HEARING LOSS

TRACIE N. WESNER · 2025 · Case ID: 25012620

MIXED

Summary

The veteran, who served from December 1973 to December 1976, with subsequent Reserve/National Guard service until 1991, appeals the denial of service connection for left ear hearing loss and hypertension, and seeks service connection for right ear hearing loss and coronary artery disease (CAD). The Board granted service connection for right ear hearing loss, hypertension, and CAD secondary to hypertension. Service connection for left ear hearing loss was denied. The veteran testified that his hearing loss began in service and worsened over time, and that his hypertension and heart disease developed during service, possibly due to Agent Orange exposure and stress. The Board found the veteran's testimony regarding right ear hearing loss and its recurrence since service to be competent and credible, noting the 1974 service examination showed right ear hearing loss. Despite a negative VA opinion and conflicting audiograms, the Board found the evidence in equipoise for the right ear, granting service connection. For the left ear, the Board found no indication of loss in service records or subsequent treatment, and the VA examiner's opinion was persuasively against service connection, leading to denial. For hypertension, the Board found the veteran's testimony credible regarding onset during service, and despite a negative VA opinion, found the private medical opinion and the 1974 service record of elevated blood pressure to be substantially probative, granting service connection due to the evidence being approximately balanced. CAD was granted secondary to hypertension based on competent medical evidence.

Rationale

Veteran's testimony found competent and credible regarding right ear hearing loss onset and recurrence.; VA examiner's opinion regarding right ear hearing loss not given probative value as it did not address competent, credible report of recurrent hearing loss.; Evidence found in equipoise, resolving doubt in Veteran's favor.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

10-39 550

Full Decision Text

Citation Nr: 25012620
Decision Date: 10/08/25 Archive Date: 10/08/25

DOCKET NO. 10-39 550
DATE: October 8, 2025

ORDER

Entitlement to service connection for right ear hearing loss is granted.

Entitlement to service connection for left ear hearing loss is denied.

Entitlement to service connection for hypertension is granted.

Entitlement to service connection for a heart condition, diagnosed coronary artery disease (CAD), is granted.

FINDINGS OF FACT

1. The Veteran's right ear hearing loss had its onset in service.

2. A left ear hearing loss disability did not have its onset within one year after the Veteran's separation from service and is not otherwise related to an in-service injury or disease.

3. Resolving doubt in the Veteran's favor, the Veteran's hypertension had its onset in service.

4. The Veteran's CAD was proximately due to his hypertension.

CONCLUSIONS OF LAW

1. The criteria for service connection for right ear hearing loss are met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.385.

2. The criteria for service connection for left ear hearing loss are not met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3,385.

3. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309.

4. The criteria for service connection for CAD are met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1973 to December 1976 with additional Reserve and/or National Guard service until 1991. Unfortunately, during the pendency of the appeal, the Veteran passed away in January 2023. The properly substituted appellant is the Veteran's surviving spouse.

This appeal is before the Board of Veterans' Appeals (Board) from a September 2008 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared and provided testimony before one of the undersigned Veterans Law Judges (VLJs) at a June 2022 hearing, and Appellant provided testimony at a March 2024 hearing before the same VLJ. Transcripts of the hearings are associated with the claims file. The claims were remanded by the Board in February 2013, July 2017, December 2019 and September 2024.

In January 2025, after the case was returned to the Board, the Appellant's representative requested a Board hearing.

In April 2025, the Appellant presented sworn testimony at a hearing before one of the other undersigned VLJs. As the transcript of the April 2025 proceeding reflects, at the hearing, the Appellant, through her attorney, waived her right to testify before a third Veterans Law Judge on the above issues pursuant to Arneson v. Shinseki, 24 Vet. App. 379 (2011) (a veteran must be provided the opportunity to testify before all members of a Board panel deciding the case).

As the transcript of the April 2025 proceeding further reflects, the VLJ chairing the hearing granted Appellant's request that the record be held open for 90 days following the hearing to submit additional evidence. Evidence and argument were submitted in July 2025 with a waiver of AOJ consideration in the first instance.

An October 2024 VA Memo reflects the VA finding that that the Veteran did not participate in Toxic Exposure Risk Activity (TERA) in service.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi
.

