Citation Nr: 18154821 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 15-13 530 DATE: November 30, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. FINDINGS OF FACT 1. Bilateral hearing loss is not etiologically related to active service and may not be presumed to have been incurred in service. 2. Tinnitus is not etiologically related to active service and may not be presumed to have been incurred in service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 2. The criteria for service connection for tinnitus have not been met. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1973 to December 1976, with additional service in the Reserves. Service Connection The Veteran asserts that his bilateral hearing loss and tinnitus are related to his active service. Specifically, the Veteran asserts that he worked as a boat mate on the deck and under it, and that his job exposed him to hazardous noise. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). The question for the Board is whether the Veteran has a current diagnosis of bilateral hearing loss and tinnitus, and, if so, if the disorders either began during active service, or are etiologically related to an in-service disease or injury. The Board finds that competent, credible, and probative evidence does not establish that bilateral hearing loss and tinnitus are etiologically related to the Veteran’s active service. A review of the service medical records (STRs) shows that they are silent for complaints of or treatment for hearing loss, tinnitus, or any ear-related issues during active service. The Veteran’s November 1973 service entrance examination and November 1976 service separation examination show that his hearing was within normal limits. The Veteran also underwent an examination in May 1981, while in the Reserves. See STRs. The November 1976 exit examination and the May 1981 examination showed only a whisper test, and no audiograms. The November 1973 entrance examination showed an audiogram. Here, the Board notes that the “whisper test” is not very reliable, and those results do not assist in determining the extent of change in the Veteran’s hearing loss levels during his service. Private treatment records showed normal hearing. The Veteran told the examiner that he had pain in his left ear, and experienced a sudden, rapid hearing loss in the past 90 days. The Veteran also reported experiencing dizziness. See private treatment records, Beltone, April 2, 2014. On a VA audiology examination in July 2014, the examiner did not diagnose the Veteran with bilateral sensorineural hearing loss for VA purposes (see 38 C.F.R. § 3.385). See VA examination, July 2014. The examiner noted that the Veteran did not participate in combat activity, and served as a boatswain mate. The Veteran related that he fired weapons with his right hand, used hearing protection, and required a hearing conservation program. The examiner stated that the test results were not valid for rating purposes and not indicative of organic hearing loss. The examiner diagnosed the Veteran with sensorineural hearing loss in the right ear, and normal hearing in the left ear. The examiner noted that pure tone thresholds were inconsistent and unreliable, and that acoustic reflexes were not commensurate with pure tone responses. Speech discrimination was 100 percent bilaterally. All audiologic findings were normal bilaterally. The examiner noted that the Veteran underwent whispers tests on his service examinations, but that a whisper test was a poor and unreliable method of evaluating frequency specific hearing thresholds. The examiner opined that the Veteran’s hearing loss was less likely than not a result of military service. The examiner reasoned that pure tone thresholds were inconsistent and unreliable, and that acoustic reflexes were not commensurate with pure tone responses. The examiner stated that the Veteran did not have any hearing loss prior to service. As for tinnitus, the Veteran told the examiner that the disorder began in 1974 and was intermittent, and that it interfered with his hearing. The examiner opined that the tinnitus was less likely as not related to the Veteran’s active service, as pure tone thresholds were inconsistent and unreliable, and acoustic reflexes were not commensurate with pure tone responses. The Veteran underwent another VA examination in December 2015. See VA examination, December 2015. The examiner reported that pure thresholds could not be tested. The examiner stated that speech reception thresholds (SRTs) were at 50dBHL, bilaterally, at onset of the examination. However, the Veteran had absolutely no difficulty hearing conversational speech during case history. The examiner noted that the Veteran was reinstructed and consequently, SRTs reduced to 25dBHL, bilaterally, which would suggest hearing within normal limits at most speech frequencies, bilaterally. Additionally, the examiner then attempted pure tone audiometry, and the Veteran responded at levels of an average of 75dBHL, bilaterally. The examiner stated that pure tone averages (PTAs) were not in agreement with SRTs, bilaterally, which was physiologically