RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01620
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Cargo Specialist, medically separated for “bilateral hearing impairment,” with a disability rating of 0%.

CI CONTENTION:  Requests review of all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’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 panel 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 panel 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 – 20090423NO 	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	
Bilateral Hearing Impairment	6100	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: N/A	

ANALYSIS SUMMARY:  

Bilateral Hearing Impairment.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the bilateral hearing loss was present at accession into the military.  The 13 July 2006 MEPS physical audiometry (measures hearing range and sensitivity) accession audiogram puretone threshold (hearing threshold levels for specific frequency pure tone stimuli) averages (sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by 4) showed (left = 25.25 dB and right = 30.0 dB) mild hearing loss (20 dB - 40 dB).  Normal hearing loss is 0 dB - 20 dB.  The 4 April 2008 baseline reference audiogram, established prior to initial duty in hazardous noise areas, puretone threshold averages (left = 27.5 dB and right = 23.75 dB) showed mild hearing loss.  

At the 13 November 2008 hearing conservation evaluation, the CI complained of difficulty understanding speech.  He denied ear pressure, tinnitus (ringing or buzzing in ears), hyperacusis (increased sensitivity to sound frequency and volume ranges), and dizziness.  The physical examination revealed normal auricles (external ears), external auditory canals (EACs), and tympanic membranes ([TMs] ear drums).  The CI reported a family history of hearing loss (mother and father).  The 13 November 2008 audiogram puretone threshold averages (left = 31.25 dB and right = 27.5 dB) showed mild sensorineural hearing loss (SNHL) hearing loss in both ears.  The bilateral tympanometry (assesses eardrum and middle ear mobility) and acoustic reflex (assesses eardrum, middle ear, inner ear, auditory nerve, auditory brainstem pathways, and facial nerve) results were normal.  A comparison of results with the baseline DD Form 2215 dated 4 April 2008 confirmed there was no Significant Threshold Shift (STS).  The Speech Recognition In Noise Test (SPRINT) had a raw score of 183 out of 200.  This converted to an 86th percentile score and the CI had less than 1 year length in service.  These findings corresponded to 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 pure-tone 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 individuals with hearing (H-3 or H-4) profiles.  The assessment listed SNHL.  

The 13 November 2008 ear, nose, and throat (ENT) encounter documented “Pt w/ audiogram showing bilateral symmetric SNHL moderate in mid-high freq.  Normal acoustic reflexes bilateral, normal tympanograms, SPRINT 183/200.  Due to limited time in service (less than 1yr) pt meets criteria for MEB and separation from military.”  The CI “noticed difficulty hearing his whole life manifested by him having to ask people to repeat themselves frequently.”  He denied aural fullness, tinnitus, vestibular symptoms, or a history of trauma or illness that he associated with decreased hearing.  The CI reported a remote history of recurrent otitis media (inner ear infection) but denied a history of TM pressure equalization (PE) tubes or ototoxic (noxious to nerves or on organs involved in hearing or balance) medications.  The physical examination revealed normal auricles and the otoscopic examination revealed clear EACs.  The TMs were clear and mobile with pneumatic otoscopy with no evidence of perforation, retraction, or middle ear effusion.  The Weber and Rinne tests (differentiate between unilateral conductive [middle ear] or sensorineural [inner ear] hearing loss) were normal.  The examiner recounted the findings of the audiometry and the assessment listed moderate bilateral SNHL.  The examiner documented “SPRINT score places patient in category E according to IAW AR 40-501, requiring generation of H-3 profile and initiation of MEB w/ recommendation of separation for military.”  A 2 December 2008 internal auditory canal (IAC) magnetic resonance imaging (MRI) study was unremarkable.  

The 13 February 2009 MEB NARSUM, 5 months before separation, recounted the findings of the audiometry, SPRINT testing, IAC MRI, and hearing conservation and ENT consultations.  Under the physical examination, the author recounted the findings of the 13 November 2008 ENT examination.  The diagnosis listed bilateral SNHL loss with a SPRINT category E.  There was no VA examination in evidence proximate to separation.  

HEARING	EXAM	
MEPS
~36 Mo. Pre Sep
(20060713)	
Baseline 
~15 Mo. Pre Sep
(20080404)
	
Hearing Conservation
~8 Mo. Pre Sep
(20081113)	
LEFT EAR	Average Hearing Loss	25.25 dB	27.5 db	31.25 db	
	Speech Discrimination	-	-	96%	
	Table VI / VIa	-/I	-/I	I/I	
RIGHT EAR	Average Hearing  Loss	30.0 dB	23.75 db	27.5 dB	
	Speech Discrimination 	-	-	100%	
	Table VI / VIa	-/I	-/I	I/I	
§4.85 RATING	Table VII	-	-	I x I = 0%	
(Average hearing loss is the sum of pure tone thresholds at 1000, 2000, 3000, and 4000 Hz divided by four)

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 6100 code (hearing impairment) citing hearing impairment, bilateral SPRINT score is 86%, falling into category E, separation from service IAW AR 40-501.  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 yield unequivocal 0% ratings for all sets of data.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel 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 hearing condition and IAW VASRD §4.85, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150620, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008708, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,