Citation Nr: 21030167 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 16-11 210 DATE: May 18, 2021 ORDER Entitlement to service connection for tinnitus is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a cardiovascular disorder, to include a heart murmur is denied. FINDINGS OF FACT 1. The evidence is against finding that tinnitus began during active service or is otherwise related to an in-service injury or disease. There is no indication that tinnitus manifested to a compensable degree during the one-year period following the Veteran's discharge from service. 2. The evidence is against finding that a bilateral hearing loss disorder began during active service or is otherwise related to an in-service injury or disease. There is no indication that bilateral sensorineural hearing loss manifested to a compensable degree during the one-year period following the Veteran's discharge from service. 3. The evidence is against finding that a cardiovascular disorder, to include a heart murmur disorder began during active service or is otherwise related to an in-service injury or disease. Cardiovascular disease was not shown until many years after service. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.309. 2. The criteria for service connection for bilateral hearing loss have are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.309. 3. The criteria for service connection for a cardiovascular disorder, to include a heart murmur are not met 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from June 1983 to June 1987 and from May 1990 to February 1991. In July 2020, the Board remanded these issues for additional development. The Board finds that there was substantial compliance with the remand directives on appeal as discussed below. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 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. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38U.S.C. §5107; 38C.F.R. §3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, a preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). For Veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases may be presumed to have been incurred in service if they manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Sensorineural hearing loss, tinnitus, and cardiovascular disease are on the list of diseases presumed to have been incurred in-service and receives a one-year presumption. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be 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, 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 (2020). 1. Entitlement to service connection for tinnitus 2. Entitlement to service connection for bilateral hearing loss The Veteran contends that her bilateral hearing loss and tinnitus is related to her time in-service. The Board respectfully disagrees. Service personnel records indicate that the Veteran's military occupational specialty (MOS) was an aircraft electrical mechanic. Noise exposure in conceded. STRs are negative for any complaints, diagnoses, or treatments for hearing loss or tinnitus in-service. Specifically, audiometric findings at a July 1982 enlistment examination, May 1986 in-service examination, and June 1987 separation examination reveal normal hearing with no reporting by the Veteran for tinnitus. The Veteran also reported negative for ear trouble, ear drum perforation or scarring, and running ears at the close of her first tour of duty. During the Veteran's second tour of duty, audiometric findings at an October 1990 in-service examination reveals normal hearing in the left ear with mild nonprogressive high frequency hearing loss in her right ear. There was no reporting by the Veteran for tinnitus. The Veteran also reported negative for ear trouble, ear drum perforation or scarring, and running ears at the close of her second tour of duty. In a February 1994 post-service Air National Guard readiness examination, the Veteran reported negative for ear trouble, ear drum perforation or scarring, and running ears during her last tour of duty. Audiometric findings at a January 1999 VA post-service examination reveals normal hearing with no reporting by the Veteran for tinnitus. The Veteran also reported negative for ear trouble, ear drum perforation or scarring, and running ears. Audiometric findings at a September 2009 VA outpatient post-service examination reveals normal hearing with no reporting of tinnitus by the Veteran. In a May 2016 VA hearing loss examination, the Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 CNC RIGHT 30 45 45 45 50 88 LEFT 30 45 50 45 45 100 Speech audiometry revealed speech recognition ability of 88 percent in the right ear and of 100 in the left ear. The examiner diagnosed the Veteran with bilateral sensorineural hearing loss. The examiner opined that the Veteran's bilateral hearing loss and tinnitus is less likely than not caused by or the result of an in-service event. The examiner also opined that the Veteran's tinnitus is less likely than not related to the Veteran's hearing loss. The examiner explained that the Veteran was diagnosed with normal hearing during her periods of active duty. The examiner also noted that medical literature from the Institute of Medicine determined that there was no scientific basis on which to conclude that hearing loss which appeared many years after noise exposure could be causally related to that noise exposure, if hearing was normal immediately after the exposure. Moreover, the Institute of Medicine determined that here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure. Regarding the Veteran's tinnitus, the examiner explained that there are no reports or complaints of tinnitus during active service. The examiner also noted that noise induced tinnitus occurs at the time of the noise exposure and does not have a delayed onset. The examiner