HERNIA INGUINAL

LAURA E. COLLINS · 2026 · Case ID: 26004520

MIXED

Summary

The veteran, who served in the Marine Corps from August 1971 to August 1974, including Reserve service, appeals the denial of service connection for prostate cancer, erectile dysfunction, hypertension, and right ear hearing loss, as well as an increased rating for tinnitus. The Board granted service connection for left inguinal hernia residuals, finding the November 2025 VA opinion to be the most probative, despite earlier opinions finding against an in-service etiology. For prostate cancer, hypertension, and erectile dysfunction, the Board denied service connection, finding the evidence weighed against an in-service onset or relation to toxic exposure risk activities, and that the Veteran's lay testimony was less probative than the VA medical opinions. The Board also denied service connection for right ear hearing loss, finding the evidence weighed against an in-service etiology related to noise exposure, despite conceded hazardous noise exposure and a favorable VA opinion in May 2024. The claim for an increased rating for tinnitus was denied, as the 10 percent rating is the maximum schedular evaluation, and the Veteran's reported symptoms did not meet the criteria for an extraschedular rating due to pyramiding concerns and lack of marked interference with employment.

Rationale

Positive November 2025 VA opinion finding nexus; In-service complaints of pain and diagnosis of hernia; In-service repair noted

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-05 546

Full Decision Text

Citation Nr: 26004520
Decision Date: 04/14/26 Archive Date: 04/14/26

DOCKET NO. 18-05 546
DATE: April 14, 2026

ORDER

Entitlement to service connection for left inguinal hernia residuals is granted.

Entitlement to service connection for prostate cancer is denied.

Entitlement to service connection for erectile dysfunction is denied.

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for right ear hearing loss is denied.

Entitlement to an initial rating in excess of 10 percent for tinnitus is denied.

FINDINGS OF FACT

1. The competent and credible evidence of record is in approximate balance as to whether left inguinal hernia residuals are related to an in-service injury or illness.

2. The competent and credible evidence of record persuasively weighs against finding that prostate cancer manifested during active-duty service or within one year thereafter, or is related to an in-service injury or disease, including a toxic exposure risk activity. The evidence is not in approximate balance.

3. The competent and credible evidence of record persuasively weighs against finding that erectile dysfunction is related to an in-service injury or disease, including a toxic exposure risk activity. The evidence is not in approximate balance.

4. The competent and credible evidence of record persuasively weighs against finding that hypertension manifested during active-duty service or within one year thereafter or is related to an in-service injury or disease including a toxic exposure risk activity. The evidence is not in approximate balance.

5. The competent and credible evidence of record persuasively weighs against finding that right ear hearing loss manifested during active-duty service or within one year thereafter or is related to an in-service injury or disease, including a toxic exposure risk activity. The evidence is not in approximate balance.

6. The Veteran is currently receiving the maximum schedular rating for tinnitus and the competent and credible evidence persuasively weighs against finding that tinnitus is manifested by other related factors, such as marked interference with employment or frequent periods of hospitalization.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a left inguinal hernia are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303.

2. The criteria for entitlement to service connection for prostate cancer are not met. 38 U.S.C. §§ 1110, 1101, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310.

4. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1101, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

5. The criteria for entitlement to service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1110, 1101, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385.

6. The criteria for entitlement to a rating in excess of 10 percent for tinnitus, to include on an extraschedular basis, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.87, DC 6260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1971 to August 1974 with additional service in the Marine Corps Reserves.

These matters are before the Board of Veterans' Appeals (Board) on appeal of an August 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony before the undersigned at a November 2022 Board hearing. A transcript of the hearing testimony has been associated with the record.

This case was previously before the Board in February 2023, April 2024 and March 2025. In April 2024 and March 2025, the Board remanded the issues for additional development. The issues have now been returned to the Board.

In December 2024 entitlement to service connection for an unspecified depressive disorder was granted and in December 2025 entitlement to service connection for obstructive sleep apnea was granted. As these decisions represent full
Board) on appeal of an August 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony before the undersigned at a November 2022 Board hearing. A transcript of the hearing testimony has been associated with the record.

In December 2024 entitlement to service connection for an unspecified depressive disorder was granted and in December 2025 entitlement to service connection for obstructive sleep apnea was granted. As these decisions represent full grants of the benefits sought on appeal, these issues are no longer before the Board.

Service Connection

Service connection is established on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d).

Certain chronic diseases, including hypertension, prostate cancer and hearing loss will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021.

1. Entitlement to service connection for a left inguinal hernia is granted.

The Veteran contends that he has a left inguinal hernia which is related to an in-service injury.

The service treatment records are significant for complaints of pain in the right lower abdominal area in January 1973.

In December 1977 Reserve records, the Veteran complained of pain in the right groin area for two weeks. The next day, he reported sharp pain in the left inguinal region and in both testicles associated with heavy lifting. He was diagnosed with a left inguinal hernia.

In January 1978 the Veteran underwent left inguinal hernia repair. It was noted that he worked "lifting 55 [gallon] drums."

In a February 1978 US Marine Corps Reserve reenlistment examination, the left inguinal hernia was reported to be successfully repaired and well healed.

In January 1981 the Veteran complained of groin pain since approximately one week ago. He was reported to have had a hernia operation in the same area one year prior.

At his November 2022 Board hearing, the Veteran asserted that he believed his current hernia residuals were related to lifting tires during active-duty service. The Veteran did not describe lifting tires during his Reserve service.

On VA examination in May 2023 the Veteran was diagnosed with inguinal hernia residuals. The Veteran described an onset of pain in the groin area during service after putting heavy tires on trucks for weeks, with a "course since onset" of continued abdominal pain and discomfort. The examiner considered the complaint of pain in the right inguinal area for one year in January 1973 and the diagnosis of left inguinal hernia in December 1977. The examiner nonetheless opined against an in-service onset of an inguinal hernia reasoning that, in the absence of chronicity during service or after service, a post-service event, illness or injury was considered to be the more likely etiology.

In April, August and September 2025 opinions, a VA examiner again opined against an in-service etiology of left inguinal hernia residuals. However, the AOJ apparently determined that those opinions were inadequate as another opinion was obtained in November 2025. That examiner found that the Veteran's left inguinal hernia residuals were likely related to lifting tires in service. The examiner reasoned that "[l]ifting weight repetitively can result in inguinal hernia as stated above. Hence
opined against an in-service onset of an inguinal hernia reasoning that, in the absence of chronicity during service or after service, a post-service event, illness or injury was considered to be the more likely etiology.

In April, August and September 2025 opinions, a VA examiner again opined against an in-service etiology of left inguinal hernia residuals. However, the AOJ apparently determined that those opinions were inadequate as another opinion was obtained in November 2025. That examiner found that the Veteran's left inguinal hernia residuals were likely related to lifting tires in service. The examiner reasoned that "[l]ifting weight repetitively can result in inguinal hernia as stated above. Hence it is m[o]re likely than not for inguinal hernia to be due to repetitive heavy lifting during service. A nexus has been established."

As the May 2023 and April, August and September 2025 medical opinions have been determined to be inadequate, the Board attributes the greatest probative value to the positive November 2025 opinion. Accordingly, service connection for left inguinal hernia residuals is warranted.

The claim is granted.

2. Entitlement to service connection for prostate cancer is denied.

3. Entitlement to service connection for erectile dysfunction is denied.

4. Entitlement to service connection for hypertension is denied.

The Veteran contends that he has prostate cancer and hypertension which are related to in-service TERAs including exposure to exposure to gunpowder smoke and dust, and that he has erectile dysfunction which is related to his prostate cancer.

Service treatment records are silent for diagnosis or complaints related to the prostate, erectile dysfunction, or hypertension. In August 1974, a blood pressure reading of 126/90 was recorded. In August 1974 the Veteran was treated for urethritis due to gonococcus.

In an October 1987 reserve treatment record, the Veteran reported pain in the right flank which he believed was related to his prostate. On examination, the treating physician gave an impression of cystitis.

In June 2005 the Veteran underwent prostate biopsy, which was negative.

An April 2008 VA imaging report shows that the prostate was mildly enlarged.

At his November 2022 Board hearing, the Veteran stated that prostate cancer was diagnosed in 2018 or 2019, and that a VA doctor had told him that the condition was related to his military service, though he could not recall the name of that physician. The representative noted that the Veteran had a blood pressure reading of 126/90 during service and stated that he believed this reading constituted hypertension.

