TINNITUS

Summary

The Veteran, who served in the U.S. Navy from July 1978 to April 1988, appeals the denial of service connection for tinnitus. The Veteran contended that his tinnitus was due to in-service noise exposure from flight line operations. The Board found that the Veteran had a current diagnosis of tinnitus, resolving all reasonable doubt in his favor, and that the in-service incurrence element was met due to his military occupational specialty in aircraft maintenance, which carried a high probability of noise exposure. However, the Board found no competent medical opinion of record linking the current tinnitus diagnosis to the in-service noise exposure. The VA examiner concluded the Veteran experienced transient ear noise, not tinnitus, and noted the absence of service treatment records or other medical documentation of tinnitus prior to a June 2021 VA examination. The Board accorded little probative value to the Veteran's lay statements regarding etiology, as he is not competent to opine on such medical matters. The Board also found that the Veteran's tinnitus did not manifest in service or within the one-year presumptive period, as his lay statements indicated onset 10-15 years post-service. Consequently, service connection for tinnitus was denied.

Rationale

No competent nexus opinion linking current tinnitus to in-service noise exposure.; Lay statements regarding etiology have little probative value as Veteran is not competent to opine on medical etiology.; Tinnitus did not manifest in service or within one year of separation; onset 10-15 years post-service.

Full Decision Text

Citation Nr: A25008887
Decision Date: 01/31/25	Archive Date: 01/31/25

DOCKET NO. 210809-177272
DATE: January 31, 2025

ORDER

Service connection for tinnitus is denied.

FINDINGS OF FACT

1. Resolving all reasonable doubt in the Veteran's favor, the evidence of record establishes a current diagnosis of tinnitus. 

2. There is no competent evidence of record establishing a nexus between the Veteran's current diagnosis of tinnitus and his exposure to hazardous noise in service. 

CONCLUSION OF LAW

The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1131, 1132, 1133, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty in the United States Navy from July 1978 to April 1988.

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a June 2021 rating decision issued by a Department of Veterans Affairs (VA) regional office, an agency of original jurisdiction (AOJ). 

In an August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time the AOJ issued the June 2021 rating decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the rating decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claim herein, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim (VA Form 20-0995, Decision Review Request: Supplemental Claim) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Generally, to establish service connection, there must be competent and credible evidence demonstrating: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be established on a presumptive basis for certain chronic diseases, to include tinnitus, if there is competent and credible evidence demonstrating that: (1) the chronic disease was shown as such in service or within the one year presumptive period and the same chronic disease manifests at any later date, however remote, unless it is clearly attributable to intercurrent causes; (2) it manifested to a compensable degree within the one year presumptive period; or (3) if the condition noted during service is not shown to be chronic, continuity of symptomatology after discharge from service. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1132, 1133; 38 C.F.R. §§ 3.307(a), 3.309(a); see also Walker v. Shinseki, 708 F.3d 
 chronic disease was shown as such in service or within the one year presumptive period and the same chronic disease manifests at any later date, however remote, unless it is clearly attributable to intercurrent causes; (2) it manifested to a compensable degree within the one year presumptive period; or (3) if the condition noted during service is not shown to be chronic, continuity of symptomatology after discharge from service. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1132, 1133; 38 C.F.R. §§ 3.307(a), 3.309(a); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Ordinarily a lay person is competent to report symptoms and experiences observable by their senses; however, a lay person is usually not competent to prove a matter requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 470 (1994).

Tinnitus has been recognized as a condition capable of both lay observation and diagnosis. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). Thus, a lay person is not only competent to provide evidence regarding the lay observable symptoms associated with his claimed tinnitus, but they are also competent to render a diagnosis thereof.

The issue of entitlement to service connection for tinnitus.

The Veteran contends that he has tinnitus due to in-service noise exposure; specifically, his 10 year exposure to flight line operations. See June 2021 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. 

In the June 2021 rating decision on appeal, the AOJ favorably found that the Veteran had a current diagnosis based on a June 2021 VA examination. 38 C.F.R. § 3.104(c). However, the AOJ did not clarify what the diagnosis was. 

Following the June 2021 VA examination, the examiner concluded that the Veteran did not have a current diagnosis of tinnitus. Rather, the examiner determined that he was experiencing transient ear noise. At the time of the examination, the Veteran described experiencing a bilateral ringing sound, which occurred four times per week and lasted for about 15 to 30 seconds. He stated it onset about 10 to 15 years prior. Citing two medical sources, the examiner explained that the Veteran's description of symptoms did not meet the definition of tinnitus. The examiner explained that transient ear noise occurs in the general population without auditory damage or pathology. Further, the examiner stated that transient ear noise is not consistent with noise-induced tinnitus. 

Given the above, it appears the AOJ favorably found that the Veteran had a diagnosis of transient ear noise and not tinnitus. 

