Veteranclaims’s Blog

November 18, 2022

Single Judge Application; Delayed Hearing loss; “[A] claimant may establish direct service connection for a hearing disability initially manifest several years after separation from service”—that is, delayed onset hearing loss—if the claimant can show a causal relationship between an in-service event and the hearing disability. Hensley v. Brown, 5 Vet.App. 155, 164 (1993); Hensley, 5 Vet.App. at 164 (noting that hearing loss that does not manifest until several years after separation may still result from an in-service event);

Filed under: Uncategorized — veteranclaims @ 12:41 pm

Designated for electronic publication only
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
No. 21-5387
JAMES J. MONROE, APPELLANT,
V.
DENIS MCDONOUGH,
SECRETARY OF VETERANS AFFAIRS, APPELLEE.
Before FALVEY, Judge.
MEMORANDUM DECISION
Note: Pursuant to U.S. Vet. App. R. 30(a),
this action may not be cited as precedent.
FALVEY, Judge: Army veteran James J. Monroe, through counsel, appeals a May 14,
2021, Board of Veterans’ Appeals decision denying service connection for bilateral hearing loss.1
The appeal is timely; the Court has jurisdiction to review the Board decision; and single -judge
disposition is appropriate. See 38 U.S.C. §§ 7252(a), 7266(a); Frankel v. Derwinski, 1 Vet.App.
23, 25-26 (1990).
We are asked to decide whether the Board breached its duty to assist by relying on an
inadequate medical examination and whether the Board provided adequate reasons or bases for its
decision. Because the Board relied on a medical examination lacking adequate rationale for its
conclusion, we will set aside that part of the Board decision denying service connection for
bilateral hearing loss and remand the matter for further proceedings. And because this provides
1 The Board dismissed claims for a rating greater than 10% for tinnitus and effective dates before September
29, 2015, for tinnitus, pseudofolliculitis barbae, and a scar post removal of a sebaceous cyst, noting that Mr. Monroe
withdrew those claims. Record (R.) at 5. Mr. Monroe does not challenge these dismissals, and the Court will not
address them. See Pederson v. McDonald, 27 Vet.App. 276, 281-85 (2015) (en banc) (declining to review the merits
of an issue not argued on appeal and dismissing the appeal of that issue). The Board also remanded Mr. Monroe’s
claims for compensable disability ratings for the cyst-removal scar and pseudofolliculitis barbae. R. at 5. The Court
lacks authority to address these nonfinal matters. See 38 U.S.C. § 7252(a); Breeden v. Principi, 17 Vet.App. 475, 478
(2004).
2
Mr. Monroe with full relief, we need not address his other arguments. See Mahl v. Principi, 15
Vet.App. 37, 38 (2001).
I. FACTS
Mr. Monroe served on active duty from February 1974 to February 1977. R. at 2546. His
February 1974 entrance exam included the following audiometric readings:
500 1000 2000 3000 6000 Hertz (Hz)
Right 25 15 5 / 20 Decibels (dB)
Left 25 25 15 / 15 (dB)
R. at 2179. A September 1978 examination conducted when Mr. Monroe joined the Louisiana Air
National Guard2 included the following audiometric readings:
500 1000 2000 3000 4000 6000 (Hz)
Right 35 20 10 5 15 30 (dB)
Left 30 15 5 5 10 20 (dB)
R. at 2144.
In September 2015, Mr. Monroe filed a claim for bilateral hearing loss. R. at 1860-61. A
private audiology report described Mr. Monroe’s hearing loss as progressive. R. at 1845. A
November 2015 VA examination noted sensorineural hearing loss in both ears and included the
following audiometric readings:
500 1000 2000 3000 4000 6000 8000 (Hz)
Right 10 10 25 75 85 85 80 (dB)
Left 10 5 25 80 95 85 80 (dB)
R. at 1831-33. The examiner noted that Mr. Monroe’s hearing was within normal limits upon
service entry and separation and that there was no documentation of an Occupational Safety and
Health Administration (OSHA)-defined standard threshold shift during service. R. at 1834. Based
on these facts, the examiner opined that it was less likely than not that Mr. Monroe’s hearing loss
was related to his military service. Id. A December 2015 rating decision denied Mr. Monroe service
2 The September 1978 examination conducted when Mr. Monroe joined the Louisiana Air National Guard is
sometimes erroneously referred to in the record and in briefs as Mr. Monroe’s active duty separation or exit
examination. For clarity, the Court will call it the September 1978 examination, and understands any references in the
record and briefs to Mr. Monroe’s active duty exit or separation examination to mean the September 1978 examination.
3
connection for bilateral hearing loss and Mr. Monroe filed a Notice of Disagreement (NOD). R. at
1823, 1789-90.
A March 2016 private medical record stated that Mr. Monroe complained of “progressive
bilateral hearing loss.” R. at 1756. In June 2016, Mr. Monroe stated that it has “been said and
documented that [his hearing] loss started during my military career as a result of my job
description.” R. at 1682.
A February 2018 Statement of the Case (SOC) continued to deny Mr. Monroe’s claim
because his hearing loss was not linked to service. R. at 1453. Mr. Monroe perfected his appeal in
March 2018 and stated that his hearing loss was “more likely than not/presumptively secondary to
loud noises in my duty as a tank driver. When the tank gun was fired the decibels became louder.
Our helmets did not muffle the noise level.” R. at 1378.
At an April 2021 Board hearing, Mr. Monroe stated that his hearing was currently not as
good as it was when he exited service. R. at 289. He also described working as a tank driver while
in service, stating that the engine was directly on his right side and “roaring in [his] ear.” R. at 291.
Mr. Monroe’s wife testified that she noticed his hearing degraded around the time that he exited
military service. R. at 289.
A May 2021 Board decision denied entitlement to service connection for bilateral hearing
loss. R. at 1. The Board found that Mr. Monroe had a current hearing loss disability for VA
purposes and that he was exposed to in-service hazardous noise. R. at 10. But the Board denied
service connection, finding that Mr. Monroe’s hearing loss did not manifest in or within one year
of separation from service and was otherwise unrelated to Mr. Monroe’s active duty service. R. at
10.
II. ANALYSIS
Mr. Monroe argues that Board breached its duty to assist by failing to obtain an adequate
medical examination. Appellant’s Brief (Br.) at 5-13. Mr. Monroe contends that the November
2015 VA medical examiner failed to explain the significance of the facts relied on when forming
her opinion. Id. at 10-11. And without an explanation connecting the facts to her conclusion, Mr.
Monroe argues that the examination is inadequate to allow the Board to make an informed decision
regarding his hearing loss. Id. Mr. Monroe also argues that the examiner failed to consider whether
his hearing loss is a delayed effect of his exposure to in-service hazardous noise. Appellant’s Br.
4
at 11; Reply Br. at 6, 9. The Secretary disagrees; he argues that the examiner provided a reasoned
opinion that connected the evidence to her conclusion. Secretary’s Br. at 15-18.
To establish service connection, generally one must show competent evidence of (1) a
current disability, (2) the incurrence or aggravation of a disease or injury while in military service,
and (3) a nexus between the in-service injury or disease and the current disability. Caluza v. Brown,
7 Vet.App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). In Mr. Monroe’s
case, the question is whether there is a nexus between his in-service noise exposure and current
hearing loss.
VA’s duty to assist includes the duty to conduct an adequate medical examination “when
such an examination or opinion is necessary to make a decision on the claim.” 38 U.S.C. §
5103A(d)(1); Stefl v. Nicholson, 21 Vet.App. 120, 123 (2007). And to be adequate, an examination
opinion “must contain not only clear conclusions with supporting data, but also a reasoned medical
explanation connecting the two,” Nieves–Rodriguez v. Peake, 22 Vet.App. 295, 301 (2008), be
“based upon consideration of the veteran’s prior medical history and examinations, ” Stefl, 21
Vet.App. at 123, and “sufficiently inform the Board of a medical expert’s judgment on a medical
question and the essential rationale for that opinion,” Monzingo v. Shinseki, 26 Vet.App. 97, 105
(2012), overruled on other grounds by Euzebio v. McDonough, 989 F.3d 1305 (Fed. Cir. 2021).
“[A] claimant may establish direct service connection for a hearing disability initially manifest
several years after separation from service”—that is, delayed onset hearing loss—if the claimant
can show a causal relationship between an in-service event and the hearing disability. Hensley v.
Brown, 5 Vet.App. 155, 164 (1993).
Whether a medical examination is adequate is a finding of
fact that the Court reviews under the “clearly erroneous” standard. D’Aries v. Peake, 22 Vet.App.
97, 104 (2008).
Here, the November 2015 VA examiner concluded that it was less likely than not that Mr.
