HEARING LOSS

DAVID H. ROBERTSON · 2025 · Case ID: A25111022

DENIED

Summary

The veteran, who served from March 1968 to November 1969, including combat service in Vietnam and awarded the Bronze Star Medal, appeals the denial of service connection for bilateral hearing loss and tinnitus. The veteran contended that his hearing loss was due to noise exposure during service, and his tinnitus was either directly related to service or secondary to hearing loss. The Board reviewed the evidence, including the veteran's contentions, service records, and multiple VA audiological examinations. The pre-induction examination showed no hearing loss, though the veteran self-reported it. Service treatment records and the separation examination were silent for hearing loss and tinnitus. A March 2025 VA examination noted in-service noise exposure but provided no contemporaneous nexus opinion. A July 2025 VA opinion found the hearing loss less likely than not related to service, based on normal hearing at enlistment/separation and a lack of nexus to military noise. A subsequent October 2025 VA examination also found the hearing loss less likely than not related to service, noting the absence of service treatment records and a late onset of symptoms inconsistent with noise exposure. The Board found the July 2025 opinion probative, despite the October 2025 examination being based on an inaccurate premise. The Board found the veteran's lay statements regarding noise exposure and hearing loss lacked probative value for etiology, as this is a medical matter. The Board denied service connection for hearing loss, finding the evidence weighed against a nexus to service and the benefit of the doubt doctrine was not applicable. The tinnitus claim was denied as secondary to hearing loss, which was not service-connected, and the VA opinions found the tinnitus less likely than not related to service, with no evidence of in-service onset.

Rationale

Service treatment records and separation examination silent for hearing loss.; VA medical opinions found condition less likely than not related to service.; Lay statements regarding etiology lacked probative value.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251027-598901

Full Decision Text

Citation Nr: A25111022
Decision Date: 12/30/25 Archive Date: 12/30/25

DOCKET NO. 251027-598901
DATE: December 30, 2025

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for tinnitus, to include as secondary to bilateral hearing loss, is denied.

FINDINGS OF FACT

1. The probative medical evidence reflects that the Veteran's bilateral hearing loss is not etiologically linked to military noise exposure.

2. The Veteran's tinnitus is not related to any injury, disease, or event incurred in service; service connection is currently not in effect for bilateral hearing loss.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.385.

2. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1101, 1110, 1154; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1968 to November 1969. Awards include the Bronze Star Medal.

The rating decision on appeal was issued in October 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In June 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2025 decision. The Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. In October 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal.

In the October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the October 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) 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[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board notes that, in the June 2025 HLR request, the Veteran did not request an optional informal conference. Under 38 C.F.R. § 3.2601(h), a claimant or his or her representative may include a request for an informal conference with a request for HLR. Following the June 2025 request, an HLR rating decision was issued in September 2025, and in October 2025, the Veteran requested an informal conference.

An informal conference is defined as contact with a "claimant's representative or, if not represented, with the claimant, telephonically, or as otherwise determined by VA, for the sole purpose of allowing the claimant or representative to identify any errors of law or fact in a prior decision based on the record at the time the decision was issued." See 38 C.F.R. § 3.2601(h).

If an informal conference is requested, "VA will make reasonable efforts to contact the claimant and/or the authorized representative to conduct one informal conference during a higher-level review, but if such reasonable efforts are not successful, a decision may be issued in the absence of an informal conference." See 38 C.F.R. § 3.2601(h).

Here, the Board finds that a remand is not required for correction of an error in satisfying the regulatory duty under 38 C.F.R. § 3.2601(h) to make reasonable efforts to provide the appellant an informal conference before issuing an HLR decision. See 38 C.F.R. § 20.802(a). As noted, the request for an informal conference came after the HLR request, and VA Form 20-0996 provided the Veteran with adequate notice of the option for an informal conference. In light of the procedural history, combined with the language of 38 C.F.R. § 3.2601(h) that indicates an informal conference is not mandatory upon request, the Board will proceed with adjudication of the Veteran's claims.

Service Connection

Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

In rendering this decision, the Board has reviewed all evidence of record whether discussed in detail. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal). To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Veteran. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

Entitlement to service connection for bilateral hearing loss

Regarding service connection claims for hearing loss, the Board notes that this particular disability is defined by regulation. Specifically, under the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the above frequencies 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. Additionally, the Board observes that precedential case law provides that the threshold for normal hearing is between 0 and 20 decibels and that higher thresholds show some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993).

