HEARING LOSS

Summary

The veteran, who served from September 1988 to February 1998, appeals the denial of service connection for epistaxis and maxillary sinusitis, and the initial rating decision for bilateral hearing loss and tinnitus. The Board found persuasive evidence supporting service connection for bilateral hearing loss and tinnitus. The veteran's military occupational specialty as an aviation machinist mate involved exposure to acoustic trauma, and service treatment records documented participation in the hearing conservation program. The discharge report of medical history noted hearing loss, and the veteran credibly testified to the onset and persistence of tinnitus since service. The Board found the VA examiner's negative opinion inadequate for failing to explain why in-service hearing threshold shifts were necessary. Resolving reasonable doubt in the veteran's favor, service connection for bilateral hearing loss and tinnitus was granted. For epistaxis and maxillary sinusitis, the veteran testified to in-service complaints, but the Board found the evidence against a service connection. A June 2020 VA examination found no current abnormalities, and private records were silent for epistaxis. While private records showed sinusitis in 2016, they also noted intact nasal membranes, and the provider did not link it to service. The Board noted the favorable finding of sinus complaints in service treatment records but found the veteran's minimization of symptoms and lack of mention of these issues on the discharge report weighed against service connection. The Board remanded the migraine claim, finding that the veteran's reported headaches due to stress, coupled with a service connection for PTSD, met the criteria for a secondary service connection claim, requiring a new VA opinion.

Rationale

Persuasive evidence supports award of service connection.; In-service report of hearing loss and credible testimony of tinnitus onset.; Inadequate VA opinion due to failure to discuss necessity of in-service hearing threshold shifts.; Resolving reasonable doubt in veteran's favor.

Full Decision Text

Citation Nr: A26034347
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 210208-139780
DATE: April 14, 2026

ORDER

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

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for epistaxis (nosebleeds) is denied.

Entitlement to service connection for maxillary sinusitis is denied.

REMANDED

Entitlement to service connection for migraines, to include as secondary to other specified trauma and stress related disorder, is remanded.

FINDINGS OF FACT

1. The evidence persuasively supports that a bilateral hearing loss disability began in service. 

2. Tinnitus began in service and continues to the present.

3. The Veteran does not have a diagnosis of epistaxis. 

4. Maxillary sinusitis is not related to service. 

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral hearing loss disability have been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.385.

2. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for epistaxis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

4. The criteria for service connection for maxillary sinusitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1988 to February 1998. 

The rating decision on appeal was issued in July 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In September 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a July 2020 decision. In January 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior July 2020 decision. Therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the July 2020 decision and any evidence submitted during an applicable evidentiary window.  

In the February 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on November 19, 2024.

Therefore, the Board may only consider the evidence of record at the time of the July 2020 AOJ decision, which was subsequently subject to higher-level review, 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). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

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

Service Connection

In order to establish service connection for a present disability the claimant must show the existence of a present disability, an in-service incurrence or aggravation of a disease or injury, and a causal relationship or "nexus" between the present disability and the in-service injury or disease. Saunders v. Wilkie,
 the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

In order to establish service connection for a present disability the claimant must show the existence of a present disability, an in-service incurrence or aggravation of a disease or injury, and a causal relationship or "nexus" between the present disability and the in-service injury or disease. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as tinnitus and sensorineural hearing loss, which are organic diseases of the nervous system, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

1. Entitlement to service connection for bilateral hearing loss disability.

2. Entitlement to service connection for tinnitus.

The Veteran contends he has bilateral hearing loss and tinnitus due to service.

The Board has carefully reviewed the evidence of record and finds that the evidence is persuasively in favor of the award of service connection for a bilateral hearing loss disability and tinnitus.

The Veteran has a bilateral hearing loss disability for VA purposes, and he is diagnosed with sensorineural hearing loss. The Veteran credibly reports recurrent tinnitus. 

The Veteran's military occupational specialty (MOS) of aviation machinists mate has at least a minimal exposure to acoustic trauma. Service treatment records (STRs) document that the Veteran was in the hearing conservation program during service

On the October 1997 discharge Report of Medical History (RMH), the Veteran reported hearing loss. The Veteran credibly testified that his tinnitus began in service and continues to the present day. 

