Citation Nr: 21066858 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 19-17 702 DATE: November 2, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss. The Veteran underwent a VA examination in November 2016 for his bilateral hearing loss. The exam showed hearing loss for VA purposes in both the left and right ears. 38 C.F.R. § 3.385. The examiner concluded that the Veteran's right ear hearing loss was not a result of his active duty service. The examiner stated that there was a threshold shift from -5 decibels recorded on the October 1966 entrance examination to 10 decibels recorded at the August 1968 separation examination at 1000 Hertz (Hz). However, the examiner reasoned that "the effects of acoustic trauma are generally not seen at 1000 Hz. Damage from acoustic trauma generally occurs in the frequency range from 3000-8000 Hz. A shift at 1000 Hz is more likely than not due to factors other than acoustic trauma." Additionally, in relation to the Veteran's left ear, the examiner also stated his hearing loss was not related to service. The examiner stated that there was no threshold shift from the October 1966 examination and the August 1968 examination indicating a lack of acoustic trauma. However, the evidence of record shows the Veteran's left ear hearing loss was present at the time of entry in October 1966 as his hearing was measured to be 45 decibels at 4000 Hz. As a result, an addendum opinion was provided in May 2019 discussing whether or not the Veteran's left ear hearing loss was aggravated beyond the natural progression of the disorder by his active duty service. The May 2019 opinion stated that while there was a 5 decibel shift from 45 decibels at 4000 Hz on the December 1965 entrance examination to 50 decibels on the August 1968 separation examination, this shift was nothing more than testing variability. The examiner further stated that "changes in hearing of ten decibels or less do not suggest an actual change in hearing threshold." The examiner then stated, "it is assume that the 1968 audiogram would have been done under [International Standards Organization American National Standards Institute] standards." The examiner concluded that after converting the 1968 audiogram from American Standards Association (ASA) standards to International Standards Organization American National Standards Institute (ISO-ANSI), "hearing level at 4000 Hz at the left ear would actually show slight improvement on the 1968 audiogram." As a result, the examiner concluded "there is no evidence to suggest a nexus between hearing loss and military noise exposure or an aggravation of the pre-existing loss at the left ear." The Veteran had an in-service audiological evaluation during service in August 1968, at which time auditory thresholds were recorded. However, because it is unclear whether such thresholds were recorded in using ASA units or ISO-ANSI units, the Board will consider the recorded metrics under both standards, relying on the unit measurements most favorable to the Veteran's appeal. As it relates to VA examinations and VA records, audiological reports were routinely converted from ISO-ANSI results to ASA units until the end of 1975 because the regulatory standard for evaluating hearing loss was not changed to require ISO-ANSI units until September 9, 1975. In light of the above, and where necessary to facilitate data comparison for VA purposes, audiometric data originally recorded using ASA standards will be converted to ISO-ANSI standard. As the May 2019 examiner assumed that the 1968 audiogram would have been done under ISO-ANSI rather than considering the measurement most favorable to the Veteran, remand is warranted and an addendum opinion. Additionally, upon remand, the AOJ should obtain a medical opinion regarding whether the Veteran's tinnitus is related to his bilateral hearing loss. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hearing loss is at least as likely as not related to service. The appropriate clinician must consider the Veteran's service treatment records after the appropriate conversions have been made. Specifically, for the Veteran's left ear, was the Veteran's left ear hearing loss aggravated beyond the natural progression of the disorder by his active military service? An in-person examination is not required unless the attending clinician deems an examination is necessary. Continued on the next page Additionally, the clinician should opine as to whether it is at least as likely as not that the Veteran's tinnitus is caused by or aggravated by his bilateral hearing loss. S. Sorathia Acting 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.