Citation Nr: 21000815 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 16-55 430 DATE: January 6, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1967 to June 1967, with additional service in the Army National Guard from 1965 to 1972. This matter comes to the Board of Veterans’ Appeals (Board) from a July 2015 rating decision which, in pertinent part, denied entitlement to service connection for bilateral hearing loss. In August 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In October 2019, the Board remanded the claim for further development. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran’s service treatment records show that the Veteran underwent audiometric examinations prior to active duty (July 1965), at separation from active duty (June 1967), and following active duty (October 1971). Pure tone thresholds, in decibels, are listed for each examination; however, the Board notes that service audiograms were recorded using American Standards Association (ASA) units or International Standards Organization-American National Standards Institute (ISO-ANSI) units during different periods. Prior to January 1, 1967, audiometric results must be converted from ASA to ISO-ANSI units. Between January 1, 1967, and December 31, 1970, and where it is unclear if the results were recorded using ASA or ISO-ANSI units, the Board will consider the audiometric results under both standards, relying on the units most favorable to the Veteran’s appeal. After December 31, 1970, the Board assumes that ISO-ANSI units were used and no conversion is needed. Conversion to ISO-ANSI units is accomplished by adding 15 decibels to the ASA units at 500 Hertz (Hz); 10 decibels at 1000, 2000, and 3000 Hz; and 5 decibels at 4000 Hz. The converted ISO-ANSI units are indicated in parentheses below. Here, the results of the Veteran’s July 1965 examination must be converted from ASA units to ISO-ANSI units; accordingly, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 (30) 15 (25) 15 (25) Not recorded 15 (20) LEFT 15 (30) 15 (25) 15 (25) Not recorded 15 (20) Here, as the Veteran’s June 1967 examination was conducted between January 1, 1967, to December 31, 1970, and the examination is unclear about what standard was used, the Board will consider the results under both standards. As such, in June 1967, pure tone thresholds, in decibels, were as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 0 (15) 0 (10) 0 (10) Not recorded 10 (15) LEFT 0 (15) 5 (15) 10 (20) Not recorded 10 (15) Here, as the Veteran’s October 1971 examination was conducted after December 31, 1970, no conversion is needed. As such, in October 1971, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 0 0 Not recorded 10 LEFT 10 0 0 Not recorded 0 At the September 2020 VA examination, the Veteran reported that he began to have difficulty hearing sounds from cars while working as a mechanic in 1973 to 1974. The Veteran reported noise exposure during service, as well as before service working on a farm and after service working as a mechanic. The examiner stated that the June 1967 and October 1971 results showed normal hearing and that the Veteran reported loud noise exposure during service as well as outside of service. The examiner opined that, taken together, it is less likely than not that the Veteran’s hearing loss is the result of military service. The Board finds that remand is required for a new examination to determine the etiology of the Veteran’s bilateral hearing loss. While the examiner noted normal hearing results in June 1967 and October 1971, the examiner did not comply with the October 2019 remand directive to consider whether the absence of audiometric test results at 3000 Hz might show a significant threshold shift. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The examiner also did not consider whether there were significant threshold shifts at other levels during service that might be a precursor to post-service hearing loss. In particular, the Veteran’s representative, at the August 2019 hearing, questioned the accuracy of the July 1965 results because it was implausible that the Veteran’s hearing would improve at the June 1967 examination after noise exposure during service. On remand, the examiner should consider whether there were significant threshold shifts (as opposed to normal measurement variability) in the July 1965, June 1967, and October 1971 results, to include considering the accuracy of the July 1965 results and the absence of audiometric results at all examinations at 3000 Hz. Moreover, while the examiner noted noise exposure outside of service, the examiner never identified the extent of this exposure, and the Board notes that the claims file contains conflicting evidence, to include a May 2015 private treatment record where the Veteran reported excessive noise exposure outside of service and August 2019 hearing testimony where the Veteran characterized his post-service noise exposure as “very minimal.” The Board further notes that a VA audiogram was performed on January 28, 2019, but the specific results were not associated with the claims file and can be found in Tools. On remand, the specific results from this audiogram should be associated with the claims file. The matter is REMANDED for the following actions: 1. Obtain the audiometric results from the January 28, 2019, audiogram that can be found in Tools and associate with the claims file. 2. Schedule the Veteran for a VA examination to determine the etiology of his bilateral hearing loss. New audiological testing is not required. The examiner must review the claims file and provide a rationale to support all opinions. The examiner should convert the July 1965 audiometric results to ISO-ANSI units and should consider the June 1967 results under ASA and ISO-ANSI units, relying on the results most favorable to the Veteran’s appeal. After completing the conversions, the examiner must opine whether the Veteran’s bilateral hearing loss at least as likely as not (1) began during active service, to include related to an in-service injury, event, or disease, including acoustic trauma from gunfire and explosions without hearing protection; (2) manifested within one year of discharge from service; or (3) was noted during service with continuity of the same symptomology since service. The Board notes that the etiology of the Veteran’s hearing loss cannot be based solely on the Veteran’s “normal” July 1965 and June 1967 results. (Continued on the next page.)   The examiner should consider whether there were significant threshold shifts (as opposed to normal measurement variability) in the July 1965, June 1967, and October 1971 results that might be a precursor to post-service hearing loss, to include considering the accuracy of the July 1965 results and the absence of audiometric results at all examinations at 3000 Hz. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Craig Ormson, 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.