RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03166
BRANCH OF SERVICE:  Army	BOARD DATE:  20150515
SEPARATION DATE:  20050413

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Military Police) medically separated for bilateral hearing loss.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent H3 profile and referred for a Medical Evaluation Board (MEB). “Borderline normal hearing, sloping to moderate sensori neural hearing loss” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “bilateral hearing loss” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My hearing loss aggravated by service was determined as depreciating my conditions has worsened and will continue to until completely deaf.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the 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/Naval 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 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:

IPEB – Dated 20050316	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Hearing Loss	6100	0%	Bilateral Hearing Loss	6100	0%	20050607	
Other x 0 (Not In Scope)	Tinnitus	6260	10%	20050607	
	Other x 5	
RATING:  0%	COMBINED RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050822 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Bilateral Hearing Loss.  The narrative summary (NARSUM) and treatment record noted that the CI had a hearing waiver for entry into Service in 1998.  His hearing loss progressed in service and he complained of tinnitus (ringing in the ears) and difficulty understanding speech in noisy environments.  He used hearing aids in both ears before deploying to Iraq.  Post-deployment he noted increased difficulty hearing despite use of hearing aids.  At the NARSUM, he denied tinnitus or vertigo (dizziness).  The NARSUM physical exam documented a normal ear nose and throat exam aside from hearing.  Audiology evaluation in March 2005 (a month prior to separation) documented mild to moderate sensorineural hearing loss in both ears with “good” word recognition scores in each ear (Speech Recognition In Noise Test [SPRINT]).

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported similar auditory-related history as the treatment records documented.  He used hearing aids in both ears and complained of onset of tinnitus during military service with worsening over the prior 2-3 years.  Exam documented bilateral mild to moderately-severe sensorineural hearing loss with “good” speech recognition for both ears.

HEARING	EXAM	NARSUM ~3 Mo. Pre Sep	MEB  ~1 Mo. Pre Sep	VA C&P ~2 Mo. After Sep	
LEFT EAR	Average Hearing Loss		35 dB	45 dB	
	Speech Discrimination	88%	96%	76%	
	Table VI / VIa		l/I	III/ll	
RIGHT EAR	Average Hearing  Loss		43 dB	50 dB	
	Speech Discrimination	84%	80%	84%	
	Table VI / VIa		lll/Il	II/lll	
§4.85 RATING	Table VII	0%	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.  Although the service speech discrimination testing (SPRINT) was not IAW VASRD §4.85(a) [requires CNC test which uses a different word set], the VA exam, used the CNC testing and both hearing evaluations were independently rated at 0% using VASRD rating criteria, including potential use of Table VI or VIa, and Table VII.

The Board considered if the CI’s disqualifying bilateral hearing loss may not have been limited to pure tone testing or specific speech recognition testing alone, but that tinnitus (as rated by the VA) may have played a part in the CI’s difficulty in safely understanding communication.  Although the NARSUM exam specifically indicated that the CI denied tinnitus, almost all other evaluations before and after that exam indicated worsening tinnitus.  Given the multiple and fairly consistent speech recognition testing (0% - non-compensable results), the Board considered that any impact from tinnitus on hearing was adequately incorporated into the 0% Table VII rating and that tinnitus was not separately unfitting or compensable.  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 0% disability rating for the hearing loss condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the bilateral hearing loss condition and IAW VASRD §4.87, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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 20140626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX AR20160003500 (PD201403166)

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: