HEARING LOSS

JONATHAN B. KRAMER · 2026 · Case ID: A26029238

MIXED

Summary

The veteran, who served from October 1960 to October 1962 with subsequent Reserve service until September 1966, appeals the denial of service connection for asthma and vertigo, and seeks an increased rating for bilateral hearing loss (BHL). The Board granted an increased rating for BHL, awarding a 50 percent rating effective August 5, 2024, based on audiological tests showing an exceptional pattern of hearing impairment, and a 40 percent rating effective May 21, 2025, based on later audiological tests. The Board denied service connection for asthma because the veteran failed to attend a scheduled VA examination without good cause, despite having a diagnosis of asthma and evidence of in-service symptoms. The Board denied service connection for vertigo, finding no nexus to service or to the service-connected tinnitus and BHL. The sole medical opinion, from a VA examiner, concluded that vertigo was less likely than not caused or aggravated by tinnitus or BHL, citing the separate nature of these inner ear conditions and the lack of objective evidence supporting a link. The Board gave greater weight to this medical opinion over the veteran's lay statements regarding etiology.

Rationale

August 2024 VA audiology exam showed exceptional hearing impairment; May 2025 VA audiogram showed exceptional hearing impairment; Applied Table VIa and Table VII for rating designations

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250826-596232

Full Decision Text

Citation Nr: A26029238
Decision Date: 03/31/26 Archive Date: 03/31/26

DOCKET NO. 250826-596232
DATE: March 31, 2026

ORDER

A 50 percent rating, but no higher, for bilateral hearing loss (BHL) from August 5, 2024, is granted, subject to the criteria governing the payment of monetary benefits.

A 40 percent rating, but no higher, for BHL from May 21, 2025 is granted, subject to the criteria governing the payment of monetary benefits.

Service connection for asthma is denied.

Service connection for vertigo is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from October 1960 to October 1962; he had additional Reserve service thereafter until September 30, 1966.

2. From August 5, 2024, BHL is manifested by no worse than Level VIII hearing acuity in the right ear and Level IX hearing acuity in the left ear.

3. From May 21, 2025, BHL is manifested by no worse than Level VII hearing acuity in the right ear and Level VII hearing acuity in the left ear.

4. Without good cause, the Veteran failed to appear at a June 2025 VA examination scheduled in conjunction with his June 2025 claim for service connection for asthma, which had been previously disallowed in prior rating decisions.

5. Vertigo was not shown in service, is not causally or etiologically related to service, and was not caused or aggravated by a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for a 50 percent rating, but no higher, for BHL from August 5, 2024 have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.85, Diagnostic Code (DC) 6100 (2025).

2. The criteria for a 40 percent rating, but no higher, for BHL from May 21, 2025 have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.85, Diagnostic Code (DC) 6100 (2025).

3. The criteria for service connection for asthma have not been met on the basis of the Veteran's failure to report for a VA medical examination. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. § 3.655 (2025)

4. Vertigo was not incurred in service and is not proximately due to or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In July 2025, the agency of original jurisdiction (AOJ) denied the claims for a rating in excess of 30 percent for BHL and for service connection for asthma and vertigo. In August 2025, the Veteran appealed to the Board via a Form 10182 and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Increased Rating for BHL

Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155;
.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Increased Rating for BHL

Service connection for BHL was granted in a May 2024 rating decision and a 30 percent rating was assigned pursuant to DC 6100, effective March 7, 2024. The Veteran filed the instant claim for increase in June 2025.

Ratings for hearing loss disability are based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination testing together with the average hearing threshold level, in decibels (dB) as measured by pure tone audiometric tests in frequencies 1000, 2000, 3000, and 4000 Hertz (Hz). 38 C.F.R. § 4.85, DC 6100.

An examination for hearing impairment for VA purposes must include a controlled speech discrimination test (Maryland CNC). To evaluate the degree of disability from defective hearing, the rating schedule requires assignment of a Roman numeral designation, ranging from I to XI. Other than exceptional cases, VA arrives at the proper designation by mechanical application of Table VI, which determines the designation based on results of standard test parameters. Table VII is then applied to arrive at a rating based upon the respective Roman numeral designations for each ear.

