TINNITUS

Summary

The Veteran served on active duty from February 1988 to August 1989. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision. The Veteran sought service connection for multiple conditions, including tinnitus, diabetes mellitus type II, chronic renal insufficiency, fibromyalgia, a heart condition, a thyroid disorder, primary optic atrophy, rheumatoid arthritis, systemic lupus erythematosus, and thrombotic thrombocytopenic purpura. The Veteran also sought service connection for residuals of a miscarriage and subsequent reproductive issues, potentially related to in-service immunizations, which was remanded. The Board granted service connection for tinnitus, finding the criteria were met. For all other claimed conditions, the Board found the evidence persuasively weighed against a service connection, citing negative findings in the evidence of record and the absence of a nexus to service or in-service immunizations. The Board noted that the Veteran's service treatment records showed no confirmation of the claimed conditions or their link to service. The Board also addressed the duty to assist error concerning the miscarriage claim, remanding it for a new VA opinion to address the etiology of the miscarriage and subsequent reproductive issues, considering an in-service finding of anemia.

Rationale

Criteria for entitlement met; Veteran's tinnitus began during service

Full Decision Text

Citation Nr: A26035680
Decision Date: 04/16/26	Archive Date: 04/16/26

DOCKET NO. 210518-160450
DATE: April 16, 2026

ORDER

Service connection for tinnitus is granted.

Service connection for diabetes mellitus type II (diabetes or DMII), to include as secondary to the service-connected disability of major depressive disorder and generalized anxiety disorder, is denied. 

Service connection for chronic renal insufficiency, post-transplant, to include as due to in-service immunizations, is denied. 

Service connection for fibromyalgia, to include as due to in-service immunizations, is denied. 

Service connection for a heart condition, claimed as a heart murmur and to include as due to in-service immunizations, is denied. 

Service connection for a thyroid disorder, to include as due to in-service immunizations, is denied. 

Service connection for primary optic atrophy of the bilateral eyes, to include as due to in-service immunizations, is denied. 

Service connection for rheumatoid arthritis, to include as due to in-service immunizations, is denied. 

Service connection for systemic lupus erythematosus, to include as due to in-service immunizations, is denied. 

Service connection for thrombotic thrombocytopenic purpura, to include as due to in-service immunizations, is denied. 

REMANDED

Entitlement to service connection for a miscarriage, status post-uterine ablation, to include as due to in-service immunizations, is remanded. 

FINDINGS OF FACT

1. The Veteran's tinnitus began during her active-duty service.

2. The competent evidence of record persuasively weighs against finding that the Veteran's diabetes mellitus, type II, is related to active military service, manifested within one year of service discharge, or was caused or aggravated by a service-connected disability.

3. The evidence of record persuasively weighs against finding that renal insufficiency began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

4. The evidence of record persuasively weighs against finding that fibromyalgia began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

5. The evidence of record persuasively weighs against finding that a heart condition began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

6. The evidence of record persuasively weighs against finding that a thyroid disorder began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

7. The evidence of record persuasively weighs against finding that primary optic atrophy of the bilateral eyes began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

8. The evidence of record persuasively weighs against finding that rheumatoid arthritis began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

9. The evidence of record persuasively weighs against finding that systemic lupus erythematosus began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

10. The evidence of record persuasively weighs against finding that thrombotic thrombocytopenic purpura began during active service, or is otherwise related to an in-service injury or disease, to include as due to in-service immunizations.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. § 1101, 1110, 1112, 1154, 5107, 7104; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.385.

2. The criteria for entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected disabilities, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309, 3.310.

3. The criteria for entitlement to service connection for renal insufficiency have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for fib
 3.385.

2. The criteria for entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected disabilities, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309, 3.310.

3. The criteria for entitlement to service connection for renal insufficiency have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for a heart condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to service connection for a thyroid disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for entitlement to service connection for primary optic atrophy of the bilateral eyes have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for entitlement to service connection for rheumatoid arthritis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for entitlement to service connection for systemic lupus erythematosus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for entitlement to service connection for thrombotic thrombocytopenic purpura have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1988 to August 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in May 2021 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA). That same month, the Veteran timely appealed such rating decision by filing a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested a Board hearing, which was held before the undersigned Veterans Law Judge in January 2025. A transcript of the hearing is associated with the record. In this regard, she is precluded from switching to a different docket as she has provided testimony at his Board hearing. 38 C.F.R. § 20.302; Williams v. McDonough, 37 Vet. App. 305 (2024).  