On VA examination in April 2023, the Veteran was diagnosed with hypertension, with a date of diagnosis of 2001. The Veteran reported that he believed his hypertension began in "about 1973-1974" and recalled that in service, he was responsible for a truck accident, and "puked" afterward. On another occasion he was thrown from a truck. The examiner inquired as to the relevance of these events and the Veteran postulated that they "may have been the start of his elevated [blood pressure]." The examiner opined against an in-service onset of hypertension, reasoning that, although there was an isolated blood pressure measurement of 126/90 in August 1974, "it is not uncommon for [blood pressure] to fluctuate from stress, hormones, excitement, exercise, etc." and that diagnosis of hypertension "is determined with elevated readings on two separate occasions." The examiner opined that the Veteran's hypertension was more likely related to other risk factors.

On prostate examination in April 2023, the Veteran was diagnosed with prostate cancer. The condition had its onset in 2017-2018 after a finding of elevated prostate-specific antigen and was treated with radiation therapy. The examiner opined against an in-service etiology of prostate cancer, reasoning that there was no relevance or causal relationship to the August 1974 finding of urethritis due to gonococcus. By contrast, the examiner noted that the Veteran had several risk factors for prostate cancer, including obesity and tobacco use which increased risk of prostate cancer.

In May 2024 a VA examiner opined that the Veteran's prostate cancer, erectile dysfunction and hypertension were unlikely related to military service, as there was a lack of substantiating evidence, such as evidence of chronicity during and after service, to support a nexus, and that a post-service event, illness or injury was considered a more likely etiology.

In a separate opinion, the May 2024 examiner opined that prostate cancer, hypertension, and erectile dysfunction were unlikely related to an in-service toxic exposure risk activity, after considering all applicable military deployments and the synergistic, combined effect of the toxic exposures. The examiner reasoned that medical literature did not support a causal relationship between prostate cancer, hypertension and erectile dysfunction
of prostate cancer.

First, the Board acknowledges that prostate cancer and hypertension are diseases which, if manifest to a degree of 10 percent within one year after separation from active duty, may be presumed to have been incurred in service. To the extent that the Veteran believes that prostate cancer and hypertension began during his active-duty service or within one year thereafter, and the representative believes that the Veteran's in-service blood pressure reading showed hypertension, the Veteran and his representative are not competent to diagnose prostate cancer or hypertension or to determine that any symptoms were manifestations of such disorders. The diagnosis of prostate cancer and hypertension is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Neither the Veteran, nor the representative are shown to possess the requisite medical experience, expertise, or training to provide competent medical evidence on these complex questions. There is no competent medical evidence showing an onset of prostate cancer or hypertension during active-duty service, or within one year thereafter. On the contrary, In an April 2023 opinion, a VA medical examiner opined that the reading of 126/90 in August 1974 did not constitute hypertension. The available evidence thus weighs persuasively against finding manifestations sufficient to identify chronic prostate cancer or hypertension in active-duty service, or within one year thereafter. Thus, service connection is not warranted on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309.

The Board next turns to the question of whether prostate cancer, erectile dysfunction or hypertension are related to an in-service injury or illness, to include a toxic exposure risk activity, but concludes that the evidence in this case weighs persuasively against finding such an etiology. There is no competent medical evidence relating prostate cancer, erectile dysfunction or hypertension to an in-service injury or illness, to include any toxic exposure risk activity. To the extent that the Veteran believes that his prostate cancer, erectile dysfunction and hypertension are related to an in-service illness or injury, to include toxic risk exposures, he is not shown to have the relevant training or education to offer a medical opinion in this regard. The etiologies of prostate cancer, erectile dysfunction and hypertension are complex as they have multiple possible etiologies. Jandreau, 492 F.3d at 1377, 1377 n.4. There is thus no competent evidence relating prostate cancer, erectile dysfunction or hypertension to an in-service injury or illness, to include the toxic exposure risk activities.

By contrast, the April 2023 VA medical opinions are against finding that prostate cancer and hypertension are related to an in-service injury or illness, and the May 2024 VA medical opinions are against finding that prostate cancer, erectile dysfunction and hypertension are related to an in-service toxic exposure risk activity. The Board finds these opinions to be highly probative and to be more probative than the Veteran's hearing testimony that he was told by a VA physician that his prostate cancer was related to service. While the Veteran is competent to report being told that his conditions are related to service, these lay reports are attributed little probative value, compared to the competent medical evidence of record.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for prostate cancer, erectile dysfunction and hypertension is warranted. Rather, the evidence weighs persuasively against finding that prostate cancer and hypertension manifested during active-duty service or within one year thereafter, or that prostate cancer, erectile dysfunction and hypertension are related to any in-service injury or illness, to include toxic exposure risk activities. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claims are denied.

