HEARING LOSS

Summary

The veteran, who served in the U.S. Army from August 1969 to May 1971, appeals the denial of service connection for hearing loss secondary to tinnitus, the denial of an increased evaluation for diabetes mellitus, type II, and the dismissal of an appeal regarding hypertension. The Board denied service connection for hearing loss, finding no in-service indication of the condition and that the Veteran's hearing loss was more consistent with aging and presbycusis than noise exposure, despite a conceded noise exposure. The Board also found no medical literature supporting tinnitus causing or worsening hearing loss. For diabetes mellitus, type II, the Board denied an increased evaluation, noting the Veteran only required an oral hypoglycemic agent and diet modification, with no insulin use, regulation of activities, or hospitalizations for ketoacidosis/hypoglycemia during the period on appeal. The Board granted a 10 percent evaluation for rhinitis, finding the evidence in equipoise regarding nasal obstruction, but denied any higher evaluation as polyps were absent. The appeal regarding hypertension was dismissed as improper, as the Veteran attempted to appeal a Regional Office decision that merely implemented a prior Board grant.

Rationale

No in-service indication of hearing loss in service treatment records.; Hearing loss attributed to aging/presbycusis, not noise exposure.; No medical literature supports tinnitus causing or worsening hearing loss.

Full Decision Text

Citation Nr: A26028564
Decision Date: 03/30/26	Archive Date: 03/30/26

DOCKET NO. 250801-561969
DATE: March 30, 2026

ORDER

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

Entitlement to an initial evaluation in excess of 20 percent for diabetes mellitus, type II, is denied.

Entitlement to an initial evaluation of 10 percent, and no higher, for rhinitis is granted, subject to regulations governing payment of monetary awards.

Entitlement to an initial evaluation in excess of 10 percent for hypertension is dismissed.

FINDINGS OF FACT

1. The Veteran's hearing loss is not secondary to service-connected tinnitus and is not otherwise related to an in-service injury or disease.

2. At no point during the period on appeal did the Veteran's diabetes mellitus, type II require insulin or regulation of activities. 

3. Throughout the period on appeal, the Veteran's rhinitis manifested complete obstruction of nasal passages and no polyps. 

4. The Veteran appealed a rating decision implementing a Board decision granting a 10 percent, and no higher, evaluation for hypertension.

CONCLUSIONS OF LAW

1. The criteria for service connection for hearing loss due to service or service-connected tinnitus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for an initial evaluation in excess of 20 percent for diabetes mellitus, type II, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.20, 4.40, 4.119, Diagnostic Code 7913. 

3. The criteria for an initial evaluation of 10 percent, and no higher, for rhinitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.97, Diagnostic Code 6522.

4. The criteria for dismissal of the appeal for an evaluation in excess of 10 percent for hypertension have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 1969 to May 1971.

The rating decisions on appeal were issued in January 2025, February 2025, and July 2025 and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. In August 2025 a notification advised the Veteran that a hearing was scheduled for December 2025. In November 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the January 2025, for the claim regarding rhinitis; February 2025, for the claim regarding hearing loss; and July 2025, for the claim regarding diabetes mellitus, agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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. 

Service Connection

1. Entitlement to service connection for hearing loss, to include as secondary to tinnitus.

The Veteran contends his hearing loss disability is due to his service-connected tinnitus.

Service connection may be granted for disability resulting from disease or
 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. 

Service Connection

1. Entitlement to service connection for hearing loss, to include as secondary to tinnitus.

The Veteran contends his hearing loss disability is due to his service-connected tinnitus.

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).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When a Veteran seeks benefits and the evidence is in relative equipoise, the Veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

The Board finds that entitlement to service connection for hearing loss is not warranted.

The Veteran's service treatment records do not show any indication of a hearing loss disability.

Subsequent to service, in November 2020 the Veteran reported no changes in his hearing. 