Therefore, the Board may only consider the evidence of record at the time of the May 2021 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his 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 on appeal 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. With respect to the claims adjudicated herein, if the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, she 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. 

Service Connection
 following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. With respect to the claims adjudicated herein, if the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, she 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. 

Service Connection 

Service connection is granted when the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a).

To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Under 38 C.F.R. § 3.310(a), service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury. Such permits a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation to a nonservice-connected disability by a service-connected disability. Id. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310(b).

In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

1. Entitlement to service connection for tinnitus.

The Veteran contends that she is entitled to service connection for tinnitus.

Tinnitus is a disorder that is capable of lay-observation and the Veteran is competent to relate her post-service symptoms of tinnitus. See Charles v. Principi, 16 Vet. App. 370 (2002).

In the May 2021 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with recurrent tinnitus and that she was exposed to hazardous noise during her military service. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). Accordingly, the first and second elements of service connection are met.

As to the third element of service connection, a nexus, the Board finds that the evidence of record supports a finding that the Veteran's tinnitus is related to her active-duty service.

A December 2020 VA examiner opined that the Veteran's tinnitus was less likely than not caused by or a result of military noise exposure. The examiner relied upon the lack of complaints in the Veteran's service treatment records (STRs). However, the Board finds this opinion to be inadequate and assigns little probative value. While the Veteran's STRs fail to demonstrate that the Veteran reported tinnitus during service, an absence of contemporaneous records documenting in-service complaints or treatments is not fatal to a claim for service connection. See Savage v. Gober,
As to the third element of service connection, a nexus, the Board finds that the evidence of record supports a finding that the Veteran's tinnitus is related to her active-duty service.

A December 2020 VA examiner opined that the Veteran's tinnitus was less likely than not caused by or a result of military noise exposure. The examiner relied upon the lack of complaints in the Veteran's service treatment records (STRs). However, the Board finds this opinion to be inadequate and assigns little probative value. While the Veteran's STRs fail to demonstrate that the Veteran reported tinnitus during service, an absence of contemporaneous records documenting in-service complaints or treatments is not fatal to a claim for service connection. See Savage v. Gober, 10 Vet. App. 488 (1997). The examiner also did not adequately consider the Veteran's reported tinnitus during her service.

Despite the lack of a positive nexus opinion, the Board finds that there is evidence of record to support a nexus between the Veteran's tinnitus and her active-duty service. The Veteran asserted that her tinnitus began during her active-duty service, and the AOJ conceded that she experienced in-service hazardous noise exposure. The Board finds no reason to doubt the credibility of these statements, and affords great probative weight to the Veteran's report of in-service onset and exposure to hazardous noise. As such, resolving any reasonable doubt in the Veteran's favor, the third element of service connection is met.

In reviewing all the evidence and resolving any reasonable doubt in favor of the Veteran, the Board finds that the Veteran's tinnitus began during her active-duty service and is etiologically related to the noise exposure she experienced in service. As such, the Veteran is entitled to service connection for tinnitus, and the claim is granted.

2. Entitlement to service connection for diabetes, to include as secondary to the service-connected disability of major depressive disorder and generalized anxiety disorder. 

In the Veteran's December 2020 VA Form21-526EZ, Application for Disability Compensation and Related Compensation Benefits, she argued that her diabetes is secondary to her service-connected psychiatric disabilities. 

In the May 2021 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with diabetes mellitus, type II, and that she is service-connected for major depressive disorder with generalized anxiety disorder. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).

A review of the Veteran's STRs shows no diagnosis of diabetes. She has reported being diagnosed in 2014, many years after separation from service.

In March 2021, a diabetes mellitus disability benefits questionnaire (DBQ) was completed. The examiner confirmed the Veteran's diagnosis of type II diabetes mellitus. The Veteran had been prescribed weekly injections of medicine and did not require regulation of activities as part of the management of the disability. 

