Citation Nr: 20028167 Decision Date: 04/22/20 Archive Date: 04/22/20 DOCKET NO. 18-40 223 DATE: April 22, 2020 ORDER Entitlement to service connection for bilateral hearing loss is granted. Entitlement to service connection for tinnitus is granted. FINDING OF FACT 1. The evidence is at least in relative equipoise regarding whether the Veteran’s hearing loss and tinnitus is due to his in-service noise exposure. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303(a), 3.307. 3.309. 3.385 (2018). 2. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303(a), 3.307. 3.309. 3.385 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S Army from October 1972 to April 1973. This appeal to the Board of Veteran’s Appeals (Board) arose from a July 2017 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran has perfected the appeal. See March 2018 Notice of Disagreement; July 2018 Statement of the Case (SOC); July 2019 Substantive Appeal (VA Form 9). Service Connection A Veteran is granted service connection where evidence shows that an injury or disease that results in a current disability was incurred during service or was aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §3.303(a). To be entitled to service connection, the evidence must support (1) a current disability; (2) an in-service injury or event; and (3) a nexus between the current disability and the in-service injury or event. 38 C.F.R. §3.303(a). Service connection can also be granted for chronic disabilities, if the evidence establishes that it manifested to a compensable degree within one year after the Veteran was separated from service. 38 C.F.R. §3.307, §3.309. Service connection for chronic disabilities can be established through a showing of continuity of symptomatology since service, as an alternative to the nexus requirement. 38 C.F.R. §3.303(b). This option is limited to chronic disabilities listed in 38 C.F.R. §3.309(a). When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not prove or disprove the claim satisfactorily. It is a substantial doubt and one within range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. §3.102 Entitlement to service connection for bilateral hearing loss and tinnitus. The Veteran contends that he developed hearing loss due to in-service noise exposure. Regarding whether the Veteran has a current diagnosis of hearing loss in accordance with VA standards, at the June 2017 VA examination, the examiner found that the Veteran had normal hearing in his right ear and hearing loss in the left ear. In a September 2017 private medical record, the doctor, an otolaryngologist with a special interest in otology, found that the Veteran had bilateral hearing loss. Audiometric testing was performed by an audiologist. A review of the report establishes that the Veteran has hearing loss in both ears in accordance with VA standards. The Veteran’s speech recognition score from Maryland CNC Test for the right ear was 92 percent. The evidence supports that the Veteran has reported recurrent tinnitus. Regarding an in-service injury or event, the Veteran asserts that as a drill sergeant, a company grade training office and battalion, he was responsible for assisting in range activities involving the firing of all manner of weapons systems, from a handgun to a tank. The Veteran’s Certificate of Release or Discharge from Active Duty (DD 214 Form) show that he was a Sharpshooter and an expert in grenades. His other service personnel record support the Veteran’s contentions of being involved with weapons. Hazardous noise exposure is consistent with circumstances of the Veteran’s service. Therefore, the Board finds that in-service noise exposure has been established. Regarding whether there is a nexus, the June 2017 VA examination opined that the Veteran’s hearing loss (in the left ear) was less likely than not caused by or the result of his in-service noise exposure. The examiner stated that the DD 214 Form supported the likelihood of exposure to hazardous noise during his service. However, hearing testing findings beginning in March 1979 identified normal hearing sensitivity in both ears. The examiner continued that although there are no documents to review from October 1972 to April 1973 regarding hearing test results, normal hearing in both ears is noted in subsequent medical examinations dated March 1979 and February 1986. Since the examiner found that the Veteran only had hearing loss in his left ear, the examiner indicated that unilateral hearing loss is not the typical result of hazardous noise exposure. The examiner cited the Institute of Medicine, which reported that based on the current understanding of auditory physiology, hearing loss from noise injuries usually occurs immediately following exposure. There was no scientific basis to conclude that permanent hearing loss directly attributable to noise exposure will develop long after noise exposure. The examiner opined that the Veteran’s tinnitus was associated with his hearing loss, as tinnitus is a known to a symptom associated with hearing loss. The examiner indicated that tinnitus was first noticed five years ago. The examination report indicated post-service occupational noise exposure. The September 2017 private doctor opined that the Veteran’s bilateral hearing loss and tinnitus was secondary to acoustic trauma sustained during active duty in the military. The doctor stated that some of it represents hereditary hearing loss in the lower frequencies, but the Veteran does have fairly typical changes, which would be consistent with acoustic trauma. The doctor noted in that report that the Veteran expressed that he felt he had some hearing loss at the time he was discharged from the military. The Veteran also reported experiencing significant tinnitus, worse in the left ear, since his active service. After a thorough consideration of the evidence, the Board finds that the evidence is in relative equipoise regarding whether the Veteran’s bilateral hearing loss and tinnitus is due to his in-service noise exposure. Both the June 2017 VA examiner and September 2017 private doctors are medical professionals who have applied the established medical consensus regarding the issue of the Veteran's claim. Thus, both medical opinions are deemed competent. The opinions are also credible, as they are based on the knowledge of the relevant facts in this case. The June 2017 examiner’s opinion is based on the combination of normal hearing found shortly service and the Institute of Medicine’s report regarding delayed onset hearing loss due to noise exposure. The September 2017 doctor’s opinion is based on the Veteran’s assertions regarding experiencing hearing difficulties shortly after service and his acoustic trauma. Both clinicians support hazardous noise exposure during the Veteran’s service. The June 2017 VA examiner did note that there were no documents regarding the Veteran’s hearing during his actual active service. Although the Veteran’s hearing was considered normal in March 1979 and February 1986, there is no way of determining if his thresholds did shift from entrance to separation, indicating some degree of diminished hearing. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Veteran asserts that he did not seek treatment during his active reserve service because he learned to live with his condition by reading lips, closed cation and increasing the volume when possible. Regarding the various reports regarding the onset of tinnitus, the June 2017 VA examiner indicated that tinnitus is associated with hearing loss. Therefore, if a nexus regarding the Veteran’s hearing loss is established, a nexus for tinnitus would be established as well. The Board finds that there is competent and credible evidence against the claim and for the claim regarding a nexus, thus the evidence is at least in relative equipoise. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Board shall give the benefit of the doubt to the claimant. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Thus, resolving reasonable doubt in favor of the Veteran, the Board finds that there is a nexus between the Veteran’s hearing loss, tinnitus, and his in-service noise exposure. Accordingly, the criteria for service connection for hearing loss and tinnitus have been met, and entitlement to service connection is warranted, DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Middleton, 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.