Citation Nr: 22016377 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 15-44 388 DATE: March 22, 2022 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1967 to January 1970. In October 2020, the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) remanded this issue to the VA Regional Office (RO) for additional development; the claims file has been returned to the Board for adjudication. Entitlement to service connection for bilateral hearing loss is remanded. The Board, in its October 2020 remand, determined that the August 2014 VA etiological opinion of record, that the Veteran's bilateral hearing loss was less likely related to service on the basis that there were no auditory threshold shifts noted at separation, was inadequate. The Board sought an opinion that did not rely exclusively on the lack of diagnosed hearing loss while in service. In a March 2021 Disability Benefits Questionnaire (DBQ), the Veteran reported in-service noise from gunfire on the shooting range for qualification with hearing protection. The Veteran reported his post-service occupational noise as working in an auto factory with hearing protection and working at a telephone company which was quiet. He reported his post-service recreational noise as hunting once yearly and riding motorcycles with stock mufflers for years. When asked to report as to the onset of his bilateral hearing loss, the Veteran asserted that none was noticed. The examiner reported that there was no significant permanent shift in hearing thresholds beyond test variability from enlistment to separation and such served as objective evidence that there was no permanent auditory damage during service from conceded noise exposure. The examiner reported that there was no complaint of or treatment for decreased hearing during service or at separation from service. The examiner discussed that while noise exposure during service is conceded and the relationship between noise, auditory damage, and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise alone and there must be a nexus of auditory damage to relate any current hearing loss to military noise exposure and not another etiology. The examiner concluded that the evidence was against such a nexus and it was less likely that the Veteran's bilateral hearing loss was related to service. In a March 2021 addendum opinion, the examiner reported that the Veteran had normal hearing at entry and separation from service and his hearing loss shown on VA examination in August 2014 was consistent with loss seen with presbycusis or the aging of the hearing organ. The examiner reported that it had been over 50 years since separation from service and the Veteran currently demonstrates excellent speech recognition and does not feel that he has hearing problem. The examiner reported that the Veteran's military occupational specialty (MOS) of military police has a moderate probability of noise exposure, however, the Veteran reported that he wore hearing protection. The examiner opined that as the Veteran did not complain of hearing problems currently or during service, and is 73 years old at the time of his latest auditory testing, it was less likely that his current bilateral hearing loss is related to service. The Board seeks additional medical comment on this issue. It appears that the VA examiner, in the March 2021 DBQ and March 2021 addendum opinion, continued to base the negative etiological opinion on the lack of diagnosed hearing loss during service and bases the opinion currently on the lack of in-service complaints for decreased hearing acuity. Of note is the examiners conclusion, in the March 2021 addendum opinion, that the Veteran had normal hearing at entry and separation from service. The Veteran's service treatment records include reports of his auditory testing conducted in August 1966, at the time of his entry into service, in January 1967, and in November 1969, at the time of his separation from service. In August 1966 and in January 1967, the Veteran's puretone thresholds, in decibels, for the right ear, were reported as 10 (25), 5 (15), 5 (15), 15 (20), and for the left ear, were reported as 15 (30), 15 (25), 15 (25), 10 (15), at, each measured at 500 Hertz, 1000 Hertz, 2000 Hertz, and 4000 Hertz, respectively. In November 1969, the Veteran's puretone thresholds, in decibels, for the right and left ears, were reported as 0 (15), 0 (10), 0 (10), 0 (5), each measured at 500 Hertz, 1000 Hertz, 2000 Hertz, and 4000 Hertz, respectively. However, because the Veteran's August 1966 audiogram is dated prior to January 1, 1967, it must be converted from American Standards Association (ASA) units to units established by the International Standards Organization (ISO)-American National Standards Institute (ANSI). The Veteran's January 1967 and November 1969 audiograms do not specify whether the puretone thresholds were recorded using ASA units or ISO-ANSI units. For service department audiograms dated between January 1, 1967, to December 31, 1970, the Board policy is to consider the audiogram under both standards, and rely on the unit measurements most favorable to the Veteran. The converted results of the instances of in-service audiometric testing are represented in parentheses above. As the threshold for normal hearing is from 0 to 20 decibels and higher threshold levels indicate some degree of hearing loss, the VA examiner's opinion, in the March 2021 addendum opinion, that the Veteran had normal hearing at entry and separation from service, requires explanation. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). It appears that the VA examiner did not convert the results of the Veteran's in-service auditory testing to the proper standard. Remand is required in order the make certain the correct medical facts are before the VA examiner in connection with any adequate etiological opinion. The matters are REMANDED for the following action: Forward the claims file to the VA examiner who conducted the March 2021 DBQ, or a suitable substitute, and obtain an adequate etiological opinion that responds fully to the Board's inquiries below. If any examiner determines that additional physical examination is required, so schedule the Veteran. The examiner must review the claims file and provide complete rationale to support any opinion rendered. The examiner must opine as to whether it is at least as likely as not (at least 50 percent probability) that the Veteran's bilateral hearing loss is related to his conceded in-service acoustic trauma? The examiner is advised that it is not sufficient to base an etiological opinion on a mere lack of documentation of complaints of decreased hearing in the service or post-service treatment records. In providing the requested opinion, the examiner must consider and discuss: (1) the converted results of the Veteran's in-service auditory testing, provided above, and the March 2021 addendum opinion that the Veteran had normal hearing at entry and separation from service; (2) the threshold for normal hearing is from 0 to 20 decibels and higher threshold levels indicate some degree of hearing loss; (3) the Veteran's description of his in-service noise exposure from gunfire on the shooting range for qualification with hearing protection and exposure to combat conditions with artillery and mortar fire as a military police officer; and (4) and his post-service noise exposure from hunting once yearly and riding motorcycles with stock mufflers for years. The examiner is advised that if there is any medical reason to accept or reject the proposition that the Veteran's reported in-service noise exposure represented the onset of his current bilateral hearing loss, this should be noted. Stated another way, is the Veteran's general assertion that his current bilateral hearing loss is related to his in-service noise exposure align with how his current bilateral hearing loss is known to develop or is the Veteran's general assertion generally inconsistent with medical knowledge or implausible? P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Department of Veterans Affairs 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.