Citation Nr: 18154835 Decision Date: 12/03/18 Archive Date: 11/30/18 DOCKET NO. 16-53 718A DATE: December 3, 2018 ORDER Service connection for asthma is granted. REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. FINDINGS OF FACT The Veteran’s asthma had its onset in active service. CONCLUSIONS OF LAW The criteria for entitlement to service connection for asthma have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1986 to February 2014. Service Connection 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 may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of (1) a current 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. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran contends that his respiratory disability, claimed as asthma, was incurred in active service. See November 2016 VA Form 9. The Board observes that service treatment records from October 1998 reveal that the Veteran sought medical attention for symptoms including shortness of breath and a “tight feeling” in his upper chest. He returned for treatment later in October 1998, and reported he had experienced pain for three weeks in his upper lung fields when taking a deep breath. On both occasions in October 1998, the medical providers’ assessment was bronchitis. In November 1998 service treatment records, the Veteran was referred to internal medicine and reported six weeks of pleuritic sharp, stinging pain. The Veteran reported he did not have a cough, but experienced chest pain on exertion. The provider indicated a number of potential causes for the Veteran’s symptoms, including infectious pulmonary process, and prescribed albuterol. In July 2002 service treatment records, the Veteran reported a history of exercise induced asthma. On the August 2002 Report of Medical History, the Veteran denied having coughed up blood, bronchitis, wheezing, or chronic cough; but he reported a history of asthma or breathing problems related to exercise, weather, and pollens, as well as shortness of breath. Service treatment records demonstrate a chest X-ray in April 2007 ruled out tuberculosis as a cause of the Veteran’s respiratory symptoms. A May 2007 thoracic CT scan revealed no bronchiectasis, or pleural effusion. During a March 2008 military periodic examination, the provider indicated the Veteran had a history of treatment for exercise induced asthma. In October 2013 service treatment records, the Veteran complained of significant shortness of breath, tightness in his chest, and occasional wheezing that improved with the use of albuterol. See also September 2013 Report of Medical History. He reported the symptoms began in 1998 after assignment in an area that was sprayed heavily with pesticide. See also November 2013 pulmonary disease note. The Veteran reported his respiratory symptoms were also triggered by cold weather and environmental allergens, and that albuterol decreased the recovery time from his symptoms of dyspnea and chest tightness. The November 2013 pulmonologist noted that the physical examination, chest X-ray, spirometry and mannitol bronchoprovocation study were unrevealing. The primary diagnosis was difficulty breathing (dyspnea); however, she indicated that a diagnosis of exercise induced asthma could not be ruled out. The Veteran was afforded a VA examination in November 2013 for the claim of entitlement to service connection for asthma. The VA examiner reported the Veteran was prescribed albuterol, and that the Veteran used it intermittently, especially after exercise. See also March 2015 correspondence from the Veteran. The VA examiner noted that the pulmonary function test in October 2013 was within normal limits. The VA examiner also stated that the November 2013 pulmonologist diagnosed the Veteran with dyspnea, but failed to address the fact that the November 2013 pulmonologist clearly stated that exercise induced asthma was not ruled out. The Board finds probative value in the medical history reported by the Veteran, and confirmed in service treatment records that demonstrate assessment and treatment for exercise induced asthma. Additionally, the Board finds probative value in the November 2013 pulmonologist’s statement that exercise induced asthma could not be ruled out as a diagnosis. Accordingly, the Board finds the evidence of record is in favor of a finding that the Veteran has a current diagnosis of asthma that began in active service. Based on the probative evidence of record, and the Veteran’s competent and credible statements, entitlement to service connection for asthma is warranted. REMANDED ISSUE The Veteran contends he has a current bilateral hearing loss disability that is related to in-service noise exposure. See September 2013 VA Form 21-526c. The Veteran reported constant exposure to loud noise over a period of 13 years where his duties involved being in or around military aircraft and vehicles, as well training with explosives. See February 2015 notice of disagreement. The Veteran’s September 1993 audiological evaluation noted that the Veteran was routinely exposed to hazardous noise in the performance of his duties. The Board finds the Veteran competent and credible to report in-service hazardous noise exposure given the type and circumstances of his service, which is also evidenced by the examiner’s remarks on his September 1993 audiological evaluation. 38 U.S.C. § 1154(a). For VA purposes, impaired hearing shall be considered a disability when the thresholds for the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz are 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. 38 C.F.R. § 3.385. Based on the results of the October 2013 VA audiological evaluation, the Veteran’s bilateral hearing impairment does not meet the criteria to be considered a disability for VA purposes. The Veteran underwent an audiological evaluation on his May 1986 entrance examination, and pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 5 0 0 5 LEFT 0 0 0 10 20 Speech audiometry testing for speech recognition was not performed. On the September 1993 audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 10 20 LEFT 0 0 5 15 15 Speech audiometry testing for speech recognition was not performed. On the October 2013 audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 25 30 35 LEFT 5 5 20 25 30 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 94 percent in the left ear. Although, on the October 2013 in-service audiological evaluation, the Veteran did not meet the criteria for hearing impairment to be considered a disability by VA regulations, the Board observes the Veteran demonstrated a worsening threshold shift from the September 1993 audiological evaluation. The Veteran has not been scheduled for a post-service hearing loss evaluation, and he continues to assert observing diminished hearing acuity. The Board finds remand is necessary to afford the Veteran an updated audiological examination, given the potential manifestations of worsened hearing acuity in service and since service. The matter is REMANDED for the following action: 1. Schedule the Veteran for an audiological evaluation to determine if the Veteran meets the criteria for a hearing loss disability as defined by VA regulations. If a current hearing loss disability, as defined by VA regulation, is found, the examiner should opine as to whether the current hearing loss at least as likely as not (50 percent or greater probability) had onset in, or is otherwise related to his period of active duty service, to specifically include in-service noise exposure. The examiner should assume as true that the Veteran was in fact exposed to loud noises as he so describes. In providing a response, the examiner should discuss the significance, if any, of what appears to be a worsening hearing acuity threshold shift during service. Any opinion provided should be supported by a clinical explanation or rationale. 2. Readjudicate the Veteran’s claim for entitlement to service connection for a bilateral hearing loss disability. If the benefit sought on appeal remains denied, issue the Veteran a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Mask, Associate Counsel