Citation Nr: 18155013 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 14-26 090 DATE: December 4, 2018 ORDER Entitlement to service connection for bilateral hearing loss (BHL) is granted. Entitlement to service connection for tinnitus is granted. FINDINGS OF FACT 1. The Veteran has current BHL that is etiologically related to exposure to hazardous noise while in service and a clear, documented decrease in hearing acuity while serving in Vietnam. 2. The Veteran’s current diagnosed tinnitus had its onset in service. CONCLUSIONS OF LAW 1. The criteria for service connection for BHL are met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from April 1967 to January 1971. He received many awards and commendations for his service in Vietnam, and the Board thanks the Veteran for his service. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision. On the Veteran’s July 2014 Form 9, he requested a videoconference hearing before the Board. However, in a mailing received in January 2015, the Veteran withdrew his request for a hearing before the Board and requested instead to have a hearing with a Decision Review Officer (DRO) at a Department of Veterans Affairs (VA) Regional Office (RO). The Board finds that the Veteran’s request for a Board hearing was properly withdrawn, and that the requested DRO hearing was held. Accordingly, the Board may proceed with making a decision on the merits. Service Connection In order to establish service connection for a claimed disorder, the following must be shown: (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). 1. Entitlement to service connection for BHL The Veteran contends that his BHL is due to his in-service noise exposure, to include firing machine guns as a door gunner in Vietnam. The Board concludes that the Veteran has a current diagnosis of BHL that is related to exposure to hazardous noise while in service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In May 2011, the Veteran was given a VA examination to evaluate his current hearing levels. The pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 25 30 65 65 LEFT 15 15 20 30 35 Speech audiometry revealed speech recognition ability of 100 percent in both ears. The examiner concluded that the Veteran had bilateral sensorineural hearing loss (BHL) for VA service connection purposes, but stated she was unable to give an opinion regarding whether there was a nexus to service because she did not have the claims file available for review. The examiner did state that the Veteran had in-service noise exposure to aircraft engines and machine gun fire, which the Board finds is corroborated by the record. She also stated that the Veteran had post-service occupational noise exposure when he worked as a truck driver, during which time the Veteran reported he also did not use hearing protection. In March 2012, after obtaining and reviewing the Veteran’s claims file, the same examiner issued an addendum opinion stating it is less likely than not the Veteran’s BHL is etiologically linked to the Veteran’s conceded in-service noise exposure because his service treatment records (STRs) show his hearing was within normal limits at the time of his discharge from service. As further explained below, the Board finds the examiner’s rationale to be inadequate because it failed to address a clear decrease in hearing acuity in service. The absence of hearing loss disability in service is not in and of itself fatal to a claim for service connection for a hearing loss disability. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). The United States Court of Appeals for Veterans Claims in Hensley v. Brown, 5 Vet. App. 155, 157 (1993) recognized that service connection for a current hearing disability is not precluded simply because hearing was within normal limits on audiometric testing at separation from service. Rather, service connection may be awarded when there is sufficient evidence to otherwise demonstrate a relationship between the Veteran’s service and his current disability. Id at 159-60. Though the Veteran’s exit examination did show hearing loss that was below a level that constitutes a disability for VA purposes, a review of the Veteran’s complete STRs shows a distinct decrease in the Veteran’s hearing acuity over the time he served in Vietnam. The Veteran’s entrance examination and report of medical history in July 1966 showed no hearing loss in either ear at any pure tone threshold level, and no complaints of ear, nose, or throat trouble. When the Veteran was examined for aircrewman candidacy in November 1967, his hearing test revealed better than perfect hearing. Specifically, where a “0” result indicates no decibel loss, and a positive number (i.e. “5” or “10”) indicates the decibels of hearing loss found, the Veteran’s test revealed “-5” readings for all pure tone threshold levels, bilaterally. Personnel records show that the Veteran began service in Vietnam as a door gunner on helicopters by approximately May 1968. As indicated above, the Board acknowledges that his duties involved exposure to hazardous noise, including machine gun fire and aircraft engines. When the Veteran’s hearing was next tested in January 1970, the examination showed the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 0 0 LEFT 5 0 0 5 0 By the time of the Veteran’s discharge examination in December 1970, his hearing showed further deterioration, though it did not constitute a disability for VA purposes. Audiometry testing revealed the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 5 5 5 LEFT 10 5 5 5 5 Thus, the Veteran’s hearing had decreased steadily over his time in Vietnam, and had lost 10 to 15 decibels at each pure tone threshold level. In July 2014 the Veteran submitted an article on hearing loss associated with combat service that the Board finds to be of high probative value considering the clear decrease in hearing acuity shown in the Veteran’s STRs. The article cites to a study by the Institute of Medicine in support of the proposition that, while those exposed to hazardous noise (such as combat Veterans exposed to repeated gun fire) often experience an immediate and drastic decrease in hearing that largely resolves within a few days, “this acoustic trauma causes long-term damage that might not yet be evident.” Thus, though the Veteran’s hearing damage appeared to be minimal at the time of his discharge, in that his hearing was still within normal limits, the cited study suggests it was evidence of long-term damage. Based upon the evidence discussed above, the Board finds that the requirements for service connection for BHL have been met. 2. Entitlement to service connection for tinnitus The Veteran asserts that his tinnitus symptoms began while serving in Vietnam. The Board concludes that the Veteran has a current diagnosis of bilateral tinnitus that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service connection may be awarded on a presumptive basis for certain chronic diseases, to include tinnitus (as an organic disease of the nervous system), listed in 38 C.F.R. § 3.309(a), that manifest in service or to a degree of 10 percent within one year of service separation. Id. §§ 3.303(b), 3.307. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson reports a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. In fact, competent medical evidence is not necessarily required when the determinative issue involves medical etiology or a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In the same March 2012 VA opinion discussed above, the examiner concluded the Veteran’s tinnitus was less likely than not related to his in-service noise exposure because the Veteran’s hearing acuity was within normal limits when he left service. In addition to the reasons already explained regarding why that rationale is inadequate, the Board notes that, tinnitus is a chronic condition entitled to presumptive service connection when the condition begins in service. The Veteran has consistently stated throughout the record that he began experiencing symptoms of tinnitus, to include a ringing sound in both ears, when he was deployed in Vietnam. The Veteran is competent to report symptoms of tinnitus and when they first began. Although the Veteran’s STRs do not explicitly state that he was experiencing tinnitus or ringing in his ears, the Board notes that the Veteran did report “ear, nose or throat trouble” on his February 1969 Report of Medical History. The physician’s notes on the matter are largely illegible, but do seem to suggest a need to follow up with an ENT specialist. While the evidence of record does not explicitly state that the Veteran began experiencing tinnitus symptoms in service, what evidence does exist all tends to   corroborate his lay statements. Accordingly, because the Veteran has been diagnosed with tinnitus and the evidence shows it began in service, the Board finds that the requirements for service connection have been met. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Anderson, Associate Counsel