Citation Nr: 21020803 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 17-00 799 DATE: April 8, 2021 ORDER Entitlement to service connection for bilateral hearing loss is denied. FINDING OF FACT The Veteran’s bilateral hearing loss is not etiologically related to active service. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from August 1962 to December 1963. In October 2018 and September 2020, the Board remanded the case for further development, which is completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for bilateral hearing loss The Veteran contends he is entitled to service connection for bilateral hearing loss due to acoustic trauma related to his military occupational specialty in service. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: ‘(1) the existence of a present disability; (2) 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.” Holton v. Shineski, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 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 is currently diagnosed with bilateral sensorineural hearing loss, an organic disease of the nervous system, which is listed as a "chronic disease" under 38 C.F.R. § 3.309 (a). 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). The Board concludes that, while the Veteran has a current diagnosis of bilateral hearing loss and evidence shows in-service acoustic trauma, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of bilateral hearing loss began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). When making a decision, the Board must consider all the evidence of record, to include lay statements. 38 U.S.C. § § 5107(b), 7104(a); 38 C.F.R. § 3.303(a). The Veteran and a fellow Airman, who served with him, provided statements describing noise exposure while operating heavy equipment as part of his duties with roads and grounds in service. The Veteran’s spouse also provided a statement describing his noise exposure in service and his current reduced hearing. The Veteran is competent to describe the presence of his observable symptoms and in-service noise exposure. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Thus, the Board finds that the Veteran experienced acoustic trauma in-service. The Veteran attended a VA examination in September 2016. The examiner reviewed the service records and reported that the August 1962 examination only contained a whispered voice test and the discharge examination dated December 1963 showed hearing within normal range. The examiner opined that it is not at least as likely as not that hearing loss was caused by or a result of service, to include noise exposure, as the service medical records revealed normal hearing at separation and no evidence of noise exposure that caused a permanent noise injury affecting hearing sensitivity. In October 2019 an addendum opinion was obtained. The examiner opined that hearing loss was less likely than not due to service as the separation examination revealed hearing thresholds within the normal range and concluded that the current hearing loss was as likely as not due to age or genetics. Both the September 2016 and October 2019 opinions rely solely on the Veteran’s service treatment records show hearing within normal limits; however, 38 C.F.R. § 3.385 establishes that service connection for a current hearing disability is not precluded where hearing was within normal limits at separation. See Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015); Hensley v. Brown, 5 Vet. App. 155, 159-60 (1993). As such, the opinions are not afforded any probative weight. The Veteran underwent another VA examination in October 2020. The examiner again opined that hearing loss is less likely than not incurred in or caused by in-service noise exposure. The examiner reported that the service medical records reveal that the Veteran reported normal hearing acuity at discharge and no issues with his ears, consistent with the audiogram findings. The examiner explained that audiogram is the objective standard for hearing loss and as his hearing was normal and he reported no concerns in-service there is no evidence of an in-service injury, event or disease, to include due to hazardous noise exposure. Additionally, the examiner explained that current literature does not support delayed onset hearing loss. The Veteran submitted the article “The Delayed Effects on Noise in the Ear”, which the examiner explained was a study conducted on rats with no research in humans. The study reported that one to two weeks after noise exposure the animals displayed hearing loss that progressed with age. Thus, the examiner noted that while hearing loss progressed with age, there was also noticeable hearing loss one to two weeks after exposure. The Veteran also cited to “Noise and Military Service 2006” with the Institute of Medicine (IOM) finding that it is possible that an individual’s awareness of the effects of noise on hearing may be delayed considerably after noise exposure. The examiner noted that the IOM also stated that based on current knowledge there is not sufficient scientific basis for the existence of delayed onset hearing loss in humans. Additionally, while the IOM did not rule out that delayed onset hearing loss might exist, it noted that the requisite longitudinal studies have not been performed and based on current knowledge of acoustic trauma, development of noise-induced hearing loss is instantaneous or rapid in onset. Thus, the IOM panel concluded that there is no reasonable basis for delayed onset hearing loss in humans at this time. The Board finds the October 2020 medical opinion to be persuasive as it contains not only clear conclusions with supporting data, but also a reasoned medical explanation that addressed and explained the medical treatises the Veteran provided in support of his claim. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board considered the Veteran’s contention that he did not have a hearing test at separation; therefore, the examiner cannot find hearing within normal limits at the time of discharge. The service treatment records reveal no audiometer findings at the August 1962 enlistment examination but there are audiometer findings at the December 1963 examination and both examinations report no limitations for hearing under the physical profile rating system. Irrespective, the service records remain void of complaints of hearing loss and the Veteran has argued that his in-service acoustic trauma caused delayed onset hearing loss thus indicating the hearing loss did not occur contemporaneously with the in-service noise exposure. Accordingly, the preponderance of the evidence is against finding that bilateral hearing loss began during service or is otherwise related to an in-service injury, event, or disease, to include acoustic trauma. Furthermore, the Board also finds that service connection is not warranted on a presumptive basis as hearing loss was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. As discussed, the service treatment records are silent as to any complaints, treatments, or diagnoses related to hearing loss. Review of the post service medical records also do not reveal a continuity of symptomology of hearing loss as throughout the period on appeal the treatment records frequently reported no hearing loss or change in hearing. (Continued on the next page)   As such, the claim for service connection for bilateral hearing loss is denied. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Prinsen, Samantha 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.