BVA9507262 
DOCKET NO.  93-12 317     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Detroit,
Michigan

THE ISSUE

Entitlement to service connection for hearing loss and tinnitus.

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of the
United States

ATTORNEY FOR THE BOARD

J. Sherman, Counsel

INTRODUCTION

The veteran had active military service from September 1959 to
August 1963, and from September 1990 to April 1991.  This appeal
arises from a July 1992 rating decision of the Detroit, Michigan,
regional office (RO) that denied service connection for the
veteran's high frequency hearing loss and tinnitus.

The veteran's service representative has raised the issue of
entitlement to service connection for additional conditions not
presently before the Board, to include residuals of burns to the
right ankle, residuals of hemorrhoids, laceration of the third
phalanx of the left hand, and chondromalacia of the left knee.
These issues are not inextricably intertwined with the issue
before the Board, and they are referred to the RO for appropriate
development.

REMAND

The veteran has alleged that his hearing worsened during his
recent period of active duty and that he has had ringing in his
ears since January 1991 with recurring pain in his right ear
since January 1991.  Although the veteran's medical records do
indicate that high frequency bilateral hearing loss was first
measured in July 1984 and that it was confirmed as recently as
March 1990, there is no hearing examination associated with the
veteran's most recent period of active duty, and no VA
audiological examination has been conducted to determine the
extent of the veteran's hearing loss or the etiology of his
tinnitus.  The veteran's most recent service medical records do
reflect that he had complaints of ear ache, and that he was
recommended to see VA for post-service examination.

The VA has a duty to assist the veteran in the development of
facts pertaining to his claim.  38 U.S.C.A. § 5107(a) (West
1991); 38 C.F.R. § 3.103(a) (1994).  The United States Court of
Veterans Appeals (Court) has held that the duty to assist
includes obtaining available records which are relevant to the
claimant's appeal.  The duty to assist is neither optional nor
discretionary.  Littke v. Derwinski, 1 Vet.App. 90 (1990).  The
duty to assist also includes, when appropriate, the duty to
conduct a thorough and contemporaneous examination of the veteran
that takes into account the records of prior medical treatment.
Green v. Derwinski, 1 Vet.App. 121 (1991).  Likewise, where the
record does not reflect the current state of the veteran's
disability, a VA examination must be conducted.  Schafrath v.
Derwinski, 1 Vet.App. 589 (1991).

When a veteran has a hearing loss on entry into service,
entitlement to service connection for hearing loss must be
predicated on a finding that the condition was aggravated by
service.  Hensley v. Brown, 5 Vet.App. 155, 160 (1993), citing 38
U.S.C.A. §§ 1110 and 1153 (West 1991) and 38 C.F.R. § 3.306(b)
(1994).  If there is an increase in disability attributable to a
pre-existing disease or injury, it is to be presumed to have been
aggravated by military service unless there is a specific finding
that the increased disability is attributable to the natural
progress of the disease.  38 U.S.C.A. § 1153 (West 1991).  Clear
and unmistakable evidence is necessary to rebut the presumption
of aggravation where there is an increase in severity during
wartime service.  38 C.F.R. § 3.306(b) (1994).  If there is
determined to be an aggravation by active service, 38 C.F.R.
§ 4.22 is to be applied to determine the appropriate disability
rating.

Finally, it appears that the veteran is also filing a claim for
service connection for a disability of the right ear manifested
by pain.  (See VA Form 21-526 received in March l992.)  This
issue has not been specifically addressed by the RO.

Accordingly, to ensure that the Department of Veterans Affairs
(VA) has met its duty to assist the claimant in developing the
facts pertinent to the claim, the case is REMANDED to the RO for
the following development:

1.  Request the veteran to furnish the
names and addresses of any physicians or
audiologists from whom he has sought
treatment or evaluation for his ears or
hearing since filing his claim for VA
compensation.  Obtain all records mentioned
by the veteran.

2.  Accord the veteran a VA special ear and
audiological examination to determine the
extent of his high frequency hearing loss
and the existence and etiology of tinnitus
and intermittent ear ache.  The claims
folder is to be made available to the
examiner prior to the examination, and the
examiner is to review all previous
audiological tests included therein.  All
indicated tests are to be performed.  The
examiner is to evaluate the veteran's high
frequency hearing loss and, if the hearing
loss is found to be more severe than when
measured in 1990, to express an opinion as
to whether the increase in severity is
attributable to the natural progress of the
disability, or whether it is at least as
likely as not that any increase in hearing
loss is attributable to noise exposure
experienced by the veteran during his most
recent period of service.  A complete
history of noise exposure during Operation
Desert Shield/Desert Storm is to be
elicited.  With respect to the tinnitus and
ear ache, an effort should be made to
determine the etiology and whether the
tinnitus is constant or intermittent.  If
the earache is a manifestation of a
specific disability, it should be so
indicated.

3.  When the above development has been
completed, review the case and prepare a
rating action on the issues listed on the
title page of this decision and on the
issue of entitlement to service connection
for a disability manifested by earache.  If
appropriate, notify the veteran of the need
to file a notice of disagreement if he so
desires with regard to the issue pertaining
to earache.  If any decision to which a
notice of disagreement has been filed
remains adverse to the veteran, he and his
representative should be furnished a
Supplemental Statement of the Case (SSOC)
and accorded an opportunity to respond.
Apprise the veteran of all due process
requirements needed to pursue his claim.

Thereafter, subject to current appellate procedures, the case
should be returned to the Board for further appellate
consideration, if appropriate.  The veteran need take no further
action until he is further informed.  The purpose of this REMAND
is to obtain additional medical information.  No inference should
be drawn regarding the final disposition of the claim as a result
of this action.

          I. S. SHERMAN
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal.  38 C.F.R. § 20.1100(b) (1994).