An October 2024 VA Memo reflects the VA finding that that the Veteran did not participate in Toxic Exposure Risk Activity (TERA) in service.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Certain chronic diseases such as cardiovascular-renal disease including hypertension, and other organic diseases of the nervous system, will also be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Presumptive service connection for chronic diseases must be considered on three bases: chronicity during service, manifestations within one year of a Veteran's separation from service, and continuity of symptomatology since service. Id.

The United States Court of Appeals for the Federal Circuit (Federal Circuit) issued a decision that addressed the issue of causation in 38 U.S.C. § 1110. Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023). The Federal Circuit explained that the phrase "resulting from" in the statute refers to "but-for" causation (which is broad, undisputedly broader than proximate causation) and is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. Spicer, 61 F.4th at 1363-64. The Federal Circuit held secondary service connection is warranted where a nonservice-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the nonservice-connected disability. "Thus, for "aggravation of nonservice-connected disabilities" it is enough to show that "but for" the service-connected disability the incremental-increase in severity of a nonservice-connected disease or injury would not have occurred. Finally, the Federal Circuit further held that 38 C.F.R. § 3.310(b), which addresses the aggravation prong of secondary service connection, is inconsistent with 38 U.S.C. § 1110 and is therefore unlawful to the extent that VA applied it to reject the Veteran's theory of compensation. Spicer, 61 F.4th at 1366. It is clear from the Federal Circuit's holding that causation and aggravation can be established without demonstrating a direct pathological link between the claimed disability and service-connected disabilities.

To deny a claim on its merits, the weight of the evidence must persuasively stand against a finding that the evidence is in "approximate balance" or "nearly equal" to the evidence that supports the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Entitlement to service connection for right ear hearing loss is granted.

Entitlement to service connection for left ear hearing loss is denied.

The Veteran testified in June 2022 that his hearing loss started in service and simply got worse over the years. Appellant testified in 2025 that the Veteran reported to her that his hearing loss began in service when a grenade went off near him during field exercises causing him to get lost. The issue progressed to the point where he got hearing aids but they did not work well for him. He told her he had problems in jobs after service due to hearing difficulties. They met in 2020 and married in 2022.

The Veteran's personnel records reflect he was a financial specialist/clerk typist without foreign service.

The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown
simply got worse over the years. Appellant testified in 2025 that the Veteran reported to her that his hearing loss began in service when a grenade went off near him during field exercises causing him to get lost. The issue progressed to the point where he got hearing aids but they did not work well for him. He told her he had problems in jobs after service due to hearing difficulties. They met in 2020 and married in 2022.

The Veteran's personnel records reflect he was a financial specialist/clerk typist without foreign service.

The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, 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, or 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.

The evidence demonstrates that in service the Veteran had hearing loss in the right ear for VA purposes in service, but not in the left ear. On a November 1974 annual service examination, he had hearing loss in the right ear according to the 38 C.F.R § 3.385 while on active duty. Specifically, Puretone thresholds in the right ear were 30 decibels at 500, 1000, 2000 and 4000 Hertz.

This matter was remanded in September 2024 because while the documented evidence of record indicated the Veteran experienced some form of hearing loss the evidence did not indicate he was diagnosed with hearing loss meeting the criteria of 38 C.F.R. § 3.385. Specifically, the 1987 and 2018 audiograms although determined he had hearing loss during air conduction testing, do not include Maryland CNC Testing, a requirement for hearing loss diagnosis under 38 C.F.R. § 3.385. Moreover, the remaining medical records do not contain any indication a diagnosis of hearing loss was made utilizing a Maryland CNC Test as prescribed under 38 C.F.R. § 3.385. Thus, while the records indicate he experienced hearing loss, the matter was remanded for opinion as it was unclear if the Veteran's hearing loss met the threshold of a hearing loss disability under 38 C.F.R. § 3.385.

