HEARING LOSS

JENNA BRANT · 2026 · Case ID: 26000679

DENIED

Summary

The Veteran, who served in the U.S. Marine Corps from January 2011 to July 2015 as an Aircraft Avionics Technician, appeals the denial of service connection for right ear hearing loss, claimed as secondary to service-connected tinnitus and left ear hearing loss. The Veteran contends his right ear hearing loss is a delayed onset condition related to in-service noise exposure, similar to that which caused his other service-connected conditions. The Board conceded in-service noise exposure due to the Veteran's MOS and awards. However, multiple VA audiological examinations, including those conducted in May 2015, July 2016, August 2020, November 2021, December 2022, March 2024, April 2024, and July 2024, consistently found normal hearing in the right ear during service and post-service, with no significant threshold shifts. Examiners opined that delayed onset of noise-induced hearing loss is unlikely and that hearing loss in one ear does not cause or aggravate hearing loss in the opposite ear. While the Veteran's representative cited studies and argued for a benefit of the doubt application, the Board found the VA opinions persuasive, noting that the Veteran's lay testimony regarding etiology is not competent. The Board denied service connection for right ear hearing loss, finding the evidence weighed against a nexus to service or aggravation by service-connected conditions.

Rationale

No evidence of right ear hearing loss during service or within one year following separation.; VA examinations consistently showed normal right ear hearing with no significant threshold shifts.; Examiners opined delayed onset of noise-induced hearing loss is unlikely and hearing loss in one ear does not affect the opposite ear.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-21 335

Full Decision Text

Citation Nr: 26000679
Decision Date: 01/20/26 Archive Date: 01/20/26

DOCKET NO. 17-21 335
DATE: January 20, 2026

ORDER

Entitlement to service connection for right ear hearing loss, to include as secondary to service-connected tinnitus and left ear hearing loss, is denied.

FINDING OF FACT

The Veteran's right ear hearing loss was not present in service or until years thereafter and is not etiologically related to any incident of active service and is not caused or aggravated by his service-connected tinnitus or left ear hearing loss.

CONCLUSION OF LAW

The criteria for service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385, 4.85.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Marine Corps from January 2011 to July 2015.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In October 2019, the Veteran testified before the undersigned at a video conference hearing. A transcript of the hearing is of record.

The matter was most recently remanded in July 2023. The case has since returned to the Board for appellate review. The July 2023 remand requested that the RO obtain an addendum medical opinion addressing the nature and etiology of the Veteran's right ear hearing loss. In August 2023, March 2024, April 2024, and July 2024, VA medical opinions were provided to address the nature and etiology of the Veteran's right ear hearing loss. For the reasons discussed below, the Board finds that the opinions are adequate to decide the claim. The Board therefore finds substantial compliance with the prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that substantial, rather than strict, compliance with remand directives is required).

Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

In order to establish service connection for a claimed disability on a direct basis, there must be competent evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be established by evidencing a chronic disease in service, including tinnitus and sensorineural hearing loss, requires a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b), 3.309. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required. Id. The provisions of 38 C.F.R. § 3.303(b) pertaining to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

For VA purposes, impaired hearing is considered disabling 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.

Service connection may also be granted on a secondary basis for a disability which is proximately
d 1331 (Fed. Cir. 2013).

Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of an established service-connected disability. 38 C.F.R. § 3.310. Similarly, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the nonservice-connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. In cases of aggravation of a veteran's nonservice-connected disability by a service-connected disability, such veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.322.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter (which includes but is not limited to equipoise), VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776, 778 (Fed. Cir. 2021).

Service connection for a right ear hearing loss.

The Veteran contends that his right ear hearing loss is a result of noise exposure during service. Specifically, he claims that he has delayed onset hearing loss in his right ear which is related to the same in-service hazardous noise exposure that caused his service-connected tinnitus and left ear hearing loss. See September 2024 Appellate Brief.

The competent medical evidence of record shows that the Veteran was diagnosed with hearing loss in his right ear which meets the criteria for hearing loss for VA rating purposes. See August 2020 VA audiological examination; see also 38 C.F.R. § 3.385.

As to an in-service incident, the Veteran's DD 214 lists his military occupational specialty (MOS) during active-duty service as an Aircraft Avionics Technician and notes that he was awarded the Expert Badge for Rifle qualification. The Duty MOS Noise Exposure Listing maintained by VA indicates that this MOS has a high probability of noise exposure. The Board therefore concedes in-service noise exposure.

The Board concludes that, while the Veteran has a current diagnosis of right ear hearing loss, the evidence of record persuasively weighs against finding that the Veteran's right ear hearing loss began during service, is otherwise related to an in-service injury, event, or disease, or is secondary to his service-connected tinnitus or left ear hearing loss.