Monroe’s hearing loss resulted from an event in military service. R. at 1834. The examiner’s
rationale for her negative nexus opinion was that a comparison between Mr. Monroe’s 1974
entrance examination and the September 1978 examination showed no change in hearing
sensitivity and that “an OSHA-defined [standard threshold shift] during military service CANNOT
be established from this audiometric data.” Id. It is clear to the Court how a lack of change in
hearing between 1974 and 1978 supports the examiner’s finding that an OSHA-defined standard
threshold shift during service cannot be established from the record. But it is unclear how the lack
5
of threshold shift between 1974 and 1978 shows that Mr. Monroe’s hearing loss was less likely
than not related to service.
True, there is no reasons or bases requirement on examiners. Acevedo v. Shinseki, 25
Vet.App. 286, 293 (2012). But an adequate medical opinion must include an explanation detailed
enough so that the examiner’s rationale for his or her conclusion is clear. Monzingo, 26 Vet.App.
at 105; Nieves-Rodriguez, 22 Vet.App. at 301. And that is the problem here. We cannot discern
the examiner’s reasoning for concluding that Mr. Monroe’s hearing loss is less likely caused by
service. The examiner explains why she concluded that Mr. Monroe’s hearing loss did not occur
in service. But she offers no rationale for her conclusion that Mr. Monroe’s hearing loss did not
result from service. See Hensley, 5 Vet.App. at 164 (noting that hearing loss that does not manifest
until several years af ter separation may still result from an in-service event)
. The examiner does
not explain why the lack of an OSHA-defined standard threshold shift in service matters to her
conclusion that Mr. Monroe’s hearing loss does not result from service. And the significance of
such a shift is a medical determination the Board may not make on its own. See Colvin v.
Derwinski, 1 Vet.App. 171, 175 (1991). In short, the examination is inadequate to inform the Board
on Mr. Monroe’s hearing loss. See Monzingo, 26 Vet.App. at 105; Nieves-Rodriguez, 22 Vet.App.
at 301. Thus, remand is warranted for the Board to obtain an adequate medical examination. See
Bowling v. Principi, 15 Vet.App. 1, 12 (2001) (emphasizing the Board’s duty to return inadequate
examination reports).
Because we are remanding his claim, we need not address additional arguments that would
lead to no broader remedy. See Mahl, 15 Vet.App. at 38. On remand, Mr. Monroe is free to submit
additional evidence and argument on the remanded matter, including those raised in his briefs, and
he has 90 days from the date of the postremand notice VA provides to do so. See Kutscherousky
v. West, 12 Vet.App. 369, 372–73 (1999) (per curiam order); see also Clark v. O’Rourke, 30
Vet.App. 92, 97 (2018). The Board must consider any such evidence or argument submitted. See
Kay v. Principi, 16 Vet.App. 529, 534 (2002); see also 38 U.S.C. § 7112 (a remand must be
performed in an expeditious manner); Fletcher v. Derwinski, 1 Vet.App. 394, 397 (1991) (“A
remand is meant to entail a critical examination of the justification for the decision.”).
6
III. CONCLUSION
On consideration of the above, the part of the May 14, 2021, Board decision denying
service connection for bilateral hearing loss is SET ASIDE and the matter REMANDED. The
appeal is otherwise DISMISSED
DATED: November 17, 2022
Copies to:
Glenn R. Bergmann, Esq.
VA General Counsel (027)

Designated for electronic publication only
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
No. 21-5387
JAMES J. MONROE, APPELLANT,
V.
DENIS MCDONOUGH,
SECRETARY OF VETERANS AFFAIRS, APPELLEE.
Before FALVEY, Judge.
MEMORANDUM DECISION
Note: Pursuant to U.S. Vet. App. R. 30(a),
this action may not be cited as precedent.
FALVEY, Judge: Army veteran James J. Monroe, through counsel, appeals a May 14,
2021, Board of Veterans’ Appeals decision denying service connection for bilateral hearing loss.1
The appeal is timely; the Court has jurisdiction to review the Board decision; and single -judge
disposition is appropriate. See 38 U.S.C. §§ 7252(a), 7266(a); Frankel v. Derwinski, 1 Vet.App.
23, 25-26 (1990).
