Citation Nr: 18145141 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-58 812 DATE: October 26, 2018 ORDER Entitlement to service connection for bilateral hearing loss is granted. Entitlement to service connection for tinnitus, as secondary to service-connected hearing loss, is granted. FINDINGS OF FACT 1. The competent and probative evidence of record indicates that the Veteran's bilateral hearing loss is related to in-service noise exposure. 2. The Veteran’s tinnitus is proximately due to or the result of his service-connected bilateral hearing loss. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. The criteria for entitlement to service connection for tinnitus, as secondary to service-connected bilateral hearing loss, have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1964 to April 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office in Muskogee, Oklahoma. Jurisdiction is with the RO in Waco, Texas. In October 2018, the Veteran testified during a Board hearing at the RO before the undersigned Veterans Law Judge. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). With chronic disease shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). To show a chronic disease in service, a combination of manifestations sufficient to identify the disease entity is required, as is sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). The Court has established that 38 C.F.R. § 3.303(b), applies to only those chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 U.S.C. § 1101. With respect to the current appeal, that list includes and organic diseases of the nervous system (including hearing loss and tinnitus). See 38 C.F.R. § 3.309(a). Service connection may also be granted for a disease first 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 addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including organic diseases of the nervous system, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a), 3.309(a). However, in order for the presumption to apply, the evidence must indicate that the disability became manifest to a compensable (10 percent) degree within one year of separation from service. See 38 C.F.R. § 3.307. Service connection is also warranted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. 38 C.F.R. § 3.310(b). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to Service Connection for Bilateral Hearing Loss The Veteran’s service treatment records include no complaint, finding or diagnosis with respect to the claimed hearing loss. On service discharge examination in March 1968, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT -10 -10 -10 -10 5 LEFT -10 -10 -10 -5 -5 Following discharge from service, a July 2013 private treatment report reflects assessment of bilateral sensorineural hearing loss. The Veteran reported his hearing loss began 2 years prior to examination, with a gradual onset over the years. He had a history of exposure to loud noise. On audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 30 35 35 40 LEFT 25 35 45 45 50 On VA QTC examination in April 2015, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 30 40 45 50 LEFT 25 40 45 50 55 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 100 percent in the left ear. The examiner diagnosed bilateral sensorineural hearing loss and opined that the disability was less likely than not caused by or a result of service. In so finding, the examiner noted that the Veteran presented with normal hearing sensitivity upon enlistment and was exposed to low to moderate amounts of hazardous noise while in service, specifically with teletypes. Service treatment records were negative for significant shifts in threshold in service, and there is no evidence of cochlear damage between 1966 and 1968. A December 2016 Ear Conditions Disability Benefits Questionnaire reflects assessment of sensorineural hearing loss and tinnitus, along with a history of noise exposure in service. A December 2016 private report from The Hearing and Tinnitus Center reflects the Veteran’s reported that he served as a communications center specialist in the Air Force from 1964 to 1968, during which he was exposed to loud noise, without hearing protection, from teletype machines, sirens on base, and working in close proximity to an airfield with 852s. He worked as a telecommunications specialist after service and was exposed to noise from high-speed printers and computers without hearing protection. On audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 35 45 45 50 LEFT 30 45 50 50 50 The examiner diagnosed symmetric mild to moderate sloping sensorineural hearing loss with excellent word discrimination, bilaterally. The degree and configuration of hearing loss was consistent with noise exposure reported during his military service and has more likely than not been significantly affected by this noise exposure. While exposure to loud noise was present at other times in his life, the effects of noise during service could not be discounted. With respect to current disability, the audiometric findings of record indicated auditory thresholds of 40 decibels or greater at the frequencies between 500-4000 Hertz. This meets the definition of hearing loss for VA purposes. 38 C.F.R. § 3.385. In regard to an in-service event, while the Veteran's service treatment records do not reflect hearing loss or related complaints, his DD214 indicates that he served in the Air Force had a military occupational specialty (MOS) of communication specialist. He has expressed that he was exposed to loud noise, including teletypes and jet engine noise. The Board finds the Veteran's reports of loud noise exposure credible. The remaining question is whether there is a medical nexus between the Veteran's in-service noise exposure and his current bilateral hearing loss. The Board notes that the 2015 VA audiologist provided an opinion against the claim, while the 2016 private examiner linked the Veteran’s hearing loss to in-service noise exposure. Both examiners considered the Veteran's medical history and symptoms, and both provided rationale in support of the conclusions reached. For the foregoing reasons, the Board finds the medical opinions, at the very least, to be of relative equipoise regarding the etiology of the Veteran's bilateral hearing loss. Given the Veteran's credible reports of noise exposure in service and his post-service diagnosis of bilateral sensorineural hearing loss that has been linked to in-service noise exposure, the Board resolves all reasonable doubt in the Veteran's favor and finds that service connection for bilateral hearing loss is warranted. Entitlement to Service Connection for Tinnitus The Veteran’s service treatment records include no complaint, finding or diagnosis with respect to the claimed tinnitus. Following service, a July 2013 treatment report reflects assessment of tinnitus. On VA QTC examination in April 2015, the Veteran reported recurrent tinnitus occurring on a daily basis, with an onset about 1 year prior to examination. The examiner opined that the disability was less likely than not caused by or a result of military noise exposure, given that the Veteran denied tinnitus while in service. However, the examiner did indicate that it was at least as likely as not that the Veteran’s tinnitus was a symptom associated with his hearing loss. A December 2016 Ear Conditions Disability Benefits Questionnaire reflects assessment of sensorineural hearing loss and tinnitus, along with a history of noise exposure in service. The December 2016 private treatment report from The Hearing and Tinnitus Center reflects the Veteran’s report of tinnitus. The examiner indicated that the tinnitus reported by the Veteran was more likely than not a symptom of his hearing loss. Both the private examiner and VA examiner related the Veteran’s tinnitus to his hearing loss, for which the Board has determined that service-connection is warranted. There is no opinion to the contrary. Accordingly, and resolving all reasonable doubt in favor of the Veteran, the Board concludes that tinnitus is the result of service-connected bilateral hearing loss. Service connection for bilateral hearing loss is therefore warranted. 38 C.F.R. § 3.310. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. E. Wilkerson, Counsel