Citation Nr: 21003052 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 17-28 836 DATE: January 19, 2021 ORDER Entitlement to service connection for left ear hearing loss is granted. Entitlement to service connection for right ear hearing loss is granted. FINDINGS OF FACT 1. The evidence is at least in equipoise as to whether the Veteran’s left ear hearing loss disability is related to his active service. 2. The evidence is at least in equipoise as to whether the Veteran’s right ear hearing loss disability is related to his active service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran’s favor, the criteria for entitlement to service connection for a left ear hearing loss disability have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2020). 2. Resolving reasonable doubt in the Veteran’s favor, the criteria for entitlement to service connection for a right ear hearing loss disability have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1978 to April 1989. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the issues on appeal for additional development in April 2020. The directives having been substantially complied with, the matter again is before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). This appeal was originally certified to the Board with an additional issue: entitlement to service connection for tinnitus. However, in an October 2020 rating decision, the RO granted entitlement to service connection for tinnitus, effective from August 19, 2015 with a 10 percent evaluation. As such, the issue is no longer in appellate status before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). The Veteran testified at a video conference hearing before a Veterans Law Judge (VLJ) in January 2020. A transcript of the hearing is associated with the claims file. After the Veteran’s Board hearing of January 2020, that VLJ who conducted the hearing departed the Board and is no longer available. 38 U.S.C. § 7107(c) specifies that a VLJ designated by the Chairman to conduct a hearing “shall, except in the case of a reconsideration of a decision under section 7103 of this title, participate in making the final determination of the claim.” By Board policy, “[i]f the VLJ who participated in a Board hearing on the current appeal is unable to participate in the final determination, the appellant will be offered an opportunity to proceed on the record with a newly assigned VLJ or to have a new hearing. When the appellant has made the election, the case will be assigned to a new VLJ for a decision or for conducting a new hearing, as appropriate. If the appellant fails to make an election within 30 days, the case will be assigned to a new VLJ for a decision without scheduling a new hearing. Here, the Board notified the Veteran in written correspondence dated December 4, 2020 that the VLJ who had held his hearing had departed the Board, and offered the Veteran the opportunity for a new hearing as described above. The Veteran did not respond within the 30-day window, and as such, the undersigned VLJ has been assigned to adjudicate this appeal, and no further Board hearing on the issues will be held. Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2020). Pursuant to 38 U.S.C. § 5103A(b)(2), whenever the Secretary, after making such reasonable efforts (as described in this section), is unable to obtain all of the relevant records sought, the Secretary shall notify the claimant that the Secretary is unable to obtain records with respect to the claim. Such a notification shall (A) identify the records the Secretary is unable to obtain; (B) briefly explain the efforts that the Secretary made to obtain those records; and (C) describe any further action to be taken by the Secretary with respect to the claim. See Moore v. Shinseki, 555 F.3d 1369, 1374 (Fed. Cir. 2009) (“VA is statutorily required to obtain all of the veteran’s relevant service medical records, not simply those which it can most conveniently locate.”) The Veteran had identified time periods of treatment for his claimed disability for which service medical records were not present in the Veteran’s claims file, and part of the Board’s remand of April 2020 included specific direction to search for those records. However, the search for additional records was unsuccessful, and the Veteran was notified as such in correspondence from VA dated September 17, 2020. See 38 C.F.R. § 3.159(e); Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016); Paralyzed Veterans of Am. v. Sec’y of Veterans Affairs, 345 F.3d 1334, 1349 (Fed. Cir. 2003). The Veteran in this case has not referred to any other deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board….to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant’s failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. 