TINNITUS

Summary

The veteran, who served in the United States Air Force from December 1990 to June 1991, March 2003 to March 2005, April 2009 to July 2009, and October 2010 to January 2011, appeals the denial of service connection for tinnitus. The veteran's claim is based on alleged noise exposure during service, particularly as a C-130 pilot during a deployment to Iraq in 2003. The veteran testified to experiencing constant tinnitus starting in 2003, consistent throughout his service and continuing to the present, and noted that he was discouraged from seeking medical treatment for hearing issues during service. The Board found the veteran's lay statements credible and probative, noting the consistency with his service as a pilot and the specific circumstances of his deployment. The Board also found the August 2020 VA examination opinion inadequate because it failed to properly address the nature of tinnitus under VA regulations, ignored the veteran's specific assertions about onset and continuity, and misstated the conclusions of a relevant Institute of Medicine study. Given the inadequacy of the negative opinion and the credible lay evidence supporting service connection, the Board found the evidence sufficient to grant service connection without further development. Service connection for tinnitus is granted.

Rationale

Credible lay evidence of in-service onset and continuity; Inadequate VA examination opinion; Tinnitus capable of lay observation

Full Decision Text

Citation Nr: A26036084
Decision Date: 04/17/26	Archive Date: 04/17/26

DOCKET NO. 210514-159092
DATE: April 17, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

FINDING OF FACT

The Veteran's tinnitus began in service and there is continuity of symptomatology since service.

CONCLUSION OF LAW

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.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the United States Air Force from December 1990 - June 1991, March 2003 - March 2005, April 2009 - July 2009, and October 2010 - January 2011. The Veteran had additional service in the National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 6, 2021 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the May 14, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on October 22, 2024. A transcript of the hearing has been associated with the claims file. 

Therefore, the Board may only consider the evidence of record at the time of the April 6, 2021 rating decision on appeal, as well as any evidence submitted by the Veteran 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. 

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, 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 may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as organic diseases of the nervous system, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); see also Fountain v. McDonald, 27 Vet. App. 258 (2015) (including tinnitus as an organic disease of the nervous system).

Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to
 F.3d 1331 (Fed. Cir. 2013); see also Fountain v. McDonald, 27 Vet. App. 258 (2015) (including tinnitus as an organic disease of the nervous system).

Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. Walker, 708 F.3d 1331.

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). If the evidence persuasively weighs against a claim, the claim is denied.

Entitlement to service connection for tinnitus

The Veteran contends that he is entitled to service connection for tinnitus. See February 2020 VA Form 21-526EZ Application for Disability Compensation. 

The AOJ made favorable findings that the Veteran has a current diagnosis of tinnitus and that he had noise exposure in service and meets the baseline requirements for presumptive service connection for tinnitus as a chronic disease. 

The remaining question for the Board is whether the Veteran's tinnitus, as a chronic disease, was noted in service with continuity of symptomatology since service. 

During the August 2020 VA hearing loss and tinnitus examination, the Veteran reported that his bilateral tinnitus began in 2003 and was constant. The examiner indicated that the Veteran reported recurrent tinnitus. 

At his October 2024 hearing, the Veteran testified that he flew C-130s for the military which is a particularly loud aircraft; that his deployment in 2003 was unique and involved significantly more noise exposure than his other service; that in 2003, while supporting the invasion of Iraq, he flew significantly more hours a week than during his other service; and that he spent a significant amount of time at forward operating bases which required leaving the generators and engines on for long periods of time, which was a significant source of noise. He also stated that it was during this deployment to Iraq that he began noticing his tinnitus, which was consistent throughout his service, after service, and continues today. Furthermore, he stated that during service he was actively dissuaded from seeking treatment from the flight doctor for anything or he'd risk being unable to fly. He said that he would not seek treatment unless he was actively bleeding. 

The representative also timely submitted undated private treatment records in October 2024. While the records are undated, they refer to a hearing test conducted in June 2024, and state that the Veteran was last seen then. The clinician documented the Veteran's reports of a history of noise exposure, noting the Veteran's only risk factor/noise exposure as his military service, and describing the Veteran's symptom of intermittent and frequent tinnitus over time in both ears.

