TINNITUS

Summary

The veteran, who served in the Air Force from April 1986 to January 1990, appeals the denial of service connection for right ear hearing loss and the grant of service connection for tinnitus. The veteran also appeals the remand of left ear hearing loss. The veteran claims tinnitus and hearing loss due to in-service acoustic trauma from his MOS as a tactical aircraft maintenance specialist and crew chief working on A-10 aircraft. The RO had favorably found a current diagnosis of tinnitus and exposure to hazardous noise. The VA examiner in June 2021 could not render an opinion on tinnitus nexus without speculation, but the Board gave more weight to the veteran's consistent lay statements about the onset of tinnitus during service, finding it related to his established in-service noise exposure. Service connection for tinnitus was granted. For right ear hearing loss, the Board reviewed audiological tests from enlistment, mid-service, separation, and post-service examinations. While the veteran had some threshold shifts and hazardous noise exposure, the Board found his right ear hearing loss did not meet the regulatory definition of disability during the relevant appeal period. The claim for right ear hearing loss was denied. The claim for left ear hearing loss was remanded because the June 2021 VA opinion was inadequate, being based on an inaccurate factual premise (lack of STRs) and potentially speculative conclusions. The Board ordered a new opinion addressing the etiology of left ear hearing loss and its relation to service, considering the veteran's competent testimony and available STRs.

Rationale

Favorable RO findings for tinnitus diagnosis and hazardous noise exposure.; Board gave more weight to veteran's lay statements regarding onset.; Found nexus between tinnitus and in-service noise exposure.

Full Decision Text

Citation Nr: A26039698
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 210910-183886
DATE: April 28, 2026

ORDER

Entitlement to service connection for tinnitus is GRANTED.

Entitlement to service connection for right ear hearing loss is DENIED.

REMAND ORDER

Entitlement to service connection for left ear hearing loss is REMANDED.

FINDINGS OF FACT

1. The Veteran sustained acoustic trauma during service.

2. The Veteran has a current tinnitus disability which began during service and is related to his acoustic trauma during service. 

3. The Veteran does not have a right ear hearing loss disability for VA purposes.

CONCLUSIONS OF LAW

1. The criteria for service connection for tinnitus have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for right ear hearing loss have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385.

FACTUAL AND PROCEDURAL HISTORY

The Veteran served on active duty in the Armed Forces from March 1981 until July 1981 and in the Air Force from April 1986 until January 1990.  

This matter comes before the Board on appeal from a June 2021 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In the September 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A hearing was held, and the Veteran testified before the Board in May 2025.  A copy of the transcript is in the record.

The Board may only consider the evidence of record at the time of the June 2021 RO decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following the Board hearing.  38 C.F.R. § 20.302 (b).  If evidence was submitted during the period after the RO issued the decision on appeal and prior to the Board hearing, the Board did not consider it in its Decision.  38 C.F.R. §§ 20.300, 20.302 (b), 20.801.  

However, because the Board is remanding the claim of entitlement to service connection for left ear hearing loss, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim.  38 C.F.R. § 3.103(c) (2)(ii).  

The Board has reviewed all evidence of record regardless of whether it is discussed in detail in the Decision.  Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal).

REASONS AND BASES FOR THE FINDINGS AND CONCLUSIONS

I.

Service Connection - Legal Criteria

Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service.  This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein.  38 U.S.C. § § 1110; 38 C.F.R. § 3.303(a).

Establishing direct service connection generally requires (1) evidence of a current disability; (2) evidence of in-service occurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service event, disease, or injury and the present disability.  Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a).

Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. 38 C.F.R. § 3.303.  The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology can be applied only
 247, 253 (1999); 38 C.F.R. § 3.303(a).

Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. 38 C.F.R. § 3.303.  The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309(a), which includes organic diseases of the nervous system, such as bilateral hearing loss.  See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015).

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).

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). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the 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.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d at 1376-77.  

When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the veteran's particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1376-77.

A veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal," and does not require that the evidence be in exact equipoise.  Evidence is in approximate balance when the evidence in favor of and opposing the veteran's claim is found to be almost exactly or nearly equal. Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).

II.

Analysis - Tinnitus 

The Veteran contends that he is entitled to service connection for tinnitus due to in-service exposure to acoustic trauma.  In a February 2021 statement, he asserted that he was a tactical aircraft maintenance specialist and a crew chief, working on A-10 aircrafts.  He noted that most of his work was on the flight line, and that he began experiencing ringing in his ears at that time which has persisted since.  

The RO has provided favorable findings confirming that the Veteran has a diagnosis of tinnitus, and that he had a high probability of exposure to hazardous noise during service due to his military occupational specialty (MOS) of aircraft mechanic.  The Board is bound by the favorable findings of the RO in the absence of clear and unmistakable evidence.  38 C.F.R. § 3.104.  Thus, the first and second elements of service connection are satisfied, and the remaining question before the Board is whether there is a nexus between his current diagnosis and in-service noise exposure.  