The Board acknowledges that tinnitus has been recognized as a condition capable of both lay observation and diagnosis. In addition to the Veteran's lay description of his symptoms during the June 2021 VA examination, an August 2021 VA Audiology Note also noted that he had a history of constant "'ringing' tinnitus" in both ears. Further, the VA audiologist noted that tinnitus management strategies were discussed with the Veteran. 

Considering the above, the Board resolves all reasonable doubt in the Veteran's favor and finds that he has a current diagnosis of tinnitus. 38 U.S.C. § 5017(b); 38 C.F.R. § 3.102. Thus, the current disability element of the claim has been met. 

In the June 2021 rating decision on appeal, the AOJ also favorably found that the Veteran had a qualifying in-service incurrence based on his military occupational specialty in aircraft maintenance, which had a high probability of exposure to hazardous noise. 38 C.F.R. § 3.104(c). No clear and unmistakable error has been shown by the evidence of record as to this finding; therefore, the Board is bound by it. Id. Consequently, the in-service incurrence element of this claim has been met as well. 

The only remaining question before the Board is whether there is sufficient evidence of a nexus between the Veteran's current diagnosis of tinnitus and his exposure to hazardous noise in service. 

In that regard, the June 2021 VA examiner did not provide a nexus opinion as to the Veteran's current diagnosis of tinnitus. However, that fact does not render the June 2021 VA examination and medical opinion inadequate. The Board's resolution of reasonable doubt in the Veteran's favor does not negate the fact that the examiner conducted an adequate examination and offered a medical opinion that was factually accurate based upon the information available
 therefore, the Board is bound by it. Id. Consequently, the in-service incurrence element of this claim has been met as well. 

The only remaining question before the Board is whether there is sufficient evidence of a nexus between the Veteran's current diagnosis of tinnitus and his exposure to hazardous noise in service. 

In that regard, the June 2021 VA examiner did not provide a nexus opinion as to the Veteran's current diagnosis of tinnitus. However, that fact does not render the June 2021 VA examination and medical opinion inadequate. The Board's resolution of reasonable doubt in the Veteran's favor does not negate the fact that the examiner conducted an adequate examination and offered a medical opinion that was factually accurate based upon the information available to them, fully articulated, and supported by sound reasoning for the conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

Of note, other than the Veteran's lay statements during the examination, there were no VA or private treatment records showing a diagnosis of tinnitus or documenting a complaint of tinnitus prior to the June 2021 VA examination. See June 2021 CAPRI (noting there were no VA treatment records found). Instead, at that time of the June 2021 VA examination, there was a private audiogram from B.I.D.M.C. of record which appears to be from September 2015, which appears to suggest that he did not experience symptoms of otalgia, otorrhea, tinnitus, or vertigo. However, the copy of the private audiogram available is blurry.

Considering the above, at the time the AOJ issued the June 2021 rating decision on appeal it had fulfilled its duty to provide the Veteran with a VA examination and obtain a medical opinion. 

There is no competent nexus opinion of record linking the Veteran's current diagnosis of tinnitus to his hazardous noise exposure in service. Although the Veteran is competent to provide evidence of lay observable symptoms associated with his tinnitus and to render a diagnosis thereof, he is not competent to provide a nexus opinion regarding the etiological relationship between his current diagnosis of tinnitus to his hazardous noise exposure in service as it involves a medical subject concerning an internal physical process over time and extends beyond an immediately observable cause-and-effect relationship. For this reason, the Board accords the Veteran's lay statements regarding the etiology of his tinnitus little probative value as he is not competent to opine on such a complex medical question. 

In view of the above, the Board finds that the evidence of record persuasively weighs against demonstrating a nexus between the Veteran's current diagnosis of tinnitus to his hazardous noise exposure in service. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

Finally, the Board has considered whether service connection for the Veteran's tinnitus on a presumptive basis as chronic disease may be granted. However, here, the Veteran's own lay statements establish that his tinnitus first onset 10 to 15 years prior to the June 2021 VA examination (between 2006 and 2011), which is more than a decade and a half post-separation from his last period of active duty service in 1988. The service treatment records submitted by the Veteran contain no reference to tinnitus or symptoms that could be construed as tinnitus in service. See Charles, 16 Vet. App. 374, citing DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1714 (28th ed. 1994) (defining tinnitus as "a noise in the ears, such as ringing, buzzing, roaring, or clicking"). Significantly, at no time has the Veteran reported experiencing tinnitus in service or symptoms that could be construed as tinnitus in service. Consequently, the evidence of record persuasively weighs against showing that his tinnitus was shown in service or onset within one year of his separation from service. See Lynch, 21 F.4th at 781-82.

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Accordingly, service connection for tinnitus is denied.

 

 

Grace J. Suh

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Duncan-Gould

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.