Citation Nr: 21021128 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 18-01 732 DATE: April 9, 2021 ORDER Entitlement to service connection for bilateral hearing loss is denied. FINDING OF FACT The Veteran’s bilateral hearing loss was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1966 to August 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an April 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019 and September 2020, the Board remanded the Veteran’s claim for additional development. The case is once again before the Board. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). Entitlement to service connection for bilateral hearing loss is denied. Direct 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. 38 C.F.R. § 3.303. Additionally, certain chronic diseases, such as sensorineural hearing loss, 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 C.F.R. §§ 3.307(a)(3), 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Starting with the first element of service connection (a current disability), this requirement is met when the Veteran has a disability at the time a claim is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability (1) when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or (2) when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or (3) when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. In March 2017, the Veteran reported to an audiologic examination. There, the examiner used an audiology report of record from July 2016 that represented the Veteran’s current condition at the time. The July 2016 audiometric test results satisfy 38 C.F.R. § 3.385. Accordingly, the Board finds the Veteran has a current disability. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Moving on to the second element of service connection (an in-service injury or disease), the Veteran’s service treatment records (STRs) are silent for complaint of or treatment for hearing loss. He underwent two audiometric tests during service in conjunction with his entry in September 1966 and exit in August 1968. Neither clearly indicates whether it was conducted using the American Standards Association (ASA) or the International Standard Organization/American National Standards Institute (ISO/ANSI) audiometry standard. Before January 1, 1967, service department audiometric test results were generally reported using the ASA. As such, the Board assumes the ASA was used for the Veteran’s entrance examination. However, because it is unclear which standard was used during the Veteran’s August 1968 exit examination, the Board will consider the testing results under both standards and rely on the results most favorable to the Veteran. At entry, the Veteran’s puretone thresholds, in decibels, were recorded as follows (converted to ISO/ANSI standard units): HERTZ 500 1000 2000 3000 4000 RIGHT 0 (15) 0 (10) 0 (10) - 0 (5) LEFT 10 (25) 15 (25) 15 (25) - 20 (25) And at exit, the military examiner recorded the following objective findings (converted to ISO/ANSI standard units): HERTZ 500 1000 2000 3000 4000 RIGHT 10 (25) 5 (15) 5 (15) - 5 (10) LEFT 10 (25) 5 (15) 5 (15) - 5 (10) Using either the ASA or ISO/ANSI standard, the Veteran’s test results do not satisfy VA’s regulatory definition for hearing loss. See 38 C.F.R. § 3.385. Consistent with this, the Veteran also affirmatively denied hearing loss on his separation medical history report. The Veteran contends that an audiogram during service showed high frequency hearing loss in his left ear. It’s true that the Veteran’s service records contain what appears to be a third audiogram dated September 1 (a hole punch obscures the year). As part of the last remand, the Board directed the examiner to address the audiogram. In response, the examiner explained that the September 1 audiogram is a Rudmose tracing of the Veteran’s entrance examination audiometric test. As the Veteran’s entrance examination happened on September 1, 1966, the dates appear to match. Accordingly, the Board finds that the Veteran’s hearing loss did not onset during service. Even so, service connection for hearing loss is not precluded for a current hearing disability where hearing was within normal limits on audiometric testing at separation from service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Here, the Veteran’s military occupational specialty (MOS) during service was aircraft instrument repairman. In the October 2017 Notice of Disagreement (NOD), the Veteran reported that his job required the helicopter to be running during repairs, and he was often around other servicemembers doing the same thing he was, exposing him to more noise. He also emphasized that the military never offered him hearing protection. Based on this, VA found that he experienced in-service hazardous noise exposure, and the Board will not disturb that favorable finding. Having established an in-service injury and a current disability, the issue before the Board is whether the Veteran’s noise exposure during service is related to his current hearing disability. Starting in June 1999, the Veteran’s VA treatment records consistently show complaints of and treatment for hearing loss. They also show a history of Eustachian tube dysfunction and a November 2013 fall that caused a sudden hearing loss. To help interpret this and the other evidence of record, the Veteran reported to two examinations during the appeal period. In August 2019 and September 2020, the Board determined the medical opinions from those examinations were inadequate and directed an addendum be obtained. In the resulting medical opinion, the examiner opined that the Veteran’s hearing loss was less likely than not incurred in or caused by service. Reviewing the evidence, the examiner noted the Veteran’s long history of gradual hearing loss and hearing aid use. She also acknowledged the Veteran’s in-service hazardous noise exposure and the relationship between noise, auditory damage, and hearing loss but found no objective evidence of permanent auditory damage on active duty. She supported the finding that the Veteran did not suffer auditory damage on active duty by comparing his hearing at entrance and separation to demonstrate the lack of shift in hearing thresholds beyond test variability (“no significant shift”). And unlike the two previous examiners, she relied on other factors to support her conclusion, pointing to the Veteran’s post-service history of Eustachian tube dysfunction, middle ear pathology, and a sudden change in hearing from a November 2013 fall. Because the October 2020 audiologist based her opinion on more than just normal audiometric test results at separation, the Board finds it adequate and highly probative. The Board acknowledges the Veteran’s belief that his hearing loss is related to his noise exposure during service. He is competent to report his experienced symptoms, such as difficulty hearing but not his hearing loss’s etiology because, in this case, the issue is medically complex and requires specialized education, training, or experience. 38 C.F.R. § 3.159(a)(2). Other than the October 2020 audiologist’s opinion, the record contains no competent, credible evidence linking the Veteran’s hearing loss to service. Therefore, the Board finds the third element of service connection (a link between the Veteran’s disability and service) not met. Although sensorineural hearing loss is one of the chronic diseases listed under § 3.309(a), presumptive service connection based on this chronic condition is not available where the Veteran’s arthritis was not diagnosed or otherwise “noted” during service or during the one-year presumptive period following service. As noted above, the Veteran’s audiometric testing at separation did not show hearing loss for VA compensation purposes, and the October 2020 audiologist found no permanent auditory damage during service. The earliest evidence in the record of a hearing loss diagnosis for VA purposes is decades after separation. As a result, the Board finds the presumption for chronic diseases is not applicable here. To summarize, the Board concludes that entitlement to service connection for bilateral hearing loss is not warranted, as the record does not show a link between the Veteran’s condition and his service. Further, service connection is not warranted on a presumptive basis as there is no competent evidence documenting sensorineural hearing loss within one year of discharge. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Canedy, 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.