Citation Nr: 21062016 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 18-10 981 DATE: October 6, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. Entitlement to service connection for bilateral hearing loss is granted. Entitlement to service connection for tinnitus is granted. FINDINGS OF FACT 1. The Veteran's PTSD is related to his active-duty service, to include service in Vietnam. 2. The Veteran's bilateral hearing loss began during active service. 3. The evidence shows the Veteran's current tinnitus began during or within one year of separation from service CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to service connection for bilateral hearing loss are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for tinnitus are met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1967 to October 1969 including in the Republic of Vietnam. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision by a Department of Veteran's Affairs (VA) Regional Office (RO). In September 2021, a virtual hearing was held before the undersigned Veterans Law Judge. This decision is being made under the "one-touch" program. A transcript of the hearing will be associated with the claims file at a later time. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). With regard to PTSD claims specifically and in addition to the criteria above, service connection for PTSD requires: (1) medical evidence establishing a diagnosis of the condition pursuant to 38 C.F.R. § 4.125 (a) (conforming to the appropriate edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)); (2) credible supporting evidence that the claimed in-service stressors actually occurred; and (3) medical evidence of a link between the current symptomatology and the claimed in-service stressors. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128 (1997); Martinez-Bodon v. Wilkie, No. 18-3721, 2020 U.S. App. Vet. Claims LEXIS 1523 (Vet. App. Aug. 11, 2020). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Certain chronic diseases, including sensorineural hearing loss and tinnitus, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). A brief description of the Veteran's reported stressors is below. 1. Entitlement to service connection for posttraumatic stress disorder. The Veteran asserts that his current PTSD is a direct result of his service in Vietnam, specifically during combat. As stated above, the first element of service connection for PTSD requires a diagnosis consistent with the most current version of the DSM, in this case, the DSM-5. The Veteran's VA outpatient records show he began seeking treatment for PTSD in October 2007; however, no formal diagnosis was noted in his records. In September 2018, the Veteran submitted a disability benefits questionnaire in which the examiner diagnosed him with "PTSD severe chronic." As a result, the first element of service connection has been met. See Shedden, 381 F.3d 1163; 38 C.F.R. § 4.125 (a). The Veteran asserts his PTSD is a result of his experiences in combat while in Vietnam. In the Veteran's April 2015 statement in support of a claim for PTSD, he summarized his traumatic experiences in Vietnam. This included experiencing a "rocket and mortar attack" at his base during the "Tet Offensive." The Veteran states the base took approximately "150 rounds" into the sleeping quarters of the Air Base as the opposition attempted to take over the base. The Veteran recounts a number of servicemembers being injured or killed during this attack. The Veteran also asserts that as a member of the air crew, he flew in a number of missions "in hostile territory" and witnessed both killed and injured individuals. In a March 2018 statement in support of his claim for PTSD the Veteran further stated that on one mission, he was tasked with aiding in a helicopter crash clean up. The Veteran witnessed the deceased air crew members still in their strapped in their seats. The Veteran provided photographic images of this occurrence which are associated with the file. The Veteran also stated that during the attack on his base, two of his friends were killed in action. In December 2018 the Veteran also submitted copies of letters he had sent home while stationed in Vietnam. In these letters dated in April 1968 and May 1968, he tells his family about the attack on his base and the loss of life that occurred as a result. The Veteran has consistently reported these same stressors for the entirety of the appeal period. Additionally, in December 2018, a friend of the Veteran submitted a statement in support of the Veteran's claim. This servicemember stated that while he did not know the Veteran during service, he was stationed at the same base during the same period of time as the Veteran. He also recalls that approximately 150 rounds of rocket and mortar fire were direct at the base that both he and the Veteran were stationed at in Vietnam. He stated the fighting went on for days. The Veteran is competent to report on the experiences he had in Vietnam and the way those events affected him. 38 C.F.R. § 3.159(a)(2). When considering the credibility of lay evidence, the Board may consider internal consistency, facial plausibility, and consistency with other evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Veteran has