HIATUS HERNIA

JIMMY L. BARDIN · 2026 · Case ID: A26028756

MIXED

Summary

The Veteran served from February 2016 to July 2019. The Veteran appeals the denial of service connection for headaches and bilateral shin splints, and the grant of service connection for tinnitus and bilateral sensorineural hearing loss. The Board denied service connection for headaches, finding they were a contemplated symptom of the Veteran's service-connected sinusitis and rating them separately would constitute pyramiding. For bilateral shin splints, the Board denied service connection due to a lack of current diagnosis and insufficient evidence of in-service injury, noting the Veteran's service treatment records were negative for complaints or treatment. Service connection for tinnitus was granted, with the Board finding the Veteran's lay statements credible and continuous since in-service noise exposure, and deeming the VA examiner's negative nexus opinion inadequate. Similarly, service connection for bilateral sensorineural hearing loss was granted based on presumptive service connection, citing the Veteran's in-service noise exposure, continuous symptoms since service, and credible lay statements, supported by medical and legal authority linking acoustic trauma to nerve damage. The claim for a foot disability, including plantar fasciitis, was remanded for a VA examination to determine diagnosis, functional impairment, and service connection.

Rationale

Headaches are a symptom of service-connected sinusitis.; Separate rating for headaches would constitute pyramiding.; Headaches contemplated in DC 6511 for sinusitis.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6511

Docket No.

250430-541895

Full Decision Text

Citation Nr: A26028756
Decision Date: 03/31/26 Archive Date: 03/31/26

DOCKET NO. 250430-541895
DATE: March 31, 2026

ORDER

Entitlement to service connection for headaches is denied.

Entitlement to service connection for bilateral shin splints is denied.

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for bilateral sensorineural hearing loss is granted.

REMANDED

Entitlement to service connection for a foot disability, to include plantar fasciitis, is remanded.

FINDINGS OF FACT

1. The Veteran's headaches are contemplated by a rating for sinusitis; a separate evaluation for headaches would constitute pyramiding of benefits which is to be avoided.

2. The Veteran does not have a current diagnosis of shin splints; further, his prior manifestations of shin splints have resolved without residual effects.

3. The evidence is at least in approximate balance as to whether the Veteran's tinnitus is etiologically related to his service.

4. The evidence shows a current disability of bilateral sensorineural hearing loss.

5. The symptoms of hearing loss were chronic in service and continuous since separation.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.14.

2. The criteria for service connection for bilateral shin splints have not been met. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.102, 3.303.

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

4. Resolving reasonable doubt in favor of the Veteran, the criteria for chronic disease presumptive service connection for bilateral sensorineural hearing loss have been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 2016 to July 2019.

The rating decisions on appeal were issued in December 2024, February 2025, and April 2025, and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applied.

In the April 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 December 2024, February 2025, and April 2025 agency of original jurisdiction (AOJ) decisions 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.

However, because the Board is remanding the claim of entitlement to service connection for a foot disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Lastly, the Board has recharacterized the Veteran's claims, as reflected on the title page to include consideration of all the related conditions reasonably raised by the record. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009).

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303.

When there is an approximate
of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

1. Entitlement to service connection for headaches

The Veteran contends that he experiences headaches as a result of his tinnitus. See December 2024 Claim. Alternatively, during his VA examination, the Veteran reported that his headaches are associated with his sinuses. See February 2025 Headaches Disability Benefits Questionnaire (DBQ).

The Veteran's report of medical history at separation documents his negative response to having frequent or severe headaches. See April 1, 2019 Report of Medical History.

The Veteran is service connected for sinusitis, which is rated under Diagnostic Code 6511. The Board notes that under the General Rating Formula for Sinusitis, headaches are contemplated. The Veteran's sinusitis is rated as 50 percent disabling, based on more than six non-incapacitating episodes per year of sinusitis characterized by repeated surgeries and headaches. See February 10, 2025 Rating Decision. Additionally, during the January 2025 VA examination associated with a claim for an increased rating for his service-connected sinusitis, the Veteran reported having headaches due to sinus issues. See January 2025 Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx, and Pharynx DBQ. The Board acknowledges the Veteran's complaints of headaches. The objective evidence of record, however, shows that his headaches are a symptom of sinusitis.

