Citation Nr: 18147784 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-19 677 DATE: November 6, 2018 ORDER Service connection for bilateral hearing loss is granted. Service connection for tinnitus is granted. FINDINGS OF FACT 1. The Veteran’s bilateral hearing loss is the result of in-service noise exposure. 2. The Veteran’s tinnitus is the result of in-service noise exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (2017). 2. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1966 to August 1968. This appeal is before the Board of Veterans’ Appeals (Board) from an February 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. Service Connection The Veteran claims service connection for bilateral hearing loss and tinnitus. In a statement in the Veteran’s December 2014 notice of disagreement, the Veteran complained that the VA had failed in its duty to assist because the last VA examination the Veteran underwent was improperly administered. The Board need not address whether the duty to assist has been fulfilled in this case, as a fully favorable decision is possible based on the evidence of record. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For certain chronic diseases, including organic diseases of the nervous system such as sensorineural hearing loss and tinnitus, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. For the purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000 and 4000 Hertz is 40 decibels or greater; or when the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. See 38 C.F.R. § 3.385. Service treatment records reflect that the Veteran’s hearing was tested at his 1966 induction examination. While no hearing abnormality was noted, U.S. military audiograms have not always adhered to the same testing standards. Historically, the Board understood Service Departments changed from American Standards Association (ASA) standards to International Standards Organization - American National Standards Institute (ISO-ANSI) standards for audiograms on November 1, 1967. Contemporary research, however, has revealed that various military branches might have inconsistently implemented their conversion to ISO-ANSI standards. Accordingly, the Board assumes the following when interpreting audiograms: (1) prior to January 1, 1967, the ASA standard is assumed; (2) between January 1, 1967 and December 31, 1970, the Board considers the data under both ASA and ISO-ANSI standards; and (3) after December 31, 1970, the ISO-ANSI standard is assumed. To facilitate data comparisons for VA purposes, audiometric data originally recorded using ASA standards are converted to ISO-ANSI units by adding between 5 and 15 decibels to the recorded data as follows: adding 15, 10, 10, 10, and 5 dB to Hz ranges 500, 1000, 2000, 3000, 4000 respectively. When converting the Veteran’s entrance examination results from ASA standards to ISO-ANSI units, the Veteran did not show hearing loss for VA purposes. Additionally, the Veteran’s 1968 separation examination does not have any audiological thresholds noted at all. The Board therefore finds that the thresholds noted at the 1966 enlistment examination are of minimal probative value beyond establishing that there was no hearing loss disability upon entry into service, as there are no separation thresholds with which to compare them. The Veteran’s service treatment records do not reflect any complaints of tinnitus. However, there is sufficient evidence in the record to indicate that the Veteran subject to military noise exposure during his service as a cable splicer while serving in Vietnam. VA treatment records reflect that at a January 2013 audiology consultation the Veteran reported loss of hearing in both ears and constant tinnitus. He reported the tinnitus had been longstanding, progressive and bothersome since his time in Vietnam. Additionally, he reported in-service noise exposure, along with post-service occupational and recreational noise exposure. Pure tone testing revealed normal to mild sensorineural hearing loss from 250-2000 hertz and severe sensorineural hearing loss from 3000-8000 hertz in both ears. Specific thresholds were not recorded. Word recognition at 60 decibels was recorded at 84 percent in both ears. In his February 2013 statement in support of his claim, the Veteran stated that while serving in Vietnam in February of 1968 a rocket hit the bunker he was in, causing him to have severe hearing loss and ringing in his ears for approximately two days. He contended that this explosion caused his current hearing loss and tinnitus. The Veteran underwent a VA examination in September 2013. Speech audiometry revealed speech discrimination ability of 72 percent in the right ear and 60 percent in the left ear. Although the pure tone thresholds test results were not found valid for rating purposes due to inconstancies with the speech discrimination testing results, the Veteran’s speech discrimination results show the Veteran had hearing loss for VA purposes. The examiner opined that the Veteran’s hearing loss is at least as likely as not caused by or a result of an event in military service due to the Veteran’s reports of mortar rocket attacks while serving in Vietnam. Additionally, the examiner opined that the Veteran’s tinnitus is at least as likely as not a symptom associated with the Veteran’s bilateral hearing loss or a direct result of the in-service noise exposure reported by the Veteran. Due to the inconsistencies in the September 2013 pure tone thresholds test results, the Veteran underwent another VA examination in December 2013. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 30 65 65 LEFT 25 25 35 50 65 Speech audiometry revealed speech discrimination ability of 96 percent in the right ear and 96 percent in the left ear. The Veteran’s prior diagnoses of bilateral sensorineural hearing loss and tinnitus were confirmed; however, the examiner opined that it was impossible to determine the etiology of his hearing loss and tinnitus without resorting to speculation as there was no audiological examination performed at separation from service; the Veteran denied suffering from hearing loss on his separation from service medical history report; and the Veteran reported occupational and recreational noise exposure post-service. The Board finds the evidence regarding whether the Veteran’s bilateral hearing loss and tinnitus were the result of in-service noise exposure to be in relative equipoise. The Veteran has been repeated diagnosed with hearing loss for VA purposes. The September 2013 VA examination is sound and the positive etiology opinions regarding the Veteran’s hearing loss and tinnitus provides complete rationales. Given this, the Board finds that the positive September 2013 etiology opinions for hearing loss and tinnitus are at least as probative as the negative December 2013 etiology opinions for both hearing loss and tinnitus. Therefore, resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran has current bilateral hearing loss and tinnitus that are the result of in-service noise exposure. Accordingly, service connection for bilateral hearing loss and tinnitus are warranted. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Capes, Law Clerk