TINNITUS

Summary

The Veteran, a U.S. Navy Veteran who served from March 1971 to March 1974, appeals the denial of service connection for tinnitus and bilateral hearing loss. The Veteran testified that he experienced ringing in his ears during service due to noise exposure aboard an aircraft carrier, and that the onset of tinnitus occurred during service. The Board found that the Veteran has tinnitus and that his service involved conceded exposure to hazardous noise. A December 2024 VA medical opinion provided a positive nexus, stating it was at least as likely as not that the tinnitus was related to military noise exposure, and was found to be the most probative evidence. Previous unfavorable opinions were discounted due to not fully considering the Veteran's testimony. Resolving reasonable doubt in the Veteran's favor, service connection for tinnitus was granted. The claim for bilateral hearing loss was remanded. The Veteran testified that his hearing loss began before working at Shell Oil after service, and that Shell records indicated hearing loss before his baseline examination. The Board found the December 2024 VA opinion regarding hearing loss inadequate due to potential issues with the cited Institute of Medicine report and the examiner's reliance on a five-year-old post-service examination. The case was remanded for a new opinion addressing the etiology of hearing loss in light of the Veteran's testimony and the potentially contradictory medical literature.

Rationale

Conceded in-service noise exposure; Positive nexus opinion from December 2024 VA examiner; Resolving reasonable doubt in Veteran's favor

Full Decision Text

Citation Nr: 26004674
Decision Date: 04/17/26	Archive Date: 04/17/26

DOCKET NO. 19-26 098
DATE: April 17, 2026

ORDER

Service connection for tinnitus is granted.

REMANDED

Entitlement to service connection for bilateral hearing loss is remanded.

FINDING OF FACT

The Veteran has tinnitus; the evidence as to whether it is etiologically related to his service is at least in equipoise. 

CONCLUSION OF LAW

Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the U.S. Navy from March 1971 to March 1974. 

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. 

In May 2022, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. 

In September 2022, August 2023, and June 2024, the Board remanded the issues on appeal to the agency of original jurisdiction (AOJ) for additional development. In the most recent remand, the Board directed the AOJ to ask the Veteran to provide a release for records from Shell Oil or, in the alternative, to provide a copy of the records himself. The Board further directed that if records from Shell Oil were procured, the AOJ was to obtain an addendum medical opinion from a VA examiner who offered opinions as to the etiology of the Veteran's hearing loss and tinnitus in May 2023, taking the new evidence into account.  

In June 2024, the AOJ sent the Veteran a letter asking him to provide a release for records from Shell Oil, or to provide the records himself. He did not provide the requested release. In July 2024, however, he submitted a copy of a record from Norco Manufacturing (the entity he had previously identified as the Shell Norco Manufacturing Complex). In December 2024, the AOJ obtained addendum medical opinions per the Board's June 2024 remand directives. In light of those actions, and inasmuch as the medical opinion as to tinnitus is fully adequate, the Board finds that the AOJ has at least substantially complied with all of the prior remand directives with respect to tinnitus. See Stegall v. West, 11 Vet. App. 268, 271 (1998). However, for the reasons set out in further detail below, the Board finds that the December 2024 addendum medical opinion with respect to hearing loss is not fully adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As such, further development of that claim is required. 

Entitlement to service connection for tinnitus

The Veteran seeks to establish service connection for tinnitus. He contends that the condition was incurred in or caused by service. He testified at the May 2022 Board hearing that he had ringing in his ears after he was exposed to noise after a shift, and that it started out as a ringing, but that in later years it was more of a humming. When asked when he first noticed tinnitus, he testified that it was before he started work at Shell, but that he did not remember if he had it in service and that he did not know what it was. He testified that he probably had it before he was discharged. 

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

Generally, in order to prove service connection, there must be 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. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). 

When there is an approximate balance of
 pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

Generally, in order to prove service connection, there must be 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. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. An approximate balance of the evidence includes, but is not limited to, equipoise. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Evidence is not in "approximate balance" or "nearly equal" when the evidence persuasively favors one side or the other. Id.

There is no material dispute that the Veteran has tinnitus, as demonstrated by an August 2017 VA examination report. The Board has also conceded that he was exposed to hazardous noise during service. The first and second elements of service connection have therefore been established. The primary question for the Board is whether there is a nexus, or link, between the Veteran's tinnitus and conceded in-service exposure to hazardous noise. 

In a December 2024 medical opinion obtained pursuant to the Board's June 2024 remand, a VA examiner offered a positive nexus opinion as to tinnitus. She noted the Veteran's May 2022 hearing testimony to the effect that he was exposed to excessive noise while working aboard an aircraft carrier below the flight deck and that the onset of his tinnitus was during his active service. She then acknowledged that although a temporary threshold shift was usually a good sign of excessive noise exposure, hearing tests in service were often not done directly after excessive noise exposure such as the kind reported by the Veteran during service, and that the temporary threshold shift was therefore not measured. Citing to medical literature for support, she reasoned that even a temporary threshold shift that did not result in a permanent hearing loss was enough to result in persistent tinnitus. Therefore, it was at least as likely as not that the Veteran's tinnitus was related to military noise exposure.

