TINNITUS

Summary

The veteran, who served from October 1972 to April 1974, appeals the denial of service connection for tinnitus. The veteran claimed the tinnitus was due to noise exposure in service. The Board found that the first two elements of service connection were met: a qualifying event occurred in service (MOS as police officer with moderate noise exposure) and the veteran was diagnosed with tinnitus. However, the Board focused on the third element: a causal connection to service. The veteran's service treatment records were silent regarding tinnitus complaints or diagnosis. The separation examination also showed no ear trouble or tinnitus. The first post-service complaint of tinnitus was reported in July 2024, nearly 50 years after service. Multiple VA examinations and addendum opinions consistently found the tinnitus to be less likely than not related to service. While one opinion contained a typographical error suggesting a positive nexus, the overall rationale and subsequent clarifications strongly supported a negative nexus. The Board gave the most weight to the final addendum opinion, which explained that without objective evidence of noise injury in service and given the long delay between service and reported onset, the tinnitus was not service-connected. The Board also found the veteran's opinion on etiology to be incompetent due to lack of medical expertise. The evidence weighed against service connection, making the benefit of the doubt doctrine inapplicable. Service connection for tinnitus was denied.

Rationale

Service treatment records silent for tinnitus complaints or diagnosis.; Separation examination showed no ear trouble or tinnitus.; Post-service onset reported in 2022, nearly 50 years after service.; Multiple VA opinions consistently found tinnitus less likely than not related to service.; Veteran's opinion on etiology deemed incompetent due to lack of medical expertise.

Full Decision Text

Citation Nr: A26014976
Decision Date: 02/18/26	Archive Date: 02/18/26

DOCKET NO. 250312-524802
DATE: February 18, 2026

ORDER

Entitlement to service connection for tinnitus is denied.

FINDING OF FACT

The Veteran's tinnitus did not manifest in service or within one year after service and is not etiologically related to the Veteran's military service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 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 from October 1972 to April 1974.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In March 2025, the Board received a VA Form 10182, Decision Review Request: Board Appeal electing the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 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, considering the new evidence in addition to the evidence previously considered. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to service connection for tinnitus is denied.

The Veteran contends he is entitled to service connection for tinnitus that is due to noise exposure in service. See March 2025 VA Form 10182.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

A disease first diagnosed after discharge may be service connected if all the evidence, including pertinent service records, establishes that it was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

Certain chronic diseases, to include organic diseases of the nervous system, such as tinnitus, may be service connected on a presumptive basis if manifested to a compensable degree within a specified period of time post-service (one year for tinnitus as an organic disease of the nervous system). 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(a). Nexus of a chronic disease listed in §3.309(a) to service may be established by showing continuity of symptomatology following service. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013).

The first two elements of service connection are not in dispute. The AOJ identified the following favorable findings: (1) the evidence shows that a qualifying event, injury, or disease had its onset during service, as the Veteran's DD 214 shows a military occupational specialty (MOS) was police officer which has moderate noise exposure; and (2) the Veteran was diagnosed with tinnitus during a VA examination. See December 2024 Rating Decision. The Board is bound by these favorable findings absent clear and convincing evidence to the contrary. 38 C.F.R. § 3.104(c).

Thus, the question for the Board is whether the tinnitus began during service, within a year of service to a compensable degree, or is otherwise related to an in-service injury, event, or disease.

Turning to the evidence of record
 findings: (1) the evidence shows that a qualifying event, injury, or disease had its onset during service, as the Veteran's DD 214 shows a military occupational specialty (MOS) was police officer which has moderate noise exposure; and (2) the Veteran was diagnosed with tinnitus during a VA examination. See December 2024 Rating Decision. The Board is bound by these favorable findings absent clear and convincing evidence to the contrary. 38 C.F.R. § 3.104(c).

Thus, the question for the Board is whether the tinnitus began during service, within a year of service to a compensable degree, or is otherwise related to an in-service injury, event, or disease.

