MIDDLE EAR DISEASE OF

Summary

The Veteran, a Veteran who served from June 1967 to April 1970, appeals the denial of service connection for cholesteatoma. The Veteran reported experiencing headaches, lightheadedness, dizziness, and tinnitus during service, and continued to experience similar symptoms post-service, including balance issues and earaches. Although cholesteatoma was not diagnosed during service, the Board found that the symptoms reported during service were consistent with the chronic cholesteatoma condition that was later diagnosed in 1994. The Board reviewed multiple VA and private examinations, noting that the July 2022 and March 2024 VA examinations supported the finding of consistent symptoms. Applying the benefit of the doubt doctrine, the Board found that the medical evidence and the Veteran's reports of symptoms demonstrated in-service occurrence of his chronic cholesteatoma. Consequently, service connection for cholesteatoma is granted.

Rationale

Veteran reported in-service symptoms of headaches, lightheadedness, dizziness, and tinnitus.; Symptoms persisted post-service and were consistent with later cholesteatoma diagnosis.; Benefit of the doubt applied due to approximate balance of evidence.

Full Decision Text

Citation Nr: A25062331
Decision Date: 07/22/25	Archive Date: 07/22/25

DOCKET NO. 250325-523558
DATE: July 22, 2025

ORDER

Entitlement to service connection for cholesteatoma is granted.

FINDING OF FACT

The Veteran's cholesteatoma was incurred during service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for cholesteatoma have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from June 1967 to April 1970. The Board recognizes his service to our country, and the sacrifices it necessarily entailed.

This matter is before the?Board of Veterans' Appeals?(Board) from an August 2024 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which is also the agency of original jurisdiction (AOJ). 

On the March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran selected Evidence review. 

Therefore, the Board may consider only the evidence of record at the time of the August 2024 AOJ decision on appeal, and any evidence submitted within 90 days of receipt of the March 2025 VA Form 10182. 38 C.F.R. § 20.303.

The August 2024 rating decision now on appeal derived from a special review of the file mandated by the AOJ in a February 2024 rating decision that found a duty to develop a more complete VA examination and opinion. The February 2024 rating decision in turn derived from an October 2023 Request for Higher Lever Review (HLR) (VA Form 20-0996) of an October 2022 rating decision. Because the AOJ ordered supplemental evidence to be developed, the HLR was treated as a supplemental claim.  The claim for service connection for cholesteatoma previously was denied in June 2021 and March 2019 rating decisions. 

This appeal has been advanced on the Board's docket. 38 C.F.R. § 20.900 (c).

The Board interprets the Veteran's request for advance on docket as an intent to have this matter reviewed in an expeditious manner, which the Board finds to be an implicit waiver of the Veteran's right to change Board dockets under Williams v. McDonough, 37?Vet. App.?305 (2024).

Entitlement to service connection for cholesteatoma is granted.

The Veteran contends that his cholesteatoma, to include symptoms of headaches, lightheadedness, dizziness and tinnitus, began during service. See July 2022 VA examination.

Service connection will generally be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a) ("Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces[.]"); Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty").

The Veteran has a current diagnosis of cholesteatoma. See February 2024 rating decision.

Regarding the in-service occurrence of the disability, the Veteran was treated during service for headaches, lightheadedness and dizziness in 1968. October 1968 record, February 2015 Service Treatment Record (STR) - Medical. The Veteran reports having those symptoms as well as tinnitus in 1969, during service. July 2022 VA examination. On his separation examination, the Veteran reported ongoing symptoms of dizziness or fainting spells, and frequent or severe headaches. April 1970 record, February 2015 STR - Medical. 

Although the cholesteatoma disorder was not diagnosed during service, the symptoms are one-in-the-same with symptoms the Veteran experienced post-service and until the present. In 1976, soon after service, the Veteran sought treatment for bilateral earaches, balance issues, and dizziness and was diagnosed with earaches. See March 2024 VA examination. The condition worsened over time and was diagnosed as cholesteatoma in 1994, and the Veteran underwent tympanoplasty and mast
. July 2022 VA examination. On his separation examination, the Veteran reported ongoing symptoms of dizziness or fainting spells, and frequent or severe headaches. April 1970 record, February 2015 STR - Medical. 

Although the cholesteatoma disorder was not diagnosed during service, the symptoms are one-in-the-same with symptoms the Veteran experienced post-service and until the present. In 1976, soon after service, the Veteran sought treatment for bilateral earaches, balance issues, and dizziness and was diagnosed with earaches. See March 2024 VA examination. The condition worsened over time and was diagnosed as cholesteatoma in 1994, and the Veteran underwent tympanoplasty and mastoidectomy for his right ear. See June 2002 record, December 2004 Medical Treatment Record (MTR) - Non-Governmental Facility (NGF). A 2002 medical record notes bilateral chronic drainage and diagnosis of cholesteatoma in the left ear as well. Id. In 2003 and 2004, medical records show the Veteran's symptoms included vomiting, staggered gait and other vestibular symptoms and he underwent a tympanotomy and mastoidectomy in each ear. See August and September records, April 2010 MTR - Government Facility. Later records show treatment and symptoms continuing until present. See, e.g., March 2013 record, June 2013 CAPRI; April 2016 record, April 2018 CAPRI. 

The Board has considered the several VA examinations and private examinations and opinions regarding the nexus between the Veteran's current cholesteatoma disability and its in-service incurrence. The Board finds that the examinations collectively support the Board's finding that the Veteran had symptoms during service consistent with a cholesteatoma disability. See, e.g., July 2022 VA examination; March 2024 VA examination.

When adjudicating appeals, the Board applies an intentionally generous standard of proof unique in American jurisprudence, created in recognition of the nation's great debt to its veterans. Wise v. Shinseki,?26?Vet. App.?517, 531?(2014). 

Here, the Board gives the Veteran the benefit of the doubt and finds the medical evidence and his reports of symptoms demonstrate in-service occurrence of his chronic cholesteatoma and therefore warrants service-connection. See Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001) (holding the finding favors the veteran when evidence is in approximate balance).

The appeal is granted.

 

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jaeger, L

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.