RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01801
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080420

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

CI CONTENTION:  No specific contention made.  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 review of disability ratings assigned 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 Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20080214	VARD - 20100813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurosensorial Hearing Loss	6100	0%	Bilateral Hearing Loss	6100	0%	20091014	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Neruosensorial Hearing Loss.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s hearing loss began after a history of noise exposure due to improperly fitted hearing protection.  The bulk of hearing loss occurred while exposed to multiple IED blasts in Iraq from January 2004 to February 2005.  An MRI of internal auditory canals on 10 August 2007 was normal.

At the 8 August 2007 audiology evaluation, 9 months prior to separation, the CI reported hearing loss which required him to turn the television and radio up louder.  He also spoke louder for 1 to 2 preceding years and had difficulty understanding speech.  He denied earache and tinnitus (ringing or buzzing in the ears).  Physical examination showed normal ears with no abnormality of ear drums and type A (normal) tympanograms.  The pure tone threshold audiogram showed thresholds in the right ear of 15 dB at 1000 Hz, 20 at 2000, 55 at 3000 and 60 at 4000.  The left ear showed 15 dB at 1000, 30 at 2000, 55 at 3000 and 60 at 4000.  Speech discrimination was 92% in each ear with masking the opposite ear using the spondee list (not the VA required Maryland consonant-nucleus-consonant (CNC) test.  The speech recognition threshold (SRT) was reported as 20 dB on the right and 25 dB on the left with pure tone audiogram (PTA) results of 17 dB on the right and 20 dB left showing good SRT-PTA agreement.  During the 30 October 2007 speech recognition in noise test, 6 months prior to separation, the CI identified 167 of the 200 words presented placing him in the 49th percentile.  The 10 January 2008 MEB NARSUM, 3 months prior to separation, listed the results of the previous testing.

At the 14 October 2009 VA Compensation and Pension (C&P) audiometric examination, 18 months after separation, the CI reported he had trouble hearing his wife clearly and he needed amplification (hearing aids) to understand speech.  He also reported constant tinnitus.  The pure tone threshold audiogram showed thresholds in the right ear of 10 dB at 1000 Hz, 10 at 2000, 40 at 3000 and 50 at 4000.  The left ear showed 20 dB at 1000, 35 at 2000, 60 at 3000 and 65 at 4000.  Speech discrimination was 96% in right ear at 40 dB and 90% at 60 dB in the left ear using Maryland CNC test.

There were two audiological evaluations proximate to separation, which the panel weighed in arriving at its rating recommendation, and are summarized in the chart below:

HEARING	EXAM	AUDIO  ~9 Mo. Pre Sep 	VA C&P ~18 Mo. Post Sep	
LEFT EAR	Average Hearing Loss	40dB	45dB	
	Speech Discrimination	92%	90%	
	Table VI / VIa	I /I	II / II	
RIGHT EAR	Average Hearing  Loss	30dB	28dB	
	Speech Discrimination 	92%	96%	
	Table VI / VIa	I/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 panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hearing loss condition 0%, coded 6100 (bilateral hearing loss), citing the audiogram 5 months before separation.  The VA also rated the hearing condition 0%, coded 6100, based on the C&P audiometric examination.  Panel members noted that 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 pure tone threshold across the hearing ranges from 1000 to 4000 Hz, and accommodate for measured speech discrimination when available.  The charted results of the audiometric evidence in this case yields unequivocal 0% ratings for both sets of data.  After due deliberation, considering all 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 neurosensorial hearing loss condition.

BOARD FINDINGS:  In the matter of the neurosensorial hearing loss condition and IAW VASRD §4.85 and §4.86, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

 AR20180011414, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXXv 

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.