Citation Nr: A21016809 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 210901-183088 DATE: October 15, 2021 REMANDED Entitlement to service connection for left ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1965 to August 1968. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). A rating decision was issued under the legacy system in August 2015. In April 2018, the Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the higher-level review (HLR) lane. The agency of original jurisdiction (AOJ) issued a RAMP HLR decision in May 2018, which is the decision on appeal. In an August 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the RAMP opt-in. 38 C.F.R. § 20.301. The Board notes that this matter has been advanced on the docket pursuant to 38 C.F.R. § 20.900(c). Entitlement to service connection for left ear hearing loss is remanded. The Veteran contends that his left ear hearing loss began during service as a result of taking 6 consecutive flights to reach Vietnam and being exposed to in-service noise from small arms fire. At the outset, the Board notes that the Veteran has been awarded service connection for right ear hearing loss and that only entitlement to service connection for left ear hearing loss is on appeal. The issue of entitlement to service connection for left ear hearing loss is remanded to correct a duty to assist error that occurred prior to the May 2018 rating decision on appeal. The Agency of Original Jurisdiction (AOJ) obtained a July 2015 medical opinion prior to the May 2018 rating decision on appeal. However, this medical opinion does not provide an adequate rationale regarding whether the Veteran's left ear hearing loss had its onset in service or is otherwise related to service. Notably, the July 2015 VA examiner found against a direct nexus between the Veteran's left ear hearing loss and his military service. The VA examiner explained that the Veteran did not have a permanent positive threshold shift for the left ear during service and no significant changes were noted in the left ear between enlistment to discharge from active-duty service The July 2015 VA examiner does not appear to have considered the conversion of the in-service audiograms from ASA standards to ISO-ANSI standards. In March 2017, the Board revised its policy regarding service connection claims for hearing loss for Vietnam-era veterans. When interpreting audiometric data from service treatment records, the Board has historically considered that service departments changed from using ASA standards to ISO-ANSI standards as of November 1967. The revised policy provides that, for service department audiograms conducted between January 1, 1967, and December 31, 1970, in which the standard used is not clearly indicated, the data should be considered under both the ASA and ISO-ANSI standards. Where necessary to facilitate data comparison for VA purposes, 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 500 1000 2000 3000 4000 add 15 10 10 10 5 Audiological testing was performed at the time of the Veteran's enlistment in March 1965, however, because it is unclear whether hearing thresholds were recorded ASA or ISO-ANSI units, the Board must consider the recorded metrics under both standards, relying on the unit measurements most favorable to the Veteran's appeal. The Veteran's enlistment audiogram results were as follows: For the 500, 1000, 2000, 3000, and 4000 Hertz ranges, the decibel loss in the left ear was, respectively, Left: -5, -10, -5, 0, and -5. Using the ISO-ANSI conversion, the decibel loss in the left ear was, respectively, 10, 0, 5, 10, 0. At the time of the Veteran's separation in August 1968, audiological test results were: For the 500, 1000, 2000, 3000, and 4000 Hertz ranges, the decibel loss in the left ear using ASA units was, respectively, 0, 0, 0, 5, 10. Using the ISO-ANSI conversion, the decibel loss in the left ear was, respectively, 15, 10, 15, 20, 15. An additional medical opinion is needed to evaluate whether a threshold shift in the Veteran's hearing occurred when considering VA's policy regarding conversion of ASA units to ISO-ANSI units. Accordingly, remand is warranted for the Veteran's claim of entitlement to service connection for left ear hearing loss. By this remand, the Board makes no determination, express or implied, concerning the credibility of the Veteran's statements and contentions. The matters are REMANDED for the following action: 1. Obtain an additional medical opinion or, if necessary, schedule the Veteran for a VA examination, to determine the etiology of the Veteran's current left ear hearing loss. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. It should also be noted that the absence of evidence of a hearing loss disability during service is not always fatal to a service connection claim. Evidence of a current 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 where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. 2. The examiner must opine as to whether it is at least as likely as not that the Veteran's left ear hearing loss is causally or etiologically related to his military service, to include any noise exposure therein. 3. The examiner should explain the significance, if any, of any threshold shift or lack thereof in service. In making this determination, he or she should convert any audiometric results using ASA standards to ISO-ANSI standards in order to facilitate data comparison. (The Board has historically considered that service departments changed ASA standards to ISO-ANSI standards as of November 1967. The revised policy provides that, for service department audiograms conducted between January 1, 1967, and December 31, 1970, in which the standard used is not clearly indicated, the data should be considered under both the ASA and ISO-ANSI standards). 4. A clear rationale for all opinions must be provided. 5. Then, readjudicate the claim. If the determination of the claim remains unfavorable to the Veteran, then issue a Supplemental Statement of the Case and afford him a reasonable period of time to respond before returning the case to the Board. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Palombi 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.