HODGKIN'S DISEASE

S. MERRICK · 2026 · Case ID: A26031877

MIXED

Summary

The veteran, who served in the United States Marine Corps from September 1987 to April 1988, appeals the denial of service connection for bilateral hearing loss, tinnitus, and prostate cancer, as well as an initial compensable rating for non-Hodgkin's lymphoma and residual scars. The Board granted service connection for bilateral hearing loss and tinnitus, finding the evidence in approximate balance and resolving doubt in the veteran's favor, citing noise exposure in service and continuity of symptomatology. The Board also granted service connection for prostate cancer, finding a private medical opinion sufficiently linked it to Camp Lejeune water contamination exposure, which the Board accepted as at least as likely as not. However, the Board denied an initial compensable rating for non-Hodgkin's lymphoma, noting it was in remission with no residuals, and denied higher ratings for neck and chest scars, finding they did not meet the criteria for disfigurement or other compensable factors. The Board relied on VA examinations for the lymphoma and scar claims, finding them credible and probative, and noted the veteran's lay testimony was competent but not sufficient to establish residuals or higher ratings without medical evidence. The Board also clarified that evidence submitted after the withdrawal of a hearing request, or after 90 days following the withdrawal, was not considered unless it was submitted prior to the March 2021 rating decision or within the 90-day window after withdrawal.

Rationale

Lymphoma in remission since March 2014; No residuals noted by VA examiner; No functional impact on work

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7715

Docket No.

210519-160411

Full Decision Text

Citation Nr: A26031877
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 210519-160411
DATE: April 7, 2026

ORDER

Entitlement to an initial compensable rating for non-Hodgkin lymphoma is denied.

Entitlement to an initial compensable rating for residual scar, neck is denied.

Entitlement to an initial compensable rating for residual scar, chest is denied.

Entitlement to service connection for bilateral hearing loss is granted.

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for prostate cancer is granted.

FINDINGS OF FACT

1. The Veteran's non-Hodgkin's lymphoma had not recurred nor metastasized since the conclusion of antineoplastic chemotherapy in March 2014, and he did not have any residuals from the condition.

2. The Veteran has a single neck scar measuring less 5 or more inches (13 or more cm.) in length, less than one-quarter inch (0.6 cm.) wide at widest part, and with hyperpigmentation but no characteristic of disfigurement.

3. The Veteran has a single scar of the anterior chest, measuring less than 144 square inches (929 sq. cm.) and without residuals or symptoms.

4. The Veteran experienced in-service noise exposure and has a current diagnosis of bilateral sensorineural hearing loss.

5. The Veteran has reported tinnitus.

6. The evidence is at least evenly balanced as to whether the Veteran's prostate cancer is related to service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial compensable rating for non-Hodgkin lymphoma have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 7715.

2. The criteria for entitlement to an initial compensable rating for residual scar, neck have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 7800.

3. The criteria for entitlement to an initial compensable rating for residual scar, chest have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 7802.

4. The criteria for entitlement to service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. 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, 3.304.

6. The criteria for service connection for prostate cancer have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from September 1987 to April 1988.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2021 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which granted the service-connection claims for non-Hodgkin's lymphoma and residual scars but denied the service-connection claims for bilateral hearing loss, tinnitus and prostate cancer.

In the May 19, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. In a June 2, 2025 letter, the Veteran, through a letter from his representative, withdrew the hearing request. The letter specifically stated: "Veteran requests to withdraw from BVA hearing pursuant to §20
Veterans' Appeals (Board) on appeal from a March 2021 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which granted the service-connection claims for non-Hodgkin's lymphoma and residual scars but denied the service-connection claims for bilateral hearing loss, tinnitus and prostate cancer.

