HEARING LOSS

KRISTI L. GUNN · 2026 · Case ID: A26038535

MIXED

Summary

The veteran, who served in the U.S. Army from January 2004 to March 2005 and December 2007 to April 2008, appeals the denial of service connection for bilateral hearing loss (BHL), right bundle branch block (RBBB), bilateral hip joint pain, bilateral shoulder pain, and tension headaches. The Board denied BHL and RBBB. For BHL, the Board found that while the veteran's MOS as an armor crewman and infantryman conceded noise exposure, the persuasive evidence, including a VA examination from October 2020 and a September 2011 VA examination, indicated that the veteran's left ear hearing loss was less likely than not service-related. The September 2011 exam showed normal hearing in the left ear, and the loss did not manifest within a year of discharge. The Board found the audiologist's opinion credible and persuasive, denying the claim. For RBBB, the Board found the evidence persuasively weighed against service connection, as the condition was a congenital defect with no superimposed disability found. The Board denied both claims. The claims for bilateral hip joint pain, bilateral shoulder pain, and tension headaches, all linked to Gulf War illness, were remanded. The Board noted the veteran served in Iraq and is entitled to presumptive service connection for qualifying chronic disabilities, including undiagnosed illnesses or MUCMI. VA examinations showed diagnoses for tension headaches and bilateral hip pain, with reduced range of motion and pain in the hips. Shoulder examinations showed full range of motion but noted pain. The Board remanded these claims for new VA medical opinions to determine the nature and etiology of the conditions, specifically asking if they were related to service or a qualifying chronic disability under Gulf War presumptions.

Rationale

Persuasive evidence against service connection; Audiologist opinion found less likely than not service-related; Hearing loss did not manifest within one year of discharge

Service Branch

U.S. ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210628-168654

Full Decision Text

Citation Nr: A26038535
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 210628-168654
DATE: April 24, 2026

ORDER

Entitlement to service connection for bilateral hearing loss (BHL) is denied.

Entitlement to service connection for right bundle branch block (RBBB) is denied.

REMANDED

Entitlement to service connection for bilateral hip joint pain, to include as due to Gulf War illness is remanded.

Entitlement to service connection for bilateral shoulder pain, to include as due to Gulf War illness is remanded.

Entitlement to service connection for tension headaches, to include as due to Gulf War illness is remanded.

FINDINGS OF FACT

1. The persuasive evidence fails to support that the Veteran has right ear hearing loss for VA purposes.

2. The evidence of record persuasively weighs against finding that the Veteran's left ear hearing loss began during active service or is otherwise related to an in-service injury or disease.

3. The Veteran's RBBB is a congenital defect and there is no evidence of an additional superimposed disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral hearing loss (BHL) are not met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385.

2. The criteria for service connection for right bundle branch block (RBBB) are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.9.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served active duty in the U.S. Army from January 2004 to March 2005 and from December 2007 to April 2008.

This case comes before the Board on appeal of a March 2021 AMA rating decision.

In the June 28, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 2, 2024.

Therefore, the Board may only consider the evidence of record at the time of the March 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included in this decision.

However, because the Board is remanding the claims listed above, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Generally, to establish service connection a Veteran must show: "(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 or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted through the application of statutory presumptions for chronic conditions, which includes
causal relationship between the present disability and the disease or injury incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted through the application of statutory presumptions for chronic conditions, which includes sensorineural hearing loss. See 38 C.F.R. §§ 3.303(b), 3.309(a); see also 38 U.S.C. §§ 1112, 1137. First, a claimant may benefit from a presumption of service connection where a chronic disease has been shown during service. 38 C.F.R. § 3.303(b). In the alternative, if a chronic disease was not shown in service, but manifested to a degree of 10 percent or more within some specified time after separation from active service, such disease shall be presumed to have been incurred or aggravated in service, even if there is no evidence of such disease during service. 38 U.S.C. §§ 1112, 1137; 38 C.F.R. § 3.307(a)(3). The application of these presumptions operates to satisfy the "in-service incurrence or aggravation" element and establish a nexus between service and a present disability, which must be found before entitlement to service connection can be granted.

Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in-service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id.

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Likewise, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence, which it finds to be more persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value.

"[I]f the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt." Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim).

1. Entitlement to service connection for bilateral hearing loss (BHL)

Here, the Veteran contends that he has bilateral hearing loss that was caused by or incurred in service. Based on the persuasive evidence, the Board disagrees.

At the outset, for VA compensation purposes, hearing loss disability is defined as: "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.

Importantly, hearing loss as defined in 38 C.F.R.
on the persuasive evidence, the Board disagrees.

Importantly, hearing loss as defined in 38 C.F.R. § 3.385 need not be shown by the results of audiometric testing during a claimant's period of active military service for service connection for such disability to be granted. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). A claimant who seeks to establish service connection for a hearing loss disability must show, as required with any claim of service connection, that a current hearing disability is the result of an injury or disease incurred in service.

In this instance, the AOJ found that the Veteran had a qualifying event during service. Specifically, the Veteran's military occupational specialty (MOS) was an armor crewman and infantryman, thus the AOJ conceded exposure to excessive military noise. As such, to warrant service connection, there must be evidence of a current hearing loss disability and a nexus, or link, between the in-service noise exposure and the current hearing loss disability.

In that regard, in the October 2020 VA examination, audiometric testing yielded the following findings:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 10 10 10 20

LEFT 10 15 15 20 45

Using the Maryland CNC Word list test, the Veteran's speech recognition score was 100 percent in the right ear and 98 percent in the left ear.

Based on the examination, the Veteran does not have right ear hearing loss for VA purposes. Conversely, the Veteran's left ear manifested with auditory threshold of 45 at 4k Hz. Thus, the Veteran exhibited left ear hearing loss for VA purposes.

As to the etiology of the Veteran's left ear hearing loss, the audiologist Dr. J.H. opined that the Veteran's left ear hearing loss was less likely than not caused by or a result of military service. Dr. J.H. explained that the Veteran was an infantryman and armor crewman, thus he was exposed to noise from gunfire, explosions, mortars, and tank firing. The Veteran informed Dr. J.H. that he used hearing protection. Likewise, he used hearing protection for small arms and tank gunnery qualifications, every year and two years, respectively. Following service, the Veteran worked in an office environment. Notably, Dr. J.H. explained that in an audiogram performed in September 2011, three years following discharge from active service, the Veteran had normal hearing for his left ear. She added that hearing for pure tones does not worsen following cessation of a given noise, based on a medical study from 2006 ("Noise and Military Service...").

In support of Dr. J.H.'s opinion, in the September 2011 VA examination audiometric testing yielded the following findings:

HERTZ

500 1000 2000 3000 4000

RIGHT 0 5 5 5 5

LEFT 0 10 5 15 25

Using the Maryland CNC Word list test, the Veteran's speech recognition score was 96 percent in the right ear and 98 percent in the left ear.

Thus, in September 2011, the Veteran did not have left ear hearing loss for VA purposes, and his hearing loss did not manifest within a year of discharge from active-duty service.

The Board finds Dr. J.H.'s opinion to be competent, credible, and highly probative. She reviewed the pertinent evidence, accounted for the Veteran's lay statements, then provided a reasoned opinion based on the evidence and medical study that dealt with hearing loss in the military. The Board acknowledges the Veteran's contentions that excessive noise exposure caused his current left ear hearing loss but finds that the more persuasive evidence is against his claim.

Accordingly, as the evidence is persuasively against the Veteran's contention, the benefit-of-doubt doctrine does not apply, and the claim is denied. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776.

2. Entitlement to
. J.H.'s opinion to be competent, credible, and highly probative. She reviewed the pertinent evidence, accounted for the Veteran's lay statements, then provided a reasoned opinion based on the evidence and medical study that dealt with hearing loss in the military. The Board acknowledges the Veteran's contentions that excessive noise exposure caused his current left ear hearing loss but finds that the more persuasive evidence is against his claim.

Accordingly, as the evidence is persuasively against the Veteran's contention, the benefit-of-doubt doctrine does not apply, and the claim is denied. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776.

