Citation Nr: 21026300 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 17-42 444 DATE: April 30, 2021 ORDER Service connection for Guillain-Barre syndrome is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT There is competent medical evidence showing that the Veteran’s Guillain-Barre syndrome was aggravated during a period of ACDUTRA (active duty for training). CONCLUSION OF LAW The criteria for service connection for Guillain-Barre syndrome have been met. 38 U.S.C. §§ 101(22), (24), 105, 1110, 1131; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran enlisted in the U.S. Naval Reserve in January 1974, and had active service from January 1974 to July 1974. His subsequent Naval Reserve service, through 2005, included periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). In November 2020, the Veteran testified at a virtual tele-hearing before the undersigned Veterans Law Judge. Entitlement to service connection for Guillain-Barre syndrome. The Veteran contends that his Gillian-Barre syndrome was aggravated during a period of ACDUTRA service. 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. Active service includes (1) active duty, but also (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or an injury incurred or aggravated in the line of duty, and (3) any period of INACDUTRA during which the individual concerned was disabled or died from an injury, but not disease, incurred or aggravated in the line of duty. 38 U.S.C. § 101(24)(B); 38 C.F.R. § 3.6(a). After review of the record, the Board concludes the Veteran has a current diagnosis of Guillain-Barre syndrome that was aggravated during a period of ACDUTRA in the line of duty. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(a). Private treatment records show that on May 24, 1985, the Veteran was seen in the Oklahoma Memorial Hospital and Clinics emergency room with complaints of numbness in both arms and lower legs, and that he sometimes fell down. Service records show that the Veteran was received for ACDUTRA on May 26, 1985, at the Naval Station in Pearl Harbor, and released from ACDUTRA on June 8, 1985. On May 26, 1985, two days after the Veteran was seen at the Oklahoma Memorial Hospital and Clinics emergency room and while he was in transit to Johnston Island Atoll for Naval Reserve Duty, he developed increased symptoms, and was seen in the emergency room at Tripler Army Medical Center (AMC). He was hospitalized at Tripler AMC for 17 days, and the discharge diagnosis was Guillain-Barre syndrome. Thereafter, on June 12, 1985, the Veteran was medically evacuated to Oklahoma and hospitalized for 4 days at Tinker Air Force Hospital for additional treatment for Guillain-Barre syndrome. In support of his claim, the Veteran submitted a report of an independent medical examination, dated in September 2017, from Dr. E., who conducts an occupational and legal medicine practice. In the report, it was noted that in May 1985, the Veteran was scheduled for service on Johnston Island, but two days prior to leaving he had numbness in his hands and feet and saw a civilian doctor in Oklahoma. The Veteran never made it to Johnston Island, and sought emergency medical treatment in Hawaii for increased symptoms, and was hospitalized at Tripler Army Medical Center and diagnosed with Guillain-Barre syndrome. Dr. E. opined that it was more likely than not that the Veteran was probably developing Guillain-Barre syndrome prior to boarding the plane to go to Johnson Island, and that it was more likely than not that the change in cabin pressure and stress of flying contributed to and aggravated his Guillain-Barre syndrome. Dr. E. further explained that when having Guillain-Barre syndrome, any kind of stress and outpouring of stress hormones could significantly affect the nerve system. The Board finds Dr. E’s opinion to be probative and persuasive as it is based on an accurate medical history, review of the Veteran’s service records, and a thorough interview and examination of the Veteran. Moreover, Dr. E.’s opinion is definitive and supported by sufficient rationale, thus, Dr. E.’s opinion is entitled to significant weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board concludes that service connection for Guillain-Barre syndrome is warranted. REASONS FOR REMAND Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends his bilateral hearing loss is related to excessive noise exposure during his Naval Reserve service, to include a period of active duty in 1974, a period of ACDUTRA in 1997, and a period of INACDUTRA at Norfolk. Service personnel records include a DD Form 214 from the Veteran’s period of active service in 1974, which lists no primary specialty occupation, but the related civilian occupation was construction, which was noted as highly probably for acoustic trauma. During this period of active service the Vetran reported being exposed to noise from construction equipment, diesel engines, weapons fire, and saws. In light of the foregoing, his exposure to excessive noise during the 1974 period of active service is established. The record also shows that service connection was granted for tinnitus due to noise exposure during his 1974 period of active service. In November 2020, the Veteran testified that since the VA examination five years prior, his wife felt his hearing loss had worsened. He testified that in service he worked on the flight line loading and unloading aircraft. As a civilian, he was a carpenter for three years but testified he was mostly moving wood and hammering nails. He did not recall when he started experiencing problems with hearing loss, and testified it was more his family members who had been complaining about it for about 10 years. When asked by his representative if he had any specific incidents of acoustic trauma in the Navy, he stated that in 1997 he participated in a military exercise called Bright Star, for about 25 days on ACDUTRA, and that his location was in Sicily, but he went to other bases including in Egypt. He reported that during this period he was exposed to CH-53s, which he described as Chinooks with twin rotors used for fleet and resupply of aircraft