Citation Nr: 21013694 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 16-62 534 DATE: March 10, 2021 ORDER Entitlement to service connection for bilateral hearing loss is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, his bilateral hearing loss is etiologically related to his military service. CONCLUSION OF LAW The criteria for entitlement to service connection for left ear hearing loss have been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1965 to October 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented sworn testimony before the undersigned in a January 2021 virtual Board hearing. A transcript of that hearing is of record. Under 38 U.S.C. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence. The law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra. Service Connection Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In addition to direct service connection, service connection may also be established under 38 C.F.R. § 3.303(b) if a chronic disease or injury is shown in service, and subsequent manifestations of the same chronic disease or injury at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. Hearing loss, and organic disease of the nervous system, is a chronic condition listed under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection may also be established for hearing loss based upon a legal presumption by showing that a disorder manifested itself to a compensable degree within one year from the date of separation from service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.307, 3.309(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Entitlement to service connection for bilateral hearing loss The Veteran asserts that he currently suffers from bilateral hearing loss that is a result of loud noises and acoustic trauma that he experienced during his active duty service. The Veteran was afforded a VA examination in October 2016 to assess the nature and etiology of his reported hearing loss. According to this audiological examination, the Veteran was diagnosed with sensorineural hearing loss in the left and right ears. Therefore, the first element of entitlement ot service connection, a current disability, has been established. The record reflects that the Veteran was an infantry crewmember while in service. The Veteran’s DD-214 also shows he earned the Vietnam Campaign Medal and Combat Infantryman Badge, among other decorations. Based on the Veteran’s MOS, combat action, and the Veteran’s testimony at the January 2021 Board hearing, the Board finds it is highly probable that the Veteran was exposed to noise exposure in service. Thus, in-service noise exposure is conceded. Having established the presence of a current disability and in-service acoustic trauma, the Board turns to the dispositive issue of nexus. The October 2016 VA examiner opined that the Veteran’s hearing loss is less likely than not incurred in or caused by the claimed in-service injury, event or illness because the Veteran’s entrance and exit exams did not show a significant change in threshold, which indicates no noise injury, and there are no in-service audiograms that objectively indicate noise injury. Sensorineural hearing loss is linked with nerve damage that most often occurs “when the tiny hair cells in the cochlea are injured.” Fountain v. McDonald, 27 Vet. App. 258, 266 (2015) (quoting VA Training Letter 10-02). More specifically, in Fountain, the United States Court of Appeals for Veterans Claims referenced VA Training Letter 10-02, in addition to other medical and legal authority, and noted that chronic sensorineural hearing loss, as an organic disease of the nervous system, was due to a problem in the inner ear or in the auditory nerve between the inner ear and the brain, and was commonly caused by chronic exposure to excessive noise, in addition to age-related hearing loss. The Court noted that chronic sensorineural hearing loss caused by acoustic trauma resulted in damage to the inner ear and qualified as an organic disease of the nervous system under 38 C.F.R. § 3.309. The Veteran sustained nerve damage to the inner ear that could have caused the current bilateral sensorineural hearing loss. This nerve damage was permanent and incapable of actual improvement because chronic sensorineural hearing loss either progresses or remains the same (i.e., progression may be prevented), while restoration (i.e., improvement) of chronic sensorineural hearing loss that was caused by acoustic trauma is not medically possible. See Fountain, 27 Vet. App. at 258; VA Training Letter 10-02. Based on this reasoning, the Veteran’s current bilateral hearing loss disability can be medically attributed to his military service. (Continued on the next page)   Resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for left ear hearing loss disability is warranted. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303(a), (d). Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Nelson, 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.