Exceptional patterns of hearing impairment allow for assignment of the Roman numeral designation using Table VI or an alternate table, Table VIA, whichever is more beneficial to the Veteran. 38 C.F.R. § 4.86. This applies to two patterns. In both patterns each ear will be evaluated separately. The first pattern is where the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hz) is 55 dB or more. 38C.F.R. § 4.86(a). The second pattern is where the pure tone threshold is 30 decibels or less at 1000 Hz and 70 dB or more at 2000 Hz. If the second pattern exists, the Roman numeral will be elevated to the next higher numeral.

Under 38 C.F.R. § 3.655(a), when entitlement to a benefit cannot be established without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination or reexamination, action shall be taken in accordance with 38 C.F.R. § 3.655(b) or (c) as appropriate.

When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655(b). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, and death of an immediate family member. 38 C.F.R. § 3.655(a). Under 38 C.F.R. § 3.655(b), when an examination is scheduled in conjunction with a claim for increase, the claim shall be denied.

Turning to the medical evidence, an August 5, 2024 VA audiology examination report reflected that at frequencies of 1000, 2000, 3000, and 4000 Hz for the right ear were 80, 75, 90, and 90 dB respectively, and for the left ear 80, 90, 90, and 105 dB respectively, for an average puretone threshold of 84 dB for the right ear and 91 dB for the left ear. The Maryland CNC speech discrimination test results were 84 percent for the right and 91 percent for the left ear.

A May 21, 2025 VA audiogram report noted that at frequencies of 1000, 2000, 3000, and 4000 Hz for the right ear were 70, 75, 85, and 95 dB respectively, and for the left ear 65, 75, 85, and 95 dB respectively, for an average puretone threshold of 81 dB for the right ear and 80 dB for the left ear. The Maryland CNC speech discrimination test results were
an average puretone threshold of 84 dB for the right ear and 91 dB for the left ear. The Maryland CNC speech discrimination test results were 84 percent for the right and 91 percent for the left ear.

A May 21, 2025 VA audiogram report noted that at frequencies of 1000, 2000, 3000, and 4000 Hz for the right ear were 70, 75, 85, and 95 dB respectively, and for the left ear 65, 75, 85, and 95 dB respectively, for an average puretone threshold of 81 dB for the right ear and 80 dB for the left ear. The Maryland CNC speech discrimination test results were 74 percent for the right and 76 percent for the left ear.

A June 2025 VA treatment record reflected that there was a significant change in the Veteran's hearing acuity.

Based on these results, an exceptional pattern of hearing is shown. Applying the August 2024 audiological rest results to Table IVa, the result is a Level VIII numerical designation for the right ear and Level IX for the left ear. Applying the May 2025 VA audiological test results to Table VIa, the result is a Level VII numeral designation for each ear.

As the hearing impairment from Table VIa is higher than the designations derived from Table VI, the results from Table VIa will be used to determine the disability rating.

When the designations of Level VIII hearing impairment for the right ear and Level IX for the left ear are applied to Table VII, the result is a 50 percent rating. As such, a 50 percent rating is warranted as of the date of the August 5, 2024 audiogram. When the designations of Level VII hearing impairment for the right ear and Level VII for the left ear are applied to Table VII, the result is a 40 percent rating. As such, a higher 40 percent rating is warranted as of the date of the May 21, 2025 audiogram.

Ratings in excess of 50 percent from August 5, 2024, and in excess of 40 percent from May 2025 are not warranted. In this regard, there is no evidence showing any more severe hearing impairment for those time periods. To this point, the Veteran was scheduled for a VA examination in June 2025 pursuant to his June 2025 claim for increase. However, a June 2025 examination scheduling request report reflected that the examination was canceled per the Veteran's request. In a July 2025 written statement he indicated that he had a bad experience at a prior examination in which he contended he was physically shocked and in severe pain due to a procedure performed and administered by a prior audiology examiner.

The Board notes that the duty to assist a claimant is not a one-way street, and in the instant case, the Veteran has failed to cooperate to the full extent in the development of his claim. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). However, as the August 2024 VA audiogram was received within one year of the May 2024 rating decision granting service connection for BHL, the June 2025 claim is not a claim for an increased rating which would require outright denial of the claim based on the Veteran's failure to appear. Nevertheless, due to the Veteran failing to report to the scheduled examination for his increased rating claim, as well as not showing good cause for his failure to appear, the appeal is decided on the evidence of record, and there is no basis on this record to grant ratings in excess of 50 percent or 40 percent for the respective time periods, to include based on any alleged functional impairment or other symptomatology. 38 C.F.R. § 3.655(b).