A review of the record shows no evidence of a diagnosis, or any right ear hearing loss during service or within one year following separation from service. While the Veteran indicated that he experienced hearing loss on his January 2015 separation examination, the examiner specified that the hearing loss was only in his left ear.

In addition, the Veteran was afforded a VA audiological examination in May 2015 which produced the following results:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 10 5 10 10

The speech recognition score, using the Maryland CNC Test, was 96 percent in the right ear. The examiner determined that there was no permanent positive threshold shift greater than normal measurement variability at any frequency between 500 and 6000 Hz for the right ear and concluded that the Veteran had normal hearing in the right ear.

The Veteran was afforded a VA audiological examination in July 2016 which produced the following results:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 5 10 15 10

The speech recognition score, using the Maryland CNC Test, was 96 percent in the right ear. The examiner explained that there is no change in hearing
using the Maryland CNC Test, was 96 percent in the right ear. The examiner determined that there was no permanent positive threshold shift greater than normal measurement variability at any frequency between 500 and 6000 Hz for the right ear and concluded that the Veteran had normal hearing in the right ear.

The Veteran was afforded a VA audiological examination in July 2016 which produced the following results:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 5 10 15 10

The speech recognition score, using the Maryland CNC Test, was 96 percent in the right ear. The examiner explained that there is no change in hearing thresholds in the right ear after comparing the November 4, 2010, audiogram to the latest audiogram. The Veteran's hearing has not decreased more than 10 dBHL in the right ear. For a threshold shift to be considered a significant change it must change more than 10 dBHL. Since the Veteran's hearing has not declined more than 10 dBHL it is less likely than not that the current complaint of hearing loss in the right ear is caused by or related to noise exposure during military service. She concluded that the Veteran had normal hearing in the right ear.

Accordingly, there is no evidence in his treatment records suggesting right ear hearing loss was shown in service or within one year following separation from service.

June 2019 VA treatment records noted the Veteran was seen for a hearing aid evaluation. The report indicated that past audiological test results revealed a bilateral sensorineural hearing loss and constant tinnitus. The Veteran has not worn hearing aids in the past. He had a previous hearing test at this clinic on July 2, 2016. He reported his hearing as worse, and he has to have people repeat themselves. The examiner determined that his right ear hearing was within normal limits from 250-4000 Hz sloping to a mild hearing loss from 6000-8000 Hz. The examiner concluded that he is a left ear hearing aid candidate and does meet the VISN 23 Hearing Aid Policy for VA issued hearing aids.

During the Veteran's October 2019 hearing, the Veteran testified that he experienced acoustic trauma from firearms, several different aircraft, a boat whistle, and many other sounds from the ship. He added that there were many times in his job where hearing protection wasn't a priority. Specifically, he could not fit into certain spaces because of the hearing protection so he had to take it off. His representative further noted that the hearing protection provided for service members with the Veteran's MOS did not provide enough protection.

The Board remanded the matter for further development in March 2020. The Veteran was afforded a VA examination in August 2020. The examiner determined that the Veteran has hearing loss in his right ear which meets the criteria for hearing loss for VA rating purposes. However, the examiner concluded that the Veteran's right ear hearing loss is less likely caused by or a result of an event in military service. She explained that the Institute of Medicine (IOM) (2006) stated there was insufficient scientific basis to conclude that permanent hearing loss, directly attributable to noise exposure, will develop long after noise exposure. The IOM panel concluded that based on their current understanding of auditory physiology a prolonged delay in the onset of noise-induced hearing loss was "unlikely." She also noted that studies from Lee, Matthews, Dubno, Mills (2005); Cruickshanks et al 2010; and Hoffman et al (2015), show that past noise history had no significant effect on rates of threshold changes later in life.

In August 2021, the Veteran's representative submitted an appellate brief explaining that the Veteran's audiology tests show a significant shift of hearing loss in the right ear and cited the Veteran's August 2020 VA examination (Appendix-2.c.). The representative further explained that it is well evidenced that noise induced hearing loss varies significantly from person to person. One area of note is that for some individuals it can be immediate, while others can take a

considerable amount of time before the effects are noticeable. Exposure to impulse or continuous loud noise causes a temporary hearing loss that disappears 16 to 48 hours later. Recent research suggests that although the loss of hearing seems to disappear, there may be residual long-term damage to your hearing.