The Veteran was afforded a VA examination in November 2022. The Veteran was diagnosed with a hearing loss disability. On the authorized audiological evaluation in, pure tone thresholds, in decibels, were as follows:

  	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	20	5	10	25	40

LEFT	15	5	10	25	45

Speech audiometry revealed speech recognition ability of 98 percent in the right ear and of 96 percent in the left ear.

The examiner rendered the opinion that hearing loss was not related to his active service. The Veteran's service treatment records and separation examination were noted to be silent for hearing loss. The Veteran had reported an onset of hearing decrease about 10 years prior to the examination. The examiner noted that the Veteran's hearing loss was more consistent with normal aging and presbycusis than noise exposure. The examiner reported that noise exposure was conceded and that the relationship between noise, auditory damage and hearing loss was well documented. However, auditory damage and hearing loss were not conceded based on noise alone. The examiner found that there was no evidence to support a nexus to relate the current hearing loss to military noise and not another etiology. 

A VA medical opinion was obtained in February 2025. The examiner found that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner further stated that though hearing loss and tinnitus
 about 10 years prior to the examination. The examiner noted that the Veteran's hearing loss was more consistent with normal aging and presbycusis than noise exposure. The examiner reported that noise exposure was conceded and that the relationship between noise, auditory damage and hearing loss was well documented. However, auditory damage and hearing loss were not conceded based on noise alone. The examiner found that there was no evidence to support a nexus to relate the current hearing loss to military noise and not another etiology. 

A VA medical opinion was obtained in February 2025. The examiner found that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner further stated that though hearing loss and tinnitus may arise from the same cause (damaged hair cells in the cochlea), and hearing loss may lead to tinnitus, there was no current medical literature to support tinnitus causing or worsening hearing loss. The examiner noted that pathophysiologically, tinnitus was a symptom, not an illness/disease which may lead to further conditions. 

The Board finds that the evidence is not at least in equipoise and entitlement to service connection for hearing loss is not warranted. Service treatment records do not show complaint, diagnosis, or treatment for any hearing loss disability. The Veteran has been noted to have a hearing loss disability during the period on appeal and there is an indication that exposure to loud noise was conceded. However, upon examination in January 2022, the Veteran's hearing loss was associated with the Veteran's aging rather than exposure to loud noise. The examiner indicated that the Veteran reported that he first noticed hearing decrease 10 years prior to the evaluation, years after separation from service. Therefore, the Board finds that the Veteran's hearing loss disability is not directly related to his active service, including any exposure to loud noise in service.

Thereafter, a VA medical opinion was obtained regarding whether the Veteran's hearing loss disability was secondary to his service-connected tinnitus disability. A VA examiner found that the disability was not secondary to tinnitus in February 2025. The examiner indicated that although hearing loss and tinnitus may arise from the same cause, there was no medical literature to support that tinnitus causes or worsens hearing loss. The Board finds that this explanation contemplates both due to and aggravated by components of entitlement to service connection on a secondary basis. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-141 (2013) (indicating that findings of "not due to," "not caused by," and "not related to" a service-connected disability are insufficient to address the question of aggravation). Therefore, the Board finds that the Veteran's hearing loss is not at least as likely as not due to or aggravated by his service-connected tinnitus disability.

As the weight of the evidence is against a finding that service connection for hearing loss is warranted, on either a direct basis or a secondary basis, the claim is denied.

Higher Evaluation

Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002).

Evaluation of a service-connected disorder requires a review of the Veteran's entire medical history regarding that disorder. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In all claims for a higher disability rating, VA has a duty to consider the possibility of assigning staged ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of
 question as to which evaluation to apply to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In all claims for a higher disability rating, VA has a duty to consider the possibility of assigning staged ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary.

1. Entitlement to an initial evaluation in excess of 20 percent for diabetes mellitus, type II.

The Veteran seeks entitlement to an initial evaluation in excess of 20 percent for diabetes mellitus.

VA evaluates diabetes mellitus under 38 C.F.R. § 4.119, Diagnostic Code 7913. A 10 percent rating is warranted when diabetes is manageable by restricted diet only. A 20 percent rating is warranted when diabetes requires one or more daily injection of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when it requires one or more daily injection of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. A 60 percent rating is warranted when diabetes requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. 38 C.F.R. § 4.119, Diagnostic Code 7913.

Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications of diabetes are considered part of the diabetic process. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1).

For VA purposes "regulation of activities" means physician-directed avoidance of strenuous occupational and recreational activities in an effort to control diabetic complications. It specifically excludes supervised and professionally directed exercise, which, along with a restricted diet, is intended to improve the health of the diabetic patient. Medical evidence is required to show that occupational and recreational activities have been restricted. Camacho v. Nicholson, 21 Vet. App. 360, 363 (2007).

Although VA regulations generally provide that symptom need only more nearly approximate the criteria for a higher rating to warrant such a rating, see 38 C.F.R. §§ 4.7, 4.21, those regulations do not apply where, as here, the conjunction "and" is used and the criteria are successive, with the criteria for the lower ratings encompassed within those for higher ratings. Id. at 366; Tatum v. Shinseki, 23 Vet. App. 152 (2009).

The Board finds that entitlement to a higher evaluation for diabetes is not warranted for any period on appeal.

VA treatment records show that the Veteran was prescribed Metformin. See VA Treatment, March 2025.

In a March 2025 treatment record, the Veteran reported that he was borderline diabetic, trying to avoid sweets, and taking his medications as prescribed. 

The Veteran was afforded a VA diabetes mellitus examination in May 2025. The Veteran was diagnosed with type II diabetes mellitus. It was reported that the Veteran was prescribed an oral hypoglycemic agent. There was no regulation of activities required. The Veteran was treated by his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than 2 times a month. The Veteran had not been hospitalized for any episode of ketoacidosis of hypoglycemic reaction in the prior 12 months. There was no progressive unintentional weight loss and loss of strength attributable to diabetes mellitus. There were no complications of diabetes identified.  

Entitlement to an evaluation in excess of 20 percent for diabetes mellitus is not warranted. During the period on appeal the Veteran's diabetes mellitus solely required an oral hypoglycemic and diet modification for control. At no point during the period on appeal did the Veteran's diabetes mell
 There was no regulation of activities required. The Veteran was treated by his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than 2 times a month. The Veteran had not been hospitalized for any episode of ketoacidosis of hypoglycemic reaction in the prior 12 months. There was no progressive unintentional weight loss and loss of strength attributable to diabetes mellitus. There were no complications of diabetes identified.  

Entitlement to an evaluation in excess of 20 percent for diabetes mellitus is not warranted. During the period on appeal the Veteran's diabetes mellitus solely required an oral hypoglycemic and diet modification for control. At no point during the period on appeal did the Veteran's diabetes mellitus require insulin or regulation of activities. Furthermore, there is no indication of hospitalization for ketoacidosis or hypoglycemia. As such, entitlement to an evaluation in excess of 20 percent for diabetes mellitus is denied.

2. Entitlement to a compensable initial evaluation for rhinitis. 

The Veteran's rhinitis is currently rated noncompensable under Diagnostic Code 6522. Under Diagnostic Code 6522 a compensable rating of 10 percent is warranted for allergic rhinitis without polyps, but with a greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. A 30 percent rating is warranted for allergic rhinitis with polyps.  

This rating code does not contain provisions for a zero percent evaluation. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31.  

The Veteran was afforded a relevant VA examination in September 2023. The Veteran was diagnosed with rhinitis. 

The Veteran reported symptoms of a constantly runny nose. He denied other symptoms and reported that he was not being treated for the condition. He reported no history of recently prescribed antibiotics. He did not take any over the counter medication for his runny nose. On examination the Veteran did not have a greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis. There was complete obstruction of the left and right side due to rhinitis. There was no permanent hypertrophy of the nasal turbinates. There were no nasal polyps. There was no granulomatous condition. 

An X-ray examination in October 2023 showed normal aeration of the paranasal sinuses, no mucosal thickening or fluid accumulation, and intact osseous structures. 

