Citation Nr: 22017644 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 17-40 092A DATE: March 25, 2022 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. VETERAN'S CONTENTIONS The Veteran contends that he should be granted service connection for his bilateral hearing loss disability. See March 2011 VA 21-526. The Veteran reported that he was exposed to hazardous noise during service. Specifically, the Veteran reported that he was not provided hearing protection when he rode in helicopters or when he went to the firing range. See November 2021 Board Hearing Trans. pg. 4. The Veteran also stated that he recalled hearing muffled sounds in the past, but he did not equate that to being a hearing loss problem. Id. Lastly, he reported that he did not work in noisy environments after service. Id. REASONS FOR REMAND The Veteran served on active duty from July 1965 to July 1968. This matter comes before the Board of Veteran's Appeal (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran selected a hearing with a Veterans Law Judge on his August 2017 VA Form 9. In August 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record Entitlement to service connection for the Veteran's bilateral hearing loss is remanded. This matter was previously remanded in November 2021 for further development to include a VA examination. The case has now returned to the Board for appellate review and, although it again regrets further delay, the Board finds that additional remand is required. Here, the Board finds that the January 2022 medical opinions are inadequate because the examiner failed to adequately explain her findings. The January 2022 examiner opined that the Veteran's hearing loss was not caused by service. See January 2022 VA Medical Opinions. In support of this finding, the examiner noted that the Veteran did not have an in-service diagnosis of hearing loss and there was no permanent threshold shift in his hearing during service. Id. Further, this examiner noted that the medical literature does not support a sudden decrease in hearing acuity after noise exposure has ended. Id. Therefore, the examiner opined that the Veteran's bilateral hearing loss was due to genetic factors, presbycusis, the Veteran's hypertension and diabetes mellitus type II disabilities, and everyday damaging levels of noise, such as lawnmowers and power tools. Id. However, the examiner failed to identify the Veteran's specific genetic factors that contributed to his hearing loss. Further, the Board finds that the record is void of any mention of the Veteran being exposed to lawnmowers or power tools after service. Moreover, although the February 2022 examiner stated that the medical literature does not support delayed onset hearing loss, the Board is aware of a line of medical research, conducted by Dr. Sharon G. Kujawa and others, that does appear to support a medical basis for delayed or latent onset of noise-induced hearing loss. As it is unclear from the February 2022 VA medical opinions whether that line of research was considered in reaching the conclusions offered, the Board finds that it should be considered by the examiner as well. Accordingly, based on the foregoing, the Board finds that an addendum opinion is necessary. See Barr v. Nicholson, 21Vet. App.303, 311 (2007). In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran's own descriptions of the history of his hearing loss disability. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). The matters are REMANDED for the following action: 1. Send the Veteran's claims file to the February 2022 VA examiner or, if unavailable, to another audiologist for an addendum opinion. The claims file must be reviewed by the audiologist. If another examination is deemed necessary, one should be scheduled. Following review of the claims file and, examination of the Veteran if deemed necessary, the audiologist should respond to the following: (a.) Is it at least as likely as not (50 percent probability or more) that the Veteran's bilateral hearing loss began during or is otherwise related to his period of active-duty service or that a hearing loss disability manifested within a year of his separation from service? i. In responding to the question posed in part (a), if you find that the Veteran's hearing loss is related to genetic factors, please identify those genetic factors. See February 2022 VA Medical Opinions. ii. In responding to the question posed in part (a), if you find that the Veteran's hearing loss is related to everyday noise exposure, please use specific examples of post-service noise exposure as reported by the Veteran. See August 2021 Board Hearing Transcript. iii. In responding to the question posed in (a), please note the Veteran is competent to report symptoms, treatment, and injuries and his reports must be considered in formulating the requested opinions. Please keep in mind that the phrase "at least as likely as not" means that "the favorable and unfavorable evidence is in approximate balance or is nearly equal. Also, in issuing the opinions, please specifically address the findings regarding the delayed onset of hearing loss in the line of research conducted by Dr. Kujawa, including the below: (b.) Sharon G. Kujawa & M. Charles Liberman, Acceleration of Age-Related Hearing Loss by Early Noise Exposure: Evidence of a Misspent Youth, 26(7) J. Neurosci. 2115-2123 (2006). (c.) Harrison W. Lin, Adam C. Furman, Sharon G. Kujawa & M. Charles Liberman, Primary Neural Degeneration in the Guinea Pig Cochlea After Reversible Noise-Induced Threshold Shift, 12 J. Ass'n Res. Otolaryngol. 605-616 (2011). (d.) Adam C. Furman, Sharon G. Kujawa & M. Charles Liberman, Noise-Induced Cochlear Neuropathy is Selective for Fibers with Low Spontaneous Rates, 110 J. Neurophysiol. 577-586 (2013). In formulating a medical opinion, if relying to any extent upon the 2005 IOM study, the examiner must (a) identify the medical text's qualifying or contradictory aspects; and (b) explain why the examiner found the contradictory aspects or conclusions in the IOM study to be less persuasive in this Veteran's case as to the question of whether delayed onset left ear hearing loss is as likely as not etiologically related to in-service noise exposure. A complete rationale is required. Please also discuss the impact of the Veteran's in-service acoustic trauma on the hair cells in his cochlea, and state whether it is at least as likely as (50 percent probability or more) not that his left ear hearing loss occurred sooner, or progressed to a greater degree of severity than it otherwise would have, as a result of his in-service noise exposure. The examiner should keep in mind that the lack of a diagnosis of hearing loss in service is not, by itself, a sufficient reason to find that there is no nexus to service. Rather, the salient question is whether any incident of service, including the Veteran's noise exposure, caused a current hearing loss disability even though it may have been initially diagnosed years after discharge from service. A complete rationale for all opinions must be provided, to include reference to pertinent evidence of record and medical literature or treatises where appropriate. If the examiner cannot provide a requested opinion without resort to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need or information or testing necessary to provide an opinion. Additionally, the examiner should indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the examiner. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Foster, 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.