also noted that the Veteran experienced more consistent noise exposure during her post-service employment as a civil servant. Lastly, the examiner explained that there is a is a wide range of conditions can cause the onset of tinnitus. Tinnitus often occurs as the result of an inner ear or auditory nerve problem, but it is also seen with a wide range of other problems such as: cardiovascular disease; thyroid disease; a reaction to drugs; excessive alcohol use; a middle ear tumor; over exposure to loud noise; heavy doses of asprin; excessive ear wax; Meniere's disease; caffeine; high blood pressure; nicotine; inner ear infection; and an auditory tumor. In a December 2020 VA hearing loss examination, the Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 CNC RIGHT 40 40 40 40 40 N/A LEFT 35 35 35 35 35 N/A The examiner noted that the results of the examination were not reliable for rating purposes as the Veteran was not giving her best effort and was uncooperative during the examination. The examiner opined that it is less likely than not that the Veteran's right ear hearing loss is related to noise exposure in-service. The examiner noted that the Veteran did not begin to experience hearing loss until 1990 when she was noted to have high frequency hearing loss in her right ear at 6000 hertz on entry into her second period of service. Moreover, the examiner noted that the Veteran's hearing below 6000 hertz showed normal thresholds in-service and remained normal in upper frequencies. The examiner also noted that the Veteran's hearing remained stable for years after service. The foregoing summary of the treatment record reveals no possibility for service connection for bilateral hearing loss or tinnitus. Although the Veteran contends that she experienced loud noise exposure in-service, her STRs do not report any complaints, diagnosis, or treatments for hearing loss or tinnitus. Moreover, in the Veteran's VA audiological examinations, the examiner did not find a nexus between the Veteran's hearing loss or tinnitus and her time in-service. Significantly, there is no opinion to the contrary. The Board also reviewed the Veteran's lay statements asserting that her bilateral hearing loss and tinnitus is related to her loud noise exposure in-service. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to her senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to bilateral hearing loss and tinnitus as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). While the Veteran has reported that her bilateral hearing loss and tinnitus has been present since service, this is not found to be probative considering the other evidence of the record. As determined by the May 2016 examiner, the onset of the Veteran's hearing loss occurred many years after discharge from service. Moreover, the Institute of Medicine determined that there is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure. Furthermore, the examiner also noted that noise induced tinnitus occurs at the time of the noise exposure and does not have a delayed onset. Although the Veteran asserts that she experienced noise exposure in-service, her STRs do not report any complaints, diagnosis, or treatments for hearing loss or tinnitus at an examination prior to discharge. Moreover, the December 2020 examiner noted that the results of the Veteran's most recent examination were not reliable for rating purposes as the Veteran was not giving her best effort and was uncooperative during the examination. The examiner opined that it is less likely than not that the Veteran's right ear hearing loss and tinnitus is related to noise exposure in-service. The examiner noted that the Veteran experienced more consistent noise exposure during her post-service employment as a civil servant. Lastly, as a pathology for bilateral sensorineural hearing loss and tinnitus was not shown until many years after separation, the Board finds no evidence to support the Veteran's contentions. Based on this evidence, the Board finds service connection is not warranted. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 3. Entitlement to service connection for a cardiovascular disorder, to include a heart mummer is remanded. The Veteran contends that her cardiovascular disorder is related to her time in-service. August 1990 STRs reveal a diagnosis of trivial mitral regurgitation and mild tricuspid regurgitation with no evidence of valvular deformities. October 1990 STRs reveal that the Veteran was treated for dizzy spells and light headedness in January 1990 which occurred frequently during the summer months. The examiner noted that the attacks have stopped since summer with treatment testing indicating negative findings with no change in follow-up examinations. During subsequent in-service examinations prior to separation, there are no examiner findings for an abnormal heart disorder, nor is there other in-service diagnosis of a heart murmur. On a post-service exam no murmur was noted. In a December 2020 VA heart examination, the examiner diagnosed the Veteran as negative for a heart disorder. The examiner noted that the Veteran was diagnosed with a heart murmur in-service. The examiner also noted that the Veteran reported experiencing light headedness after deployment and was seen by a medical doctor post-service around 1992/1993. The examiner opined that it is less likely than not that the Veteran's claimed heart murmur is related to her time in-service. The examiner explained that the Veteran's heart was found to be normal on a recent echocardiogram. The examiner also noted that the Veteran's December 2020 physical examination noted a murmur, but there was no evidence to support the diagnosis. In an echocardiogram dated January 2021, EF of 73 percent was noted with normal systolic function and mild aortic valve sclerosis without stenosis and no pathologic