Citation Nr: 22018499 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 17-19 845 DATE: March 29, 2022 REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, served on active duty from July 1968 to April 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In his April 2017 VA Form 9, the Veteran requested a hearing before the Board. However, the Veteran withdrew his request for a Board hearing in correspondence dated December 2021. The Board observes that additional VA treatment records were associated with the claims file after the RO's adjudication in the February 2019 Supplemental Statement of the Case (SSOC), without a waiver of initial RO consideration. See Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Public Law No. 112-154, 126 Stat. 1165 (amending 38 U.S.C. § 7105 to provide that if new evidence is submitted with or after a substantive appeal received on or after February 2, 2013, then it is subject to initial review by the Board unless the Veteran explicitly requests agency of original jurisdiction (AOJ) consideration). Nonetheless, since the Board is remanding the claim for further development and the entire claims file is to be reviewed by the VA examiner prior to rendering any opinion, there is no prejudice to the Veteran. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c) and 38 U.S.C. § 7107(b). 1. Entitlement to service connection for a bilateral hearing loss disability is remanded. The Veteran asserts he is entitled to service connection for a bilateral hearing loss disability. The Board finds that remand is necessary prior to appellate review of this claim. In the 1960s, the military changed its standard of measuring hearing acuity, replacing the American Standards Association (ASA) units with the current International Standards Organization/American National Standards Institute (ISO/ANSI) units. Prior to January 1, 1967, service departments are assumed to have used ASA units. Service departments are assumed to have changed to ISO/ANSI units after December 31, 1970. For the period between January 1, 1967, and December 31, 1970, VA is to consider the data under both the ASA and ISO/ANSI standards unless it is clearly indicated which units were used, and it will rely on the unit measurements most favorable to the Veteran's appeal. To convert audiometric data from the ASA standards to the ISO/ANSI standards, the following decibel amounts will be added to the recorded data: Hertz 250 500 1000 2000 3000 4000 6000 8000 add 15 15 10 10 10 5 10 10 In this matter, the Veteran was afforded a VA compensation examination in December 2016 and the examiner, an audiologist, opined that it is less likely as not that the Veteran's bilateral hearing loss disability is related to his military service. The examiner relied, in part, on the finding that the Veteran's hearing was essentially normal in service, with no significant threshold shifts. However, it is unclear whether the December 2016 VA examiner converted the audiometric data obtained during the Veteran's service from ASA to ISO/ANSI units. The Veteran's period of service fell between January 1, 1967, and December 31, 1970, so VA is to consider the data under both the ASA and ISO/ANSI standards unless it is clearly indicated which units were used. A December 1968 audiogram specifically notes "ASA" next to the audiometric data obtained, but it is not clearly indicated which units were used on audiometric testing during the Veteran's January 1968 induction examination and April 1970 separation examination. Furthermore, based on the rationale provided for the December 2016 VA medical opinion, it does not appear that the VA examiner considered the audiometric data obtained in January 1968 in reaching her opinion. Therefore, on remand, an additional medical opinion should be obtained which converts the Veteran's service audiometric data from ASA to ISO/ANSI units, and the VA examiner should consider the January 1968, December 1968, and April 1970 service audiometric data when providing an etiology opinion. Additionally, the Board requires clarification as to the question of preexistence. The December 2016 VA examiner checked the box indicating that hearing loss did not preexist the Veteran's service. Nonetheless, without even converting the audiometric data obtained during the Veteran's January 1968 induction examination, the Veteran is shown to have a hearing loss disability for VA purposes in his left ear, as the auditory threshold at 4000 hertz (Hz) was 40 decibels or greater (specifically, 50 decibels). After converting that same audiometric data to ISO/ANSI units, the Veteran is shown to have a hearing loss disability for VA purposes in both ears, since the auditory threshold at 4000 hertz (Hz) was 40 decibels or greater, bilaterally. Thus, the Board finds that, no matter which units were used in the January 1968 audiometric testing, the Veteran's left ear hearing loss disability existed prior to his active service. Because a preexisting left ear hearing loss disability was "noted" upon entrance to active service, service connection may be granted only if it is shown that the left ear hearing loss was aggravated by service; that is, if the left ear hearing loss was worsened in severity beyond its natural progression during service. On remand, the RO should obtain a medical opinion addressing these questions. In contrast, the question of whether a right ear hearing loss disability was "noted" on service entrance depends upon which units were used during the January 1968 induction examination. As discussed previously, the Board will rely on the unit measurements most favorable to the Veteran's appeal. In relying on the pre-conversion measurements from audiometric testing in January 1968, the Veteran's right ear hearing loss disability was not "noted" on service entrance. However, the January 1968 audiometric data does reveal an auditory threshold higher than 20 decibels in the right ear at 4000 Hz (specifically, 35 decibels), which shows some degree of hearing loss per Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Therefore, VA medical opinions should be obtained as to whether the Veteran's right ear hearing loss disability clearly and unmistakably preexisted service and/or was not aggravated by his service. Accordingly, the matter is REMANDED for the following action: 1. Obtain an addendum VA medical opinion regarding the nature and etiology of the Veteran's bilateral hearing loss disability. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner. If another examination is indicated, one should be provided to the Veteran. After a review of the entire claims file, the examiner is asked to respond to the following: (a) Convert the audiometric data obtained during the Veteran's January 1968, December 1968, and April 1970 examinations from ASA to ISO/ANSI units and report the results of such conversion. (b) Then, provide opinions as to the following: a. Regarding the Veteran's right ear hearing loss disability: i. Did the right ear hearing loss disability clearly and unmistakably exist prior to his entrance to service? ii. If the right ear hearing loss disability clearly and unmistakably existed prior to service, was it clearly and unmistakably NOT AGGRAVATED beyond its natural progression by the Veteran's service? iii. If the right ear hearing loss disability did not clearly and unmistakably exist prior to service, did it at least as likely as not (at least an approximate balance of positive and negative evidence) have its onset during the Veteran's service or is otherwise related to it? b. Regarding the Veteran's left ear hearing loss disability: i. Was the preexisting left ear hearing loss disability at least as likely as not (at least an approximate balance of positive and negative evidence) aggravated (permanently worsened) during his active service? ii. If so, was the increase in severity clearly and unmistakably due to the natural progression of the disease? A complete rationale must be provided for all opinions. 2. Thereafter, please review the addendum VA medical opinion(s) and ensure that all requested questions are fully answered by the examiner. If not, please take the appropriate corrective action. 3. Lastly, readjudicate the remanded claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. M. Gill, Associate 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.