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 Veteran 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 claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection – Hearing Loss Disability General Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: “(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-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). The United States Court of Appeals for Veterans Claims held that “when audiometric test results at a veteran’s separation from service do not meet the regulatory requirements for establishing a ‘disability’ at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service.” In evaluating claims of service connection for hearing loss, it is observed that the threshold for normal hearing is from zero to 20 decibels, with higher threshold levels indicating some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 160 (1993). To make this determination, the Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Depending on the evidence and the contentions of record in a particular case, lay evidence can be competent and sufficient to establish a diagnosis and medical etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include organic diseases of the nervous system such as sensorineural hearing loss, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For organic diseases of the nervous system, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). Service connection for hearing loss can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been “shown in service,” there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In making that decision, the Board must determine the probative weight to be ascribed as among multiple medical opinions, and state the reasons and bases for favoring one opinion over another. See Winsett v. West, 11 Vet. App. 420, 424-25 (1998); see also Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). This responsibility is particularly important where medical opinions diverge. The Board is also mindful that it cannot make its own independent medical determinations, and that there must be plausible reasons for favoring one medical opinion over another. See Evans at 31; see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3 (2020). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. 1. Entitlement to service connection for left ear hearing loss disability 2. Entitlement to service connection for right ear hearing loss disability The Veteran contends that his service in the Navy serving on submarines with duties as a machinist’s mate during active service caused his current bilateral hearing loss disability. On his September 2015 formal claim, he identified the source of his hearing loss as being around loud machinery, to include engines and generators. He noted he was never given ear protection or warned that on-the-job noise could injure his hearing later in life. The Veteran noted during his Board hearing that exposure to the loud noises was considered part of the job and that he and his shipmates accepted it as a military necessity at the time. For this reason, he asserts that he is entitled to service connection for bilateral hearing loss. Date of Claim Discussion The Board notes the Veteran’s assertion that he originally made a claim for service connection for his bilateral hearing loss and tinnitus back in 1991 both during his Board hearing and in a statement made in 2017 now in the claims file. The Board notes the claims file contains what VA considers to be the formal claim for the Veteran’s service connection claims for hearing loss and tinnitus to have been on a VA Form 21-0966, Intent to File, received on August 19, 2015, which was followed by the formal claim form on a VA Form 21-526EZ received on September 17, 2015. The Board points out in general that effective on and after March 24, 2015, VA updated the regulations concerning the filing of claims. 79 Fed. Reg. 57,660 (Sept. 24, 2014) (codified in 38 C.F.R. Parts 3, 19, and 20 (2015)). In part, the Department replaced the informal/formal claims process with a standardized and more formal process. See 79 Fed. Reg. at 57,663-64; see also 38 C.F.R. § 3.155 (2020). As a result of the rulemaking, a complete claim on an application form is required for all types of claims. 38 C.F.R. § 3.155(d). An “intent to file a claim” may also be filed pending completion of the prescribed form for “complete claims,” either orally or on a prescribed VA Form for that purpose. 38 C.F.R. § 3.155(b). A claimant who wants to file for benefits under laws administered by VA but does not communicate that desire orally or on a prescribed VA Form (on paper or electronically) is not considered to have filed a claim. 38 C.F.R. § 3.150(a). (Emphasis added.) As such, because the pertinent correspondence from the Veteran is dated in August 2015, after the formal claim requirement was established effective March 24, 2015, the Board notes that any attempt to file a formal claim must be on the appropriate form. See 79 Fed. Reg. 57,660 (Sept. 24, 2014). The Board has reviewed the complete claims file as part of this adjudication and finds no instances of earlier, informal claims prior to March 24, 2015 that might otherwise be referred back to the agency of original jurisdiction for adjudication. The Board finds no record or documentation of any earlier intent to file in the claims file, and thus finds that the effective date for the Veteran’s hearing loss is the date he filed his intent to file form on August 19, 2015. See 38 C.F.R. § 3.155(b)(1)(ii). Evidence and Analysis First, the evidence of record demonstrates that the Veteran has a current bilateral hearing loss disability that comports with VA’s definition of disability resulting from hearing impairment. 