BVA9501452 DOCKET NO. 93-10 498 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for bilateral hearing loss. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant and his wife. ATTORNEY FOR THE BOARD Melissa F. Marquez, Associate Counsel INTRODUCTION The appellant had active service from May 1951 to April 1955, and from November 1990 to March 1991, as well as periods training in the Naval Reserves from 1973 to 1990. These periods, especially active duty for training, and the duties performed therein have not been verified. This matter came before the Board of Veterans' Appeals (hereinafter Board) on appeal from a June, 1991, rating decision of the Pittsburgh, Pennsylvania, Regional Office (hereinafter RO), of the Department of Veterans Affairs (hereinafter VA), which denied entitlement to service connection for bilateral hearing loss. The Board's decision is limited to the issue developed for appellate review. It is unclear from the record, however, whether the appellant intends to raise a claim for entitlement to service connection for tinnitus. If so, the appellant should contact the RO, and the RO should then take appropriate action. Kellar v. Brown, 6 Vet.App. 157 (1994). It is apparent from the record that the appellant has raised a claim for entitlement to service connection for bilateral hearing loss, both on a direct basis as a result of acoustic trauma suffered during his first period of service, as well as on an aggravation basis, due to an increase of such bilateral hearing loss during his second period of service. As the Board has determined that this case is in need for further development for the issue of service connection based on aggravation of bilateral hearing loss during the second period of service, discussion of the direct service connection claim is deferred pending completion of the requested developments. REMAND The appellant's service medical records from his first period of service, including examinations upon entrance and separation from such service, do not indicate any complaints, findings, or diagnosis of bilateral hearing loss. Service medical records further indicate that the appellant underwent physical examinations for the Naval Reserves. Such physical examinations, dated from 1973 to 1990, reveal no complaints, findings, or diagnoses of bilateral hearing loss. In particular, the appellant's hearing was reported to be 15/15 in the spoken voice on examinations dated in September 1976, January 1978, and January 1980. Service records do reflect that an audiogram was performed in February 1989 prior to a possible duty assignment in a hazardous noise area. At that time, audiometric results thresholds of 25, 25, 55, 60, and 70 decibels in the right ear; and thresholds of 20, 15, 55, 70, and 75 decibels, in the left ear, at 500, 1000, 2000, 3000, and 4000 Hertz, respectively. No speech recognition percentages were given. Subsequently, the record reflects that the appellant was called to active duty due to the Gulf War. Service records indicate that he was examined and determined to be physically fit for entering active overseas duty, with no complaints or findings of bilateral hearing loss noted at this time. However, no audiogram was performed. In December 1990, while on active duty, the appellant was seen for a long history of bilateral hearing loss. January 1991 audiometry results indicated thresholds of 15, 25, 55, 70, and 70 decibels at 500, 1000, 2000, 3000 and 4000 hertz, respectively, for the right ear; and 10, 15, 55, 70, and 75 decibels at 500, 1000, 2000, 3000, and 4000 hertz, respectively, for the left ear. The average right ear pure tone threshold was 55 decibels, with right ear speech recognition at 80 percent; the average left ear pure tone threshold was 54 decibels, with left ear speech recognition at 84 percent. The examiner concluded that the appellant then suffered from noise induced high frequency sensorineural hearing loss related to civilian occupational noise exposure as a railroad engineer. He further found that there had been no change in such hearing loss following the baseline audiogram performed in 1989. Records reflect that the appellant was subsequently fitted for hearing aides. During the examination upon separation from this second period of service, the appellant complained of hearing loss, but no audiogram was performed. Post-service medical reports of record include an April 1991 VA audiogram, as well as a February 1992 audiogram performed on behalf of the appellant's employer, Conrail. Results of the April 1991 VA audiogram indicated thresholds of 15, 20, 55, 70, and 80 decibels at 500, 1000, 2000, 3000 and 4000 hertz, respectively, for the right ear; and 15, 15, 55, 75, and 75 decibels at 500, 1000, 2000, 3000, and 4000 hertz, respectively, for the left ear. The average right ear pure tone threshold was 56 decibels, with right ear speech recognition at 64 percent; the average left ear pure tone threshold was 55 decibels, with left ear speech recognition at 76 percent. Results from the February 1992 private employment audiogram indicated thresholds of 20, 95+, 55, 75, and 85 decibels in the right ear; and thresholds of 20, 15, 55, 70, and 70 decibels, in the left ear, at 500, 1000, 2000, 3000, and 4000 Hertz, respectively. During a July 1992 personal hearing, the appellant testified that he believed his current hearing loss was a result of acoustic trauma suffered during his first period of service, as he was stationed on an aircraft carrier for over three years with no ear protection provided. He stated that he was exposed to acoustic trauma during active duty for