The Board remanded the matter for further development in September 2021. The Veteran was afforded a VA examination in November 2021. The Veteran reported military noise exposure from gunfire, cannons, large weapons, naval ship weapons, helicopter engines, jet engines, and grenades in combat training. He also reported not wearing hearing protection most of the time. The examiner determined that the Veteran has hearing loss in his right ear which meets the criteria for hearing loss for VA rating purposes. However, the examiner concluded that the Veteran's right ear hearing loss is less likely caused by or a result of an event in military service. He also determined that it is less likely that the Veteran's right ear hearing loss is caused or aggravated by his service-connected left ear hearing loss. He explained that hearing loss due to noise exposure can occur bilaterally but occasionally can occur in one ear only. The Veteran's right ear hearing was normal during the entrance examination, and he maintained normal hearing post-separation. Noise has a cumulative effect on the inner ear causing more hearing loss with greater exposure. Damage to the ears as a result of hazardous noise is measurable on an audiogram when the hazardous noise stops. In the case of military noise exposure, the separation audiogram measures the cumulative amount of cochlear damage caused in service. Any measurable hearing loss after the audiogram at separation is not a result of military noise. Other conditions contribute to hearing loss after service including genetics, aging, cardiovascular conditions, and side effects from medication in addition to numerous other known causes. Entrance and separation audiograms were reviewed from the Veteran's file. The results indicated that hearing thresholds were within normal limits at each frequency tested after the military related noise exposure stopped. Previous VA examinations from May 2015 and July 2016 showed normal hearing at each frequency with no significant threshold shift in hearing. Damage attributed to the hazardous noise reported, were measured and found to have not impacted the Veteran's hearing at the point of separation from the military.

The examiner further explained that a noise induced hearing loss has to be measurable. The greater the exposure, the greater the hearing loss that will be present. Once the hazardous noise ceases or stops, the hearing loss due to noise

will also stop (Neeraj N Mathur, 2020) (https://emedicine.medscape.com/article/857813-clinical). Most scientific evidence indicates that previously noise-exposed ears are not more sensitive to future noise exposure and that hearing loss from noise does not progress (in excess of what would be expected from the addition of age-related threshold shifts) once the exposure to noise is discontinued (Noise-induced Hearing Loss, Journal of Occupational and Environmental Medicine: June 2003 - Volume 45 - Issue 6 - p 579-581). Current research of the mechanisms and processes involved in the recovery from noise exposure suggests that a delay of many years in the onset of noise-induced hearing loss following an earlier noise exposure is extremely unlikely (Institute of Medicine).

The information regarding noise-induced hearing loss can develop slowly over time is in reference to repeated exposure to hazardous noise. Damage from hazardous noise exposure is measurable on an audiogram whether it is immediate or gradual. Gradual does not mean it occurs later in life; it means the hearing loss can progress gradually after repeated exposure to hazardous noise that can be

measured (https://www.uofmhealth.org/health-library/tf3714).

The Board remanded the matter for further development in April and November 2022. The Veteran was afforded a VA examination in December 2022. The examiner concluded that the Veteran's right ear hearing loss is less likely than not caused by or a result of an event in military service. He explained that the Veteran did not experience a permanent positive threshold shift during military service. When comparing the Veteran's earliest available service audiogram to the Veteran's latest audiogram, the Veteran did not experience a significant threshold shift at any tested frequency on the right ear.

The examiner also concluded that the Veteran's right ear hearing loss is less likely than not proximately due to or the result of Veteran's service-connected conditions. He explained that "tinnitus does not and cannot cause hearing loss although it is often a symptom of hearing loss. It is possible for the cause of the Veteran's hearing loss in the left ear to also cause hearing loss in the right ear; however, it is not physiologically possible for a hearing loss in
He explained that the Veteran did not experience a permanent positive threshold shift during military service. When comparing the Veteran's earliest available service audiogram to the Veteran's latest audiogram, the Veteran did not experience a significant threshold shift at any tested frequency on the right ear.

The examiner also concluded that the Veteran's right ear hearing loss is less likely than not proximately due to or the result of Veteran's service-connected conditions. He explained that "tinnitus does not and cannot cause hearing loss although it is often a symptom of hearing loss. It is possible for the cause of the Veteran's hearing loss in the left ear to also cause hearing loss in the right ear; however, it is not physiologically possible for a hearing loss in one ear to cause a hearing loss in the opposite ear. This means that the Veteran's right ear hearing loss could not be caused by tinnitus or by a hearing loss in the opposite ear."

