Citation Nr: 19171925 Decision Date: 09/17/19 Archive Date: 09/17/19 DOCKET NO. 16-63 986 DATE: September 17, 2019 ORDER An initial compensable rating for mitral valve prolapse is denied. New and material evidence having been received, the application to reopen the claim for service connection for bilateral hearing loss is granted. Service connection for bilateral hearing loss is granted. FINDINGS OF FACT 1. The Veteran had active service from December 1979 to December 1999. 2. For the entire appeals period, the Veteran’s valvular heart disease was not manifested by a workload of greater than 7 METs but no greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, nor was continuous medication required. 3. Service connection for bilateral hearing loss was originally denied in an unappealed rating decision in May 2010; evidence received since the last final denial is new and raises a reasonable possibility of substantiating the claims. 4. Bilateral hearing loss is etiologically related to acoustic trauma sustained in service. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for mitral valve prolapse have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.104, Diagnostic Code (DC) 7000. 2. The May 2010 rating decision, which denied the claim of entitlement to service connection for bilateral hearing loss, is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2018). 3. New and material evidence has been received to reopen service connection for bilateral hearing loss. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018). 4. Bilateral hearing loss was incurred in service. 38 U.S.C. §§ 1131, 5103(a), 5103A (2012); 38 C.F.R. § 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Increased Rating for Mitral Valve Disability Disability ratings are determined by the applications of the VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. The mitral valve prolapse is evaluated under DC 7000 which provides ratings as follows: a workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required (10 percent). One MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2). In a March 2015 VA examination, the examiner diagnosed atherosclerotic cardiovascular disease. The Veteran required continuous medication for control of his heart condition and had atrial fibrillation and a myocardial infarction in 2012. The examiner also indicated that there was no evidence of a heart valve condition, infectious heart condition, pericardial adhesions, cardiac hypertrophy, or cardiac dilation. The Veteran’s heart rate was 65 and his heart rhythm was noted as irregular along with normal heart sounds and clear auscultation of the lungs. The point of maximal impact was the 5th intercostal space. His blood pressure was 133/70. The examiner did not make any finding as to the Veteran’s left ventricular ejection fraction. The METs test showed dyspnea and METs level of five to seven. In an October 2015 addendum opinion, the VA examiner indicated that the Veteran’s mitral valve prolapse caused episodic palpitations, non-cardiac chest pain, and minimal exertional shortness of breath noted. He noted that the Veteran was not taking cardiac medication for mitral valve prolapse. Additionally, he indicated that the Veteran’s reduced METs were not due to mitral valve prolapse. Additionally, the relevant evidence of record includes the Veteran’s medical treatment records. Of note, private echocardiogram reports dated December 2012 and January 2013, a left ventricular ejection fraction (LVEF) of 60 percent were noted. Taking the applicable medical evidence into consideration, the record of evidence does not reflect that the Veteran is entitled to a compensable rating for his mitral valve prolapse. Specifically, the evidence does not show a workload of greater than seven METs but no greater than ten METs resulting in dyspnea, fatigue, angina, dizziness, or syncope. The examiner further clarified that the Veteran was not taking cardiac medication for mitral valve prolapse and that his reduced METs were not due to mitral valve prolapse. Thus, the medical evidence does not support a claim for a higher rating. The Board has also considered the Veteran’s lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s mitral valve prolapse has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiner has the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinion great probative value. As such, these records are more probative than the Veteran’s subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeal is denied. New and Material Evidence to Reopen Claim for Hearing Loss Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C. § 5108 ; 38 C.F.R. § 3.156. “New” evidence means evidence “not previously submitted to agency decisionmakers.” “Material” evidence means “evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim.” 38 C.F.R. § 3.156(a). In order to be “new and material” evidence, the evidence must not be cumulative or redundant, and “must raise a reasonable possibility of substantiating the claim,” which has been found to be enabling, not preclusive. See Shade v. Shinseki, 24 Vet. App. 110 (2010). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). With respect to bilateral hearing loss, the claim was originally denied in September 2000 for lack of a current diagnosis and medical nexus. It was denied again in May 2010 rating decision. The Veteran did not appeal and the decision became final. At the time of the prior final denial, VA examination reports, private treatment records, service treatment records (STRs), and VA treatment records were available for review. Evidence associated with the claims file since the May 2010 rating decision includes testimony from a June 2019 hearing before the undersigned and recent VA examinations and private and VA treatment records that show a current diagnosis of bilateral hearing loss as defined by VA regulations. As the claim was originally denied in part for lack of a current diagnosis, and given that a current diagnosis is now established, the application to reopen is granted and the appeal is granted to this extent. Service Connection for Bilateral Hearing Loss Having reopened the claim, the Board will address it on the merits. For VA purposes, 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 (dB) or greater, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000 or 4000 Hz are 26 dB or greater, or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, “the threshold for normal hearing is from 0 to 20 dBs [decibels] and higher threshold levels indicate some degree of hearing loss.” Hensley v. Brown, 5 Vet. App. 155 (1993). Hearing loss is recognized by VA as a “chronic disease” under 38 C.F.R. § 3.309 (a); therefore, the presumptive provisions of 38 C.F.R. §§ 3.303 (b), 3.307, and 3.309 apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). As an initial matter, bilateral hearing loss has been diagnosed. Specifically, the April 2015 VA examiner diagnosed bilateral sensorineural hearing loss. Therefore, a current disorder has been shown and the first element of service connection has been met. Next, the evidence supports a finding of in-service acoustic trauma and hearing loss during service. The Veteran’s military occupational specialty was aerospace maintenance craftsman. He has also stated that he was exposed to frequent noise on the flight line, around the aircrafts and also in the hangars. As such, the second element of service connection has been met. Next, as to continuity, the Veteran has indicated that he has experienced hearing loss since service. In this regard, a November 2016 private otolaryngology evaluation noted that the Veteran experienced decreased hearing for the past 26 years. The Board has resolved reasonable doubt in his favor and finds that he had continuous symptoms of hearing loss since service separation and meets the requirements of presumptive service connection under 38 C.F.R. § 3.303(b). Although the April 2015 VA examiner was unable to opine as to whether the Veteran’s hearing loss was caused by active service without resorting to speculation, the Board does not need to reach the weight assignable to the VA examination because service connection is granted on a presumptive basis under 38 C.F.R. § 3.303 (b) for the “chronic” disease of bilateral hearing loss based on a finding of “continuous” symptoms of bilateral hearing loss since service. In sum, there is evidence of acoustic trauma in-service and continuous symptoms of bilateral hearing loss since service; therefore, bilateral hearing loss is presumed to have been incurred in service and the appeal is granted. Because the Board is granting service connection on a presumptive basis based on continuous symptoms of bilateral hearing loss since separation, all other service connection theories are rendered moot. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Grzeczkowicz, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.