The Veteran was provided negative VA medical opinions in June 2020. The examiner's sole rationale for denying service connection was that there was no in-service permanent shifts in hearing thresholds beyond test variability. The examiner failed to discuss why an in-service permanent threshold in hearing thresholds is necessary to establish a nexus between service and hearing loss and tinnitus. As such, this VA medical opinion is inadequate because the examiner did not provide a well-reasoned rationale An inadequate medical opinion is not probative. 

The Board finds the Veteran's in-service report of hearing loss and his credible testimony that tinnitus began in service and continues to the present is sufficient to establish a nexus. 

As such, resolving reasonable doubt in favor of the Veteran, service connection for a bilateral hearing loss disability and tinnitus are granted.

3. Entitlement to service connection for epistaxis.

4. Entitlement to service connection for maxillary sinusitis.

The Veteran contends he has epistaxis and sinusitis that began in service. 

He testified that he experienced nosebleeds in service which continue to the present day when his nose becomes dry. He also testified that he has experienced sinusitis which began in service and continues to present day. 

The Board finds the evidence is against a nexus to service for these conditions.

The Veteran underwent a VA nasal examination in June 2020. The examiner found no evidence of nosebleeds or sinusitis on the examination. The Veteran's private medical records are silent for a diagnosis of epistaxis. In November 2024, the Veteran submitted a statement from his private doctor that said the Veteran was diagnosed with sinusitis. Private medical records show an instance of sinusitis in early 2016. Notably, other February and March 2016 private medical records documented the Veteran's nasal mucous membranes as intact and without abnormalities. The private provider did not indicate that the Veteran's sinusitis was related to service.   

The Board notes the favorable findings that STRs document sinus complaints and epistaxis in service. However, the Veteran's discharge RMH does not indicate any issues with these conditions. The Veteran testified that he minimized his conditions because he hoped to return to active duty as an officer. But on the discharge RMH, the Veteran did report his other conditions of hearing loss,
 a statement from his private doctor that said the Veteran was diagnosed with sinusitis. Private medical records show an instance of sinusitis in early 2016. Notably, other February and March 2016 private medical records documented the Veteran's nasal mucous membranes as intact and without abnormalities. The private provider did not indicate that the Veteran's sinusitis was related to service.   

The Board notes the favorable findings that STRs document sinus complaints and epistaxis in service. However, the Veteran's discharge RMH does not indicate any issues with these conditions. The Veteran testified that he minimized his conditions because he hoped to return to active duty as an officer. But on the discharge RMH, the Veteran did report his other conditions of hearing loss, pain in the chest, and nervous trouble of any kind. The Board finds that the Veteran did report the disabilities that he experienced when he left service, but made no mention of sinus or epistaxis issues.  

The Board acknowledges the Veteran's contention that he has experienced epistaxis and sinusitis since service, but records do not indicate complaints of these conditions until several years after service.  There is also no evidence that any such conditions were related to a period of service.  As a layperson, such an opinion requires specialized medical testing and expertise which falls outside the realm of the common knowledge of a layperson. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 

Without a competent and credible diagnosis of epistaxis, and without competent and credible evidence that supports that epistaxis or sinusitis are related to service, a claim for service connection cannot proceed in this case. As such, the Board finds service connection for sinusitis or epistaxis is not warranted. 

REASONS FOR REMAND

Entitlement to service connection for migraines, to include as secondary to other specified trauma and stress related disorder.

A March 2016 private treatment record documents that the Veteran complained of headaches due to stress. This statement raises the possibility of secondary service connection, but the AOJ did not acquire a secondary service connection opinion. 

VA must provide a medical examination or opinion 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 claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83.

In this case, the Veteran has reported migraines, and he is service connected for other specified trauma and stress related disorder. During treatment, he reported headaches due to stress. Therefore, all the prongs of McLendon are met.

The failure to acquire an opinion regarding secondary service connection is a pre-decisional duty to assist error which must be corrected with a remand. 

Provide the Veteran's claims file to an appropriate clinician for an opinion on the likely etiology of migraines.

After review, the examiner is asked the following:

a)	Is it at least as likely as not that migraines were caused and/or aggravated by service-connected other specified trauma and stress related disorder? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions.

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A full rationale must be provided for all medical opinions.

 

 

Ann K. Minami

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	P. McDaniels, 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.