The absence of in-service evidence of hearing loss is not fatal to a claim for service connection. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. Hensley, 5 Vet. App. at 159. Moreover, to establish service connection for sensorineural hearing loss, a veteran is not obligated to show that his hearing loss was present during active service. However, if there is insufficient evidence to establish that a claimed chronic disability was present during service or during the one-year presumptive period thereafter, the evidence must establish a nexus between his current disability and his in-service exposure to loud noise. Godfrey v. Derwinski, 2 Vet. App. 352 (1992).

The Veteran contends that he is entitled to service connection for bilateral hearing loss as directly related to noise exposure during service in Vietnam. See March 2025 Fully
hearing loss. Hensley, 5 Vet. App. at 159. Moreover, to establish service connection for sensorineural hearing loss, a veteran is not obligated to show that his hearing loss was present during active service. However, if there is insufficient evidence to establish that a claimed chronic disability was present during service or during the one-year presumptive period thereafter, the evidence must establish a nexus between his current disability and his in-service exposure to loud noise. Godfrey v. Derwinski, 2 Vet. App. 352 (1992).

The Veteran contends that he is entitled to service connection for bilateral hearing loss as directly related to noise exposure during service in Vietnam. See March 2025 Fully Developed Claim, VA Form 21-526EZ.

The Veteran's DD214 reflects that his military occupational specialty (MOS) during service was radio teletype operator. He was also awarded various commendations for his service during combat, to include the Bronze Star Medal.

On the Veteran's December 1967 pre-induction examination, hearing loss was not noted. However, he self-reported hearing loss on his contemporaneous pre-induction Report of Medical History.

The Veteran submitted a statement in March 2025 highlighting that he first began to experience difficulty with hearing during service. While serving in Vietnam, he was exposed to extreme noise environments and, since separation, he had difficulties with hearing that persisted through to present day.

The Veteran underwent a VA audiological examination in April 2025 and the examiner noted in-service noise exposure due to guns, bombs, and air strikes for approximately two years. Following service, the Veteran worked as a truck driver for 36 years; there was no evidence of recreational noise exposure. Pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 20 20 20 40

LEFT 20 15 20 30 45

Speech audiometry revealed speech recognition ability of 100 percent in the left ear and 96 percent in the right ear. Based on these results, the examiner found sensorineural hearing loss bilaterally. However, a contemporaneous nexus opinion was not provided.

A nexus opinion was provided by the April 2025 VA examiner in July 2025 and she opined that the Veteran's condition was less likely than not incurred in or caused by service. Puretone thresholds were within normal limits in both ears at enlistment and separation. Although the relationship between noise, auditory damage, and hearing loss was well established, auditory damage and hearing loss was not conceded based on noise exposure alone. There needed to be a nexus of auditory damage to relate the current hearing loss to military noise and not another etiology. The evidence was against a nexus in this case and, therefore, the Veteran's hearing loss was less likely than not related to service.

The Veteran underwent an additional VA audiological examination in October 2025 and reported noise exposure due to bombs and wearing a radio headset for full shifts as part of his MOS. He also fired M14 and M16 weapons but did not recall wearing hearing protection. Following service, he worked as a truck driver and did not wear hearing protection. Finally, the Veteran denied recreational noise exposure following service. Pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 25 35 45 55

LEFT 20 25 50 65 80

Speech audiometry revealed speech recognition ability of 96 percent in the left ear and 92 percent in the right ear. Based on these results, the examiner found sensorineural hearing loss bilaterally. However, the condition was less likely than not incurred in or caused by service. Service treatment records and the separation examination were silent for hearing loss. The Veteran reported an onset of hearing decrease following separation after exposure to recreational and/or occupational noise. Although the relationship between noise, auditory damage, and hearing loss was well established, auditory damage and hearing loss was not conceded based on noise exposure alone. There was no evidence to support a nexus to relate current hearing loss to military noise exposure and not another etiology. Therefore, it was less likely as not that the current hearing loss was related to military noise exposure.

At the outset, the Board finds the October 2025 VA examination inadequate, as it is predicated on an inaccurate factual premise. Specifically, the examiner found that the Veteran reported an onset of hearing decrease following separation after exposure to recreational and/or occupational noise. However, the Veteran has consistently reported that he worked as a truck driver following service and did not have any
the relationship between noise, auditory damage, and hearing loss was well established, auditory damage and hearing loss was not conceded based on noise exposure alone. There was no evidence to support a nexus to relate current hearing loss to military noise exposure and not another etiology. Therefore, it was less likely as not that the current hearing loss was related to military noise exposure.

