Citation Nr: 21077512 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 17-22 638A DATE: December 30, 2021 ORDER A compensable rating for bilateral hearing loss is denied. REMANDED Entitlement to service connection for migraine headaches, to include as secondary to service-connected tinnitus, is remanded. FINDING OF FACT The Veteran had level I hearing for VA purposes in both the left and right ears. CONCLUSION OF LAW The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.85, Diagnostic Code 6100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1970 to June 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from February 2016 and March 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Board remanded these two claims for further development. Hearing Loss Evaluations of defective hearing range from 0 to 100 percent. This is based on impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometric tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz. To evaluate the degree of disability from service-connected hearing loss, the rating schedule establishes eleven auditory acuity levels ranging from numeric level I for essentially normal acuity, through numeric level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII, Diagnostic Code 6100. Table VI in 38 C.F.R. § 4.85 is used to determine the numeric designation of hearing impairment based on the pure tone threshold average from the speech audiometry test and the results of the Maryland CNC speech discrimination test. The vertical lines in Table VI represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The horizontal columns in Table VI represent nine categories of decibel loss based on the pure tone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row corresponding to the percentage of discrimination and the horizontal column corresponding to the pure tone decibel loss. The Veteran underwent a VA examination in December 2015. Pure tone thresholds, in decibels, were as follows: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average Hz Right Ear 25 25 40 55 36 Left Ear 20 25 30 45 30 Speech audiometry revealed speech recognition ability of 98 percent in both ears. Utilizing Table VI, this corresponds to a hearing level of I in the right ear and I in the left ear. Under Table VII, this results in a 0 percent rating for hearing loss. In addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In that regard, the examination report shows that the Veteran reported difficulty hearing his wife, the television, and hearing in background noise. In September 2021, the Veteran underwent another VA examination. Pure tone thresholds, in decibels, were as follows: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average Hz Right Ear 25 30 45 60 40 Left Ear 25 25 35 55 35 Speech audiometry revealed speech recognition ability of 96 percent both ears. Utilizing Table VI, this corresponds to a hearing level of I in the right ear and I in the left ear. Under Table VII, this results in a 0 percent rating for hearing loss. At the examination, the Veteran reported difficulties with conversation. The Veteran, however, was found to be more than capable of communicating to medical providers. Based on the application of the Veteran's hearing tests to the rating criteria, the Board finds that a rating higher than 0 percent for bilateral hearing loss is not warranted. The functional effects of hearing loss on the Veteran's daily life activities and occupational functioning have been discussed by the Veteran at his VA examinations and have been taken into consideration by VA. See 38 C.F.R. § 4.10; Martinak, 21 Vet. App. at 455-56. The Veteran has reported having trouble hearing people or understanding what they are saying; this is reflective of the type of mild functional difficulty that would be expected to be caused by his recorded levels of hearing loss, but it does not, on its own, indicate that a higher rating is warranted. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (Manifestations such as difficulty hearing speech are the types of difficulties contemplated by the schedular criteria for hearing loss.). Accordingly, the VA examinations of record are sufficiently in compliance with the provisions of VA regulations, and they are afforded great probative value in determining the Veteran's level of hearing impairment. The most probative medical evidence as to the nature of the appellant's hearing loss are the audiometric findings, and those discussed above reveal that the Veteran's hearing loss does not warrant a compensable rating. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; the preponderance of the evidence is against the Veteran's claim, and the doctrine is not applicable. 38 U.S.C. § 5107(b). REASON FOR REMAND Migraines The Board previously remanded this case for an examination and an opinion by a VA examiner concerning the Veteran's migraines and whether they were secondary to service connection. The examiner stated that a baseline level of severity could not be determined. It is unclear why a baseline level of severity could not be ascertained from the Veteran's lay statements. Moreover, the examiner stated that tinnitus is not "a common etiology" of headaches. "A common etiology" is an unclear phrase, and it does not actually address the Veteran's headaches and how they are affected by his service-connected tinnitus. The matters are REMANDED for the following action: Obtain an addendum medical opinion regarding the etiology of the Veteran's migraine headaches. Specifically, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) his migraines are related to service or are a) caused or b) aggravated by tinnitus. The rationale for the opinion must be provided. The Board notes that even if tinnitus is not found to be a "common etiology" for headaches, the examiner must discuss how tinnitus has impacted this particular Veteran's headaches. In providing the rationale, the examiner should discuss whether a baseline for his migraine headaches can be determined, and whether this baseline has been worsened by tinnitus. If a baseline cannot be determined, he/she must explain why a baseline level of severity cannot be ascertained from the Veteran's lay statements and other evidence of record. Mary E. Rude Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Chalker, Associate 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.