In sum, after a careful review of the evidence of record, a 50 percent rating, but no more, is granted from August 5, 2024 and a 40 percent rating, but no more, is granted from May 21, 2025.

Service connection

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may be granted on a secondary basis for a disability which is aggravated by
connection

Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

Asthma

At the outset, the Board notes that this issue is currently under consideration in a separate appeal, Board Direct Docket number 251119-623759. Such appeal will consider evidence that was entered into the record subsequent to the July 2025 rating decision on appeal in this decision.

As previously noted, when entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination, or reexamination, action shall be taken in accordance with paragraph (b) or (c) of 38 C.F.R. § 3.655 as appropriate. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. 38 C.F.R. § 3.655(a).

When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655(b). When the examination was scheduled in conjunction with any other original claim, a supplemental claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied. Id.

The Veteran contends that service connection is warranted for asthma. In a July 2025 written statement, he essentially argued that asthma began during service and continued ever since. Specifically, he reported that he had asthma and pneumonia in service and that ever since service his lungs have been weak.

Initially, the record reflects a diagnosis of asthma. In this regard, asthma was diagnosed in June 2025 VA treatment records as well as in private treatment records from July 2024. As such, the first element of service connection is met.

Next, the service treatment records (STRs) reflect that he was found to have asthma in July 1961. As such, the second element of service connection is met.

As to the third element of service connection, a medical nexus, the Veteran was scheduled for a VA examination in June 2025 to determine the nature and etiology of his asthma. However, a June 2025 examination scheduling request report reflected that the examination was canceled per the Veteran's request. The record contains no information or explanation from the Veteran as to the reason for his requested cancellation of this examination.

Based on the above, the Board finds that entitlement to service connection for asthma cannot be established without a VA examination. 38 C.F.R. § 3.655(a). See also Turk v. Peake, 21 Vet. App. 565, 569 (2008). Further, good cause has not been shown for his failure to attend the scheduled examination.

In this case, service connection for asthmatic bronchitis was denied in an unappealed September 1971 rating decision. Service connection for asthmatic bronchitis was subsequently
report reflected that the examination was canceled per the Veteran's request. The record contains no information or explanation from the Veteran as to the reason for his requested cancellation of this examination.

In this case, service connection for asthmatic bronchitis was denied in an unappealed September 1971 rating decision. Service connection for asthmatic bronchitis was subsequently denied in an unappealed February 2003 rating decision because new and material evidence had not been received. Additionally, service connection for pneumonia was denied in the February 2003 rating decision based on a lack of nexus to service.

It is clear based on the Veteran's various written statements, including from March 2024, that the disorder variously characterized as pneumonia, asthma and/or bronchitis/asthmatic bronchitis is the same disability for which he is now seeking service connection (based on his June 2025 claim) and which has been previously denied (as described above); it does not amount to a separate new original claim for compensation. Velez v. Shinseki, 23 Vet. App. 199, 204 (2009) (quoting Boggs v. Peake, 520 F.3d 1330, 1337 (Fed. Cir. 2008).

Here, the Veteran has not provided any argument or justifiable reason or explanation as to why he did not appear for the scheduled VA examination needed to assist in deciding this claim. Instead, the record reflects that he requested cancellation of the examination without explanation. The duty to assist the Veteran in the development of evidence pertinent to his claim is not a "one-way street." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). If a veteran wishes help, he cannot passively wait for it in circumstances where he may or should have evidence that is essential in obtaining the putative evidence. Id.; see also Hyson v. Brown, 5 Vet. App. 262, 265 (1993) (noting that it is the burden of the veteran to keep the VA apprised of his whereabouts and if he does not keep VA informed, "there is no duty on the part of the VA to turn up heaven and earth" to find him or her).

Accordingly, the Board finds that the Veteran failed to report for his scheduled examination without good cause. The claim for service connection for asthma is not an original claim for compensation. Thus, the claim is denied. 38 C.F.R. § 3.655(b).