consistently reported the same events in service since April 2015. His assertions are supported by his VA medical records, his military personnel record, and assertions from a fellow servicemember present during the attack on their base. As a result, he is also found by the Board to be credible. Finally, as there is no evidence to rebut any assertion the Veteran has made, his lay statements are deemed highly probative. Furthermore, the Veteran is entitled to the combat presumption for PTSD stressors under 38 C.F.R. § 3.304(f)(2) and (f)(3). Under 38 C.F.R. § 3.304(f)(2), if the evidence shows that the Veteran engaged in combat with the enemy and the claimed PTSD stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, then, absent clear and convincing evidence to the contrary, the Veteran's lay testimony alone may establish an in-service stressor. Moreover, under 38 C.F.R. § 3.304(f)(3), the Veteran may establish a PTSD stressor related to the Veteran's fear of hostile military or terrorist activity through lay evidence if a VA psychiatrist or psychologist confirms that the stressor is adequate to support a PTSD diagnosis. The Veteran's DD Form 214 gives a military occupational specialty (MOS) of "ACFT mechanic and repairman." The Veteran's military personnel records show he earned a National Defense Service Medal, Vietnam Service Medal, Vietnam Campaign Medal, an Army Commendation Medal, Air Medal, and a Good Conduct Medal. Additionally, the Veteran's record shows he was stationed in Vietnam from August 1967 to October 1969. The Veteran's assertions of his experiences in Vietnam show that the Veteran engaged in combat with the enemy in a manner consistent with his MOS and the period in which he was stationed in Vietnam. Furthermore, there is no clear and convincing evidence to the contrary. Therefore, the Veteran is entitled to the presumptions of § 3.304(f)(2) for the claimed stressors. See also 38 U.S.C. § 1154(b). The second element of service connection has been met. The question remaining before the Board is whether the Veteran's current PTSD is a result of the stressors indicated by the Veteran. The Veteran's service treatment records are silent for treatment for or symptoms of PTSD. The record reflects that the Veteran had been receiving treatment for PTSD and accompanying symptoms through the VA since October 2007. The Veteran underwent a VA examination in May 2015. The examiner declined to diagnose the Veteran with PTSD and instead diagnosed the Veteran with alcohol use disorder and unspecified depressive disorder. However, the examiner stated that due to the Veteran's alcohol consumption it was "impossible, without resulting to speculation, to [diagnose] a trauma-related disorder such as PTSD." The examiner also stated that the Veteran's current mental health symptoms "have themes related to Vietnam." He also suggested that due to this link, reevaluation after a decrease in alcohol consumption would be welcomed. However, as the Veteran had been treated for PTSD related symptoms through the VA and has diagnosis of PTSD, the Board affords this examination no probative weight as to nexus. In the Veteran's October 2015 notice of disagreement, he asserts that he was receiving treatment for PTSD through the VA. The Veteran's VA outpatient treatment records show a diagnosis for PTSD in April 2015 and continued treatment for this condition. In the Veteran's February 2018 VA Form 9, Appeal to the Board, he again asserts he has been treated for PTSD through the VA for a number of years. As stated above, his VA outpatient records confirm this assertion. In a March 2018 statement in support of his claim for PTSD the Veteran again recounts the same stressors in Vietnam as indicated above. The Veteran also submitted pictures of the damage from the attack on his base. In July 2018 the Veteran submitted a PTSD disability benefits questionnaire from his primary mental health care provider of over two years. Here, the provider diagnosed the Veteran with PTSD consistent with the DSM-5 criteria. The provider indicated that the Veteran had total occupational and social impairments. The provider than stated that the Veteran's PTSD is "directly derived from his military service." The evidence of record shows that the Veteran was first treated for PTSD through the VA in 2007. He has a formal diagnosis of PTSD found in both his VA treatment records and in the July 2018 disability benefits questionnaire. Additionally, his treating physician stated his PTSD was directly related to his experiences in service. The only probative nexus evidence of record indicates that the Veteran's current PTSD diagnosis is a direct result of the stressors experienced while serving in Vietnam. As a result, a preponderance of the evidence supports a finding that the Veteran's current PTSD is related to service to include the stressors and traumatic events asserted by the Veteran. The claim is granted. 