We are asked to decide whether the Board breached its duty to assist by relying on an
inadequate medical examination and whether the Board provided adequate reasons or bases for its
decision. Because the Board relied on a medical examination lacking adequate rationale for its
conclusion, we will set aside that part of the Board decision denying service connection for
bilateral hearing loss and remand the matter for further proceedings. And because this provides
1 The Board dismissed claims for a rating greater than 10% for tinnitus and effective dates before September
29, 2015, for tinnitus, pseudofolliculitis barbae, and a scar post removal of a sebaceous cyst, noting that Mr. Monroe
withdrew those claims. Record (R.) at 5. Mr. Monroe does not challenge these dismissals, and the Court will not
address them. See Pederson v. McDonald, 27 Vet.App. 276, 281-85 (2015) (en banc) (declining to review the merits
of an issue not argued on appeal and dismissing the appeal of that issue). The Board also remanded Mr. Monroe’s
claims for compensable disability ratings for the cyst-removal scar and pseudofolliculitis barbae. R. at 5. The Court
lacks authority to address these nonfinal matters. See 38 U.S.C. § 7252(a); Breeden v. Principi, 17 Vet.App. 475, 478
(2004).
2
Mr. Monroe with full relief, we need not address his other arguments. See Mahl v. Principi, 15
Vet.App. 37, 38 (2001).
I. FACTS
Mr. Monroe served on active duty from February 1974 to February 1977. R. at 2546. His
February 1974 entrance exam included the following audiometric readings:
500 1000 2000 3000 6000 Hertz (Hz)
Right 25 15 5 / 20 Decibels (dB)
Left 25 25 15 / 15 (dB)
R. at 2179. A September 1978 examination conducted when Mr. Monroe joined the Louisiana Air
National Guard2 included the following audiometric readings:
500 1000 2000 3000 4000 6000 (Hz)
Right 35 20 10 5 15 30 (dB)
Left 30 15 5 5 10 20 (dB)
R. at 2144.
In September 2015, Mr. Monroe filed a claim for bilateral hearing loss. R. at 1860-61. A
private audiology report described Mr. Monroe’s hearing loss as progressive. R. at 1845. A
November 2015 VA examination noted sensorineural hearing loss in both ears and included the
following audiometric readings:
500 1000 2000 3000 4000 6000 8000 (Hz)
Right 10 10 25 75 85 85 80 (dB)
Left 10 5 25 80 95 85 80 (dB)
R. at 1831-33. The examiner noted that Mr. Monroe’s hearing was within normal limits upon
service entry and separation and that there was no documentation of an Occupational Safety and
Health Administration (OSHA)-defined standard threshold shift during service. R. at 1834. Based
on these facts, the examiner opined that it was less likely than not that Mr. Monroe’s hearing loss
was related to his military service. Id. A December 2015 rating decision denied Mr. Monroe service
2 The September 1978 examination conducted when Mr. Monroe joined the Louisiana Air National Guard is
sometimes erroneously referred to in the record and in briefs as Mr. Monroe’s active duty separation or exit
examination. For clarity, the Court will call it the September 1978 examination, and understands any references in the
record and briefs to Mr. Monroe’s active duty exit or separation examination to mean the September 1978 examination.
3
connection for bilateral hearing loss and Mr. Monroe filed a Notice of Disagreement (NOD). R. at
1823, 1789-90.
A March 2016 private medical record stated that Mr. Monroe complained of “progressive
bilateral hearing loss.” R. at 1756. In June 2016, Mr. Monroe stated that it has “been said and
documented that [his hearing] loss started during my military career as a result of my job
description.” R. at 1682.
A February 2018 Statement of the Case (SOC) continued to deny Mr. Monroe’s claim
because his hearing loss was not linked to service. R. at 1453. Mr. Monroe perfected his appeal in
March 2018 and stated that his hearing loss was “more likely than not/presumptively secondary to
loud noises in my duty as a tank driver. When the tank gun was fired the decibels became louder.
Our helmets did not muffle the noise level.” R. at 1378.
At an April 2021 Board hearing, Mr. Monroe stated that his hearing was currently not as
good as it was when he exited service. R. at 289. He also described working as a tank driver while
in service, stating that the engine was directly on his right side and “roaring in [his] ear.” R. at 291.
Mr. Monroe’s wife testified that she noticed his hearing degraded around the time that he exited
military service. R. at 289.
A May 2021 Board decision denied entitlement to service connection for bilateral hearing
loss. R. at 1. The Board found that Mr. Monroe had a current hearing loss disability for VA
purposes and that he was exposed to in-service hazardous noise. R. at 10. But the Board denied
service connection, finding that Mr. Monroe’s hearing loss did not manifest in or within one year
of separation from service and was otherwise unrelated to Mr. Monroe’s active duty service. R. at
10.
