Citation Nr: 1320121 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 07-24 083 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to service connection for bilateral hearing loss. REPRESENTATION Veteran represented by: The American Legion WITNESSES AT HEARING ON APPEAL Veteran and spouse ATTORNEY FOR THE BOARD Saira Spicknall, Counsel INTRODUCTION The Veteran served on active duty from January 1978 to May 1998. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2006 rating decision of the Winston-Salem, North Carolina Department of Veterans Affairs (VA) Regional Office (RO), which granted a petition to reopen a final disallowed claim for entitlement to service connection for bilateral hearing loss, but denied service connection on the merits for this issue. The Veteran testified at a hearing before the undersigned Veterans Law Judge of the Board via a video conference (video conference hearing) in September 2008. A transcript of that hearing has been associated with the claims file. This case was previously remanded by the Board in October 2010 and March 2012 for additional development. Both remands implied that the Board concurred in reopening the claim for service connection for hearing loss. A review of the Virtual VA paperless claims processing system reflects that additional records have been added to the present appeal. These records include VA medical records. A supplemental statement of the case (SSOC) was issued in August 2012, which addressed this additional evidence. FINDING OF FACT Affording the Veteran the benefit of the doubt, a current bilateral hearing loss disability was incurred in service. CONCLUSION OF LAW Resolving all doubt in favor of the Veteran, the criteria for the establishment of service connection for bilateral hearing loss has been met. 38 U.S.C.A. §§ 1110, 1131, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Veterans Claims Assistance Act (VCAA) The VCAA, codified, in part, at 38 U.S.C.A. § 5103, was signed into law on November 9, 2000. Implementing regulations were created, codified at 38 C.F.R. § 3.159 (2012). The legislation has eliminated the well-grounded claim requirement, has expanded the duty of VA to notify the appellant and the representative, and has enhanced its duty to assist an appellant in developing the information and evidence necessary to substantiate a claim. See generally VCAA. In this case, the Board finds that the RO has substantially satisfied the duties to notify and assist, as required by the VCAA. To the extent that there may be any deficiency of notice or assistance, there is no prejudice to the Veteran in proceeding with this issue given the fully favorable nature of the Board's decision. Pertinent Laws and Regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2012). In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disorder on a direct basis, there must be: (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of the in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection will also be presumed for certain chronic diseases, including sensorineural hearing loss, if manifested to a compensable degree within one year after discharge from service. 38 U.S.C.A. § 1112; 38 C.F.R §§ 3.307, 3.309. This presumption, however, is rebuttable by probative evidence to the contrary. 38 U.S.C.A. § 1113. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2012). However, the Court of Appeals for Veterans Claims (Court) cited a 1988 medical treatise that stated that the threshold for normal hearing is from 0 to 20 dB, and that higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). A recent edition of this treatise retains the same definition. See Current Medical Diagnosis and Treatment, 162, Stephen J. McPhee et.al. eds., 47th Ed. (2008). In VA audiological examinations, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). The determination as to whether the requirements for service connection are met is based on an analysis of all of the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C.A. § 7104(a) (West 2002); 38 C.F.R. § 3.303(a) (2012). See Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding a material issue, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). See Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). If the Board determines that the preponderance of the evidence is against the claim, then it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule will not be applicable. Ortiz, 274 F.3d at 1365. With regard to VA examinations, the Board notes that the most recent examination is not necessarily and always controlling; rather, consideration is given not only to the evidence as a whole but to both the recency and adequacy of examinations. See Powell v. West, 13 Vet. App. 31, 35 (1999). Analysis The Veteran contends that he currently experienced bilateral hearing loss caused by exposure to high noise levels in service. The Veteran's DD Form 214 and service records demonstrate that he served as a U.S. Army telecommunications specialist. He was qualified as a basic paratrooper and was assigned to tours of duty with field and air defense artillery units as well as signal battalions. The Veteran did not receive any combat awards but was deployed to the Southwest Asia Theater of Operations