Vertigo

The Veteran contends that service connection is warranted for vertigo because it is secondary to his tinnitus.

Initially, the record reflects a diagnosis of vertigo according to July 2024 private and June 2025 VA treatment records as well as an August 2024 VA examination report (which reflects a diagnosis of benign paroxysmal positional vertigo (BPPV)). Next, he is service connected for tinnitus and BHL. As such, the first and second elements of secondary service connection are met.

However, as to the third element, a nexus between vertigo and service-connected tinnitus (or BHL), the medical evidence weighs persuasively against the claim. In this regard, the only medical opinions of record weigh against secondary service connection.

A September 2024 VA examiner opined that the Veteran's vertigo was less likely as not caused or aggravated by the service-connected tinnitus. The examiner noted that the Veteran reported symptoms of vertigo (including nausea and dizziness), recurrent falls, increasing tinnitus which he felt made his vertigo worse. The examiner also noted that he had vestibular rehabilitation therapy, which was marginally helpful, and that he had also been evaluated by an ENT surgeon and was taking meclizine for his vertigo.

The examiner reasoned that the weight of the peer reviewed studies does not support causal relationship between tinnitus and BPPV. While tinnitus or BPPV often co-occur in studies, they are separate conditions. Tinnitus is an abnormal ringing or buzzing sound. Vertigo is the sensation of spinning or loss of balance and may cause nausea or vomiting. They are both related to inner ear conditions. Hearing loss is due to a disruption of the transmission of the sound wave to the cochlea which could be due to anatomical condition, foreign bodies, wax, otitis, middle ear effusions, or dysfunction of the ossicular chain. The tinnitus is caused by conditions affecting the hearing of the inner ear or cochlea. In contrast, the vertigo affects the vestibular system of the inner ear or cochlea. Although they may be comorbid, they are separate conditions. Most vertigo or BPPV is due to displacement of crystals in the semicircular canals of the ear and are idiopathic or have no known cause. However, increasing age is a known risk factor for BPPV. Other secondary causes may include head trauma, Menier's disease, vestibular neuronitis, migraines, labyrinthitis, iatrogenic causes The examiner noted that the Veteran had a history of migraines noted in VA treatment records. Otherwise the cause of the Veteran's vertigo is unknown except for increasing age. The examiner found no objective evidence that vertigo was caused by hearing loss or tinnitus.

As to aggravation, the examiner noted that the natural course of BPPV or vertigo is to be episodic and the spells of vertigo could vary in severity or duration. The examiner found no objective evidence in the medical literature or by review of the claims file evidence that the course of the Veteran's vertigo or BPPV was worsened beyond natural progression by the tinnitus or BHL.

As there is no evidence in the record showing that vertigo is caused or aggravated by tinnitus or BHL, there is no basis on which to grant the claim.

As to whether vertigo is directly related to service, the STRs are negative for vertigo or any related symptoms, and the Veteran does not contend that vertigo was shown in service. As such the second element of direct service connection is not met.

As to a medical nexus, the only medical opinion is against the claim. Notably, the September 2024 VA examiner opined that it was less likely than not that vertigo was due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of BPPV and military service. Without chronicity during service or after service, the examiner opined that a post-service event, illness, or injury is a more likely etiology. As such, medical evidence weighs against vertigo being causally or etiologically related to service. In sum, therefore, the evidence weighs persuasively against the claim.

The Board has considered the Veteran's lay statements that vertigo was caused by service or service-connected disability. While he is competent to report symptoms as this requires only personal knowledge as it comes to him through the senses, he is not competent to offer an opinion as to the etiology of the current disorder due to the medical complexity of the matter involved.

Such competent evidence concerning the nature and extent of the Veteran's vertigo has been provided by the medical personnel who examined him during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations.

Their findings as provided in the clinical evidence and September 2024 vertigo examination directly address the criteria under which this disorder is evaluated. The VA and private medical professionals explained their reasoning based on an accurate characterization of the evidence. Therefore, the Board attaches greater probative weight to the clinical findings than to his lay statements regarding etiology.

In sum, after a careful review of the record, the evidence weighs persuasively against the claim for service connection for vertigo and there is no doubt to be resolved. As such, the appeal is denied.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Redman

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

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