II. ANALYSIS
Mr. Monroe argues that Board breached its duty to assist by failing to obtain an adequate
medical examination. Appellant’s Brief (Br.) at 5-13. Mr. Monroe contends that the November
2015 VA medical examiner failed to explain the significance of the facts relied on when forming
her opinion. Id. at 10-11. And without an explanation connecting the facts to her conclusion, Mr.
Monroe argues that the examination is inadequate to allow the Board to make an informed decision
regarding his hearing loss. Id. Mr. Monroe also argues that the examiner failed to consider whether
his hearing loss is a delayed effect of his exposure to in-service hazardous noise. Appellant’s Br.
4
at 11; Reply Br. at 6, 9. The Secretary disagrees; he argues that the examiner provided a reasoned
opinion that connected the evidence to her conclusion. Secretary’s Br. at 15-18.
To establish service connection, generally one must show competent evidence of (1) a
current disability, (2) the incurrence or aggravation of a disease or injury while in military service,
and (3) a nexus between the in-service injury or disease and the current disability. Caluza v. Brown,
7 Vet.App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). In Mr. Monroe’s
case, the question is whether there is a nexus between his in-service noise exposure and current
hearing loss.
VA’s duty to assist includes the duty to conduct an adequate medical examination “when
such an examination or opinion is necessary to make a decision on the claim.” 38 U.S.C. §
5103A(d)(1); Stefl v. Nicholson, 21 Vet.App. 120, 123 (2007). And to be adequate, an examination
opinion “must contain not only clear conclusions with supporting data, but also a reasoned medical
explanation connecting the two,” Nieves–Rodriguez v. Peake, 22 Vet.App. 295, 301 (2008), be
“based upon consideration of the veteran’s prior medical history and examinations, ” Stefl, 21
Vet.App. at 123, and “sufficiently inform the Board of a medical expert’s judgment on a medical
question and the essential rationale for that opinion,” Monzingo v. Shinseki, 26 Vet.App. 97, 105
(2012), overruled on other grounds by Euzebio v. McDonough, 989 F.3d 1305 (Fed. Cir. 2021).
“[A] claimant may establish direct service connection for a hearing disability initially manifest
several years after separation from service”—that is, delayed onset hearing loss—if the claimant
can show a causal relationship between an in-service event and the hearing disability. Hensley v.
Brown, 5 Vet.App. 155, 164 (1993). Whether a medical examination is adequate is a finding of
fact that the Court reviews under the “clearly erroneous” standard. D’Aries v. Peake, 22 Vet.App.
97, 104 (2008).
Here, the November 2015 VA examiner concluded that it was less likely than not that Mr.
Monroe’s hearing loss resulted from an event in military service. R. at 1834. The examiner’s
rationale for her negative nexus opinion was that a comparison between Mr. Monroe’s 1974
entrance examination and the September 1978 examination showed no change in hearing
sensitivity and that “an OSHA-defined [standard threshold shift] during military service CANNOT
be established from this audiometric data.” Id. It is clear to the Court how a lack of change in
hearing between 1974 and 1978 supports the examiner’s finding that an OSHA-defined standard
threshold shift during service cannot be established from the record. But it is unclear how the lack
5
of threshold shift between 1974 and 1978 shows that Mr. Monroe’s hearing loss was less likely
than not related to service.
True, there is no reasons or bases requirement on examiners. Acevedo v. Shinseki, 25
Vet.App. 286, 293 (2012). But an adequate medical opinion must include an explanation detailed
enough so that the examiner’s rationale for his or her conclusion is clear. Monzingo, 26 Vet.App.
at 105; Nieves-Rodriguez, 22 Vet.App. at 301. And that is the problem here. We cannot discern
the examiner’s reasoning for concluding that Mr. Monroe’s hearing loss is less likely caused by
service. The examiner explains why she concluded that Mr. Monroe’s hearing loss did not occur
in service. But she offers no rationale for her conclusion that Mr. Monroe’s hearing loss did not
result from service. See Hensley, 5 Vet.App. at 164 (noting that hearing loss that does not manifest
until several years af ter separation may still result from an in-service event). The examiner does
not explain why the lack of an OSHA-defined standard threshold shift in service matters to her
conclusion that Mr. Monroe’s hearing loss does not result from service. And the significance of
such a shift is a medical determination the Board may not make on its own. See Colvin v.
