Citation Nr: 21016177 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 15-37 771 DATE: March 22, 2021 ORDER Service connection for right ear hearing loss is denied. FINDING OF FACT The evidence of record, including February 2012 and December 2020 medical opinions explained that the Veteran’s right ear hearing loss was not aggravated beyond its natural progression during his active duty military service. CONCLUSION OF LAW The criteria for service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1131, 1112, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Army Reserves from October 1974 to February 1975 in active duty for training and served on active duty from September 1975 to October 1976. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Puerto Rico. In March 2019, a videoconference hearing was held before the undersigned. A transcript of the hearing is of record. In August 2019, the Board remanded the Veteran’s right ear hearing loss service connection claim for further development. Service connection for right ear hearing loss is denied. Legal Criteria Service connection for a disability may be granted when the evidence shows that a current disability results from an injury or disease that was incurred or aggravated in active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.30 (a). The general requirements of service connection are (1) a current disability, (2) medical or lay evidence of an in-service incurrence or aggravation of a disease or injury, and (3) evidence of a causal link (“nexus”) between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA is responsible for determining whether the evidence supports the claim or is evenly balanced for and against the claim (in “relative equipoise”), with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection based on aggravation of a pre-existing condition may be awarded when a pre-service medical condition is worsened by military service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). A preexisting medical condition will be presumed to have been aggravated by service, where there is an increase in disability during such service, unless there is a specific finding that the increase is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). If there is an increase in severity, then “clear and unmistakable evidence” is required to rebut the presumption of aggravation. However, if (based on all the relevant evidence) the medical condition did not increase in severity during service, then aggravation may not be conceded. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Every Veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. See 38 U.S.C. § 1111. Mere history of pre-service existence of a disease does not constitute a notation of such condition. For example, if, at the entrance examination, a veteran reports a history of a medical condition, but the corresponding clinical evaluation does not indicate any abnormality, the condition is not considered to have been “noted.” See Crowe v. Brown, 7 Vet. App. 238 (1994). However, where a preexisting medical condition is noted on the clinical evaluation section of the entrance examination, then the question becomes whether service connection is warranted based on in-service aggravation of the pre-existing condition. Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels (dB) or greater, where the auditory thresholds for at least three of these frequencies are 26 dB or greater, or when the Maryland CNC speech recognition scores are less than 94 percent. 38 C.F.R. § 3.385. The Board has reviewed all evidence in the claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence as appropriate and the analysis will focus on what the evidence shows, or fails to show, as to the claims. Factual Background The Veteran is claiming service connection for right ear hearing loss. The Veteran’s April 1974 enlistment auditory examination revealed the following pure tone thresholds in decibels in the Veteran’s right ear: 20 (500 Hertz), 15 (1000 Hertz), 15 (2000 Hertz), and 35 (4000 Hertz). The physician noted that there was minor impairment of auditory acuity. The Veteran’s August 1976 separation auditory examination revealed the following pure tone thresholds in decibels in the Veteran’s right ear: 25 (500 Hertz), 15 (1000 Hertz), 25 (2000 Hertz), and 30 (4000 Hertz). A November 1975 military personnel record shows the Veteran was recommended for a general discharge due to reasons other than his hearing loss difficulties. Additionally, in September 1976, the Veteran responded to the recommendation for discharge and there is no mention of any hearing difficulties in that response. As the Board previously determined the Veteran’s February 2012 VA audiological examination was inadequate, it will not be relied on in this decision. During the Veteran’s December 2020 VA audiology examination, his right ear pure tone thresholds in decibels were 50 (500 Hertz), 65 (1000 Hertz), 70 (2000 Hertz), 75 (3000 Hertz), and 75 (4000 Hertz). The examiner opined that the Veteran’s current hearing loss disability was less likely than not (less than 50 percent probability) incurred in or caused by in-service acoustic trauma. The examiner noted that Veteran’s service treatment records noted no significant threshold shifts by military standards. Further, the examiner reasoned that there was no evidence that the Veteran was discharged due to his hearing loss difficulties as reported by the Veteran and the next audiological evaluation was 26 years after service. Further, the examiner reasoned that the medical literature does not support delated onset hearing loss many years after hazardous noise exposure. The examiner also opined that the Veteran’s hearing loss was not aggravated beyond its natural progression. The examiner reasoned that the Veteran did not seek further evaluations in the initial years, the Veteran was not discharged because of his hearing loss, and there were no significant threshold shifts during active service. Analysis The Veteran has established a current disability for hearing loss in the right ear, pursuant to 38 C.F.R. § 3.385. The Veteran’s entrance audiological examination noted hearing loss in the right ear and the December 2019 VA examiner opined that the Veteran’s hearing loss did pre-exist service; therefore, his right ear hearing loss pre-existed his active duty service. See 38 C.F.R. § 3.304(b). Thus, the presumption of soundness is rebutted. Because the Veteran’s disability was noted on his entrance examination and pre-existed service, his claim for service connection becomes one of aggravation. After reviewing the Veteran’s claims file, the Board finds that there is no evidence that the Veteran’s pre-existing right ear hearing loss underwent an increase in severity during service. The Veteran’s service treatment records do not show a significant shift in right ear auditory thresholds during service. Additionally, the December 2019 examiner opined that it was less likely than not that the Veteran’s right ear hearing loss was aggravated by his active service. This opinion was supported by the lack of significant change between the entrance and separation examinations and by the additional factors relevant to this Veteran’s medical history, as explained by the examiner. Although the Veteran experienced a slight threshold shift in hearing loss from entrance to separation (from 20 to 25 in the 500 Hz range and from 15 to 25 in the 2000 Hz range) and the December 2019 VA examiner did note this explicitly. Further, the examiner indicated that the claims file had been reviewed and is, therefore, presumed to be aware of that information. See Rizzo v. Shinseki, 580 F.3d 1288, 1292 (Fed. Cir. 2009) (applying the presumption of regularity to VA medical examiners in the discharge of their regular duties). In the context of this information, the examiner’s rationale that “[t]here was no significant change in hearing thresholds” from induction to separation makes sense. See February 2012 and December 2020 VA examination. The Board finds that the examination report and opinions, taken as a whole, are legally adequate. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (explaining that “[t]here is no requirement that a medical examiner comment on every favorable piece of evidence in a claims file” to render an adequate opinion); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (explaining that there is no reasons or bases requirement imposed on examiners). Specifically, as it relates to the December 2019 examiner’s opinions, they are based on accurate facts, a review of the Veteran’s claims file and military records and provide an adequate rationale for their opinions. Additionally, the December 2019 opinion was also supported by the service treatment records and, therefore, the Board assigns the opinion significant probative weight. Additionally, the Veteran’s November 1975 military personnel records support the examiner’s conclusion that hearing loss difficulties were not the reason for the Veteran’s discharge. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran’s pre-service right ear hearing loss increased in severity during service beyond its natural progression. Thus, service connection for right ear hearing loss is not warranted. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Williams, 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.