In the May 19, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. In a June 2, 2025 letter, the Veteran, through a letter from his representative, withdrew the hearing request. The letter specifically stated: "Veteran requests to withdraw from BVA hearing pursuant to §20.704(e). Veteran does not withdraw his appeal. Veteran only withdraws his hearing request. Veteran preserves his right to submit additional evidence for 90 days pursuant to 38 C.F.R. § 20.302(b)."

Therefore, the Board may only consider the evidence of record at the time of the March 2021 agency of original jurisdiction (AOJ/RO) decision 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/RO 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.

The Board notes that the Veteran continued to seek claims after he sought appellate review from the Board. As such, the Veteran received VA examinations and provided "updated medical records" and private medical opinions. Any evidence that was not received within 90 days of the Veteran's request to withdraw his Board hearing or reflect a treatment date prior to the March 2021 rating decision were not reviewed or considered by the Board.

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 prostate cancer, any evidence the Board could not consider will be considered by the AOJ/RO in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

By way of procedural background, the Veteran initially submitted a claim for service connection in December 2019, which included claims for bilateral hearing loss, tinnitus, non-Hodgkins lymphoma and prostate cancer due to Camp Lejeune contaminated water. A rating decision was issued in March 2021, which granted the claims for service-connection for non-Hodgkin's lymphoma and residual scars of neck and chest, all of which were assigned noncompensable ratings. The March 2021 rating decision denied the claims of bilateral hearing loss and tinnitus as they neither occurred in nor were caused by service. The March 2021 rating decision denied the claim for service connection for prostate cancer as there was no link to service.

The Veteran timely submitted a notice of disagreement (10182/NOD) in May 2021, seeking review of the claim. As such, the claims for an initial compensable rating for non-Hodgkin lymphoma; an initial compensable rating for residual scar, neck; and initial compensable rating for residual scar, chest; service connection for bilateral hearing; service connection for tinnitus; and service connection for prostate cancer are properly before the Board for adjudication.

Increased Disability Ratings Laws and Regulations

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to
the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of a veteran working or seeking work. 38 C.F.R. § 4.2. Reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Staged ratings are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509- 10 (2007).

Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a veteran's service-connected disability. 38 C.F.R. § 4.14 (2020). However, it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; the critical element in permitting the assignment of several evaluations under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

In rendering a decision on appeal, the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Entitlement to an initial compensable rating for non-Hodgkin lymphoma.

The Veteran generally asserts that an initial compensable rating is warranted for his non-Hodgkin's lymphoma.

For the entire period on appeal, the Veteran's non-Hodgkin's lymphoma has been rated as noncompensable under DC 7715. Pursuant to Diagnostic Code 7715, non-Hodgkin's lymphoma is rated 100 percent with active disease or during the treatment phase. Six months after discontinuance of surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e). If there has been no local recurrence or metastasis, the condition should be rated on residuals. 38 C.F.R. § 4.117.

Treatment phase is defined as the "active, aggressive period of combative medical management and care designed to fully arrest, if not cure, the underlying malignant disease process." Bethea v. Derwinski, 2 Vet. App. 252 (1992) (nonprecedential decision of the Court, while not binding, "may be cited or relied upon,
procedures, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e). If there has been no local recurrence or metastasis, the condition should be rated on residuals. 38 C.F.R. § 4.117.

At a February 2015 post-service hematology treatment, the Veteran reported he received six cycles of treatment from October 2013 to March 2014. The Veteran had no adverse events during therapy, no dose reductions or delays in therapy and testing demonstrated a complete response to therapy. A review of the Veteran's remaining post-service treatment records show the Veteran continued monitoring without incident or residual. See Tennessee Valley VAMC.

The Veteran was afforded a February 2021 VA hematologic/lymphatic examination. The VA examiner noted a diagnosis of non-Hodgkin's lymphoma. The Veteran reported onset in 2013. The Veteran reported that he served four months at Camp Lejeune while in the military from August 3, 1987, to April 13, 1988. The Veteran reported that he had a lump on the left side of his neck and had a biopsy done with Tennessee Oncology which came back as non-Hodgkin's lymphoma. The Veteran reported no continuous medication was required for control and he had completed antineoplastic chemotherapy in March 2014. The VA examiner noted the Veteran had no functional impact to his ability to work as a result of the non-Hodgkin's lymphoma.