At the outset, the Board finds the October 2025 VA examination inadequate, as it is predicated on an inaccurate factual premise. Specifically, the examiner found that the Veteran reported an onset of hearing decrease following separation after exposure to recreational and/or occupational noise. However, the Veteran has consistently reported that he worked as a truck driver following service and did not have any recreational noise exposure at any point during his life. An opinion that relies on an inaccurate factual premise can be of little probative weight. See Reonal v. Brown, 5 Vet. App. 458 (1993).

However, the Board finds the July 2025 VA medical opinion to be highly probative as the examiner reviewed the record, interviewed the Veteran in April 2025, considered the lay statements and contentions of the Veteran, and provided opinions supported by a clear rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In addition, the examiner considered the circumstances of the Veteran's service and claim, to include being in combat in Vietnam and exposed to loud noise, when rendering the opinion.

The Board has also considered the lay assertions of record, including the contention of the Veteran in support of a medical nexus. The Veteran generally contends that his exposure to loud noise during combat many decades ago is the cause of his bilateral hearing loss. As a lay person, the Veteran is competent to report observable symptoms, such as trouble hearing. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of a disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4. (Fed. Cir. 2007). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

However, the matter of a medical etiology for a disability not capable of lay observation, such as whether noise exposure during military service from 1968 to 1969 is the cause of hearing loss that manifests decades later, is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In the instant case, there is no suggestion that the Veteran has developed an expertise in the diagnosis and/or etiology for such a disability. Therefore, as he does not have the appropriate medical training and expertise to competently diagnose nor provide an etiology opinion as to the cause of his bilateral hearing loss, the lay assertions in this regard have no probative value. Jandreau, 492 F. 3d 1372 (Fed. Cir. 2007); see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).

Accordingly, the Board finds that the probative medical evidence of record weighs against a finding that the Veteran's exposure to loud noise during combat in Vietnam during service is the cause of his bilateral hearing loss; thus, service connection for bilateral hearing loss is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt rule and finds it not applicable as the evidence is not in approximate balance. 38 U.S.C. § 5107(b) (2018); Lynch, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for tinnitus

The Veteran contends that he is entitled to service connection for tinnitus as directly related to service or secondary to bilateral hearing loss. See March 2025, Fully Developed Claim, VA Form 21-526EZ.

The Veteran submitted a statement in March 2025 highlighting that he first began to experience ringing in his ears during service, at which time he was exposed to extreme noise environments.

Entitlement to service connection for tinnitus

The Veteran submitted a statement in March 2025 highlighting that he first began to experience ringing in his ears during service, at which time he was exposed to extreme noise environments.

At the April 2025 VA examination, the Veteran reported tinnitus that began four months earlier that was "almost constant, bilateral, sounds like ringing." The examiner noted that hearing loss and tinnitus were related conditions but also concluded that the condition was less likely than not caused by or a result of military noise exposure. Hearing was within normal limits in both ears at enlistment and during separation and there were no reports or diagnosis of tinnitus during service. The examiner noted the Veteran's March 2025 statement but highlighted that tinnitus due to noise exposure or acoustic trauma was known to have a noticeable onset immediately or soon following the incident. However, in this instance, the Veteran reported tinnitus decades after service.

At the October 2025 VA examination, the Veteran again reported tinnitus but was unsure of its onset. The examiner found that the condition was at least as likely as not associated with hearing loss, as tinnitus was known to be a symptom associated with hearing loss. However, the condition was less likely than not caused by or a result of military noise exposure. The onset of tinnitus was reported to be post-separation, and there was no report of tinnitus in service treatment records, at separation or in the medical records until the time of the claim. Current medical literature did not support late onset noise-induced tinnitus.

At the outset, the Board notes that service connection is not in effect for bilateral hearing loss, as that claim has been denied in the instant decision. Therefore, service-connection on a secondary basis must be denied as a matter of law.

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Furthermore, the Board finds the available VA medical opinions to be the most probative evidence of record. The examiners' findings are credible and competent, as they were provided with thorough rationales with regards to the Veteran's tinnitus and its lack of connection to service. The Board notes that there is nothing in the record to link the Veteran's tinnitus to his time in service and that his statements alone, while probative, are not competent to provide such a link.

As a result, the examiner was able to conclude that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim and entitlement to service connection for tinnitus must be denied. Lynch, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

David Robertson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Daniels, Counsel

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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