Citation Nr: 21064721 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 15-45 607 DATE: October 21, 2021 ORDER Service connection for right ear hearing loss is denied. FINDING OF FACT The right ear hearing loss preexisted service and did not increase in severity during service. CONCLUSION OF LAW The criteria for service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1111, 1112, 1131, 1137, 1153; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 1977 to July 1982. A hearing before the undersigned Veterans Law Judge was held in March 2019. This matter was previously before the Board, most recently in April 2021. 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 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. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment. 38 U.S.C. §§ 1111, 1137; 38 C.F.R. § 3.304(b). The Veteran was found to have right ear hearing loss on the December 1976 entrance examination for service. Consequently, the presumption of soundness does not apply to his right ear hearing acuity. If a preexisting disorder is noted upon entry into service, and the claimant brings a claim for service connection on the basis of aggravation under section 1153, the burden falls on the claimant to establish aggravation of the preexisting disorder. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. §§ 3.304, 3.306. The burdens and evidentiary standard to determine whether conditions noted at entrance into service were aggravated by service are different from the burdens and evidentiary standard to determine whether conditions not noted at entrance into service were aggravated. If a preexisting condition noted at entrance into service is not shown to have as likely as not increased in severity during service, the analysis stops. Only if such condition is shown by an as likely as not standard to have increased in severity during service does the analysis continue. In such cases, the increase is presumed to have been due to service unless there is clear and unmistakable evidence that the increase during service was not beyond the natural progression of the condition. See 38 C.F.R. § 3.306. The record includes in-service audiometric findings dated in December 1979 and August 1980. An October 2012 VA examiner determined the Veteran's right ear hearing acuity was "essentially unchanged" during service, continuing to show moderately severe hearing loss; that no significant change in hearing was noted during service; and that it was less likely than not that hearing loss was aggravated beyond natural progression during service. A February 2021 VA medical opinion reveals an audiologist's determination that the preexisting hearing loss was not aggravated beyond normal progression during service. The audiologist explained that there was no significant decrease in hearing acuity during service, as shown by comparison of the 1976 entrance examination and the exams in 1978 and 1979. The audiologist explained that the criteria for a significant threshold shift was +/- 15 decibels or greater at 1000, 2000, 3000, or 4000 Hertz or a shift of +/- 10 decibels or greater in the average across 2000, 3000, and 4000 Hertz. The audiologist stated that the criteria was not met during service and noted that the Veteran had reported decreased hearing acuity after a stroke in 2010. A May 2021 VA medical opinion reveals an otolaryngologist's opinion that it was less likely than not that the right ear hearing loss was aggravated beyond its natural progression during service. The otolaryngologist noted review of the record, including the December 1976, December 1979, and August 1980 audiograms and the October 2012 VA examination record. The otolaryngologist noted that right ear had moderately-severe hearing loss at entry in December 1976, which was due to meningitis in 1972. The otolaryngologist noted that the Veteran reported worsening of the right ear hearing acuity in approximately 1978 or 1979 but stated that hearing was essentially unchanged per the December 1979 examination, which continued to show moderately severe hearing loss. The otolaryngologist stated that because there was no significant change in hearing noted from enlistment to an exam around the time of the reported decrease in hearing acuity, it was less likely than not that hearing loss was aggravated beyond its natural progression. The otolaryngologist added that the Veteran had meningitis prior to enlisting which led to a right ear hearing loss. The otolaryngologist explained that meningitis is a known cause of hearing loss from scarring of the nerve responsible for hearing. The otolaryngologist reported that the 1980 audiogram did not show a significant worsening in his right ear hearing. The otolaryngologist reported that a significant shift is a shift noted as 15 decibels or greater as there can be a 10 decibels shift in the absence of hearing loss as part of normal INTER test variability. The otolaryngologist reported that hearing loss from meningitis is expected to worsen on its own and that there was no significant shift during service to indicate that worsened hearing beyond the natural progression of the disease. As such, it is less likely than not that his current right ear hearing loss is related to military service The Board finds service connection is not warranted for right ear hearing loss. The Board finds the medical evidence indicates that there was not a worsening of the right ear hearing loss during service. The Board acknowledges the Veteran's contention that his current right ear hearing loss is related to service and was worsened in service. Although the Veteran might have noted what he believes were increased symptoms during service as a result of his service activities, that does not mean that the underlying pathology permanently increased in severity during service, and the Board notes that the Veteran is not competent to determine that his right ear hearing acuity decreased in severity during service. In any event, his contentions are less probative than the medical evidence, which indicates that the right ear hearing loss did not increase in severity. The Board finds the 2021 medical opinions are particularly probative. The opinions are supported by a rationale that is consistent with the record and explain the requirements for the "significant threshold shift" that could suggest an increase in hearing impairment. The opinions also explain why the in-service audiograms, including that dated in 1980, do not reveal a significant threshold shift. Notably, although there was an increase in decibels at the Hertz in August 1980 when compared to December 1976, the increase was too minimal to be indicative of an actual increase in hearing impairment. In making this determination, the Board notes that although the December 1976 entrance examination record does not report the puretone threshold for 3000 Hertz, the record includes the December 1976 audiogram which does reveal the puretone threshold for 3000 Hertz and this audiogram was explicitly reviewed by the May 2021 otolaryngologist. Thus, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Snyder, 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.