2. Entitlement to service connection for right bundle branch block (RBBB)

Here, the Veteran contends that his heart disability was caused by or incurred in service. Based on the persuasive evidence, the Board disagrees.

Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. However, in this instance, as discussed further below, the evidence reflects that the Veteran's heart disability (RBBB) is a congenital defect. Defects are defined as "structural or inherent abnormalities or conditions which are more or less stationary in nature." VAOPGCPREC 82-90. Congenital or developmental defects are not diseases or injuries within the meaning of applicable legislation for disability compensation purposes. 38 C.F.R. § 3.303(c). Congenital or developmental defects automatically rebut the presumption of soundness and are considered to have pre-existed service. 38 C.F.R. § 3.303(c); see also Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009) (holding that the presumption of soundness does not apply to congenital defects).

Notwithstanding the provisions discussed above, disability superimposed upon a congenital or developmental defect may be service connected. See VAOPGCPREC 82-90 (July 18, 1990) (noting that congenital and developmental defects can be subject to superimposed disease or injury such that service connection may be granted where the superimposed disease or injury occurs during service). Therefore, although 38 C.F.R. §§ 3.303(c), 4.9, and 4.127 prohibit any grant of service connection for a congenital or development defect, an additional superimposed disability may provide a basis for service connection.

Here, the collective medical evidence establishes the Veteran's heart disability, a right bundle branch block (RBBB), is a congenital defect. Service treatment records (STRs) from May 200, June 2000, and October 2000, all show a diagnosis and prognosis of congenital right bundle branch block (RBBB). In the June 2000 record, the Veteran was seen as follow-up for his RBBB that was found during a physical. At that time, there was no evidence of ischemic heart disease or structural heart disease. The doctor, Dr. J.B., explained that the Veteran had an isolated congenital RBBB and required no further evaluation or intervention. Likewise, in a previous record, the Veteran's RBBB was noted to be asymptomatic. In fact, the Veteran went through active-duty service and reserve service without any complaints or symptoms related to his RBBB. See e.g., STRs.

Moreover, in the September 2016 VA examination, the Veteran reported he had not had any symptoms that had been attributed to his RBBB. No cardiac symptoms were caused by the RBBB. The RBBB was believed to be congenital and stable over subsequent years. On examination, there was no diagnosis of a superimposed disability on the Veteran's RBBB. Similarly, in a November 2017 VA examination, there was no evidence of a heart disability superimposed on the Veteran's RBBB.

In the February 2019 VA examination, the Veteran was shown to have RBBB as a congenital/normal variant. However, there was evidence of first-degree AV (atrioventricular) block, which is a form of cardiac arrythmia. The examiner remarked that the Veteran did not have coronary artery disease (CAD) or a history of myocardial infarction (MI). The RBBB and 1st degree AV block were abnormalities in the conduction of the heart and did not show up on the stress test, so it was not indicated. Additionally,
a November 2017 VA examination, there was no evidence of a heart disability superimposed on the Veteran's RBBB.

In the February 2019 VA examination, the Veteran was shown to have RBBB as a congenital/normal variant. However, there was evidence of first-degree AV (atrioventricular) block, which is a form of cardiac arrythmia. The examiner remarked that the Veteran did not have coronary artery disease (CAD) or a history of myocardial infarction (MI). The RBBB and 1st degree AV block were abnormalities in the conduction of the heart and did not show up on the stress test, so it was not indicated. Additionally, the Veteran reported no cardiac symptoms. There was no evidence that the Veteran's cardiac arrythmia was a superimposed disability of his RBBB. Moreover, there was no evidence that the Veteran's 1st degree AV block was a superimposed disability that was caused or aggravated by service.

As discussed above, service connection may be warranted for congenital defects if competent and credible evidence establishes the presence of a superimposed disability on the congenital heart defect. In the present case, the evidence persuasively weighs in favor of finding there is not a superimposed disability on the congenital heart defect.

Accordingly, as the evidence is persuasively against the Veteran's contention, the benefit-of-doubt doctrine does not apply, and the claim is denied. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral hip joint pain, to include as due to Gulf War illness is remanded.

