically undebatable) evidence that the Veteran's bilateral hearing loss and/or tinnitus existed prior to service. (i) If the clinician answers in the affirmative, the clinician should opine as to whether there is clear and unmistakable (i.e., medically undebatable) evidence that (1) there was no increase in disability during service or (2) any increase in disability was due to the natural progress of the pre-existing condition(s). (d) The clinician should opine as to whether there is clear and unmistakable (i.e., medically undebatable) evidence that the Veteran had conditions that would affect his hearing and/or tinnitus prior to service. (i) If the clinician answers in the affirmative, the clinician should opine as to whether there is clear and unmistakable (i.e., medically undebatable) evidence that (1) there was no increase in disability during service or (2) any increase in disability was due to the natural progress of the pre-existing conditions. (ii) If the clinician answers in the affirmative, the clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that these pre-existing conditions caused the Veteran's bilateral hearing loss and/or tinnitus. In formulating his or her opinions, the clinician should consider and address the competent medical and lay evidence of record, including but not limited to: (i) The Veteran's service treatment records, to include all in-service audiological testing and records indicating that the Veteran had been diagnosed with various ear conditions prior to service; (ii) The Veteran's Military Occupational Specialty (MOS) and its probability of hazardous noise exposure as noted in the Department of Defense MOS Noise Exposure Listing; (iii) The Veteran's VA medical records; and (iv) The Veteran's competent lay statements regarding his first-hand in-service experiences and the onset and continuity of his symptomatology. If the clinician determines that the Veteran's bilateral hearing loss and/or tinnitus is/are less likely than not due to his active duty service and/or aggravated beyond their natural progression by his active duty service, the clinician should discuss what other factor(s) caused the disorders. In other words, the clinician should ascertain the most likely etiology of the Veteran's bilateral hearing loss and tinnitus. The clinician must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. 2. Then, the RO should readjudicate the issues of entitlement to service connection for bilateral hearing loss and entitlement to service connection for tinnitus. If the above-sought benefits remain denied, the RO should issue a Supplemental Statement of the Case (SSOC) to the Veteran and his representative. An appropriate period of time should be allowed for response before returning this appeal to the Board. Zi-Heng Zhu Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoffman 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.