Citation Nr: 21076629 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 18-08 184 DATE: December 27, 2021 ORDER Entitlement to service connection for right ear hearing loss is denied. REMANDED Entitlement to service connection for left ear hearing loss is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a right ear hearing loss disability for VA purposes at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from March 1963 to December 1966. The Board thanks the Veteran for his service. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision. In December 2020, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. The Veteran waived consideration by a Department of Veterans Affairs (VA) Regional Office (RO) for any additionally received evidence. A transcript of the hearing is associated with the claims file. This matter was most recently before the Board in May 2021, at which time it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) for further development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c). 1. Entitlement to service connection for right ear hearing loss The Veteran contends that he has bilateral hearing loss related to military noise exposure while serving in Vietnam. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). For VA compensation and pension purposes, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least 3 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 question for the Board is whether the Veteran has a current right ear hearing loss disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of right ear hearing loss and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran has had two VA examinations conducted to assess his hearing loss. On the authorized audiological evaluation in April 2014, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 5 10 25 Speech audiometry revealed speech recognition ability of 96 percent in the right ear. Thus, objective testing in April 2014 showed that the Veteran's right ear hearing loss did not meet the requirements to be considered a disability for compensation purposes because none of the thresholds measured at 26 Hertz or above, and the Veteran's speech recognition score was not less than 94 percent. At the Veteran's December 2020 hearing, he reported that he subjectively believed his right ear hearing had decreased since his VA examination in 2014. On the authorized audiological evaluation in August 2021, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 10 15 25 Speech audiometry revealed speech recognition ability of 94 percent in the right ear. Although objective testing did confirm that the Veteran's hearing had worsened since his April 2014 examination, the Veteran's right ear hearing loss still does not meet the requirements to be considered a disability for compensation purposes because none of the thresholds measured at 26 Hertz or above, and the Veteran's speech recognition score was not less than 94 percent. The Board acknowledges an August 3, 2021 VA audiology note reading "Pure tone results indicated normal hearing in the right ear and a mild sloping to severe high frequency sensorineural hearing loss, bilaterally." Although the statement appears to present some ambiguity because it states both that the Veteran had normal hearing in the right ear and sloping hearing loss bilaterally, the Board finds that the ambiguity has been adequately resolved. Specifically, because the objective findings on VA examination (which was conducted later the same month) reveal that the Veteran does not meet the criteria for a hearing loss disability, the Board finds that any ambiguity in the medical evidence was resolved prior to certification of the appeal to the Board. Based on the objective testing of record, the Board finds that the preponderance of the evidence is against finding that the Veteran has a right ear hearing loss disability for VA compensation purposes. As such, entitlement to service connection must be denied. REASONS FOR REMAND 1. Entitlement to service connection for left ear hearing loss is remanded. In a November 2021 Informal Hearing Presentation (IHP), the Veteran's representative submitted descriptions of and citation to several studies and government webpages that have not been addressed in any nexus opinion of record. In particular, a CDC resource may support service connection for hearing loss secondary to the Veteran's service-connected diabetes mellitus because it states that "Hearing loss is more common in people with diabetes." Additionally, the Veteran's representative referenced several medical studies addressing the mechanism by which "short term" noise exposure hearing loss can lead to accelerated long term hearing loss. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for left ear hearing loss because no VA examiner has opined has considered the medical evidence submitted by the Veteran's representative as to direct and secondary service connection. As such, remand for an addendum opinion is necessary. The matters are REMANDED for the following action: 1. Attempt to associate with the record any outstanding VA treatment records generated since September 2021. 2. Obtain an addendum opinion from an appropriate clinician that responds to the following: (a.) Is the Veteran's left ear hearing loss at least as likely as not (approximately 50% or greater probability) related to conceded in-service hazardous noise exposure while working on the flight lines in Vietnam with consideration of the article "Delayed Effects of Noise on the Ear," 1983, https://pubmed.ncbi.nlm.nih.gov/6841281/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442866/ and J Otolaryngol Head Neck Surg. 2017; 46: 41. Published online 2017 May 23 doi: 10.1186/s40463-017-0219-x and numerous other articles cited in the Appellant Brief dated November 18, 2021 in the virtual file? These studies appear to contradict findings in the April 2014 and August 2021 VA examinations regarding a correlation between temporary hearing loss and later development of permanent hearing loss. The clinician should also note that VA cannot make any conclusions regarding a threshold shift at 3000 Hertz because the frequency was not tested in the Veteran's March 1963 entrance examination. Lay statements from the Veteran's spouse regarding subjective evidence of decreased hearing after the Veteran's return from Vietnam should also be given consideration. (b.) Is the Veteran's left ear hearing loss at least as likely as not (approximately 50% or greater probability) proximately due to his service-connected diabetes mellitus with consideration of https://www.cdc.gov/diabetes/pdfs/library/Diabetes-Ears-h.pdf and https://www.hearingportland.com/blog/diabetes-hearing-loss-connection/ cited in the Appellant Brief dated November 18, 2021 in the virtual file? and (c.) Is the Veteran's left ear hearing loss at least as likely as not (approximately 50% or greater probability) aggravated by (any increase in disability) his service-connected diabetes mellitus? M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Beeler, C. 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.