Citation Nr: 18157384 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 16-62 642 DATE: December 12, 2018 ORDER Entitlement to service connection for left ear sensorineural hearing loss (SNHL) is granted. FINDING OF FACT The competent medical evidence shows that it is at least as likely as not that the Veteran’s left ear SNHL was incurred as due to service. CONCLUSION OF LAW The criteria for service connection for left ear SNHL have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1964 to October 1967. The Statement of the Case issued in this appeal also included the claim of service connection for tinnitus. In the December 2016 Substantive Appeal, however, the Veteran only noted “left ear” adjacent to a box indicating that he was “only appealing these issues” and did not reference the tinnitus claim at all. The Regional Office has only certified the left ear hearing loss claim to the Board, and there has been no further reference to tinnitus in the record. The Board thus finds that only the left ear hearing loss claim is before the Board at the present time. At the outset, pursuant to VA regulation, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory threshold for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hertz 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; see also 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (applicable to service connection claims broadly). VA audiometric readings prior to June 30, 1966, and service department audiometric readings prior to October 31, 1967, must be converted from American Standards Association (ASA) units to International Standard Organization (ISO (ANSI)) units. The Veteran’s service personnel records reflect that his military occupational specialty (MOS) during his career was a radio relay repairman; however, a copy of his DD-214 form shows that he was decorated as a rifle marksman, which strongly suggests that he was exposed to loud arms fire while in service. The Board thus accepts that he experienced significant noise exposure during service. Puretone thresholds in decibels on an entrance examination dated in November 1964 were, as converted from ASA to ISO (ANSI) units, the following: HERTZ 500 1000 2000 3000 4000 LEFT 15 15 15 15 10 On a July 1967 separation examination puretone thresholds in decibels were the following, again as converted from ASA to ISO (ANSI) units: HERTZ 500 1000 2000 3000 4000 LEFT 30 25 30 * not tested* 20 The Veteran was afforded a VA audiology examination in January 2015. Puretone thresholds on an audiometric examination were: HERTZ 500 1000 2000 3000 4000 LEFT 20 25 45 50 50 Speech discrimination scores using the Maryland CNC word list were 100 percent in the right ear and 98 percent in the left ear. The examiner diagnosed the Veteran with SNHL in the left ear only and then opined that the left ear SNHL was less likely than not caused by or the result of in-service noise exposure on the basis that “left ear test results appear to be within normal limits” on the July 1967 separation examination. The Board finds this VA examination opinion to be entirely inadequate, and, in fact, not supported by the record. The examiner’s opinion was entirely based upon the finding of left ear hearing within normal limits at separation. This is unacceptable for two reasons. First, the absence of disability at separation, in and of itself, is an insufficient basis for a negative nexus opinion, particularly in light of the Veteran’s conceded in-service noise exposure. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Second, while the Board concedes that there was no left ear hearing loss disability in service, that is not the same as saying that there was no left ear hearing loss, period. Indeed, in this case, three of the Veteran’s post-ISO (ANSI) conversion puretone thresholds at separation were at 25 decibels or higher (and no findings were provided at 3000 Hertz). The United States Court of Appeals for Veterans Claims (Court) has held that “audiometric testing measures threshold hearing levels (in decibels (dB)) over a range of frequencies (in Hertz (Hz)); the threshold for normal hearing is from 0 to 20 dB, and higher threshold levels indicate some degree of hearing loss.” Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Hearing loss, as opposed to hearing loss disability, is thus conceded in service. In summary, the claims file contains persuasive evidence of in-service noise exposure, a significant (if not disability-level) indication of hearing loss at separation from service relative to findings at entrance, and a totally inadequate negative nexus opinion to which the Board attaches no probative value. While the Board could conceivably remand this case for a more thorough medical nexus opinion, the combination of the in-service noise exposure and the puretone threshold elevations at separation from service lead the Board to believe that it is at least as likely as not that the Veteran’s left ear hearing loss disability is due to service. Resolving all doubt in favor of the Veteran, the appeal is thus granted. 38 U.S.C. § 5107(b). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher M. Collins, Associate Counsel