When a claim involves a diagnosis, like tinnitus, based on purely subjective complaints, the Board is within its province to weigh the Veteran's statements and determine whether it supports a finding of service incurrence and continued symptoms since service. Barr v. Nicholson, 21 Vet. App. 303, 305(2007). If it does, such lay evidence may be sufficient to establish service connection. Id. Here, the Veteran is competent to describe symptoms of tinnitus, and his statements are consistent with the circumstances of his service, i.e., his position as a pilot in the Air Force. The Board therefore finds his statements credible and probative. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). 

The Board notes that the August 2020 VA examiner opined that the Veteran's tinnitus was less likely than not caused by or the result of military noise exposure. The examiner stated that tinnitus is accepted to be a symptom capable of lay detection associated with many conditions and circumstances outside of noise exposure. When caused by noise exposure, tinnitus most commonly accompanies hearing loss
 the Veteran is competent to describe symptoms of tinnitus, and his statements are consistent with the circumstances of his service, i.e., his position as a pilot in the Air Force. The Board therefore finds his statements credible and probative. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). 

The Board notes that the August 2020 VA examiner opined that the Veteran's tinnitus was less likely than not caused by or the result of military noise exposure. The examiner stated that tinnitus is accepted to be a symptom capable of lay detection associated with many conditions and circumstances outside of noise exposure. When caused by noise exposure, tinnitus most commonly accompanies hearing loss and/or significant threshold shifts. According to the examiner, the Veteran did not present with either hearing loss or significant threshold shifts between audiograms most proximal to documented dates of entry and separation. The examiner also referenced the 2005 Institute of Medicine report, stating that it found that the most profound auditory effects of noise exposure occur immediately following exposure. Therefore, it was less likely than not that the Veteran's tinnitus was caused by or a result of military noise exposure. 

In an October 2024 brief, the Veteran's representative argued that the August 2020 VA examination documented that the Veteran is competent to report his tinnitus as an observable symptom, noted he reported his onset in 2003 and continuity of symptoms since then, and then provided a negative nexus opinion with a generic, copied and pasted rationale that tinnitus is "most commonly" associated with hearing loss. The representative argued that the fact that tinnitus is "most commonly" associated with hearing loss has no bearing or relevance on whether the Veteran's specific condition was caused by his service. In addition, the representative argued that the examiner's rationale is contradicted by the examiner's own documented history noting continuous symptoms since 2003, while the Veteran was on active duty. 

The Board finds the August 2020 VA examiner's opinion inadequate for multiple reasons. First, as the Veteran's representative argues, by tying tinnitus to hearing loss, the VA examiner ignored the nature of tinnitus under VA regulations and caselaw, i.e., a ringing in the ears capable of lay observation for which medical expertise is not required to establish its existence. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). Next, the VA examiner's opinion simply ignored the Veteran's statements concerning the onset of constant tinnitus in service. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (finding that an examiner impermissibly ignored the appellant's lay assertions). Finally, the examiner cited a study by the Institute of Medicine (IOM) but misstated the conclusions of the IOM study, as that study did not conclude that there was affirmative evidence that delayed-onset hearing loss/tinnitus was impossible, but rather concluded that there was not currently sufficient scientific evidence to demonstrate such a relationship. See McCray v. Wilkie, 31 Vet. App. 243 (2019). Accordingly, the Board gives the August 2020 VA examiner's negative opinion no probative weight in this matter. 

The Board could remand for another medical opinion. However, based on the applicable legal standard, the uncontested facts established to date, and the absence of a reasonable basis to believe that additional development could alter the approximate balance of evidence, a remand is not appropriate. See 38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews v. McDonough, 34 Vet. App. 216, 225 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim"). The evidence of record in this case is sufficient to allow the VA to discern that service connection is warranted. Id. 

Since the Board has deemed the August 2020 VA opinion inadequate, there is no evidence opposing the Veteran's claim. Further, as explained above, the Board has found the Veteran's reports of experiencing tinnitus in service and since service credible and probative. 

Accordingly, as the Veteran has credibly asserted that his tinnitus began in service and that he has had continuity of symptomatology since service, service connection for tinnitus as a chronic disease is granted.

 

 

Marissa Caylor

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.B.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not
 service connection is warranted. Id. 

Since the Board has deemed the August 2020 VA opinion inadequate, there is no evidence opposing the Veteran's claim. Further, as explained above, the Board has found the Veteran's reports of experiencing tinnitus in service and since service credible and probative. 

Accordingly, as the Veteran has credibly asserted that his tinnitus began in service and that he has had continuity of symptomatology since service, service connection for tinnitus as a chronic disease is granted.

 

 

Marissa Caylor

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.B.

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.