Citation Nr: 21001624 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 17-13 803 DATE: January 11, 2021 ORDER Entitlement to service connection for left ear hearing loss is granted. REMANDED Entitlement to service connection for a right shoulder condition is remanded. Entitlement to service connection for a left wrist condition is remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his left ear hearing loss is at least as likely as not related to acoustic trauma in service. CONCLUSION OF LAW The criteria for service connection for left ear hearing loss are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty July 1987 to September 1987 and May 1993 to June 1998. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared for a hearing before the undersigned Veterans Law Judge in March 2020. A transcript of the proceeding is of record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for left ear hearing loss The Veteran contends that his left ear hearing loss was caused by in-service noise exposure. The Veteran was granted service connection for right ear hearing loss in 2014. Service connection is established where a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). The threshold for normal hearing is from 0 to 20 decibels; higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155 (1993) (citing Current Medical Diagnosis & Treatment, Stephen A. Schroeder, et. al. eds., at 110-11 (1988)). But before service connection may be granted for hearing loss, it must be of a particular level of severity. For 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 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 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. Initially, the Veteran is currently diagnosed with a left ear hearing loss disability in accordance with 38 C.F.R. § 3.385. See April 2017 VA examination. The Veteran’s DD Form 214 shows that he served in Kuwait and earned the sharpshooter marksmanship qualification badge with rifle bar. His military occupational specialty was unit supply specialist. Acoustic trauma in service has been established by the Veteran’s grant of service connection for hearing loss in the right ear. Therefore, the question is one of nexus. See Davidson, supra. The Veteran’s service treatment records indicate some hearing loss on the left which appears to have improved at the time of discharge. February 1986 enlistment audiological evaluation report indicates that the puretone thresholds at the frequencies of 500, 1000, 2000, 3000, 4000, and 6000 Hertz were 15, 10, 10, 15, 15, and 25 decibels, in the left ear, respectively. An April 1993 audiological evaluation report indicates that the puretone thresholds at the frequencies of 500, 1000, 2000, 3000, 4000, and 6000 Hertz were 10, 10, 15, 15, 10, and 45 decibels, in the left ear, respectively. However, two April 1998 separation audiological evaluation reports indicate that the puretone thresholds at the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz were 5, 10, 15, 25, 20, and 10 decibels, and 5, 10, 15, 25, 20, 20, and 10 decibels, in the left ear, respectively. So according to Hensley there was some degree of hearing loss of 45 decibels at 6000 Hertz in the left ear in April 1993 which appeared to resolve at separation, and some degree of hearing loss of 25 decibels at 3000 Hertz at the time of separation from active service. Though service treatment records (STRs) show that the Veteran did not have hearing loss according to § 3.385 when examined for discharge from service, service connection for hearing loss is not precluded if there is sufficient evidence to demonstrate a relationship between the Veteran’s service and his current hearing disability. Hensley, supra. Further, the August 2014 VA examination report indicated that it is at least as likely as not that the audiological examination at separation from service were inaccurate and did not actually represent the Veteran’s true hearing condition. Accordingly, the examiner opined that, even though the Veteran’s hearing loss was not a disability for VA purposes under § 3.385 at the time, it is at least as likely as not that the Veteran’s left ear hearing loss is a continuation of the threshold shifts that were present at separation and therefore it is at least as likely as not that the veteran’s current hearing loss is related to his military service. The Board is aware that the April 2017 VA examiner opined against relation to service based on the lack of a significant threshold shift at separation from service. However, given the August 2014 VA examination opinion in favor of relation to service, and evidence of some hearing loss on the left in service and at separation, the evidence is at least in relative equipoise on this matter and the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. §§ 1154(b), 5107; 38 C.F.R. § 3.102; see also Gilbert, 1 Vet. App. at 55. Therefore, the benefit of the doubt is resolved in favor of the Veteran, and entitlement to service connection for left ear hearing loss is granted. REASONS FOR REMAND Entitlement to service connection for a right shoulder condition is remanded. The Veteran is currently diagnosed with degenerative arthritis of the right shoulder. See July 2014 VA treatment records. At the March 2020 Board hearing, the Veteran credibly testified that he injured his shoulder in service after he picked up his rucksack. Further, the Veteran testified that he has had twitching and periodic flare-ups of pain in that shoulder since the initial injury. The August 2014 VA examination found the shoulder condition clearly and unmistakable preexisted service and clearly and unmistakable was not aggravated beyond its natural progression by service. However, this opinion cited no evidence in support of its conclusion. Further, a review of the records finds no evidence suggesting a preexisting shoulder condition. The Board notes the Veteran’s entrance examinations to his first and second periods of service do not note any shoulder conditions. Accordingly, the August 2014 VA examination is inadequate. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). 2. Entitlement to service connection for a left wrist condition is remanded. The Veteran is diagnosed with left wrist tendonitis. See August 2014 VA examination. At the March 2020 Board hearing, the Veteran credibly testified that he injured his wrist picking up a rack of machine guns in service for which he received treatment at that time, and has had pain in that joint since the in-service injury. Service treatment records indicate a left wrist injury in January 1997. The August 2014 VA examination opined against relation to service due to a lack of objective medical records indicating continued care since service. However, this opinion did not consider the Veteran’s lay statements regarding continuing symptoms since service; thus, it is inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right shoulder condition, to include degenerative arthritis: (a.) is at least as likely as not related to service, to include the claimed in-service lifting injury. (b.) (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? The examiner’s attention is drawn to the Veteran’s competent statements that he has experienced twitching and flare-ups of pain in his right shoulder since the claimed in-service injury. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left wrist condition, to include tendonitis, is at least as likely as not related to service, to include the claim in-service lifting injury. The examiner’s attention is drawn to the Veteran’s competent statements that he has experienced flare-ups of pain in his left wrist since the claimed in-service injury. The need for additional physical examination of the Veteran is left to the discretion of the examiner. In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? The examiner must provide a complete explanation for all opinions. If the examiner is unable to render the requested opinions without resorting to speculation, the examiner must state whether there is inadequate factual information, whether the question falls beyond the knowledge of the examiner, whether the question falls beyond the scope of the medical community, or another reason. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.L. Blevins, 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.