Derwinski, 1 Vet.App. 171, 175 (1991). In short, the examination is inadequate to inform the Board
on Mr. Monroe’s hearing loss. See Monzingo, 26 Vet.App. at 105; Nieves-Rodriguez, 22 Vet.App.
at 301. Thus, remand is warranted for the Board to obtain an adequate medical examination. See
Bowling v. Principi, 15 Vet.App. 1, 12 (2001) (emphasizing the Board’s duty to return inadequate
examination reports).
Because we are remanding his claim, we need not address additional arguments that would
lead to no broader remedy. See Mahl, 15 Vet.App. at 38. On remand, Mr. Monroe is free to submit
additional evidence and argument on the remanded matter, including those raised in his briefs, and
he has 90 days from the date of the postremand notice VA provides to do so. See Kutscherousky
v. West, 12 Vet.App. 369, 372–73 (1999) (per curiam order); see also Clark v. O’Rourke, 30
Vet.App. 92, 97 (2018). The Board must consider any such evidence or argument submitted. See
Kay v. Principi, 16 Vet.App. 529, 534 (2002); see also 38 U.S.C. § 7112 (a remand must be
performed in an expeditious manner); Fletcher v. Derwinski, 1 Vet.App. 394, 397 (1991) (“A
remand is meant to entail a critical examination of the justification for the decision.”).
6
III. CONCLUSION
On consideration of the above, the part of the May 14, 2021, Board decision denying
service connection for bilateral hearing loss is SET ASIDE and the matter REMANDED. The
appeal is otherwise DISMISSED
DATED: November 17, 2022
Copies to:
Glenn R. Bergmann, Esq.
VA General Counsel (027)

Designated for electronic publication only
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
No. 21-5387
JAMES J. MONROE, APPELLANT,
V.
DENIS MCDONOUGH,
SECRETARY OF VETERANS AFFAIRS, APPELLEE.
Before FALVEY, Judge.
MEMORANDUM DECISION
Note: Pursuant to U.S. Vet. App. R. 30(a),
this action may not be cited as precedent.
FALVEY, Judge: Army veteran James J. Monroe, through counsel, appeals a May 14,
2021, Board of Veterans’ Appeals decision denying service connection for bilateral hearing loss.1
The appeal is timely; the Court has jurisdiction to review the Board decision; and single -judge
disposition is appropriate. See 38 U.S.C. §§ 7252(a), 7266(a); Frankel v. Derwinski, 1 Vet.App.
23, 25-26 (1990).
We are asked to decide whether the Board breached its duty to assist by relying on an
inadequate medical examination and whether the Board provided adequate reasons or bases for its
decision. Because the Board relied on a medical examination lacking adequate rationale for its
conclusion, we will set aside that part of the Board decision denying service connection for
bilateral hearing loss and remand the matter for further proceedings. And because this provides
1 The Board dismissed claims for a rating greater than 10% for tinnitus and effective dates before September
29, 2015, for tinnitus, pseudofolliculitis barbae, and a scar post removal of a sebaceous cyst, noting that Mr. Monroe
withdrew those claims. Record (R.) at 5. Mr. Monroe does not challenge these dismissals, and the Court will not
address them. See Pederson v. McDonald, 27 Vet.App. 276, 281-85 (2015) (en banc) (declining to review the merits
of an issue not argued on appeal and dismissing the appeal of that issue). The Board also remanded Mr. Monroe’s
claims for compensable disability ratings for the cyst-removal scar and pseudofolliculitis barbae. R. at 5. The Court
lacks authority to address these nonfinal matters. See 38 U.S.C. § 7252(a); Breeden v. Principi, 17 Vet.App. 475, 478
(2004).
2
Mr. Monroe with full relief, we need not address his other arguments. See Mahl v. Principi, 15
Vet.App. 37, 38 (2001).
