BVA9507378 DOCKET NO. 90-46 510 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for hiatus hernia. 2. Entitlement to service connection for skin cancer. 3. Entitlement to service connection for disorder manifested by coughing and choking. 4. Whether new and material evidence has been received to reopen the claim for entitlement to service connection for dengue fever. 5. Entitlement to service connection for disorder manifested by blood in the urine. 6. Entitlement to service connection for post-traumatic arthritis of the back and the left wrist. 7. Entitlement to service connection for hearing loss. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. R. Olson, Counsel INTRODUCTION The veteran's active military service extended from September 1940 to May 1946. He was held as a prisoner of war by the Japanese government from April 1942 to September 1945. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 1987 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. That rating decision, in part, denied service connection for hiatus hernia, skin cancer, stomach ulcer, a disorder manifested by coughing and choking, dengue fever, a disorder manifested by blood in the urine, and post-traumatic arthritis of the back and the left wrist. A January 1990 rating decision by the St. Petersburg RO denied service connection for a hearing loss. The Board remanded the appeal in July 1991 for neurological examination of the veteran and for medical opinions. The requested development has been completed. The RO granted service connection for peripheral neuropathy of the left lower extremity, rated as 10 percent disabling, and for peripheral neuropathy of the right lower extremity, rated as 10 percent disabling, in a rating decision in December 1991. The representative's informal hearing presentation of September 1994 questioned the effective date of service connection for peripheral neuropathy. That issue has not been developed for consideration by the Board and is referred to the RO. In a letter dated in February 1992, the veteran explained that the term "ulcer" was a mistake and that he was seeking an increased rating for his service-connected irritable bowel syndrome. I accept the veteran's letter as the written withdrawal of the claim for service connection for a stomach ulcer. The increased rating claim has not been developed for appellate consideration and is not properly before the Board at this time. Recent correspondence in the claims folder also indicates that the veteran may be seeking increased ratings for other service-connected disabilities. These matters are referred to the RO for appropriate action. The veteran has recently asserted that he has possible nutritional amblyopia, ischemic heart disease, and injury residuals of the right elbow, right shoulder and neck as the result of his prisoner of war experience. Issues pertaining to these disabilities have not been developed for appellate consideration and are not properly before the Board at this time. They are referred to the RO for appropriate disposition. As the development requested in the Board's previous remand has been completed, the Board now proceeds with its review of the remaining issues on appeal. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO committed error in denying service connection for a hiatus hernia, skin cancer, a disorder manifested by coughing and choking, dengue fever, a disorder manifested by blood in the urine, post-traumatic arthritis of the back and the left wrist, and a hearing loss. He argues that he has the claimed disabilities as a result of combat and the hardships and deprivations he experienced while a prisoner of war. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against service connection for a hiatus hernia. The veteran has not submitted well-grounded claims for service connection for skin cancer, a disorder manifested by coughing and choking, a disorder manifested by blood in the urine, or post-traumatic arthritis of the left wrist. The veteran has not submitted new and material evidence to reopen a claim of service connection for dengue fever. The evidence supports service connection for post- traumatic arthritis of the lumbar spine and for hearing loss. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. A hiatus hernia was not present during service or for many years thereafter. 3. The hiatus hernia demonstrated in 1968 was not the result of disease or injury during the veteran's active military service. 4. Skin cancer is not shown at any time during or after service. 5. A disability resulting from disease or injury manifested by coughing and choking was not present during service or manifested after service. 6. The RO denied service connection for dengue fever in June 1946. 7. The veteran was notified of the denial of service connection for dengue fever in June 1946 and did not appeal this decision. 8. The additional evidence received since the June 1946 rating decision reiterates that the veteran had dengue fever in service and does not contain a diagnosis of dengue fever or medical identification of its residuals. 9. A disability resulting from disease or injury manifested by blood in the urine was not present during service or manifested after service. 