In June 2023, the Veteran's representative submitted an appellate brief indicating that the Veteran appears to have had an Occupational Safety and Health Administration (OSHA) significant shift in service. The pre-service enlistment audiogram of November 2010 and the January 2011 audiogram, after entrance, shows an OSHA significant shift under 29 CFR 1910.95. The DoD uses the same definition. Additionally, the STRs have an integrity and reliability problem. The January 2015 separation physical is largely blank, to include the audiogram, height, and weight. Yet it is signed off on and approved by two Navy officers. The representative further stated that VA audiology examinations are done to minimize ratings, VA audiology has a plus or minus 20 decibel margin of error, and the Veteran is entitled to the benefit of VA's 20 decibels of reasonable doubt. According to VA audiologists they cannot tell the difference between 35 and 55, 0 and 50, or between 40 and 80 (See 38 C.F.R. § 3.302 and 4.2). The Veteran is entitled to the +/- 20 decibels of VA reasonable doubt. VA audiology examinations are further problematic in that they do not reflect everyday life and are set up to minimize the rating. This is in conflict with VA's general policy in rating in 38 C.F.R. § 4.10 which discusses that the basis of disability evaluations is functioning under the ordinary conditions of daily life. VA also has a duty to maximize benefits, not to minimize them. Bradley v. Peake, 22 Vet. App. 280, 294 (2008).

Moreover, the representative indicated that VA audiologists missed page 44 of the IOM report and the two pages on long term effects of acoustic trauma that

precede it. It is established that even with apparent recovery of normal hearing

after acoustic trauma there can be widespread and ongoing damage to the cochlear hairs and their nerves becoming manifested only over time. The Veteran's representative cited to several medical articles regarding long term effects of acoustic trauma, hair cell damage and death from noise, occupational noise-induced hearing loss, delayed effects of noise on the ear, excitotoxicity, cochlear damage after noise, immediate and delayed cochlear neuropathy after noise exposure in pubescent mice, and hearing loss in children.

The Board remanded the matter for further development in July 2023. A VA medical opinion was provided in August 2023. The examiner concluded that the claimed condition was less likely than not aggravated beyond its natural progression by the Veteran's service-connected conditions. She noted that tinnitus is only a symptom, and not a disease or illness in itself. While tinnitus may be due to hearing loss, the reverse is not true. Tinnitus occurs due to cochlear damage, that can also lead to hearing loss, but again, tinnitus would not aggravate or make worse someone's hearing. She added that there is no scientific evidence to show that hearing loss in one ear would cause the opposite ear to worsen. Right and left cochleas function independently and have their own auditory pathways which are tonotopically paired with neurons in the auditory cortex. Hearing loss on one side does not affect the opposite ear.

Subsequently, the RO obtained another opinion in March 2024. The examiner concluded that the claimed condition was less likely incurred in or caused by military service. He explained that the risk for hearing loss is based on the intensity of the noise which is a function of loudness and distance as well as duration of exposure. So even though the Veteran may be exposed to noise, it does not indicate one will develop hearing loss. The most objective measure of hearing and acoustic trauma is the audiogram. When acoustic trauma is present it will
left cochleas function independently and have their own auditory pathways which are tonotopically paired with neurons in the auditory cortex. Hearing loss on one side does not affect the opposite ear.

Subsequently, the RO obtained another opinion in March 2024. The examiner concluded that the claimed condition was less likely incurred in or caused by military service. He explained that the risk for hearing loss is based on the intensity of the noise which is a function of loudness and distance as well as duration of exposure. So even though the Veteran may be exposed to noise, it does not indicate one will develop hearing loss. The most objective measure of hearing and acoustic trauma is the audiogram. When acoustic trauma is present it will show up in the audiogram as a 15 dB or greater shift preferentially at the higher frequencies which are more susceptible to noise. In this case, as correctly noted in his two previous VA examinations that assessed for the same condition, there were no significant shifts in his right ear hearing while in the service. This is objective evidence that his right ear did not suffer any acoustic trauma while in the service.

The examiner also concluded that the claimed condition was less likely than not aggravated beyond its natural progression by the veteran's service-connected conditions. He explained that the Veteran showed no shifts in his right ear throughout his military service through 2015. The audiogram is the most objective data to assess for acoustic trauma. As there was no shift in his hearing while in service this is objective evidence that his hearing was not aggravated at all by his military service. Furthermore, left ear hearing loss and tinnitus cannot cause right ear hearing loss.

Afterward, the RO obtained another opinion in April 2024. The examiner concluded that the Veteran's right ear hearing loss is less likely as not related to military noise exposure. He explained that noise has a cumulative effect on the inner ear causing more hearing loss with greater exposure. Damage to the ears as

a result of hazardous noise is measurable on an audiogram when the hazardous noise stops. The Veteran's entrance and separation audiograms from active duty were reviewed. Normal hearing was present at both entrance and separation with no significant threshold shifts in hearing. Damage attributed to the hazardous noise reported were measured and found to have not impacted the Veteran's hearing at the point of separation from the military. Post-separation audiograms from May 2015 and July 2016 also revealed right ear normal hearing at each frequency tested. Again, no significant threshold shifts were observed from entrance exam to these post-separation audiograms. The Veteran does report post-separation occupational noise exposure as an electrical technician. He stated he wears hearing protection at all times at his occupation.

