TINNITUS

Summary

The Veteran, who served in the U.S. Air Force from June 1965 to July 1969, appeals rating decisions concerning bilateral tinnitus, normocytic anemia, and a left inguinal hernia. The Board granted service connection for bilateral tinnitus, finding that while the VA examiner opined against a service connection due to normal hearing in service and the nature of the Veteran's MOS, the Veteran's subjective reports of tinnitus were credible and, when balanced with the negative evidence, warranted application of the benefit of the doubt doctrine. Service connection for normocytic anemia as secondary to chronic hemorrhoids was also granted. The Board found persuasive the opinion of Dr. D.G., a VA medical professional, who stated that the Veteran's chronic hemorrhoids were at least as likely as not aggravating the anemia beyond its natural progression, citing persistent rectal bleeding and the absence of other identified pathologies. The claim for left inguinal hernia was remanded due to a pre-decisional duty to assist error. The VA examiner's September 2025 examination was inadequate because it failed to acknowledge objective evidence of a left inguinal hernia repair, despite the Veteran's consistent reports and medical records documenting the condition and related pain. The Board found that the AOJ's failure to obtain an adequate examination and opinion constituted a duty to assist error, necessitating remand for a proper assessment of the hernia's etiology and relationship to service or service-connected varicocele.

Rationale

Veteran's subjective reports of tinnitus are credible.; Evidence is in approximate balance.; Benefit of the doubt doctrine applied.

Full Decision Text

Citation Nr: A26039604
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260220-632464
DATE: April 28, 2026

ORDER

Entitlement to service connection for bilateral tinnitus is granted.

Entitlement to service connection for normocytic anemia, to include as secondary to service-connected chronic hemorrhoids is granted.

REMANDED

Entitlement to service connection for left inguinal hernia is remanded.

FINDINGS OF FACT

1. The Veteran has experienced ringing in his ears related to bilateral tinnitus during service and it has persisted since then.  

2. The Veteran's normocytic anemia is caused or aggravated by his service-connected chronic hemorrhoids.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for bilateral tinnitus are met.  38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for normocytic anemia as secondary to chronic hemorrhoids are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served active duty in the U.S. Air Force from June 1965 to July 1969.

This case comes before the Board on appeal of AMA rating decisions from September 2025 and November 2025.

In the February 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the September and November 2025 agency of original jurisdiction (AOJ) decisions on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 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 in this decision. 

However, because the Board is remanding the claim above, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims.  38 C.F.R. § 3.103(c)(2)(ii). 

Service Connection

Generally, to establish service connection 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 any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.         38 C.F.R. § 3.303 (d). 

Service connection may also be granted through the application of statutory presumptions for chronic conditions, which includes tinnitus.  See 38 C.F.R. §§ 3.303 (b), 3.309 (a); see also 38 U.S.C. §§ 1112, 1137.  First, a claimant may benefit from a presumption of service connection where a chronic disease has been shown during service.  38 C.F.R. § 3.303 (b).  In the alternative, if a chronic disease was not shown in service, but manifested to a degree of 10 percent or more within some specified time after separation from active service, such disease shall be presumed to have been incurred or aggravated in service, even if there is no evidence of such disease during service.  38 U.S.C. §§ 1112, 1137; 38 C.F.R. § 3.307 (a)(3
); see also 38 U.S.C. §§ 1112, 1137.  First, a claimant may benefit from a presumption of service connection where a chronic disease has been shown during service.  38 C.F.R. § 3.303 (b).  In the alternative, if a chronic disease was not shown in service, but manifested to a degree of 10 percent or more within some specified time after separation from active service, such disease shall be presumed to have been incurred or aggravated in service, even if there is no evidence of such disease during service.  38 U.S.C. §§ 1112, 1137; 38 C.F.R. § 3.307 (a)(3).  The application of these presumptions operates to satisfy the "in-service incurrence or aggravation" element and establish a nexus between service and a present disability, which must be found before entitlement to service connection can be granted.

Service connection for a recognized chronic disease can also be established through continuity of symptomatology.  Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309.  For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service connected unless attributable to an intercurrent cause.  38 C.F.R. § 3.303 (b).  For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings.  Id.  When the condition noted in-service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required.  Id.

Additionally, service connection may be granted on a secondary basis.  Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury.  38 C.F.R. § 3.310.  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).

In making all determinations, the Board must fully consider the lay assertions of record.  A layperson is competent to report on the onset and continuity of his current symptomatology.  See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge).  Likewise, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence, which it finds to be more persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant.  Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. 

"[I]f the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt." Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim).

1. Entitlement to service connection for bilateral tinnitus

Here, the Veteran contends that he has bilateral tinnitus that was caused by or incurred in service.  Based on the persuasive evidence, the Board agrees.