from September 1990 to March 1991. He retired at the rank of Sergeant First Class. Service personnel records also show duties and circumstances consistent with noise exposure from artillery fire and anti-aircraft missile systems during some tours of duty. Therefore, the Board concludes that the Veteran was exposed to high noise environments in service. Service treatment records contain the results of seven audiometric tests during the Veteran's service from February 1982 to January 1996. All showed normal auditory thresholds with the exception of a slightly above normal threshold at 6000 Hz in the left ear in 1989 and 1994. Normal thresholds at this frequency in the left ear were measured in subsequent examinations. Outpatient military records showed that the Veteran was treated for ear infections in July 1994 and January 1997 with no follow up after a course of medication. The Veteran denied any hearing loss in medical history questionnaires as part of physical examinations in July 1986 and January 1996. In a November 1997 Report of Medical History, the Veteran denied any chronic organic ear disorders and reported a history of hearing loss. A November 1997 retirement physical examination revealed normal findings of the ears upon clinical evaluation and audiometric test results noted on the physical examination form showed abnormal hearing at several frequencies in both ears. Audiometric testing revealed that the hearing threshold levels in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 15 35 35 35 LEFT 25 30 10 25 25 Based on these results audiometric testing, the Veteran was referred for an audiology follow-up. He underwent a second hearing examination in November 1997, at which time military audiologist noted the abnormal results on the retirement physical examination and the Veteran's report of subjective hearing loss, worse on the left, and occasional tinnitus. The audiologist noted that the Veteran had exposure to noise while serving in artillery units. Audiometric testing revealed that the hearing threshold levels in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 25 15 20 20 LEFT 10 15 10 15 20 Speech response testing was excellent. Imittance testing showed normal middle ear function. The audiologist noted that reliability of the testing was "inconsistent/fair/poor" without explanation but concluded that the results were within normal limits. The Veteran filed a claim for service connection for hearing loss in June 1998, at which time he reported that his hearing loss began in 1996. In a December 1998 VA audiology examination, a VA audiologist noted the Veteran's reports of intermittent, twice weekly episodes of tinnitus and difficulty hearing conversations for the previous ten years, thus placing the onset in the late 1980s. On examination, the audiologist noted normal ear canals and ear drums. Audiometric testing revealed that the hearing threshold levels in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 20 35 25 LEFT 20 15 15 20 25 Upon retest audiometric testing revealed that the hearing threshold levels in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 40 40 25 40 45 LEFT - 25 20 25 35 Speech recognition scores were 100 and 96 percent on the right and left ears respectively. The audiologist noted that the Veteran required re-instruction and re-testing and that there was poor agreement between speech response tests and pure tone levels. Nevertheless, the audiologist concluded that the Veteran's hearing acuity was within normal limits under the VA criteria for disability. In May 1999, the RO denied service connection for bilateral hearing loss because the service and VA examinations did not show hearing loss that met the VA criteria for a disability. VA outpatient treatment reports from May 1999 to January 2012 reflect that the Veteran initially complained of decreased hearing in both ears in May 1999, within one year of his separation from active service, and was subsequently treated for and diagnosed with hearing loss. In December 2004, the Veteran received VA emergency room treatment for fever, sore throat, and a right ear ache. He was diagnosed with acute otitis medial with effusion in the right ear and pharyngitis. In an April 2005 VA outpatient treatment report, a VA audiologist noted the Veteran's report that his ear infection resolved but that he continued to experience difficulty hearing. On examination, the audiologist noted normal organic ear function and unoccluded ear canals. Audiometric testing revealed that the hearing threshold levels in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 30 45 55 55 65 LEFT 30 40 45 60 60 Speech discrimination scores were 88 and 92 percent in the right and left ears respectively, although it is unclear whether Maryland CNC speech discrimination testing was used at that time. The Veteran was diagnosed with mild to severe sensorineural hearing loss, bilaterally. VA outpatient treatment reports reflect that the Veteran was fitted for VA hearing aids in November 2005, and the devices were issued in December 2005. In a December 2005 VA audiology examination, a VA audiologist noted that the claims file was required for the examination but not available for her review. Significantly, the audiologist did not indicate an awareness of the April 2005 test or the outpatient treatment and prescribed hearing aids. The audiologist commented that audiometric testing on active duty was normal. Without the claims file, it is not clear how this information was available. The audiologist noted that the Veteran had been assigned to artillery units and that he was a truck driver after service. He also noted the Veteran denied any recreational noise exposure. The audiologist did not provide pure tone or speech discrimination test data but commented that the distortion product otoacoustic emissions (DPOAEs) were within normal limits bilaterally from 500 to 4000 Hz. She commented that, although no testing was accomplished prior to the Veteran's discharge from service, in her opinion, it was unlikely that hearing would have demonstrated a significant decreased between the last recorded examination and the Veteran's discharge from active service to have reached levels consistent with hearing loss. Again, without the claims file, it is not clear how this information was available. She commented that, although not overtly uncooperative, the Veteran's behavioral responses were in significant disagreement with face to face conversational ability and DPOAEs were an objective test of cochlear reserve. The audiologist concluded that the DPOAE results were "robust" and were not indicative of the ear canal damage that would be expected if caused by noise exposure. It is not clear whether the audiologist performed the required VA pure tone testing and used different terminology or was referring to a different type of test. The audiologist noted that there was significant disagreement between the DPOAEs and face to face conversational ability and that the Veteran reported that he was not able to hear any sounds less than 50 to 60 decibels during the speech response testing. After no improvement with additional instruction, the testing was discontinued. Although the audiologist noted that the DPOAEs were "robust" and not consistent with noise damage, she did not provide a clear opinion whether the test results were sufficient to evaluate the VA criteria for disability without speech discrimination scores or whether any deficiency could be resolved with further testing. In a September 2008 video conference hearing, the Veteran testified that he first experienced hearing-related symptoms in the early 1980s. He stated that his symptoms were ear aches and drainage and that he was treated on several occasions with ear drops. He also testified that that the military examiners told him his hearing acuity was not deficient. The Veteran's spouse stated that she observed the Veteran raising the volume on the radio and television and being unable to hear her conversation during service. The Veteran reported that he was provided VA hearing aids in 2005 but was unable to wear them when his ears were draining. After receiving oral testimony in September 2008, the Board found the December 2005 VA examination was inadequate and remanded the claim in October 2010 for an audiometric examination to include a review of the claims file and testing to determine whether the VA disability criteria were met, and if so, whether there was a relationship, if any, to noise exposure in service. In an August 2011 VA audiology examination, a different VA audiologist noted a review of the claims file. Although the service personnel and treatment records showed that the Veteran served in signal, artillery, and air defense units, the audiologist noted that the Veteran's entire service was in artillery. The audiologist provided tabular results of two tests in service (1992 and 1996) and the two tests performed shortly before retirement that showed hearing loss followed by normal hearing but with inconsistent results. The audiologist provided only the pure tone test values for the VA test in 1998 that showed normal hearing and for the VA test in April 2005 that showed hearing loss that met the VA criteria for disability. Further, the audiologist noted results of a VA audiometric test obtained in late November 2005 that was not previously in the claims file or considered by the RO or the Board. The test showed pure tone thresholds at or below 15 decibels at all frequencies bilaterally with no speech discrimination scores. It is not clear whether this was the test evaluated by the examiner in December 2005. Regarding the Veteran's subjective symptoms, the audiologist noted that the Veteran had no difficulty communicating without hearing aids and that he reported no impact of a hearing disability on occupational functioning or activities of daily life. These observations are inconsistent with the Veteran's hearing testimony and with the outpatient clinicians who diagnosed hearing loss and issued hearing aids. On examination, the audiologist noted no organic ear disorders. Audiometric testing revealed that the hearing threshold levels in decibels were at 60 decibels or higher at all relevant frequencies bilaterally. However, speech discrimination scores based on the Maryland CNC word list were at 96 percent in the right ear and 98 percent in the left ear. The audiologist noted that the pure tone results were inconsistent with the speech reception