2. Entitlement to service connection for bilateral hearing loss. The Veteran asserts his current hearing loss is a direct result of his exposure to hazardous noise while in service and has continued to the present. Specifically, the Veteran asserts that he began to experience hearing loss in service while working on helicopter engines without being provided hearing protection and his hearing has declined since that time. As stated in the above section, the Veteran's DD Form 214 shows his MOS as an ACFT mechanic and repairman. In a March 2018 correspondence from the Veteran, he stated while working on his aircraft, others were taking off and landing near him constantly which exposed him to "a lot of loud, high pitched sounds from turbine engines." He also stated that due to the dusty and dirty conditions on base, the aircraft turbine engines collected a substantial amount of build-up which required cleaning. As part of his MOS, the Veteran was required to provide said cleaning to the engines. To accomplish this the Veteran was required to get on the engine deck, remove the inlet filters, and start the engine while leaning directly over it. The engine would be revved to a high RPM while he pumped the solvent into the engine. This created a "very high-pitched sound from the turbine." He further stated that when doing this task, approximately once every two weeks for over two years, the Veteran was not provided any ear protection. The Veteran asserts this is the cause of his hearing loss that began in service. A hearing loss disability is defined for VA compensation purposes with regard to audiologic testing involving puretone frequency thresholds and speech discrimination criteria. 38 C.F.R. §3.385. For purposes of applying the laws administered by VA, impaired hearing will be considered 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. Id. As an initial matter, the Veteran has a current disability of bilateral hearing loss as shown by his June 2015 VA examination. Additionally, there was a qualifying injury of acoustic trauma based on his MOS during service, as described above. Therefore, the first and second element of service connection have been met. The remaining question is whether there is a nexus between the acoustic trauma in service and his current bilateral hearing loss. The Veteran asserts that his bilateral hearing loss began in service and has persisted to the present. The Veteran underwent a VA examination in June 2015. Here the Veteran reported that he served in Vietnam for two years and three months working as a helicopter crew chief without hearing protection. The Veteran reported to the examiner that during his separation from service, he was told he would have problems hearing at high frequencies due to the turbine noise. Once retired from service, the Veteran worked as an electrician, which has low levels of hazardous noise exposure. While the Veteran did not recall the exact year of his hearing loss onset, his wife stated he "has been hard of hearing for years." The examiner stated that it was less likely than not that the Veteran's current bilateral hearing loss was related to his active-duty service. The examiner reasoned that the Veteran had hearing within normal limits during his February 1967, December 1968, and October 1969 in service audiology examinations. The examiner stated that a delayed onset of hearing loss due to acoustic trauma was not likely if hearing was normal immediately after the exposure. However, the examiner did not consider all of the Veteran's in-service audiograms as there were two additional undated examinations found in the Veteran's service treatment records. Additionally, the examiner did not consider the Veteran's assertions that his hearing loss began in service and had continued to decline since then. As a result, the Board finds this examination is not adequate and is afforded no probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, when interpreting audiometric data from service treatment records, it is important to note that Service Departments changed from using American Standards Association (ASA) standards, to using International Standards Organization American National Standards Institute (ISO-ANSI) standards when providing audiograms beginning at some point between approximately January 1, 1967 and December 31, 1970, however, the conversion date was not consistent between all branches of the Armed Forces. Accordingly, if the standard used is not clearly indicated on the Service Department audiogram(s), it is presumed that prior to January 1, 1967 the ASA standard was used. For in-service audiograms conducted between January 1, 1967 and December 31, 1970, where the standard used is unclear, the data under both ASA and ISO-ANSI standards will be considered. For in-service audiograms conducted after December 31, 1970, it is presumed that the ISO-ANSI standard was used. The Veteran served on active duty from February 1967 to October 1969. As a result, despite the two additional audiograms lacking a specific date, their presence in the Veteran's service treatment records indicate they were provided between February 1967 and October 1969. When there is no indication of which standard was used to conduct the audiogram, ASA or ISO-ANSI, for the period from January 1, 1967 to December 31, 1970, the original audiogram will be assumed to have been conducted in ASA, allowing the VA to convert the audiogram and consider the measurements under ISO-ANSI. The audiogram most favorable to the Veteran shall be used. There is one undated audiogram in the Veteran's file that does not indicate