BVA9503644 DOCKET NO. 92-19 202 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New York, New York THE ISSUE Entitlement to service connection for bilateral hearing loss. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and his wife ATTORNEY FOR THE BOARD Jeffrey J. Schueler, Associate Counsel INTRODUCTION The veteran served on active duty from August 1943 to January 1946. In an August 1992 Supplemental Statement of the Case, the regional office (RO) noted that at a May 1992 personal hearing the veteran withdrew his claim of entitlement to an increased evaluation for residuals of a shrapnel wound in the back. A review of the claims folder does not reveal subsequent argument or submission of additional evidence with regard to that issue. As such, the issue for appellate review is as stated on the titled page of this decision. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that while serving in combat as a front-line medic in World War II, he was exposed to gunfire and other loud noises that resulted in his current bilateral hearing loss. He maintains that his hearing has worsened over time and that he must now wear hearing aids in both ears. DECISION OF THE BOARD The Board of Veterans' Appeals (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 the claim of entitlement to service connection for bilateral hearing loss. FINDINGS OF FACT 1. All available relevant evidence necessary for an equitable disposition of the claim has been obtained by the RO. 2. Bilateral hearing loss is not shown to have been present until over 38 years after service separation and is not shown to be related to the veteran's wartime service. CONCLUSION OF LAW Bilateral hearing loss was not incurred in or aggravated by wartime service, and sensorineural hearing loss may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds initially that the appellant's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, it is not inherently implausible. We also find that the facts relevant to the issue on appeal have been properly developed and that the statutory obligation of the Department of Veterans Affairs (VA) to assist the appellant in the development of his claim has been satisfied. 38 U.S.C.A. § 5107(a) (West 1991). The service medical records are not available, having been destroyed in the 1973 fire at the National Personnel Records Center (NPRC) at St. Louis, Missouri. The VA must place an increased emphasis on the duty to assist the veteran in cases where service medical records are not available. Moore v. Derwinski, 1 Vet.App. 401 (1991) (duty to assist is particularly great in light of the unavailability of service medical records). A subsequent government search produced information extracted from hospital admission cards created by the Office of the Surgeon General, Department of the Army, for the year 1945, but did not produce service medical records. Records for veterans, such as the appellant, who were separated from the U.S. Army but who were not retired and did not have a reserve obligation are stored at NPRC. The two searches requested by the VA constituted a reasonable search for records pertaining to the veteran. On appellate review, we see no areas in which further development might be fruitful. In order to establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1994). Where a veteran served 90 days or more during a period of war and sensorineural hearing loss (which is a disorder of the central nervous system) becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during active service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). Service connection may also 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) (1994). As noted above, the veteran's service medical records were apparently destroyed in a 1973 fire at NPRC. Information extracted from hospital admission cards created by the U.S. Army's Office of the Surgeon General shows treatment for wounds caused by an artillery shell in January 1945, but does not show evidence of treatment for bilateral hearing loss. The evidence of record subsequent to service separation pertaining to the bilateral hearing loss claim includes a September 1984 audiometric evaluation prepared by Dev R. Chitkara, M.D., showing pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 75 70 65 -- 80 LEFT 60 55 65 -- 90 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 88 percent in the left ear. Dr. Chitkara commented that the evaluation's reliability was "good" and that the veteran had a moderate to severe sensorineural hearing loss in the left ear and a severe sensorineural hearing loss in the right ear, with consistent speech scores. Also of record is a September 1988 audiometric study prepared by Phaiboon Romsaitong, M.D., showing pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 105 80 95 -- 100+ LEFT 50 55 75 -- 95 Speech audiometry revealed speech recognition ability of 60 percent in the right ear and of 72 percent in the left ear. Dr. Romsaitong noted that the veteran had a history of impaired hearing, that his nose and throat were clear; that the eardrums were intact, bilaterally; and that a tuning fork, tympanogram, and audiogram showed sensorineural hearing loss, bilaterally. The diagnosis reported was of bilateral presbycusis, and he recommended a hearing aid. In a September 1990 letter, Richard D. Hamburg, M.D., wrote that the veteran was under his care for sensory nerve deafness. At