Citation Nr: 18153305 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 14-31 616 DATE: November 27, 2018 ORDER Entitlement to service connection for a bilateral hearing loss disability is granted. Entitlement to service connection for tinnitus is granted. FINDINGS OF FACT 1. The Veteran’s current bilateral hearing loss is related to in-service noise exposure. 2. The Veteran’s current tinnitus is related to in-service noise exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 2. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1962 to October 1966. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a May 2013 rating decision of the Detroit, Michigan, Regional Office (RO) of the Department of Veterans Affairs (VA). Service Connection Entitlement to service connection for a bilateral hearing loss disability and entitlement to service connection for tinnitus are granted. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(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”—the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 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. The Veteran seeks service connection for bilateral hearing loss and tinnitus. He asserts that he developed each disability as a consequence of in-service noise exposure. He notes being exposed to jet plane noise on a daily basis. Service treatment records are negative for complaints or findings of hearing loss or tinnitus. There is conflicting medical evidence in this case. A May 2013 VA audio examination report shows that the Veteran reported difficulty hearing in the presence of background noise. The examination revealed a diagnosis of sensorineural hearing loss bilaterally. The VA examiner opined that the Veteran’s hearing loss was not as least as likely as not caused by or a result of an event in military service. The VA examiner stated that the Veteran’s enlistment and discharge audiological evaluations yielded normal hearing bilaterally. The Veteran also reported constant, bilateral tinnitus since service. He stated that the condition was bothersome. The VA examiner opined that the Veteran’s claimed tinnitus was less likely than not caused by or a result of military noise exposure. The VA examiner stated that it was well understood that there were many causes of tinnitus. Hearing loss was the most common factor associated with tinnitus; however, in the absence of hearing loss or changes in hearing, the etiology of tinnitus could not be determined to a reasonable degree of certainty based on the evidence. The VA examiner noted that this did not rule out tinnitus as a symptom of other conditions associated with military service. If there were other conditions with a known association to tinnitus, these would need to be considered, especially if they had a nexus to military service. There was no compelling scientific evidence to support the onset of tinnitus in the absence of hearing loss. In the alternative, in a medical note dated in June 2012, a private doctor noted that the Veteran had been exposed to high levels of noise on a daily basis while in service, as the Veteran had an office in an airport hangar where jet pilots trained. The private doctor noted audiological treatment of the Veteran and provided a diagnosis of marked sensorineural hearing loss bilaterally. He also noted that the Veteran experienced bilateral tinnitus. The private doctor opined that it was at least as likely as not that the Veteran’s hearing loss and tinnitus were due to his military service. In an October 2013 note, the private doctor further noted that hearing loss due to noise exposure may not be indicated at the time of discharge and that noise induced damage may not show up for years after discharge. The private doctor opined that it was at least as likely as not that the Veteran’s hearing loss was due to his military service. Significantly, in a September 2014 note, a second private doctor noted a review of the Veteran’s service record and reported noise exposure and opined that it was at least as likely as not that the Veteran’s hearing loss and tinnitus were due to his military service. This doctor based this opinion on “his audiogram and noise exposure in the military.” Both doctors are employed by the same ear, nose, and throat (ENT) center. The Board finds that the medical evidence of record is at least in equipoise. In this case, the Veteran has a hearing impairment for VA purposes in both ears pursuant to 38 C.F.R. § 3.385. The Board is mindful of the negative May 2013 VA examination report; however, the report only serves to place the medical evidence in a state of relative equipoise with the opinions of the two ENT doctors. The mandate to accord the benefit of the doubt is triggered when the evidence has reached a stage of equipoise. In this matter, as there is competent medical evidence both in favor of and against the claims, the Board is of the opinion that equipoise has been attained. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). As such, after resolving all reasonable doubt in the Veteran’s favor, service connection is found to be warranted for a bilateral hearing loss and for tinnitus. These claims are thus granted in full. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A-L Evans, Counsel