Citation Nr: 18156365 Decision Date: 12/11/18 Archive Date: 12/07/18 DOCKET NO. 16-56 934 DATE: December 11, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1962 to November 1964. The Veteran filed a Motion to Advance his case on the Docket (AOD) due to advanced age and financial constraints. See 38 C.F.R. § 20.900 (c); 38 U.S.C. § 7107 (a)(2). This motion was denied on April 14, 2018. Entitlement to service connection for bilateral hearing loss is remanded. While the Board sincerely regrets further delay in this matter, a remand is necessary to ensure that the Veteran receives every possible chance to have his claim granted. Specifically, the record is inconsistent and incomplete as to the severity of the Veteran’s hearing loss. Thus, it cannot currently be determined whether the Veteran has a current disability of hearing loss under VA regulations. VA considers impaired hearing a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the above 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. Here, in his September 2014 Notice of Disagreement, the Veteran asserts that working as a field artillery cannoneer caused his hearing loss. This exposure is consistent with his military occupation specialty of Field Artillery Basic. Moreover, a threshold shift in the Veteran’s hearing may have occurred during service. His induction hearing examination was taken using the whispered voice test, which is no longer in use. The Veteran had normal hearing according to this examination. At separation, the Veteran’s threshold was measured at 5 dB in the right ear at frequencies up to 2000 Hz, and 10 dB in the left ear at those frequencies. However, the Board is unable to determine whether the Veteran currently has hearing loss that meets § 3.385. Specifically, the Veteran’s most recent VA examination, dated August 2014, indicates pure tone values of 25 dB at frequencies of 2,000 Hz, 3,000 Hz, and 4,000 Hz. A subsequent note from September 2015 indicates that the Veteran’s hearing worsened; however, it does not indicate to what extent. A March 2017 audiology note observes mild sensorineural hearing loss at 4,000 Hz in the right ear, but normal hearing at the rest of the frequencies. Finally, a hearing aid fitting note dated January 2018 reflects a “significant decrease in hearing ability in both ears compared to previous testing obtained on March 15, 2017.” However, rather than displaying specific thresholds for each frequency, the note merely indicates that the Veteran has hearing loss in the range of 26 to 40 dB in the right ear at 3,000 Hz and in the range of 26 to 40 dB in the left ear from 3,000 to 8,000 Hz. As to hearing loss for the purposes of § 3.385, this information is vague – the Veteran might have hearing loss of 26 dB at two frequencies, three frequencies, or four. Similarly, he might or might not have hearing loss at 40 dB at any frequency in either ear. It is impossible to tell based on the current record. Given the above, the Board finds that a new VA examination should be provided to obtain valid and complete test results and an etiology opinion. If a current hearing loss disability is demonstrated in either ear, the Board requests that the VA examiner review the claims file and specifically consider the threshold shift during service between his entrance examination in October 1962 and his separation examination in October 1964. As such, the VA examiner should opine as to whether the Veteran’s current hearing loss is etiologically related to service, including in-service noise exposure and the identified hearing threshold shift during service. The fact that the Veteran’s hearing was within normal limits at separation from service should not be the sole basis for the opinion. Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (the threshold for normal hearing is from 0 to 20 decibels). The Board notes a negative nexus opinion provided in the August 2014 VA examination. The examiner opines that because “there is not sufficient evidence … to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after cessation of that noise exposure,” the Veteran’s stated hearing loss is less likely than not related to military exposure. However, this opinion is based in part on the fact that the Veteran’s hearing was within normal limits at separation. The Court of Appeals for Veterans’ Claims has held that when audiometric test results at a veteran’s separation from service do not meet the requirements of 38 C.F.R. § 3.385, a veteran may nevertheless establish service connection for current hearing disability with evidence that the current disability is causally related to service. See Hensley, 5 Vet. App. at 159; 38 C.F.R. § 3.303(d) (service connection is warranted for a disease first diagnosed after service when all of the evidence indicates it is related to service). Given the Veteran’s conceded exposure to acoustic trauma in service, it is possible that he has current hearing loss that is related to service. However, this cannot be determined using the current VA examination report or the Veteran’s subsequent audiology examinations of record. As such, a new VA examination is necessary to determine any such link. The matter is REMANDED for the following action: 1. Obtain all treatment records from the VA Medical Center in Miami, Florida since October 2018, as well as any other VA facility from which the Veteran has received treatment. If the Veteran has received additional private treatment, he should be afforded an appropriate opportunity to submit records of this treatment. 2. Schedule the Veteran for an examination to determine the nature, extent, onset and etiology of the Veteran’s bilateral hearing loss. The claims file must be provided to the examiner for review. 3. The examiner should provide an opinion as to whether it is at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran’s bilateral hearing loss onset in, or is otherwise etiologically related to, his active service, to include noise exposure therein. The fact that the Veteran’s hearing was within normal limits at separation from service should not be the sole basis for a negative opinion. The examiner must also consider the Veteran’s lay statements regarding his bilateral hearing loss. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Z. Maskatia, Associate Counsel