Citation Nr: 18146375 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-38 943 DATE: October 31, 2018 ORDER Entitlement to service connection for bilateral hearing loss is granted. Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for stroke, to include as secondary to the service-connected anxiety disorder, is remanded. FINDING OF FACT There is an approximate balance of positive and negative evidence as to whether the Veteran’s bilateral hearing loss disability and tinnitus were related to his military service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in favor of the appellant, bilateral hearing loss was incurred in active duty military service. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.385 (2017). 2. Resolving reasonable doubt in favor of the appellant, tinnitus was incurred in active duty military service. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.385 (2017). REASONS AND BASES FOR FINDING AND CONCLUSIONS In the August 2016 VA Form 9, the Veteran requested a hearing before the Board. In a written statement received in February 2017, the Veteran requested to withdraw the request for a hearing before the Board. Accordingly, the hearing request is withdrawn. 38 C.F.R. § 20.702(e). The Veteran died in February 2017. The appellant is the Veteran’s surviving spouse, and has been properly substituted as the claimant in this case. 1. Entitlement to service connection for bilateral hearing loss 2. Entitlement to service connection for tinnitus The appellant contends that the Veteran’s bilateral hearing loss and tinnitus were related to noise exposure during his combat service in the Republic of Vietnam. A June 2013 VA hearing loss and tinnitus examination report shows the Veteran had a current hearing loss disability for VA purposes, as well as a diagnosis of constant bilateral tinnitus. See 38 C.F.R. § 3.385. The June 2013 VA examiner opined that it was less likely than not the Veteran’s hearing loss was related to service because there was no objective evidence of acoustic trauma in either ear during service, as his hearing was normal upon separation and there were no significant threshold shifts. The VA examiner opined the Veteran’s tinnitus was at least as likely as not a symptom associated with his hearing loss and not related to acoustic trauma, noting there were no complaints of tinnitus in the service treatment records. The VA examiner stated the Veteran’s hearing loss and tinnitus were more than likely impacted by civilian noise exposure, presbycusis, and/or some other etiology. In an April 2016 report, Dr. D.K.G. from Hearing Solutions, Inc. noted the Veteran’s reports of exposure to the firing of various combat weapons during his service in Vietnam, and the Veteran’s report that his tinnitus began during military service following rounds of weapons being fired on the battlefield. Dr. D.K.G. stated the Veteran did not have a significant history of occupational or recreational noise compared to his active duty noise exposure. Following her interview and examination of the Veteran, Dr. D.K.G. opined that the Veteran’s bilateral hearing loss and constant bilateral tinnitus were more likely than not a result of acoustic trauma suffered when he was exposed to intense noise levels during active duty service. The Board finds the medical opinions are of similar weight of probative value. Although Dr. D.K.G. did not review the Veteran’s service treatment records, the Veteran’s reports regarding his in-service noise exposure appear to be consistent with those reported to the June 2013 VA examiner. See also April 2016 Veteran statement. The Veteran’s reported in-service noise exposure would also be consistent with the circumstances, conditions, and hardships of his one year of combat service as a Light Weapons Infantryman in the Republic of Vietnam. See DD Form 214. Further, Dr. D.K.G.’s report indicates she considered the Veteran’s reported civilian noise exposures as the VA examiner had, but that she also considered the Veteran’s competent report that the ringing in his ears began during his combat service, which the VA examiner did not address. See Layno v. Brown, 6 Vet. App. 465 (1994); see also Charles v. Principi, 16 Vet. App. 370, 374-75 (2002). Accordingly, the Board finds the evidence for and the evidence against the appellant’s claim is at least in relative equipoise, and so the Board affords the appellant the benefit of the reasonable doubt, and finds there is medical evidence of record establishing a link between the Veteran’s noise exposure in service and his bilateral hearing loss disability and tinnitus. Accordingly, the Board finds that grants of service connection are warranted for bilateral hearing loss and tinnitus. See 38 C.F.R. § 3.303(d); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Entitlement to service connection for stroke, to include as secondary to service-connected anxiety disorder, is remanded. The appellant contends the Veteran’s stroke was secondary to his service-connected anxiety disorder. The Board cannot make a fully-informed decision because the record does not contain an adequate opinion as to whether the Veteran’s stroke was aggravated by his service-connected anxiety disorder. See February 2017 VA medical opinion. In an August 2016 opinion, Dr. S.W. opined the Veteran’s stroke was related to his hypertension which was directly affected by his history of anxiety, but did not provide a rationale for this opinion. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s stroke. After a review of the evidentiary record, the clinician is asked to opine whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s stroke was either caused or aggravated by his service-connected anxiety disorder. Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the clinician should attempt to identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. The clinician should specifically address the August 2016 opinion of Dr. S.W.; the “Mental stress as a causal factor in the development of hypertension and cardiovascular disease,” abstract submitted by the Veteran; and the March 2016 Vet Center counselor statement indicating she worked with the Veteran on the correlation between chronic stress reactions and health issues and the impact of stress on the body. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If the benefit sought is not granted to the appellant’s satisfaction, send the appellant a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Delhauer, Counsel