impossible. The examiner reinstructed the Veteran multiple times, with clear, firm instructions, at 75dBHL, binaurally. Other testing was within normal limits, suggesting no middle ear pathology and no damage or lesion to the auditory pathways, and pointing to the fact that hearing was grossly intact. There was normal outer hair cell function of the cochlea. The examiner reported that word recognition could not be completed, as the Veteran omitted the last consonant of each word, and it was therefore invalid. In short, the examiner stated that examination of the outer, middle, and inner ear, as well as cranial nerve structures, all suggested that the Veteran’s hearing was within normal limits, bilaterally. The examiner stated that the test results were not valid for rating purposes, and not indicative of organic hearing loss. Audiologic findings were normal bilaterally. Hearing was normal bilaterally. As for tinnitus, the Veteran reported that he has had the disorder on and off for years. The examiner stated that she could not provide an opinion as to the etiology of the tinnitus, as the STRs did not provide an exit examination, and the VA examination results were invalid. VA treatment records show that the Veteran stated that he did not experience any hearing loss. See VA treatment records, September 25, 2012; October 16, 2013; February 1, 2016. He also denied changes in hearing. See VA treatment records, January 12, 2012; May 10, 2013; November 22, 2013; July 9, 2015; July 11, 2016. VA treatment records also show that the Veteran stated that he experienced slight decrease in hearing in his left ear over the past year. He also stated that he experienced hearing loss and tinnitus. See VA treatment records, May 23, 2014; June 4, 2014; August 5, 2014. In his lay statements, the Veteran related that he was exposed to the noise resulting from his work as a boatswain mate, which caused his claimed bilateral hearing loss and tinnitus. The Board acknowledges that the Veteran is competent to report that he experiences bilateral hearing loss and tinnitus. Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). The Board notes that the Veteran is competent to report that he experiences symptoms of a bilateral hearing loss and tinnitus because that is information that comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). In certain circumstances, service connection may also be established by showing continuity of symptoms since service. 38 C.F.R. § 3.303 (a) (2017); see Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258, 272 (2015) (holding that “the Secretary has made clear that sensorineural hearing loss [and tinnitus are] considered subject to § 3.309(a) as an ‘[o]rganic disease[] of the nervous system.’“). However, although the Veteran contends that his bilateral hearing loss and tinnitus are related to active service, the Veteran’s opinion is insufficient to provide the requisite etiology of the claimed bilateral hearing loss and tinnitus because those matters require medical expertise, especially where the Board also finds that the evidence does not support a continuity of symptomatology of bilateral hearing loss and tinnitus. Indeed, the evidence does not show complaints of or treatment for hearing loss and tinnitus symptoms from separation from service until about 2014, about 38 years after separation from active service. 38 C.F.R. § 3.159 (a)(1) (2017); Duenas v. Principe, 18 Vet. App. 512 (2004); Bostain v. West, 11 Vet. App. 124 (1998); Stadin v. Brown, 8 Vet. App. 280 (1995); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). In fact, the Veteran explicitly denied experiencing any hearing loss or tinnitus before 2014. And, in 2014, he related that his hearing in the left ear decreased slightly only in the past year. The Veteran’s statements regarding hearing loss and tinnitus being related to service are not competent evidence as he is not medically qualified to prove a matter requiring medical expertise, such as an opinion as to etiology or an opinion as to the existence of a disorder. His statements as to a continuity of symptomatology are less persuasive because hearing loss and tinnitus were not shown in service, or after service until about 2014. In addition, no evidence exists in the Veteran’s STRs to show that he had any hearing-related issues in active service. In sum, no medical evidence supports the Veteran’s contentions that his bilateral hearing loss and tinnitus are in any way related to his active service. In addition, it is important for the Veteran to understand that there is no medical opinion which diagnosed the Veteran with hearing loss for VA purposes. While the July 2014 VA examiner diagnosed the Veteran with some hearing loss (but not severe enough for VA purposes), the December 2015 examiner stated that the Veteran’s hearing was normal. Neither tied the Veteran’s claimed tinnitus to his active service. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for bilateral hearing loss and tinnitus, and the claims must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Given that the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lech, Counsel