In this case, the greater weight of the evidence shows that headaches are a symptom or manifestation of the Veteran's sinusitis. This symptom is specifically contemplated in Diagnostic Code 6511 and is noted to have been considered when the Veteran's rating for sinusitis was assigned. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994); Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009).

In consideration of 38 C.F.R. § 4.14 and Esteban, the Board concludes that to assign a separate rating for headaches under Diagnostic Code 8100 would constitute impermissible pyramiding.

As such, the Veteran's appeal for entitlement to service connection for headaches must be denied.

2. Entitlement to service connection for shin splints

The Veteran is seeking service connection for bilateral shin splints. The Veteran contends that his injury was caused by marching and running during service. See December 2024 Claim.

The Veteran's service treatment records are negative for any complaints or treatment for shin splints. At his April 2019 separation examination, no shin or lower extremity abnormalities were noted. See April 1, 2019 Report of Medical Examination.

In January 2025, the Veteran was afforded a VA examination for lower leg conditions. See January 2025 Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ). The VA examiner reported that the Veteran did not have a current diagnosis for shin splints but did have a right leg shin splint condition that was acute/resolved.

The Veteran underwent another lower leg examination in February 2025. See February 2025 Knee and Lower Leg Conditions DBQ. The examiner noted that the Veteran did not currently have a diagnosis of shin splints.

The Veteran's post-service medical treatment records are negative for any complaints, diagnosis or treatment for shin splints.

Here, although the Veteran contends to have shin splints, the medical evidence of record does
afforded a VA examination for lower leg conditions. See January 2025 Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ). The VA examiner reported that the Veteran did not have a current diagnosis for shin splints but did have a right leg shin splint condition that was acute/resolved.

The Veteran's post-service medical treatment records are negative for any complaints, diagnosis or treatment for shin splints.

Here, although the Veteran contends to have shin splints, the medical evidence of record does not show that he was diagnosed with a disability.

In the absence of proof of a current disability, there can be no valid claim for service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 224 (1192). Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for shin splints is not warranted. See 38 U.S.C.§ 5107 (b); 38 C.F.R. § 3.102. The Veteran's appeal is denied.

3. Entitlement to service connection for tinnitus

The Veteran contends his tinnitus is due to his service. See August 2024 Claim.

In a December 2024 rating decision, the AOJ made favorable findings that the Veteran has a current disability and conceded military noise exposure based on the Veteran's military occupational specialty (MOS), thus there was an in-service event, injury, disease that had its onset during service. Therefore, the first and second elements of service connection are established.

The key question is whether there is a nexus between the Veteran's tinnitus and his in-service noise exposure.

In that regard, while the January 2023 VA examiner rendered a negative nexus opinion, it was based on the lack of documentation during service, but the opinion failed to consider the Veteran's report that this tinnitus began in service and has continued since. See Dalton v. Peake, 21 Vet. App. 23 (2007). As such, the Board finds the opinion to be inadequate and affords it little probative weight.

The Board finds the record contains competent and credible assertions from the Veteran that he has continuously experienced tinnitus symptoms since his in-service noise exposure.

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is considered competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1377 (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). In the matter before us, there is no reason to doubt the competency and credibility of the Veteran to report the symptoms he has observed.

Under these circumstances, as the record contains competent and credible assertions from the Veteran that he has continuously experienced tinnitus symptoms since his in-service noise exposure and given that there is no adequate or significant evidence contradicting his account of in-service acoustic trauma and associated tinnitus since service, the Board resolves all reasonable doubt in the Veteran's favor and finds that service connection for tinnitus is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. His appeal is granted.

4. Entitlement to service connection for bilateral hearing loss

The VA examiner diagnosed the Veteran with bilateral sensorineural hearing loss in the September 2024 examination. See September 2024 Hearing Loss and Tinnitus DBQ.

As noted above, in service noise
Veteran that he has continuously experienced tinnitus symptoms since his in-service noise exposure and given that there is no adequate or significant evidence contradicting his account of in-service acoustic trauma and associated tinnitus since service, the Board resolves all reasonable doubt in the Veteran's favor and finds that service connection for tinnitus is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. His appeal is granted.

4. Entitlement to service connection for bilateral hearing loss

The VA examiner diagnosed the Veteran with bilateral sensorineural hearing loss in the September 2024 examination. See September 2024 Hearing Loss and Tinnitus DBQ.

As noted above, in service noise exposure is conceded. See December 2024 Rating Decision.

