TINNITUS

Summary

The Veteran, who served in the Marine Corps from June 2010 to August 2010 and November 2011 to March 2015, appeals the rating decision concerning service connection for several conditions. The Veteran sought service connection for tinnitus, cervical spine disability, low back disability, left shoulder disability, left leg disability, and a digestive disability. The Board reviewed the evidence, including the Veteran's service treatment records, VA examinations from April and March 2021, and a July 2025 medical opinion from the Veteran's wife, who is a board-certified endocrinologist and associate professor of medicine. The VA examinations were found to have inadequate rationale regarding nexus to service, particularly for the cervical spine, low back, and left shoulder conditions, as they relied solely on the absence of in-service complaints. The Veteran's wife provided favorable medical opinions for all claimed conditions, linking them to service or to other service-connected disabilities. For tinnitus, she opined it was characteristic of noise-induced damage. For the cervical spine, low back, and left shoulder, she attributed the disabilities to service-related injuries and repetitive strain. The left leg disability was found secondary to the service-connected right knee degenerative arthritis due to compensatory movement patterns. The digestive disability was found secondary to the service-connected psychiatric disability (PTSD) due to recognized links between stress, alcohol/tobacco use, and acid reflux. The Board found these private opinions persuasive and adequately rationalized, especially in contrast to the VA opinions. Applying the benefit of the doubt, service connection was granted for all claimed conditions.

Rationale

Favorable private medical opinion from wife; Opinion linked tinnitus to noise exposure; VA examiner provided no opinion on etiology

Full Decision Text

Citation Nr: A26033779
Decision Date: 04/13/26	Archive Date: 04/13/26

DOCKET NO. 210510-158488
DATE: April 13, 2026

ORDER

Service connection for tinnitus is granted.

Service connection for a cervical spine disability is granted.

Service connection for a low back disability is granted.

Service connection for a left shoulder disability is granted.

Service connection for a left leg disability is granted.

Service connection for a digestive disability is granted.

FINDINGS OF FACT

1. The most persuasive evidence does not weigh against finding that the Veteran's tinnitus is etiologically related to his active duty service.

2. The most persuasive evidence does not weigh against finding that the Veteran's cervical spine disability is etiologically related to his active duty service.

3. The most persuasive evidence does not weigh against finding that the Veteran's low back disability is etiologically related to his active duty service.

4. The most persuasive evidence does not weigh against finding that the Veteran's left shoulder disability is etiologically related to his active duty service.

5. The most persuasive evidence does not weigh against finding that the Veteran's left leg disability is etiologically related to his service-connected right knee degenerative arthritis.  

6. The most persuasive evidence does not weigh against finding that the Veteran's digestive disability is etiologically related to his service-connected posttraumatic stress disorder (PTSD) with unspecified tobacco related disorder and unspecified alcohol related disorder.    

CONCLUSIONS OF LAW

1. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for tinnitus have been met.  38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

2. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for a cervical spine disability have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for a low back disability have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

4. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for a left shoulder disability have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for a left leg disability have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

6. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for a digestive disability have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Marine Corps from June 2010 to August 2010 and from November 2011 to March 2015.  

The rating decision on appeal was issued in April 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the May 10, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held before the undersigned Veterans Law Judge on May 2, 2025.  Therefore, the Board may only consider the evidence of record at the time of the April 2021 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  No evidence pertaining to these issues was submitted during a period the Board may not consider, other than evidence resubmitted during a period the Board may consider.   

The Veteran
, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held before the undersigned Veterans Law Judge on May 2, 2025.  Therefore, the Board may only consider the evidence of record at the time of the April 2021 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  No evidence pertaining to these issues was submitted during a period the Board may not consider, other than evidence resubmitted during a period the Board may consider.   

The Veteran's claim for service connection for acid reflux has been recharacterized as a digestive disability, including acid reflux.  See?Clemons v. Shinseki, 23?Vet. App.?1, 5 (2009).

Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303.  Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service.  38 C.F.R. § 3.303(d).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 

The presumption of service connection applies to anyone who served on active duty for 90 days of active, continuous service.  38 C.F.R. § 3.307(a)(1); Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991).  Post-service development of an "organic disease of the nervous system" to a degree of 10 percent within one year from the date of termination of such service, establishes a rebuttable presumption that the disease was incurred in service.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.  Tinnitus is an "organic disease of the nervous system" and is subject to presumptive service connection under 38 C.F.R. § 3.309(a).  Fountain v. McDonald, 27 Vet. App. 258 (2015).  Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned.  38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  

Service connection may also be granted on a secondary basis.  Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310.  Secondary causation exists when, "but for" the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain.  Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted).  Secondary aggravation exists when the non-service-connected disability, although not caused by a service-connected disability, would be less severe were it not for a service-connected disability. Id. at 1364.  For example, secondary aggravation may be established where the natural progression of the nonservice-connected disability could have been arrested or improved but for the service-connected disability.  Id.  If a disability is service-connected via secondary aggravation, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation.  38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). 