The Board has considered the VA examination and found it to be credible, competent, and probative. Among the factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. Hayes v. Brown, 5 Vet. App. 60 (1993) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence); Wood v. Derwinski, 1 Vet. App. 190 (1992). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion he reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467 (1993).

The Board finds that, while the Veteran is competent to report lay-observable symptoms, he is not competent to provide assessment whether his non-Hodgkin's lymphoma is currently active, which requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

Accordingly, the Board finds that the Veteran is not entitled to a compensable disability rating for residuals of lymphoma. The rating criteria provides for a total disability rating while manifesting active lymphoma, while being treated for lymphoma, or for six months after treatment ends. The evidence shows that the Veteran's non-Hodgkin's lymphoma is in remission, and has been since he last underwent treatment for the condition in March 2014.

Additionally, the Board finds that the evidence of record does not show that the Veteran experienced any residuals as a result of his non-Hodgkins lymphoma since receiving treatment for the condition. The medical records identify the lymphoma as being in remission and otherwise asymptomatic, with no functional effect on work. The Veteran has not mentioned or alluded to experiencing any residuals of the non-Hodgkins lymphoma and has not provided any competent, medical evidence displaying such residuals.

Accordingly, the Board finds that the most probative and persuasive evidence is against the assignment of an initial compensable disability rating for non-Hodgkin's lymphoma, as there is no evidence indicating that, during the period on appeal, the Veteran's condition was in an active disease process, during a treatment phase, recurred, metastasized, or resulted in any residuals commensurate with an increased disability rating pursuant to Diagnostic Code 7715. Therefore, the Veteran's appeal with respect to the claim for an initial compensable disability rating for non-Hodgkin's lymphoma must be denied. 38 U.S.C. § 5107; 38 C.F.R
any competent, medical evidence displaying such residuals.

For these reasons, the Board finds that the evidence weighs persuasively against the claim for a compensable initial rating for non-Hodgkin's lymphoma. Because the evidence weighs substantially against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for an initial compensable rating for non-Hodgkin's lymphoma is denied.

Entitlement to an initial compensable rating for residual scar, neck.

Entitlement to an initial compensable rating for residual scar, chest.

The Veteran generally asserts that an initial compensable rating is warranted for his neck scar and chest scar.

For the entire period on appeal, the Veteran's neck scar has been rated as noncompensable under DC 7800 and his chest scar has been rated as noncompensable under DC 7802. Under the scar regulations, scars of the head, face, or neck are rated under 38 C.F.R. § 4.118, Diagnostic Codes 7800 to 7805.

Under the scar regulations, DC 7800 provides the rating criteria for burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. A 10 percent rating is warranted when there is one characteristic of disfigurement. A 30 percent rating is warranted when there is visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, or lips), or; with two or three characteristics of disfigurement. A 50 percent rating is assigned for visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement. An 80 percent rating is assigned for visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement. 38 C.F.R. § 4.118, DC 7800.

The 8 characteristics of disfigurement, for purposes of evaluation under § 4.118, are: (1) scar 5 or more inches (13 or more cm.) in length, (2) scar at least one-quarter inch (0.6 cm.) wide at its widest part, (3) surface contour of scar elevated or depressed on palpation, (4) scar adherent to underlying tissues, (5) skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.), (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.), (7) underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.), and (8) skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). 38 C.F.R. § 4.118, DC 7800, Note (1).

Diagnostic Code 7801 provides ratings for scars, other than the head, face, or neck, that are associated with underlying soft tissue damage. Scars that are associated with underlying soft tissue damage in an area or areas exceeding 6 square inches (39 square centimeters) are rated as 10 percent disabling. Scars in an area or areas exceeding 12 square inches (77 square centimeters) are rated as 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 square centimeters) are rated as 30 percent disabling. Scars
an area exceeding six square inches (39 sq. cm.). 38 C.F.R. § 4.118, DC 7800, Note (1).

Diagnostic Code 7801 provides ratings for scars, other than the head, face, or neck, that are associated with underlying soft tissue damage. Scars that are associated with underlying soft tissue damage in an area or areas exceeding 6 square inches (39 square centimeters) are rated as 10 percent disabling. Scars in an area or areas exceeding 12 square inches (77 square centimeters) are rated as 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 square centimeters) are rated as 30 percent disabling. Scars in an area or areas exceeding 144 square inches (929 square centimeters) are rated as 40 percent disabling. 38 C.F.R. § 4.118, Diagnostic Code 7801 (in effect since August 13, 2018).

Diagnostic Code 7802 provides ratings for scars, other than the head, face, or neck, that are not associated with underlying soft tissue damage. A scar that is not associated with underlying soft tissue damage in an area or areas of 144 square inches (929 square centimeters) or greater is rated as 10 percent disabling. 38 C.F.R. § 4.118, Diagnostic Code 7802 (in effect since August 13, 2018).

The body is separated into six zones defined as each extremity, the anterior trunk, and the posterior trunk. A separate evaluation may be assigned for each affected zone of the body. 38 C.F.R. § 4.118 DC 7802 Notes (1), (2).

Diagnostic Code 7804 provides ratings for scars that are unstable or painful. One or two scars that are unstable or painful are rated as 10 percent disabling. Three or more scars that are unstable or painful are rated as 20 percent disabling. Five or more scars that are unstable or painful are rated as 30 percent disabling. Note (1) to DC 7804 provides that an unstable scar was one where, for any reason, there was frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7804 (in effect since August 13, 2018).

Diagnostic Code 7805 provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate diagnostic code. 38 C.F.R. § 4.118, Diagnostic Code 7805.

Turning to the evidence, the Veteran was afforded a February 2021 VA scar examination. The VA examiner noted a diagnosis of a left neck scar and a right upper chest scar, both related to the Veteran's diagnosed non-Hodgkin's lymphoma.

At the February 2021 examination, the Veteran's anterior trunk scar, due to port placement for chemotherapy, located at the right upper chest measuring 6 cm x.2 cm, was not tender to palpation, not unstable upon inspection and did not have underlying soft tissue damage.

At the February 2021 examination, the Veteran's left neck scar from biopsy for non-Hodgkin's lymphoma, measured 6.5 cm x .2 cm, with no surface contour elevation on palpation or depression on palpation, scar was not adherent to underlying tissue, underlying soft tissue was not missing, there was no hypopigmentation, no induration/inflexibility or abnormal texture, however, there was hyperpigmentation that measured .12 sq. cm.

The February 2021 VA examiner noted the Veteran's scars had no functional impact on the Veteran's ability to work. Moreover, no pain was reported.

The Board notes that while the Veteran had hyperpigmentation to his neck scar, the hyperpigmentation and scar itself did not exceed six square inches (39 sq. cm.). Moreover, there is no evidence that the scar or hyperpigmentation are painful, tender, deep, unstable, or cause limitation of motion, and are otherwise asymptomatic. Therefore, the hyperpigmentation and scar did not rise to the level of a characteristic of disfigurement as it did not exceed six square inches (39 sq. cm.). See 38 U.S.C. § 4.118 DC 7800 Note 1. Accordingly, a compensable rating of 10 percent for a characteristic of disfigurement for the Veteran's neck scar is not warranted.

Likewise, the Veteran's anterior trunk scar or chest scar did not exceed an area of 144 square inches (929 sq. cm.). Moreover, there is no evidence that the scar is painful, tender, deep, unstable, causes limitation of motion, and is otherwise
, or cause limitation of motion, and are otherwise asymptomatic. Therefore, the hyperpigmentation and scar did not rise to the level of a characteristic of disfigurement as it did not exceed six square inches (39 sq. cm.). See 38 U.S.C. § 4.118 DC 7800 Note 1. Accordingly, a compensable rating of 10 percent for a characteristic of disfigurement for the Veteran's neck scar is not warranted.

A review of the Veteran's post-service treatment records are silent for any complaints, diagnosis or treatment for any instability, pain, symptom or other complication with the Veteran's scars resulting from the treatment from his non-Hodgkin's lymphoma. See Tennessee Valley VAMC.

The Board acknowledges that the Veteran is competent to describe his symptoms without any specialized knowledge or training. Layno v. Brown, 6 Vet. App. 465; Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011), Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Furthermore, the Board finds that the Veteran is competent to report symptoms that the Veteran experienced, as they would be readily apparent. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service and post-service symptoms).

The Board has also considered the Veteran's general allegations and his sincere belief that his scars warrant higher ratings. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the etiology of the medically complex disorder of scars. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Scars are medically complex processes because of their multiple possible etiologies and require specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

Accordingly, the Board finds higher evaluations are not warranted for the Veteran's neck and chest scars.

For these reasons, the Board finds that the evidence weighs persuasively against the claim for higher ratings for the Veteran's neck and chest scars. Because the evidence weighs substantially against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for entitlement to an initial compensable rating for residual scar, neck is denied. Additionally, the claim for entitlement to an initial compensable rating for residual scar, chest is denied.

Service Connection Laws and Regulations

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Only chronic diseases listed under 38 C.F.R. § 3.309(a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303(b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187
or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995).

In rendering a decision on appeal the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382(1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998).

A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment, including by a veteran. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner's opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the weight of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

Entitlement to service connection for bilateral hearing loss.

Entitlement to service connection for tinnitus.

The Veteran generally asserts that service connection is warranted for his hearing loss. The Veteran additionally asserts that he has
5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis).

Entitlement to service connection for bilateral hearing loss.

Entitlement to service connection for tinnitus.

The Veteran generally asserts that service connection is warranted for his hearing loss. The Veteran additionally asserts that he has tinnitus and that is the result of his military service.

Where the Veteran asserts entitlement to a chronic disease but there is insufficient evidence of a diagnosis in service, service connection may be established under 38 C.F.R. § 3.303(b) by demonstrating a continuity of symptomatology since service, but an award solely on this basis is only permissible if the chronic disease is listed under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection for hearing loss may be granted where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service (as opposed to intercurrent causes). Hensley v. Brown, 5 Vet. App. 155, 159 (1993).

"[W]hen audiometric test results at a veteran's separation from service do not meet the regulatory requirements for establishing a 'disability' at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service." Id. at 160.

The Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal," and does not require that the evidence be in exact equipoise. Under 38 U.S.C. § 5107 the benefit of the doubt rule is clear and unambiguous on its face. Evidence is in approximate balance when the evidence in favor of and opposing the Veteran's claim is found to be almost exactly or nearly equal. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. Lynch v. McDonough, 21 F.4th 776 (2021).

Impaired hearing is considered a disability for VA compensation purposes when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; the thresholds for at least three of these frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Court has held that a veteran may establish the required nexus between current hearing loss disability and his term of military service if he can show by competent evidence that his hearing loss disability resulted from the in-service acoustic trauma even where the hearing loss disability does not arise in service. Godfrey v. Derwinski, 2 Vet. App. 352 (1992).

