BVA9504300 DOCKET NO. 93-05 505 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to service connection for bilateral sensorineural hearing loss. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for organic heart disease. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD James A. Frost, Associate Counsel INTRODUCTION The veteran served on active duty from October 1968 to March 1990. This appeal arises from rating decision in October 1990 and May 1991 by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Board notes that in his original claim of April 1990, the veteran sought service connection for hypertension but did not mention heart disease. The rating decision of May 1991 denied service connection for heart disease. In a letter to the RO in February 1992, the veteran stated his belief that he had a high blood pressure or a heart problem. The Board finds that the veteran thereby clarified his claim and thus the issues now in appellate status are as stated above. After developing additional evidence in this case, the Board, in accordance with Thurber v. Brown, 5 Vet.App. 119 (1993), informed the appellant's representative in a December 1994 letter of the additional evidence developed and provided an opportunity to respond. The representative did not respond. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has a hearing impairment. He points to findings of hearing loss by service department, VA and private examiners. He also contends that he has hypertension and/or heart disease. He points to electrocardiographic findings and elevated blood pressure readings in service and after service. 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 the veteran's claims. FINDINGS OF FACT 1. The veteran does not have a hearing loss disability in either ear, under VA standards. 2. The veteran does not have essential arterial hypertension. 3. The veteran does not have organic heart disease. CONCLUSIONS OF LAW 1. Bilateral sensorineural hearing loss was not incurred in or aggravated by service, nor may it be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.307, 3.309, 3.385, 4.85(c) (1993). 2. Hypertension was not incurred in or aggravated by service, nor may it be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.307, 3.309. 3. Organic heart disease was not incurred in or aggravated by service, nor may it be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board notes that the veteran's claims are "well- grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented claims which are plausible. The Board is also satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). I. Hearing Loss Service medical records contain an entry in February 1969 that an examination for submarine duty showed a slight hearing loss in the right ear, not considered disqualifying; results of audiometric testing were not reported. Thereafter, periodic examinations showed no pure tone threshold above 20 decibels until an audiometric examination in August 1984. That examination produced the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 25 20 15 20 25 LEFT 20 15 15 20 25 At an audiometric examination in July 1989, the pure tone thresholds were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 10 20 20 LEFT 15 20 10 20 25 At an examination for retirement in January 1990, the pure tone thresholds were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 30 30 15 25 25 LEFT 40 45 30 30 40 A high frequency hearing loss, not considered disqualifying, was noted. At a VA audiological examination in May 1990, the pure tone thresholds were as follows: HERTZ 1000 2000 3000 4000 RIGHT 10 10 10 20 LEFT 20 25 25 35 The chief of audiology certified that, pursuant to 38 C.F.R. § 4.85(c), the evaluation should be on pure tones only, due to the veteran's foreign accent. A mild high frequency sensorineural hearing loss in the left ear was found. In December 1990, the veteran underwent a private audiological examination. The pure tone thresholds reported were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 15 15 20 LEFT 15 15 15 20 30 Speech discrimination was reported as excellent, bilaterally. A mild sensorineural hearing loss at 4,000 hertz in the right ear and a mild sensorineural hearing loss throughout the conversational voice range in the left ear were found. The RO scheduled the veteran for another VA audiological examination in June 1992, for which he failed to report. Service connection may be granted for disability resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. Service connection may also be granted for sensorineural hearing loss when it is manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Furthermore, applicable regulations provide that service connection for impaired hearing shall not be established unless hearing status meets pure tone and speech recognition criteria. Hearing status shall not be considered service connected when the thresholds for the frequencies of 500, 1,000, 2,000, 3,000, and 4,000 hertz are all less than 40 decibels; the thresholds for at least three of these frequencies are 25 decibels or less; and speech recognition scores are 94 percent or better. 38 C.F.R. § 3.385; effective on and after May 3, 1990. In the veteran's case, his auditory acuity in the right ear has been within normal limits, under VA standards, on all tests during service and after service. With regard to the left ear, although pure tone thresholds were elevated at the examination for retirement in January 1990, on VA testing in May 1990 and at a private examination in December 1990, his auditory acuity in that ear was within normal limits, under VA standards. Although he was accorded an opportunity to have his hearing tested again by VA in June 1992, he failed to report for that examination. The Board therefore finds that there is insufficient evidence of record at this time to show a present hearing loss disability in either ear. Service connection for bilateral sensorineural hearing loss is thus not established. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309, 3.385. II. Hypertension and Heart Disease Service medical records disclose that in the 1980's the veteran experienced elevated blood pressure readings, that is, 140/90 or higher. In March 1988, a diagnosis of borderline hypertension was rendered. At an annual physical examination in December 1988, his blood pressure was 140/82; an electrocardiogram was reported as rule out left ventricular hypertrophy, otherwise normal. At an examination in July 1989, his blood pressure was 154/81. At a retirement examination in January 1990, his blood pressure was 148/92; borderline high blood pressure, not considered disabling, was noted. An electrocardiogram showed normal sinus rhythm. His heart was reported as normal. At a VA medical examination in May 1990, the veteran claimed to have had elevated blood pressure for five years, for which he had received no treatment. He had no history of a myocardial infarction or a cerebral vascular accident. He regularly used salt. His blood pressure was reported as: 130/78, sitting; 126/70, recumbent; and, 140/80, standing. All pulses were normal. No murmurs, edema or renal bruits were found. There was no radial-femoral pulse delay. Diagnoses included no hypertension on this examination. In November 1990, the veteran was admitted to a United States Navy medical facility for a complaint of chest pain. His blood pressure was recorded as 150/100. An electrocardiogram showed frequent premature ventricular beats and left ventricular hypertrophy, by voltage. On stress testing, he attained 100 percent of the target heart rate, with some unifocal premature ventricular contractions; his blood pressure and heart rate responses were appropriate; ischemia was not found. The test was considered negative. At a VA examination for hypertension in June 1992, blood pressure readings were as follows: 140/82, sitting; 130/78, recumbent; and, 130/85, standing. The veteran did not have an enlarged heart and was taking no medications. The diagnosis was no hypertension. At a VA examination for heart disease in June 1992, the veteran stated that he had had hypertension in service, which was not treated. He had been admitted to a naval hospital in November 1990 for chest pain and unifocal premature ventricular contractions. An exercise tolerance test was normal, with some unifocal premature ventricular contractions. No definite diagnosis of heart disease had ever been made in the veteran's case. On examination, his chest was clear to percussion and auscultation; there were no rales, rhonchi or wheezes; breath sounds were normal; there was no murmur or fourth heart sound; there was no edema. An electrocardiogram showed left ventricular hypertrophy, by moderate voltage criteria. The diagnoses included history of noncardiac chest pain, of no clinical significance, and history of benign unifocal premature ventricular contractions, not clinically significant. Heart disease was not found. Service connection may be granted for hypertension and/or cardiovascular disease which is manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. With regard to hypertension, medical science has determined that persistent findings of blood pressure 140/90 or higher are indicative of essential hypertension. J. Willis Hurst, et. al. eds., The Heart, Arteries and Veins, 1143 (7th ed. 1990); Eugene Braunwald, ed., Heart Disease: A Textbook of Cardiovascular Medicine, 818-19 (4th ed. 1992); Jean D. Wilson, et. al. eds., Harrison's Principles of Internal Medicine, 1002-03 (12th ed. 1991). Although the veteran did have elevated blood pressure readings in service and at the emergency room of a naval facility in November 1990, his blood pressure was within normal limits when taken repeatedly at VA examinations in May 1990 and June 1992. The Board finds that the evidence of record is insufficient to show that the veteran has persistent essential hypertension, as that disease is understood by contemporary medicine. Service connection for hypertension is thus not established. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. With regard to the veteran's belief that he may have heart disease, no physician, either while he was in service or since then, has diagnosed organic heart disease. Although electrocardiograms in December 1988 and November 1990 showed left ventricular hypertrophy and the electrocardiogram in December 1990 showed premature ventricular contractions, such findings do no demonstrate a disease entity for which service connection may be granted. In the absence of a definitive diagnosis of some recognized form of organic heart disease, service connection for such a disability is not established. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. However, we advise the veteran that if he should develop essential hypertension or organic heart disease, he should submit evidence of it to reopen his claim. His claim will then be readjudicated on its merits. While the Board has considered the doctrine of affording the veteran the benefit of any existing doubt with regard to the issues on appeal, the record does not demonstrate an approximate balance of positive and negative evidence as to warrant resolution of this matter on that basis. 38 U.S.C.A. § 5107(b). ORDER Service connection for bilateral sensorineural hearing loss is denied. Service connection for hypertension is denied. Service connection for organic heart disease is denied. BRUCE KANNEE 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.