TINNITUS

Summary

The Veteran served on active duty from April 1973 to September 1973. The Veteran appeals the denial of service connection for tinnitus and hearing loss. The Board found that the Veteran's tinnitus onset during service, supported by his credible lay statements and a private physician's opinion linking it to noise exposure, met the criteria for service connection. The Board also found the December 2020 VA clinician's opinion inadequate for failing to address the Veteran's lay statements regarding tinnitus onset and continuity. While there was some doubt regarding the exact onset date of tinnitus, the Board resolved this doubt in the Veteran's favor, granting service connection for tinnitus. The Board further granted service connection for bilateral hearing loss as secondary to the service-connected tinnitus. This was based on the Veteran's credible reports of decreased hearing acuity alongside worsening tinnitus, and a private audiologist's conclusion that the hearing loss was associated with the tinnitus. The Board found the negative VA opinion regarding hearing loss inadequate as it relied solely on the lack of a documented threshold shift during service, which is not a proper basis for denial. The claim for tinnitus is granted, and the claim for hearing loss secondary to tinnitus is also granted.

Rationale

Competent and credible lay statements of onset during service; Private physician opinion links tinnitus to noise exposure; VA clinician opinion inadequate for ignoring lay statements

Full Decision Text

Citation Nr: A26019640
Decision Date: 03/04/26	Archive Date: 03/04/26

DOCKET NO. 210114-132761
DATE: March 4, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for hearing loss as secondary to service-connected tinnitus based on causation is granted.

FINDINGS OF FACT

1. The Veteran's tinnitus onset during and has continued since service.

2. The Veteran's bilateral hearing loss was caused by his service-connected tinnitus.

CONCLUSIONS OF LAW

1. The criteria for service connection for tinnitus have been met.  38 U.S.C. §§ 1101, 1110, 1113, 5107;?38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for hearing loss as secondary to service-connected tinnitus based on causation have been met.  38 U.S.C. §§ 1101, 1110, 1113, 5107;?38 C.F.R. §§ 3.102, 3.303, 3.310.  

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1973 to September 1973.

The rating decision on appeal was issued in December 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In the January 14, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on October 8, 2024.

Therefore, the Board may only consider the evidence of record at the time of the December 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302 (a).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302 (a), 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 claims, 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 may be granted for a disability resulting from disease or injury incurred in or aggravated during active military service. ?38 U.S.C. § 1110;?38 C.F.R. § 3.303 (a).? Service connection may also be granted for any disability diagnosed after discharge, when all the evidence, including that pertinent to service,?establishes?that the disability was incurred in service.? 38 C.F.R. § 3.303(d).? 

Service connection?may be granted on either a direct or secondary basis.  Entitlement to service connection on a direct basis requires competent medical or lay evidence of: (1) a current disability; (2) an in-service incurrence or?injury, and (3) a nexus between the current disability and the in-service incurrence or injury. ?38 C.F.R. § 3.303. ?Entitlement to?service connection?on a?secondary?basis requires competent medical or lay evidence of: (1) a current disability that is not already service connected; (2) at least one service-connected disability; and (3) a?medical?nexus between the current disability and the service-connected disability.  38 C.F.R. § 3.310 (a);?Allen v. Brown,?7?Vet. App.?439?(1995).? 

1. Entitlement to service connection for tinnitus is granted.

In his December 2020 filing for service connection, the Veteran asserted an onset of tinnitus during service such that service connection is warranted for his current tinnitus disability.  See VA Form 21-526EZ, Fully Developed Claim, December 2020.  The Board agrees, and for
) a current disability that is not already service connected; (2) at least one service-connected disability; and (3) a?medical?nexus between the current disability and the service-connected disability.  38 C.F.R. § 3.310 (a);?Allen v. Brown,?7?Vet. App.?439?(1995).? 

1. Entitlement to service connection for tinnitus is granted.

In his December 2020 filing for service connection, the Veteran asserted an onset of tinnitus during service such that service connection is warranted for his current tinnitus disability.  See VA Form 21-526EZ, Fully Developed Claim, December 2020.  The Board agrees, and for the reasons below, finds service connection is warranted for tinnitus.

Notably, the December 2020 rating decision on appeal favorably found the Veteran to have a current diagnosis of tinnitus and that he was exposed to hazardous noise during service.  See Rating Decision - Narrative, December 2020.  Accordingly, the first two elements of service connection for tinnitus have been met and the remaining question is whether the Veteran's tinnitus onset during or is otherwise etiologically related to his military service-the third element of service connection.

Regarding the third element of service connection, the Veteran has competently and credibly reported an onset of tinnitus during service and ringing in his ears since service.  See Hearing Transcript, October 2024 ("...did you notice any kind of hearing loss when you first got out?" "...It was actually just the ringing in - the ringing mainly not like total hearing loss"); see also Charles v. Principi, 16 Vet. App. 370 (2002) (holding that tinnitus is a disability that can be established based on lay statements alone).  In further support of an etiological association between the onset of his tinnitus and his military service, the Veteran also submitted after his hearing an opinion from his primary care physician.  In the opinion, the primary care physician noted that tinnitus can be caused by exposure to loud noises, the Veteran was exposed to loud noises during service, and thus it is at least as likely as not that the Veteran's current tinnitus is related to his service.  See Medical Treatment Record - Non-Government Facility, received October 2024, dated October 2024.  The Board finds this opinion and the Veteran's lay statements of onset and continuity to be highly persuasive evidence that there is a nexus between the Veteran's currently diagnosed tinnitus and his military service.  Accordingly, the third element of service connection has been met.

