RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-00825
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20080408	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Infantryman, medically separated for “bilateral sensorineural hearing loss with tinnitus” with a disability rating of 0%.

CI CONTENTION:  The CI asserts he has hearing aids for both ears and his hearing continues to worsen.  The CI’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 - Dated 20080409	VARD - 20080501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Sensorineural Hearing Loss with Tinnitus	6100	0%	Bilateral Sensorineural Hearing Loss	6100	0%	20080116	
			Recurrent Left Ear Tinnitus	6260	10%	20080116	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 1 0%	

ANALYSIS SUMMARY:  

Bilateral Sensorineural Hearing Loss (HL) with Tinnitus.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated by an audiologist in May 2007 and found to have bilateral high frequency HL and tinnitus (ringing in ears).  The average decibel (dB) loss (dB level at 1000, 2000, 3000, and 4000 Hz added and divided by four) was 36.25 dB in the left ear, with 100% speech discrimination and 27.5 dB in the right ear, also with 100% speech discrimination.  A hearing aid (HA) was recommended for the left ear.  The CI reported a history of difficult hearing in the field while deployed.  A Speech Recognition in Noise Test (SPRINT) was performed on 23 May 2007 and the CI scored in the lowest category (E), in the 29th percentile.  The CI was referred for an MOS Medical Review Board (MMRB), which directed a MEB.

At the MEB examination (recorded on DD Form 2807 and 2808) dated 3 October 2007, 6 months prior to separation, the CI reported HL and was noted to have a hearing aid.  Audiogram results were (dB@Hz): left ear - 15@1000, 25@2000, 65@3000, 55@4000; right ear - 5@1000, 15@2000, 25@3000, 80@4000.  The MEB NARSUM examination on 4 December 2007, 4 months before separation, noted normal physical exam of the ears and noted the CI had a hearing aid for the left ear.  Regarding the CI’s current functional status, the MEB examiner noted that the CI reported that he was unable to hear adequately in a combat environment during deployment without an HA, and the examiner indicated that an HA would be difficult to maintain in a deployed situation.

At the VA Compensation and Pension (C&P) exam on 16 January 2008, 3 months before separation, the CI reported HL and ringing in the left ear.  Examination of the external ears was normal.  Audiometry showed left ear - 25@1000, 30@2000, 70@3000, and 70@4000; right ear - 15@1000, 25@2000, 35@3000, and 60@4000.  Speech discrimination was 100% in the right ear and 92% in the left ear.  

The audiometric evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
Hearing Loss   
HEARING	EXAM	MEB 2808 ~6 Mo. Pre Sep	VA C&P ~3 Mo. Pre Sep	
LEFT EAR	Average Hearing Loss	40 dB	49 dB	
	Speech Discrimination	-%	92%	
	Table VI / VIa	-- / I	I / III	
RIGHT EAR	Average Hearing  Loss	 26 dB	34 dB	
	Speech Discrimination 	-%	100%	
	Table VI / VIa	-- / I	I / I	
§4.85 RATING	Table VII	0%	0%	
(Average hearing loss is the sum of pure tone thresholds at 1000, 2000, 3000, and 4000 Hz divided by four)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral sensorineural HL with tinnitus condition 0%, coded 6100, based upon the audiogram performed by audiology in May 2007.  The VA rated the HL condition 0%, coded 6100, based upon the audiogram performed at the VA C&P exam.  The VA also rated the left ear tinnitus 10%, coded 6260 (recurrent tinnitus).  According to VASRD 6100 instructions for evaluation of hearing impairment, Table V1a (numeric designation of hearing impairment based only on puretone threshold average) is used to determine the Roman numeral designation for hearing impairment based only on the puretone threshold average HL, and is only to be used if the examiner certifies the reason that a speech discrimination score could not be provided.  This is likely the reason the PEB relied on the earlier audiology evaluation which provided both measures and not the audiogram noted at the MEB DD Form 2808 exam, which did not note speech discrimination scores.  However, if a percentage for hearing impairment was calculated with the DD Form 2808 audiogram, the puretone threshold average HL was 40 dB for the left ear and 26 dB for the right ear.  Both the left and right ear Roman numeral designations would be I, and Table VII (percentage evaluation for hearing impairment), indicates a 0% rating, which would be the same as that determined by the PEB based on the earlier hearing testing performed by audiology.

The VA C&P exam findings showed the left ear with a puretone average HL of 49 dB and 92 percent speech discrimination and right ear with a puretone average HL of 34 dB and 100 percent speech discrimination.  From Table VI (numeric designation of hearing impairment based on puretone threshold average and speech discrimination), the Roman numeral designation is derived for each ear by intersecting the percent of speech discrimination row with the puretone threshold average column and the Roman numeral is “I” for both the left and right ears in this case.  A 0% rating is derived from Table VII by intersecting row I, the better ear, with column I, the poorer ear (either ear can be used as the poorer ear for Table VII as they both equate to the same Roman numeral).  The Board considered if a separate rating could be recommended for the bilateral tinnitus.  Tinnitus was not profiled or implicated by the commander’s statement.  There was no performance based evidence in the record that there was functional impairment due to the bilateral tinnitus condition that could be considered separately unfitting for continued military service.  Therefore, the Board concluded that this condition could not be recommended for additional disability rating.  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 sensorineural HL and tinnitus condition.  

BOARD FINDINGS:  In the matter of the bilateral sensorineural hearing loss and tinnitus condition and IAW VASRD §4.85, 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 20140220, with attachments
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, AR20160008570 (PD201400825)

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