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

Turning to the evidence, at the Veteran's January 1987 enlistment examination, the Veteran's pure tone thresholds, in decibels, were as follows:

HERTZ

1000 2000 3000 4000 average

RIGHT 5 5 15 5 7.5

LEFT 5 5 5 5 5

In August 1987, during the Veteran's service, the Veteran's pure tone threshold, in decibels, were as follows:

HERTZ

1000 2000 3000 4000 average

RIGHT 5 10 5 0 5

LEFT 5 0 10 15 7.5

LEFT 5 5 5 5 5

In August 1987, during the Veteran's service, the Veteran's pure tone threshold, in decibels, were as follows:

HERTZ

1000 2000 3000 4000 average

RIGHT 5 10 5 0 5

LEFT 5 0 10 15 7.5

A review of the Veteran's service treatment records (STRs) are silent for any complaint, diagnosis or treatment for hearing loss, tinnitus or ringing in the ears. As noted above, at audiograms at his January 1987 enlistment examination, an August 1987 audiogram and April 1988 audiogram, the Veteran had hearing within normal limits and no complaints of tinnitus. At the Veteran's April 1988 separation examination, the Veteran was noted to have "normal" ears.

At the Veteran's April 1988 separation examination, the Veteran's pure tone threshold, in decibels, were as follows:

HERTZ

1000 2000 3000 4000 average

RIGHT 10 10 10 20 12.5

LEFT 10 5 15 15 11.25

During the Veteran's post-service VA treatment, the Veteran's treatment records were silent for any complaint, diagnosis or treatment for hearing loss, ringing in the ears or tinnitus. See Tennessee Valley VAMC.

The Veteran was afforded a March 2021 VA audio examination. The VA examiner noted a diagnosis of bilateral sensorineural hearing loss. The Veteran denied tinnitus. The Veteran reported that he had hearing problems sometimes, and other times he felt he could hear well. The Veteran reported the onset was a "long time ago" and reported "difficultly hearing at times." The Veteran denied tinnitus.

During the March 2021 VA audiological evaluation, pure tone thresholds, in decibels, were as follows:

HERTZ

1000 2000 3000 4000 average

RIGHT 50 55 45 45 48.75

LEFT 35 30 35 35 33.75

Speech audiometry revealed speech recognition ability scores using the Maryland CNC Test of discrimination score of 94 percent was noted in the right ear and 96 in the left ear.

The March 2021 VA examiner opined the Veteran did not have a permanent positive threshold shift (worse than reference threshold) greater than normal measurement variability at any frequency between 500 and 6000 HZ for the right or left ear. Additionally, the VA examiner opined the Veteran's hearing loss was less likely than not caused by or the result of an event in military service.

The VA examiner reasoned: "There is no significant permanent shift in hearing thresholds beyond test variability from entrance exam dated 01/23/1987 to separation exam dated 04/07/1988, which is objective evidence of no permanent auditory damage on active duty from conceded noise. There is no report of complaint/treatment for hearing decrease in STRs or at separation. Although noise exposure is conceded and the relationship of noise, auditory damage and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise alone. There must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology. The evidence is against a nexus in this case, therefore it is less likely than not that the hearing loss is related to military noise exposure."

The Board notes that the March 2021 rating decision favorably found that the Veteran had a current diagnosis of bilateral hearing loss for VA purposes, and that he was exposed to hazardous noise in service based on his military occupational specialty (MOS) of mechanic. 38 C.F.R. § 3.104(c).

In November 2022, the Veteran provided a private medical opinion during which the Veteran reported he was exposed to numerous loud noises while in the service. Such "exposures include and were limited to Howitzers, Sherman tanks, 50 caliber machine guns, and 16mm small arm fire on a regular basis. He reports that while in the service, he would experience a high-pitched tone in his ears." The private provider also noted: "The only auditory trauma that this gentleman sustained was while he was in the service. In addition, while still in the service, he noted ringing in his ears, i.e., the onset of tinnitus. Given this veteran's specific medical history and the above medical literature, it is much more likely than not that his tinnitus is the direct result of the auditory trauma he sustained while in the service."

The question becomes whether the Veteran's bilateral hearing loss began during service or is otherwise related to service.