The October 2024 VA clinician provided a negative nexus opinion regarding hearing loss in both ears but acknowledged the instance of right ear hearing loss in service on one occasion. The examiner found this to be a temporary threshold shift in the right ear only, with no permanent threshold shift seen from December 1973 to August 1976. The examiner observed that hearing was within normal limits for both ears on the hearing exam from 1976. They observed that on March 1988 VA examination there was normal hearing in both ears except in the right ear at 6 kHz where a mild (30 dB) loss was seen. It was observed that in February 1989 testing an audiologist reported initial responses were very elevated, they were all slow and labored, and after a long evaluation period in the test booth, the reported thresholds are felt to closely represent try organic acuity. Hearing was within normal limits in both ears. Tinnitus was not noted. A March 1990 screening examination showed a mild to severe hearing loss which the October 2024 examiner noted was not believed to be valid due to the significant change from the 1989 and 1990 examinaion. The examiner explained that hearing does not change that significantly in both ears in such a short period of time and since the Veteran had fair reliability on the previous examination that was performed by an audiologist and not a technician, the October 2024 examiner stated it is more likely than not that the 1990 test is not valid. A September 2000 examination done at the VA indicated that hearing was within normal limits in both ears with excellent speech discrimination.

It was noted that a VA audiogram from June 2018 indicated a moderate to severe sensorineural hearing loss with 96 percent in the right and 88 percent in the left word recognition scores. However, this test does not conform to 38 C.F.R. § 3.385.

In rendering a negative opinion, the October
such a short period of time and since the Veteran had fair reliability on the previous examination that was performed by an audiologist and not a technician, the October 2024 examiner stated it is more likely than not that the 1990 test is not valid. A September 2000 examination done at the VA indicated that hearing was within normal limits in both ears with excellent speech discrimination.

In rendering a negative opinion, the October 2024 examiner stated that if the hearing loss was due to active duty noise exposure, it would be expected to have been seen while in service or shortly afterwards, which is not the case for this Veteran since his hearing was within normal limits on the VA examination from 2000, more than 24 years after his service time. The examiner also pointed out that his records also mentioned that his job as a civilian was shipyard/construction which are both known to be very noisy work environments. Thus, the VA examiner concluded that it is more likely than not that the hearing loss present on exams from 2010 and 2018 is due to his years of civilian work in shipyards and construction.

The Appellant has resubmitted a June 2022 medical statement from a private doctor indicating that hearing loss noted in 1974 was related to service.

Here, the Board finds that the testimony constitutes competent and credible evidence that he noticed the hearing problems in the right ear during service and that the problem was recurrent since that time. See Charles v. Principi, 16 Vet. App. 370, 374 (2002); see also Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board ascribes no probative value to the 2024 VA examiner's opinion as to the right ear it does not address the competent, credible report of recurrent hearing loss in the right ear since service. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007).

With respect to continuity of symptomatology, VA recognizes sensorineural hearing loss as a chronic disease and the Court has held that, under 38 C.F.R. § 3.303(b), the theory of continuity of symptomatology is an alternative route to establish service connection for specific chronic diseases and can only be used in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309(a). See Walker. This is an organic disease of the nervous system for purposes of 38 C.F.R. § 3.309(a). Fountain v. McDonald, 27 Vet. App. 258 (2015).

For the above reasons, the evidence is, at worst, evenly balanced or approximately so with regard to whether the Veteran's right ear hearing loss had its onset during service.

Finding the evidence in equipoise, the Board finds that service connection for right ear hearing loss is warranted. 38 C.F.R. § 3.303(b); see also Walker; Fountain.

Here, though, there was no indication of left ear hearing loss for VA purposes in the service treatment records or in the subsequent decades of treatment and examination records. The Veteran's MOS does not suggest military noise exposure, though it is noted he reports he had some during field exercises. The testimony of the Appellant was admittedly a recitation of what the Veteran had told her. The testimony as it relates to the left ear has been considered but is outweighed as to in-service hearing loss or post service hearing loss as defined by VA due to the documented lack of hearing loss on testing. Moreover, the October 2024 VA clinician's opinion is persuasively against finding any left ear hearing loss was related to service. The opinion is probative as to the left ear inasmuch as there was no documented left ear hearing loss in service or for decades thereafter. The June 2022 private opinion is outweighed as to the left ear as it is noted that the hearing loss in 1974 was in the right ear. As the Veteran did not meet the criteria for left ear hearing loss, set forth at 3.385, the evidence is persuasively against finding the criteria for left ear hearing loss are met. Service connection for left ear hearing loss is thus denied.

Entitlement to service connection for hypertension is granted.