Similar to tinnitus, sensorineural hearing loss is linked with nerve damage that most often occurs "when the tiny hair cells in the cochlea are injured." See Fountain v. McDonald, 27 Vet. App. 258, 266 (2015). More specifically, in Fountain, the Court referenced medical and legal authority, and noted that chronic sensorineural hearing loss, as an organic disease of the nervous system, was due to a problem in the inner ear or in the auditory nerve between the inner ear and the brain, and was commonly caused by chronic exposure to excessive noise, in addition to age related hearing loss. The Court noted that chronic sensorineural hearing loss caused by acoustic trauma resulted in damage to the inner ear and qualified as an organic disease of the nervous system under 38 C.F.R. § 3.309. Furthermore, lay evidence concerning continuity of symptoms after service, if credible, can ultimately be considered competent, regardless of a lack of contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board further notes that the disability of sensorineural hearing loss is a chronic disability for which service connection may be established by way of credible statements of continuity of symptomatology.

At the September 2024 VA examination, the Veteran reported that his hearing loss and tinnitus began during active service and continued to the present. Further, the Board notes that the VA examiner reported that the Veteran's tinnitus is a symptom of his hearing loss. Finally, the Veteran has not had any post-service exposure to hazardous noise exposure.

Because the Veteran sustained nerve damage that caused the service-connected tinnitus, by necessary logical inference, the Veteran sustained the same nerve damage to the inner ear that caused the current sensorineural hearing loss. The Board finds that, based upon both medical and legal authority, the in service acoustic trauma caused permanent nerve damage to the auditory nerve or inner ear, which denotes the onset of the current sensorineural hearing loss in service; therefore, the Board finds that the symptoms of bilateral hearing loss began during service and have been continuous since service separation. The Board also finds that the Veteran's statements regarding his hearing loss are competent and credible with respect to the onset and continuing symptoms of hearing loss, and associated symptom of tinnitus, the Board has assigned his statements high probative value. See Charles v. Principi, 16 Vet. App. 370, 374 (2002).

To the extent that this grant of service connection for bilateral sensorineural hearing loss is based upon the plausible, consistent, and credible lay evidence, "nothing in the regulatory or statutory provisions [relating to evidence to be considered] requires both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself." See Buchanan v. Nicholson, 451 F. 3d at 1335.

Accordingly, based on the totality of the evidence, the Board finds that presumptive service connection for the Veteran's bilateral hearing loss is warranted. 38 U.S.C. § 1110, 5107(b); 38 C.F.R. § 3.102; 3.303(b).

REASONS FOR REMAND

Entitlement to service connection for bilateral plantar fasciitis.

The Veteran currently does not have a foot diagnosis, although he has reported general foot pain including "constant pain when walking and cramping." See December 2024 Claim.

Given the Veteran's competent report of pain and the onset and continuity of the claimed foot pain, a VA examination is necessary to determine whether there is a foot disability diagnosis or functional impairment underlying his reports of foot pain; and if so, whether such is related to his service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that pain alone can constitute a disability for VA
bilateral plantar fasciitis.

The Veteran currently does not have a foot diagnosis, although he has reported general foot pain including "constant pain when walking and cramping." See December 2024 Claim.

The AOJ denied the claim without providing the Veteran with an examination. This is a pre-decisional duty to assist error. A remand is necessary to correct it.

The matter is REMANDED for the following action:

Schedule the Veteran for a VA examination with an appropriate clinician to address the claimed foot disability.

After reviewing the claims file and performing an examination, the clinician must address the following:

(A) The clinician must identify all current diagnoses relevant to the claimed foot disability.

(B) If a diagnosis cannot be provided, the clinician must address whether the condition manifests in symptoms that cause functional impairment. In doing so, the clinician must acknowledge and discuss the Veteran's competent statement regarding difficulty walking and cramping.

(C) For each diagnosis, the clinician must opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that it is related to his service. In doing so, the clinician must acknowledge and discuss the Veteran's competent statement regarding having foot pain due to "rucking" in service. See December 2024 Claim.

The clinician is asked to explain the reasons behind any opinions expressed and conclusions reached. The clinician is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the likelihood is at least approximately balanced or nearly equal, if not higher. Note that the lack of documented treatment in service, or a long period after, while probative, cannot serve as the sole basis for a negative finding. The Veteran's lay contentions must be considered and weighed in making the determination.

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Smith, S. 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.

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