Citation Nr: 18158807 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 17-19 204 DATE: December 18, 2018 ORDER Service connection for bilateral hearing loss is granted. Service connection for tinnitus is granted. FINDINGS OF FACT 1. The Veteran has currently diagnosed tinnitus and bilateral sensorineural hearing loss for VA compensation purposes. 2. The Veteran was exposed to acoustic trauma during active service. 3. The evidence is in equipoise as to whether the Veteran’s hearing loss and tinnitus are related to the in-service acoustic trauma. CONCLUSIONS OF LAW 1. The criteria to establish service connection for bilateral hearing loss disability are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385 (2017). 2. The criteria to establish service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) (2017) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 Fed. Cir. 2013). 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) medical 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). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment, including by a veteran. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner’s opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Analysis for Hearing Loss and Tinnitus The Veteran contends that his currently diagnosed sensorineural bilateral hearing loss and tinnitus are due to noise exposure during service. Specifically, the Veteran has stated that his disabilities are due to noise exposure from aircraft noise while serving in the Air Force as a vehicle operator. Turning to the evidence in this case, a current bilateral hearing loss disability has been established, showing the Veteran has hearing loss for VA purposes under 38 C.F.R. § 3.385 (see October 2014 VA examination report showing speech recognition scores as 66% in the right ear and 62% in the left ear). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board also finds that the Veteran has a current tinnitus disability. The Veteran is competent to describe observable symptoms such as ringing in the ears as these are observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Charles v. Principi, 16 Vet. App. at 374 (a veteran is competent to testify that he experienced ringing in his ears in service and had experienced ringing in his ears ever since service). Next, the Veteran has provided (and the file also corroborates) competent and credible evidence of in-service incurrence of acoustic trauma during service; as such, an in-service injury is demonstrated. The Veteran’s DD Form 214 shows that the Veteran had a military occupational specialty of vehicle operator. He also reported that, as a driver in a motor pool, he was qualified to operate all vehicles and equipment. The Veteran indicated that he was on the flight line 60 to70% of the time and was exposed to running aircrafts and generators. For these reasons, the Board finds that the Veteran was exposed to loud noise in service. Upon review of all the evidence of record, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s hearing loss and tinnitus are related to the in-service noise exposure. Weighing against the claim is an October 2014 VA medical opinion. Specifically, the examiner opined that the Veteran’s hearing loss was not related to service. In support of this opinion, the examiner indicated that audiograms dated in November 1962, December 1962, and August 1966 had been reviewed; however, all thresholds were within normal limits and there were no significant threshold shifts noted at any frequency when the initial and subsequent thresholds were compared. Further, the examiner noted that, although the Veteran’s military occupational specialty was considered at a high probability for noise exposure, thresholds were evaluated at induction and separation and did not demonstrate any significant change during the period of service. Records showed no hearing loss or significant changes in hearing thresholds greater than normal measurement variability during military service. There was also no record of complaint or treatment of the claimed conditions (hearing loss or tinnitus) in service records. Weighing in favor of the claim is a December 2014 statement from audiologist M. P. During the evaluation, M. P. indicated that the Veteran was on the flight line 60-70% of the time and was exposed to running aircrafts and generators while in service. The Veteran was not provided hearing protection at that time. During the evaluation, the Veteran reported that his ears would ring intermittently while in service after exposure to noise on the flight line. M. P. indicated that a hearing examination was conducted, which showed severe sensorineural hearing loss. Further, M. P. opined that the Veteran’s exposure to loud noise while in service was significant and that it was more likely than not that the in-service noise exposure contributed to his hearing loss and tinnitus. This was based on the fact that noise exposure caused structural changes in cochlear sensory cells and their supporting cells, which in turn, compromised cochlear function. According to M. P., these changes caused both temporary and permanent auditory threshold shifts and ultimately permanent and progressive sensorineural hearing loss and tinnitus. In sum, the Board finds that there is evidence weighing both in favor and against the Veteran’s claims. Accordingly, the evidence as to whether the Veteran has hearing loss and tinnitus as a result of in-service noise exposure is at least in equipoise. Resolving reasonable doubt in his favor, the Board finds that the Veteran has bilateral hearing loss and tinnitus disabilities are the result of service. Thus, service connection for bilateral hearing loss and tinnitus is warranted. Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Casadei, Counsel