The Board finds that the December 2024 medical opinion is the most probative evidence of record as to the etiology of the Veteran's tinnitus. The opinion was based on a review of the record, with full consideration of the Veteran's statements, and is supported by a rationale and citation to medical literature. It is therefore entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-304 (2008). 

The Board acknowledges that VA examiners in August 2017 and May 2023 offered unfavorable opinions with respect to nexus. However, the August 2017 VA examiner was unable to fully consider the Veteran's statements as to the onset and presence of tinnitus inasmuch as she offered her opinion prior to the May 2022 hearing. The May 2023 VA examiner also failed to fully consider the Veteran's May 2022 hearing testimony with respect to tinnitus, referring in her opinion only to what the Veteran reported as related by the August 2017 VA examiner. Because neither examiner fully considered the Veteran's lay statements, their opinions are of limited probative value. At minimum, the evidence as to whether the Veteran's tinnitus is etiologically related to his in-service noise exposure is in equipoise. 

In light of the foregoing, and resolving reasonable doubt in the Veteran's favor, the Board finds that the criteria for an award of service connection for tinnitus have been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The appeal of this issue is granted. 

REASONS FOR REMAND

Entitlement to service connection for bilateral hearing loss is remanded.

The Veteran contends that his hearing loss is due to the same in-service noise exposure that caused his tinnitus. At the May 2022 hearing, he testified that he worked for Shell Oil after service, beginning in 1979, just five years after his separation from service. He testified further that records from Shell showed that he had a hearing loss disability before he started there. 

In light of the Veteran's May 2022 hearing testimony, the Board previously found that records
. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The appeal of this issue is granted. 

REASONS FOR REMAND

Entitlement to service connection for bilateral hearing loss is remanded.

The Veteran contends that his hearing loss is due to the same in-service noise exposure that caused his tinnitus. At the May 2022 hearing, he testified that he worked for Shell Oil after service, beginning in 1979, just five years after his separation from service. He testified further that records from Shell showed that he had a hearing loss disability before he started there. 

In light of the Veteran's May 2022 hearing testimony, the Board previously found that records from Shell Oil could be relevant to his claim and directed the AOJ to assist the Veteran in obtaining them. In July 2024, as noted, the Veteran submitted a record from Shell Oil (i.e., the Shell Norco Manufacturing Complex) dated in December 1997, in lieu of providing a release. The record does not contain any audiometric test results, but notes that a hearing test showed hearing loss in the high frequency range only, and that he did not have a standard threshold shift from his baseline examination, which meant that there had been no significant change in hearing since his baseline examination. 

In December 2024, a VA examiner other than the May 2023 examiner offered an unfavorable nexus opinion as to hearing loss. She stated that while the record from Shell Oil/Norco Manufacturing did not provide actual threshold measurements, it did indicate that there had been no significant change in hearing since the Veteran's baseline examination, which reportedly occurred in 1979, five years after his release from active duty. The examiner surmised from the 1997 report that the hearing loss could have been 30 decibels in the high frequencies (which generally means frequencies equal to or greater than 4,000 Hertz) in 1979, and that if that was the case, it would not represent a significant threshold shift when compared to the reports of the Veteran's service entrance and separation examinations.

The examiner further concluded that the objective evidence clearly showed that there was no significant threshold shift during service, and that a hearing test five years after separation, even if thresholds were available, was too long of a time to reasonably assume that the disability could be related to the Veteran's military noise exposure. She then pointed to two medical articles, one of which was a 2006 study from the Institute of Medicine (IOM) concerning delayed onset hearing loss, to support her opinion. 

The United States Court of Appeals for Veterans Claims (Court) has directed attention to the fact that the IOM report on which the December 2024 examiner relied contains apparent qualifiers or contradictions that may impact the probative value of medical opinions that rely upon it. See McCray v. Wilkie, 31 Vet. App. 243 (2019). In light of the Court's observation, the Board will remand the case for an addendum opinion.

This matter is REMANDED for the following action:

1. Arrange to provide the record on appeal to the VA examiner who offered an opinion with respect to the etiology of the Veteran's hearing loss in December 2024. 

The examiner should be asked to review the record and provide an addendum opinion as to whether it is at least as likely as not (i.e., whether the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hearing loss had its onset in, or is otherwise attributable to, service, to include as due to his conceded in-service exposure to hazardous noise. 

In so doing, the examiner must acknowledge and discuss any apparent qualifiers or contradictions in the IOM report as they relate to the acknowledgement therein that definitive studies have not been performed to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of noise exposure.

If the December 2024 VA examiner is no longer employed by VA or is otherwise unable to provide the opinion requested, arrange to obtain the requested information from another qualified examiner. The need for another in-person examination, or telephone or video interview of the Veteran is left to the discretion of the examiner.  

A complete rationale for all opinions must be provided.

2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraph, the issue remaining on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response.

 

 

DAVID A. BRENNINGMEYER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Oldroyd,