carriers, landing and taking off, and that when he was exposed to these cargo-sized helicopters he had nausea, a feeling of muffling his hearing sensitivity, and ringing in his ears, which took days to go away. He testified he was also exposed to DC-9s landing at Norfolk Naval Air Station (NAS) when assigned there for a weekend drill or INACDUTRA. While the Veteran has reported excessive noise exposure throughout his Naval Reserve service, as noted above, service connection may be granted for hearing loss only if it is shown that his hearing loss is related to noise exposure (acoustic trauma) during a period of active service, ACDUTRA or INACDUTRA. Review of service personnel records shows that the Veteran had a period of annual training (ACDUTRA) from October 26, 1997 to November 9, 1997, assigned to Fleet Air Mediterranean, in Naples, Italy. In a November 1998 evaluation report, it was noted that he completed a refresher training on C-130 loading and unloading procedures involving both passengers and vehicles, and that on annual training he worked at “Fleet Mail Center, NAS Sigonella, Italy, Cairo West Egypt, and IAP Ben Gurion Israel” and that he “segregated mail and cargo as to destination; safeguarding mail until shipment to Cairo West”. Service treatment records (STRs) include November 1986, March 1986, and October 1987 examinations at which left and right ear whisper/spoken voice tests were conducted. Audiometric testing was conducted in February 1996, September 1996, and March 1997. On the September 1996 examination, a finding of mild high frequency hearing loss, left ear, was noted. Further in September 1996, a reference audiogram was conducted, following exposure in noise duties, and it was noted that the Veteran had previously been issued hand formed ear plugs. A June 2015 VA examination report shows a current left ear hearing loss disability, but not right ear hearing loss disability. See 38 C.F.R. § 3.385. The examiner opined that the Veteran’s current hearing loss was not related to military noise exposure/acoustic trauma/military duties. For rationale, the examiner noted that during the Veteran’s active service in 1974, his occupation involved construction which involved a high probability of exposure to hazardous noise. The examiner further noted that the Veteran served in the Naval Reserve from 1974 through 2005, and that audiograms from February 1996 to March 1997 showed his hearing was within normal limits, bilaterally, “which would assume hearing was within normal limits at separation from active duty”. The examiner noted that three examinations from March 1986 to October 1987 showed 15/15 hearing in both ears based on the results of a whispered voice test, which was not a valid measurement of hearing sensitivity since it provides no ear or frequency information and cannot be compared to the audiograms from 1996-1997. The examiner also noted there was no shift shown in service. Finally, the examiner opined that the Veteran’s tinnitus, which he reported began in the Navy in 1974 due to construction work, was related to military noise exposure, and that his tinnitus was not associated with hearing loss. In light of the foregoing, a remand is warranted. In June 2015, the VA examiner addressed whether the Veteran’s current hearing loss may be related to his period of active service in 1974, but did not address other periods of active service, to include the period of ACDUTRA from October 26, 1997 to November 9, 1997. Additionally, in light of the testimony that the Veteran’s hearing has worsened since the 2015 VA examination, current audiometric testing should be conducted. Additionally, although numerous STRs and service personnel records are of record, there are minimal records pertaining to the Veteran’s period of active service in 1974, to specifically include no copies of any enlistment or separation examinations that may have been conducted. Further, although the Veteran reported a weekend drill at Norfolk NAS where he was exposed to noise from C-9’s, he did not provide a date for that period of INACDUTRA. While review of his service personnel records shows other periods of INACDUTRA, the Board is unable to verify this period. On remand, the AOJ should ensure that all STRs and service personnel records have been obtained for the Veteran. The matter is REMANDED for the following actions: 1. Contact the appropriate service department and attempt to obtain all outstanding service personnel and/or treatment records for the Veteran's periods of service, to specifically include his active service from January to July 1974. All attempts to procure such records must be documented in the file. If no records are available, a negative response must be included in the record. 2. After all available and additional records are associated with the claims file, schedule the Veteran for an appropriate VA examination to determine whether any current bilateral hearing loss disability is related to noise exposure during a period of active duty service. Any indicated diagnostic tests and studies, to include an audiogram, must be accomplished. If hearing loss disability is shown pursuant to 38 C.F.R. § 3.385, the examiner should be asked to opine whether the Veteran's hearing loss is at least as likely as not (i.e., a 50 percent or greater degree of probability) related to active service, to include the period of active duty from January to July 1974, and the period of ACDUTRA from October 26, 1997 to November 9, 1997. The examiner should be advised that the Veteran's exposure to excessive noise during service has been established, and that the absence of in-service evidence of hearing disability is not fatal to the claim. The examiner should also be advised that the Veteran is competent to report he had hearing loss during and since a period of active service. The examiner should explain the rationale for any opinion given, and if unable to provide any opinion without resort to speculation, this should be stated, and an explanation provided as to why this is so. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Casula 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.