Citation Nr: 21020836 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-41 572 DATE: April 8, 2021 ORDER Service connection for hearing loss is denied.   FINDING OF FACT The Veteran’s hearing loss is not related to service. CONCLUSION OF LAW The criteria for service connection for hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1965 to December 1967. The claim is on appeal from a June 2016 rating decision. In November 2019, the Veteran testified at a Board hearing. The case was previously before the Board in February 2020, with the issue of service connection for hearing loss remanded for further development and a new medical opinion. While the case was in remand status, in a January 2021 rating decision, the RO granted service connection for bilateral tinea pedis with onychomycosis. As the benefit sought for that claim was granted in full, that issue is no longer before the Board. To the extent an appeal on a rating reduction for prostate cancer has been perfected, the Veteran awaits a hearing on the issue, and it will be decided in a separate, future Board decision, when in order. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection for hearing loss. Legal Criteria 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; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). For the purposes of applying the laws administered by VA, 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 when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 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. VA is responsible for determining whether the evidence supports the claims or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case the claims are denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Analysis The Veteran seeks service connection for hearing loss, and contends that it is a result of his military occupational specialty (MOS) as a personnel carrier. He testified there were 50-caliber weapons right above his left ear, and 60-caliber weapons directly behind him while performing his duties as a driver, which led to his current hearing loss. See Veteran’s November 2019 hearing testimony. The Veteran’s Certificate of Release or Discharge (DD214) shows service as a light weapons infantryman, and service personnel records (SPRs) indicate his duty was “Rifleman” during his time in Vietnam. His service treatment records (STRs) are silent as to complaints or treatment of hearing loss or any other ear condition, with normal audiometric readings on both his entrance and separation examinations from the military. Post-service medical records reflect the Veteran reporting subjective hearing loss since March 2012, and he has been diagnosed with sensorineural hearing loss in both ears to be considered a disability for VA purposes under 38 C.F.R. § 3.385. The Veteran was first afforded a VA examination in May 2016 in connection with his claims for bilateral hearing loss and tinnitus. While the audiologist found that his tinnitus condition was a result of noise exposure in service, she opined that his hearing loss was less likely as not caused by or a result of his active duty. As rationale, the examiner noted that there were no threshold shifts in hearing during service, and his entrance and separation examinations were within normal limits. She also stated that “a noise induced hearing loss will not progress once it is stopped.” Pursuant to the Board’s February 2020 remand, the Veteran’s claims file was also forwarded to an otolaryngologist (ENT) for an expert medical opinion in April 2020. After review of the file, the ENT opined that the Veteran’s hearing loss was less likely than not incurred in or caused by an in-service injury, event, or illness. He provided the rationale that the Veteran’s entrance and exit audiograms were normal, there were no threshold shifts between enlistment and discharge audiograms, and hearing loss was not documented until 51 years following his military discharge. The examiner concluded that the Veteran’s hearing loss is more likely related to presbycusis (age-related hearing loss). The Board finds that the April 2020 ENT expert opinion is clear and unequivocal. It is based on the relevant information, including review of the Veteran’s STRs and MOS with potential noise exposure, post-service treatment records, and with consideration of his personal medical history and age. Moreover, the examiner’s explanations are logical and follow from the facts and information given. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-06 (2012); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no indication that hearing loss manifested to a compensable degree within one year of service, or that there was a continuity of symptomatology for a chronic disease noted in service. The Board notes there are no medical opinions of record linking the Veteran’s hearing loss to service, and thus there is insufficient evidence in support of the nexus element. The Board has also considered the Veteran’s statements regarding being near loud weapons while driving as a personnel carrier during his time in Vietnam, as to whether he participated in combat activity to warrant a presumption of injury during active duty, even without an “official record” that such injury or disability occurred. See 38 U.S.C. § 1154(b). The Veteran’s SPRs show that he had combat service as he participated in a Vietnam counteroffensive during service. While noise exposure has already been established, the lay and medical evidence shows that the Veteran’s hearing loss did not manifest until many years after service. Thus, competent medical evidence of a nexus is necessary for this specific claim. See Collette v. Brown, 82 F.3d 389, 392 (Fed. Cir. 1996). (Continued on the next page)   Finally, the Board acknowledges the Veteran’s contentions that his noise-induced hearing loss is related to his in-service noise exposure. While the Veteran’s assertions are consistent, as a lay person he has not been shown to have specialized training sufficient to render an opinion as to the etiology of hearing loss diagnosed many years after service, as such is a complex medical question. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In sum, the preponderance of the evidence is against the claim, particularly the nexus element, and the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for hearing loss is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morford, 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.