Citation Nr: 21031457 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 17-20 673 DATE: May 21, 2021 ORDER Entitlement to service connection for left ear hearing loss is granted. FINDING OF FACT The Veteran's left ear hearing loss is attributable to a 1991 head injury that was proximately caused by his posttraumatic stress disorder (PTSD) symptoms. CONCLUSION OF LAW The criteria for service connection for left ear hearing loss have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. § 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION 1. Service connection for left ear hearing loss The Veteran contends that hearing loss in both his right and left ears is related to head injury in 1991 that was proximately caused by symptoms of his service-connected PTSD. Service connection may be established on a direct basis for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Aggravation of a non-service-connected disease or injury by a service-connected disability may also be service-connected. 38 C.F.R. § 3.310(b). For VA disability benefits purposes, impaired hearing is considered a disability when the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Court of Appeals for Veterans Claims (Court) has indicated that the Board of Veterans' Appeals (Board) must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran had active service from January 1968 to November 1970. In May 2016 he sought service connection for nerve deafness related to his PTSD. VA earlier had established service connection for his PTSD. In the course of the Veteran's claim and appeal, he explained that in May 1991 he sustained head injury, with skull fracture, subarachnoid hemorrhage, and subdural hematoma. He reported that he incurred the head injury in an altercation. He stated that the symptoms and manifestations of his PTSD included paranoia and impaired anger control. He asserted that those symptoms made him prone to fighting and contributed to causing the May 1991 altercation. In an August 2016 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for nerve deafness. The Veteran appealed that denial to the Board. In March 2019 the Veteran had a Board hearing, at the Board's headquarters, before the undersigned Veterans Law Judge. In August 2019 the Board remanded the hearing loss service connection issue for a VA mental health file review and examination with opinion as to the likelihood that the Veteran's mental disorder symptoms caused his involvement in the 1991 altercation. In a February 2020 VA examination, the examining psychologist expressed the opinion that the Veteran's PTSD symptoms at least as likely as not caused the 1991 altercation and resulting head injury. In a February 2020 rating decision, the RO granted service connection for right ear hearing loss and for tinnitus. The RO issued a supplemental statement of the case on the issue of service connection for left ear hearing loss. In the Veteran's examination at separation from service, on testing, in each of his ears, auditory thresholds at the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz were each under 26 decibels. The Veteran had private treatment in May and June 1991 following the head injury from the altercation. On audiological evaluation in June 1991, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 35 45 45 80 80 LEFT 5 10 20 50 50 In a private audiological evaluation in March 2005, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 45 50 60 95 95 LEFT 10 15 25 55 65 Speech recognition scores were 0 percent in the right ear and 88 percent in the left ear. Continued on next page In a private audiological evaluation in February 2006, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 45 55 50 85 85 LEFT 5 5 15 60 55 Speech recognition scores were 24 percent in the right ear and 76 percent in the left ear. On private audiological evaluation in February 2010, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 40 55 60 90 100 LEFT 10 10 20 60 60 Speech recognition scores were 14 percent in the right ear and 100 percent in the left ear. Continued on next page On VA audiological evaluation in June 2016, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 45 45 60 75 95 LEFT 10 5 20 25 35 Speech recognition scores were 32 percent in the right ear and 94 percent in the left ear. On VA testing in 2016 the Veteran's left ear hearing did not meet the 38 C.F.R. § 3.385 criteria for hearing impairment to be considered a disability. After the 1991 head injury, however, and on testing multiple times over subsequent years, his left ear hearing did meet the criteria for hearing impairment to be considered a disability. The tests that showed disabling left ear hearing impairment are sufficient to establishment that such disability existed following the head injury. The Board grants service connection for his left ear hearing loss. In combination with the service connection for right ear hearing loss that was established earlier, the Veteran's bilateral hearing loss is service connected. K. PARAKKAL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. J. Kunz, 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.