Citation Nr: 21015972 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 17-19 056 DATE: March 18, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a cognitive/comprehension disorder (claimed as hearing loss) to include as due to exposure to jet fuel is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1965 to March 1969. This matter comes before the Board of Veterans’ Appeals (Board) from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The claims were previously remanded by the Board in December 2017. 1. Entitlement to service connection for bilateral hearing loss is remanded. 2. Entitlement to service connection for a cognitive/ comprehension disorder (claimed as hearing loss) to include as due to exposure to jet fuel is remanded. During his May 2017 Board hearing, the Veteran testified that when he sought service connection for “hearing loss” that he was seeking compensation benefits as they related to his inability to understand or comprehend or (possibly) hear words. He did not know if he had any actual hearing loss or if he had a cognitive/comprehension problem regarding understanding speech. The Veteran reported that he had come across a study that indicated that his in-service (in combat) exposure to jet fuel may have resulted in neurological problems preventing him from understanding speech. The Veteran submitted internet treatises to support his claim that his exposure to jet fuel may be the cause of his “hearing” or comprehension difficulties. The articles indicated that jet fuel injured the brain such that there was a “disconnect between what the ears hear and the deciphering into understandable language.” One article listed that “the VA study showed definitive links to auditory processing dysfunctions among those who had exposure to the fuel.” In reviewing the 2012 VA examination, the Veteran’s puretone testing results did not, in and of itself, indicate he had a hearing disability by VA’s disability standards. Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or, when 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’s puretone thresholds at his 2012 VA examination were as follows: Hertz 500 1000 2000 3000 4000 Avg. Right 25 20 15 20 25 20 Left 15 15 15 20 25 19 Speech discrimination scores were 94% for the right ear and 92% for the left. The Board remanded the claim in December 2017 to determine if the Veteran has a current auditory processing disability that is separate and distinct from a hearing loss disability. In February 2018, the Veteran underwent a VA examination of the central nervous system and neuromuscular diseases. The examination indicated that the Veteran neither had nor has ever had a central nervous system disorder. Also, in February 2018, the Veteran underwent an additional VA examination for hearing loss. The Veteran’s puretone thresholds at this VA examination were as follows: Hertz 500 1000 2000 3000 4000 Avg. Right 35 30 25 55 50 40 Left 15 15 10 30 25 20 Speech discrimination scores were 64% for the right ear and 78% for the left ear. In May 2019, a VA physician completed two medical opinions which both concluded that the Veteran’s February 2018 VA examination was insufficient based on: (1) difference between thresholds greater than 20db at 3 and 4K Hz; and a Stenger test was not performed; (2) speech scores were obtained at one presentation level, only, no performance intensity function was performed; (3) results obtained are not consistent with normal progression of hearing loss examination from 2012; and (4) results are not consistent with Veteran’s ability to communicate with healthcare providers or lack of diagnosis or treatment for hearing loss. However, the examiner reported that the Veteran’s prior August 2012 VA examination appeared to be valid. Yet, the Board cannot rely on the previous August 2012 VA examination because it does not take into account the Veteran’s statements that his disability may be an audio processing issue that is separate and distinct from a bilateral hearing loss condition. Moreover, as there is also a claim for bilateral hearing loss on appeal, a valid bilateral hearing loss examination that complies with the Board’s previous remand instruction for a VA hearing loss examination, in addition to the August 2012 examination, is required. Accordingly, a remand is needed because, at this point, it is still not clear whether the Veteran has undergone the appropriate VA examination to determine if he has an auditory processing condition. Additionally, a remand is needed for an additional adequate bilateral hearing loss VA examination, and the claims are inextricably intertwined. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Schedule an additional examination to determine the nature and etiology of the hearing loss disorder. After reviewing the claims folder, interviewing the Veteran, and examining him, the examiner should answer the following questions: (a.) Is it at least as likely as not (50/50 probability or greater) that the Veteran has hearing loss as a result of his exposure to hazardous noise in service? (b.) Are the Veteran's word recognition scores compatible with his puretone testing results? (Note that the Veteran has put forth a claim that his exposure to jet fuel may be causing an auditory processing dysfunction.) The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. Please explain in detail any opinion provided and the supporting rationale. 3. Review the May 2019 VA examiner’s opinion that the previous 2018 examination is invalid. 4. After directive, (2) schedule the Veteran for a VA cognitive or other applicable VA examination. Following testing and interview of the Veteran, the examiner should provide the following: (a.) Does the Veteran have a cognitive or comprehension disorder, to include an auditory processing dysfunction? (b.) If the Veteran has a cognitive/comprehension/auditory processing dysfunction, then is it at least as likely as not (50/50 probability or greater) that it is the result of exposure to jet fuel in service? In providing this opinion, please review the Agency for Toxic Substances & Disease Registry’s Public Health Statement related to jet fuels in the claims file. (c.) Please address the May 2019 VA examiner’s two opinions to ensure adequate examination results. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. Please explain in detail any opinion provided and the supporting rationale. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.