Citation Nr: 21005999 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-15 365 DATE: February 3, 2021 ORDER Entitlement to service connection for bilateral hearing loss is granted. FINDING OF FACT The Veteran’s bilateral hearing loss is due to in-service exposure to noise and ototoxicants. CONCLUSION OF LAW The criteria for entitlement to service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1977 to May 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in January 2018. A transcript of the hearing is associated with the electronic claims file. The Board issued a prior remand on this claim in August 2018. In a June 2020 rating decision, the RO granted service connection for tinnitus. As this is a total grant of the benefit sought on appeal, this issue is no longer before the Board. 1. Entitlement to service connection for bilateral hearing loss. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if preexisting such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). Generally, to establish entitlement to service connection, a veteran must show 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 an in-service injury or disease. All three elements must be proved. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels (dB) or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As noted above, the Veteran separated from service in May 1979. He then filed a claim for service connection for hearing loss immediately thereafter in June 1979 contending that he was never issued ear plugs and believed that the lack of earplugs contributed to his hearing loss. The Veteran’s service records confirm that he worked in aircraft maintenance, and the Veteran has contended that the noise from the aircrafts and chemical exposure while working on the flight line in service are the cause of his hearing loss. The Veteran was given a VA examination for bilateral hearing loss in April 2014 and it was opined that his current hearing loss is less than likely related to service because his audiogram at his enlistment exam was within normal limits, his audiogram during service was within normal limits, and his audiogram at separation was within normal limits. However, the examiner did not discuss the Veteran’s prior claim for service connection for hearing loss filed right after he separated from service. Moreover, the examiner listed the Veteran’s reports of target shooting activities, but the Veteran explained that his only target practice was during service. The Board notes that the Veteran provided a February 2018 opinion from a private audiologist, regarding the nature and etiology of his bilateral hearing loss. While this opinion indicated that the Veteran’s current hearing loss is “consistent with the history of noise exposure during military service” it did not provide a rationale for such findings. A medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions." See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, the Board remanded the claim in order to afford the Veteran another VA opinion. The audiologist was specifically instructed to address the evidence of record and the Veteran’s contentions. The Board notes that in March 2019 the Veteran was given another VA examination for his bilateral hearing loss and a negative nexus opinion was provided. However, this opinion does not address the evidence of record, or the Veteran’s contentions. The Veteran provided additional evidence in support of his claim. In January 2019 and July 2019 letters, private audiologist J.Z. noted that although the Veteran’s service treatment records indicate minimal change in hearing thresholds during his military service, his work history indicates exposure to not only high levels of noise (jet engines) but likely exposure to ototoxicants from the fumes and chemicals associated with a carrier deck. J.Z. maintained that ototoxicants impact the function of the inner ear and affect hearing and balance function according to the Safety and Health Information Bulletin Preventing Hearing Loss Caused by Chemical (Otoxicity) and Noise Exposure. J.Z. explained that the effects of noise and ototxicants can have synergistic or additive effect, resulting in hearing loss risk at lower sound levels than noise or chemical exposure alone. In addition to the hearing loss, these inner ear and central pathway changes can result in tinnitus. The onset of tinnitus may precede or be delayed from the onset of the hearing loss. The Board finds the private audiologist’s 2019 opinion adequate and persuasive to substantiate the claim. As there is evidence of a current disability, evidence of in-service incurrence of an injury, and medical opinion evidence of a causal relationship between the current disability and an in-service injury, service connection for bilateral hearing loss is warranted. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Ruiz, 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.