BVA9507966 DOCKET NO. 93-13 673 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUE Entitlement to service connection for bilateral hearing loss. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. K. Mulroy, Associate Counsel INTRODUCTION The veteran had active duty from September 1966 to September 1968. In a rating decision dated in March 1992, the Baltimore, Maryland, Regional Office (hereinafter the RO) denied service connection for bilateral hearing loss. The veteran has appealed to the Board of Veterans' Appeals (hereinafter the Board) and is representing himself in this matter. The Board notes that the veteran was not provided with one of the relevant regulations regarding service connection for hearing loss, 38 C.F.R. § 3.385 (1994), in the Statement of the Case, or in the Supplemental Statement of the Case. In light of the Board's decision below, a remand to correct this omission is not necessary. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that as a turbine helicopter mechanic during service, he was exposed to excessively loud noises, particularly the helicopters themselves, and also machine gun fire and mortars, which have resulted in a bilateral hearing loss disability. He maintains that his hearing has been decreasing since service. He also asserts that his hearing loss was evident on an examination during service, although his separation examination revealed no hearing loss. He has stated that he does not recall undergoing a hearing test upon separation. 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(s). 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 service connection for bilateral hearing loss is warranted. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained. 2. Bilateral hearing loss is causally related to in-service acoustic trauma. CONCLUSION OF LAW Bilateral hearing loss is attributable to service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.385 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the veteran's claim is well-grounded within the meaning of 38 U.S.C.A. § 5107. That is, the Board finds that the veteran has presented a claim that is plausible. The Board is satisfied that all reasonable efforts have been made in helping the veteran prove his claim. There is no indication of outstanding evidence and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. In determining whether service connection is warranted, the Department of Veterans Affairs (hereinafter the VA) is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case, the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet.App. 49 (1991). Service connection may be established for disability resulting from injury suffered or disease contracted in the line of duty, or for aggravation of a pre-existing injury or disease. 38 U.S.C.A. § 1110. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Impaired hearing will be considered to be 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, 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 (1994). Audiometric testing measures threshold hearing levels (in decibels (dB)) are a range of frequencies (in Hertz (HZ)); the threshold for normal hearing is from 0 to 20 dB, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet.App. 155, 157 (1993). As previously noted, the veteran had active duty from September 1966 to September 1968. There are several reports of hearing examinations in the service medical records, inclusive of those dated in February 1966 (enlistment examination), December 1966, April 1967, and June 1967 (flight physical examinations), and June 1968 (separation examination). All the examinations, except the separation examination in 1968, were conducted under the ASA standard, rather than the ISO standard which is the current standard and the standard under which the separation examination was conducted. It appears that using the adjusted standards, the veteran did have some degree of hearing loss reported on the examination in December 1966, April 1967 and June 1967. However, it was not of a degree to be classified as a disability. 38 C.F.R. § 3.385. On the separation examination, all thresholds were read as zero decibels. On none of these examination, nor on the medical histories associated with them, did the veteran ever complain of hearing loss. There are no references to complaints of or treatment for hearing loss in the service medical records. In a VA outpatient treatment record dated in July 1991, it was indicated that the veteran complained of gradual hearing loss of the right ear with no pain, discharge, fever or prior infection. The diagnosis was subjective hearing loss of the right ear. In a consultation with an ear, nose and throat physician dated in November 1991, the physician noted that the veteran reported a history of loud noise exposure during service, and complained of progressive right ear hearing loss. The diagnosis was history of hearing loss, asymptomatic. In a VA outpatient treatment record dated in December 1991, an audiogram was interpreted as revealing that thresholds of the right ear were read as 45 decibels at a frequency of 500, 35 decibels at a frequency of 1000, 20 decibels at a frequency of 2000, 35 decibels at a frequency of 3000, and 45 decibels at a frequency of 4000. Thresholds of the left ear were read as 30 decibels at a frequency of 500, 30 decibels at a frequency of 1000, 15 decibels at a frequency of 2000, 25 decibels at a frequency of 3000, and 40 decibels at a frequency of 4000. Speech discrimination was noted as 100 percent. The diagnosis for the right ear was moderate to severe flat mixed type hearing loss with excellent speech discrimination. A tympanometry was interpreted as indicating a possible healed perforation, but additional testing for a lesion was negative. The diagnosis for the left ear was mild low frequency mixed loss, moderate to severe high frequency sensorineural hearing loss, with speech discrimination noted as excellent, and the tympanometry was interpreted as the same as on the right. In an outpatient treatment consultation record dated in January 1992, an ear, nose and throat physician noted the results of the above December 1991 audiogram as reported to him by telephone. At a hearing dated in June 1992, the veteran testified that during service his specialty had been as a helicopter maintenance man. He stated that he had also been a door gunner and was exposed to machine gun fire, and had been exposed to the sounds of artillery and mortar. He pointed out that some hearing loss was indicated on an examination during service, although no loss was noted on his separation examination, and he stated that he did not remember undergoing a hearing examination upon separation. He testified that he had worked in carpentry prior to service and briefly after service. He reported that he had worked in an administrative position for 16 of the 17 years since service and had not been exposed to any loud noises such as explosions since service. In a statement dated in September 1992, a private physician interpreted a recent audiogram as revealing a sensorineural hearing loss bilaterally, with a conductive component on the right. A magnetic imaging resonance was noted as revealing no lesions. The physician opined that although sensorineural hearing loss can be attributable to aging, noise exposure such as the veteran was exposed to in service can contribute to sensorineural hearing loss. He stated that noise exposure would not contribute to the conductive component of the veteran's hearing loss. Upon review of all the evidence, the Board concludes that bilateral hearing loss has been established for purposes of service connection. Regulations state that service connection for impaired hearing will be considered to be a disability when the any of the auditory thresholds are 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. The results of the VA audiogram in 1991 indicated that both of the first two criteria were met for each ear, thus indicating that the veteran does have a current bilateral hearing loss disability. The next question for the Board is whether such hearing loss disability was incurred in service or is otherwise attributable to service. Although some hearing loss was noted during service, such loss was variable and slight, and no loss was noted on his separation examination. However, it is noted that the veteran was assigned as a helicopter maintenance man during service, and would thus have been exposed to the types of severe noise exposure that could result in hearing loss. Additionally, the veteran's private physician has opined that the veteran's sensorineural hearing loss is at least arguably attributable to noise exposure during service. It is noted that the Board is not free to ignore medical opinions in the file. The Board finds that the private physician's opinion, although somewhat equivocal, is significantly probative to the issue of causality. The Board concludes that when the veteran is afforded reasonable doubt, the evidence is in equipoise such as to warrant a finding that the veteran currently suffers from bilateral hearing loss which is attributable to acoustic trauma in service, and that service connection is therefore warranted. ORDER Service connection for bilateral hearing loss is granted. LAWRENCE M. SULLIVAN 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.