The benefit of the doubt rule provides that an appellant will prevail in a case where the positive evidence is in approximate balance with the negative evidence.
 not for a service-connected disability. Id. at 1364.  For example, secondary aggravation may be established where the natural progression of the nonservice-connected disability could have been arrested or improved but for the service-connected disability.  Id.  If a disability is service-connected via secondary aggravation, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation.  38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). 

The benefit of the doubt rule provides that an appellant will prevail in a case where the positive evidence is in approximate balance with the negative evidence.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  It is only when the weight of the evidence is persuasively against the claim that the claim must be denied.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).    

1. Tinnitus

The Veteran contends that his tinnitus is etiologically related to noise exposure during his active-duty service.  VA has conceded that he was exposed to hazardous noise levels in service.  

At the time of his February 2015 separation examination, the Veteran reported a history of temporary ear pain after a head injury.  

The Veteran was afforded a VA examination for hearing loss and tinnitus in March 2021.  The Veteran denied experiencing any tinnitus and denied recurrent tinnitus.  For this reason, the clinician provided no opinion as to the etiology of his tinnitus.  

The Veteran has submitted a July 2025 medical opinion by his wife, a board-certified endocrinologist and associate professor of medicine.  She noted that she has known the Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She added that, at the time of the March 2021 VA examination, the Veteran had confused hearing loss and tinnitus in giving his reports.  She opined that his symptoms were "characteristic of noise-induced inner ear damage" and, given the "temporal relationship between these exposures and his symptoms," his tinnitus was connected to his military service.   

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's tinnitus is etiologically related to his active duty service.  Accordingly, the Board finds that granting service connection for tinnitus is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case.  38 C.F.R. § 3.303(a).

2. Cervical Spine Disability

The Veteran contends that his cervical spine disability is etiologically related to injuries during his active-duty service.  VA has conceded that he has a current cervical spine disability.

The Veteran's service treatment records do not note any reports of cervical spine symptoms or diagnoses of cervical spine disabilities.

The Veteran was afforded a VA examination for neck conditions in April 2021.  The clinician diagnosed degenerative arthritis and cervical disc protrusion with left upper extremity radiculopathy.  The Veteran reported onset of symptoms during active duty service that he attributed to athletic injuries.  He reported worsening symptoms since onset.  The clinician opined that the Veteran's cervical spine disability was not incurred in or caused by active duty service because it was not mentioned in service treatment records.  This is not an adequate rationale.  For this reason, this opinion is of limited probative value and will play no role in the Board's decision.

The Veteran has submitted a July 2025 medical opinion by his wife, a board-certified endocrinologist and associate professor of medicine.  She noted that she has known the Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She opined that his current cervical spine disabilities were of a type "well documented in sports medicine literature" and that his cervical spine disabilities therefore resulted from "service-related injuries and repetitive neck strain."  

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's cervical spine disability is etiologically related to his active duty service.  Accordingly, the Board
 Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She opined that his current cervical spine disabilities were of a type "well documented in sports medicine literature" and that his cervical spine disabilities therefore resulted from "service-related injuries and repetitive neck strain."  

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's cervical spine disability is etiologically related to his active duty service.  Accordingly, the Board finds that granting service connection for a cervical spine disability is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case.  38 C.F.R. § 3.303(a).

3. Low Back Disability

The Veteran contends that his low back disability is etiologically related to injuries during his active-duty service.  VA has conceded that he has a current low back disability.

The Veteran's service treatment records do not note any reports of low back symptoms or diagnoses of low back disabilities.

The Veteran was afforded a VA examination for back conditions in April 2021.  The clinician diagnosed lumbosacral strain.  The Veteran reported onset of symptoms during active duty service that he attributed to carrying gear and weightlifting.  He reported worsening symptoms since onset.  The clinician opined that the Veteran's low back disability was not incurred in or caused by active duty service because it was not mentioned in service treatment records.  This is not an adequate rationale.  For this reason, this opinion is of limited probative value and will play no role in the Board's decision.

The Veteran has submitted a July 2025 medical opinion by his wife, a board-certified endocrinologist and associate professor of medicine.  She noted that she has known the Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She opined that his in-service low back injuries were "precisely the mechanisms cited in the medical literature for inducing" his current low back disabilities and that his low back disabilities were therefore "directly attributable to his military service."  