Entitlement to service connection for a heart condition claimed as coronary artery disease and to include as
related to service. The opinion is probative as to the left ear inasmuch as there was no documented left ear hearing loss in service or for decades thereafter. The June 2022 private opinion is outweighed as to the left ear as it is noted that the hearing loss in 1974 was in the right ear. As the Veteran did not meet the criteria for left ear hearing loss, set forth at 3.385, the evidence is persuasively against finding the criteria for left ear hearing loss are met. Service connection for left ear hearing loss is thus denied.

Entitlement to service connection for hypertension is granted.

Entitlement to service connection for a heart condition claimed as coronary artery disease and to include as secondary to hypertension is granted.

The Veteran reported and now Appellant reports that his hypertension developed initially while he was in service and was recurrent since that time. The Veteran reported and Appellant stated he told her that he had no trouble with hypertension or heart disease until he went into service. He believed his elevated blood pressure readings in service were due to exposure to Agent Orange, and he showed her spots on his chest that he felt were indicative of the exposure. He reported to her he had no blood pressure or heart problems prior to service. He told Appellant that he experienced substantial stress in service training for secret missions and he felt this negatively affected his blood pressure and heart.

The record reflects there was diagnosed hypertension and CAD prior to the Veteran's death.

The Veteran's STRs show that Veteran exhibited an elevated blood pressure reading in December 1973, noted at 140/82. 'High blood pressure' was noted in November 1974. The 1976 separation report of medical examination did not note any issues related to elevated blood pressure or hypertension. A March 1982 post service medical record notes the Veteran has a history of hypertension.

The Veteran underwent a VA hypertension and heart disease examination in October 2024 as ordered in the September 2024 Board remand to address whether hypertension manifested prior to active service, during active service, or within one year of active service separation.

The examiner opined that the Veteran's hypertension was less likely than not caused by the Veteran's service he did not have hypertension during service. The examiner found that, despite a few elevated levels, there is no evidence of consistently elevated blood pressure to warrant hypertension during active duty. For example blood pressure prior to military separation was normal with 114/80 in May 1976.

The examiner opined that the Veteran's CAD was at least as likely as not caused by his hypertension. Hypertension (high blood pressure) contributes to the development of coronary artery disease, as the smooth blood vessel walls of the heart are damaged, hastening the buildup of plaque formation. The examiner stated that blood pressure is a fluctuating vital sign and an elevated level does not signify a diagnosis of chronic hypertension. The examiner also stated that the history of hypertension noted in 1982 does not signify hypertension existed more than 5 years prior. The examiner noted that records show the Veteran was obese, which is a significant risk factor for development of hypertension. The examiner cited to medical literature for support of the opinion.

The Appellant has resubmitted a June 2022 medical statement from a private doctor asserting that the Veteran's hypertension first manifested in service and continued. This doctor also noted that hypertension is a leading cause of CAD.

In this case, the Board finds the Veteran is competent to report regarding the symptoms he experienced, and the Board finds his testimony credible. See also Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau, 492 F.3d 1372. Consequently, the Board finds that the lay and medical evidence shows that the Veteran's hypertension began during service and has been recurrent since then.

Due to the Veteran's competent testimony regarding the onset and continuing treatment of hypertension, the Board finds that, resolving all reasonable doubt in the Veteran's favor, service connection for hypertension is warranted. 38 C.F.R. § 3.303(b).

As to weighing the negative VA medical opinion regarding hypertension versus the June 2022 resubmitted opinion on hypertension, the Board finds the June 2022 private opinion, when reconsidered in the context of the entirety of the current record, substantially probative as to hypertension, because even though a diagnosis is not required, there is no reasons or bases requirement for clinicians, and medical opinions must be read as a whole and in the context of the evidence of record. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). The clinician's ultimate conclusion that the in-service high blood pressure readings were an early manifestation of hypertension is consistent with the evidence of record and the lack of a diagnosis is not dispositive on this question. See 38 C.F.R. § 3.303(d) (service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service).

The Board as finder of fact finds that the evidence is at least approximately balanced as to the theory that the current hypertension began in service. Accordingly, service connection for hypertension is warranted.

Moreover, the competent medical evidence persuasively shows that the CAD is due to hypertension. 38 C.F.R. § 3.310. Thus, service connection for CAD as secondary to hypertension is granted.

Tracie N. Wesner

Veterans Law Judge

Board of Veterans' Appeals

Jonathan Hager

Veterans Law Judge

Board of Veterans' Appeals

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Nancy Rippel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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