The examiner also concluded that the Veteran's right ear hearing loss is less likely than not aggravated by the Veteran's service-connected tinnitus or left ear hearing loss. He explained that aside from noise exposure, there are numerous conditions that can contribute to hearing loss, such as genetics, aging, cardiovascular conditions, and side effects from medication. There is no evidence to support a hearing loss in one ear causes/aggravates a hearing loss in the opposite ear. Additionally, hearing loss is often associated with tinnitus, but there are individuals with hearing loss that never develop tinnitus. While individuals can perceive difficulty hearing due to their tinnitus, it does not cause or aggravate hearing loss beyond natural progression.

Eventually, the RO obtained another opinion in July 2024. The examiner concluded that the claimed condition was less likely than not caused by the indicated toxic exposure risk activity (TERA), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. She noted the Veteran's hazardous exposures and explained that although there has been found to be an association of hearing loss to some of the Veteran's toxic exposure risk activities (i.e. long-term exposure to toluene), there is no evidence based medical studies that show a delayed onset of hearing loss related to these activities. As there was no change detected in the Veteran's hearing screens from the start of military service to the end of military service.

In September 2025, the Veteran's representative submitted an appellate brief indicating that because VA has conceded the Veteran's exposure to hazardous noise (and granted service connection for the left ear), it is counter-intuitive to grant service connection for one ear but not the other. The representative also cited studies from Dr. K and Dr. L, which indicate progressive underlying neuropathology from hazardous noise exposure can have profound long-term consequences on auditory processing.

Based on the evidence of record, the Board finds that it persuasively weighs against the award of service connection for right ear hearing loss, to include as secondary to service-connected tinnitus and left ear hearing loss, because there is no evidence of record establishing the nexus element of the claim. In addition, there is also no competent medical evidence linking his right ear hearing loss to his service-connected tinnitus or left ear hearing loss. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc). Accordingly, service connection for right ear hearing loss, to include as secondary to service-connected tinnitus and left ear hearing loss, is denied.

The Board finds the November 2021 opinion (regarding direct service connection and secondary causation) and later August 2023 and April 2024 opinions (regarding aggravation) to be fully adequate. Here, the examiners fully addressed the nexus question and found that the Veteran's right ear hearing loss is more likely related to a post-service event, illness, or injury, such as genetics, aging, cardiovascular conditions, and side effects from medication. Additionally, the examiners determined that hearing loss in one ear does not affect the opposite ear and tinnitus does not cause or aggravate hearing loss. The opinions reflect that the examiners reviewed the file, considered the Veteran's lay statements, and provided an informed opinion fully responsive to the question at issue. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). There are no contrary probative opinions available.

With regard to direct service connection, the Board notes that the Veteran's service treatment records (STRs) are silent for a diagnosis of right ear hearing loss or symptoms of right ear haring loss and the January 2015 separation examiner specifically noted hearing loss in the left ear. Neither the Veteran nor his representative have provided any contentions that the right ear hearing loss began during active-duty service. Notably, they contend that he has delayed onset hearing loss in his right ear related to service. See September 2024 Appellate Brief. Additionally, there is no competent medical opinion of record that links the Veteran's right ear hearing loss to service. Specifically, the November 2021 examiner determined that it is much more likely that the Veteran's right ear hearing loss is related to a post-service event, illness, or injury, such as genetics, aging, cardiovascular conditions, or side effects from medication. He noted that hearing loss due to noise exposure can occur bilaterally but occasionally can occur in one ear only. He further noted that the Veteran's right ear hearing was normal during the entrance examination, and he maintained normal hearing post-separation. Previous VA examinations from May 2015 and July 2016 showed normal hearing at each frequency with no significant threshold shift in hearing. Additionally, current research of the mechanisms and processes involved in the recovery from noise exposure suggests that a delay of many years in the onset of noise-induced hearing loss following an earlier noise exposure is extremely unlikely.

