Citation Nr: 21070969 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 13-18 775A DATE: November 29, 2021 ORDER Entitlement to service connection for left ear hearing loss with patulous eustachian tube is granted. FINDING OF FACT Resolving all doubt in the Veteran's favor, her left ear hearing loss with patulous eustachian tube is related to her in-service radiation therapy. CONCLUSION OF LAW The criteria for service connection for left ear hearing loss with patulous eustachian tube have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1980 to December 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during an October 2017 videoconference hearing. A transcript of that hearing is associated with the claims file. This case was most recently before the Board in September 2019 when it was remanded for additional development. It has returned for adjudication. Entitlement to service connection for a left ear disability The Veteran asserts that she has a left ear disability related to her period of active service. Specifically, the Veteran asserts that during service, she underwent radiation therapy for a tumor that led to her current hearing loss. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). The Veteran was afforded multiple VA examinations during the appeal period. During an October 2012 VA examination, the Veteran was diagnosed with patulous eustachian tubes. During a March 2020 VA examination, the Veteran was diagnosed with bilateral sensorineural hearing loss. Accordingly, the requirements of Shedden element (1) have been satisfied. The Veteran's service treatment records reflect that she did, indeed, undergo radiation therapy to treat a pituitary tumor in 1982. Additionally, the Veteran reported hearing loss on her August 1982 report of medical history and the treatment records reflect multiple complaints of ear infections during service. Accordingly, the requirements of Shedden element (2) have been satisfied. The question before the Board is whether the Veteran has a current left ear disability that had its onset during, or is otherwise etiologically related to, her period of active service. After a review of the evidence and affording the Veteran the benefit of the doubt, the Board finds that she does. During the October 2012 VA examination, the examiner specifically found that the Veteran received hormone injections in service and later developed prolactinoma which required radiation therapy. The radiation therapy led to patulous eustachian tubes. After a March 2021 examination, the examiner opined that it was as likely as not that the eustachian tube dysfunction, called patulous eustachian tube, is secondary to service. The examiner agreed that patulous eustachian tube was a result of a complication of the radiation treatment for the pituitary tumor. The examiner further noted that patulous eustachian tube causes hearing loss. The Board notes the negative nexus opinions obtained by the VA in May 2021. Specifically, that examiner found it was less likely than not that the Veteran's left ear hearing loss was incurred in or caused by her service based on a lack of medical records documenting hearing loss during military service. Additionally, the examiner found it was less likely than not that the Veteran's hearing loss was caused by or aggravated by the status-post pituitary tumor that was resected and treated with radiation. However, the rationale was that there was no medical documentation of the hearing loss being caused by or aggravated by the radiation. The Board finds that these opinions are inadequate. As indicated above, the Veteran noted hearing loss during the separation report of medical history. Further, the May 2021 examiner did not address the March 2021 opinion noting that patulous eustachian tube, caused by the in-service radiation treatment, can cause hearing loss. Accordingly, the May 2021 opinions are afforded no probative value. In reviewing the probative evidence of record, the Board finds that the evidence is at least in equipoise as to whether the Veteran's in-service radiation treatment caused her left ear patulous eustachian tube which caused her current left ear hearing loss. As such, and affording the Veteran the benefit of the doubt, the Board finds that the requirements of Shedden element (3) have been met and service connection for a left ear disability is warranted. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The claim for service connection for a left ear hearing loss with patulous eustachian tube is granted. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.