which standard was used. Evaluating the evidence in the light most favorable to the Veteran, the Board finds that as his active-duty service coincides with the applicable dates for consideration of audiograms under both ASA and ISO-ANSI, the undated audiogram that does not indicate the standard used will be evaluated under both. See STR received 5/5/2015 (pg. 31). In light of the above, and where necessary to facilitate data comparison for VA purposes in the decision below, including under 38 C.F.R. § 3.385, audiometric data originally recorded using ASA standards will be converted to ISO-ANSI standard by adding between 5 and 15 decibels to the recorded data as follows: Hertz 250 500 1000 2000 3000 4000 6000 8000 add 15 15 10 10 10 5 10 10 The Veteran's original undated audiogram as recorded in his military personnel records is as follows: Hertz 500 1000 2000 3000 4000 Right 25 10 0 10 5 Left 25 10 0 10 10 Once converted from ASA to ISO-ANSI, the Veteran's audiogram is as follows: Hertz 500 1000 2000 3000 4000 Right 40 20 10 20 10 Left 40 20 10 20 15 As stated above, the audiogram that yields evidence most favorable to the Veteran will be the standard considered. The undated audiogram found in the Veteran's service treatment records show hearing loss for VA purposes while in service once converted from ASA to ISO-ANSI. Thus, the evidence shows bilateral hearing loss for VA purposes in service, establishing the presumption of onset of a chronic disease in service under 38 C.F.R. §§ 3.307 (a), 3.309(a). There is no probative evidence to rebut the presumption. As a result, the preponderance of the evidence is in favor of finding that the Veteran's bilateral hearing loss began in service. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.309. The claim is granted. 3. Entitlement to service connection for tinnitus. The Veteran asserts that his tinnitus began in service as a result of his MOS and has continued through to the present. The Veteran was diagnosed with tinnitus in March 2015 during a VA outpatient audiology consultation. The Veteran reported "constant tinnitus which began during military service." This diagnosis was confirmed in a June 2015 VA examination. A diagnosis recent to the claim satisfies the current disability element of service connection. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Moreover, the Veteran has reported experiencing tinnitus to the present and is competent to diagnosis this disability. Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus is a disorder that can be observed by a lay person). As to the second service connection element of an in-service injury, as stated above the Veteran's MOS as an ACFT mechanic and repairman exposed him to a significant level of hazardous noise. This includes consistent exposure to aircraft engine noise with no ear protection. The Board finds competent and credible evidence to establish an in-service injury of acoustic trauma. The question remaining before the Board is whether the Veteran's tinnitus began during or is related to acoustic trauma in active service. Because tinnitus is a chronic disease within the parameters of 38 C.F.R. §§ 3.303(b), 3.307, and 3.309(a), service connection may also be established by (a) evidence of (i) the existence of tinnitus in service or within one year of separation and (ii) present manifestations of the same tinnitus, or (b) when a tinnitus is not present during service, evidence of continuity of symptomatology. Fountain. The Veteran's service treatment records are negative for complaints or treatment for tinnitus. The mere fact that his assertions are not supported by contemporaneous clinical evidence does not render them inherently uncredible. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). The Veteran first began reporting tinnitus symptoms in March 2015 when attempting to seek medical aid for the condition. The Veteran reported ringing in both of his ears. The Veteran underwent a VA examination in June 2015. The Veteran reported his symptoms began in the late 60's or early 70's which places the onset during or shortly after his separation from service. However, the examiner indicated that his current tinnitus was not related to his active-duty service as there was no evidence of acoustic trauma in service. However, the examiner failed to consider the Veteran's lay assertions that his tinnitus symptoms began in service and have persisted to the present. As the examiner did not consider all of the pertinent evidence of record, to include the Veteran's lay assertions, the Board finds this examination inadequate for VA purposes. Nieves-Rodriguez, 22 Vet. App. 295. The Veteran consistently reports the onset of his tinnitus during or shortly after his active-duty service and continuity of symptoms to the present. The Board has no reason to doubt the Veteran's credibility concerning onset of tinnitus and continuing symptoms. The competent, credible, and probative evidence shows tinnitus onset during or within one year of service. Service connection for tinnitus is granted. 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309. The claim is granted. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Associate Counsel, S. Conti 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.