Citation Nr: 18148414
Decision Date: 11/08/18	Archive Date: 11/07/18

DOCKET NO. 10-49 483
DATE:	November 8, 2018
ORDER
Entitlement to service connection for a bilateral hearing loss disability is denied.
FINDING OF FACT
The probative evidence is against a finding that the Veteran has, or has had at any time during the appeal, a current bilateral hearing loss disability.
CONCLUSION OF LAW
The criteria for service connection for a bilateral hearing loss disability are not met.  38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.385 (2017). 
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty from June 1990 to October 1990, and from October 1995 to October 1998.
As will be discussed below, the Board is denying the Veteran’s service-connection claim for a bilateral hearing loss disability based on a finding that a hearing loss disability as defined by VA under the provisions of 38 C.F.R. § 3.385 is not shown by the probative evidence of record.  The Board observes that in an October 2018 Informal Hearing Presentation, the Veteran’s representative highlighted the fact that the Veteran was assessed as having vestibular neuritis during service.  If the Veteran wishes to file a service-connection claim for such disability, he may do so by filing the form prescribed by the Secretary.  
Entitlement to service connection for a bilateral hearing loss disability
The Veteran claims entitlement to service connection for bilateral hearing loss.  The question for the Board is whether he has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.
The Board concludes that the Veteran does not have a current bilateral hearing loss disability as defined by VA, and has not had one at any time during the pendency of the claim.  38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d), 3.385.
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 500, 1000, 2000, 3000, or 4000 Hertz are 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies are 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.
The Veteran’s initial March 2010 VA examination notes the following puretone thresholds:


HERTZ	500	1000	2000	3000	4000
RIGHT	20	20	15	20	30
LEFT	20	25	20	25	35

Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 96 percent in the left ear.  Because the audiometric results did not meet VA’s definition of hearing loss in 38 C.F.R. § 3.385, the examiner did not provide an opinion as to whether any hearing loss disability was related to the Veteran’s military service.
An August 2012 VA audiological evaluation notes the following puretone thresholds:
HERTZ	500	1000	2000	3000	4000
RIGHT	15	20	15	15	20
LEFT	15	15	20	15	35

Speech audiometry revealed speech recognition ability of 92 percent in the right ear and 96 percent in the left ear.  
A November 2013 private audiogram notes the following puretone thresholds:
HERTZ	500	1000	2000	3000	4000
RIGHT	25	20	25	30	30
LEFT	30	35	35	30	40

Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 100 percent in the left ear, although there is no indication that the Maryland CNC test was used.  
An October 2014 VA examination notes the following puretone thresholds:
HERTZ	500	1000	2000	3000	4000
RIGHT	15	20	15	15	25
LEFT	15	20	20	20	30

Speech audiometry revealed speech recognition ability of 100 percent bilaterally.  Once again, because the audiometric results did not meet VA’s definition of hearing loss in 38 C.F.R. § 3.385, the examiner did not provide an opinion.
In a September 2015 VA opinion, a VA examiner noted the Veteran’s 92 percent speech discrimination score during the August 2012 VA audiological evaluation.  However, the examiner noted that the Veteran’s speech discrimination was excellent before, as evidence by the March 2010 VA examination, and after, as evidence by the October 2014 VA examination.
A May 2016 VA examination notes the following puretone thresholds:
HERTZ	500	1000	2000	3000	4000
RIGHT	20	20	15	15	25
LEFT	15	20	25	20	35

Speech audiometry revealed speech recognition ability of 100 percent bilaterally.  
After audiological testing, the examiner then discussed the other evidence of record, including the August 2012 VA audiological evaluation which showed a 92 percent speech discrimination score in the Veteran’s right ear, and the November 2013 private audiological evaluation which revealed a puretone threshold of 40db at 4000 Hz in the Veteran’s left ear.  With regard to the August 2012 VA audiological evaluation, the examiner noted that, while the Maryland CNC word list was used, only a partial list of twenty-five words was used.  The examiner explained that proper protocol for compensation and pension testing required the use of a fifty-word list.  As such, the examiner determined that the August 2012 word recognition score of 92 percent was invalid.  
Concerning the adequacy of the November 2013 private audiological evaluation, the examiner essentially characterized the one-time test result showing left-ear hearing loss for VA purposes to be a medical outlier, specifically noting that all other audiometric testing results (both before and after the November 2013 audiological evaluation) showed minimal fluctuation, which would be expected across test sessions.  The examiner determined that the November 2013 audiological evaluation represented a “marked departure from the pattern of hearing both prior to and following” the audiological evaluation.  The examiner concluded that the validity of the November 2013 testing was questionable.  
When evaluating medical evidence, generally, the degree of probative value which may be attributed is dependent on factors such as its thoroughness and the degree of detail.  Prejean v. West, 13 Vet. App. 444, 448-49 (2000).  Furthermore, in weighing the probative value of evidence, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995).  
Here, the Board finds that the most consistent and accurate hearing acuity assessments of record are those that show the Veteran does not have a right or left ear hearing loss disability for VA purposes.  Indeed, there are only two indications throughout the appeal period of potential hearing loss that meet the definition outlined in 38 C.F.R. § 3.385—the August 2012 speech recognition score of 92 percent in the right ear, and the November 2013 left ear audiometric test results.  The August 2012 speech recognition score has been determined to be invalid by a subsequent VA examiner, as the test was not administered according to protocol.  In addition, all prior and subsequent speech recognition scores consistently show percentages too high to be considered disabling by VA standards.  Similarly, the May 2016 VA examiner reviewed all of the Veteran’s prior audiometric test results and came to the medical conclusion that the November 2013 hearing thresholds showing a one-time worsened hearing acuity in the left ear, returning to normal at all subsequent tests was unreliable, and should not be used for rating purposes.  
The Board affords the opinion of the May 2016 VA examiner high probative value, as it is well-supported and explained with a clinical explanation.  The May 2016 VA examiner’s opinion supports a finding that the most accurate assessments of hearing acuity throughout the appeal period are those showing a level of hearing loss in both ears that does not reach the level of severity to be considered a disability for VA purposes. Thus, the Board affords the August 2012 speech recognition score of 92 percent in the right ear, and the November 2013 left ear audiometric test results little to no probative value.
The Board in no way calls into question the Veteran’s observations of diminished hearing acuity.  The probative evidence discussed above however does not demonstrate that the Veteran’s hearing loss is so severe as to constitute a disability for VA purposes.  




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Therefore, the Board finds that service connection for bilateral hearing loss is not warranted.  In reaching this decision, because a preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and his claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).
 
V. Chiappetta
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	James R. Springer, Associate Counsel