RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00314
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2 (Infantry) medically separated for “bilateral sensorineural hearing loss,” with a disability rating of 0%. 

CI CONTENTION:  The applicant’s hearing is worse.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:  

SERVICE PEB – 20070612	VARD - 20111209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Sensorineural Hearing Loss	6100	0%	Bilateral Hearing Loss	6100	0%	20110712	
COMBINED RATING:  0%	COMBIEND RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Bilateral Hearing Loss.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the bilateral hearing loss began approximately 2 years prior to referral for MEB.  The baseline reference audiogram, established prior to initial duty in hazardous noise areas, showed puretone threshold averages (sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four) within the normal (0dB - 20dB) limits.  The subsequent reference audiogram was established following exposure in noise duties.  The puretone threshold averages showed moderate (40dB - 55dB) right ear (42.5dB) hearing loss and mild (20dB - 40dB) left ear (36dB) hearing loss.  Six days later, audiology at hearing conservation performed repeat audiometry.  The puretone threshold averages showed moderate (40dB - 55dB) right ear (50dB) and left ear (42.5dB) hearing loss.  The evaluation documented that the baseline audiometry performed in basic training was normal for the bilateral ears.  The CI reported a high level of environmental noise exposure from small arms (right handed shooter) and endorsed firing without hearing protection most (65-70%) of the time.  The comprehensive audiometry documented mild to moderate sensorineural hearing loss.  Speech audiometry documented the speech recognition threshold (SRT) was 20dB for the right ear and 15dB for the left ear.  Speech discrimination testing is typically performed at 40dB above the SRT.  Word recognition was characterized as excellent with 100% (at 60dB) speech discrimination for the right and 100% (at 55dB) for the left.  The Speech Recognition in Noise Test (SPRINT) had a raw score of 152 out of 200.  This converted to a 23rd percentile score and the Category E (Separation from service) designation.  (SPRINT was developed by and used by the Army as a more valid predictor of communication abilities [than puretone thresholds or word recognition in quiet] for issues involving fitness for duty from a hearing perspective.)  The SPRINT score, together with length of service, are plotted on a chart to determine a letter category for service recommendations in individuals with hearing (H-3 or H-4) profiles.  In the NARSUM, 2 months before separation, the CI complained of muffled hearing and bilateral tinnitus (ringing or buzzing in ears), but denied vertigo (spinning sensation).  The screening audiogram at entry revealed normal (H1) hearing.  Six months prior, he was noted to have a significant shift in his hearing to an H3 (H3 - SRT in better ear <30dB with or without hearing aid).  The CI denied a history of head trauma, intravenous antibiotics, neurosyphilis, or a temporal history of loud noise exposure with a direct effect of hearing loss.  The ear examination revealed intact tympanic membranes (eardrums) which were mobile on insufflation (air/gas introduction).  There was no evidence of effusion (fluid collection), erythema (redness), or perforation.  The Weber test (differentiates between unilateral conductive [middle ear] or sensorineural [inner ear] hearing loss) was negative.  The examiner recounted the findings of the audiology consultation.  The diagnosis listed symmetric bilateral moderate-to-severe sensorineural hearing loss (H3 and SPRINT Category E).  In the Compensation and Pension (C&P) examination by audiology, the CI reported that after training with machine guns, he gradually noticed constant ringing in both ears.  He reported current bilateral hearing loss, constant loud ringing, and difficulty understanding speech.  The CI denied a history of head trauma, ear trauma, or ear disease.  Treatment was a right ear hearing aid and a sound pillow at night.  The examiner recounted the findings from the NARSUM, baseline (normal) audiogram, and two subsequent (sensorineural hearing loss) audiograms.  The puretone threshold averages showed moderate (40dB - 55dB) right ear (55dB) and left ear (48.8dB) hearing loss.  The bilateral tympanometry (assesses eardrum and middle ear mobility) results were normal and the acoustic reflex (assesses eardrum, middle ear, inner ear, auditory nerve, auditory brainstem pathways, and facial nerve) results were consistent with tympanometry and audiometric test results.  Speech audiometry documented a modified performance intensity function with a starting presentation level of 40dB regarding SRT was obtained.  Initial speech discrimination (Maryland CNC word list) was 76% (at 75dB) for the right and 90% (at 75dB) for the left.  The best performance with the Maryland CNC word list was 92% (at 81dB) for the right and 90% (at 75dB) for the left.  The Maryland CNC speech recognition performance on the bilateral ears was documented as good.  Subjective factors were difficulty hearing and ringing in both ears.  Objective factors were reduced auditory thresholds and Maryland CNC scores.  The diagnoses listed bilateral sensorineural hearing loss (moderately severe right and moderate left) and tinnitus.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 6100 code (hearing impairment) citing bilateral sensorineural hearing loss, average decibel loss (right = 50dB, left = 43.5dB), and speech discrimination (right = 100%, left = 100%).  The VA assigned a 0% rating under the 6100 code based on the VA C&P exam 4 years after separation, citing military acoustic trauma, significant puretone threshold shift in-service, puretone threshold, and percent speech discrimination.  The VASRD §4.85 and §4.86 rating schedules for hearing impairment are completely objective and derived from audiometric testing.  They are based on average puretone threshold across the hearing ranges, and accommodate for measured speech discrimination.  The charted results of the audiometric evidence in this case yields unequivocal 0% ratings for both sets of data.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral hearing loss condition.

BOARD FINDINGS:  In the matter of the bilateral hearing loss condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140108, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160006630 (PD201400314)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA