HEARING LOSS

Summary

The Veteran, who served in the U.S. Air Force across multiple periods between January 1992 and June 2008, including service in Southwest Asia, appeals the denial of service connection for bilateral hearing loss and the remand of his claim for esophageal disabilities, including hiatal hernia and GERD. The Board found the claim for bilateral hearing loss denied, as the Veteran's service treatment records and VA examinations did not establish a current hearing loss disability meeting VA criteria. Specifically, audiometric testing did not meet the required thresholds for a disability rating, and lay testimony regarding hearing issues was insufficient without professional diagnostic results. The Board remanded the esophageal disability claim because the VA medical opinion was inadequate. The examiner failed to address specific evidence regarding the onset of GERD symptoms during service in 2001 and the diagnosis of GERD in 2011, and her findings regarding the cause of GERD and hiatal hernia were inconsistent with the record. Further development is required for the esophageal claim, including obtaining updated treatment records and a new, comprehensive VA examination addressing the Veteran's specific statements and the conflicting evidence.

Rationale

No current hearing loss disability established per 38 C.F.R. § 3.385; Audiometric testing did not meet VA criteria; Lay testimony insufficient without professional diagnostic results

Full Decision Text

Citation Nr: 26004899
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 19-38 017
DATE: April 23, 2026

ORDER

Service connection for bilateral hearing loss is denied.

REMANDED

Entitlement to service connection for an esophageal disability, to include hiatal hernia and/or gastroesophageal reflux disease (GERD), is remanded.

FINDING OF FACT

The evidence is persuasively against a finding that the Veteran has had a hearing loss disability of either ear for VA purposes at any time during the pendency or proximate to the filing of his claim.

CONCLUSION OF LAW

The criteria for an award of service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Air Force from January 1992 to October 1992, August 1994 to November 1994, September 2001 to August 2002, and May 2008 to June 2008. He also had service in the United States Air Force Reserve.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Houston, Texas.

In November 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge, sitting in St. Louis, Missouri. A transcript of that hearing has been associated with the record.

The issues currently on appeal were previously before the Board in September 2023, when they were remanded to the agency of original jurisdiction (AOJ) for additional development. In the remand, the Board directed the AOJ, in pertinent part, to ask the Veteran to identify and provide an appropriate release for any non-VA providers who might possess new or additional evidence pertinent to the disabilities at issue, to obtain updated VA treatment records, and to procure VA examinations and medical opinions in connection with his claims. 

In January 2024, the AOJ sent the Veteran a letter asking him to identify and provide an appropriate release for records from non-VA providers. In May 2024, the AOJ obtained updated VA treatment records. In light of those actions, the Board finds that the AOJ has at least substantially complied with the records development ordered in the September 2023 remand. See Stegall v. West, 11 Vet. App. 268 (1998). 

In June 2024, the AOJ procured a new VA examination and medical opinion with respect to the Veteran's claim for service connection for bilateral hearing loss. In May 2024, the AOJ obtained a new VA examination and medical opinion with respect to his claim for service connection for an esophageal disability. The June 2024 VA examination with respect to hearing loss is fully adequate and, as such, the Board finds that the AOJ has substantially complied with all of the Board's remand directives as to that issue. As to the esophageal disability, however, the Board finds that the medical opinion is not fully adequate inasmuch as it does not substantially comply with the Board's specific September 2023 remand directives. See Stegall, supra; Barr v. Nicholson, 21 Vet. App. 303, 310 (2007) (when VA undertakes to provide a veteran with an examination and/or opinion, it must be adequate). As such, further development of that claim is required.

The Board notes that the AOJ furnished the Veteran a Supplemental Statement of the Case (SSOC) in August 2024. Although additional evidence has been added to the record since that time, none of it bears meaningfully on the outcome of the Veteran's hearing loss claim. As such, there is no need to return the case to the AOJ for consideration of the new evidence or, alternatively, to solicit a waiver of AOJ review from the Veteran, before proceeding with the adjudication of that claim. See 38 C.F.R. §§ 19.31, 20.1305(c).

As a final introductory matter, the Board notes that claims for service connection for right and left knee disabilities, irritable bowel syndrome (IBS), and tinnitus were also previously on appeal. In an August 2024 rating decision, the AOJ granted service connection for right and left knee strain, IBS, and tinnitus. Inasmuch as the August 2024 rating decision represents a full grant of the benefits sought on appeal with respect to those issues, they are
 AOJ for consideration of the new evidence or, alternatively, to solicit a waiver of AOJ review from the Veteran, before proceeding with the adjudication of that claim. See 38 C.F.R. §§ 19.31, 20.1305(c).

As a final introductory matter, the Board notes that claims for service connection for right and left knee disabilities, irritable bowel syndrome (IBS), and tinnitus were also previously on appeal. In an August 2024 rating decision, the AOJ granted service connection for right and left knee strain, IBS, and tinnitus. Inasmuch as the August 2024 rating decision represents a full grant of the benefits sought on appeal with respect to those issues, they are no longer before the Board. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997).  

Entitlement to service connection for bilateral hearing loss

The Veteran seeks to establish service connection for bilateral hearing loss. He contends, in essence, that he has a bilateral hearing loss disability that was caused by service, as due to in-service exposure to hazardous noise. 

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).

The requirement of a current disability is satisfied when the claimant is shown to have the disability either at the time he files his claim for service connection, or during the pendency of that claim, even if the disability resolves prior to final adjudication. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). When the record contains a recent diagnosis of disability prior to the filing of a claim for benefits based on that disability, the report of diagnosis is relevant evidence that must be addressed in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013).

Specific to claims for service connection for hearing loss, impaired hearing is considered a "disability" for VA purposes only when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; when the thresholds for at least three of these frequencies 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. An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist, must include a controlled speech discrimination (Maryland CNC) test and a puretone audiometry test, and must be conducted without the use of hearing aids. 38 C.F.R. § 4.85(a).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997). In the absence of proof of a present disability, there can be no valid claim.  Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

The Veteran was first afforded a VA examination in connection with his claim in August 2013. The puretone thresholds on audiometric testing were as follows (in decibels):?

HERTZ

	500	1000	2000	3000	4000	Avg

Right Ear	5	5	0	10	15	8

Left Ear	0	5	0	10	15	8

Speech discrimination (Maryland CNC) scores were 100 percent, bilaterally, and the examiner indicated that the test results were valid for rating purposes.

The Veteran was afforded a second VA examination in connection with his claim in June 2024. The puretone thresholds on audiometric testing were as follows (in decibels):

HERTZ

	500	1000	200
 August 2013. The puretone thresholds on audiometric testing were as follows (in decibels):?

HERTZ

	500	1000	2000	3000	4000	Avg

Right Ear	5	5	0	10	15	8

Left Ear	0	5	0	10	15	8

Speech discrimination (Maryland CNC) scores were 100 percent, bilaterally, and the examiner indicated that the test results were valid for rating purposes.

The Veteran was afforded a second VA examination in connection with his claim in June 2024. The puretone thresholds on audiometric testing were as follows (in decibels):

HERTZ

	500	1000	2000	3000	4000	Avg

Right Ear	15	10	15	25	30	20

Left Ear	15	15	20	20	20	18.75

Speech discrimination (Maryland CNC) scores were 94 percent in the right ear and 96 percent in the left ear, and the examiner indicated that the test results were valid for rating purposes.

The claims file does not contain any other examination reports that meet the definition of an examination for hearing impairment for VA purposes during the period on appeal. While acknowledging that the claims file contains other puretone audiometry tests that were obtained during that period in connection with the Veteran's service in the U.S. Air Force Reserve, the reports of those examinations are not valid for purposes of assessing whether the Veteran has a current hearing loss disability for VA purposes because they do not include a controlled speech discrimination test. 38 C.F.R. § 4.85(a).

In light of the foregoing, the Board must conclude that the evidence is persuasively against the Veteran's claim. Simply put, the evidence does not establish that he has had a hearing loss disability of either ear as defined by VA regulation at any time during the pendency or proximate to the filing of his claim. 38 C.F.R. § 3.385.

The Board notes that the Veteran is competent to report a history of in-service noise exposure and current problems with decreased auditory acuity. See 38 C.F.R. § 3.159 (a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno, 6 Vet. App. 465, 469-70 (1994). However, the presence of a hearing loss "disability" for VA purposes is not something that is capable of lay observation; rather, such a finding requires professionally administered test results satisfying the criteria set out at 38 C.F.R. § 3.385. In the absence of such evidence, service connection for hearing loss must be denied. 

REASONS FOR REMAND

Entitlement to service connection for an esophageal disability, to include hiatal hernia and/or GERD is remanded.

The Veteran seeks to establish service connection for esophageal disabilities, to include hiatal hernia and/or GERD. His primary contention with respect to GERD is that it had its onset during his active-duty service while deployed following 9/11 (2001). In that regard, he testified at the November 2021 hearing that he began to experience symptoms of GERD when he started getting to higher stress environments. He also testified that while deployed and during combat operations, he developed symptoms after gaining weight from eating ready to eat meals (MREs) for months on end. He stated that after vomiting a couple of times, he sought treatment in December 2001 and was given some medication.

With respect to hiatal hernia, the Veteran testified that he had been diagnosed with a hiatal hernia approximately five years prior to the hearing, that he had undergone two surgeries to correct the condition, and that since the surgery his GERD symptoms were almost non-existent. The Board also notes that the Veteran testified that he had been told by his primary care physician that his hiatal hernia was the cause of his GERD, which is consistent with a May 2024 medical opinion wherein a VA examiner found that the Veteran's hiatal hernia was the likely cause of his GERD. 

In the September 2023 remand, the Board outlined several pieces of evidence that were directly relevant to the Veteran's claim, including the Veteran's November 2021 hearing testimony to the effect that the onset of his symptoms occurred while he was deployed, evidence showing a diagnosis of GERD as early as 2011, and the Veteran's report symptoms of GERD in a September 2019 Report of Medical History from a period of reserve service. 

The Board noted further that the Veteran had been afforded a VA examination in connection with his claim in July 2017, but that the examiner failed to address relevant evidence of record, and that evidence added
 that the Veteran's hiatal hernia was the likely cause of his GERD. 

In the September 2023 remand, the Board outlined several pieces of evidence that were directly relevant to the Veteran's claim, including the Veteran's November 2021 hearing testimony to the effect that the onset of his symptoms occurred while he was deployed, evidence showing a diagnosis of GERD as early as 2011, and the Veteran's report symptoms of GERD in a September 2019 Report of Medical History from a period of reserve service. 

The Board noted further that the Veteran had been afforded a VA examination in connection with his claim in July 2017, but that the examiner failed to address relevant evidence of record, and that evidence added to the claims file since the time of the examination could impact the examiner's assessment. The Board remanded the claim to the AOJ for a new VA examination and opinion on that basis, directing the examiner to identify any pertinent disabilities that the Veteran had had during the period on appeal, and to provide an etiological opinion with respect to each identified disability. The Board specifically directed the examiner to discuss the Veteran's statements regarding the onset of his symptoms while deployed, his diagnosis of GERD as early as 2011, and his report of GERD symptoms in the September 2019 STR. 

As noted, the Veteran was afforded a new VA examination in connection with his claim in May 2024. The examiner found that the Veteran had GERD, identifying the date of diagnosis as January 2018, and that he also had a hiatal hernia, identifying the date of diagnosis as March 2019. She noted the Veteran's report that the condition began about 15 years earlier due to illness, and that he had vomiting after eating foods and lying down. She also noted that he had two hiatal hernia repair surgeries, the first in 2018 and a second in 2019. 

The examiner offered a negative nexus opinion as to direct service connection, reasoning that the Veteran's entrance examination was silent for any gastrointestinal abnormalities. She noted that a March 2000 flight examination was also silent for gastrointestinal abnormalities and that there was no evidence in the STRs showing that he was ever evaluated or treated for GERD while in service. She added that the first mention of acid reflux was on a retirement physical dated in September 2019, which was over ten years after his separation from active-duty service. 

Inasmuch as a May 2024 toxic exposure risk activity (TERA) memorandum noted that the Veteran's service in Turkey and Bahrain confirmed participation in TERA during service, the AOJ also obtained an opinion as to whether the Veteran's esophageal disabilities were due to any in-service toxic exposures. The same examiner offered a negative nexus opinion in that regard, reasoning that toxic environmental exposure had not been shown to cause GERD or hiatal hernia in medical literature. She then explained the physiological process of GERD and noted that common risk factors included obesity, smoking, and hiatal hernia, and that the Veteran's hiatal hernia was the likely cause of the GERD. She concluded that no conceded in-service exposures were known to affect the lower esophageal sphincter. As to hiatal hernia, she stated that it was a condition where part of the stomach bulged through the hiatus of the diaphragm, and that it could be congenital but that other risk factors included age, obesity, and repetitive straining. 

On review, the Board finds that the May 2024 VA medical opinion as to direct service connection for the Veteran's esophageal conditions is not fully adequate for multiple reasons. First, the examiner failed to take into consideration the specific evidence identified by the Board. Although the Board requested the examiner to specifically discuss the Veteran's reports regarding the onset of his symptoms while deployed (in 2001), the examiner cited to evidence prior to that date to support her finding that service treatment records (STRs) were silent for gastrointestinal abnormalities. She also failed to address the fact that GERD was diagnosed as early as 2011, and in her examination report indicated that the date of diagnosis was January 2018. Second, the opinion is not consistent with the evidence of record. The examiner's finding that the Veteran did not report acid reflux symptoms until ten years after his separation from active duty is not consistent with the fact that GERD was diagnosed as early as 2011. Third, the May 2024 opinion does not clearly differentiate between the two identified disabilities. 