After careful review
tanks, 50 caliber machine guns, and 16mm small arm fire on a regular basis. He reports that while in the service, he would experience a high-pitched tone in his ears." The private provider also noted: "The only auditory trauma that this gentleman sustained was while he was in the service. In addition, while still in the service, he noted ringing in his ears, i.e., the onset of tinnitus. Given this veteran's specific medical history and the above medical literature, it is much more likely than not that his tinnitus is the direct result of the auditory trauma he sustained while in the service."

The question becomes whether the Veteran's bilateral hearing loss began during service or is otherwise related to service.

After careful review of the evidence, the Board find that service connection for bilateral hearing loss is warranted. The VA examiner conceded that the Veteran's duties as a mechanic was consistent with noise exposure in service. The Veteran stated that his hearing loss commenced in service. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). The record supports the Veteran's contention that he experienced hearing loss during service. The Veteran is competent to describe symptoms observable to his senses; as such, he is also competent to describe his hearing loss. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Charles v. Principi, 16 Vet. App. 370, 374 (2003). The Board also finds that his statements with respect to continuity of symptomatology to be credible. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-38 (Fed. Cir. 2006).

The Veteran also stated he experienced tinnitus as a symptom of his hearing loss. As part of the November 2022 private opinion, the provider noted that the Veteran reported that "while still in service, [the Veteran] noted ringing in his ears, i.e. the onset of tinnitus." Indeed, the November 2022 private examiner noted that the Veteran's tinnitus was at least as likely as not a symptom associated with his hearing loss, as tinnitus is known to be a symptom associated with hearing loss. Tinnitus may occur as a symptom of nearly all ear disorders including sensorineural or noise-induced hearing loss. See The MERCK Manual, Sec. 7, Ch. 82, Approach to the Patient with Ear Problems. "High frequency tinnitus usually accompanies [noise-induced] hearing loss." The MERCK Manual, Section 7, Ch. 85, Inner Ear; see also Fountain v. McDonald, 27 Vet. App. 258 (2015). In this case, the Veteran asserted that the onset of his tinnitus was during his military service, thus he has had a continuous symptom of hearing loss since he was in service. Further, the private examiner stated: "The only auditory trauma that this gentleman sustained was while he was in the service." Accordingly, the Board finds that this weighs in favor of the Veteran's hearing loss also commencing in service given that tinnitus is a symptom of hearing loss.

Moreover, given that the Veteran indicated he experienced hearing loss in service, which continued post-service, and because sensorineural hearing loss (organic disease of the nervous system) is a chronic disease under 38 C.F.R. § 3.309(a), an award of service connection is appropriate solely based on evidence of continuity of symptomatology. Walker, 708 F.3d at 1336-1340.

In sum, the Board finds the positive and negative evidence to at least be in approximate balance as to whether the Veteran's current hearing loss began during active service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral hearing loss is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-82.

The Board also finds that the evidence is in approximate balance as to whether the Veteran's tinnitus began during service or is related to service.

As noted above, where the Veteran asserts entitlement to a chronic disease but there is insufficient evidence of a diagnosis in service, service connection may be established under 38 C.F.R. § 3.303(b) by demonstrating a continuity of symptomatology since service, but an award solely on this basis is only permissible if the chronic disease is listed under 38 C.F.R. § 3.309(a). Walker, 708 F.3d at 1331.

The November 2022 private examiner noted the Veteran was diagnosed with tinnitus,
F.4th at 781-82.

The Board also finds that the evidence is in approximate balance as to whether the Veteran's tinnitus began during service or is related to service.

The November 2022 private examiner noted the Veteran was diagnosed with tinnitus, and that tinnitus is a chronic disability per 38 C.F.R. § 3.309 which may be considered for presumptive service connection.