That examiner subsequently provided a medical opinion, explaining that no evidence supported a causal relationship between the Veteran's diabetes and her time in service or her service-connected psychiatric conditions. The examiner referenced medical literature as well as the Veteran's specific medical history and symptoms when offering this opinion. 

Accordingly, the Board finds this medical opinion to be adequate. In this regard, the examiner thoroughly reviewed and discussed the relevant evidence, considered the contentions of the appellant, and provided a supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As there is no medical opinion of record to the contrary, the March 2021 medical opinion is the most probative evidence of record. Therefore, the third element of service connection has not been met, and the claim is denied.

In reaching this conclusion, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran's diabetes did not result from her time in service to include her service-connected psychiatric disabilities. Thus, the benefit-of-the-doubt rule
." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran's diabetes did not result from her time in service to include her service-connected psychiatric disabilities. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

3. Entitlement to service connection for chronic renal insufficiency, post-transplant, to include as due to in-service immunizations. 

4. Entitlement to service connection for fibromyalgia, to include as due to in-service immunizations. 

5. Entitlement to service connection for a heart condition, to include heart murmur due to in-service immunizations. 

6. Entitlement to service connection for a thyroid disorder, to include as due to in-service immunizations. 

7. Entitlement to service connection for primary optic atrophy of the bilateral eyes, to include as due to in-service immunizations. 

8. Entitlement to service connection for rheumatoid arthritis, to include as due to in-service immunizations. 

9. Entitlement to service connection for systemic lupus erythematosus, to include as due to in-service immunizations. 

10. Entitlement to service connection for thrombotic thrombocytopenic purpura, to include as due to in-service immunizations.

The Veteran contends that her remaining claims should be granted, as she believes these disabilities stem from in-service immunizations. This is the sole contention and she has advanced no other theory of entitlement to service connection.

The Board notes that in the May 2021 rating decision, the AOJ made favorable findings that the Veteran has current diagnoses of renal insufficiency, thyroid impairment, primary optic atrophy, rheumatoid arthritis, and lupus erythematosus. The Board is bound by these favorable findings. 38 C.F.R. § 3.104 (c). Further, additional medical evidence associated with the record indicates that the Veteran has diagnoses of fibromyalgia, hypertension, and thrombotic thrombocytopenic purpura. Therefore, the first element of service connection is met as to these claims.

However, regarding an in-service event, injury, or incurrence, the Board notes that the Veteran's service medical and personnel records do not indicate symptoms of or treatment for any of these conditions. Importantly, at the January 2025 Board hearing, the Veteran explained that all of these conditions developed after her separation from active-duty service when she fell ill in 2013. She specifically reported becoming ill unexpectedly, spending several months in the ICU due to a coma, and waking up with blindness and her other claimed disorders. See January 2025 Board Hearing Transcript.

The Veteran was afforded various VA medical examinations in order to evaluate whether her claimed conditions could be medically linked to her reported in-service incident. Each condition was, thereafter, addressed in various nexus opinions issued in December 2020, except for the negative nexus opinion for lupus, which was issued in May 2021. Specifically, each examiner considered the entirety of the evidence, to include the Veteran's lay statements, and found it less likely than not that each claimed condition was related to the Veteran's military service, to include any vaccines or immunizations received therein. To support each opinion, the examiners found that there is simply no medical evidence available, to include within the Veteran's file or from a review of relevant primary source medical literature, to support the existence of an etiological relationship between immunizations and the Veteran's claimed conditions.

In this regard, the Board affords great probative weight to the December 2020 and May 2021 VA examiners' determinations, as such considered all pertinent evidence of record, to include the Veteran's statements, her relevant medical history, and her current physical examination. Importantly, they provided a complete rationale, relying on and citing to the records reviewed. Nieves-Rodriguez, supra; Stefl, supra.

It is also important to note that, like these medical examiners, the Board cannot rely on the Veteran's statements alone to find that any of her claimed disabilities are etiologically related to service. See Jandreau, supra. In this regard, while the Veteran genuinely believes that her claimed conditions are related to her in-service vaccinations and immunizations, the etiology of such disorders involves a medical subject concerning an internal physical process extending beyond an immediately observable
 as such considered all pertinent evidence of record, to include the Veteran's statements, her relevant medical history, and her current physical examination. Importantly, they provided a complete rationale, relying on and citing to the records reviewed. Nieves-Rodriguez, supra; Stefl, supra.