5. Entitlement to service connection for right ear hearing loss is granted.

The Veteran contends that he has right ear hearing loss which is related to in-service noise exposure. The Veteran was granted service connection for left
balanced as to whether service connection for prostate cancer, erectile dysfunction and hypertension is warranted. Rather, the evidence weighs persuasively against finding that prostate cancer and hypertension manifested during active-duty service or within one year thereafter, or that prostate cancer, erectile dysfunction and hypertension are related to any in-service injury or illness, to include toxic exposure risk activities. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claims are denied.

5. Entitlement to service connection for right ear hearing loss is granted.

The Veteran contends that he has right ear hearing loss which is related to in-service noise exposure. The Veteran was granted service connection for left ear hearing loss in an August 2015 rating decision, but was denied service connection for right ear hearing loss in the same decision.

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Even though disabling hearing loss is not demonstrated at separation, a veteran may, nevertheless, establish service connection for a current hearing disability by submitting evidence that a current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993).

Service treatment records are silent for diagnosis or complaints related to right ear hearing loss, though hazardous noise exposure is conceded based on the Veteran's military occupational specialty of tank crewman. In-service audiometric testing does not reveal hearing loss for VA purposes at any time during active-duty service.

On VA examination in August 2015, audiological testing revealed right ear hearing loss for VA purposes. The examiner opined that left ear hearing loss was service-related, but that right ear hearing loss was not. The examiner reasoned that the service treatment records revealed no significant threshold shifts for the right ear. The examiner explained that in the absence of a right ear threshold shift in service, there was no evidence of a permanent noise injury affecting hearing sensitivity in that ear.

At his November 2022 Board hearing, the Veteran testified to hazardous noise exposure during his service as a tank crewman and asserted that he believed his right ear hearing loss was related to that noise exposure.

On VA examination in April 2023, the examiner opined against an in-service etiology of right ear hearing loss, reasoning that there was no significant, permanent threshold shift in the right ear during service, and no complaint/treatment for hearing decrease in the service treatment records or at separation.

In May 2024 a VA examiner opined that right ear hearing loss was unlikely related to an in-service toxic risk exposure activity, reasoning:

[T]here is no medical evidence or objective evidence found in the claims file to support a relationship between toxic exposure risk activities and diagnosis of hearing loss. The [m]edical [l]iterature does not support late onset toxic induced hearing loss. Literature suggesting exposure to hazards like some solvents and fuels that result in hearing loss states that the onset of the hearing loss is proximal to the exposure and that it would have to be prolonged exposure to result in hearing loss. Also, the literature states that those that suffer hearing loss as a result of exposure to certain hazards like solvents/fuels notice dizziness, fullness or pressure and or tinnitus at the time of the exposure. The claims file is inconclusive for complaints of this nature.

In April 2025, a VA examiner opined against an in-service etiology of right ear hearing loss, reasoning that service records revealed no significant permanent threshold shift from entrance to separation, which was "objective evidence of no permanent auditory damage on active duty from conceded noise." The examiner further noted that there was no complaint or treatment for decreased hearing in the service treatment records or at separation.

The Board acknowledges that as an organic disease of the nervous system, sensorineural hearing loss is a disease which, if manifest to a degree of 10 percent within one year after separation from active duty, may be presumed to have been incurred in service. To the extent that the Veteran believes that right ear hearing loss began during his active-duty service or within one year thereafter, he is not competent to provide a diagnosis of hearing loss or determine that any symptoms were manifestations of a sensorineural hearing loss, or of hearing loss for VA compensation purposes generally. The diagnosis of the appellant's hearing loss is medically complex, as diagnosis of hearing loss requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau, 492 F.3d 1377, 1377 n.4. The Veteran is not shown to possess the requisite medical experience, expertise, or training to administer and interpret audiometry testing or to provide competent medical evidence on this complex question. While the Veteran may have experienced a subjective decrease in hearing ability, it must meet the standard at 38 C.F.R. § 3.385 for VA disability benefits purposes. The Board thus gives more probative weight to the competent medical evidence of record. The available evidence thus weighs persuasively against finding manifestations sufficient to identify chronic hearing loss in active-duty service, or within one year thereafter. Thus, service connection is not warranted on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309.

The Board turns to the question of whether right ear hearing loss is directly related to active-duty noise exposure or a toxic exposure risk activity. While the Veteran has stated that he believes his right ear hearing loss is related to in-service noise exposure, the Veteran does not have the requisite medical experience, expertise, or training to provide a competent nexus opinion. The etiology of hearing loss is medically complex as it has multiple possible etiologies. Jandreau, 492 F.3d at 1377 n.4. The Board thus gives more probative weight to the May 2024 examiner's opinion against a relationship with in-service toxic exposure risk activities and the April 2025 VA audiologist's opinion against a relationship with in-service noise exposure.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for right ear hearing loss is warranted. Rather, the evidence weighs persuasively against finding that right ear hearing loss manifested during active-duty service or within one year thereafter, or that right ear hearing loss is related to any in-service injury or illness, to include noise exposure or toxic exposure risk activities. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b), Lynch, 21 F.4th 776. The claim is denied.

Increased Rating

Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1999). Nevertheless, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods within the period on appeal.

Where there is a question as to which of the two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

6. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied.

The Veteran contends that his tinnitus is more severely disabling than the currently assigned 10 percent rating.

A 10 percent evaluation is assigned for recurrent tinnitus. 38 C.F.R. § 4.87, DC 6260. Only a single evaluation may be assigned, whether the sound is perceived in one ear, both ears, or in the head, Id. at Note (2), and the Veteran is currently assigned the maximum schedular rating under the assigned DC
disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

6. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied.

The Veteran contends that his tinnitus is more severely disabling than the currently assigned 10 percent rating.

On VA examination in August 2015, the Veteran reported tinnitus symptoms intermittent, non-localizing, ringing-type tinnitus that occurs weekly and lasts for minutes. The functional impact of tinnitus was that it made it difficult for him to hear.

At his November 2022 Board hearing, the Veteran reported that he sometimes had ear pain "for a few minutes" accompanying the tinnitus, and that his tinnitus caused him to lose sleep.

On VA examination in April 2023 the Veteran reported intermittent tinnitus in both ears, described as a crunching sound which occurred "every now and then" lasting "for a few minutes and he cringes over the sound." The functional impact of tinnitus was that it "makes him cringe." The examiner further noted that the Veteran reported ear pain, described as "excruciating."

In a September 2023 addendum opinion, the examiner stated:

Research shows that tinnitus coupled with ear pain can cause irritability, distraction from tasks, sleep deprivation, etc. Although Veteran did not seem to expound in detail on effects of tinnitus in all aspects of his life, he did report tinnitus associated with ear pain at least two to three times during the [compensation and pension appointment] dated [April 18, 2023]. Therefore, I opine that tinnitus associated with ear pain has a great impact on his life and has gotten worse over time.

On VA examination in April 2025, the Veteran reported tinnitus once per week, lasting a few minutes. The functional impact of tinnitus (in combination with hearing loss) was that the Veteran had difficulty hearing in noise and had to rely more on visual cues. He had difficulty hearing women's voices, and hearing loss and tinnitus may impact his ability to work in a noisy environment.

As 10 percent is the highest schedular evaluation available for tinnitus, the Veteran's appeal for a higher schedular rating must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994).

However, the issue of entitlement to an extraschedular rating was raised by the Veteran's November 2022 Board hearing testimony describing ear pain and difficulty sleeping resulting from tinnitus. See 38 C.F.R. § 3.321. Accordingly, the Board directed that the case be referred to the Director of Compensation Services for extraschedular consideration in its April 2024 remand. The Director of Compensation Services considered the case in December 2024, but concluded that an extraschedular rating was not warranted.

The Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran's disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant's symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the Veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111.

In this case, the Board concludes that entitlement to an extraschedular rating is not shown. Considering the first Thun element, the Veteran has reported that his tinnitus sometimes causes ear pain and disrupts his sleep. The Board finds these symptoms are not explicitly contemplated by the rating criteria for tinnitus under 38 C.F.R. § 4.87, DC 6260.

Turning to the second Thun element, the record does not present specific evidence of other related factors, such as
the Veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111.

