Citation Nr: 21023110 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 18-40 127 DATE: April 20, 2021 ORDER Entitlement to service connection for bilateral hearing loss is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his bilateral hearing loss is related to in-service noise exposure. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss have been satisfied. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 1970 to December 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2018 rating decision issued by a Department of Veterans Affairs (VA) regional office. In February 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. The Veteran contends that his bilateral hearing loss was caused by his active duty service. Specifically, the Veteran asserts that as a result of his duties as a diesel-electric locomotive repairman, he was exposed to loud noises while working on trains in a large tunnel. See February 2021 Hearing Tr. at 2-3. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as organic diseases of the nervous system like sensorineural hearing loss. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The Veteran has a current bilateral hearing loss disability. See 38 C.F.R. § 3.385. For example, at his December 2017 VA examination he was diagnosed with bilateral sensorineural hearing loss. Thus, the remaining question is whether the current bilateral hearing loss disability is related to service. Service treatment records show no complaints, diagnosis, or treatment related to a hearing loss. During the December 1971 separation examination, evaluation of the ears was normal and normal hearing was shown on audiometer. In August 2017, the Veteran submitted a private medical opinion by audiologist A.M. In the opinion, it was noted that the Veteran was exposed to excessive noise from locomotive engines and firearms due to his service duties as a diesel mechanic. It was noted that the Veteran was not provided hearing protection during his time in service. Post service, the Veteran worked primarily in office positions at an Air Force base. After performing an examination and interviewing the Veteran, audiologist A.M. diagnosed the Veteran with bilateral hearing loss that is at least as likely as not initiated by his exposure to hazardous noise from locomotive engines and firearms due to his service duties as a diesel mechanic. The Veteran presented for a VA examination in December 2017, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner opined that the Veteran’s hearing loss was not at least as likely as not caused by or a result of an event in military service. In support of this conclusion, the examiner explained that the Veteran’s hearing thresholds at the time of entrance and separation were within normal limits. The examiner noted that medical literature has found that noise induced hearing loss will not progress once it is stopped. Thus, the examiner concluded that the Veteran’s hearing loss is less likely than not related to military noise exposure or acoustic trauma. In the section of the examination pertaining to tinnitus, it was noted that the Veteran was exposed to excessive noise (acoustic trauma) during service. In April 2018, the Veteran submitted a private medical opinion by audiologist R.W. In the opinion, it was noted that the Veteran reported that while in service, he was exposed to hazardous noise from firing ranges, M-14 and M-16 rifles, hand grenades, .45 caliber pistols, M-79 grenade launchers, M-60 machine guns, locomotives, diesel engines, pneumatic tools, impact wrenches, and infiltration course explosions. Audiologist R.W. opined that the Veteran’s bilateral hearing loss is at least as likely as not related to his military experience as a diesel locomotive mechanic based and his being exposed to hazardous noises such as firing ranges, as noted above. Audiologist R.W. noted that the Veteran’s recreational activities and civilian occupation as a welder and tooling supervisor, performed with ear protection, was not comparable to the hazardous military noise exposure. Audiologist R.W. further noted that acoustic trauma results in progressive underlying neuropathology that has prolonged long-term consequence on the auditory process. In support of its findings, audiologist R.W. cited a 2009 research study about noise induced hearing loss which found that lack of evidence of hearing loss at the time of noise exposure does not support that a delay in loss in hearing cannot occur. Audiologist R.W. noted that normal threshold sensitivity can mask ongoing and dramatic neural degeneration in noise-exposed ears. In a May 2018 supplemental VA medical opinion, the examiner further noted that there is a lack of evidence in the claims file of any complaints of hearing loss during service and the time between service and the date of the private audiological examination in August 2017 is significant without evidence of any audiology treatment in the intervening years. The examiner noted that medical records are silent for any complaints, treatments, or evaluation of hearing loss from separation in 1971 until present, a 45 year gap. The examiner further noted that there is no evidence of chronicity or continuity of care. Upon review of the record and resolving reasonable doubt in the Veteran’s favor, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current bilateral hearing loss is related to service. In that regard, the Board acknowledges and gives some probative weight to the VA medical opinions which found that the records were silent for in-service reports of bilateral hearing loss and that medical literature indicated that noise induced hearing loss will not progress once it is stopped. Even so, the Board notes that the Veteran’s duties in service may have resulted in noise exposure as it is reasonable to find that the Veteran may have been exposed to loud noises while working on locomotives. Some excessive noise exposure during service was also noted during the December 2017 VA examination, even if the issue discussed was tinnitus. As to nexus between the in-service exposure to noise and his current disability, the Board gives some probative weight to the August 2017 and April 2018 private medical opinions which found that the Veteran’s bilateral hearing loss was likely due to in-service noise exposure as a result of his duties. The opinions were also given after an examination and also considered the Veteran’s occupational duties post service. Notably, the April 2018 opinion was given with support from medical literature which indicated the possible masked presence of noised induced hearing loss even if the record at the time does not indicate report of hearing loss during service. Overall, medical professionals looking at the same facts have come to opposite conclusions and supported their opinions with clear rationale. When it comes to VA benefits, any doubt is resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The evidence in favor of and against the claim is relatively equal in this case. Resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral hearing loss is warranted. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.