Citation Nr: 18157455 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 17-32 475 DATE: December 12, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a bipolar disorder is granted. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has bilateral hearing loss due to a disease or injury in service, to include as a result of acoustic trauma experienced while serving in Korea. 2. The Veteran’s bipolar disorder is related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.385. 2. The criteria for service connection for bipolar disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1951 to February 1953. A hearing was not requested. In March 2018, the Board remanded the Veteran’s claims to obtain VA examinations and a statement regarding in-service hearing loss. In an October 2018 rating decision, the RO granted entitlement to service connection for PTSD at an initial rating of 100 percent. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for bilateral hearing loss Service connection will be presumed for certain chronic diseases, including bilateral hearing loss, if manifest to a compensable degree within one year after discharge from service. See 38 C.F.R. §§ 3.307, 3.309. Because there is no indication that the Veteran’s hearing loss was manifested within one year of service, service connection is not available on a presumptive basis. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hz 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. Even if disabling loss is not demonstrated at separation, a veteran may establish service connection for a current hearing disability by submitting evidence that a current disability is causally related to service. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993). The Veteran’s February 2017 audiological examination revealed a diagnosis of hearing loss. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 70 55 60 75 60 LEFT 60 50 65 65 75 Speech recognition ability using the Maryland CNC test was 52 percent in the right ear and 28 percent in the left ear. These values constitute a current diagnosis of bilateral hearing loss so as to satisfy the first element of service connection. The second element is also satisfied, in that several statements from the Veteran’s family members indicate that he was exposed to loud noises when delivering food to soldiers serving on the front lines of Korea. See, e.g., July 2018 statement (obtained in response to the Board’s prior remand instructions). Unfortunately, the nexus element is not satisfied. The examiner notes that the Veteran was fitted for a left ear hearing aid in 2009 and for bilateral hearing aids in 2014. The examiner also reviewed the testimony of the Veteran’s daughter, who noted that the Veteran’s hearing loss started between 1996 and 1998. Given the late onset of hearing loss and the Veteran’s advanced age at the time of hearing loss, the examiner concludes that the Veteran’s hearing loss is less likely than not related to service. In reaching this conclusion, the examiner specifically addressed the literature that was listed in the Board’s prior remand instructions. The examiner stated that if the Veteran “had had a complete audiogram with normal findings at separation” the articles would still not have supported entitlement to service connection. This is primarily due to the Veteran’s advanced age at the time when he was diagnosed with hearing loss. According to the examiner, the literature does not support “delayed onset of hearing loss caused by noise which has an onset some 60 years post separation from the military.” In other words, the Veteran’s hearing loss is too remote from service to support entitlement to hearing loss under the indicated literature. These medical opinions are probative because they are based on a review of the record and contain clear conclusions with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301–02 (2008). Because the preponderance of this evidence is against the existence of a nexus, the Veteran’s claim must be denied. 2. Entitlement to service connection for a bipolar disorder Regarding a bipolar disorder, the first element is satisfied, in that a December 2011 VA medical record indicates a diagnosis of bipolar disorder. The second element is satisfied, in that the Veteran and his family members argue that this disorder is the result of delivering food to battle lines in Korea. The nexus element is also satisfied. An October 2018 VA examiner first notes that it is “difficult to ascertain” an association between the Veteran’s bipolar disorder and service because bipolar disorder has “genetic and physiological factors.” According to DSM-5, “[a] family history of bipolar disorder is one of the strongest and most consistent risk factors for bipolar disorder.” In the Veteran’s case, the examiner notes that the Veteran’s bipolar disorder does not have a genetic component, based on an undisputed statement from a family member that there is no history of mental illness on either side of the Veteran’s family. Although the examiner was not able to provide a definitive link, this evidence indicates that the Veteran’s bipolar disorder is at least as likely as not related to service. The reasons for this conclusion is that the major associative factor, genetics, is not present, and no factor other than service is indicated. On the basis of this evidence, the Board finds that there is a nexus between the Veteran’s bipolar disorder and service. As all of the elements for service connection are satisfied, the Veteran is entitled to prevail with respect to his claim. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Cannon, Associate Counsel