a July 1991 VA examination, the veteran complained of loss of hearing in both ears, with greatest difficulty in conversations. He attributed the onset of the hearing loss to exposure to artillery and shell fire during service and indicated that he had been exposed to vocational noise subsequent to service, but not on a steady basis. An audiological evaluation showed pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 80 90 95 95 100+ LEFT 55 65 80 85 95 Speech audiometry revealed speech recognition ability of 80 percent in the right ear and of 68 percent in the left ear. The examiner reported that the right ear had a severe to profound sensorineural to mixed hearing loss from 1000 Hz to 4000 Hz, and that the left ear had a moderately severe to profound sensorineural hearing loss from 1000 Hz to 4000 Hz. The examiner reported that the canals and tympanic membranes for both ears were clear and intact, respectively, and noted that the ear, nose, and throat examination was normal. The veteran testified at a personal hearing in May 1992 that he was exposed to gun and shell fire while serving as a front-line medic in combat in Algiers, Italy, and Southern France. The veteran's wife testified that she started to notice that the veteran had to ask that comments be repeated in approximately 1950. The veteran then stated that he retired in 1977 as a teacher and that for five years prior to his retirement, in approximately the 1970's, was the first time he went to a doctor for treatment. Also of record is an undated document appearing to be from a publication titled simply "Hearing Loss." This document purports to show that [w]hile there a variety of causes, the most prevalent is exposure to noise. Noise damages the hair cells in the inner ear so that they can no longer signal the auditory nerve to transmit electrical signals to the brain. While most hearing loss is the result of long- term, cumulative exposure to moderate noise, just one gunshot can result in some permanent hearing loss. For purposes of applying the laws administered by the VA, impaired hearing will be considered to be a disability when the auditory threshold of any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 5000, 1000, 2000, or 4000 Hz 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). The results of the private audiometric evaluations in September 1984 and September 1988, as well as the results of the VA audiologic evaluation in July 1991, show pure tone thresholds for 500, 1000, 2000, 3000, and 4000 Hz to be greater than 40 decibels. The veteran's current bilateral hearing loss, therefore, is a disability for VA purposes. However, although the veteran has a current bilateral hearing loss disability, the evidence of record does not show that this current disability is related to wartime service. The claims folder does not include documentation of a bilateral hearing loss during active service. And it does not contain evidence showing that a sensorineural hearing loss was manifested in the first post-service year. Thus, presumptive service connection for hearing loss is not warranted. The first clinical evidence of a hearing loss is the September 1984 audiology report of Dr. Chitkara, prepared over 38 years after the veteran's service separation, showing sensorineural hearing loss in both ears. Dr. Chitkara did not relate this hearing loss to the veteran's active service. Dr. Romsaitong's September 1988 audiological evaluation also showed a current hearing loss and a history of impaired hearing, but did not relate that disorder to the veteran's active service. The VA's audiologic examination in July 1991 also showed a current bilateral hearing loss; although the examiner noted a history of noise exposure during active service related by the veteran, the examiner did not express an opinion as to etiologic relationship to that noise exposure. Dr. Hamburg's September 1990 letter only showed that the veteran was treated in September 1990 for sensory nerve deafness, but did not show any evidence relevant to a relationship of bilateral hearing loss to active service. Finally, the undated copy of a publication titled "Hearing Loss" generically discussed the etiology associated with hearing loss, but did not refer to the veteran's bilateral hearing loss and, therefore, is not probative to the issue on appeal. The veteran's contentions that his current bilateral hearing loss is related to active service are not supported by evidence of record. The testimony of the veteran and his wife is credible insofar as it pertains to establishing that he was exposed to acoustic trauma during service and was noted to have a hearing loss at a point in time after service. As they are laypersons presumably untrained in medicine, their testimony is not competent evidence in relating the current hearing loss to service or to any incident(s) therein. The state of the record is such that bilateral hearing loss is not shown until over 38 years after service separation. Without an objective medical link, it would require resorting to speculation to conclude that the hearing loss is related to active service. It is the determination of the Board that the preponderance of the evidence is against the claim of entitlement to service connection for bilateral hearing loss. ORDER Service connection for bilateral hearing loss is denied. GEORGE R. SENYK 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.