It is also important to note that, like these medical examiners, the Board cannot rely on the Veteran's statements alone to find that any of her claimed disabilities are etiologically related to service. See Jandreau, supra. In this regard, while the Veteran genuinely believes that her claimed conditions are related to her in-service vaccinations and immunizations, the etiology of such disorders involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). 

Accordingly, the Veteran's opinion as to the etiology of her renal insufficiency, fibromyalgia, heart condition, thyroid disorder, primary optic atrophy of the bilateral eyes, rheumatoid arthritis, lupus, and thrombotic thrombocytopenic purpura is not competent evidence and, consequently, is afforded no probative weight. Therefore, due to the absence of additional evidence, to include supported medical opinions, the Board must find that there is no in-service event, incurrence, or injury relating to these disabilities. 

Based on the foregoing, the Veteran's claims of entitlement to service connection for renal insufficiency, fibromyalgia, a heart condition, a thyroid disorder, primary optic atrophy of the bilateral eyes, rheumatoid arthritis, lupus, and thrombotic thrombocytopenic purpura must be denied. Again, consideration has been given to the benefit of the doubt doctrine; however, as the weight of the probative evidence is against the Veteran's claim, it is not applicable. See 38 U.S.C. § 5107 (b); see also Gilbert, supra. 

REASONS FOR REMAND

1. Entitlement to service connection for a miscarriage, status post-uterine ablation, to include as due to in-service immunizations. 

The Veteran seeks service connection for residuals of a miscarriage, which she says occurred in 1989 on her way home after separation from military service. She reported that she has had reproductive issues since that time, and believes they are all related to her military service, to include possibly her in-service immunizations. 

The Board notes that a VA examination report was obtained in December 2020, which documented the reported miscarriage in 1989 and a uterine ablation in 1992. The disability benefits questionnaire also documented the Veteran's report of ongoing heavy menses with cramping. The examiner went on to provide a negative nexus opinion, stating that there was no medical evidence to confirm an etiological link between the Veteran's in-service vaccinations and any subsequent gynecological issues. This limited finding was the extent of the opinion. 

However, the Board finds that another opinion must be obtained that more broadly and thoroughly addresses the etiology of the Veteran's reported miscarriage and subsequent reproductive issues, status post-uterine ablation. In this regard, the Veteran's July 18, 1989, prenatal examination report includes a finding of anemia, occurring prior to separation from service. Accordingly, the Board finds that the AOJ committed a pre-decisional duty to assist error by not obtaining a medical opinion that addresses this relevant in-service finding. In this regard, VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination that is accurate and fully descriptive.  McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also 38 U.S.C. § 5103A (d)(2).

Thus, this pre-decisional duty-to-assist error should be remedied on remand by obtaining a VA opinion with adequate supporting rationale.

The matters are REMANDED for the following action:

Obtain an opinion regarding the onset and etiology of the Veteran's claimed condition of miscarriage residuals, to include any reproductive issues requiring uterine ablation. After reviewing the record, to include the Veteran's January 2025 Board hearing testimony, the examiner is asked to opine whether it is at least as likely as not that the Veteran developed a disorder during active-duty service that resulted in a miscarriage in 1989 and/or any residual reproductive disorder diagnosis. 


 U.S.C. § 5103A (d)(2).

Thus, this pre-decisional duty-to-assist error should be remedied on remand by obtaining a VA opinion with adequate supporting rationale.

The matters are REMANDED for the following action:

Obtain an opinion regarding the onset and etiology of the Veteran's claimed condition of miscarriage residuals, to include any reproductive issues requiring uterine ablation. After reviewing the record, to include the Veteran's January 2025 Board hearing testimony, the examiner is asked to opine whether it is at least as likely as not that the Veteran developed a disorder during active-duty service that resulted in a miscarriage in 1989 and/or any residual reproductive disorder diagnosis. 

When rendering this opinion, the examiner must consider the July 18, 1989, in-service prenatal examination report, which includes a finding of anemia. 

A rationale for any opinion offered should be provided.

 

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Breckenridge, Meredith A.

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.