Turning to the evidence of record, the Veteran's service treatment records (STRs) are silent for complaints, findings, treatment, or diagnosis pertaining to tinnitus. On the Veteran's separation examination, he marked "no" as to whether he had or had ever had ear trouble, hearing loss, and the Veteran reported no tinnitus symptoms. The examiner marked the Veteran's ears as normal. 

The post-service medical evidence does not show a complaint, finding, treatment, or diagnosis regarding tinnitus until a July 2024 VA examination, when the Veteran reported the onset of tinnitus in 2022. The examiner opined that the tinnitus was less likely than not caused by or a result of military noise exposure, because of the amount of time that passed between the Veteran's 1974 separation and reported 2022 onset.

As the prior examiner stated that there were no audiometric testing results in service, but the record did in fact include such testing, the AOJ obtained an addendum opinion in August 2024. At that time, a different examiner opined that the Veteran's tinnitus was less likely than not related to service. In support of this opinion, citing to medical literature, the examiner stated: "There is no evidence in the record that the claimed tinnitus is causally related to noise injury. Because there is no evidence that hearing loss or significant threshold changes occurred during military service, there is no basis on which to conclude that claimed tinnitus was caused by noise exposure." The examiner explained that only seldomly does noise cause tinnitus without also causing hearing loss, while in a separate opinion stating that the Veteran's hearing loss was not caused by the in-service noise exposure. The examiner explained that without an objectively verifiable noise injury, an association between the tinnitus and the noise exposure cannot be made. The examiner acknowledged the Veteran's noise exposure, but differentiated between that and a noise injury. The examiner concluded that based on the absence of reports in the STRs, normal hearing at separation, and the research available on tinnitus, the current tinnitus was less likely than not related to noise exposure in service.

After a request for a higher-level review, the AOJ erroneously found that the prior examiners had focused on the Veteran's exposure to a toxic exposure risk activity instead of his military occupation specialty (MOS), which showed a high probability of noise exposure. Parenthetically, the Board clarifies that both the July and August 2024 examiners acknowledged the veteran's in-service noise exposure, and the August 2024 examiner discussed such exposure in detail, again distinguishing between the acknowledged event of noise exposure, versus the existence of a resulting injury from such exposure. Nevertheless, the AOJ scheduled another examination in November 2024, wherein the Veteran did not report suffering from tinnitus. Thus, the examiner said the Veteran did not have a diagnosis of tinnitus and offered no medical opinion. See November 2024 VA Examination Report.

Due to conflicting medical evidence regarding the presence of tinnitus, the AOJ requested an addendum opinion discussing whether the Veteran has tinnitus and whether that tinnitus is related to service. In a November 2024 addendum opinion, an audiologist indicated that the Veteran did suffer from tinnitus but that it was less likely than not related to service. In support of this opinion, the audiologist explained that Veteran reported onset of tinnitus in 2022, post military service, with no complaints of tinnitus noted in service, and normal hearing on entrance and exit examination, which the audiologist explained is objective evidence of no permanent auditory damage on active duty. The audiologist explained that, "[t]he relationship between noise exposure, auditory damage and tinnitus is documented in the research and the objective evidence supports a nexus of auditory damage. Somewhat confusingly, the examiner then said, "the current tinnitus is at least as likely as not related to hazardous noise exposure during military service." The audiologist cited to a medical article titled "Noise and Military Service - Implications for Hearing Loss and Tinnitus" Institutes of Medicine of the National Academy (2006), explaining it indicated that as the interval between a noise exposure and the onset of tinnitus lengthens,
 service, and normal hearing on entrance and exit examination, which the audiologist explained is objective evidence of no permanent auditory damage on active duty. The audiologist explained that, "[t]he relationship between noise exposure, auditory damage and tinnitus is documented in the research and the objective evidence supports a nexus of auditory damage. Somewhat confusingly, the examiner then said, "the current tinnitus is at least as likely as not related to hazardous noise exposure during military service." The audiologist cited to a medical article titled "Noise and Military Service - Implications for Hearing Loss and Tinnitus" Institutes of Medicine of the National Academy (2006), explaining it indicated that as the interval between a noise exposure and the onset of tinnitus lengthens, the possibility that tinnitus will be triggered by other factors increases. Additionally, they noted that current knowledge of cochlear physiology does not provide sufficient scientific basis for the existence of delay-onset tinnitus.

As the prior opinion included the one line in the rationale stating tinnitus was at least as likely as not due to service, which conflicted with the stated opinion, the AOJ obtained a December 2024 addendum opinion from the same audiologist to explain the discrepancy. The audiologist confirmed that the Veteran's tinnitus was less likely than not related to service. In support of this opinion, the audiologist included the same rationale as previously, merely fixing the one line to read "tinnitus is less likely than not related to service."

Initially, it is clear that the inclusion of the line "the current tinnitus is at least as likely as not related to hazardous noise exposure during military service" in the November 2024 opinion was a typographical error and does not confuse the examiner's opinion. A medical examination report must be read as a whole, and as long as it is based on correct facts and sufficiently informs the Board of the medical expert's judgment on a medical question and the "essential rationale" for the opinion, it will be found adequate. Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012). The Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (citing Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)). In this case, the audiologist's rationale otherwise exclusively supported the negative determination, and was consistent with the endorsed opinion. Further, the later clarification addendum utilized nearly the entirely same rationale while fixing only that typographical error. Thus, the only positive evidence of record was clearly a typographical error and was not intended to be relied upon.

Initially, the record does not reflect and the Veteran does not contend that his tinnitus manifested in service or within a year following his separation from service in 1974. Rather, he consistently reported in VA examinations an onset in 2022, nearly 50 years after service, and his VA treatment records include a denial of tinnitus as late as February 2022. See February 2022 VA Primary Care Note. Consequently, service connection for tinnitus on the basis that it became manifest in service, or on a chronic presumptive basis for manifesting within one year following separation from service, is not warranted.

Turning to whether the Veteran's tinnitus was then caused by his in-service noise exposure, the medical evidence of record uniformly weighs against such a relationship. In so finding, the Board relies on each of the above VA opinions, with most probative wight being afforded to the final December 2024 addendum. While the first opinion of record was somewhat threadbare in analysis, relying only on the length of time between the noise exposure and the onset of tinnitus, it was confirmed by each subsequent opinion, which explained in detail the reasoning. The later opinions proffered considered all of the pertinent evidence of record, to include the statements of the Veteran and prior examination findings, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiners offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

When determining the adequacy and probative value of a medical opinion, the Board must consider whether the medical text evidence that the medical opinion relies on contains qualifying or contradictory aspects. McCray v. Wilkie, 31 Vet. App. 243 (2019). If the Board finds that a
, the examiners offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

When determining the adequacy and probative value of a medical opinion, the Board must consider whether the medical text evidence that the medical opinion relies on contains qualifying or contradictory aspects. McCray v. Wilkie, 31 Vet. App. 243 (2019). If the Board finds that a medical text that serves as the basis for a medical opinion contains apparent qualifiers or contradictions, or if the veteran raises the issue or it is reasonably raised from review of the evidence of record, the Board must address that issue and explain whether those aspects of the medical text diminish the probative value of the medical opinion evidence or render the opinion inadequate, and if not, why not. Id.

Regarding the IOM report, the McCray Court noted that, although the report concluded that "based on current knowledge of cochlear physiology there was no sufficient scientific basis for the existence of delayed-onset hearing loss," the report also stated that "[t]here is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure" and that "definitive studies to address this issue have not been performed." The Court determined that these statements appeared to be contradictory or qualifying and that it was incumbent on the Board to discuss such apparent contradictions or qualifiers when providing adequate reasons and bases.