I. FACTS
Mr. Monroe served on active duty from February 1974 to February 1977. R. at 2546. His
February 1974 entrance exam included the following audiometric readings:
500 1000 2000 3000 6000 Hertz (Hz)
Right 25 15 5 / 20 Decibels (dB)
Left 25 25 15 / 15 (dB)
R. at 2179. A September 1978 examination conducted when Mr. Monroe joined the Louisiana Air
National Guard2 included the following audiometric readings:
500 1000 2000 3000 4000 6000 (Hz)
Right 35 20 10 5 15 30 (dB)
Left 30 15 5 5 10 20 (dB)
R. at 2144.
In September 2015, Mr. Monroe filed a claim for bilateral hearing loss. R. at 1860-61. A
private audiology report described Mr. Monroe’s hearing loss as progressive. R. at 1845. A
November 2015 VA examination noted sensorineural hearing loss in both ears and included the
following audiometric readings:
500 1000 2000 3000 4000 6000 8000 (Hz)
Right 10 10 25 75 85 85 80 (dB)
Left 10 5 25 80 95 85 80 (dB)
R. at 1831-33. The examiner noted that Mr. Monroe’s hearing was within normal limits upon
service entry and separation and that there was no documentation of an Occupational Safety and
Health Administration (OSHA)-defined standard threshold shift during service. R. at 1834. Based
on these facts, the examiner opined that it was less likely than not that Mr. Monroe’s hearing loss
was related to his military service. Id. A December 2015 rating decision denied Mr. Monroe service
2 The September 1978 examination conducted when Mr. Monroe joined the Louisiana Air National Guard is
sometimes erroneously referred to in the record and in briefs as Mr. Monroe’s active duty separation or exit
examination. For clarity, the Court will call it the September 1978 examination, and understands any references in the
record and briefs to Mr. Monroe’s active duty exit or separation examination to mean the September 1978 examination.
3
connection for bilateral hearing loss and Mr. Monroe filed a Notice of Disagreement (NOD). R. at
1823, 1789-90.
A March 2016 private medical record stated that Mr. Monroe complained of “progressive
bilateral hearing loss.” R. at 1756. In June 2016, Mr. Monroe stated that it has “been said and
documented that [his hearing] loss started during my military career as a result of my job
description.” R. at 1682.
A February 2018 Statement of the Case (SOC) continued to deny Mr. Monroe’s claim
because his hearing loss was not linked to service. R. at 1453. Mr. Monroe perfected his appeal in
March 2018 and stated that his hearing loss was “more likely than not/presumptively secondary to
loud noises in my duty as a tank driver. When the tank gun was fired the decibels became louder.
Our helmets did not muffle the noise level.” R. at 1378.
At an April 2021 Board hearing, Mr. Monroe stated that his hearing was currently not as
good as it was when he exited service. R. at 289. He also described working as a tank driver while
in service, stating that the engine was directly on his right side and “roaring in [his] ear.” R. at 291.
Mr. Monroe’s wife testified that she noticed his hearing degraded around the time that he exited
military service. R. at 289.
A May 2021 Board decision denied entitlement to service connection for bilateral hearing
loss. R. at 1. The Board found that Mr. Monroe had a current hearing loss disability for VA
purposes and that he was exposed to in-service hazardous noise. R. at 10. But the Board denied
service connection, finding that Mr. Monroe’s hearing loss did not manifest in or within one year
of separation from service and was otherwise unrelated to Mr. Monroe’s active duty service. R. at
10.
II. ANALYSIS
Mr. Monroe argues that Board breached its duty to assist by failing to obtain an adequate
medical examination. Appellant’s Brief (Br.) at 5-13. Mr. Monroe contends that the November
2015 VA medical examiner failed to explain the significance of the facts relied on when forming
her opinion. Id. at 10-11. And without an explanation connecting the facts to her conclusion, Mr.
Monroe argues that the examination is inadequate to allow the Board to make an informed decision
regarding his hearing loss. Id. Mr. Monroe also argues that the examiner failed to consider whether
his hearing loss is a delayed effect of his exposure to in-service hazardous noise. Appellant’s Br.
4
at 11; Reply Br. at 6, 9. The Secretary disagrees; he argues that the examiner provided a reasoned
opinion that connected the evidence to her conclusion. Secretary’s Br. at 15-18.
To establish service connection, generally one must show competent evidence of (1) a
current disability, (2) the incurrence or aggravation of a disease or injury while in military service,
and (3) a nexus between the in-service injury or disease and the current disability. Caluza v. Brown,
7 Vet.App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). In Mr. Monroe’s
case, the question is whether there is a nexus between his in-service noise exposure and current
hearing loss.