training while working with mortar firing and on machine gun ranges. He further stated that he worked for Conrail as a carman repairing business cars and locomotives for approximately 30 years. Finally, he testified that his current hearing loss pre-existed his second period of service, and was aggravated therein. The Board has a duty to assist the appellant in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1993). This duty to assist involves obtaining relevant medical examinations where indicated by the facts and circumstances of the individual case. See Murphy v. Derwinski, 1 Vet.App. 78 (1990); Littke v. Derwinski, 1 Vet.App. 90 (1990). The objective clinical evidence indicates that the appellant did in fact have a bilateral hearing loss disability prior to entering his second period of service. See 38 C.F.R. § 3.385 (1993); Hensley v. Brown, 5 Vet.App. 155, 159-60 (1993) (citing 38 C.F.R. § 4.85, Tables VI, VIa, VII (1992)). There is a medical question as to whether the slight differences in the frequencies constitutes a normal variant or aggravation. There is also a question as to the etiology of the hearing loss, to include a determination of the veteran's duties during Reserve duty, and during his periods of active duty. These matters are in need of further medical opinion. See Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991). Furthermore, there are no personnel records from the appellant's first period of service, nor any of his annual active duty for training periods, currently associated with the claims folder. As the appellant additionally alleges direct service connection for bilateral hearing loss attributable to such periods of service, such records are necessary for a complete determination on appeal. Accordingly, the case is REMANDED for the following developments: 1. The RO should contact the appellant to determined whether any additional audiograms were performed in connection with his employment with Conrail, or any other relevant treatment not currently associated with the claims folder. If the appellant does in fact indicate such additional treatment records, and after obtaining the appropriate signed authorization for release of information forms from the appellant, the RO should contact Conrail, or any other physician, hospital, or treatment center (private, VA or military) named by the appellant to obtain any and all personnel, medical or treatment records or reports relevant to the above mentioned claim. All pieces of correspondence, as well as any personnel, medical or treatment records obtained, should be made a part of the claims folder. If private treatment is reported and those records are not obtained, the appellant and his representative should be provided with information concerning the negative results, and afforded an opportunity to obtain the records. 38 C.F.R. § 3.159 (1993). 2. The RO should, with the veteran's assistance as needed, obtain verification of periods of Reserve Duty, especially those during which the veteran claims acoustic trauma. Personnel record from both periods of service, as well as from Reserve duty should be obtained for association with the claims folder. 3. The RO should then schedule the appellant for an audiological examination to determine the nature , etiology, and severity of any bilateral hearing loss currently manifested. In particular, the examiner is requested to determine whether the appellant's current bilateral hearing loss, if found, is attributable to acoustic trauma suffered during his initial period of service, long term intercurrent industrial acoustic trauma, reported acoustic trauma during active reserve duty, or any other factors. Secondly, the examiner is requested to give an opinion as to the nature of any increase in the appellant's bilateral hearing loss during his second period of service, i.e., whether it was due to the natural progress of the pre-existing disease, or otherwise. All indicated tests and studies should be done. If these matters cannot be medically determined without resort to mere conjecture, this should be commented upon in the report. The examiner is further requested to adequately summarize the relevant history, including all audiometric results, as well as all current objective clinical findings and subjective complaints, and describe in detail the reasons for all medical conclusions. The examination should be conducted and reported in accordance with the guidelines set forth in the VA Physician's Guide for Disability Evaluation Examinations. The claims folder should be made available to the examiner for review purposes prior to the examination and the entry of the opinions requested. In order to avoid undue delay in this case, the RO should make certain that the instructions contained in the REMAND decision, detailing the requested developments, have, in fact, been substantially complied with. When these developments has been completed, and if the benefit sought is not granted, the case should be returned to the Board for further appellate consideration, after compliance with appropriate appellate procedures, including issuance of a supplemental statement of the case. It is requested that this statement specifically set forth the reasons and bases for the decision. No action by the appellant is required until he receives further notice. The Board intimates no opinion, either legal or factual, as to the ultimate disposition warranted in this claim, pending completion of the requested developments. MICHAEL D. LYON 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. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).