The Veteran stated he was exposed to loud noise in service, and the March 2021 rating decision conceded that he was exposed to hazardous in service based on his MOS of mechanic. The Veteran indicated that the approximate onset of tinnitus was during service. Tinnitus is a disorder that is readily observable by laypersons and does not require medical expertise to establish its existence. Layno, 6 Vet. App. at 469-71; Charles, 16 Vet. App. at 370. As such, resolving any reasonable doubt in the Veteran's favor, the Board finds his reports regarding tinnitus are credible and entitled to probative weight.

The Board is aware that the March 2021 VA examiner's opinion includes an unfavorable opinion. However, tinnitus is a disease that is capable of lay observation. Id. Due to the inherently subjective nature of tinnitus, the Board finds that the Veteran's statements as to its onset in service and its continued presence are found to be at least as probative as the March 2021 opinion, and any reasonable doubt is resolved in the Veteran's favor. See Lynch v, 21 F.4th at 776.

Thus, service connection for tinnitus and bilateral hearing loss is granted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

Entitlement to service connection for prostate cancer.

The Veteran generally asserts that his diagnosed prostate cancer is the result of his military service and service connection is warranted.

Regarding the Veteran's assertion that his alleged disorder is due to his in-service exposure to water contamination while he was stationed at Camp Lejeune, the Board notes that service connection may also be proven by presumption. Effective March 14, 2017, a Veteran, or former reservist or member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987 shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service. 38 C.F.R. § 3.307 (a)(7). If a Veteran served on Camp Lejeune during the time frame specified, certain diseases including kidney cancer, liver cancer, non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer shall be service-connected even though there is no record of such disease during service. 38 C.F.R. § 3.309 (f). The diseases listed in §3.309(f) shall have become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307 (a)(7)(ii). The Veteran's claimed prostate cancer is not subject to the presumption.

The Board notes that March 2021 rating decision found a favorable finding that the Veteran had been diagnosed with prostate cancer, citing a January 10, 2020 VAMC record. Under the AMA, favorable findings made by the AOJ/RO are binding on the Board as there is no evidence to the contrary. 38?C.F.R. §?3.104(c).

The Veteran provided a November 2022 private medical opinion regarding the Veteran's claim for service connection for prostate cancer. The private examiner outlined a study comparing Camp Lejeune and Camp Pendleton which found that most or all deaths of prostate cancer had cumulative exposure above the median and workers at Camp Lejeune were at an elevated risk for developing prostate cancer when compared with Camp Pendleton workers. Based on this study, the November 2022 private examiner concluded that "Given
, citing a January 10, 2020 VAMC record. Under the AMA, favorable findings made by the AOJ/RO are binding on the Board as there is no evidence to the contrary. 38?C.F.R. §?3.104(c).

The Veteran provided a November 2022 private medical opinion regarding the Veteran's claim for service connection for prostate cancer. The private examiner outlined a study comparing Camp Lejeune and Camp Pendleton which found that most or all deaths of prostate cancer had cumulative exposure above the median and workers at Camp Lejeune were at an elevated risk for developing prostate cancer when compared with Camp Pendleton workers. Based on this study, the November 2022 private examiner concluded that "Given that prostate cancer by its general nature has a much longer survivability, relative short studies would not be able to identify the mortality change due to exposure to said contaminate water. Therefore, it is as least as likely as not that this veteran's prostate cancer is related to his Camp Lejeune contaminated water exposure."

The private medical opinion supports an etiological relationship between the Veteran's prostate cancer and presumed exposure to contaminated water at Camp Lejeune. Based on this opinion, the Board finds that all elements for service connection for prostate cancer on a direct basis have been met. The private physician provided a thorough rationale for the basis of the medical opinion. Thus, the Board can find no basis upon which to assign greater probative weight to any of the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning).

For the reasons set forth above, the evidence is at least evenly balanced as to whether the Veteran's prostate cancer is related to his military service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in the Veteran's favor, service connection is warranted for prostate cancer. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

S. Merrick

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Melnyk, H.

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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