VA’s duty to assist includes the duty to conduct an adequate medical examination “when
such an examination or opinion is necessary to make a decision on the claim.” 38 U.S.C. §
5103A(d)(1); Stefl v. Nicholson, 21 Vet.App. 120, 123 (2007). And to be adequate, an examination
opinion “must contain not only clear conclusions with supporting data, but also a reasoned medical
explanation connecting the two,” Nieves–Rodriguez v. Peake, 22 Vet.App. 295, 301 (2008), be
“based upon consideration of the veteran’s prior medical history and examinations, ” Stefl, 21
Vet.App. at 123, and “sufficiently inform the Board of a medical expert’s judgment on a medical
question and the essential rationale for that opinion,” Monzingo v. Shinseki, 26 Vet.App. 97, 105
(2012), overruled on other grounds by Euzebio v. McDonough, 989 F.3d 1305 (Fed. Cir. 2021).
“[A] claimant may establish direct service connection for a hearing disability initially manifest
several years after separation from service”—that is, delayed onset hearing loss—if the claimant
can show a causal relationship between an in-service event and the hearing disability. Hensley v.
Brown, 5 Vet.App. 155, 164 (1993). Whether a medical examination is adequate is a finding of
fact that the Court reviews under the “clearly erroneous” standard. D’Aries v. Peake, 22 Vet.App.
97, 104 (2008).
Here, the November 2015 VA examiner concluded that it was less likely than not that Mr.
Monroe’s hearing loss resulted from an event in military service. R. at 1834. The examiner’s
rationale for her negative nexus opinion was that a comparison between Mr. Monroe’s 1974
entrance examination and the September 1978 examination showed no change in hearing
sensitivity and that “an OSHA-defined [standard threshold shift] during military service CANNOT
be established from this audiometric data.” Id. It is clear to the Court how a lack of change in
hearing between 1974 and 1978 supports the examiner’s finding that an OSHA-defined standard
threshold shift during service cannot be established from the record. But it is unclear how the lack
5
of threshold shift between 1974 and 1978 shows that Mr. Monroe’s hearing loss was less likely
than not related to service.
True, there is no reasons or bases requirement on examiners. Acevedo v. Shinseki, 25
Vet.App. 286, 293 (2012). But an adequate medical opinion must include an explanation detailed
enough so that the examiner’s rationale for his or her conclusion is clear. Monzingo, 26 Vet.App.
at 105; Nieves-Rodriguez, 22 Vet.App. at 301. And that is the problem here. We cannot discern
the examiner’s reasoning for concluding that Mr. Monroe’s hearing loss is less likely caused by
service. The examiner explains why she concluded that Mr. Monroe’s hearing loss did not occur
in service. But she offers no rationale for her conclusion that Mr. Monroe’s hearing loss did not
result from service. See Hensley, 5 Vet.App. at 164 (noting that hearing loss that does not manifest
until several years af ter separation may still result from an in-service event). The examiner does
not explain why the lack of an OSHA-defined standard threshold shift in service matters to her
conclusion that Mr. Monroe’s hearing loss does not result from service. And the significance of
such a shift is a medical determination the Board may not make on its own. See Colvin v.
Derwinski, 1 Vet.App. 171, 175 (1991). In short, the examination is inadequate to inform the Board
on Mr. Monroe’s hearing loss. See Monzingo, 26 Vet.App. at 105; Nieves-Rodriguez, 22 Vet.App.
at 301. Thus, remand is warranted for the Board to obtain an adequate medical examination. See
Bowling v. Principi, 15 Vet.App. 1, 12 (2001) (emphasizing the Board’s duty to return inadequate
examination reports).
Because we are remanding his claim, we need not address additional arguments that would
lead to no broader remedy. See Mahl, 15 Vet.App. at 38. On remand, Mr. Monroe is free to submit
additional evidence and argument on the remanded matter, including those raised in his briefs, and
he has 90 days from the date of the postremand notice VA provides to do so. See Kutscherousky
v. West, 12 Vet.App. 369, 372–73 (1999) (per curiam order); see also Clark v. O’Rourke, 30
Vet.App. 92, 97 (2018). The Board must consider any such evidence or argument submitted. See
Kay v. Principi, 16 Vet.App. 529, 534 (2002); see also 38 U.S.C. § 7112 (a remand must be
performed in an expeditious manner); Fletcher v. Derwinski, 1 Vet.App. 394, 397 (1991) (“A
remand is meant to entail a critical examination of the justification for the decision.”).
6
III. CONCLUSION
On consideration of the above, the part of the May 14, 2021, Board decision denying
service connection for bilateral hearing loss is SET ASIDE and the matter REMANDED. The
appeal is otherwise DISMISSED
DATED: November 17, 2022
Copies to:
Glenn R. Bergmann, Esq.
VA General Counsel (027)

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