Citation Nr: 0310262 Decision Date: 05/29/03 Archive Date: 06/02/03 DOCKET NO. 94-46 146 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUES 1. Entitlement to an increased rating for a hearing loss disability, currently evaluated at 40 percent disabling. 2. Entitlement to service connection for vertigo, diagnosed as Meniere's disease. 3. Entitlement to a rating in excess of 10 percent for a hearing loss disability for the period from July 14, 1993, to June 10, 1999. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L.A. Howell, Counsel INTRODUCTION The veteran served on active duty from February 1969 to December 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) North Little Rock, Arkansas, which denied the claims on appeal. A hearing was held before the undersigned Veterans Law Judge in October 2002. A transcript of the hearing testimony has been associated with the claims file. FINDINGS OF FACT 1. VA has made all reasonable efforts to assist the veteran in the development of his claims and has notified him of the information and evidence necessary to substantiate his claims. 2. At a hearing before the Board in October 2002, prior to the promulgation of a decision, the veteran requested a withdrawal of the issue of entitlement to a higher rating for a hearing loss disability. 3. Service medical records are negative for complaints of, treatment for, or diagnosis of vertigo or Meniere's disease. 4. The evidence is in equipoise as to whether the veteran's currently-diagnosed Meniere's disease is secondary to his service-connected hearing loss and tinnitus. 5. The veteran's hearing impairment was manifested by no worse than level IV hearing in the right ear and level V hearing in the left ear for the period from July 14, 1993, to June 10, 1999. CONCLUSIONS OF LAW 1. The criteria for withdrawal of his Substantive Appeal by the veteran on the issue of entitlement to an increased rating for a hearing loss disability have been met. 38 U.S.C.A. §§ 5103(a), 5103A, 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204(b), (c) (2002) (as amended). 2. Vertigo, diagnosed as Meniere's disease, is proximately due to service-connected disability. 38 U.S.C.A. §§ 5103(a), 5103A (West 2002); 38 C.F.R. § 3.310 (2002); Allen v. Brown, 7 Vet. App. 439 (1995). 3. The criteria for a rating in excess of 10 percent for a hearing loss disability for the period from July 14, 1993, to June 10, 1999, have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A (West 2002); 38 C.F.R. §§ 4.85, 4.86, 4.87 (as in effect prior to June 10, 1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to an Increased Rating for a Hearing Loss Disability, Currently Rated at 40 Percent Disabling. Under 38 U.S.C.A. § 7105, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. Further, a Substantive Appeal may be withdrawn in writing at any time before the Board promulgates a decision. 38 C.F.R. §§ 20.202, 20.204(b) (2002). Except for appeals withdrawn on the record at a hearing, appeal withdrawals must be in writing. 38 C.F.R. § 20.204(c) (2002) (as amended by 68 Fed. Reg. 13235 (April 18, 2003)). At the hearing before the Board in October 2002, the veteran indicated his intent to withdraw the claim of entitlement to an increased rating for a hearing loss disability. Specifically, page 2 of the transcript testimony shows as follows: Chairman: Okay. Mr. [veteran's name] prior to going on the record you said that you were satisfied with the 40 percent rating for the hearing loss. You're not seeking a rating in excess of 40 percent. Veteran: Uh, 40 percent was what it was at, uh, yeah. I agree to that. As such, the Board finds that the veteran has withdrawn this appeal as to that issue, and there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal and it is dismissed without prejudice. Parenthetically, the Board notes that subsequent to the October 2002 hearing, the veteran submitted written statements suggesting a new claim for a higher than 40 percent rating for a hearing loss disability. If he desires to again pursue this claim, he should do so with specificity at the RO. II. Entitlement to Service Connection for Vertigo, Diagnosed as Meniere's Disease. The veteran contends, in essence, that vertigo is due to his service-connected hearing loss disability. In the alternative, he asserts that he should be service connected for vertigo on a direct basis. Under the relevant regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (2002). However, continuity of symptoms is required where the condition in service is not, in fact, chronic or where diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (2002). Further, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2002). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In addition, the regulations provide that service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2002). Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. Direct Service Connection. As an initial matter, the Board notes that the service medical records are completely negative for complaints of, treatment for, or diagnosis of vertigo or Meniere's disease. A service separation examination noted bilateral high frequency hearing loss but made no mention of vertigo, dizziness, or Meniere's disease. At the hearing in October 2002, the veteran stated that he first started having symptoms of vertigo after he had been released from service. Therefore, there is no evidence of a chronic disorder shown in service. Next, there is no evidence of continuity of symptomatology as evidenced by the absence of treatment for many years after service. To that end, the Board notes that the first mention of vertigo or Meniere's disease is contained in an April 1988 treatment note for cough and difficulty swallowing. As part of the assessment, the veteran reported a past history of vertigo a-year-and-a-half previously, which went away for six months, and occasional instability. Further testing was recommended but there was no specific diagnosis made with respect to the dizziness. Follow-up treatment records show no additional complaints of dizziness. Medical records from the early 1990s show on-going treatment for vertigo. Nonetheless, the Board places significant probative value on the, at a minimum, nearly 16-year gap between discharge from military service and the first reported medical history of dizziness and finds that the post-service symptomatology is too remote in time to support a finding of in-service onset, particularly given the lack of continuity of symptomatology during the multi-year gap between military discharge in 1970 and the first mention of dizziness in 1988. See also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim). Therefore, the Board finds no continuity of symptomatology for vertigo. Next, service connection may be granted when all the evidence establishes a medical nexus between military service and current complaints. In this case, the Board finds that none of the treating physicians have attributed the veteran's current vertigo, now diagnoses as Meniere's disease, directly to active military service. While there has been medical discussions regarding a relationship between Meniere's disease and the veteran's hearing loss disability (discussed in more detail below), no examiner has suggested that the veteran's vertigo started in military service. Moreover, the Board places significant probative value on a March 1999 medical statement by a VA physician/reviewer. The physician/reviewer indicated that he had considered the entire claims file and noted a history of hearing loss and tinnitus, and the initial complaints of vertigo beginning as early as 1986 (based on the veteran's 1988 statement). He opined that the 16-year period of time was "too long for an active disease to not have made its presence known." The mere contentions of the veteran as to a medical nexus between military service and vertigo, no matter how well-meaning, without supporting medical evidence that would etiologically relate his complaints with an event or incurrence while in service, will not support a claim for service-connection. Caluza v. Brown, 7 Vet. App. 498 (1995); Lathan v. Brown, 7 Vet. App. 359 (1995); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1994); King v. Brown, 5 Vet. App. 19 (1993). In the absence of a chronic disability shown during military service, the lack of post-service treatment for many years after service separation, and no objective medical evidence of a nexus between military service and the veteran's current complaints of vertigo, his claim for service connection on a direct basis must be denied. Secondary Service Connection. In an August 1998 statement, Dr. G.W. Facer, a private physician at the Mayo Medical School, noted that an ENG (electronystagmography) showed a complete right unilateral weakness without much function in the right ear. Focusing on the issue of a nexus between hearing loss and Meniere's disease, he stated: "I certainly believe your hearing and balance problems are related." On the other hand, the Board notes a September 1998 medical statement by a VA physician/reviewer undertaken specifically for the purpose of addressing whether there was a causal relationship between vertigo and hearing loss. The physician/reviewer remarked that he had reviewed the entire medical record and concluded that there was "no relationship between vertigo . . . and any hearing loss that was documented during [the veteran's] military time." In a March 1999 medical statement the same physician/reviewer concluded that the veteran's later development of vertigo, dizziness, Meniere's disease or labyrinthine disorder was "unfortunate but totally unrelated" to hearing loss. These opinions are consistent with a June 2000 VA examination undertaken specifically to address the claimed relationship between a service-connected hearing loss disability and the subsequent development of Meniere's disease. After a review of the veteran's past medical history, an interview with the veteran, and a physical examination, the examiner opined that the veteran did, indeed, have Meniere's disease but concluded that it was not service connected and had "no relationship" to his service-connected disease process (hearing loss). At the hearing in October 2002, the veteran reported that he first started having symptoms of vertigo shortly after he got out of service, probably in 1973. He related that since that time he usually experienced symptoms once or twice a year and was told by physicians that it was just an inner ear problem which would go away. However, the condition had gradually increased in severity since 1980. He stated that Dr. Facer told him that the hearing loss, tinnitus and Meniere's disease were bound to be related because the inner ear was only about the size of a pea. After the hearing in October 2002, the veteran submitted additional statements from private treating physicians in support of his claim. In an October 2002 statement, John J. Shea III, M.D., indicated that he was unable to state to a reasonable degree of medical certainty whether or not the veteran's hearing loss and vertigo were related or separate medical problems. In another October 2002 statement, Stephen G. Harner, M.D., noted that the veteran had two problems, one of Meniere's disease causing fluctuating hearing loss and loss of vestibular function, and the other of a hearing loss disability consistent with a combination of heredity, noise, and age. He remarked that he was unable to totally separate the two situations. Finally, Craig N. Bash, M.D., in a statement dated in October 2002, offered an "independent medical evaluation" at the veteran's request. Dr. Bash stated that he reviewed the following information: Service Medical Records; Post service Medical records; Rating Decisions; Statements of the Case; Physician statements; Patient letter 2002; Medical literature review. Dr. Bash offered the following impression: It is my opinion that this patient's current vertigo is secondary to his service related hearing loss/tinnitus. Dr. Bash presented a detailed medical history, rationale, and discussed other medical opinions and references. He itemized 5 reasons for his opinion that the veteran's vertigo was secondary to his service related hearing loss/tinnitus; pointed out that his opinion was consistent with the opinion of Dr. Facer; and explained why he had discounted the contrary opinions. The Board has considered the veteran's written statements and sworn testimony to the effect that he first experienced dizziness in 1973 and was subsequently told he had an inner ear problem which would eventually go away. He stated at a hearing before the Board that his trouble with dizziness and vertigo had been getting worse since the 1980s. He was first diagnosed with Meniere's disease in 1994 or 1995 and had been treated at the Mayo Clinic in 1998. He indicated that Dr. Facer told him that the things going on in his inner ear were bound to be related. He stressed that he had been missing work because of Meniere's disease, used a walking stick to help with balance, and took medication for the disorder. Although his statements may be probative of symptomatology, they are not competent or credible evidence of a diagnosis, date of onset, or medical causation of a disability. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992); Miller v. Derwinski, 2 Vet. App. 578, 580 (1992). The veteran lacks the medical expertise to offer an opinion as to the existence of any current disorder, as well as to medical causation of any current disability. Id. It is apparent to the Board that resolution of the secondary claim essentially revolves around conflicting medical opinions regarding the veteran's assertion that Meniere's disease is related to his service-connected hearing loss disability. On one hand, Drs. Facer and Bash opined that the veteran's dizziness was related to hearing loss. On the other hand, two VA physicians clearly determined that the veteran's Meniere's disease was not related to hearing loss. The remaining two private physician opinions indicated that they were unable to separate the complaints of vertigo and hearing loss. Of note, when weighing certain medical opinions, the Board observes that inquiry must be made into the nature of the expressed opinion, the clinical data used to formulate the opinion, its rationale, or any other factors that would give it substance. Bloom v. West, 12 Vet. App. 185 (1999). The Board finds that Dr. Shea's opinion neither supports nor weighs against the veteran's claim as he was apparently unable to state whether there was a relationship between hearing loss and vertigo. Therefore, the Board finds it of little probative value. Dr. Harner's opinion tends to weigh against the veteran's claim. If read carefully, Dr. Harner indicated that Meniere's disease caused fluctuating hearing loss, not that hearing loss caused Meniere's disease. He concluded that he was unable to separate the two entities but this opinion does not support a cause and effect relationship between service-connected hearing loss (as the cause) and Meniere's disease (as the effect). Dr. Bash, in a detailed letter, noted that he had reviewed the service medical records, post-service