Citation Nr: 21072022 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-58 417 DATE: December 2, 2021 REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. REASONS FOR REMAND The Veteran had active service from March to August 1965, with additional active duty for training (ACDUTRA) from August 1965 to January 1969. This matter comes before the Board of Veterans Appeals (Board) on appeal from a September 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the Veteran's electronic claims folder. Entitlement to service connection for a bilateral hearing loss disability is remanded. The Veteran contends that he is entitled to service connection for a bilateral hearing loss disability because he was exposed to in-service gunfire. See July 2016 VA Form 21-4138; Board Hearing Transcript, p.4. In July 2017, the Veteran was afforded a VA hearing loss examination where the examiner opined that it was less likely than not that the Veteran's hearing loss was related to service. The examiner reasoned that a March 1967 audiogram revealed normal hearing and that "significant changes in hearing [were] very unlikely between enlistment and this exam." In a February 2018 deferred rating decision, the RO requested an addendum opinion from the examiner. Specifically, the RO requested that the examiner convert the Veteran's audiometric results to ISO-ANSI standards and then address any shifts in audio results. In a February 2018 addendum, the examiner again opined that the Veteran's hearing loss disability was not related to service. The examiner indicated that he converted the Veteran's March 1967 audiogram to ANSI 1969 calibration standards. At the August 2021 Board hearing, the Veteran's representative argued that no conversion of the audiograms was necessary. See Board Hearing Transcript, p.5. Based on the foregoing, the Board finds that a remand is necessary to obtain an addendum opinion. In that regard, the Board finds that the February 2018 examiner's opinion was based on an inaccurate factual background. Specifically, neither the July 2017 nor the February 2018 medical opinions considered the July 1965 audiogram. The Board further notes that audiometric test results dated prior to January 1, 1967 are presumed to have been reported in units pursuant to standards set forth by the American Standards Association (ASA), unless otherwise indicated. Since November 1, 1967, those standards have been set by the International Standards Organization (ISO)-American National Standards Institute (ANSI). In order to facilitate data comparison, any ASA units (found in service medical records) must be converted to ISO-ANSI units as appropriate. VA uses a system to convert ASA units to ISO units that adds 15 dB to 500 Hz, 10 dB to 1000, 2000, and 3000 Hz, and 5 dB at 4000 Hz. At his July 1965 periodic examination, the Veteran's puretone thresholds (converted from ASA to ISO-ANSI values) were 10, 5, 5, and 0 in the right ear. In the left ear, converted puretone thresholds were 10, 5, 5, and -5. These findings do no indicate hearing loss for VA purposes. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (holding that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss). However, at his March 1967 periodic examination, the Veteran's puretone thresholds (no conversion needed because after January 1, 1967) were 0, 0, 0 and 0 in the right ear. In the left ear, puretone thresholds were 5, 10, 0, and 10. Neither opinion addressed the threshold changes from the Veteran's July 1965 audiogram to the March 1967 audiogram. Between January 1, 1967 and December 31, 1970, VA will consider the data under both ASA and ISO-ANSI standards. Therefore, the Board finds that a remand is necessary to obtain an addendum opinion which considers all relevant evidence, including the July 1965 audiogram and the significance, if any, of threshold shifts. The matters are REMANDED for the following action: Obtain an addendum opinion from July 2017 examiner (or a suitable substitute) regarding the etiology of the Veteran's bilateral hearing loss disability. (If it is determined that additional examination is needed, it should be scheduled in accordance with applicable procedures.) The Veteran's electronic claims file should be made available to and reviewed by the examiner. The examiner should address the following: Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hearing loss disability was incurred in or is otherwise related to service, to include due to conceded in-service noise exposure. In offering this opinion, the VA examiner must convert the in-service July 1965 examination from ASA standard to ISO units AND indicate in the report that the conversions have been made and reconsidered. Any noted shift should be record. The significance of those findings, if any, should also be evaluated. The examiner should note VA assumes that hearing tests conducted prior to January 1, 1967 were conducted using the American Standards Association (ASA) units rather than under the currently utilized International Standards Organization - American National Standards Institute (ISO-ANSI) units. Between January 1, 1967 and December 31, 1970, VA will consider the data under both ASA and ISO-ANSI standards. Where necessary to facilitate data comparison for VA purposes between the two standards, VA has determined that it is appropriate to convert ASA measurements to ISO-ANSI measurements. 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 standards by adding 15, 10, 10, 10, and 5 decibels at 500, 1000, 2000, 3000, and 4000 Hertz, respectively. In rendering the above opinion, the examiner is advised that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). 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. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). A complete rationale, including citation to appropriate medical principles, is requested. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Baskerville 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.