At the outset, the Board notes that tinnitus is, by definition "a noise in the ears, such as ringing, buzzing, roaring, or clicking.  It is usually subjective in type."  Dorland's Illustrated Medical Dictionary, 1914 (30th ed. 2003).  As such, tinnitus is "subjective," as its existence is generally determined by whether the Veteran claims to experience it.  For VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone.  See Charles v. Principi, 16 Vet. App. 370 (2002).  Importantly, if the veteran reports ringing in his or her ears, then a diagnosis of tinnitus is generally applied without further examination.

In the September 2025 VA examination, the Veteran reported the onset of tinnitus in 1968, as he had to
 subjective in type."  Dorland's Illustrated Medical Dictionary, 1914 (30th ed. 2003).  As such, tinnitus is "subjective," as its existence is generally determined by whether the Veteran claims to experience it.  For VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone.  See Charles v. Principi, 16 Vet. App. 370 (2002).  Importantly, if the veteran reports ringing in his or her ears, then a diagnosis of tinnitus is generally applied without further examination.

In the September 2025 VA examination, the Veteran reported the onset of tinnitus in 1968, as he had to deliver supplies to the flight line which exposed him to aircraft noise.  He explained that the ringing was intermittent but had progressed since onset.  The Veteran noted that it occurred two to three times a week lasting for a minute at a time.  The audiologist noted that the Veteran's tinnitus was a symptom of his bilateral hearing loss.  

However, the audiologist opined that the Veteran's tinnitus was not caused by service as the Veteran's military occupational specialty (MOS) as a stock clerk is associated with low probability of hazardous noise exposure.  Likewise, the Veteran had normal hearing bilaterally on entrance and separation.  She added that the Institute of Medicine stated there was no scientific basis to conclude that permanent hearing loss directly attributable to noise exposure would develop long after that noise exposure.

The audiologist's opinion is competent, credible, and probative; however, the positive and negative evidence is in approximate balance.  Specifically, as noted above, tinnitus is a disability that is subjective in nature, thus the Veteran's contention that his tinnitus was incurred in service and manifested since then, is competent, credible, and probative.

Accordingly, as the evidence is in relative equipoise, the benefit of the doubt doctrine applies, and the claim is granted.  See 38 U.S.C. § 5107; Lynch, 21 F.4th 776.

2. Entitlement to service connection for normocytic anemia, to include as secondary to service-connected chronic hemorrhoids

Here, the Veteran contends that his normocytic anemia was caused by or incurred in service or secondary to his chronic hemorrhoids.  Based on the persuasive evidence, the Board agrees.

At the outset, the AOJ found that the Veteran had a current diagnosis of normocytic anemia.  Additionally, the Veteran had participation in toxic exposure risk activity (TERA) due to agent orange exposure in Vietnam.  Likewise, the AOJ found that the Veteran's normocytic anemia had been aggravated beyond its natural progression by his service-connected hemorrhoid disability.

Based on the foregoing, the Board finds that the Veteran's anemia was aggravated by his service-connected hemorrhoid disability as noted in the AOJ's favorable findings.  Specifically, in the October 2025 VA medical opinion, Dr. D.G. opined that the Veteran's chronic hemorrhoids are at least as likely as not aggravating the normocytic anemia beyond its natural progression.  He explained that laboratory results from 2019-2024 showed persistent mild anemia with concurrent documentation of intermittent rectal bleeding and internal hemorrhoids on colonoscopy.  Dr. D.G. added that chronic blood loss of this type represented a medically recognized aggravating factor for anemia, even in the absence of a precise baseline.  Additionally, Dr. D.G. explained that no alternate systemic or marrow pathology had been identified to explain the persistence of anemia.

The Board finds Dr. D.G.'s opinion to be competent, credible, and highly probative.  He reviewed the pertinent evidence, accounted for the Veteran's lay statements, then provided an opinion based on medical principles and the evidence.

Accordingly, as the evidence is persuasively in support of the Veteran's contention, the claim of entitlement to service connection for normocytic anemia is granted.  38 C.F.R. 3.310.  

REASONS FOR REMAND

Entitlement to service connection for left inguinal hernia is remanded.

Under the AMA, the Board must remand issues when necessary to correct a pre-decisional duty to assist error or AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim.  See 38 C.F.R. § 20.802(a).  

Here, the Veteran contends that his left inguinal hernia was caused by or incurred in service or secondary to his service-connected left testicle varicocele.  Based on the evidence, remand to correct a pre-decisional duty to assist error is warranted.

Specifically, in the September 202
Entitlement to service connection for left inguinal hernia is remanded.

Under the AMA, the Board must remand issues when necessary to correct a pre-decisional duty to assist error or AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim.  See 38 C.F.R. § 20.802(a).  

Here, the Veteran contends that his left inguinal hernia was caused by or incurred in service or secondary to his service-connected left testicle varicocele.  Based on the evidence, remand to correct a pre-decisional duty to assist error is warranted.

Specifically, in the September 2025 VA examination, the examiner indicated that there was no diagnosis of a left inguinal hernia due to a lack of objective evidence.  The examiner added that although the provided records documented a history of left inguinal hernia repair, the histories in the VA progress notes were based on the Veteran's reported personal history.  Lastly, the examiner noted that the Veteran's diagnosed condition was left varicocele during service and status post varicocelectomy in February 1973.  

However, the September 2025 VA examination was inadequate as the examiner had an incorrect factual premise.  See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012).  First, the examiner indicated that the Veteran did not have a current diagnosis of left inguinal hernia.  Yet, in a May 2002 VA treatment record, physical examination revealed that the Veteran had a small reducible indirect hernia of the left inguinal region.  Then again, in August 2005, the Veteran was assessed with a left inguinal hernia.  Moreover, in a March 2008 VA treatment record, the attending physician indicated that the Veteran had a history of hernia repair and testicular varicocele with chronic intermittent lower extremity pain.  Furthermore, in an October 2008 VA treatment record, the Veteran presented with chronic low back pain and radiating left groin pain, described as a 7 out of 10 and constantly sharp in nature.  The Veteran attributed his left groin pain to a hernia repair performed in 1973 with persistent radiating numbness throughout his left lower extremity.  

Although there was no diagnosis of a left inguinal hernia in the September 2025 VA examination, the Veteran filed his claim for a hernia in November 1977, thus during the pendency of his appeal, he had a diagnosis of left inguinal hernia.  See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Brammer v. Derwinski, 3 Vet. App. 223 (1992).

Moreover, in a March 2009 private examination, the Veteran presented with diagnosis of varicocele on the left testicle and spermatocele on the right testicle.  The Veteran reported that he was diagnosed with the abnormalities in 1968.  Among other issues, the Veteran could not perform heavy lifting or perform strenuous work or exercises.  He could not lift anything or sleep on his left side or back.  Notably, he stated that he had pain in left lumbar area, between his legs, and down his left leg to his feet.  More importantly, Dr. J.P. noted that the Veteran had a left inguinal herniorrhaphy scar that measured 4 cm by .2 cm.  The Veteran also had a separate tender scar of the left scrotal sac.  

Therefore, although the VA examiner indicated that the Veteran's left inguinal hernia repair was only reported subjectively, there was objective evidence of a left inguinal herniorrhaphy.  

Accordingly, the AOJ's failure to obtain an adequate VA examination and medical opinion constitute a pre-decisional duty to assist error requiring remand for appropriate corrective action.  See 38 C.F.R. § 20.802(a); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

The matter is REMANDED for the following action:

1. Obtain a VA medical opinion to determine the nature and etiology of the Veteran's left inguinal hernia.  If an opinion cannot be obtained without an examination, then a VA examination should be afforded to the Veteran.  The record, including a copy of this remand, must be made available to and reviewed by the
  

Accordingly, the AOJ's failure to obtain an adequate VA examination and medical opinion constitute a pre-decisional duty to assist error requiring remand for appropriate corrective action.  See 38 C.F.R. § 20.802(a); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

The matter is REMANDED for the following action:

1. Obtain a VA medical opinion to determine the nature and etiology of the Veteran's left inguinal hernia.  If an opinion cannot be obtained without an examination, then a VA examination should be afforded to the Veteran.  The record, including a copy of this remand, must be made available to and reviewed by the examiner. 

The VA examiner should address the following: 

(a.) Is it likely (an approximate balance of positive and negative evidence) that the Veteran's left inguinal hernia had its onset during service or is otherwise causally related to any event or circumstance of the Veteran's service?

(b.) Is it likely (an approximate balance of positive and negative evidence) that the Veteran's left inguinal hernia is caused by his left testicular varicocele or varicocelectomy?

(c.) Is it likely (an approximate balance of the positive and negative evidence) that the Veteran's left inguinal hernia is aggravated by his left testicular varicocele or varicocelectomy?

2. The examiner should cite to the medical and competent lay evidence of record and explain the rationale for all opinions given.  If after consideration of all pertinent factors it remains that the opinion sought cannot be given without resort to speculation, it should be so stated, and the provider must (to comply with governing legal guidelines) explain why the opinion sought cannot be offered without resort to speculation.

 

 

KRISTI L. GUNN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	I. Umo, 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.