Citation Nr: 18155305 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 16-60 899 DATE: December 4, 2018 ORDER Service connection for bilateral hearing loss is denied. Service connection for tinnitus is granted. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has bilateral hearing loss etiologically related to an in-service event, disease, or injury, to include in-service noise exposure. 2. The Veteran’s has credibly reported that he first noticed tinnitus during service, and has experienced it ever since. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1972 to December 1974. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection can also be established on a secondary basis for a disability that is proximately due to, or the result of, a service connected disease or injury. 38 C.F.R. § 3.310(a). The Veteran asserts that his bilateral hearing loss and tinnitus are a result of military noise exposure. The record indicates that the Veteran has current diagnoses for tinnitus and bilateral hearing loss. Additionally, the record indicates that during his active service the Veteran received a sharpshooter badge with riffle bar and an expert badge with grenade bar. He has also described extensive military noise exposure and served in an artillery unit. Therefore, the Veteran is considered to have experienced military noise exposure. As such, the remaining determination is whether the Veteran’s current hearing loss and tinnitus is causally related to his military service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a), (d). The record contains conflicting medical opinions regarding whether the Veteran’s bilateral hearing loss and tinnitus are at least as likely as not related to an in-service injury, event, or disease, including military noise exposure. An August 2015 private opinion from practitioner A.G. indicates that the Veteran’s military service could not be ruled out as a contributing factor to his current hearing loss and tinnitus. The Veteran was assessed with tinnitus and mild to moderately severe bilateral sensorineural hearing loss. The Veteran reported military noise exposure to include artillery without the use of hearing protection. He reported a civilian work history in manufacturing with no exposure to hazardous noise, and recreational activities with no noise exposure. As rationale for this opinion, the practitioner noted the Veteran’s self-reported medical history. The January 2016 VA examiner opined that the claimed conditions were not related to military service. The Veteran was assessed with bilateral hearing loss and tinnitus. The Veteran reported an onset of tinnitus, primarily in the right ear, during active service while working on a training base. He reported decreased hearing in both ears and trouble understanding others. The Veteran’s military noise exposure was fully documented. The examiner noted that the Veteran’s 1971 enlistment examination and 1974 separation examination showed normal hearing bilaterally, with no significant threshold shifts (STS), and that there was no indication that the Veteran sustained auditory impairment noise exposure based on audiograms of record. The examiner further noted that the Veteran’s service made no mention of tinnitus. Additionally, while a 2015 post-service audiogram showed bilateral hearing loss, there was excellent speech discrimination. The examiner cited medical research that found that hearing loss from noise injuries occurs immediately following exposure and that there is no scientific basis to conclude that permanent hearing loss directly attributable to noise exposure will develop long after such noise exposure. The examiner concluded that based on the Veteran’s MOS, service audiograms, post-service medical records, and the relevant medical research, there was no basis to conclude that his hearing loss was caused by or the result of his military service, to include military noise exposure therein. In a February 2016 evaluation, private practitioner M.B. opined that the claimed conditions were related to military service. The Veteran was assessed with mild to moderate, mixed hearing loss bilaterally. The Veteran reported difficulty hearing and understanding in most listening situations. He reported military service and an MOS of cook with an Artillery Unit. The Veteran reported significant military noise exposure. He also reported civilian work history in parts, manufacturing, and driving, with no need for ear protection. He denied any recreational noise exposure. The practitioner opined that the Veteran’s exposure to military noise resulted in acoustic trauma, hearing loss, and tinnitus. The practitioner also noted that acoustic trauma results in progressive underlying neuropathology that has prolonged long-term consequences on the auditory process. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against finding that the Veteran’s bilateral hearing loss and tinnitus began during service or is otherwise related to an in-service injury, event, or disease, including military noise exposure. The Board finds the VA examiner’s opinion highly probative and affords it great weight. This opinion is grounded in the Veteran’s service medical history, current medical testing, and relevant medical literature. This opinion also provided an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Notably, the VA examiner found that the Veteran’s service audiological examinations indicated normal hearing. Further there was no indication that the Veteran experienced significant threshold shifts between entrance and separation. The examiner further noted that the medical research indicates that hearing loss from noise exposure is immediate rather than delayed long after such exposure. The private medical opinions, however, are found to be less probative than the VA examiner’s opinion. Significantly, practitioner A.G. provided an opinion with equivocal language, based on the history provided by the Veteran. Similarly, practitioner M.W. cited the Veteran’s reported sources of noise exposure as rationale. Yet the private audiologists failed to address the absence of any hearing loss at time of separation based on audiometric testing at that time. While the Board has conceded Veteran’s military noise exposure, military noise exposure alone is not sufficient to establish a causal link between the Veteran’s service and his current disabilities. There is no indication that the private practitioners reviewed the Veteran’s service audiological evaluations or the VA claims file. Neither private practitioner addressed the objective evidence that the Veteran did not experience hearing loss during service, normal hearing at separation from service, or the significantly delayed onset of hearing loss. While practitioner M.W. noted that long-term consequences can result from acoustic trauma, the objective evidence of record fails to indicate that the Veteran experienced acoustic trauma during active service (as audiometric testing at separation showed normal hearing). As such M.W.’s opinion fails to adequately address the Veteran’s significantly delayed onset of hearing loss, particularly in light of the medical literature cited by the VA examiner. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his hearing loss is related to an in-service injury, event, or disease, including military noise exposure, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of organ systems in the body and the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA medical opinion and the objective medical evidence of record. Accordingly, service connection for bilateral hearing loss is not warranted. The result with tinnitus is different. The Court of Appeals for Veterans Claims (Court) has specifically held that tinnitus is a type of disorder associated with symptoms capable of lay observation. See Charles v. Principi, 16 Vet. App. 370 (2002). Tinnitus, unlike hearing loss, is a disability which cannot at this time be tested on. Rather, the Veteran is uniquely situated to report when he first began to experience symptoms of tinnitus. Here, the Veteran credibly reported that he first noticed tinnitus in his right ear while in service and that the condition has continued since that time. The Veteran did not seek to embellish his account in any way, and the Board finds it to be credible. Thus, the Veteran’s tinnitus, a chronic disability, began in service and has continued since. Therefore, the criteria for service connection have been met and service connection for tinnitus is granted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. I. Sims, Associate Counsel