The Board notes the IOM citation in the November 2021 opinion and acknowledges that in June 2019, the Court issued a decision in McCray v. Wilkie, 31 Vet. App. 243 (2019). In McCray, the Court discussed the above noted IOM report. The Court noted that the IOM report concluded, in part, that "based on current knowledge of cochlear physiology there was no sufficient scientific basis for the existence of delayed-onset hearing loss." However, the IOM report also indicated that "[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure" and that "definitive studies to address this issue have not been performed." The Court then held that if the Board finds that a medical text that serves as the basis for a medical opinion contains apparent qualifiers or contradictions, or if the Veteran raises the issue or it is reasonably raised from review of the evidence of record, the Board must address that issue and explain whether those aspects of the medical text diminish the probative value of the medical opinion evidence or render
delayed-onset hearing loss." However, the IOM report also indicated that "[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure" and that "definitive studies to address this issue have not been performed." The Court then held that if the Board finds that a medical text that serves as the basis for a medical opinion contains apparent qualifiers or contradictions, or if the Veteran raises the issue or it is reasonably raised from review of the evidence of record, the Board must address that issue and explain whether those aspects of the medical text diminish the probative value of the medical opinion evidence or render the opinion inadequate, and if not, why not. McCray, 31 Vet. App. at 257.

Although not raised by the Veteran, the Board acknowledges that the November 2021 VA examiner relied, in some part, on the IOM report as a basis for providing a negative opinion and the IOM report has apparently qualifying or contradictory statements, as noted by the Court in McCray. The Board finds that does not render the entire November 2021 VA opinion inadequate or diminish its probative value as to the point of whether the Veteran's right ear hearing loss is due to in-service noise exposure.

The IOM report acknowledged that there was insufficient evidence to address the question of delayed onset noise-induced hearing loss. Nevertheless, the IOM report's own finding that, based on the anatomical and physiological data available on the recovery process of noise exposure, it is unlikely that delayed hearing loss effects occur is probative. This statement tends to show that the limitation was considered, but the IOM was confident in the available data (anatomical and physiological) to make a conclusion utilizing a strongly worded term (unlikely). Indeed, the committee noted its understanding of the mechanisms and processes involved in the recovery from noise exposure as it suggested a delay of many years in the onset of noise-induced hearing loss following an earlier noise exposure is extremely unlikely. The Board finds that the use of the word extremely also lends much support to finding that the report retains its probative value and is not inadequate. The Board further notes that no opposing studies or other contradictory medical evidence have been submitted in this appeal. 38 U.S.C. § 5107(a); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009) (stating that the claimant has the burden to present and support a claim for benefits and noting that the benefit of the doubt standard in section 5107(b) is not applicable based on pure speculation or remote possibility).

Moreover, the McCray court referenced a medical text's qualifying or contradictory aspects as one factor on a non-exhaustive list that is relevant to the Board's evaluation of the probative value and adequacy of a medical opinion. McCray, 31 Vet. App. 243. Here, the November 2021 VA examiner only partially relied on the findings of the IOM report and discussed other factors that led to his ultimate conclusion. Thus, the VA examiner did not rely entirely on the IOM report in forming the conclusion but, instead, considered all relevant facts in this case. His opinion and rationale are the most probative evidence of record on the etiology of the Veteran's right ear hearing loss. Reading the examiner's opinion as a whole, the examiner relied on accurate facts, expressly considered the Veteran's in-service noise exposure, described the Veteran's disability in sufficient detail, related medical literature to the Veteran's specific facts, and provided a reasoned medical explanation that connected his conclusion to supporting data. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007).

Again, the Board acknowledges the Veteran's assertions that noise exposure during active-duty service caused his right ear hearing loss, to include delayed onset hearing loss. The Board notes that the Veteran is competent to attest to lay observable symptoms such as decreased hearing and ringing in his ears. However, he is not competent to opine regarding complex medical issues such as to the etiology of hearing loss. A nexus opinion has been provided by a medical examiner with the appropriate education, experience, and training. 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). As above, the VA examiner specifically noted that hearing loss due to noise exposure can occur in one ear only and a delay of many years in the onset of noise-induced hearing loss following an earlier noise exposure is extremely unlikely. The Board finds
, he is not competent to opine regarding complex medical issues such as to the etiology of hearing loss. A nexus opinion has been provided by a medical examiner with the appropriate education, experience, and training. 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). As above, the VA examiner specifically noted that hearing loss due to noise exposure can occur in one ear only and a delay of many years in the onset of noise-induced hearing loss following an earlier noise exposure is extremely unlikely. The Board finds that the VA examiner's opinion is the most probative in determining the etiology of the Veteran's right ear hearing loss. As that opinion is against the claim, the Board finds that the claim for service connection must be denied.

The Board acknowledges the medical articles referenced and/or submitted by the Veteran and his representative, to include the articles referenced in the August 2021, June 2023, and September 2024 appellate briefs. However, the medical articles are not specific to the Veteran and the facts of his case and were not accompanied by a valid medical opinion in support. These articles, by their own general terms, do not serve to establish the required competent medical evidence of a nexus, with respect to the Veteran's individual case. See Sacks v. West, 11 Vet. App. 314 (1998). The United States Court of Appeals for Veterans Claims has held that "[g]enerally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive." Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). None of the medical articles submitted were accompanied by the opinion of any medical expert linking the Veteran's right ear hearing loss to service. Thus, the Board finds the medical articles are of little probative value as they are not backed by a quality medical opinion. Moreover, the November 2021 examiner directly addressed the Veteran's contention, reasoning that delayed onset of noise-induced hearing loss following an earlier noise exposure is extremely unlikely.

The Board acknowledges the representatives claim that the pre-service enlistment audiogram of November 2010 and the January 2011 audiogram, after entrance, shows an OSHA significant shift under 29 CFR 1910.95. See June 2023 Appellate Brief. VA does not have a definition of what constitutes a "significant" threshold shift (STS). The Department of Defense defines an STS as an "average change of plus or minus 10 dB at 2000, 3000, and 4000 Hz, relative to the reference audiogram, in either ear, without age corrections." Dep't of Def., Instr. No. 6055.12, Hearing Conservation Program (HCP), (Aug. 14, 2019), https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/605512p.pdf?ver=2019-08-14-073309-537. OSHA measures the standard threshold shift, also with the STS initialism, to assess hearing loss from occupational noise exposure. OSHA defines STS as "a change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at 2000, 3000, and 4000 Hz in either ear." 29 C.F.R. § 1910.95(g)(10) (2021). While the Board acknowledges that neither the Department of Defense nor the OSHA standards are binding on VA, the Board finds them to be useful for understanding what constitutes an STS in the absence of a VA definition. Here, it doesn't matter whether or not an OSHA significant shift occurred between November 2010 and January 2011 because the Veteran's STRs indicate that there is no right ear hearing loss for VA disability compensation purposes throughout his service. Additionally, his STRs from April 2012 noted that his right ear revealed normal hearing (250-8kHz).

Additionally, the representative claims the Veteran's STR's have an integrity and reliability problem. He added that the January 2015 separation exam is largely blank, to include the audiogram, height and weight. See June 2023 Appellate Brief. However, there is no evidence that service treatment records are incomplete. Additionally, the Veteran's service treatment records are credible and probative
matter whether or not an OSHA significant shift occurred between November 2010 and January 2011 because the Veteran's STRs indicate that there is no right ear hearing loss for VA disability compensation purposes throughout his service. Additionally, his STRs from April 2012 noted that his right ear revealed normal hearing (250-8kHz).

The Board also acknowledges the representative's argument that the December 2022 VA examiner had less than seven months in practice and is practicing out of a Des Moines, Iowa Holiday Inn Express and indicated a request for remand. See June 2023 Appellate Brief. However, the examiner is a licensed audiologist and neither the Veteran nor his representative has identified any particular misconduct by the December 2022 VA examiner or any particular error in the examination report. The Board has reviewed the December 2022 VA examination report and finds no error in the conduct or recording of the examination. Additionally, the Veteran received multiple adequate VA examinations concerning his right ear hearing loss since the December 2022 VA examination. As such, the Board concludes that VA has satisfied its duty to assist in providing the Veteran with an adequate examination. Accordingly, the Board finds that remand for an additional examination is not appropriate, and the Board must decide this issue based on the evidence of record.

Furthermore, the June 2023 brief states that VA audiology examinations are done to minimize ratings and according to VA, the margin of error or "normal measurement variability" that VA audiologists use is +/- 20 decibels at least and cited two other Board decisions for support. He added that According to VA audiologists they cannot tell the difference between 35 and 55, 0 and 50, or between 40 and 80. He cited 38 C.F.R. § 3.302 which concerns service connection for mental unsoundness in suicide and 38 C.F.R. § 4.2 which concerns interpretation of examination reports. He concluded by stating that the Veteran is entitled to the +/- 20 decibels of VA reasonable doubt and VA audiology examinations are problematic in that they do not reflect everyday life. Here, to the extent the Board decisions noted appear to address similar factual circumstances to the present appeal, previous Board decisions are nonprecedential in nature and are not binding on the Board on future adjudications. See 38 C.F.R. § 20.1303. The brief asks the Board to apply VA's 20 decibel margin of error to the VA audiograms used for rating. However, the United States Court of Appeals for Veterans Claims has held that "[r]atings for hearing impairment are derived by the mechanical application of the Rating Schedule to the numeric designations assigned after audiometry evaluations are rendered." Lendenmann v. Principi, 3 Vet. App. 345 (1992). This holding does not permit the Board to change the numeric designations assigned after testing by applying a 20-decibel margin of error to the VA audiograms used for rating in this case.