source of a murmur. The examiner also noted that the Veteran's mitral valve revealed no evidence of mitral valve regurgitation and no indication of aortic valve regurgitation with METS noted at 5-7. In a February 2021 VA addendum opinion to clear up the December 2020 heart examiners conflicting opinion, the examiner opined that it is less likely than not that the Veteran's aortic valve stenosis is etiologically related to the Veteran's military service, but at least as likely as not due to mitral regurgitation and prolapse. The examiner explained that the Veteran's heart disorder could be both aortic stenosis and mitral regurgitation which have symptoms that are alike, but during an examination, aortic stenosis is not likely heard and is usually only noted during an echocardiogram. The examiner also explained that mitral regurgitation can be heard during an examination and is at least as likely due to aortic stenosis. The examiner also opined that aortic stenosis is more than likely related to age and not due to service. Concerning the Veteran's heart murmur, the examiner opined that the Veteran's heart murmur is less likely than likely due to service and more likely due to aging. The examiner also opined that that the Veteran's mitral regurgitation is as least as likely as not due to service as it was documented in service and has continued since her time in service. Lastly, the examiner opined that the Veteran's aortic stenosis is at least as likely due to age and not due to regurgitation from service. The examiner explained that aortic stenosis is a disorder which is generally documented during an echocardiogram. The examiner also noted that an echocardiogram dated January 2021 documents an EF of 73 percent with normal systolic function and mild aortic valve sclerosis without stenosis and no pathologic source of a murmur. The examiner also noted that the Veteran's mitral valve was normal with no evidence of mitral valve regurgitation and no indication of aortic valve regurgitation with METS noted at 5-7. The foregoing summary of the treatment record reveals no possibility for service connection for bilateral hearing loss or tinnitus. Although the Veteran was diagnosed with trivial mitral regurgitation and mild tricuspid regurgitation with no evidence of valvular deformities, during subsequent in-service examinations prior to separation, there are no examiner findings for an abnormal heart disorder, nor is there an in-service diagnosis of a heart murmur. Her STRs do not report any complaints, diagnosis, or treatments for a chronic heart disorder. Moreover, the December 2020 VA heart examiner diagnosed the Veteran a negative for a heart disorder. The examiner explained that the Veteran heart was found to be normal on a recent echocardiogram. The Board also reviewed the Veteran's lay statements asserting that her cardiovascular disorder is related to her time in-service. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to her senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a cardiovascular disorder as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2020). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). While the Veteran was diagnosed with trivial mitral regurgitation and mild tricuspid regurgitation with no evidence of valvular deformities, there were no examiner findings for a chronic abnormal heart disorder. An incidental finding of a murmur in this case, according to the examiners, is not indicative of cardiovascular pathology. It was not consistently found and produced no disablement. As determined by the February 2021 examiner the Veteran's aortic valve stenosis is not etiologically related to the Veteran's military service, but at least as likely as not due to mitral regurgitation and prolapse. The examiner explained that the Veteran's heart disorder could be both aortic stenosis and mitral regurgitation which have symptoms that are alike, but during an examination, aortic stenosis is not likely heard and is usually only noted during an echocardiogram. The examiner also explained that mitral regurgitation can be heard during an examination and is at least as likely due aortic stenosis. The examiner opined that aortic stenosis is more than likely related to age and not due to service. Concerning the Veteran's heart murmur, the examiner opined that the Veteran's heart murmur is less likely than likely due to service and more likely due to aging. The examiner also opined that that the Veteran's mitral regurgitation is as least as likely as not due to service as it was documented in service and has continued since her time in service. Lastly, the examiner opined that the Veteran's aortic stenosis is at least as likely due to age and not due to regurgitation from service. The examiner explained that aortic stenosis is a disorder which is generally documented during an echocardiogram. The examiner also noted that an echocardiogram dated January 2021 documents an EF of 73 percent with normal systolic function and mild aortic valve sclerosis without stenosis and no pathologic source of a murmur. The examiner also noted that the Veteran's mitral valve was normal with no evidence of mitral valve regurgitation and no indication of aortic valve regurgitation with METS noted at 5-7. In summation, the examiner determined that the objective evidence demonstrates that the Veteran's aortic valve stenosis is attributed to aging and not mitral valve regurgitation or any other in-service injury or event. Lastly, as a pathology of a cardiovascular disorder was not shown until many years after separation, the Board finds no evidence to support the Veteran's contentions. Based on this evidence, the Board finds service connection is not warranted. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Elliot Harris 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.