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's low back disability is etiologically related to his active duty service.  Accordingly, the Board finds that granting service connection for a low back disability is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case.  38 C.F.R. § 3.303(a).

4. Left Shoulder Disability

The Veteran contends that his left shoulder disability is etiologically related to injuries during his active-duty service.  VA has conceded that he has a current left shoulder disability.

The Veteran's service treatment records do not note any reports of left shoulder symptoms or diagnoses of left shoulder disabilities.

The Veteran was afforded a VA examination for shoulder and arm conditions in April 2021.  The clinician diagnosed left shoulder degenerative arthritis.  The Veteran reported onset of symptoms during active duty service that he attributed to weightlifting and athletic training.  He reported worsening symptoms since onset.  The clinician opined that the Veteran's left shoulder disability was not incurred in or caused by active duty service because it was not mentioned in service treatment records.  This is not an adequate rationale.  For this reason, this opinion is of limited probative value and will play no role in the Board's decision.

The Veteran has submitted a July 2025 medical opinion by his wife, a board-certified endocrinologist and associate professor of medicine.  She noted that she has known the Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She opined that his current left shoulder disabilities were "congruent with a service-induced overuse injury culminating in degenerative change" and provided a detailed rationale for this opinion.  

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's left shoulder disability is etiologically related to his active duty service.
 She noted that she has known the Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She opined that his current left shoulder disabilities were "congruent with a service-induced overuse injury culminating in degenerative change" and provided a detailed rationale for this opinion.  

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's left shoulder disability is etiologically related to his active duty service.  Accordingly, the Board finds that granting service connection for a left shoulder disability is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case.  38 C.F.R. § 3.303(a).

5. Left Leg Disability

The Veteran contends that his left leg disability is etiologically related to his active-duty service.  Specifically, he contends that his left leg disability is due to his service-connected right knee degenerative arthritis.  He has also raised other theories, such as direct service connection but, because this theory is dispositive, it is unnecessary for the Board to address these other theories of service connection.  VA has conceded that he has a current left leg disability.  

The Veteran was afforded a VA examination for knee and lower leg conditions in April 2021.  The clinician diagnosed left knee strain.  The clinician only provided an opinion with regard to direct service connection.

The Veteran has submitted a July 2025 medical opinion by his wife, a board-certified endocrinologist and associate professor of medicine.  She noted that she has known the Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She opined that his current left knee disability was secondary to his service-connected right knee disability "due to compensatory movement patterns" and provided a detailed rationale for this opinion, including that his symptoms "follow the expected pattern of contralateral overload."  

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's left knee strain was caused or aggravated by his service-connected right knee disability.  Accordingly, the Board finds that granting service connection for a left leg disability is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case.  38 C.F.R. § 3.303(a).

6. Digestive Disability

The Veteran contends that his digestive disability is etiologically related to his active-duty service.  Specifically, he contends that his digestive disability is due to his service-connected psychiatric disability.  He has also raised other theories, such as direct service connection but, because this theory is dispositive, it is unnecessary for the Board to address these other theories of service connection.  VA has conceded that he has a current digestive disability.  

The Veteran was afforded VA examinations for intestinal conditions and  esophageal conditions in April 2021.  The clinician diagnosed gastroenteritis.  The clinician only provided an opinion with regard to direct service connection.

The Veteran has submitted a July 2025 medical opinion by his wife, a board-certified endocrinologist and associate professor of medicine.  She noted that she has known the Veteran since 2008, prior to his active duty service, and described her observations of his symptoms.  She diagnosed dyspepsia and opined that it was secondary to his service-connected psychiatric disability, noting that "persistent heavy alcohol intake and tobacco use are well-recognized precipitants of gastroesophageal reflux disease (GERD), and the hyperarousal and chronic stress of PTSD further exacerbate acid reflux."   

(Continued on the next page)

?

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's dyspepsia was caused or aggravated by his service-connected psychiatric disability.  Accordingly, the Board finds that granting service connection for a digestive disability is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case.
al and chronic stress of PTSD further exacerbate acid reflux."   

(Continued on the next page)

?

The medical opinion of the Veteran's wife is favorable to his claim and supported by an adequate rationale.  The record contains no adequate medical opinion to the contrary.  In light of the totality of the circumstances, and after resolving all reasonable doubt in his favor, the evidence of record does not weigh persuasively against finding that the Veteran's dyspepsia was caused or aggravated by his service-connected psychiatric disability.  Accordingly, the Board finds that granting service connection for a digestive disability is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case.  38 C.F.R. § 3.303(a).

 

 

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Frank, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.