10. The veteran is a former prisoner of war, interned for at least 30 days, who has post-traumatic arthritis of the lumbar spine manifested by x-ray findings and some limitation of motion of the spine. 11. Post-traumatic arthritis of the left wrist is not shown during or after service. 12. The veteran's current hearing loss is the result of noise exposure during his prisoner of war experience in service. CONCLUSIONS OF LAW 1. A hiatus hernia was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1994). 2. The veteran has not submitted a well grounded claim for service connection for skin cancer. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran has not submitted a well-grounded claim for service connection for a disorder manifested by coughing and choking. 38 U.S.C.A. § 5107(a) (West 1991). 4. The decision of the RO in June 1946 denying service connection for dengue fever is final. 38 U.S.C.A. § 7105(c) (West 1991). 5. The evidence received since the RO denied service connection for dengue fever in June 1946 is not new and material and the veteran's claim for that benefit has not been reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156 (1994). 6. The veteran has not submitted a well-grounded claim for service connection for a disorder manifested blood in the urine. 38 U.S.C.A. § 5107(a) (West 1991). 7. Post-traumatic osteoarthritis of the lumbar spine was incurred in active military service. 38 U.S.C.A. §§ 101(16), 1110, 1112(b), 1154, 5107(b) (West 1991); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (1994). 8. The veteran has not submitted a well-grounded claim for service connection for post-traumatic osteoarthritis of the left wrist. 38 U.S.C.A. § 5107(a) (West 1991). 9. A hearing loss was incurred in active military service. 38 U.S.C.A. §§ 101(16), 1110, 1154 (West 1991); 38 C.F.R. §§ 3.303, 3.304(d),(e) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Preliminary Considerations The veteran's claims that are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991) have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 1991). Satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation. Service connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. § 3.304(d) (1994). Where disability compensation is claimed by a former prisoner of war, omission of history or findings from clinical records made upon repatriation is not determinative of service connection, particularly if evidence of comrades in support of the incurrence of the disability during confinement is available. Special attention will be given to any disability first reported after discharge, especially if poorly defined and not obviously of intercurrent origin. The circumstances attendant upon the individual veteran's confinement and the duration thereof will be associated with pertinent medical principles in determining whether disability manifested subsequent to service is etiologically related to the prisoner of war experience. 38 C.F.R. § 3.304(e) (1994). If a veteran is (1) a former prisoner of war and; (2) as such was interned or detained for not less than 30 days, post-traumatic osteoarthritis shall be service connected if manifested to a degree of 10 percent or more at any time after discharge or release from active military service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 C.F.R. § 3.307 are also satisfied. 38 U.S.C.A. § 1112(b) (West 1991); 38 C.F.R. § 3.309(c) (1994). I. Hiatus Hernia The veteran contends that a hiatus hernia was incurred as a result of beatings he received while a prisoner of war. The hardships experienced by the veteran during service and the post service finding of a hiatus hernia make this a plausible claim. The evidence of a hiatal hernia consists of records of private hospitalization for chest pain in July and August 1968, which show that the veteran had experienced the chest pain when he lay down and that he had experienced it about 10 days earlier. An upper gastrointestinal x-ray study disclosed a small, sliding type hiatus hernia with marked gastroesophageal reflux. There are also references in VA treatment records in January and December 1986 to symptoms attributed to a hiatal hernia. The service medical records show that the veteran had gastrointestinal complaints, such as poor appetite and stomach rumbling, following his repatriation, but contain no reference to a hiatal hernia. After service, further gastrointestinal complaints led to private and VA hospitalizations in February 1947. Amoebic colitis and an inguinal hernia were found. The hernia was surgically repaired and outpatient treatment provided for the colitis. Continued gastrointestinal symptoms resulted in readmission to a private hospital in October 1947; upper gastrointestinal x-ray studies were reported as normal. Examination and testing did not disclose any organic basis for the veteran's gastrointestinal troubles. VA gastrointestinal examinations in January 1950 and July 1959 did not disclose any pertinent abnormalities. The hiatal hernia was not reported on studies after the 1968 hospitalization. It is noteworthy that there was no mention of a hiatal hernia in December 1972, when repairs were done for other hernias -- an umbilical hernia, a right direct inguinal hernia, left direct and indirect inguinal hernias, and a left femoral hernia. Also, the report of a May 1984 VA upper gastrointestinal series specifies that there was no evidence of a hiatal hernia. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 1991). This requires a current disability, and a current hiatal hernia has not been demonstrated. Further, even if the hiatal hernia manifested in 1968 is still present, the evidence does not establish that it resulted from disease or injury during service. The hiatal hernia was first manifested approximately 22 years after the veteran left service. During that time, he had been repeatedly examined for gastrointestinal complaints and none of the examiners reported a hiatal hernia. Moreover, while the veteran had numerous complaints and symptoms, the chest pain, particularly on lying down, was not manifested until 1968. The veteran lacks the requisite expertise to relate his beatings during his captivity to a hiatal hernia manifested many years later, see Espiritu v. Derwinski, 2 Vet.App. 492 (1992); Grottveit v. Brown, 5 Vet.App. 91 (1993), and there is no medical evidence linking the 1968 hiatal hernia to his prisoner of war experiences. Although I do not doubt the veteran's prisoner of war experiences, the evidence does not establish a link between a current hiatus hernia disability and the circumstances of the veteran's combat service or his prisoner of war experience. Consequently, service connection for a hiatus hernia must be denied. 38 U.S.C.A. §§ 101(16), 1110, 1131, 1154 (West 1991); 38 C.F.R. §§ 3.303, 3.304(d),(e) (1994). II. Skin Cancer The veteran's claim for service connection for skin cancer is not well grounded and must be dismissed. In a manuscript submitted with his appeal in November 1988, and again at his hearing in April 1989, the veteran referred to an area on his lip or mouth that he suspects is skin cancer. The record, however, does not contain any medical evidence of the existence of skin cancer. The service medical records do not refer to skin cancer, and the veteran's skin was normal on the May 1946 examination for separation from service. After service, skin abnormalities noted include dermatitis on the veteran's hands, noted during a January 1950 VA examination; fungus on both feet, noted during a VA examination in April 1984; and actinic keratosis, excised from the veteran's left wrist in June 1985, as shown by VA treatment records. On other occasions, such as a June 1981 VA examination, no skin abnormalities were recorded. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110 (West 1991); 38 C.F.R. § 3.303 (1994). Skin cancer may be presumed to have been incurred during active military service if it is manifest to a degree of 10 percent within the first year following active service. 38 U.S.C.A. §§ 1101, 1112 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). The veteran has a responsibility to submit evidence to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). That is, there must be some evidence of record to indicate a plausible claim. There is no such evidence here. Despite the many medical reports, there is no competent medical evidence that the veteran has or ever had skin cancer. Consequently, the claim is not plausible. III. Coughing and Choking Although the veteran may experience coughing and a choking sensation, service connection is not granted for such manifestations per se, but for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 1991). Here again, the service medical records do not establish the existence of a disease or injury manifested by coughing or choking in service. After service, the record shows that the veteran has been repeatedly examined over the years by private and VA physicians. They have not reported any disease or injury manifested by coughing and choking. There is no plausible evidence that the veteran has such a disorder, nor that it resulted from disease or injury during service. This claim is not well grounded and must be dismissed. 38 U.S.C.A. §§ 101(16), 1110, 1131, 1154, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.304(d),(e) (1994). IV. Dengue Fever Dengue fever or its residuals were not noted when the veteran was examined in September 1945 or during his October 1945 hospitalization. When he was examined for separation from service in May 1946, he reported having had dengue fever. The examiners did not report any active symptoms at that time. In June 1946, the RO denied service connection for dengue fever as not found on examination. The veteran was informed of this action by a letter dated in June 1946 and a timely appeal is not of record. Unappealed decisions by the RO become final. 38 U.S.C.A. § 7105(c) (West 1991). A final decision on a claim may be reopened and the claim reconsidered on the basis of all the evidence of record, if new and material evidence is submitted. 