thresholds, word recognition scores, otoacoustic emissions, acoustic reflexes, and behavioral response. She noted that the behavioral responses were also inconsistent in the past, but did not comment on the April 2005 results that were not noted to be deficient and were used as a basis to issue hearing aids. Nevertheless, based on this testing, the audiologist concluded that it was less likely than not that the Veteran had hearing loss which was related to an event or noise exposure during his active duty service, explaining that that the Veteran had no hearing disability at the time of discharge from service and no current hearing disability. In a March 2012 remand, the Board found that the December 2005 and August 2011 VA examinations were inadequate because that results were internally inconsistent or not consistent with the Veteran's subjective symptoms as reported in his September 2008 hearing. In addition, neither VA examiner discussed the April 2005 VA outpatient audiology examination demonstrating the Veteran had a current hearing disability. An April 2012 VA audiology examination was performed by the same VA audiologist who performed the August 2011 VA examination. She noted that she was unable to test the Veteran's pure tone threshold values and no audiometric testing results were recorded. She explained that the Veteran did not respond reliably to pure tone testing and did not respond at all until the stimuli were over 70 decibels, which indicated severe hearing loss. However, she noted that he was able to converse at normal conversational levels without his hearing aids. She also noted that the objective testing indicated no more than mild loss. The audiologist concluded that the poor agreement between the test results indicated a poor test reliability. In noting that the test results were not valid for rating purposes, the examiner found that the Veteran responded appropriately to conversational speech with no visual cues and acoustic reflexes were present bilaterally. DPOAE resting revealed good outer hair cell function, while the Veteran did not respond to pure tones until 70 decibels. Equipment function was verified and found to be working appropriately. The Veteran was re-instructed and, although he did not appear to be overtly uncooperative, the inconsistencies continued and testing was then discontinued. Speech discrimination scores based on the Maryland CNC word list were at 76 percent in both ears, however, the audiologist noted that the use of speech discrimination scores was not appropriate for this Veteran because of language difficulties, cognitive problems, inconsistent speech discrimination scores, etc., that made the combined use of pure tone averages and speech discrimination scores inappropriate. Acoustic immitence, ipsilateral acoustic reflexes and contralateral acoustic reflexes were all normal in both ears. The audiologist could not provide a medical opinion without resorting to speculation regarding the etiology of the Veteran's hearing loss as she was unable to get accurate testing to give information about the Veteran's hearing loss. At a May 2012 VA ear condition examination, the Veteran was diagnosed with chronic otitis externa. He reported that he began to complain about ear problems somewhere between 1980 and 1985 and was just given medications for ear infections. He stated a hearing test was performed at separation from his active service and he was told his hearing was "okay." The Veteran stated that he continued to complain of hearing problems at the VA medical center (VAMC) after discharge from active service but nothing was done and he was given bilateral hearing aids around December 2004 to January 2005. The examiner, a physician's assistant, noted the Veteran had hearing impairment with vertigo and tinnitus. A physical examination of the external ear, ear canal, tympanic membrane and gait revealed normal findings. Romberg and limb coordination tests were normal. The examiner found that the Veteran's organic ear problem (for external or medial ear) was not caused by or a result of his military service. He found that the Veteran was seen one time in the military for otitis externa and otitis media and was not seen again for this kind of problem until December 2004 and that both times he was treated and the condition resolved. He also noted that the Veteran apparently had sensorineural hearing loss and/or tinnitus but he did not see either in the August 2011 or April 2012 VA audiology examination reports. Finally, the examiner concluded that he was not an audiologist and therefore could not give any other opinion other than that discussed in his report. In a June 2012 VA examination report, the VA examiner, a family nurse practitioner, noted that the Veteran was interviewed and examined today in the ear, nose and throat (ENT) clinic prior to being worked in for a third audiology VA examination that year. She was unaware of the recent VA audiology examinations in 2011 and 2012. She also stated the questions pertaining to the claim were more appropriately answered in the expertise of an audiologist and the examination was sent to the audiology clinic where the Veteran was afforded an examination by two audiologists. She noted that the true