2. Entitlement to service connection for bilateral shoulder pain, to include as due to Gulf War illness is remanded.

3. Entitlement to service connection for tension headaches, to include as due to Gulf War illness is remanded.

Here, the Veteran contends that his bilateral hip joint pina, bilateral shoulder pain, and tension headaches were caused by or incurred in service. Based on the evidence, remand is necessary.

At the outset, under the AMA, the Board must remand issues when necessary to correct a pre-decisional duty to assist error or AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. See 38 C.F.R. § 20.802(a).

Importantly, the Veteran served in Iraq from December 2007 to April 2008. Thus, he is a Persian Gulf veteran entitled to presumptive service connection. Specifically, service connection may be presumptively granted for a Persian Gulf veteran with a qualifying chronic disability that became manifest to any degree at any time. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a MUCMI. 38 C.F.R. § 3.317(a)(2)(i).

A "Persian Gulf Veteran" is one who served in the Southwest Asia Theater of operations during the Persian Gulf War. Id. A "qualifying chronic disability" is defined as: (a) an undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as fibromyalgia, chronic fatigue syndrome, or a functional gastrointestinal disorder) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2)(B); 38 C.F.R. § 3.317. The term "medically unexplained chronic multi-symptom illness" means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.

In this instance, the Veteran underwent VA examinations in October 2020 which showed a diagnosis of tension headaches, bilateral hip pain, and bilateral shoulder pain. On examination of the Veteran's hips and shoulders, no diagnosis was made. The Veteran had reduced range of motion (ROM) in his hips and reported pain and flare-ups. On his shoulder examination, the Veteran had full ROM of his shoulders but there was pain noted on the examination. Likewise, the Veteran reported flare-ups of his shoulder condition. On his headache examination, there was evidence of tension headaches that the examiner remarked was a diagnosable chronic multi symptom illness with at least partially explained etiology. Moreover, in post-deployment records from April 2008, the Veteran indicated that he had swollen, stiff or painful joints during his deployment, which persisted thereafter. Likewise, the Veteran reported being tired even after sleeping. Moreover, the Veteran has claimed that he is usually fatigued which has been attributed as a residual symptom of Lyme disease. The Board notes that the Veteran has been diagnosed with obstructive sleep apnea, which may explain his tiredness. However, given that the Veteran has been diagnosed with tension headaches and has bilateral hip and shoulder pain without a diagnosis of a condition, a medical opinion to determine if he has a qualifying chronic disability related to his deployment is warranted. See 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Obtain a VA medical opinion to determine the nature and etiology of the Veteran's tension headaches, bilateral hip pain, and bilateral shoulder pain. If an opinion cannot be obtained without an examination, then a VA examination should be afforded to the Veteran. The record, including a copy of this remand, must be made available to and reviewed by the examiner(s).

The VA examiner(s) should address the following:

(a.) Is it likely (an approximate balance of positive and negative evidence) that the Veteran's tension headaches had its onset during service or is otherwise causally related to any event or circumstance of the Veteran's service, to include as due to an undiagnosed illness or a medically unexplained chronic multi symptom illness (MUCMI).

(b.) Is it likely (an approximate balance of positive and negative evidence) that the Veteran's bilateral hip pain had its onset during service or is otherwise causally related to any event or circumstance of the Veteran's service, to include as due to an undiagnosed illness or a medically unexplained chronic multi symptom illness (MUCMI).

(c.) Is it likely (an approximate balance of positive and negative evidence) that the Veteran's bilateral shoulder pain had its onset during service or is otherwise causally related to any event or circumstance of the Veteran's service, to include as due to an undiagnosed illness or a medically unexplained chronic multi symptom illness (MUCMI).

2. The examiner(s) should cite to the medical and competent lay evidence of record and explain the rationale for all opinions given. If after consideration of all pertinent factors it remains that the opinion sought cannot be given without resort to speculation, it should be so stated, and the examiner(s) must (to comply with governing legal guidelines) explain why the opinion sought cannot be offered without resort to speculation.

KRISTI L. GUNN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board I. Umo, 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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