Citation Nr: 21008276 Decision Date: 02/12/21 Archive Date: 02/12/21 DOCKET NO. 19-36 394 DATE: February 12, 2021 ORDER Entitlement to service connection for bilateral hearing loss is denied. FINDING OF FACT The Veteran’s bilateral hearing loss was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service event, injury, or disease. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss have not been satisfied. 38 U.S.C. §§ 1112, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1955 to December 1957. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a September 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. In August 2020, the Board remanded the case to the RO for additional development. As the requested development has been completed, no further action is necessary to comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as organic diseases of the nervous system like sensorineural hearing loss. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The Veteran has a current bilateral hearing loss. For example, at his October 2020 VA examination he was diagnosed with bilateral sensorineural hearing loss. Thus, the remaining question is whether the current hearing loss disability is related to service. The Veteran asserts his hearing loss is due to in-service noise exposure or ear wax buildup and resulting infections. The Veteran testified that he has seen several private doctors about his hearing loss. These doctors advised the Veteran that his exposure to gunfire contributed to his current hearing loss, although it is not the sole cause. Those records have not been associated with the file and unfortunately, they do not appear to be available. 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 of 500, 1000, 2000, 3000 and 4000 Hertz is 40 decibels or greater; or when the thresholds for at least three of these frequencies 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 threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). As discussed below, the Veteran underwent two audiological examinations in service. Based on knowledge of service audiometric practice it is assumed that a veteran’s service department audiometric tests prior to January 1, 1967 were in ASA units and require conversion to the currently used ISO units. The ASA units generally assigned lower numeric scores to hearing loss than do the ISO units, and conversion to ISO units is accomplished by adding 15 decibels to the ASA units at 500 Hertz, 10 decibels to the ASA units at 1000 Hertz, 2000 Hertz, and 3000 Hertz, and 5 decibels to the ASA units at 4000 Hertz. See VA Interim Issues 21-66-16, 21-66-17 (June 6, 1966); 10-66-20 (June 8, 1966); DM&S Manual M-2, Part XVIII, Chapter 4, paragraph 4.02, Use of International Standards Organization (ISO) for Audiological Examinations. In order to facilitate data comparison, the thresholds converted to the ISO standard are stated in parenthesis below. The Veteran’s entrance audiological examination occurred in December 1955 and the whispered voice test showed normal hearing. During service, in May 1957, the Veteran experienced otitis externa (the cause of the infection was undetermined). The next month, June 1957, he underwent an audiological examination with the pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 (35) 15 (25) 10 (20) -- illegible LEFT 15 (30) 15 (25) 15 (25) -- 15 (20) In September 1957, the pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 (15) 10 (20) 0 (10) -- 0 (5) LEFT 5 (15) 5 (15) 0 (10) -- 10 (15) In October 1957 he had a slight to moderate buildup of cerumen (ear wax) with some discharge. Otherwise, service treatment records show no complaints, diagnosis, or treatment related to hearing loss. At separation in December 1957, the whispered voice test was normal. As the Veteran reported other ailments during service related to his ears, such as itching and drainage, and hearing loss is the type of problem that a reasonable person would report while in the military when seeking treatment for other ear issues, if the Veteran was experiencing problems with his hearing during service the Board would expect that he would have reported these problems to medical professionals. In a report of medical history at separation, the Veteran reported ear trouble but this was described as an ear skin condition that was improving. Hearing loss was not reported. Again, if hearing loss was present during service, the Board would expect the Veteran would have reported hearing loss at separation when describing his ear troubles. A hearing loss disability is not shown by medical evidence until a December 2014 VA examination. As sensorineural hearing loss is not shown to have been present during service or in the first year after separation of service, and continuity of symptomatology leading to a diagnosis of sensorineural hearing loss is not shown, in-service incurrence of sensorineural hearing loss cannot be presumed. See 38 C.F.R. §§ 3.307, 3.309(a). While in-service incurrence cannot be presumed, the question as to whether the Veteran’s current hearing loss is otherwise related to service remains. The Veteran presented for VA examinations in August 2018, December 2018, and October 2020, at these times he was interviewed by the examiners who also reviewed the pertinent medical history and performed examinations. The examiners concluded it was less likely than not that the Veteran has a hearing loss disability related to service. In support of this conclusion, the August 2018 examiner explained that the September 1957 hearing test, occurring three months before separation, was normal. Furthermore, the examiner noted that the Veteran’s current audiogram shape is not consistent with noise induced hearing loss, but characteristic of presbycusis (age related hearing loss). The December 2018 VA examiner noted that service treatment records showed no hearing loss or significant changes in hearing thresholds greater than normal measurement variability. (ASA/ISO threshold conversions were taken into consideration). Furthermore, there was no record of complaint or treatment of the claimed condition in service records. According to the examiner, the Institute of Medicine concluded that based on their current understanding of auditory physiology a prolonged delay in the onset of noise-induced hearing loss was “unlikely.” The VA examiner found there was no reasonable basis to conclude the Veteran had delayed-onset hearing loss attributable to his service. The October 2020 VA examiner determined the Veteran’s hearing loss is not related to service, including any reported noise exposure, his cerumen build-up, or his ear infections. Again, it was noted that the shape of the Veteran’s current audiogram is not consistent with hearing loss due to noise exposure (such as training on the rifle range), or the 1957 otitis externa, or cerumen buildup. The examiner found it significant that at the end of service there was no hearing loss. According to the examiner, hearing loss due to external otitis or cerumen build up would most likely be conductive and resolve when the event was over, and there is no sign on audiologic records through service, especially at the end of service, that supports those as a cause of the Veteran’s current hearing loss. Citing the American College of Occupational and Environmental Medicine, the VA examiner stated hearing loss due to noise exposure does not progress in excess of what would be expected from the addition of age-related threshold shifts once the exposure to noise is discontinued. In other words, once an individual is removed from a hazardous noise environment, the threat is also removed and he or she is no longer in danger of acquiring hearing loss from that noise source. Given the lack of threshold shifting during service and the shape of the audiogram, the examiner opined it is less likely than not that the Veteran’s hearing loss is related to military noise, otitis externa, or cerumen buildup. Instead, the examiner attributed the Veteran’s hearing loss to presbycusis; that is, the loss of hearing that gradually occurs in most individuals as they grow older. The Board finds these opinions highly probative as they were made by medical professionals with consideration of the specific facts in this case and after examination of the Veteran. The opinions are also supported by other evidence of record, such as a hearing test report near the time of separation from service showing no hearing loss disability. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinions. The Board has considered the Veteran’s statements, to include his assertions that his hearing loss is related to service. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., problems hearing other people; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Russell P. Veldenz, 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.