38 U.S.C.A. § 5108 (West 1991). New and material evidence means evidence not previously submitted to agency decision makers that bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156 (1994). To be "new," additional evidence must be more than merely cumulative. The additional evidence must also be "material." That is, it must be relevant and probative and there must be a reasonable possibility that, when viewed in the context of all the evidence both new and old, the additional evidence would change the outcome. See Manio v. Derwinski, 1 Vet.App. 140, 145 (1991), Colvin v. Derwinski, 1 Vet.App. 171, 174 (1991). In 1950, the veteran submitted a 1949 notarized statement by Edward L. DeGroot, a fellow prisoner of war. The statement referred, in part, to the veteran's recurrent bouts of dengue fever, which the veteran contracted in 1944. This, and other statements referring to the veteran having suffered from dengue fever while a prisoner of war, are cumulative of his report of having suffered from dengue fever, which was recorded on examination for separation from service and considered in 1946. What is needed to establish his claim for service connection for dengue fever is credible evidence that he has residual disability resulting from dengue fever or, alternatively, that he still suffers from the active disease. Many medical reports have been added to the file since 1946. None of them show dengue fever or its residuals. The veteran asserts that he has a low white blood cell count as a result of the dengue fever during service. He is not a medical expert and is, therefore, not qualified to present credible evidence as to whether there are current manifestations of dengue fever. See Espiritu; Grottveit. Therefore, his statements are not new and material evidence. The medical records do not indicate that a low white blood cell count was attributed to dengue fever. Since the veteran has not presented new and material evidence, the prior denial remains final. V. Blood in the Urine The claim of service connection for a disorder manifested by blood in the urine is not well grounded. The service medial records do not report any such disorder, and his genitourinary system was described as normal on several examinations after his captivity, including the May 1946 examination for separation from service. A VA urology consultation report from July 1984 indicates that the veteran reported that 2 to 3 years earlier he had noted bloody spots in his underwear. A physician had attributed them to a urinary infection and had treated the veteran successfully with antibiotics. The same problem was said to have recurred once a month before the consultation. Examination included an urinalysis that was negative. The veteran returned in August 1984 and reported that the symptom had not recurred. Subsequent VA clinical notes and other medical records do not show any recurrence of the symptom. There is no medical evidence linking this symptom to service. Although I do not doubt that the veteran noted blood in his urine following beatings as a prisoner of war, the veteran is not a medical expert and is, therefore, not qualified to present credible evidence as to whether he has a disease or injury manifested by this symptom. See Espiritu; Grottveit. There is no plausible evidence in the record that establishes that he now has a disability resulting from disease or injury, incurred in service, manifested by blood in the urine. Therefore, this claim is not well grounded and must be dismissed. 38 U.S.C.A. §§ 101(16), 1110, 1131, 1154, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.304(d),(e) (1994). VI. Post-Traumatic Arthritis of the Back The veteran's combat and prisoner of war service, as well as the information he has provided and recent medical findings, would lead a fair and impartial individual to believe the claim for post-traumatic arthritis of the back is plausible. In a letter dated in February 1947, the veteran reported having back pain since service, which he attributed to hard manual labor and the conditions in the prison camps. In March 1947, he told a VA neuropsychiatric examiner that he had suffered from back aches since working in the mines while a prisoner, although he did not report any specific incident of back trauma. The veteran again reported back complaints at a July 1954 VA neuropsychiatric examination. He stated that the lower part of his back was weak all the time and that he could hardly do manual labor. His back became tired with climbing, etc. There was no radiation. Chiropractic treatment helped. The examiner specified that the veteran was never injured. On the July 1959 VA examination, the veteran reported private treatment for a back condition. The report of the July 1981 VA examination shows that the veteran reported painful joints all over. The examiner considered the veteran's spine mobility to be fair. X-ray studies of the lumbosacral spine revealed minimal osteoarthritis changes in the lumbar segments. There was very minimal wedging of the body of the 3rd, which the radiologist concluded was "probably on the basis of old trauma." VA clinical notes show that the veteran continued to experience low back pain. A May 1989 rehabilitation medicine service consultation report shows that a transcutaneous electric nerve stimulator was recommended for pain and tenderness in the lumbosacral spine area and in the right paraspinal muscles. The report of a VA consultation later in May 1989 shows that the veteran reported having pain in the lumbosacral