At a hearing in a separate appeal in August 2024 the Veteran denied treatment. He stated that he had a constant runny nose.

In a non-VA statement, dated in November 2024, a physician noted that the Veteran had personally dealt with a runny nose ever since service. 

Affording the Veteran the benefit of the doubt, the Board finds that the Veteran's rhinitis warrants an initial evaluation of 10 percent, and no higher. On examination in September 2023, the Veteran's rhinitis was noted to not cause greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis. However, immediately thereafter, the examiner found that the left and right nasal passages were completely obstructed due to rhinitis. As such, the evidence is at least in equipoise that the Veteran's rhinitis causes obstruction of one or both of the nasal passages. However, at no point during the appeal did the Veteran's rhinitis manifest polyps. Therefore, an evaluation of 10 percent, and no higher, for rhinitis, is granted.

Finally, when evidence of unemployability is submitted during the course of an appeal of a rating assigned for a disability, a claim for entitlement to a total disability rating based on individual unemployability (TDIU) rating is considered part and parcel of the increased rating claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The matter of entitlement to a TDIU is not raised in the instant claims for higher evaluations. Although a VA examiner in October 2023 indicates that his rhinitis impacts his ability to work, the examiner explains that it is an "inconvenience" because he is constantly blowing his nose. Another VA examiner in May 2025 reported that the Veteran's diabetes mellitus did not impact his ability to work. The Veteran has not raised the issue of entitlement to a TDIU. Therefore, the Board will not consider TDIU herein.

3. Entitlement to an initial evaluation in excess of 10 percent disabling for hypertension.

By way of background, a February 2025 Board decision granted entitlement to an initial evaluation of 10 percent
 of entitlement to a TDIU is not raised in the instant claims for higher evaluations. Although a VA examiner in October 2023 indicates that his rhinitis impacts his ability to work, the examiner explains that it is an "inconvenience" because he is constantly blowing his nose. Another VA examiner in May 2025 reported that the Veteran's diabetes mellitus did not impact his ability to work. The Veteran has not raised the issue of entitlement to a TDIU. Therefore, the Board will not consider TDIU herein.

3. Entitlement to an initial evaluation in excess of 10 percent disabling for hypertension.

By way of background, a February 2025 Board decision granted entitlement to an initial evaluation of 10 percent, but no higher, for hypertension, and thereafter, in a February 2025 rating decision, the Regional Office implemented the Board's grant of benefits. In August 2025, the Veteran submitted a Notice of Disagreement on a VA Form 10182 appealing the February 2025 implementing decision. Thus, the Veteran has attempted to appeal the February 2025 rating decision implementing a Board grant of a higher initial evaluation for hypertension. 

The Board notes that a Veteran may not challenge the merits of a Board decision by expressing disagreement with the RO's implementing rating decision. See Harris v. Nicholson, 19 Vet. App. 345, 348 (2005); see also Smith v. Brown, 35 F.3d 1516, 1526 (Fed. Cir. 1994) (construction of regulation to permit review by RO of a Board decision to be avoided); Donovan v. Gober, 10 Vet. App. 404, 409 (1997) ("an RO must not be placed in the anomalous position of reviewing the decision of the [Board], a superior tribunal.").

The Court of Appeals for Veterans Claims (Court) recently explained in Encarnacion v. McDonough, 36 Vet. App. 31 (2023), "The regional office's "purely ministerial implementation of the Board's judgment was not a 'decision' of the Secretary and thus could not be appealed through the filing of a NOD." As such, an RO decision implementing a Board grant is not a "decision" the Board has the authority to review under 38 U.S.C. § 7104 (a).

Therefore, the submission of the August 2025 NOD appealing the February 2025 rating decision effectuating the Board's decision regarding the initial evaluation assigned for hypertension was improper.

As such, dismissal of the appeal of this issue is appropriate. 38 U.S.C. § 7104 (a); 38 U.S.C. § 7105 (d).

 

 

T. RAYMOND

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Robert J. Burriesci, 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.