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 of 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Every post-service audiological examination, VA or private, demonstrated hearing loss in both ears of the Veteran. The Board has previously conceded exposure to loud noises and acoustic trauma for the Veteran during his active service and will not change that finding here. The Veteran has stated that during his service from June 1978 to April 1989, and especially once he began duties aboard submarines in 1979 that he was exposed to significant levels of noise. Specifically, he has argued that his occupational specialty as a machinist’s mate exposure him to loud noise from generators and engines aboard ship. Further, there is no evidence that the Veteran’s statements concerning noise exposure are not credible. As such, the Board finds that noise exposure in service has been shown. See 38 C.F.R. § 1154(a). The Veteran’s military induction examination in December 1977 indicated a zero to ten decibel threshold level for all measured frequencies of 500, 1000, 2000, or 4000 Hertz (Hz). While there are only a very limited set of service medical records for this Veteran, there were no entries in the available service treatment notes about any hearing issues. The Veteran submitted with his August 2015 claim a private audiological examination by a private audiologist and an opinion for service connection by an ears, nose, throat (ENT) physician who provided an full ENT workup for the Veteran to investigate his hearing loss and the possible causes of it. This comprehensive audiological examination, performed in March 2015 for the purposes of hearing aid qualification and calibration, noted at the test frequencies of 500, 1000, 2000, 3000, and 4000 Hertz, the results were 85, 90, 90, 90, and 85 for the right ear, and 25, 25, 40, 50, and 70 for the left ear. Maryland CNC testing was 84 percent in each the left ear and zero percent in the right ear. The Veteran’s ENT physician, who provided a comprehensive examination and who had provided and supervised the medical care of this Veteran since May 2015, noted it was highly likely that the Veteran’s progressive hearing loss was a direct result of his service as a submariner and machinist during his active military service. This examiner noted that VA had already recognized the active service effects on the Veteran’s hearing with his VA audio examinations that resulted in the provision of hearing aids and the existence of long-standing tinnitus. This examiner also noted the progression of worsening hearing for this Veteran began while still in service. The Veteran supplied a buddy statement from R.A. in May 2017 to illustrate his hearing loss in service. This fellow sailor served with the Veteran aboard two of the three submarines the Veteran also served upon, and note he thought the Veteran had the hearing of a “90 year old man,” and that the Veteran was always hard of hearing during the time he knew him. The Veteran testified at a Board videoconference hearing in January 2020. The Veteran testified that he first noticed his hearing loss in the mid-1980s while still on active duty, and that he first sought medical care for his hearing problems around 1990, 1991 from the VA. The Veteran repeated his claim that his service around very noisy machinery and generators had led to his decline in hearing acuity, to include tinnitus, and that it progressively worsened after service. The Veteran said he considered himself deaf in his right ear now and that VA-supplied hearing aids had only limited help. The Veteran also testified that his severe hearing problems had cost him a job at a chemical plant where he had worked for years, because his supervisor thought his severe hearing loss was a safety risk for the Veteran at this job. Also, in January 2020, another buddy of the Veteran, K.W.M., provided a statement in support of the Veteran’s claims regarding his hearing loss. This buddy, who served with the Veteran, noted the Veteran’s reputation as the mechanical expert on diesel engines meant he was always called upon to operate these engines, along with air compressors and generators. This buddy, who was a supervisor of the Veteran in service, noted he had to repeat instructions to the Veteran numerous times for him to understand them completely. Buddy K.W.M. also noted having met the Veteran at subsequent reunions and noticed the Veteran’s hearing had worsened since service. In May 2020, another buddy of the Veteran, P.J.C., provided an extensive statement where he noted the mechanical systems the Veteran dealt with in the course of his service duties, and that he often worked in noisy, enclosed spaces as part of his work, amplifying the negative effects of the noise exposure. P.J.C., who served with the Veteran, noted that the extremely hazardous noise exposure encountered was considered part of the job, even though the noise was unbearable at times. This buddy was also in contact with the Veteran after service, and noted the worsening of the hearing loss after service, along with his own. This buddy noted that even during active service, he had to have the Veteran face him directly up close in order to communicate verbally with him, and that the excessive noise had taken a toll on the Veteran. In September 2020, the Veteran underwent a VA audiological examination. The report contains minimal information concerning the Veteran’s statements during examination but shows that he reported having difficulty hearing other’s speech and claims that he was deaf in his right ear. The examiner documented the Veteran’s exposure to acoustic trauma in service from his occupational specialties as sailor who was a machinist and worked around generators and engines. The Veteran denied any recreational noise exposure. Examination revealed bilateral sensorineural hearing loss, with both ears showing significant hearing loss at 2000 Hz and higher frequencies. For the test frequencies of 500, 1000, 2000, 3000, and 4000 Hertz, the results were 95, 95, 95, 90, and 85 for the right ear, and 25, 30, 45, 75, and 80 for the left ear. Maryland CNC testing was zero percent for the right ear, and 94 for the left. The puretone threshold average was 92 decibels for the right