results of audiology testing revealed the Veteran had normal hearing, despite audiogram thresholds showing much poorer hearing than was discerned with organic testing by otoacoustic emissions (OAEs). She also noted that as the Veteran had normal hearing, there was no reason to proceed with an evaluation for the fourth time since 2005. Finally, she noted that testing in 2005 represented findings of an acute ear infection, that the ear examination was normal today, and organic testing such as OAEs was not performed in 2005 and therefore, the validity of those values could not be confirmed. In a June 2012 VA audiology examination report, two audiologists, including the one who performed the VA examination in December 2005, were asked to evaluate the Veteran's hearing. The Veteran demonstrated no difficulty with communication when talking with the VA audiologist prior to the beginning of the examination. He answered several questions asked at a low level without visual cues and with the practitioner's back turned toward him. Hearing test results revealed many inconsistencies. The audiologist noted that the volunteered responses to pure tone stimuli were consistently higher (by 20 to 40 decibels) than obtained in the speech reception thresholds, which would indicate responses were most likely not reflective true organic hearing acuity. Objective measures were performed, including, tympanometry which was within normal limits bilaterally and ipsi reflexes which were present at all levels suggesting normal middle ear function. In addition, DPOAE results were robust and demonstrated no evidence of outer hair cell damage such as would be expected with hearing changes due to noise exposure. Such changes were noted to be usually evident on this type of testing before they reached a level of clinical significance during pure tone testing. The Veteran performed excellently on word recognition testing with CNC words presented at 30 decibels with results of 96 percent in the right ear and 100 percent in the left ear. The word recognition testing was noted to be at a level similar to that of a whisper and at least 20 decibels softer than any volunteered response to pure tone stimuli. The Veteran was also noted to be able to hold an entire conversation with the audiologist over a microphone at 45 decibels. The audiologist noted that this was well below any volunteered response to pure tones. No shortcomings in test equipment were found and the equipment calibration was up-to-date and biologic checks of the equipment were performed before and during the evaluation, indicating that the equipment was functioning appropriately. The Veteran's level of cooperation was questionable as he was instructed and reinstructed many times on the testing procedures and the importance of providing reliable results. With each re-instruction his response changed. Due to the inconsistencies in the examination results, as well as in previous results, the audiologist who performed the December 2005 VA examination, N.J. Au. D CCC-A, was asked to evaluate the Veteran's hearing with the examiner/audiologist from the June 2012 VA examination. N.J. noted that the Veteran was reinstructed by the current audiologist in the June 2012 examination and was told that the inconsistencies would render the examination too inconsistent for submission for a rating. When given the option, the Veteran elected for another trial, although behavioral responses were too elevated to be considered consistent with either the speech reception thresholds or his quite robust OAEs. These responses were noted to be 20 to 60 decibels better than those previously volunteered earlier in the examination. The responses were noted to have demonstrated essentially normal hearing bilaterally. N.J. found that the test in 1997 near the Veteran's discharge from active service was within normal limits and showed no significant shift in hearing threshold in areas normally associated with hearing loss due to noise exposure. She cited to the Institute of Medicine, which concluded that hearing loss due to noise exposure "did not enjoy" a delay in onset and therefore, as the Veteran's hearing was normal at discharge, it was less likely that he experienced sensorineural hearing loss after discharge. She also noted that it was very unlikely, based on OAEs, that the Veteran currently had sensorineural hearing loss. N.J. found there was no evidence of hearing loss on active duty and, therefore, it was not likely that noise contributed to hearing loss. She noted that it did not appear that the Veteran had any hearing loss present at the current time, although an ENT specialist was more qualified to comment on any relationship to ear infections in 1994 and 1997; however, there appeared to be no conductive component, such as would be expected to be associated with ear infections or residuals of such infections present at that time. N.J. opined that it was likely that the April 2005 audiometric examination was not representative of his true organic hearing in her opinion and the Veteran was seen in December 2005 for a VA examination and his responses were found to be inconsistent. The Veteran most recently submitted private medical evidence consisting of audiometric evaluations and