Citation Nr: 18132298
Decision Date: 09/06/18	Archive Date: 09/06/18

DOCKET NO. 14-30 667
DATE:	September 6, 2018
Entitlement to service connection for right ear hearing loss is remanded.
1. Entitlement to service connection for right ear hearing loss is remanded.
The Veteran had more than 37 years of service in the Army National Guard (ARNG), and had several military occupational specialties (MOS) within the field that reasonably resulted in noise exposure.  

The Board finds that at this point an addendum medical opinion is the best route to determine the nature and etiology of his hearing loss in the right ear. The June 2011 VA examiner found that the Veteran’s claimed in-service noise exposure did not cause his hearing loss, it appears that only the objectively documented Service Treatment Record (STR) information was duly considered in any depth when making that determination.  As frequently cited, based upon VA caselaw a claimant’s own competent reported assertions also carry great weight and/or any other evidence which goes towards causal nexus.  See generally, Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992); Hensley v. Brown, 5 Vet. App. 155, 159 (1993).  Therefore, an addendum opinion is needed with regard to full and fair consideration of the Veteran’s complete assertions.  He has given explanation of the total range of symptomatology he had by an August 2014 VA Form 9 (Substantive Appeal to the Board).  He discussed noise exposure from having been nearby a firing range, helicopters, and military ground vehicles.  
The Board further recognizes the duration of the Veteran’s service as a factor in the significance of his noise exposure.  Further, for claim purposes, that history itself helps support the claim if not independently completely establishing it since to date the exact dates of National Guard service are not on file.  This further is a case where the in-service audiograms fluctuated over time.  
The matter is REMANDED for the following action:
1. Provide the Veteran’s claims file to a qualified clinician to determine the nature and etiology of his right ear hearing loss.  The electronic claims files must be made available for the examiner to review, and the examiner should confirm this review was completed. 
The examiner should determine whether the Veteran’s previously diagnosed right ear hearing loss is at least as likely as not (50 percent or greater probability) etiologically related to his military service as due to his several instances of reported in-service noise exposure, this arising out reported noise exposure from having been in proximity to a firing range, helicopters, and military ground vehicles (given further those notated sources of in-service noise exposure indicated upon the Veteran’s August 2014 VA Form 9).  
The examiner is requested to further take into account the Veteran’s STRs over several years of service within the Army National Guard, including with regard to the periodically completed in-service audiograms.  
The examiner should consider the Veteran’s lay assertions.  
It is not sufficient to provide a negative opinion based solely on normal hearing at separation.  
The examiner should include in the examination report the rationale for any opinion expressed. However, if the examiner cannot respond to the inquiry without resort to speculation, he or she should so state, and further explain why it is not feasible to provide a medical opinion.
2. Review the claims file. If the directives specified in this remand have not been implemented, take appropriate corrective action before readjudication. Stegall v. West, 11 Vet. App. 268 (1998).
3. Then readjudicate the claim on appeal based upon all evidence of record.  If the benefit sought on appeal is not granted, the Veteran and his representative should be furnished with a Supplemental Statement of the Case (SSOC) and afforded an opportunity to respond.
D. Martz Ames
Veterans Law Judge
Board of Veterans’ Appeals

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