Citation Nr: 18129083 Decision Date: 08/23/18 Archive Date: 08/23/18 DOCKET NO. 15-22 902 DATE: August 23, 2018 REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to service connection for bilateral knee tenonitis is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1964 to October 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from July 2013 and January 2016 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for left ear hearing loss. The Board has determined that additional development is necessary prior to the adjudication of the Veteran’s claim for service connection for left ear hearing loss. The Board finds the Veteran’s July 2013 VA audiological examination is not adequate regarding left ear hearing loss. First, the VA examiner did not consider the Veteran’s converted audiometric results for his in-service November 1964 and September 1967 audiometric testing. Audiology testing standards were set by the American Standards Association (ASA) until November 1, 1967. After that date, audiometric tests were conducted using International Standards Organization (ISO) or American National Standards Institute (ANSI) measurement. However, as it relates to VA examinations and VA records, audiological reports were routinely converted from ISO-ANSI results to ASA units until the end of 1975 because the regulatory standards for evaluating hearing loss were not changed to require ISO-ANSI units until September 9, 1975. Current VA regulations that define hearing loss for VA purposes are based on the decibel (dB) measurement recorded in the ISO-ANSI units. 38 C.F.R. § 3.385. Accordingly, the VA uses a system to convert ASA units to ISO-ANSI units that adds 15 dB to 500 Hertz (Hz), 10 dB to 1000, 2000, and 3000 Hz, and 5 dB to 4000 Hz. In view of the fact that the Veteran’s November 1964 and September 1967 audiometric examinations were likely conducted under the ASA testing standards, the Board has applied the conversion standard to these audiometric results. The Veteran’s November 1964 enlistment examination shows converted puretone thresholds in the left ear at 500, 1000, 2000, and 4000 Hz were 15, 10, 5, and 5 dB respectively. The Veteran’s September 1967 separation examination shows converted puretone thresholds in the left ear at 500, 1000, 2000, and 4000 Hz were 20, 10, 15, and 10 dB respectively. In addition, the examiner stated that the Veteran had hearing loss prior to service. Specifically, the examiner stated the Veteran had high frequency hearing loss in his left ear at entrance. However, left ear hearing loss was not noted on the Veteran’s entrance examination. The only condition noted on the enlistment examination was pes planus. The Veteran’s unconverted enlistment audiometric examination showed puretone thresholds in the left ear at 500, 1000, 2000, 3000, 4000, and 6000 Hz were 0, 0, 5, 0, 0, and 30 dB. As the VA examiner stated that the Veteran had left ear high frequency loss at enlistment, it appears he was referring to the 30 dB recording at 6000 Hz. VA considers impaired hearing to be a disability when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hz is 40 dB or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2017). As such, the 6000 Hz frequency is not considered when determining whether hearing loss exists for VA purposes. Under both the converted and unconverted November 1964 audiometric results, the Veteran does not meet the requirements for left ear hearing loss prior to service. As such, the examiner’s statement that the Veteran had hearing loss prior to service is inaccurate. Therefore, the Veteran should be afforded a new VA audiological examination on remand. 2. Entitlement to service connection for bilateral knee tendonitis The Veteran was afforded a VA lower leg and knee examination in January 2016. The examiner stated that the Veteran had a current diagnosis of bilateral knee tendonitis. The examiner stated that the bilateral knee tendonitis was less likely than not incurred in or caused by the claimed in-service injury. The rationale provided was that “although the condition examined today is somewhat similar to the condition described in the STRs in 1966, veteran has not established that this is in fact the same or related condition.” The Board finds that the examiner’s rationale is not sufficient to support his opinion. The Veteran was treated for right knee tendonitis in May 1965. The Veteran reported that in Jump School he had painfully sore knees for several weeks. Whether the Veteran’s current disability is related to his in-service treatment for right knee tendonitis is a complex medical question, and is not determinable by lay observation. As such, the Veteran is not competent to establish that the conditions are related. This determination is within the expertise of the medical examiner. The January 2016 VA examiner did not provide any rationale as to why the Veteran’s current condition was not related to his in-service symptoms. As such, the Veteran should be afforded a new VA knee and lower leg condition. The matters are REMANDED for the following action: 1. Send a letter to the Veteran requesting that he identify all VA and non-VA health care providers. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide Veteran and his representative the required notice and opportunity to respond. 2. After obtaining any outstanding treatment records, ensure that the Veteran is scheduled for a VA audiological examination, by an examiner who has not previously examined him, to determine the nature and etiology of the Veteran’s left ear hearing loss. The examiner must review the claims file in conjunction with the examination and consider the Veteran’s converted in-service audiometric testing results. The examiner should provide complete rationale for any conclusion reached. The examiner must accept as fact that the Veteran did not have a hearing loss disability, for VA purposes, at entrance into service. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s left ear hearing loss was related to his service. 3. Ensure the Veteran is scheduled for a VA knee and lower leg condition examination by an examiner who has not previously examined him. The examiner must review the claims file in conjunction with the examination and consider the Veteran’s in-service treatment for right knee tendinitis in 1965 and 1966. The examiner must provide complete rationale for any conclusion reached. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s bilateral knee tendonitis is related to his service, to include his in-service treatment for right knee tendonitis. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Norah Patrick, Associate Counsel