The Board acknowledges a VA clinician in December 2020 opined that the Veteran's tinnitus is secondary to his hearing loss; however, the VA clinician did not address the Veteran's lay statements that his tinnitus onset during service and that his hearing loss onset at some later unknown date.  See C&P Exam, December 2020 (showing the Veteran reporting "decreased hearing bilaterally of unknown onset" and "[a history of] bilateral tinnitus with an estimated onset during military service.").  The United States Court of Appeals for Veterans Claims (Court) has stated that medical examiners may not impermissibly ignore a Veteran's lay assertions and that medical examiners must address lay statements to provide the Board with an adequate medical opinion.  See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) ("...it appears that the medical examiner impermissibly ignored the appellant's lay assertions"); Miller v. Wilkie, 32 Vet. App. 249, 260 (2020) ("The examiner must address the veteran's lay statements to provide the Board with an adequate medical opinion").  Accordingly, the December 2020 VA clinician's opinion on the etiology of the Veteran's tinnitus is inadequate and carries no persuasive evidentiary weight.

The Board also acknowledges that a December 2020 letter from an audiologist to the Veteran's primary care physician also submitted after the Veteran's October 2024 hearing shows the Veteran reporting a sudden onset of tinnitus five years prior.  Medical Treatment Record - Non-Government Facility, dated December 2020, received October 2024.  Thus, there is some reasonable doubt as to whether the Veteran's tinnitus onset during service or after service.  However, considering the Veteran has otherwise reported an onset of tinnitus during service, the Board will resolve this reasonable doubt and conclude that it did.

In sum, the three elements of service connection for tinnitus have been met.  The claim is granted.

2. Entitlement to service connection for hearing loss as secondary to service-connected tinnitus based on causation is granted.

In his December 2020 filing, the Veteran reported an onset of hearing loss during service.  At his December 2020
 years prior.  Medical Treatment Record - Non-Government Facility, dated December 2020, received October 2024.  Thus, there is some reasonable doubt as to whether the Veteran's tinnitus onset during service or after service.  However, considering the Veteran has otherwise reported an onset of tinnitus during service, the Board will resolve this reasonable doubt and conclude that it did.

In sum, the three elements of service connection for tinnitus have been met.  The claim is granted.

2. Entitlement to service connection for hearing loss as secondary to service-connected tinnitus based on causation is granted.

In his December 2020 filing, the Veteran reported an onset of hearing loss during service.  At his December 2020 VA examination and his October 2024 Board hearing, he clarified his assertion: his tinnitus onset first and led to his current hearing loss.  See C&P Exam, December 2020 (showing the Veteran reporting "decreased hearing bilaterally of unknown onset" and "[a history of] bilateral tinnitus with an estimated onset during military service."), and Hearing Transcript, October 2024 ("...did you notice any kind of hearing loss when you first got out?" "...It was actually just the ringing in - the ringing mainly not like total hearing loss").  The Board finds service connection for bilateral hearing loss is warranted as secondary to his herein service-connected tinnitus on a causative basis.

Again, the rating decision on appeal favorably found the Veteran to have a current diagnosis of bilateral hearing loss.  See Rating Decision - Narrative, December 2020.  Accordingly, the first element of secondary service connection has been met.  Regarding the second element of secondary service connection, the Board has herein awarded service connection for tinnitus.  Accordingly, the second element of secondary service connection has been met.

Regarding the third element of secondary service connection, the Veteran competently and credibly reported at his Board hearing that ringing onset first and that the ringing eventually worsened and led to him being unable to hear people talking or the television.  See Hearing Transcript, October 2024 at 4-7.  The Veteran is not competent to report the presence of a hearing loss disability for VA purposes as that requires specialized knowledge and testing.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  However, the Veteran is competent to report the sensation of decreased hearing acuity, and the Board finds no reason to doubt the credibility of his reported onset of decreased hearing acuity alongside the worsening of his tinnitus, which he is also competent to report.  Layno v. Brown, 6 Vet. App. 465, 469-70 (1994), see Charles, 16 Vet. App. 370.  Moreover, though not including a complete rationale, the Board is persuaded that the Veteran's tinnitus onset first and led to his current hearing loss given the December 2020 letter from an audiologist to his primary care physician in which the audiologist stated the Veteran has "associated hearing loss (both ears)" due to his worsening moderately-severe tinnitus.  See Medical Treatment Record - Non-Government Facility, dated December 2020, received October 2024.  The Board finds less fault in there not being a complete rationale for this audiologist's conclusion given that it was in correspondence between two medical professionals.

Accordingly, given the Veteran's competent and credible reports of decreased hearing acuity alongside the worsening of his herein service-connected tinnitus, and the private audiologist's conclusion that the Veteran's hearing loss is associated with his tinnitus, the Board finds the third element of secondary service connection has been met and that service connection is warranted.

The Board acknowledges the negative VA opinion from December 2020.  However, the VA clinician relied entirely on the lack of a documented auditory threshold shift during service, which is not proper.  Service connection for hearing loss is not precluded simply by the lack of a demonstrated threshold shift during service.  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) 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 v. Brown, 5 Vet. App. 155, 157 (1993).  Accordingly, because the December 2020 VA opinion on the etiology of the Veteran's hearing loss impermissibly relied entirely on the lack of a documented threshold shift during service, the Board finds that it is not persuasive and does not weigh against the herein award of secondary service connection.  

(Continued on the
87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385) 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 v. Brown, 5 Vet. App. 155, 157 (1993).  Accordingly, because the December 2020 VA opinion on the etiology of the Veteran's hearing loss impermissibly relied entirely on the lack of a documented threshold shift during service, the Board finds that it is not persuasive and does not weigh against the herein award of secondary service connection.  

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?

The claim is granted.

 

 

A. S. CARACCIOLO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Infante, Peter

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.