Turning to the second Thun element, the record does not present specific evidence of other related factors, such as marked interference with employment or frequent periods of hospitalization, resulting from tinnitus symptoms. The Board acknowledges that the September 2023 addendum opinion indicated that tinnitus "has a great impact on his life," though the examiner also stated that the "Veteran did not seem to expound in detail on effects of tinnitus in all aspects of his life."

With regard to difficulty sleeping, the Veteran has been awarded service connection for an unspecified depressive disorder, rated 30 percent disabling from November 17, 2014 to September 19, 2024 and 70 percent disabling thereafter, under 38 C.F.R. § 4.130, DC 9435. That DC contemplates chronic sleep impairment, and the medical evidence of record shows that chronic sleep impairment is considered a symptom of the Veteran's unspecified depressive disorder. See April 2023 VA psychiatric examination. Therefore, any additional award of benefits based on that symptom would violate the rule against pyramiding (rating the same disability or its manifestations under different DCs). See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The Board acknowledges that service connection for tinnitus is in effect from January 24, 2014. However, there is no evidence that the Veteran was experiencing sleep disruption due to tinnitus during this period, as the Veteran did not report sleep impairment due to tinnitus until many years later. Thus, for the period where a separate rating could be assigned for sleep impairment, it is precluded in this case due to the rule against pyramiding.

Turning to the reported ear pain, that symptom has been reported to only occur intermittently and last only for a few minutes. At the April 2025 VA examination, the Veteran reported tinnitus occurred only once per week. The Board acknowledges that the Veteran has reported his ear pain associated with tinnitus is "excruciating." However, there is no evidence of any hospitalization or interference with employment associated with these brief (a few minutes) and relatively infrequent (once per week) episodes of excruciating ear pain. There is simply no evidence that they are of the duration or frequency to produce "marked" interference with employment. On the contrary, the Board finds that any resulting interference with employment would reasonably be expected to be minimal due to the short duration and relative infrequency of symptom occurrence.

Additionally, while the September 2023 addendum opinion also reported irritability and distraction from tasks, these were not symptoms specifically reported by the Veteran; rather, the examiner listed these as examples of effects which tinnitus with ear pain might produce. Nonetheless, the Board has considered these potential symptoms as well, but again, there is no evidence that such symptoms have caused hospitalization, or specific interference with employment. While such symptoms could cause some interference with employment, based on the duration and frequency of tinnitus reported by the Veteran, the Board concludes that such interference would be less than "marked." Moreover, symptoms such as irritability and distraction from tasks are also contemplated by The General Rating Formula for Mental Health Disorders, under which his award of service connection for unspecified depressive disorder is rated. See 38 C.F.R. § 4.130. Therefore, separate ratings for the same symptoms would be impermissible pyramiding.

The Board concludes that, to the extent that the Veteran's tinnitus impacts his daily life and work, such functional impairment is contemplated by the assigned 10 percent rating under 38 C.F.R. § 4.87, DC 6260.

Finally, the Board acknowledges that previously, the Board directed that this case be referred to the Director of Compensation Services for extraschedular consideration. The fact of the Board's earlier referral could be considered to imply a finding that both Thun elements are met. 22 Vet. App. 111. In this case, at the time of referral in April 2024, the Veteran was not service-connected for an unspecified depressive disorder and was therefore not compensated for sleep impairment . However, as service connection for an unspecified depressive disorder was later granted in December
tinnitus impacts his daily life and work, such functional impairment is contemplated by the assigned 10 percent rating under 38 C.F.R. § 4.87, DC 6260.

Finally, the Board acknowledges that previously, the Board directed that this case be referred to the Director of Compensation Services for extraschedular consideration. The fact of the Board's earlier referral could be considered to imply a finding that both Thun elements are met. 22 Vet. App. 111. In this case, at the time of referral in April 2024, the Veteran was not service-connected for an unspecified depressive disorder and was therefore not compensated for sleep impairment . However, as service connection for an unspecified depressive disorder was later granted in December 2024, sleep impairment became compensated and a separate rating for that symptom would now violate the rule against pyramiding as discussed above. Accordingly, despite the Board's previous referral for extraschedular consideration, the second Thun element is not met here, and an extraschedular rating is not warranted in this case.

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Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to a rating in excess of 10 percent for tinnitus is warranted. Rather, the evidence persuasively weighs against finding it results in other related factors, such as marked interference with employment or frequent periods of hospitalization. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b), Lynch, 21 F.4th 776. The claim is denied.

Laura E. Collins

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bametzreider, Paul

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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