A VA medical opinion was obtained in June 2021.  The Veteran reported that he had experienced tinnitus for as long as he could remember, noting that it began during service.  The examiner acknowledged that the Veteran had reported tinnitus since service but found that no opinion could be rendered without resorting to mere speculation.  

A lay person is competent to describe symptoms of ringing in the ears.  Charles v. Principi, 16 Vet. App. 370, 374-75 (2002).  If a veteran reports ringing in his or her ears, then a diagnosis of tinnitus is generally applied without further examination.  In addition, since the diagnosis of tinnitus is so heavily reliant upon lay statements, the etiology
A VA medical opinion was obtained in June 2021.  The Veteran reported that he had experienced tinnitus for as long as he could remember, noting that it began during service.  The examiner acknowledged that the Veteran had reported tinnitus since service but found that no opinion could be rendered without resorting to mere speculation.  

A lay person is competent to describe symptoms of ringing in the ears.  Charles v. Principi, 16 Vet. App. 370, 374-75 (2002).  If a veteran reports ringing in his or her ears, then a diagnosis of tinnitus is generally applied without further examination.  In addition, since the diagnosis of tinnitus is so heavily reliant upon lay statements, the etiology of the disorder is similarly reliant upon them.  The date that a veteran reports that the tinnitus symptoms began is generally accepted as the date that the disorder began, without further examination.  Thus, while service connection for tinnitus requires a medical diagnosis of tinnitus and a medical nexus relating the diagnosis to military service, lay testimony plays an unusually important role in these determinations.

In this case, while the Board acknowledges that the opinion obtained by VA found no conclusion could be reached without resorting to mere speculation, the Board assigns significantly more probative weight to the Veteran's statements regarding the onset of his symptoms beginning in service, in light of his service history and MOS, and his consistent reports of timing and circumstances of onset of tinnitus.

For these reasons, the Board finds that the Veteran's tinnitus is caused by his established in-service noise exposure.  Therefore, all three elements of service connection are met, and the appeal is granted. 

III.

Analysis - Right Ear Hearing Loss

With respect to a claim for service connection for hearing loss, impaired hearing will be considered a disability when: (1) the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000 and 4000 Hertz is 40 decibels or greater; (2) the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or (3) speech recognition scores using the Maryland CNC Test are less than 94 percent.  38 C.F.R. § 3.385.  The threshold for normal hearing is from 0 to 20 decibels, with higher threshold levels indicating some degree of hearing loss.  Hensley v. Brown, 5 Vet. App. 155, 157 (1993). 

The absence of in-service evidence of hearing loss is not fatal to a claim for service connection.  Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992).  Evidence of a current hearing loss disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss.  Hensley, 5 Vet. App. at 159.  To establish service connection for sensorineural hearing loss, a veteran is not obligated to show that his hearing loss was present during active service.  However, if there is insufficient evidence to establish that a claimed chronic disability was present during service or during the one-year presumptive period thereafter, the evidence must establish a nexus between his current disability and his in-service exposure to loud noise.  Godfrey v. Derwinski, 2 Vet. App. 352 (1992).

The Veteran asserts that he has right ear hearing loss which is related to his in-service hazardous noise exposure.  His MOS was an aircraft technician, and so, exposure to hazardous noise has been conceded.  However, the first question before the Board is whether the Veteran has a current disability.  After careful review of the record, the Board finds that the Veteran has not had a right ear hearing loss disability for VA purposes.  38 C.F.R. § 3.385.  

Service treatment records (STRs) revealed the following Puretone thresholds in decibels at his August 1986 enlistment examination:  

 	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	5	0	0	0	5

In July 1988, the Veteran was given another audiological evaluation.  The examiner found Puretone thresholds in decibels were:

 	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	0	0	0	0	0

In November 1989, the Veteran was given another audiological evaluation at separation.  The examiner found Puretone thresholds in decibels were:

 	 	 	HERTZ	 	 

 
 at his August 1986 enlistment examination:  

 	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	5	0	0	0	5

In July 1988, the Veteran was given another audiological evaluation.  The examiner found Puretone thresholds in decibels were:

 	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	0	0	0	0	0

In November 1989, the Veteran was given another audiological evaluation at separation.  The examiner found Puretone thresholds in decibels were:

 	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	10	5	0	10	5

In July 2021, the Veteran was afforded a VA examination.  The examiner acknowledged that the Veteran had a MOS that had a high probability for hazardous noise exposure.  

The Veteran then underwent audiological testing which revealed the following Puretone thresholds in decibels:  

 	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	25	10	20	20	25

Maryland CNC word recognition testing showed a score of 100 percent in the right ear. 