The Board also acknowledges the Veteran's representative's contention that VA audiology examinations are intended to minimize ratings and do not to reflect an everyday environment, and the CNC score is not intended to simulate real world performance, but rather to give the highest score possible. Nevertheless, the Court has upheld VA's policy of conducting audiometric testing in a sound-controlled room, which is designed to obtain the necessary information for the full and accurate application of the hearing loss rating schedule. See Martinak v. Nicholson, 21 Vet. App. 447, 454 (2007). In Doucette, the Court recognized that VA's audiometric tests are specifically designed to measure the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment; thus, the Veteran's inability to hear or understand speech or to hear other sounds in various contexts is sufficiently measured during the VA examination and such functional effects are contemplated by the schedular rating criteria. See Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017). Moreover, the Veteran's representative is not competent to provide an etiological link to service. The issue is medically complex, as it requires a specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377,
recognized that VA's audiometric tests are specifically designed to measure the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment; thus, the Veteran's inability to hear or understand speech or to hear other sounds in various contexts is sufficiently measured during the VA examination and such functional effects are contemplated by the schedular rating criteria. See Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017). Moreover, the Veteran's representative is not competent to provide an etiological link to service. The issue is medically complex, as it requires a specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Board assigns no probative weight to the representative's assertions.

Service connection may also be established on a presumptive basis for certain chronic diseases, to include sensorineural hearing loss, which develops to a compensable degree within one year after separation from service, even though there is no evidence of that disease during active service. That presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

The Board finds that the Veteran's right ear hearing loss has not shown to have manifested to a compensable degree in service or within a year after service. A review of the record shows no evidence of a diagnosis, or any hearing loss during service or within one year following separation from service. The first indication of right ear hearing loss was noted in June 2019 when the examiner determined that his right ear hearing was within normal limits from 250-4000 Hz sloping to a mild hearing loss from 6000-8000 Hz. Eventually, an August 2020 VA examination report noted that the Veteran was diagnosed with hearing loss in his right ear which meets the criteria for hearing loss for VA rating purposes (five years after service). Thus, there is no evidence suggesting that chronic right ear hearing loss was shown as such in service or within one year following separation from service.

Therefore, the totality of the evidence does not show that the Veteran's right ear hearing loss began in service or within one year after service; nor does the evidence show continuity of symptomatology following service. Service connection for right ear hearing loss is therefore not warranted on a presumptive basis. 38 C.F.R. §§ 3.303(b), 3.307, 3.309.

With regard to secondary service connection, the competent medical evidence of record does not support a link between right ear hearing loss and the service-connected tinnitus and left ear hearing loss. None of the examiners of record determined that the Veteran's right ear hearing loss is caused or aggravated by his service-connected tinnitus or left ear hearing loss. Additionally, the August 2023 opinion noted that tinnitus would not aggravate or make worse someone's hearing and hearing loss in one ear does not affect the opposite ear. Moreover, the April 2024 examiner supported the August 2023 examiner's opinion by noting that there is no evidence to support that a hearing loss in one ear causes or aggravates a hearing loss in the opposite ear and tinnitus does not cause or aggravate hearing loss beyond natural progression.

While the Veteran may believe his right ear hearing loss is caused or aggravated beyond its natural progression by his service-connected tinnitus and/or left ear hearing loss, the Veteran in this case is not competent to provide an etiology opinion regarding this issue nor rebut the examiner's rationale which is predicated on an accurate factual basis. The issue is medically complex, as right ear hearing loss has multiple possible etiologies, requires specialized testing to diagnose. Therefore, such opinions are outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA medical opinions. Again, there are no contrary probative opinions available.

In short, the weight of the evidence is against finding that the Veteran's right ear hearing loss is related to active service, to include his TERA, or is caused or aggravated by his service-connected tinnitus and left ear hearing loss. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The criteria for
3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA medical opinions. Again, there are no contrary probative opinions available.

In short, the weight of the evidence is against finding that the Veteran's right ear hearing loss is related to active service, to include his TERA, or is caused or aggravated by his service-connected tinnitus and left ear hearing loss. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The criteria for service connection for right ear hearing loss are not met. Accordingly, there is no benefit of the doubt to resolve in the Veteran's favor and the claim for service connection for right ear hearing loss must be denied. 38 U.S.C. § 5107(b).

Jenna Brant

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Miller, D. M. Associate Counsel

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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