ear and 58 for the left ear. In an opinion for service connection also dated September 2020, the examiner concluded that the Veteran’s bilateral hearing loss was less likely than not, less than 50 percent probability, caused by acoustic trauma in service, noting that the Veteran’s entrance examination showed no complaints of hearing loss, and that “medical evidence is clear there is a change in hearing acuity many years after noise exposure is unrelated to past military service noise exposure.” The Board notes a mix of opinion but finds the September 2020 VA audiologist’s opinion to be of lesser probative weight because of its conclusory nature with no specifics as to the reasoning of the negative opinion. The Board notes with emphasis that the United States Court of Appeals for Veterans Claims (Court or CAVC) has previously noted in other similar cases that IOM report upon which the VA examiner referenced that a medical text must do more than just provide speculative generic statements about a disability or the relationship between the disability and purported causal factors. See, e.g., No. 17-1875, p. 11, 2019 U.S. App. Vet. Claims (June 18, 2019) (unpublished) (citing Wallin v. West, 11 Vet. App. 509, 514 (1998)). Furthermore, an excerpt from a generic medical text that does not apply medical principles regarding causation or etiology to the facts of the individual Veteran’s case generally won’t provide sufficient evidence, standing alone, to serve as the basis for an award of service connection. Libertine v. Brown, 9 Vet. App. 521, 523 (1996). The Board notes from the IOM report itself that “[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after the cessation of that noise exposure” and that “definitive studies to address this issue have not been performed.” IOM Report, supra at 151-152, available at www.nationalacademies.org/hmd/Reports/2005/Noise-and-Military-Service-Implications-for-Hearing-Loss-and-Tinnitus.aspx. (Emphasis added.) The Board finds here that the September 2020 VA examiner’s reliance on general statements from an extensive medical study to the particular facts of this Veteran’s case is overly broad and not specific enough to provide any reasonable support of the VA examiner’s opinion. To be adequate, a medical opinion must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Board also questions the level of attention of this September 2020 examiner to the Veteran’s claims file, noting that she recorded his military occupational specialty on her examination report as “mechanic,” when in fact the Veteran’s service personnel records indicate his occupational career field was as a submarine machinist mate specializing in diesel engine and generator maintenance and operation. On the other hand, the positive opinion offered by the August 2015 private physician examiner specifically noted a review of the Veteran’s service history and his conclusions referenced detail of the VA examination and the lay statements of the Veteran, and therefore is considered to be of strong probative value. Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). The Board also notes the Veteran’s consistent statements over time, his testimony before a Veterans Law Judge in January 2020, and the three detailed, comprehensive buddy statements provided in May 2017, January 2020, and May 2020. Importantly, there is no reason to doubt the credibility of the Veteran’s self-reported history of exposure to excessive noise during service, and experiencing a hearing loss during, and since, service. A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A layperson is competent to identify a medical condition where the condition may be diagnosed by its unique and readily identifiable features. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). The record establishes the Veteran has current bilateral hearing loss considered disabling for VA purposes, and the Board has conceded hazardous noise exposure while in service. When the evidence is in equipoise and there is reasonable doubt, as here, the Board gives the benefit of the doubt in favor of the Veteran. Competent evidence of a current bilateral hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Here, all VA and private examinations in the Veteran’s claims file establish the presence of bilateral hearing loss. In-service noise exposure is conceded. The Board finds the September 2020 opinion to be of limited probative value because it cites only generalized statements that are conclusory rather than relating the opinion directly to the Veteran’s medical and lay evidence. In contrast, the Board finds the August 2015 positive opinion by an ENT physician to be highly probative for reasons stated earlier, and also the positive statements of the Veteran, to include during testimony before a VLJ during a Board hearing, and his three buddy statements. The Board finds that there is credible evidence of symptoms of hearing loss in service and continuity of symptoms since service. Multiple lay statements from the Veteran and three credible buddy statements all point to continuity of hearing problems for the Veteran since service. When there is an equipoise of evidence, as here, the Veteran prevails on his claims. The Board finds that the evidence is at least in equipoise as to whether the Veteran’s current bilateral hearing loss disability is related to his military service. As such, the Board finds a grant of service connection for bilateral hearing loss disability is appropriate. See 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Setter, 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.