Citation Nr: 21042133 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-53 066 DATE: July 12, 2021 ORDER Entitlement to service connection for bilateral hearing loss is granted. FINDING OF FACT There is a balance of positive and negative evidence of record regarding whether the Veteran's bilateral hearing loss is related to his in-service noise exposure. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for entitlement to service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from December 1969 to January 1974. His claim comes before the Board of Veterans' Appeals (Board) on appeal of a November 2015 Department of Veterans Affairs (VA) rating decision. The Veteran testified in support of this claim during a hearing held before the undersigned Veterans Law Judge (VLJ) in July 2021. The transcript of this hearing is not yet available. However, this appeal meets the criteria for VA's one-touch initiative program, and as such, this decision is being prepared pursuant to such program. To provide an immediate response to the Veteran after his hearing, a transcript of the hearing will be added to the Veteran's file later, in the normal course of business. Service Connection Entitlement to service connection for bilateral hearing loss The Veteran seeks service connection for bilateral hearing loss on a direct basis as related to in-service noise exposure experienced while working as an aircraft mechanic. During his hearing, the Veteran testified that an August 1973 audiogram shows an in-service shift/decline in hearing. His spouse, to whom the Veteran has been married since 1971, testified that, since 1972, she has observed the Veteran's hearing difficulty. The Veteran requests that the Board afford him reasonable doubt in the resolution of his claim. The evidence supports this claim. 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. To satisfy the three-element test for service connection, the evidence must show: (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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be presumed for certain chronic conditions, including organic diseases of the nervous system, if one served continuously for 90 days or more during a period of war or during peacetime after December 31, 1946, and the condition manifested to a degree of at least 10 percent within one year of the date of discharge from service. 38 U.S.C. §§ 1101, 1112(a), 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Hearing impairment is to be considered 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. Here, post-service treatment records dated since 2015, an October 2015 VA examination report and a March 2019 opinion of a private Physician's Assistant confirm that the Veteran had bilateral sensorineural hearing loss. The question is thus whether this loss initially manifested during or within a year of the Veteran's active service or is otherwise related to such service. During service, including on entrance and separation examinations in June 1969 and August 1973, the Veteran did not report hearing difficulties, and examiners did not note hearing loss. Service records, including February 1970 Hearing Conservation Data (data), confirm that the Veteran served as an aircraft mechanic during that time, the duties of which exposed him to noise on the flight line and in the hangar shop. This data reflects that, while working in this capacity, the Veteran did not wear ear protection. The Veteran presented with ear pain on multiple occasions but never mentioned hearing difficulties; examiners attributed the pain to earwax. On separation examination conducted in August 1973, the Veteran reported that he had had ear, nose or throat trouble, but again, he did not mention hearing difficulties. Comparing audiograms conducted in December 1969, on entrance examination, and in August 1973, on separation examination, the Veteran had increased threshold shifts of between 10 and 15 decibels across all hearing parameters. Two medical professionals have addressed whether the Veteran's bilateral hearing loss is related to his active service, including the noise exposure. In October 2015, a VA examiner reviewed the Veteran's service records and concluded that the hearing loss is less likely than not caused by or the result of an in-service event. The examiner based this conclusion on the following findings: (1) The Veteran had normal hearing on enlistment and separation; (2) He now has diabetes, a condition known to have hearing loss as a co-morbidity; (3) He is 64; and (4) Thirty percent of people over the age of 60 have age-related hearing loss. (Continued on the next page) In March 2019, HC, a private Physician's Assistant, reviewed the Veteran's claims file and prepared a comprehensive written opinion complete with well-reasoned rationale and supporting medical literature. She concluded that the Veteran's sensorineural hearing loss is at least as likely as not service connected. She explained that the Veteran had a very plausible mechanism of injury with daily in-service exposures to high frequency and high decibel aircraft noise. She based her conclusion relating the hearing loss to this injury on the following findings: (1) The Veteran served as an aircraft mechanic; (2) From enlistment to separation, there are clear and documented standard threshold shifts across all hearing parameters bilaterally; (3) Per OSHA criteria, such a shift should be documented if it changed an average of at least 10 decibels; (4) Although the Veteran did not complain of hearing loss while in service, his military occupational service duties were highly probable for hazardous noise exposure; (5) He was frequently or constantly exposed to high impulse noises such as daily jet engine sounds and mechanical and aircraft equipment; (6) Although he reported wearing hearing protection, he was subjected to extremely loud noises that protection could not supersede; (7) He had no other recreational, medication or occupational exposures that would contribute to hearing loss; (8) His only known contributing factors are age and diabetes, but the diabetes is well controlled with diet and exercise; (9) The Veteran reported that he noticed hearing difficulties shortly after service but did not seek an evaluation, which is common, as most people do not seek treatment until hearing loss begins interfering with their daily living; and (10) Noise-induced hearing loss can be caused by one-time exposure to an intense impulse sound or by continuous exposures to loud sounds over a period of time, and often, hearing damage from such exposure is gradual, going unnoticed until it becomes pronounced. There is clearly a balance of positive and negative evidence of record on the matter of whether the Veteran's bilateral hearing loss is related to his in-service noise exposure. As such, on the nexus question, reasonable doubt must be resolved in the Veteran's favor. 38 U.S.C. § 5107(b) (when there is approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA will resolve reasonable doubt in claimant's favor). The criteria for entitlement to service connection for bilateral hearing loss are met. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. N. 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.