RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03398
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “bilateral high frequency sensorineural hearing loss,” with a disability rating of 0%.

CI CONTENTION:  The applicant asks that all conditions be considered.  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 based on 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 - 20081119	VARD - 20090716	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral High Frequency Sensorineural Hearing Loss	6100	0%	Bilateral Hearing Loss	6100	20090615	20090615
	
Bilateral Tinnitus	Not Unfitting	Tinnitus	6260	NSC		
Occasional Lightheadedness and Dizziness without True Vertigo	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral High Frequency Sensorineural Hearing Loss.  The service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM) dated 7 October 2008 indicated the CI reported in February 2008 that he was exposed to multiple IED blasts during his deployment in 2006 to 2007.  He also noted the FOB [forward operating base] was on top a steam plant that had constant blasts of steam that were excessively loud and prevented communication.  In May 2007 he was exposed to two of the loudest blasts, the second of which was during an attack after which he could not hear for a few days; his ears bled; and he had dizziness with nausea for 3-4 days.  He reported constant high pitched tinnitus (ringing in the ears) (see below) bilaterally with associated dizziness in the morning with nausea for more than 3 hours and headaches that were aggravated by sounds.  Audiological examination revealed visible tempanomembranes bilaterally, normal tympanograms (to measure the functioning of the middle ear) bilaterally, acoustic reflexes present bilaterally, normal thresholds through 3 kHz with severe sensorineural hearing loss 4-8 kHz bilaterally, excellent discrimination bilaterally, and no rollover note (to determine retrocochlear pathology (e.g. acoustic neuromas)) bilaterally.  Thresholds were stable compared to those of 28 July 2006.  Hearing aids were discussed as well as the proper use of hearing protection devices.  The CI was found to have an H-3 hearing level.  

The NARSUM indicated the CI scored in the 59th percentile of SPRINT [speech recognition in noise test] testing and was categorized as E; separation from service was recommended in March 2008.  The NARSUM examiner noted the CI was not wearing hearing aids and he was able to follow conversation in a quiet room without difficulty.  However, the CI had significant hearing loss.   He did receive hearing aids in the spring of 2008 and they worked fairly well, but he generally did not wear them in crowded or noisy environments.  He had some otalgia described as a sharp, stabbing pain in both ears, which happened infrequently.  The NARSUM diagnoses were bilateral high frequency sensorineural hearing loss and bilateral tinnitus (see below).  Audiometer results in October 2008 at the MEB examination reported on DD Form 2808, Report of Medical Examination, revealed an average loss 31 dB on the right and average loss of 31 dB (decibels measure sound pressure) on the left.  A permanent P3 profile was issued in August 2008 and approved in September 2008 for mild to severe high frequency hearing loss with limitations of no deployment and standard hearing loss restrictions—no duty to noise levels in excess of 85 dB or weapons firing or duties that require acute listening skills.  The commander’s statement dated 28 October 2008 indicated the CI was not performing duties in his military specialty and had limitations based on his profile.  

At the VA Compensation and Pension (C&P) Audiology examination dated 15 June 2009, performed 3 months after separation, the CI reported hearing loss and tinnitus with problems hearing when in background noise situations.  Middle ear function was normal and testing supported the presence of a high frequency cochlear hearing deficit bilaterally.  Audiological testing of both ears revealed high frequency sensorineural hearing loss at 4000 Hz with excellent speech discrimination scores.  The hearing 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	EXAM	MEB  ~5 Mo. Pre Sep
20081007 	VA C&P ~2 Mo. After Sep
20090615 	
LEFT EAR	Average Hearing Loss	31 dB	29 dB	
	Speech Discrimination	100%	94%	
	Table VI / VIa	I  / I	I / I	
RIGHT EAR	Average Hearing  Loss	31 dB	28 dB	
	Speech Discrimination 	100%	96%	
	Table VI / VIa	I / I	  I / I	
§4.85 RATING	Table VII	0%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using code 6100 for bilateral high frequency sensorineural hearing loss.   The VA assigned a 0% rating using code 6100 for bilateral hearing loss and a 10% rating using code 6260 for tinnitus. The Board sought a route to a higher rating, but was unable to find one in the absence of either a more significant average hearing loss and/or a lower speech discrimination score.  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 hearing loss condition.  

Contended PEB Conditions: Bilateral Tinnitus and Occasional Lightheadedness and Dizziness without True Vertigo.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The bilateral tinnitus and occasional lightheadedness and dizziness without true vertigo were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   

Tinnitus.  The CI reported constant high pitched tinnitus (ringing in the ears) bilaterally with associated dizziness in the morning with nausea for more than 3 hours and headaches that were aggravated by sounds.  The CI’s tinnitus sound matching on the left at 3-4 kHz @ 82 dB HL (decibels hearing level) and on the right at 4 kHz @ 74 dB HL.  The CI had significant hearing loss and daily tinnitus, which he had gradually gotten used to it, but it still persisted.  At the VA examination the CI reported having tinnitus, which he heard at night in his entire head (non-lateralizing) when trying to sleep and found it annoying.  The VA examiner opined tinnitus was as likely as not a symptom associated with the hearing loss.  

Occasional Lightheadedness and Dizziness without True Vertigo.  A note in September 2008 indicated the CI had vestibular pathology by ENG (electronystagmography).  Further studies were ordered to define the pathology and course of rehabilitation, but dizziness, without true vertigo symptoms, was extensively evaluated by audiology, ENT [ear, nose and throat] and neurology and a TBI Clinic; however, no specific etiology was discovered.  The symptoms gradually resolved with time and the CI reported only rare transient lightheadedness, sometimes associated with certain head movements, and it was not a limitation. The aforementioned was reviewed and considered by the Board.   There was no performance based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral sensorineural hearing loss condition and IAW VASRD §4.85, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral tinnitus and occasional lightheadedness and dizziness without true vertigo conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140708, 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, AR20160011341 (PD201403398)

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