Citation Nr: 21074253 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-20 082 DATE: December 14, 2021 ORDER Entitlement to service connection for bilateral hearing loss is denied. FINDING OF FACT The preponderance of the evidence is against finding that bilateral hearing loss began during active service, within one year of his discharge from active service, or is otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from September 1963 through June 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the issue on appeal for further development in May 2020 and August 2021. The appeal has been returned to the Board for further appellate review. Additional VA treatment records were uploaded into the electronic record in November and December 2021, after the September 2021 supplemental statement of the case (SSOC). The VA treatment records dated after September 2021 have not been considered by the AOJ in conjunction with this appeal. See 38 C.F.R. § 20.1304. However, the additional evidence is either duplicative or is not pertinent to the claim adjudicated herein; thus, there is no need to remand for consideration in the first instance. Entitlement to service connection for bilateral hearing loss is denied. The Veteran claims that he incurred bilateral hearing loss as a direct result of his in-service exposure to the loud and damaging noise of jet engines and to jet fuels. Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C. § 1110, 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Without evidence of disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. See 38 C.F.R. § 3.303(d). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, including hearing loss, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). At the outset, the Board notes that for VA purposes, impaired hearing is considered disabling 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 Veteran has a current diagnosis of hearing loss for VA purposes. See August 2013 and March 2017 VA examination reports. Additionally, the Board concedes the Veteran's acoustic trauma and his exposure to chemicals, including jet fuel, as being consistent with the places, types, and circumstances of his service. 38 U.S.C. § 1154(a). Therefore, the remaining element of service connection to discuss is whether the Veteran's current bilateral hearing loss is related to his in-service noise exposure. The Board finds, for the following reasons, that the preponderance of the evidence weighs against finding that his bilateral hearing loss began during active service, within one year of his discharge from active service, or is otherwise related to an in-service injury, event, or disease. The Veteran had an audiological evaluation at his time of entry in August 1963 and at the time of his separation in June 1967, at which time auditory thresholds were recorded. Neither the Veteran's enlistment examination report, his separation examination report, nor any other service treatment records, reflect any in-service hearing difficulties or hearing loss diagnosis. The Veteran's VA treatment records show that in November 2010, he reported a progressive decrease in hearing, bilaterally, over last several years, including difficulty hearing TV, female voices, and when background noise is present. He reported a military occupational specialty while on active duty of aviation mechanic and related exposure to the loud noises of aircraft, without the benefit of hearing protection. He reported minimal occupational noise exposure after service, but he did report riding a motorcycle recreationally after discharge for less than 5 years. The Veteran's private and VA treatment records, however, do not otherwise indicate the likely etiology of the Veteran's hearing loss. The Veteran was afforded VA hearing examinations in August 2013, March 2017, and August 2020. The Board deemed the August 2013 and March 2017 VA hearing examinations inadequate in its previous May 2020 Board remand. Additionally, the Board also found the August 2020 VA opinion deficient because the examiner did not discuss the military's transition from the use of American Standards Association (ASA) standards to International Standards Organization American National Standards Institute (ISO-ANSI) standards, between January 1, 1967 and December 31, 1970, when conducting in-service hearing examinations. Accordingly, the Board remanded the appeal in August 2021 for an addendum opinion. Considering the foregoing, in this decision, the Board will focus on the August 2020 examination report and the September 2021 addendum opinion. In the August 2020 VA examination report, the examiner opined that the Veteran's hearing loss was less likely than not incurred during active service and less likely than not caused by or the result of the Veteran's in-service noise and jet fuel exposure. The examiner's rationale regarding in-service onset of hearing loss, was essentially that: (a) the Veteran claimed hearing loss in service but there is no evidence to show hearing loss at that time or within 1 year of discharge; (b) the Veteran's hearing was normal during his separation examination; (c) he was on active duty for a relatively short period of time, as compared to the intervening 35-plus years after his separation and before the first showing of hearing loss; and (d) any number of factors could have contributed to the current hearing loss, including post military occupational noise exposure and/or the natural progression of hearing loss due to aging. The examiner cited studies indicating that a delayed onset of noise induced hearing loss is unlikely after the cessation of noise exposure. The examiner's rationale regarding causation of the Veteran's hearing loss by exposure to jet fuel was essentially that: (a) the March 2014 VA Research Currents study cited by the VA Regional Office (RO), as discussed in the Board's May 2020 remand, indicates that exposure to jet fuels may cause auditory processing dysfunctions, not hearing loss; and (b) the lack of any documentation of hearing loss during service weighs against finding that in-service jet fuel exposure caused the hearing loss. A September 2021 VA addendum opinion was obtained in order for the examiner to consider and address the military's transition from ASA standards to ISO-ANSI standards between January 1, 1967 and December 31, 1970, when reviewing the Veteran's in-service audiological testing results. The examiner essentially opined that even considering the transition from ASA to ISO-ANSI standards, there was no clinically significant worsening of the Veteran's hearing shown in his separation examination when compared to his enlistment examination. The examiner also opined that the Veteran's hearing loss was less likely than not incurred during active service or caused by his in-service noise and/or jet fuel exposure. The examiner's rationale was that: (a) there was no clinically significant worsening of the Veteran's hearing documented in his service treatment records; (b) the lack of a clinically significant worsening of the Veteran's hearing during active service is significant to rule out that the military is a contributing component; and (c) a right ear speech discrimination score of 100 percent and a left ear score of 96 percent during the 2013 VA examination, over forty years after military service, indicated that benzene based fuel sources are not a contributing factor for the Veteran's hearing loss. The Board finds, upon review of the evidence of record, including, but not limited to that discussed above, that it is less likely than not that the Veteran incurred hearing loss due to his active service or within one year of his discharge from active service. The Board recognizes that it is the Veteran's firm belief that his bilateral hearing loss is related to noise and jet fuel exposure in service. However, while the Veteran is competent to report on the symptoms he observes, the Board finds that he is not competent to diagnose or determine the etiology of his bilateral hearing loss. These issues are medically complex and require medical training and credentials. An opinion regarding diagnosis and the nature and etiology of the Veteran's bilateral hearing loss requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). The Board acknowledges the Veteran's claim that a hearing test was not performed during his separation examination. However, this claim was made over 50 years after his separation examination. The Veteran's separation examination report of record clearly contains results of a hearing test. There is no competent evidence in the claims file of an impaired hearing disability, as described in 38 C.F.R. § 3.385, during the year after the Veteran's separation from active duty. Moreover, the August 2020 VA examination report and the September 2021 addendum opinion collectively indicate that the normal hearing results during the separation examination make it less likely than not that hearing loss was incurred during the Veteran's active service, and there is no competent evidence to the contrary. Thus, the Board finds that the Veteran's impaired hearing disability did not have its onset during the Veteran's active service. The August 2020 VA examination report and the September 2021 addendum opinion, collectively, also indicate that the Veteran's impaired hearing disability was not caused by his in-service noise or jet fuel exposure, as benzene based fuel sources are not a contributing factor for the Veteran's hearing loss. The opinions set forth in those reports are supported by adequate rationales, and they are not countered by any competent evidence of record to the contrary. The Board concludes that, while the Veteran has bilateral hearing loss, it did not manifest to a compensable degree within a presumptive period. The earliest record available noting bilateral hearing loss is over 40 years after the Veteran's separation from service and outside of the presumptive period. Regarding the auditory processing dysfunctions discussed in the March 2014 VA Research Currents study, the Board notes that the Veteran has not claimed any such auditory processing dysfunctions; rather, he has very clearly claimed hearing loss, which he has described as difficulty hearing sounds in the first place, and not an inability to decipher or interpret what he does hear. As this article was first introduced into the record by the RO, and not by the Veteran, and the Veteran has not claimed to suffer from any auditory processing dysfunctions, the Board finds that a claim for such a disability has not been submitted or raised by the record. Indeed, upon review of the March 2014 VA Research Currents study cited by the RO, the Board finds that it addresses the causation of auditory processing dysfunctions (which is described by the author as "dyslexia, but for the ears," and characterized by "sound com[ing] through fine... but the brain has a hard time deciphering the message"), and not hearing loss, which was also noted in the September 2021 addendum opinion. For all of the above-mentioned reasons, the Board finds that the preponderance of the evidence is against finding that the Veteran's bilateral hearing loss began during active service, or is otherwise related to an in-service injury or disease. For that reason, the Board concludes that the Veteran is not entitled to service connection for hearing loss. In denying this claim, the Board finds that the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Banks, 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.