Citation Nr: 21070420 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 15-36 974 DATE: November 23, 2021 ORDER Service connection for bipolar disorder, generalized anxiety disorder (GAD), and alcohol use disorder, in remission, is granted. Service connection for bilateral hearing loss is denied. THE VETERAN'S CONTENTIONS The Veteran testified that his depression began when he was in the Air Force and he began drinking alcohol heavily at the same time. He also testified that he did not seek treatment because he was afraid that it would impact his security clearance. He explained that he continued drinking heavily after service. See November 2018 hearing transcript, pp. 13-17. The Veteran testified that his military occupational specialty (MOS) was Morse systems operator. See November 2018 hearing transcript, p. 2. He explained that this involved spending eight hours per day listening to beeps with static, white noise, and distortion, and transcribing what he was hearing. Id., p. 3. He stated that the VA has already recognized his noise exposure because he was granted entitlement to service connection for tinnitus. Id., p. 3. He believes that he is similarly entitled to service connection for hearing loss related to his in-service noise exposure. FINDINGS OF FACT 1. The Veteran's bipolar disorder, GAD, and alcohol use disorder in remission, began in service. 2. Bilateral hearing loss was noted when the Veteran entered active duty service. 3. There is clear and unmistakable evidence that the Veteran's bilateral hearing loss was not aggravated by his service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bipolar disorder, GAD, and alcohol use disorder in remission, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria to establish service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 1153, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(b), 3.306. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Air Force from November 1986 to April 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a video conference hearing in November 2018.A transcript of the proceeding is of record. In June 2019, these issues were remanded by the Board. 1. Bipolar disorder, GAD, and chronic alcoholism in remission Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). A VA examination was conducted in July 2021. The examiner diagnosed bipolar disorder, GAD, and chronic alcoholism in remission. See July 2021 VA examination report. The Board acknowledges that the examiner provided a negative nexus opinion regarding the relationship between the Veteran's bipolar disorder, generalized anxiety disorder, and alcohol use disorder in remission, and his service. However, the examiner noted that the Veteran self-medicated his bipolar disorder and GAD with alcohol. The examiner also acknowledged that, while in service in England, the Veteran isolated and drank heavily. The Board finds the Veteran's testimony that his depression began when he was in the Air Force, that he began drinking alcohol heavily at the same time, and that he did not seek treatment because he was afraid that it would impact his security clearance, to be credible. In light of the Veteran's credible testimony and the VA examiner's statement that the Veteran self-medicated for his bipolar disorder and GAD with alcohol; the Board resolves doubt in the Veteran's favor and finds that his bipolar disorder, GAD, and chronic alcoholism in remission began during service. As such, service connection for bipolar disorder, GAD, and chronic alcoholism, in remission, is granted. 2. Bilateral hearing loss 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, 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. The law provides that a veteran who served during a period of war, or during peacetime service after December 31, 1946, is presumed to be in sound condition when he entered into military service, except for conditions noted on the entrance examination. 38 U.S.C. §§ 1111, 1132. The Veteran's May 1986 entrance examination shows that the Veteran exhibited hearing loss for VA purposes in his right and left ears prior to his entrance into service as his auditory threshold at 500 Hertz was 75 decibels in both ears. Thus, there is no presumption of soundness with respect to the Veteran's bilateral hearing loss. See 38 U.S.C. § 1111; see also Wagner v. Principi, 370 F.3d 1089, 1093 (Fed. Cir. 2004); Crowe v. Brown, 7 Vet. App. 238 (1994). As the Veteran's bilateral hearing loss existed prior to military service, the claim is one of entitlement to compensation based on aggravation of a preexisting disability. 38 U.S.C. § 1153. Where a preexisting disease or injury is noted on the entrance examination, 38 U.S.C. § 1153 provides that "[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). For veterans who served during a period of war or after December 31, 1946, clear and unmistakable evidence is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. Clear and unmistakable evidence includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the disability at issue. 38 C.F.R. § 3.306(b). Temporary or intermittent flare-ups of symptoms of a preexisting condition, alone, do not constitute sufficient evidence for a noncombat veteran to show increased disability for the purposes of determinations of service connection based on aggravation under 38 U.S.C. § 1153 unless the underlying condition worsened. 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. § 3.306(b). The Veteran served on active duty during a period of war. As such, the regulations direct VA to presume that the Veteran's preexisting hearing loss was aggravated by active duty if the evidence demonstrates that it underwent an increase in severity during his active service. In order to rebut this presumption, it must be shown by clear and unmistakable evidence that the Veteran's hearing loss was not aggravated or that the aggravation was due to the natural progression of the disability. The Veteran's May 1986 entrance examination shows that the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 75 0 0 15 10 LEFT 75 30 25 25 30 The Veteran's military occupational specialty was a Morse systems operator, which the Veteran contends exposed him to noise from translating code using headphones. See DD Form 214; February 2012 VA examination; November 2018 hearing transcript, p. 3. A December 1986 service treatment record notes that the Veteran's hearing test results did not change since his entrance examination. A June 1988 audiogram shows that the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 15 10 15 LEFT 15 10 10 10 10 These audiogram results represent improvement in the Veteran's hearing during service. The Board notes that an examination was not conducted upon the Veteran's separation from service. A separation examination is not of record. In May 2020, the RO requested all service treatment records (STRs) and it was determined that all available STRs were uploaded. See May 2020 request for information. The July 2021 Supplemental Statement of the Case (SSOC) notes that, based on the Board remand directives, the RO made additional attempts to obtain any outstanding military records; and that the RO received a response from the National Personnel Records Center (NPRC) that they had previously sent all available records. The SSOC notes that the RO sent the Veteran two letters asking for additional records and did not receive a response. The RO determined, upon review of the Veteran's personnel records, that a separation examination was not completed. A VA examination was conducted in February 2012. The February 2012 VA examination does not show hearing loss for VA purposes pursuant to 38 C.F.R. § 3.385. The audiogram shows that the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 20 20 25 25 LEFT 15 20 20 30 35 The word recognition scores were 96 percent in the right ear and 94 percent in the left ear. A VA examination was conducted in July 2021. The July 2021 VA examination shows that the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 30 35 40 45 45 LEFT 30 35 40 50 45 The word recognition scores were 82 percent in the right ear and 90 percent in the left ear. The examiner acknowledges that the Veteran's hearing loss existed prior to his service. However, he determined that the pre-existing hearing loss was not aggravated beyond normal progression in military service. He explained that his current hearing at 500 Hz is still markedly better than it was during his entrance examination and therefore his hearing loss did not worsen during his service, but rather improved. There is no contrary competent medical opinion of record. In light of the audiograms showing improvement in the Veteran's bilateral hearing loss following his entrance into service, and the July 2021 VA examiner's opinion noted above, the Board finds that there is clear and unmistakable evidence that the Veteran's bilateral hearing loss was not aggravated beyond its normal progression by his service. Accordingly, the Veteran's claim of entitlement to service connection for bilateral hearing loss is denied. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Samuelson, 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.