The Board also finds that while the TERA opinion appears to be adequate as to whether GERD was caused by any in-service toxic exposures, the examiner's finding therein that that hiatal hernia is the most likely cause of GERD is contradicted by other evidence of record. While it may be true that hiatal hernia is a common risk factor of GER
 January 2018. Second, the opinion is not consistent with the evidence of record. The examiner's finding that the Veteran did not report acid reflux symptoms until ten years after his separation from active duty is not consistent with the fact that GERD was diagnosed as early as 2011. Third, the May 2024 opinion does not clearly differentiate between the two identified disabilities. 

The Board also finds that while the TERA opinion appears to be adequate as to whether GERD was caused by any in-service toxic exposures, the examiner's finding therein that that hiatal hernia is the most likely cause of GERD is contradicted by other evidence of record. While it may be true that hiatal hernia is a common risk factor of GERD, in the present case the evidence demonstrates that the Veteran's GERD was diagnosed at least as early as 2011, which is prior to the date that the examiner identified as the date of diagnosis for hiatal hernia. 

The Board finds further that the TERA opinion with respect to hiatal hernia is not fully adequate because the examiner did not offer a clear opinion as to whether that disability was caused by any in-service exposures. She also failed to apply the risk factors present in the Veteran's case specifically.  

For all of these reasons, the Board finds that the May 2024 VA medical opinions are not fully adequate. As such, further development is required. Stegall, supra. Updated records of VA treatment should also be procured. 

These matters are REMANDED for the following action:

1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record.

2. After the foregoing development has been completed, arrange to provide the record on appeal to the VA examiner who offered opinions as to the etiology of the Veteran's GERD and hiatal hernia in May 2024. 

After reviewing the record, the examiner should offer separate opinions as to whether it is at least as likely as not (i.e., whether the likelihood is at least approximately balanced or nearly equal, if not higher), that the Veteran's GERD and/or hiatal hernia had their onset in, or are otherwise attributable to, the Veteran's periods of service.  

In proffering the requested opinion as to GERD, the examiner should consider and address the Veteran's November 2021 hearing testimony to the effect that he began to experience symptoms of GERD when he started getting to higher stress environments after 9/11 (2001), and that while deployed and during combat operations, he developed symptoms after gaining weight from eating ready to eat meals (MREs) for months on end and that after vomiting a couple of times he sought treatment in December 2001 and was given some medication. The examiner should also consider and address a June 2011 non-VA treatment record showing that the Veteran was diagnosed with GERD as early as 2011, and his reports of GERD symptoms in the September 2019 STR from a period of reserve service. 

If the examiner finds that the most likely cause of the Veteran's GERD is hiatal hernia, she must provide a rationale for why that is so in light of the fact that the claims file demonstrates that the Veteran was diagnosed with GERD as early as 2011, and that in her own May 2024 examination report she identified the date of diagnosis of hiatal hernia as having occurred later, in March 2019. 

In proffering the requested opinion as to hiatal hernia, the examiner must identify any risk factors that are applicable to the Veteran's case. She must also offer a specific opinion as to whether it is at least as likely as not that the Veteran's hiatal hernia was caused by any in-service TERAs (in this case any exposures conceded by virtue of the Veteran's service in Southwest Asia). In addressing that question, the examiner must specifically consider (a) the total potential exposure through all applicable military deployments of the Veteran, and (b) the synergistic, combined effect of all toxic exposure risk activities of the Veteran. 

If the May 2024 VA examiner is no longer employed by VA, or is otherwise unable to offer the requested opinions, arrange to obtain the requested information from another qualified examiner. The need for another in-person, or video or telephone interview of the Veteran is left to the discretion of the examiner. 

A complete medical rational for all opinions expressed must be provided. 

3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues remaining on appeal should be readjudicated based on the entirety of the evidence.
 military deployments of the Veteran, and (b) the synergistic, combined effect of all toxic exposure risk activities of the Veteran. 

If the May 2024 VA examiner is no longer employed by VA, or is otherwise unable to offer the requested opinions, arrange to obtain the requested information from another qualified examiner. The need for another in-person, or video or telephone interview of the Veteran is left to the discretion of the examiner. 

A complete medical rational for all opinions expressed must be provided. 

3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues remaining on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued an SSOC. An appropriate period of time should be allowed for response.

 

DAVID A. BRENNINGMEYER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Oldroyd, 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.