In May 2025, the Veteran had a private audiological examination conducted.  The examiner conducted a hearing test and provided the following Puretone thresholds in decibels:

 	 	 	HERTZ	 	 

 	500	1000	2000	3000	4000

RIGHT	20	10	25	20	30

While it was unclear which speech recognition test was conducted, the Veteran scored a 100 percent in speech recognition in his right ear.  

All available post-service treatment records submitted during the allowed evidence period have also been considered but did not reflect any evidence of more severe hearing loss, or a right ear hearing loss disability for VA purposes.  

The Veteran was exposed to hazardous noise exposure during service and there was a slight threshold shift in the Veteran's hearing acuity during service.  The Court in Hensley v. Brown recognized that Puretone thresholds of 20 decibels or more can be indicative of some hearing loss and due consideration must be made by examiners of the significance of any in-service threshold shifts.  5 Vet. App. 155, 164 (1993). 

However, service connection first and foremost requires a current disability and for VA purposes, a hearing loss disability is defined by regulation.  See 38 C.F.R. § 3.385.  While the Board does not doubt the Veteran has some amount of hearing loss in his right ear, during the relevant period on appeal, his right ear hearing loss did reach the severity required to establish a disability as defined in the controlling regulation.  

Accordingly, the Board finds that there is no disability during the relevant appeal period.  As the evidence is persuasively against the claim, the benefit of the doubt doctrine does not apply.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  The claim is denied.

REASONS FOR REMAND

IV.

Left Ear Hearing Loss

The Veteran contends that he has left ear hearing loss which is a result of his active-duty service.  He contends that he experiences left ear hearing loss as a result of exposure to hazardous noise during active service on the flight line.  

The RO has made favorable findings that the Veteran has a current diagnosis of left ear hearing loss for VA purposes, and that he was exposed to hazardous noise during service.  The Board will not disturb these favorable findings.  38 C.F.R. § 3.104.  

Accordingly, the first and second elements of direct service connection are met and the remaining question before the Board is whether there is a nexus between the Veteran's active duty or service-connected disabilities and his current left ear hearing loss. 

In June 2021, the Veteran had a VA examination.  The examiner confirmed a diagnosis of left ear hearing loss and exposure to hazardous noise but ultimately determined that no opinion could be rendered without resorting to mere speculation.  The examiner reasoned that there were no examinations or audiological evaluations in the Veteran's STRs.  

The Veteran's STRs in evidence at the time of the examination reflect at least three audiological evaluations complete with Puretone thresholds.  The Board concludes that the June 2021 VA opinion is inadequate for adjudication because it is premised on incorrect factual predicate.  A corrective opinion should have been obtained by the RO prior to adjudication of the claim in the first instance, a pre-decisional duty-to-assist error.  See Reonal V. Brown
 VA examination.  The examiner confirmed a diagnosis of left ear hearing loss and exposure to hazardous noise but ultimately determined that no opinion could be rendered without resorting to mere speculation.  The examiner reasoned that there were no examinations or audiological evaluations in the Veteran's STRs.  

The Veteran's STRs in evidence at the time of the examination reflect at least three audiological evaluations complete with Puretone thresholds.  The Board concludes that the June 2021 VA opinion is inadequate for adjudication because it is premised on incorrect factual predicate.  A corrective opinion should have been obtained by the RO prior to adjudication of the claim in the first instance, a pre-decisional duty-to-assist error.  See Reonal V. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinion based on inaccurate factual premise may properly be rejected as non-probative).  The examiner also determined that no opinion could be rendered without mere speculation but did not clarify whether that was due to the limitations of their knowledge or because the limits of medical knowledge had been exhausted.  This, too, renders the opinion inadequate.  As the VA opinion is inadequate, it was a pre-decisional duty-to-assist error for the RO to rely on this opinion to adjudicate the claim without first obtaining an addendum or other curative opinion and this must be remedied on remand. 

The matter is REMANDED for the following actions:

1. Obtain an addendum opinion from an appropriate clinician to assess the etiology of the Veteran's left ear hearing loss.  The entire claims file should be made available to, and reviewed by, the examiner.  Another examination should not be scheduled unless deemed necessary by the provider.  The examiner is then asked to provide an opinion which discusses:

(a.) Whether it is at least as likely as not (likelihood is at least approximately balanced, or nearly equal, if not higher) that the Veteran's left ear hearing loss began during, or is otherwise related to, his active-duty service.  

The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports should be acknowledged and considered in formulating any opinion.  If medical literature is relied upon, the examiner should identify and specifically cite each reference material used.  The examiner should specifically discuss any contradictory evidence in the claims file and reconcile that evidence with their findings.

All opinions should be accompanied by supporting rationale explaining how the examiner arrived at the conclusions expressed.

If the examiner determines that s/he cannot provide an opinion without resorting to speculation, s/he should explain the inability to provide an opinion, identifying precisely what facts could not be determined.  In particular, s/he should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion.

 

 

STEVEN V. ADLER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M.Y.R., 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.