The Board acknowledges that a corollary August 2024 opinion regarding hearing loss provided by the same examiner who offered the concurrent tinnitus opinion, tangentially related to this appeal, and the November and December 2024 opinions rely, in part, on the IOM report as a basis for providing negative opinions and the IOM report has apparently qualifying or contradictory statements, as noted in McCray. The Board finds that this does not render the opinions inadequate or diminish probative value to zero. The IOM report concluded that "based on current knowledge of cochlear physiology there was no sufficient scientific basis for the existence of delayed onset hearing loss" while also stating that "definitive studies to address this issue have not been performed." However, based on the evidence available, the report stated that it was "unlikely" that delayed hearing loss effects occur. This statement tends to show that the limitation was considered, but the IOM was confident in the available data (anatomical and physiological) to make a conclusion utilizing a strongly worded term ("unlikely"). Indeed, the committee noted its understanding of the mechanisms and processes involved in the recovery from noise exposure as it suggested "a delay of many years in the onset of noise-induced hearing loss following an earlier noise exposure is extremely unlikely."

The absence of definitive scientific evidence does not mean that a delayed onset of hearing loss following acoustic trauma is probable, or even just as likely as not. Thus, the IOM report is not necessarily given overwhelming probative value but is still given significant probative value. The report is still an informed medical conclusion based on data about hearing loss and the Board finds that it is of significant enough probative value to be instructive to the examiner. Furthermore, there have been no opposing studies or other contradictory evidence submitted in the appeal. See 38 U.S.C. § 5107(a) ("a claimant has the responsibility to present and support a claim for benefits...."); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009) (stating that the claimant has the burden to "present and support a claim for benefits").

Moreover, the Court in McCray referenced "a medical text's qualifying or contradictory aspects" as one factor on a non-exhaustive list that is relevant to the Board's evaluation of the probative value and adequacy of a medical opinion. McCray, 31 Vet. App. at 257. Here, the examiners specifically noted the Veteran's noise exposure in-service, and resulting lack of acoustic injury, and that the Veteran stated the onset was in 2022, roughly 50 years after service. The examiners considered this evidence, as well as in-service audiometric test results and other medical literature, to conclude that the medical evidence was more consistent with tinnitus unrelated to in-service noise exposure. Thus, the VA examiners did not rely entirely on the IOM report in forming conclusions, but instead considered all relevant facts in the case. Therefore, the above examinations and opinions remain probative to the Board's analysis.

The Board
 and adequacy of a medical opinion. McCray, 31 Vet. App. at 257. Here, the examiners specifically noted the Veteran's noise exposure in-service, and resulting lack of acoustic injury, and that the Veteran stated the onset was in 2022, roughly 50 years after service. The examiners considered this evidence, as well as in-service audiometric test results and other medical literature, to conclude that the medical evidence was more consistent with tinnitus unrelated to in-service noise exposure. Thus, the VA examiners did not rely entirely on the IOM report in forming conclusions, but instead considered all relevant facts in the case. Therefore, the above examinations and opinions remain probative to the Board's analysis.

The Board has also considered the Veteran's assertions that his tinnitus is due to noise exposure in service; however, such determination is a complex medical matter requiring training and experience which he does not possess. In this regard, the Veteran is not shown to have any medical training that would qualify him to provide an opinion regarding the onset or etiology of an audiological disorder. Here, the question regarding the development and/or etiology of tinnitus involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the etiology of tinnitus, such falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). While the Veteran may be competent to note the onset and diagnose tinnitus, again the first reported onset was in 2022, and he is not competent to provide an etiological opinion beyond that initial observable diagnosis. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinion as to the etiology of his tinnitus is not competent evidence and, consequently, is afforded no probative weight.

In sum, the Veteran cannot meet the elements of service connection for tinnitus under any theory of entitlement reasonably raised by the Veteran or by the record. In this instance, the evidence is neither evenly balanced nor approximately, but rather evidence persuasively weighs against finding that service connection is warranted. Thus, the benefit of the doubt doctrine is not applicable to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Therefore, the appeal must be denied. 

 

J.M. ESTES

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Lopiano

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.