assessments in October 2012 and December 2012. These private audiological evaluations reflect audiometric results that are shown in graphic form instead of numeric form. See Kelly v. Brown, 7 Vet. App. 471 (1995). Although it is unclear whether Maryland CNC speech discrimination was used in October 2012 and W-22 speech lists were used in December 2012, the October 2012 audiometric evaluation indicates hearing threshold levels in decibels greater than 50 at all relevant frequencies, bilaterally, and the December 2012 audiometric evaluation indicates hearing threshold levels in decibels greater than 35 at all relevant frequencies, bilaterally. The October 2012 and December 2012 private medical evaluations reflect diagnoses of moderate to severe sloping sensorineural hearing loss bilaterally. Thus, the most recent audiological evidence of record indicates the Veteran has a current hearing loss disability for VA compensation purposes. See 38 C.F.R. § 3.385. After a careful review of the record, and resolving all doubt in favor of the Veteran, the Board has determined, based upon the medical and satisfactory lay evidence set forth above, that the Veteran has a current hearing loss disability which was incurred during his active service. As noted above, the Veteran's service information supports his reports of exposure to excessive noise during his active service. In addition, the Board finds that the Veteran's statements regarding his exposure to excessive noise during active service are credible as they are supported by his service records, as discussed below. See Baldwin v. West, 13 Vet. App. 1 (1999) (the Board must analyze the credibility of the evidence). In addition, while the reports of the Veteran and his wife as to the onset of his hearing problems are not internally consistent with the Veteran's earlier reports of onset of the disability, the medical evidence of record clearly demonstrates the Veteran complained of hearing loss in November 1997, just prior to his active service, and continued to complain of hearing problems from the date of his June 1998 claim for service connection for hearing loss, within a month of his discharge from active service, and thereafter. Thus, the reports of a continuity of hearing loss since active service are credible as they are supported by the service treatment records, the Veteran's post service claims, and post service medical evidence. In this case, the most recent VA examination does demonstrate that the Veteran meets the criteria for a bilateral hearing loss disability under 38 C.F.R. § 3.385. The Board observes that the December 2005 and August 2011 VA examinations were previously found to have been inadequate. While the April 2012, May 2012, and June 2012 VA examinations and opinions furnished detailed reports with opinions, the examiners failed to consider the Veteran's accounts of a continuity of symptoms along with the medical evidence supporting these claims since his November 1997 retirement examination in active service. These opinions also were based on the fact that the Veteran did not have any hearing loss disability in service or at any time thereafter, however, the audiometric test results from November 1997 demonstrated that a hearing threshold level of 25 decibels was recorded at 1000 Hertz in Veteran's right ear upon reevaluation and subsequent audiometric findings thereafter revealed that both ears demonstrated at least one hearing threshold level was at 25 decibels in one of the relevant frequencies, indicating some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Moreover, in considering the October 2012 and December 2012 private graphical audiometric findings indicate that the Veteran's average pure tone thresholds in each ear meet the criteria for a hearing loss disability, and particularly as both private audiometric reports demonstrate hearing threshold levels were at 35 decibels or greater at each of the frequencies from 500 Hertz to 4000 Hertz in both ears, the Board will resolve all doubt in favor of the Veteran and find that the evidence of record demonstrates the presence of a bilateral hearing loss disability for VA compensation purposes. See 38 C.F.R. § 3.385. Finally, in considering the April 2012, May 2012, and June 2012 VA examinations and opinions and the October 2012 and December 2012 private audiological and medical records, the Board finds that this evidence, taken together with the credible lay statements and testimony of record and post service medical evidence, put the evidence in relative equipoise as to whether the Veteran has a current bilateral hearing loss disability for VA compensation purposes which is related to military noise exposure during his active service. Accordingly, the Board will resolve doubt in favor of the Veteran and find that his bilateral hearing loss is related to his military noise exposure. Thus, resolving all reasonable doubt in favor of the Veteran, service connection for bilateral hearing loss is warranted. 38 C.F.R. § 3.102 (2012). See also 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Service connection for bilateral hearing loss is granted. ____________________________________________ KELLI A. KORDICH Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs