TINNITUS

J. NICHOLS · 2026 · Case ID: A26038336

MIXED

Summary

The veteran, who served in the Army from March 2005 to October 2016, appeals the denial of service connection for tinnitus and the denial of an increased rating for GERD from February 1, 2020. The Board granted service connection for tinnitus, finding the veteran competent to identify the condition and credible in his testimony regarding its onset during service and continuity of symptoms. The Board found the initial VA opinion inadequate due to a lack of rationale and a failure to address the veteran's reported symptoms. Service connection for tinnitus was established based on the veteran's testimony and service treatment records noting the condition. For GERD, the Board found the evidence in equipoise for a 30 percent rating from February 1, 2020, based on the veteran's testimony of persistently recurring symptoms, including substernal pain and considerable impairment of health without medication, despite a VA examiner's less favorable findings. The claim for lumbar spine spondylosis with chronic sprain was remanded for a new VA examination to clarify the severity of the condition, particularly during flare-ups, due to a pre-decisional duty to assist error in the prior rating decision.

Rationale

Veteran competent to identify tinnitus; Veteran's testimony credible; VA medical opinion inadequate due to lack of rationale; Continuity of symptoms established

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210519-160772

Full Decision Text

Citation Nr: A26038336
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 210519-160772
DATE: April 23, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

An increased rating of 30 percent, but no higher, is granted for gastroesophageal reflux disease (GERD) from February 1, 2020, subject to the regulations governing the payment of monetary awards.

REMANDED

Entitlement to an increased rating for lumbar spine spondylosis (spinal osteoarthritis) with chronic sprain due to Bastrup syndrome, currently rated 10 percent disabling, is remanded.

FINDINGS OF FACT

1. The Veteran was diagnosed with tinnitus during active duty, and he has had intermittent tinnitus since that time.

2. The evidence is at least in equipoise that, from February 1, 2020, the Veteran's GERD has resulted in persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, and considerable impairment of his health, without medication.

CONCLUSIONS OF LAW

1. 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

2. The criteria for an increased rating of 30 percent, but no higher, have been met for gastroesophageal reflux disease (GERD) from February 1, 2020, subject to the regulations governing the payment of monetary awards. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.114, Diagnostic Code 7346.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Army from March 2005 to October 2016.

This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2021 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In May 2021, the Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), requesting a hearing with a Veterans Law Judge.

In March 2025, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the transcript is of record.

As the Veteran's case is proceeding on the hearing docket, the Board may only consider the evidence of record at the time of the 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).

1. Entitlement to service connection for tinnitus

The Veteran contends that he has tinnitus which onset during his active duty service and has continued to the present.

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted 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).

Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Turning to the evidence, the Veteran's military occupation
(d).

Turning to the evidence, the Veteran's military occupation specialty was policeman, which carries a moderate risk of exposure to hazardous noise.

The Veteran's service treatment records are silent for any complaint, diagnosis, or treatment for tinnitus until April 2016. In April 2016, a physical disability evaluation listed tinnitus as a disability and found that the Veteran met retention standards.

A June 2016 Army audiology examination diagnosed tinnitus and stated "The service member has a reported constant high pitched tinnitus in both ears. This tinnitus is most noticeable when he is quiet situations and it does not cause sleep disturbance." The Veteran said that his tinnitus onset during his deployment 2007-2008 following exposure to frequent artillery noise and a pipe bomb. See C&P Exam, June 21, 2016; STR, October 25, 2016, p81; STR, November 10, 2016, p8.

In February 2021, VA completed a Disability Benefits Questionnaire (DBQ) for Hearing Loss and Tinnitus. Concerning tinnitus, the examiner said that the Veteran did not report recurrent tinnitus. The examiner then remarked that the Veteran "reports tinnitus up to 5 times per month with a feeling of being underwater followed by a tone lasting 1-2 minutes. Veteran reports these symptoms began in 2011." However, the examiner found that the Veteran's reported symptoms did not meet the Dauman and Tyler (1992) definition of tinnitus cited in the Tinnitus Handbook. Instead, the examiner found that the Veteran had transient ear noise which he said occurs in the general population without auditory damage or pathology and is less likely than not related to military noise exposure.

In March 2025, the Veteran testified before the Board of Veterans' Appeals. Concerning his tinnitus, the Veteran testified that he noticed it during active duty, and that at the time of the hearing it would normally occur a few times per month. He said that it was so severe that he could not hear any other sounds, and that it lasted between two and ten minutes.

Turning to the criteria for service connection, the evidence is divided as to whether the Veteran has a diagnosis of tinnitus. The VA medical opinion found that the Veteran's symptoms did not meet a medical definition of tinnitus. However, the opinion did not explain what that definition was. Conclusory opinions without a rationale are inadequate for VA purposes. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). See also Stefl v. Nicholson, 21 Vet. App. 120 (2007) (conclusory, contradictory, or incomplete analysis is not adequate.) Therefore, the VA medical opinion is inadequate for analysis.

The Veteran was diagnosed with tinnitus twice during service and he has reported tinnitus since his service. 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). Here, the Veteran is competent to identify tinnitus, and his statements are credible. Therefore, a current disability has been established, and the first requirement of service connection has been met. See Saunders, supra.

The second requirement for service connection is in-service incurrence of a disease or injury. Id. The Veteran served as a military policeman, a military occupational specialty which has a moderate probability of exposure to hazardous noise. The Veteran
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). Here, the Veteran is competent to identify tinnitus, and his statements are credible. Therefore, a current disability has been established, and the first requirement of service connection has been met. See Saunders, supra.

The second requirement for service connection is in-service incurrence of a disease or injury. Id. The Veteran served as a military policeman, a military occupational specialty which has a moderate probability of exposure to hazardous noise. The Veteran also testified that during his service he was nearby when a pipe bomb exploded as well as multiple improvised explosive devices. His testimony is credible, and therefore, the second requirement of service connection has been met.

Turning to the third requirement, the February 2021 VA DBQ concluded that the Veteran had transient ear noise instead of tinnitus, and that the transient ear noise was less likely than not caused by his active duty service because it occurs in the general population without auditory damage or pathology. As noted above, the diagnosis of transient ear noise lacked a rationale and was therefore inadequate. The medical opinion relied on the diagnosis of transient ear noise instead of tinnitus and therefore it is also inadequate for VA purposes. See Nieves-Rodriguez, Stefl, supra.

As tinnitus is an organic disease of the nervous system, service connection may be established by a showing that the disability onset during service or within one year of separation from service or showing that it was noted in service with symptoms continuously since separation from service. 38 C.F.R. § 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Here, the Veteran was diagnosed with tinnitus in April 2016 and again in June 2016, both of which were during his active duty service. He testified that he has had intermittent tinnitus since his separation from service. See Hearing Transcript, March 12, 2025, p16-17. There is no evidence indicating otherwise. Therefore, service connection has been established by showing continuity of symptoms under Walker.

2. Entitlement to an increased rating for gastroesophageal reflux disease (GERD) from February 1, 2020, which is currently rated 10 percent disabling

A November 2016 rating decision granted service connection for GERD with an evaluation of 0 percent effective October 21, 2016. That decision was not appealed. The Veteran filed a notice of intent to file a claim on February 1, 2020, followed by a claim for an increased rating on January 29, 2021. The April 2021 rating decision granted an increased rating of 10 percent effective February 1, 2020. The Veteran appealed the April 2021 rating decision to the Board. Therefore, the Board must determine the proper rating from February 1, 2020, forward. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994) (an increased rating claim is one "[w]here entitlement to compensation has already been established and an increase in the disability rating is at issue.")

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

The Veteran's GERD has been rated using the criteria of Diagnostic Code 7346. Under the criteria of DC 7346, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is warranted under DC 7346 for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114.

Turning to the
Code 7346. Under the criteria of DC 7346, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is warranted under DC 7346 for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114.

Turning to the evidence during the period on appeal, in September 2020, the Veteran reported to VA personnel that for the past three or four days he had a burning pain in his stomach and belching during meals. See CAPRI, February 4, 2021, p1.

In April 2021, a VA contractor completed a DBQ for Esophageal Conditions. Based on an in-person examination and a review of the VA e-folder, the examiner diagnosed GERD. Symptoms at the time of this examination included daily epigastric pain, reflux, and regurgitation. A list of symptoms included persistently recurrent epigastric distress, pyrosis, reflux, and regurgitation, but without pain, and not productive of considerable impairment of health. The examiner found no esophageal stricture. The Veteran used TUMs antacid medication continuously for his GERD.

In March 2025, the Veteran testified before the Board. The Veteran said that a private doctor told him that his esophagus had a stricture, that he had started using a steroid inhaler, and that he continued to have acid reflux and difficulty swallowing. The Veteran said that he also had substernal arm or shoulder pain when he did not use medication. See Hearing Transcript, March 12, 2025, p8-12.

Applying the rating criteria, the evidence is at least in equipoise that the Veteran has persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The April 2021 examiner found that the Veteran had four of the six criteria, but not substernal, arm, or shoulder pain, and not productive of considerable impairment of health. Based on the Veteran's testimony and the VA treatment records, the evidence is at least in equipoise that, without medication, the Veteran's condition results in substernal, arm, or shoulder pain, and considerable impairment of his health. Therefore, a 30 percent rating is warranted from February 1, 2020. See 38 C.F.R. § 4.114., DC 7346.

In order to warrant a higher 60 percent rating, the evidence must show pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. See 38 C.F.R. § 4.114., DC 7346. The April 2021 examiner found that there was no pain, vomiting, material weight loss, hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. Neither the VA treatment records nor the Veteran's testimony report symptoms of this level of severity. Therefore, a higher rating of 60 percent is not warranted. Id.

Under Ingram v. Collins, if the diagnostic criteria do not explicitly contemplate medication use, the Board must discount any beneficial effects of medication use when adjudicating entitlement to increased ratings. Ingram v. Collins, 38 Vet. App. 130 (2025). The diagnostic criteria of DC 7346 do not explicitly contemplate medication use. The Veteran's March 2025 testimony described his condition without the use of medication. By assigning a rating based on his testimony about his symptoms without medication, the Board has discounted the beneficial effects of medication use.

Total Disability Rating Based on Individual Unemployability (TDIU)

The Board has also considered whether a claim for a total disability rating based on individual unemployability (TDIU) was reasonably raised by the record as part and parcel of the increased rating claims during the period on appeal, pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). However, after a review of the record, the Board finds that TDIU was not raised by the record. Specifically, the evidence during the appeal period does not demonstrate that the Veteran is unable to secure or maintain substantially gainful employment
testimony about his symptoms without medication, the Board has discounted the beneficial effects of medication use.

Total Disability Rating Based on Individual Unemployability (TDIU)

The Board has also considered whether a claim for a total disability rating based on individual unemployability (TDIU) was reasonably raised by the record as part and parcel of the increased rating claims during the period on appeal, pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). However, after a review of the record, the Board finds that TDIU was not raised by the record. Specifically, the evidence during the appeal period does not demonstrate that the Veteran is unable to secure or maintain substantially gainful employment, and he has not contended that is the case. As such, TDIU will not be considered herein.

REASONS FOR REMAND

Entitlement to an increased rating for lumbar spine spondylosis (spinal osteoarthritis) with chronic sprain due to Bastrup syndrome, currently rated 10 percent disabling, is remanded.

Following the January 2021 claim for an increased rating for lumbar spine spondylosis, VA obtained a DBQ for Back Conditions in April 2021. The examiner stated that the Veteran did not have flare ups of his back condition. However, the Veteran's representative pointed out that at least one VA treatment record states that the Veteran's back pain at times becomes so severe that the Veteran is unable to walk. See CAPRI, February 4, 2021, p175 (describing "severe low back pain that occurs with running or working out and in the past has been so bad that he's not been able to walk.") This VA treatment record was in evidence at the time of the April 2021 rating decision; therefore, VA's reliance on the April 2021 DBQ was a pre-decisional duty to assist error which must be corrected on remand.

The matter is REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected lumbar spine spondylosis (spinal osteoarthritis) with chronic sprain due to Bastrup syndrome. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

(a.) In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

(b.) In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. The examiner should be aware of the VA treatment record (describing "severe low back pain that occurs with running or working out and in the past has been so bad that he's not been able to walk.") See CAPRI, February 4, 2021, p175. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

J. NICHOLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Dean, Robert

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.

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