medical records, rating decisions, statements of the case, physician statements, a letter from the veteran dated in 2002, and medical literature. He outlined the veteran's past medical history of hearing loss, the April 1988 complaint of dizziness, and subsequent evaluation and treatment for vertigo. He concluded that it was clear that the veteran had hearing loss, tinnitus, and disabling vertigo. He concluded that the veteran's vertigo was related to hearing loss because (i) the veteran had normal hearing when he entered service, (ii) that the veteran had service-induced hearing loss, (iii) that the veteran developed vertigo in the early 1970s shortly after service separation which was consistent with the waxing and waning course of Meniere's disease, (iv) that the veteran does not have vascular loop syndrome, and (v) that the veteran does not have any other differential diagnoses. Next, Dr. Bash challenged the medical opinions contradicting his position on the basis that the onset of symptoms of vertigo was shortly after the veteran's release from service, not the 16 years as asserted by one physician. Further, Dr. Bash quoted a statement in support of the waxing and waning nature of Meniere's disease. Dr. Bash bases his medical opinion, in part, upon the fact that there had been no other cause identified for the veteran's Meniere's disease. To that end, he noted that the veteran did not have vascular loop syndrome and identified several conditions that "may also be present with hearing loss and vertigo unrelated to position change . . . ." Similarly, he challenged the opinions of the other physicians on the basis that they did not provide the veteran with an alternative cause for Meniere's disease. In addition, Dr. Bash took exception to the other medical opinions for several reasons. In Alemany v. Brown, 9 Vet. App. 518 (1996), the United States Court of Appeals for Veterans Claims (Court) noted that in light of the benefit of the doubt provisions of 38 U.S.C.A. § 5107(b), an accurate determination of etiology is not a condition precedent to granting service connection; nor is "definite etiology" or "obvious etiology." In Gilbert v. Derwinski, 1 Vet. App. 49 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." In Gilbert the Court specifically stated that entitlement need not be established beyond a reasonable doubt, by clear and convincing evidence, or by a fair preponderance of the evidence. Under the benefit of the doubt doctrine established by Congress, when the evidence is in relative equipoise, the law dictates that the veteran prevails. Thus, to deny a claim on its merits, the preponderance of the evidence must be against the claim. In view of the above, the Board is of the opinion that the nexus between the veteran's service-connected hearing loss/tinnitus and his vertigo has been satisfied by the evidence. The veteran has obtained a medical opinion providing a nexus between his service-connected hearing loss/tinnitus and his vertigo which at a minimum places the evidence in equipoise. In view of the aforementioned opinion of a medical professional who had an opportunity to review the records in the case, the Board concludes that the veteran's vertigo cannot be dissociated from the service- connected hearing loss/vertigo. Thus, with application of the benefit of the doubt rule, the Board finds that the veteran's vertigo is secondary to service-connected disabilities. III. Entitlement to a Rating in Excess of 10 Percent for the Period from July 14, 1993, to June 10, 1999. In addition to the regulations addressing increased ratings discussed above, the Board notes that the applicable rating criteria for hearing loss, 38 C.F.R. § 4.85 et seq., was amended effective June 10, 1999. See 64 Fed. Reg. 25202-25210 (May 11, 1999). VA must apply only the earlier version of the regulation for the period prior to the effective date of the change. VAOPGCPREC 3- 2000 (2000). Since the current claim is for a rating in excess of 10 percent for the period prior to June 10, 1999, only the former version of the regulation is applicable. To evaluate the degree of disability from defective hearing, the rating schedule establishes eleven auditory acuity levels from level I for essentially normal acuity through level XI for profound deafness. 38 C.F.R. §§ 4.85, 4.87, Tables VI, VII. Organic impairment of hearing acuity is measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by a pure tone audiometry test. See 38 C.F.R. § 4.85. Ratings of hearing loss disability involve mechanical application of the rating criteria to the findings on official audiometry. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The schedular evaluations are intended to make proper allowance for improvement by hearing aids. 38 C.F.R. § 4.86. Historically, the veteran filed a claim for an increased rating for a hearing loss disability on July 14, 1993. By rating decision dated in April 1999, his rating was increased to 10 percent and made effective to July 14, 1993. In September 2000, the RO again increased the veteran's hearing loss disability to 40 percent and made it effective to June 10, 1999. The veteran contends that his disability rating should be higher for the period from July 14, 1993, to June 10, 1999. The medical evidence associated with the claims file during the relevant time frame fails to support the veteran's claim for a higher rating. First, in a VA audiological evaluation in October 1993, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/R 15 50 80 80 LEFT N/R 15 40 75 85 Speech audiometry revealed speech recognition ability of 90 percent in the right ear and of 90 percent in the left ear. Based on the evidence above and in light of the criteria set for at 38 C.F.R. § 4.85, the Board finds that the veteran's defective auditory acuity was a level II in the right ear and a level II in the left ear. These finding do not warrant a rating in excess of 10 percent. The next VA audiogram is dated in August 1996, and showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/R 40 55 80 80 LEFT N/R 40 55 80 90 Speech audiometry revealed speech recognition ability of 84 percent in the right ear and of 88 percent in the left ear. Based on the evidence above and in light of the applicable regulations, the Board finds that the veteran's defective auditory acuity was a level III in the right ear and a level III in the left ear in August 1996 and a higher than the currently-assigned 10 percent disability rating is not warranted. Again, in point of fact, a level III in the right ear and level III in the left ear warrants a noncompensable rating. The next VA audiogram is dated in December 1996, and showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/R 40 60 75 80 LEFT N/R 40 55 80 90 Speech audiometry revealed speech recognition ability of 90 percent in the right ear and of 88 percent in the left ear. Based on the evidence above and in light of the applicable regulations, the Board finds that the veteran's defective auditory acuity was a level III in the right ear and a level III in the left ear in December 1996 and no higher disability was warranted based on this examination. The next VA audiogram is dated in March 1998, and showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/R 45 65 80 75 LEFT N/R 45 70 85 95 Speech audiometry revealed speech recognition ability of 80 percent in the right ear and of 78 percent in the left ear. Based on the evidence above and in light of the applicable regulations, the Board finds that the veteran's defective auditory acuity was a level IV in the right ear and a level V in the left ear in March 1998. These are the first findings which meet the criteria for a rating of 10 percent. However, these findings do not warrant a rating in excess of 10 percent. The next VA audiogram is dated in November 1999 and shows pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/R 75 80 85 85 LEFT N/R 80 85 95 100 Speech audiometry revealed speech recognition ability of 68 percent in the right ear and of 58 percent in the left ear. These findings reflect level VII hearing impairment in the right ear and level VIII hearing impairment in the left ear. The examiner noted that the veteran was experiencing an exacerbation of his Meniere's disease symptoms and that since this active disease may respond to treatment, rating the hearing loss based on these test results could be premature. These are the first findings which meet the criteria for a rating of 40 percent. The veteran vigorously asserts that private audiograms dated between July 1993 and June 1999 reflect that he is entitled to a higher rating. However, the Board is unable to accept the private audiograms for rating purposes. Significantly, the regulations specifically require that "an examination . . . for VA purposes . . . must be conducted by a state- licensed audiologist and must include a controlled speech discrimination test (Maryland CNC)." 38 C.F.R. § 4.85 (emphasis added). In this case, the private audiograms either do not indicate which speech stimuli was used or did not use the Maryland CNC word list. Because the Maryland CNC list was not used, the private audiograms are not adequate for rating purposes. The Board stresses that it does not question the validity of the private audiograms for diagnostic purposes; rather the Board finds that they are not adequate for rating purposes under the regulations, which requires use of the Maryland CNC speech stimuli. Therefore, the Board is bound to rely only on the VA audiograms for rating the veteran's hearing loss disability, which were conducted according to VA rating protocol. Given that the VA audiograms failed to show that a higher rating was warranted for the period from July 1993 to June 1999, the veteran's claim for an excess rating but be denied. Finally, in considering the veteran's claims, the Board has considered the Veterans Claims Assistance Act of 2000 (VCAA), which, among other things, redefined the obligations of VA with respect to the duty to assist and included an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. The law also eliminated the concept of well-groundedness and is applicable to all claims filed