Citation Nr: 21015745 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-41 163A DATE: March 18, 2021 ORDER Entitlement to service connection for fibrous dysplasia, left nasal cavity is denied. Entitlement to service connection for bilateral hearing loss is denied. FINDINGS OF FACT 1. The preponderance of evidence weighs against finding that the Veteran’s fibrous dysplasia, left nasal cavity is etiologically related to service. 2. The preponderance of evidence weighs against finding that the Veteran’s bilateral hearing loss is etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a fibrous dysplasia, left nasal cavity have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 1990 to November 1990 and from November 1990 to June 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In August 2020, the Board last remanded the claims to obtain new examinations with opinions providing full rationales regarding etiology, to include addressing testimony regarding in-service acoustic trauma and environmental exposure. Service Connection 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). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Entitlement to service connection for a fibrous dysplasia, left nasal cavity. The Veteran contends that her fibrous dysplasia, left nasal cavity is related to service. She testified that during service she was exposed to sandstorms, petroleum fuels, and fires. See August 2018 Hearing Transcript. April 1990 service treatment records (STRs) show normal respiratory system. March 2008 VA examination showed lesion involving the left anterior ethmoid air cells with opacification of the left frontal sinus, consistent with a fibro osseous lesion such as fibrous dysplasia or an ossifying fibroma. January 2011 VA treatment record showed chronic frontal sinusitis frontal sinus fibrous dysplasia. An October 2020 VA examiner opined that the Veteran’s claimed fibrous dysplasia, left nasal cavity was less likely than not incurred in or caused by the claimed in-service event or illness. The examiner stated that there is no evidence of fibrous dysplasia while in service. The examiner explained that it is considered a genetic mutation, not a congenital condition, and it is not due to exposures. As such, the examiner reasoned, this would have occurred, regardless of service, or theater of service. Further, the examiner stated that there is no evidence in the current, widely accepted, peer-reviewed literature of environmental exposure causing fibrous dysplasia. The examiner stated that the monostotic fibrous dysplasia was found during the workup for chronic sinusitis beginning in 2008, which is a span of 17 years post-service. Given the relatively rapid progression and development/worsening of symptoms, the examiner opined, it is highly unlikely this would have persisted for 17 years without manifesting earlier. Therefore, the examiner concluded, it is less likely than not that the Veteran’s fibrous dysplasia had its nexus in service or is due to or caused by possible environmental exposures while in service. Instead, the examiner opined that the onset/worsening of sinus symptoms in 2008, more likely than not, coincides with development and growth of the sinus tumor. Monostotic means single bone involvement. Upon review of the record, the Board concludes that the evidence of record does not establish a medical link between the Veteran’s fibrous dysplasia, left nasal cavity, and her service. Although the Veteran is competent to report her subjective symptoms and conditions of her service, to include environmental hazards, she is not competent to make a finding as to whether her fibrous dysplasia, left nasal cavity is related to service. The determination of the etiology of such a condition is a medical question, which requires medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Circ. 2007). The Veteran has not been shown to have such requisite medical knowledge or expertise. The examiner opined that her disability is less likely than not related to service, to include environmental exposure. The VA opinion provided a rationale based on the Veteran’s lay reports and medical history. Consequently, the Board gives such opinion greater probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), Barr v. Nicholson, 21 Vet. App. 303 (2007), Stefl v. Nicholson, 21 Vet. App. 120 (2007), Prejean v. West, 13 Vet. App. 444 (2000). Based on the above, the evidence weighs against a finding that fibrous dysplasia, left nasal cavity is caused by any in-service event, to include environmental exposure. Service connection is also not warranted as a chronic disability under 38 C.F.R. § 3.307(a), as the competent medical evidence of record does not demonstrate that it was noted as chronic in service or manifested to a compensable degree in service or within the one year presumptive period. See 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The Board has reviewed and considered the Veteran’s claim but as the preponderance of evidence is unfavorable, and an approximate balance of positive and negative evidence has not been shown, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Service connection for bilateral hearing loss. The Veteran contends that her bilateral hearing loss is related to service. For VA purposes, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or the auditory thresholds for at least three 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 Veteran underwent a VA audiological examination in September 2019. For both ears, she had decibel loss of at least 40. Therefore, she has hearing loss for VA purposes. As to the second element, she testified that she was exposed to the loud noise of engines while working as a mechanic during service. See August 2018 Hearing Testimony. Thus, based on the circumstances of the Veteran’s service, acoustic trauma has been conceded. Accordingly, the question currently before the Board is whether the Veteran’s bilateral hearing loss is related to an in-service injury, event, or disease, including in-service noise exposure/acoustic trauma. The Board finds that the evidence of record does not establish a nexus between her current hearing loss and in-service noise exposure/acoustic trauma. The Veteran does not contend that hearing loss was diagnosed in service and the medical evidence does not otherwise reflect in-service incurrence. Instead, the contention on appeal is that post-service hearing loss disability developed due to in-service acoustic trauma. June 1990 and September 1995 VA audiological examinations indicate normal hearing. February 2008 treatment records notes conductive hearing loss. March 2013 VA examination shows sensorineural hearing loss. Upon remand, the Veteran underwent a VA examination in September 2020 examiner. The examiner opined that claimed hearing loss was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that there is no significant permanent shift in hearing thresholds beyond test variability from entrance to separation, which is objective evidence of no permanent auditory damage on active duty from conceded noise. Further, the examiner stated that there is no report of complaint/treatment for hearing decrease in STRs or at separation and the first complaint of hearing loss is in February 2008, where conductive hearing loss is noted due to serous otitis media infection. The examiner stated that conductive hearing loss indicating that neural function is normal, but middle ear fluid is causing an elevation in hearing. Additionally, the examiner stated that the first mention of sensorineural hearing loss is not until 2013 C&P evaluation, which is more than 20 years post separation from active duty. The examiner explained that although noise exposure, as detailed in the 2018 Board hearing, is conceded and the relationship of noise, auditory damage and hearing loss is well established, auditory damage and hearing loss are not conceded based on noise alone. The examiner opined that there must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology and the evidence is against a nexus in this case and, therefore, it is less likely than not that the hearing loss is related to military noise exposure. Current literature does not support late onset hearing loss from noise exposure, the examiner concluded. The Board finds that the VA examiner’s opinion adequately addresses the evidence of record and lay contentions and in-service acoustic trauma. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data based on the evidentiary record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent that the opinion is, in part, based on normal hearing during service, the Court indicated that a claimant may establish service connection for hearing loss by submitting evidence of a relationship, even if separation testing does not meet the requirements for establishing a disability for VA purposes at that time. Hensley v. Brown, 5 Vet. App. 159 (1993). Here, although the Veteran is competent regarding assertions of hazardous noise exposure, there is no evidence that suggests a relationship between such exposure and current hearing loss. Although the Veteran has testified to persistent symptoms of hearing loss since service, the VA examiner properly considered whether noise exposure during service resulted in her current hearing loss and found it less likely based on the record. The Veteran maintains that her hearing loss is related to noise exposure in service. Although the Veteran is credible as to her testimony regarding decreased hearing and the circumstances of her military service, there is no indication that she has the training or expertise to competently opine on the cause of her hearing loss. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Service connection is also not warranted for bilateral hearing loss as a chronic disability under 38 C.F.R. § 3.307(a), as the competent medical evidence of record does not demonstrate that the Veteran’s bilateral hearing loss was noted as chronic in service or manifested to a compensable degree in service or within the one year presumptive period. See 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Accordingly, as the preponderance of the evidence weighs against service connection, this claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.