TINNITUS

Summary

The Veteran, who served honorably in the United States Navy from April 1988 to April 1991, appeals the denial of service connection for multiple conditions, including tinnitus, obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), urinary frequency, insomnia, a lung condition due to asbestos exposure, vertigo, and headache disorder. The Veteran also appeals the denial of direct service connection for a lung condition due to asbestos exposure. The Board granted service connection for tinnitus, finding the Veteran's claim persuasive and supported by evidence of hazardous noise exposure in service. The Board denied claims for OSA, GERD, urinary frequency, insomnia, lung condition due to asbestos exposure, vertigo, and headache disorder, citing a lack of current disability or insufficient evidence linking them to service, and noting the Veteran's failure to attend a scheduled VA examination for some of these conditions. The Board remanded claims for a left shoulder condition, right elbow condition, right shoulder condition, and cervical spine condition, finding a pre-decisional duty-to-assist error in failing to provide VA examinations for these musculoskeletal issues, as lay reports indicated potential in-service injuries and current pain.

Rationale

Veteran has current disability; Related to service; Hazardous noise exposure in service

Full Decision Text

Citation Nr: A26032770
Decision Date: 04/09/26	Archive Date: 04/09/26

DOCKET NO. 250802-571470
DATE: April 9, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for obstructive sleep apnea (OSA) is denied. 

Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. 

Entitlement to service connection for urinary frequency is denied.

Entitlement to service connection for insomnia is denied.

Entitlement to service connection for a lung condition due to asbestos exposure is denied.

Entitlement to service connection for vertigo is denied.

Entitlement to service connection for headache disorder is denied.

REMANDED

Entitlement to a service connection for left shoulder condition is remanded.

Entitlement to service connection for right elbow condition is remanded.

Entitlement to service connection for right shoulder condition is remanded.

Entitlement to a service connection for a cervical spine condition is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his tinnitus is at least as likely as not related to service.

2. The Veteran failed to appear, without good cause shown, for a scheduled VA examination in December 2024, for his GERD, OSA, and urinary frequency claims.

3. The evidence of record persuasively weighs against finding that the Veteran has had insomnia, lung condition, or vertigo at any time during or approximate to the pendency of the claim.

4. The evidence of record persuasively weighs against finding that a headache disorder began during active service or is otherwise related to an in-service injury or disease, to include toxic exposure activity.

CONCLUSIONS OF LAW

1. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for obstructive sleep apnea (OSA) are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for gastroesophageal reflux disease (GERD) are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for urinary frequency are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for insomnia are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for lung condition are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for vertigo are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for headache disorder are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had honorable active-duty service in the United States Navy from April 1988 to April 1991.

The claims were denied in November and December 2024 rating decisions. In the August 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 November and December 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and
 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 November and December 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of bilateral shoulder disability, cervical spine condition, and right elbow 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). 

SERVICE CONNECTION

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).

Service treatment records do not show any complaints for the claimed conditions. At an April 1991 separation examination, evaluation of the Veteran was normal. In a corresponding report of medical history, the Veteran denied having any medical issues and indicated his health was good. See also July 1992 Annual certificate of Physical Condition (denying any change to his physical condition since separation). 

1. Entitlement to service connection for tinnitus is granted.

The Veteran contends that his tinnitus resulted from his service, specifically exposure to hazardous noises. See May 2024 Statement in Support of claim; see also May 2024 fully developed claim.

The Board concludes that the Veteran has a current disability that is related to service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). For VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002).

Service treatment records (STRs) are silent for any complaints of tinnitus. At his October 1996 separation examination, evaluation of his ears was found to be normal. See also April 1995 five-year examination. In an October 1996 corresponding Report of Medical History, the Veteran denied any ear trouble. See also April 1995 Report of medical history.

In October 2024, the Veteran presented for a VA examination for his tinnitus claim. The Veteran reported intermittent bilateral tinnitus, lasting 20 seconds in duration and occurring every other day. He informed the examiner symptoms onset in 1991 when exposed to noise from the engine room. Tinnitus was diagnosed. The examiner opined the diagnosed tinnitus was less likely than not related to service because the Veteran's symptoms do not meet the definition of tinnitus. In support of the opinion, the examiner noted tinnitus experts agree ear or head sounds must be prolonged lasting more than five minutes at a time and more than once a week. The transient ear noise is not consistent with noise induced tinnitus and les likely than not related to military noise exposure.  

The Veteran presented for a VA examination in February 2020 regarding his tinnitus claim. The Veteran reported ringing began about 1996 and that tinnitus is intermittent. He described the ears being affected daily from a few seconds to one or two minutes. The examiner noted the Veteran had recurrent tinnitus; however, they found the Veteran's tinnitus to be less likely than not related to service. In support of the opinion, the examiner concluded the tinnitus was more likely transient air noise. The examiner provided medical
 agree ear or head sounds must be prolonged lasting more than five minutes at a time and more than once a week. The transient ear noise is not consistent with noise induced tinnitus and les likely than not related to military noise exposure.  

The Veteran presented for a VA examination in February 2020 regarding his tinnitus claim. The Veteran reported ringing began about 1996 and that tinnitus is intermittent. He described the ears being affected daily from a few seconds to one or two minutes. The examiner noted the Veteran had recurrent tinnitus; however, they found the Veteran's tinnitus to be less likely than not related to service. In support of the opinion, the examiner concluded the tinnitus was more likely transient air noise. The examiner provided medical evidence distinguishing chronic tinnitus and transient air noise as chronic tinnitus must last at least five minutes. The Board places minimal probative value in the October 2024 VA examiner's opinion. While the Board understands the discussion between transient air noise and tinnitus, the VA examiner still diagnosed the Veteran with tinnitus. Furthermore, the VA examiner's opinion was less whether the tinnitus was caused by service, but the classification of tinnitus.

Upon review of the record, the Board finds the evidence to at least be in approximate balance as to whether the Veteran's current tinnitus is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for tinnitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

2. Entitlement to service connection for obstructive sleep apnea (OSA) is denied.

See section below.

3. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied.

See section below.

4. Entitlement to service connection for urinary frequency is denied.

The Veteran contends that during service he woke up in the engine room with "acid in my throat" and has persisted since his asbestos exposure. See May 2024 Statement in support of claim; see also May 2024 Fully Developed Claim. The Veteran generally claims OSA and urinary frequency. See May 2024 Fully Developed Claim.

The first element required for service connection is a current disability.

The Board finds that the persuasive weight of the evidence shows no current GERD, OSA, or urinary frequency disability, either by diagnosis or by functional impairment, including based on lay evidence reports.  See Saunders v. Wilkie, 886 F.3d 1356 (2018).

The competent evidence of record does not demonstrate a current OSA, GERD, or urinary frequency disability in any of the medical treatment records and the Veteran is not competent to render his own diagnosis.  See generally King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2009) (holding that it was not erroneous for the Board to find that a lay veteran claiming service connection for a back disorder and his wife lacked the "requisite medical training, expertise, or credentials needed to render a diagnosis" and that their testimony "could not establish medical causation nor was it a competent opinion as to medical causation").

While the Board is cognizant of the ruling in Saunders, which held that pain alone could constitute a disability, in this case the evidence has not demonstrated, and the Veteran has not even alleged, that GERD, OSA, or urinary frequency pain has resulted in an impairment of earning capacity. As such, in this case, neither the lay nor the medical evidence shows a functionally impairing disability.

The Veteran was scheduled for a VA examination and was a "no show".

The Board notes that VA's duty to assist is not a one-way street.  See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).  The Veteran must cooperate with VA's efforts to obtain evidence necessary to adjudicate his claims, including attending scheduled VA examinations.  38 C.F.R. § 3.655.

The Board finds that good cause has not been shown.  The Veteran has failed to assist VA in the development of the claim and the evidence of record does not establish the first element of service connection. See August 2024 Subsequent Development Record (notifying the Veteran of additional evidence needed for the claim and providing him with a medical release form). In July 2024, the Veteran notified the VA that he had enclosed all remaining information or evidence that will support his claim and to decide the claim as soon as possible. See 5103 Notice Acknowledge. 

Accordingly, as the persuasive weight of the evidence is against a finding of entitlement to service connection for OSA, GERD, and urinary frequency, the claim must be denied.  38 U.S.C. § 5107; 38 C.F.R
 assist VA in the development of the claim and the evidence of record does not establish the first element of service connection. See August 2024 Subsequent Development Record (notifying the Veteran of additional evidence needed for the claim and providing him with a medical release form). In July 2024, the Veteran notified the VA that he had enclosed all remaining information or evidence that will support his claim and to decide the claim as soon as possible. See 5103 Notice Acknowledge. 

Accordingly, as the persuasive weight of the evidence is against a finding of entitlement to service connection for OSA, GERD, and urinary frequency, the claim must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).  The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran.

5. Entitlement to service connection for insomnia is denied.

The Veteran contends that he has an insomnia disability related to service. See May 2024 fully developed claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of a insomnia and has not had one at any time during the pendency of the claim or recent to the filing of the claim.  Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Service treatment records do not show any complaints or symptoms of sleep trouble.

There are no private or VA medical treatment records available in the record. The Veteran informed the AOJ that he did not wish to submit additional evidence for his claim. See July 2024 5103 Notice Acknowledgement. The AOJ sent the Veteran a subsequent development letter to the Veteran in August 2024. The letter included a VA form 21-4142 authorization and consent to release information to the Department of Veterans Affairs and informed the Veteran that the VA could obtain his medical records with completion and return of the form. There is no evidence of record that the Veteran returned or completed the form.

The Veteran has not been afforded a VA examination under McLendon. Generally, a VA medical examination or opinion is necessary when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the veteran qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim.  38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Here, the Board does not find remand is necessary to correct a pre-decisional duty-to-assist error as there is no competent evidence of a current disability or persistent or recurrent symptoms of a disability. The AOJ provided the Veteran with the proper form to obtain treatment records that may be beneficial to the Veteran's claim. The Veteran did not complete or submit the form to the AOJ. In addition, the Veteran has not submitted medical documentation of a current diagnosed disability.

The Board has considered the Veteran's statement that he has insomnia that is related to service. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., frequent urination and defecation; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis.  See Davidson v. Shinseki, 581 F.3d 1313 (2009).  The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues.  Thus, his lay assertions do not constitute evidence upon which service connection can be granted or warrant competent evidence of a current disability. Therefore, the Board finds there was not a pre-decisional duty-to-assist error in not affording him an examination. As there is no evidence of a current diagnosed digestive disorder, the claim must be denied.

If
 (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis.  See Davidson v. Shinseki, 581 F.3d 1313 (2009).  The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues.  Thus, his lay assertions do not constitute evidence upon which service connection can be granted or warrant competent evidence of a current disability. Therefore, the Board finds there was not a pre-decisional duty-to-assist error in not affording him an examination. As there is no evidence of a current diagnosed digestive disorder, the claim must be denied.

If the Veteran has evidence of a current diagnosis of a digestive disorder, he may submit a supplemental claim with the evidence for further consideration by the AOJ.

6. Entitlement to service connection for a lung condition due to asbestos exposure is denied.

See section below.

7. Entitlement to service connection for vertigo is denied.

The Veteran contends that he has a lung condition and vertigo that are due to service. See May 2024 Fully Developed Claim. Specifically, he contends that he has a lung condition due to asbestos exposure while serving on USS Mount Whitney and in the engine room. See May 2024 Statement in Support of Claim. Additionally, he contends that he has a vertigo disability caused by his headaches. Id.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of vertigo or lung condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim.  Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Veteran presented for a VA examination in November 2024 for his claims. He reported symptoms of congestion, sore throat, runny nose, nausea, vomiting, sweating, shortness of breath, and dizziness. The examiner determined that, while the Veteran experienced subjective symptoms noted above, the Veteran did not have a diagnosis of vertigo or lung condition. The examiner noted that diagnostics were normal and/or benign for either condition. 

While the Veteran believes there is a current diagnosis of a lung condition and vertigo, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires knowledge of the vestibular and respiratory system and synergistic effects related to toxic exposure.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the competent medical evidence.

8. Entitlement to service connection for headaches is denied. 

The Veteran contends that he has a headache disability due to toxic exposure risk activity (TERA) incurred in service. See May 2024 Statement in Support of Claim. He reported service in the Persian Gulf with the Navy and that after his deployment, he began experiencing headaches. Id. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of headaches, and evidence shows that exposure to chemicals occurred, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of headaches began during service or is otherwise related to an in-service injury, event, or disease. 

The Veteran presented for a VA examination in October 2024 for his claim. He reported symptoms of head pain and exposure to gases and fumes aboard his ship. The examiner opined that the Veteran's headache disorder was less likely than not due to toxic exposure activity in service. In support of the opinion, the examiner noted that after consideration of all military deployments and synergistic effects of claimed toxic exposure, there was no pathology or objective findings to substantiate the Veteran's subjective reports of a headache disorder caused by TERA exposure.  The examiner's opinion is probative, because it is based on an the available accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Veteran believes the claimed headache disorder is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of neurological system.
 that after consideration of all military deployments and synergistic effects of claimed toxic exposure, there was no pathology or objective findings to substantiate the Veteran's subjective reports of a headache disorder caused by TERA exposure.  The examiner's opinion is probative, because it is based on an the available accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Veteran believes the claimed headache disorder is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of neurological system. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the October 2024 VA opinion.

REASONS FOR REMAND

1. Entitlement to a service connection for left shoulder condition is remanded.

See section 4 below.

2. Entitlement to service connection for right elbow condition is remanded.

See section 4 below.

3. Entitlement to service connection for right shoulder condition is remanded.

See section 4 below. 

4. Entitlement to a service connection for a cervical spine condition is remanded.

The Veteran contends he has cervical spine, bilateral shoulder, and right elbow disabilities due to injuries sustained in service. See May 2024 Statements in Support of Claim. 

There are no complaints of musculoskeletal pain in service and no medical records indicating a current musculoskeletal disability. However, the Board notes lay reports of pain may be enough to establish a current disability.  

During the period on appeal, the Veteran was not afforded a VA examination for his claims as there was no documentation of a current disability. The Board finds a pre-decisional duty-to-assist error in not affording the Veteran a VA examination for his claims as there is evidence of a disability that may have occurred or resulted from service, and requiring additional competent medical evidence for the VA to make a decision. As such, the matters must be remanded for a VA examination. 

The matters are REMANDED for the following action:

Schedule the Veteran for the appropriate VA examinations to address claims for service connection for a bilateral shoulder disability, cervical spine disability, and right shoulder disability.  The examiner should opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral shoulder, right elbow, and cervical spine conditions (1) had an onset in service or (2) is related to an injury or disease incurred in service.

If any opinion requested above cannot be rendered without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training).

The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion.  If the examiner finds the lack of documented treatment in service or post-service to be of medical significance given the relative severity, common symptomatology, and usual treatment of the claimed condition(s), the examiner should explain such a finding in the opinion.

If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted.  Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?

 

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jarman, Timothy

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.