on or after the date of enactment or those filed before the date of enactment but not yet final as of that date. 38 U.S.C.A. § 5103A (West 2002). Additionally, in August 2001, VA issued regulations implementing the provisions of VCAA "to establish clear guidelines consistent with the intent of Congress regarding the timing and the scope of assistance VA will provide to a claimant who files a substantially complete application for VA benefits." In this case, VA's duties have been fulfilled to the extent possible with regard to the issue decided in this decision. First, VA must now notify the veteran of any information, and any medical or lay evidence, not previously provided to the Secretary, that is necessary to substantiate the claim, and indicating which portion of that information and evidence, if any, is to be provided by the veteran and which portion, if any, the Secretary will attempt to obtain on behalf of the veteran. See 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159 (2002); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In this particular case, a careful review of the record reveals that, throughout the pendency of this appeal, the RO has fully complied with VA's re-defined duties to assist claimants and has kept the veteran informed of its actions to develop the record, of the need for him to submit specific types of competent evidence that would substantiate his claims, and of the specific reasons for denying his claims. By virtue of the information contained in the February 1994, April 1999, and September 2000 rating decisions, the September 1994 and March 2001 statements of the case, and the multiple supplemental statements of the case issued during the pendency of the appeal, the veteran and his representative were told that there was no evidence showing that he was entitled to a higher rating prior to June 1999 and were given notice of the information, medical evidence, or lay evidence necessary to substantiate the claim for service connection. With respect to the claim for a higher rating, the Board notes that the RO notified him that his private audiograms during that period were not sufficient for rating purposes by supplemental statement of the case issued in September 2000. He subsequently underwent additional VA and private audiograms, which have been submitted for the record. In addition, he has submitted multiple medical statements in support of his claim for service connection. All the medical records referenced by the veteran, including lay statements, private medical records, and VA records have been associated with the claims file. To that end, the Board finds that all relevant evidence has been submitted and that there is no further need to notify the veteran as to any additional evidence. Next, VA has a duty to assist the veteran in obtaining evidence necessary to substantiate the claim, unless no reasonable possibility exists that such assistance would aid in that endeavor. 38 U.S.C.A. § 5103A (West 2002). To that end, it appears that a full compliment of service medical records are associated with the claims file. Further, all medical records identified by the veteran have been associated with the claims file, including VA outpatient clinical records, private treatment records, and private medical statements. Moreover, the RO provided the veteran with notice of the amended hearing loss regulations and considered his disability under the new regulations. Next, the veteran asked and was provided with an opportunity to present testimony before the Board in October 2002. In addition, he underwent several VA examinations specifically to address the issues on appeal. In view of the foregoing, the Board finds that all reasonable efforts to secure and develop the evidence that is necessary for an equitable disposition of the claims on appeal have been made by the agency of original jurisdiction. VA has substantially met the requirements of the VCAA. Every possible avenue of assistance has been explored, and the veteran has had ample notice of what might be required or helpful to his case. In the circumstances of this case, a remand or a request for further development of these matters would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant are to be avoided). As such, the Board finds that the record as it stands is sufficient to decide the claims and no additional development is needed. Therefore, the Board finds that the mandates of the VCAA have been satisfied and a decision on the merits is not prejudicial to the veteran under Bernard v. Brown, 4 Vet. App. 384 (1993). ORDER The claim for an increased rating for a hearing loss disability, currently evaluated at 40 percent disabling, is dismissed without prejudice. The claim for entitlement to service connection for vertigo, diagnosed as Meniere's disease, is granted. The claim for entitlement to a rating in excess of 10 percent for the period from July 14, 1993, to June 10, 1999, is denied. ____________________________________________ Gary L. Gick Veterans Law Judge, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.