spine area since working in a Japanese coal mine in 1944. He also reported beatings. Evidence against the claim of service connection for post- traumatic arthritis of the back includes the service medical records, which do not contain any reports of back injuries. Pertinent findings on the examinations in 1945 and 1946 were normal. In addition, the report of the veteran's VA hospitalization from February 1947 into April 1947 shows that the veteran was examined, but contains no back findings or diagnoses. A thorough examination was also performed during the veteran's hospitalization at a private facility in October 1947 for gastrointestinal complaints. There were no back complaints or findings recorded. Likewise, there were no back complaints or abnormal findings on the January 1950 VA examination. Subsequent to the x-ray findings in 1981, the impression recorded in a July 1984 report of x-rays of the lumbar spine was narrowing of the L4-5 interspace with eburnation, considered compatible with intervertebral disc disease at that level, and mild hypertrophic lipping throughout, otherwise, normal lumbosacral spine. Similarly, a radiology report of March 1989 shows osteophytosis involving L2 to L5 and slight posterior wedging of all the disc spaces. The impression was mild degenerative lumbar spondylosis with probably multi-level disc derangement. Because the veteran is a former prisoner of war, the service medical records which show no back complaints and normal musculoskeletal findings are not determinative. See 38 C.F.R. § 3.304(e). The veteran and his fellow prisoners of war have described his arduous labor in the coal mines; some comrades have specifically mentioned that the veteran suffered from back pain then. The veteran has also reported beatings, in addition to the arduous labor. Because the veteran was interned for at least 30 days, there is a presumption of service connection for post- traumatic osteoarthritis manifested to a degree of 10 percent at any time. 38 U.S.C.A. § 1112(b) (West 1991); 38 C.F.R. § 3.309(c) (1994). This degree of disability would require x-ray evidence of the post-traumatic osteoarthritis and some limitation of motion, objectively confirmed. See 38 C.F.R. § 4.71a, codes 5003, 5010 (1994). In this case, there is x-ray evidence in 1981 of post-traumatic changes in the spine. The description of the mobility of the spine as "fair," in the absence of range of motion recorded in degrees, will suffice to establish at least some limitation of motion. Accordingly, on the basis of the statutory and regulatory presumption, which has not been rebutted by affirmative evidence to the contrary, 38 C.F.R. § 3.307(d), I conclude that the veteran has traumatic arthritis of the lumbar spine as a result of injury while he was a prisoner of war during service. 38 U.S.C.A. §§ 101(16), 1110, 1112 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309(c) (1994). VII. Post-Traumatic Arthritis of the Left Wrist The RO, in part, denied service connection for residuals of fracture of the left wrist by a rating decision in July 1985. The veteran was notified of this decision by a letter dated in August 1985. He did not appeal this decision, which became final. See 38 U.S.C.A. § 7105(c) (West 1991). The claim for post-traumatic arthritis of the left wrist is based on the same incident in which the veteran has claimed that the wrist was broken while he was a prisoner of war. Both the RO and the veteran, however, have treated the current claim for arthritis of the left wrist as separate and distinct from the earlier denial of service connection for residuals of a fractured left wrist, rather than as an attempt to reopen a claim for service connection for residuals of a fracture of the left wrist. Because the veteran is a former prisoner of war interned for at least 30 days, there is a presumption of service connection for post-traumatic osteoarthritis manifested to the required degree at any time. 38 U.S.C.A. § 1112(b) (West 1991); 38 C.F.R. § 3.309(c) (1994). The veteran's statements that he has post- traumatic arthritis of the left wrist cannot be considered as credible evidence as to whether he has post-traumatic osteoarthritis, as he is not a medical expert. See Espiritu; Grottveit. The wrist fracture was first medically reported on the July 1981 VA examination. The examiner noted a marked deformity of the left wrist. X-ray studies of the left wrist showed a separation of the styloid process of the ulnar bone, apparently from an old fracture. There were also minimal arthritic changes involving the metacarpocarpal articulations and the carpocarpal articulations. The radiologist did not identify these changes as traumatic arthritis. The veteran has been examined and treated on numerous occasions since that time. While the deformity and wrist fracture residuals were noted, the examining physicians did not diagnosis a post-traumatic osteoarthritis of the wrist. There is no medical evidence of the presence of post-traumatic osteoarthritis of the left wrist. Therefore, the claim is not well grounded. VIII. Hearing Loss The veteran asserts that he sustained a hearing loss as a result of exposure to noise while serving in a tank in combat and later using a jack hammer in a coal mine while a prisoner of war. Exposure to noise is consistent with the combat and prisoner of war experiences that the veteran has described. 