Citation Nr: 21000459 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-01 350 DATE: January 5, 2021 ORDER Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for hearing loss is remanded. FINDING OF FACT Tinnitus had its onset in service. CONCLUSION OF LAW The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from August 1968 to March 1970. In January 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed. The Board previously remanded this appeal in May 2019. 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. 38 U.S.C. §§ 1110; 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F. 3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service-connected. Sensorineural hearing loss and tinnitus may be presumed to have been incurred in service if it was compensably disabling within a year of a Veteran's separation from active duty. 38 C.F.R. §§ 3.307, 3.309(a). 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 at 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz 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 though a disabling hearing loss was not demonstrated at separation, a Veteran may, nevertheless, establish service connection for a current hearing disability by submitting evidence that a current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). 1. Entitlement to service connection for tinnitus The Veteran contends that tinnitus began in service. At the Board hearing in January 2019, the Veteran testified that he fired weapons on a daily basis. He testified that he had ringing in his ears and could not hear for days at a time. The Veteran has a current diagnosis of tinnitus. See June 2014 and September 2020 VA examinations. The evidence supports a finding of noise exposure in service. The Veteran was in an artillery battalion. A VA treatment record dated in August 2014 reflects that he reported a history of firing and loading Howitzers, sometimes without ear protection. The remaining question is whether his current tinnitus is related to his noise exposure during service. In August 2014, the Veteran reported progressive hearing loss and tinnitus since service. A June 2014 VA examination noted recurrent tinnitus. The Veteran reported that constant tinnitus may have started in service. In a September 2018 statement, the Veteran noted that he was exposed to noise in the field artillery. He stated, “I began experiencing a noise or ringing in my ears. That has stayed with me to this day.” A December 2019 VA examination shows that the Veteran reported bilateral, ringing tinnitus that began in the military. He attributed his tinnitus to firing a Howitzer without hearing protection. The examiner opined that a relationship between the Veteran’s tinnitus and service is speculative, in the absence of an objectively verifiable noise injury. The examiner did not discuss the Veteran’s history of service in the artillery, which involved exposure to loud noises. The Veteran's competent and credible testimony indicates that tinnitus initially manifested in service and continued since service. The Veteran's statements and testimony provide sufficient basis to establish a chronic disability that initially manifested in service with continuous symptoms since service. Accordingly, service connection for tinnitus is granted. REASONS FOR REMAND Entitlement to service connection for hearing loss is remanded. The Board previously remanded the claim for a VA examination and medical opinion. The examiner was asked to opine whether hearing loss is related to exposure to weapons noise during service. The examiner was advised that, if it is unclear what standards were used in the entrance and separation audiograms, the examiner should consider the thresholds under both ASA and ISO-ANSI standards. The Veteran had a VA examination in December 2019. The examiner noted that ASA standards were used for the enlistment audiogram in December 1968. The examiner stated that it was unclear what standards were used for the separation audiogram in February 1970. The examiner opined that no significant threshold shifts occurred for either ear, regardless of the standards that are used. A pre-induction audiogram in January 1968 reflects the following thresholds. The examiner indicated that the induction audiogram applied ASA standards. The conversion to ISO-ANSI standards is shown below in parentheses. 1000 2000 3000 4000 RIGHT -5 (5) -5 (5) Not tested -5 (0) LEFT -5 (5) -5 (5) Not tested -5 (0) The separation audiogram in February 1970 showed the following thresholds: 1000 2000 3000 4000 RIGHT 10 5 Not tested 10 LEFT 10 5 Not tested 15 The December 2019 examiner indicated that it was not clear whether the separation audiogram used ASA or ISO-ANSI standards. However, the examiner opined that there were no significant shifts with the application of either standard. The Board notes that, if ASA standards were used on both the induction and separation examinations, there was a shift at all tested thresholds. However, if the separation examination used ISO standards, there was a shift at 4000 Hz only. An addendum opinion is necessary to address any threshold shifts in more detail. The matters are REMANDED for the following action: 1. Obtain an addendum opinion to address the etiology of the Veteran's bilateral hearing loss. The examiner must opine whether it is at least as likely as not that the Veteran's bilateral hearing loss began during his period of active service or is otherwise related to his active service, to include in-service noise exposure in the artillery. (a) The examiner must address any threshold shifts applying both ISO and ANSI standards. (b) The examiner must explain the significance, if any, of any threshold shifts. The examiner should discuss whether the threshold shifts are the result of his noise exposure in service. The Veteran’s service occupation in the field artillery is considered to have a high probability of noise exposure. The examiner should indicate whether the threshold shift during service is indicative of hearing loss. (c) If the examiner finds that the threshold shifts in service are not significant, the examiner should elaborate as to what level of threshold shift would be considered significant. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Catherine Cykowski 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.