38 U.S.C.A. § 1154 (West 1991); 38 C.F.R. § 3.304(d),(e) (1994). He has also submitted several statements from fellow prisoners of war. Some of these mention the veteran's work in a coal mine and one, dated in May 1988 from Benson Guyton, refers specifically to the veteran having operated a jackhammer in the coal mine while a prisoner of war. The service medical records show that the veteran's hearing was measured during the September 1945 examination as 15/15 bilaterally for whispered voice. In October 1945, the veteran reported that he had an ear infection for about 6 months while he was a prisoner. He had had no trouble for 18 months. The ear became sore the day before he was examined. He was examined by a physician specializing in ears. Wax was found and removed. There was no inflammation of the external auditory canals or tympanic membranes. Measurement of hearing was 15/15 bilaterally for whispered voice on the May 1946 examination for separation from service. The hearing measurement on the January 1950 VA examination was 20/20 bilaterally for conversational voice. On the July 1981 VA examination, the veteran's ears were normal and no hearing loss was noted. The earliest information on a hearing loss is dated in 1983. In December 1983, the veteran was seen by a VA specialist. The veteran reported that others felt he had problems with his hearing. He gave a history of noise exposure. He reported a high frequency tinnitus in both ears. Examination of the ear canals and tympanic membranes demonstrated no abnormalities. Audiometry revealed a mild to severe hearing loss. The assessment was a high frequency hearing loss probably from noise exposure. The February 1990 VA audiology evaluation also showed a hearing loss. It was noted that the veteran had experienced noise exposure during World War II, while a prisoner of war. The pure tone audiometic test results in decibels are reported in the following table: DATE EAR 500Hz 1000Hz 2000Hz 3000Hz 4000Hz 12/83 right 10 10 30 60 65 left 15 15 30 60 65 2/90 right -10 -5 45 55 60 left 25 20 40 60 60 The criteria for hearing loss disability are set out at 38 C.F.R. § 3.385 (1994), which was effective May 3, 1990. The veteran's claim for service connection for hearing loss was received by VA on January 8, 1990. Consequently, 38 C.F.R. § 3.385 cannot be applied to deny the veteran's claim. See Karnas v. Derwinski, 1 Vet.App. 308, 312-313 (1991). The reported test results for pure tone audiometry fall within the bounds for which hearing status shall be considered service connected under 38 C.F.R. § 3.385 by two measures: the thresholds at the above-reported required frequencies are not all less than 40 decibels, and there are not at least three frequencies for which the threshold is 25 decibels or less. Accordingly, I conclude that the record does demonstrate that the veteran has a hearing loss for which service connection may be considered. I must next determine whether that hearing loss was incurred in service. As set forth above, omission of history or findings from clinical records made upon repatriation is not determinative of service connection, particularly if evidence of comrades in support of the incurrence of the disability during confinement is available. I must give special attention to any disability first reported after discharge, especially if poorly defined and not obviously of intercurrent origin. I must associate the circumstances and duration of the veteran's confinement with pertinent medical principles to determine whether disability manifested subsequent to service is etiologically related to the veteran's prisoner of war experience. 38 C.F.R. § 3.304(e) (1994) In this case, the first audiometric test results of record, albeit nearly 40 years after the veteran's service, demonstrate a hearing loss that was considered "probably" due to noise exposure. Clearly, the veteran's labors with a jackhammer in a coal mine while he was a prisoner of war would constitute noise exposure. I acknowledge that his post-service employment in a meat packing plant might also have exposed him to a significant level of noise. When, however, the hearing loss is not obviously of intercurrent origin and is consistent with the circumstances of his prisoner of war experience, I conclude that the evidence favors granting service connection for hearing loss as a result of the veteran's service. 38 U.S.C.A. §§ 101(16), 1110, 1154 (West 1991); 38 C.F.R. §§ 3.303, 3.304(d),(e) (1994). ORDER Service connection for a hiatus hernia is denied. The claims for service connection for skin cancer, a disorder manifested by coughing and choking, a disorder manifested by blood in the urine, and post-traumatic arthritis of the left wrist are dismissed. New and material evidence not having been submitted to reopen a claim of service connection for dengue fever, the appeal for the benefit is dismissed. Service connection for post-traumatic osteoarthritis of the lumbar spine and for hearing loss is granted. MARY GALLAGHER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.