TINNITUS

Summary

The Veteran, an Army Veteran who served from November 2003 to November 2006, including service in Southwest Asia and receipt of the Iraq Campaign Medal, appeals the denial of service connection for tinnitus. The Veteran contends his tinnitus is related to hazardous noise exposure during service, specifically from artillery mortar training and routine exposure to live fire artillery, mortars, and bombs while deployed in Iraq. The Board found that in-service noise exposure was conceded and that the Veteran's tinnitus is a chronic condition for which lay testimony is competent. While a VA examiner opined negatively, citing a lack of in-service complaints and normal hearing on separation exams, the Board found this opinion inadequate for failing to address the Veteran's competent lay statements regarding symptom onset and continuity. The Board also noted a separate VA examination related to potential toxic exposure risk activity (TERA) which provided an unfavorable opinion regarding tinnitus causation, but the Board found this opinion irrelevant as the Veteran's claim was based on noise exposure, not toxic exposure. Applying the benefit of the doubt and finding the Veteran's reports credible, the Board granted service connection for tinnitus.

Rationale

In-service noise exposure conceded; Tinnitus is a chronic condition with competent lay reporting; Benefit of the doubt applied in favor of Veteran

Full Decision Text

Citation Nr: A26039854
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250424-537305
DATE: April 28, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, the Veteran's tinnitus is related to his in-service hazardous noise exposure.

CONCLUSION OF LAW

The criteria for entitlement to service connection for tinnitus are 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 Army from November 2003 to 2006, with service in Southwest Asia. The Veteran is a recipient of the Iraq Campaign Medal with two bronze service stars and the Global War on Terrorism Service Medal. 

Although the Veteran initially requested Higher-Level Review when submitting the February 2025 VA Form 20-0996, Decision Review Request: Higher-Level Review, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development.

In March 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which denied the claim based on the evidence of record at the time of that decision.  In April 2025, VA timely received the Veteran's notice of disagreement (NOD), via VA Form 10182, appealing that decision to the Board, and requesting Direct Review by a Veterans Law Judge.  Therefore, the Board may only consider the evidence of record at the time of the decision on appeal. See 38 C.F.R. §§ 20.300(a), 301. 

The Board will not consider evidence received after the AOJ decision unless the claimant files a timely request for a Board hearing or an opportunity to submit additional evidence on the NOD (VA Form 10182). 38 C.F.R. § 20.301. The Veteran has not filed such a request. 

If additional evidence was submitted after the AOJ decision, the Board will not consider it. If the Veteran would like VA to consider any evidence that was added to the claims file 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(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. See also Cook v. McDonough, 36 Vet. App. 175 (2023).

Entitlement to service connection for tinnitus is granted.

The Veteran contends that his tinnitus is related to his in-service hazardous noise exposure. See Statement in Support of Claim (VA Form 21-4138), April 4, 2024; VA Form 20-0995, April 4, 2024.

Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

The absence of in-service evidence of hearing loss disability and associated tinnitus during a claimant's period of active duty is not fatal to a claim for service connection. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Competent evidence and a medically sound basis for attributing such disability to service, may serve as a basis for a grant of service connection. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993).

The United States Court of Appeals for Veterans Claims (CAVC) held in Fountain v. McDonald, 27 Vet. App. 258, 273 (2015), that under VA regulations tinnitus is a disease, rather than merely a symptom, and that 38 C.F.R. § 3.309(a) "includes tinnitus, at a minimum where there is evidence of acoustic trauma,
inski, 3 Vet. App. 87, 89 (1992). Competent evidence and a medically sound basis for attributing such disability to service, may serve as a basis for a grant of service connection. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993).

The United States Court of Appeals for Veterans Claims (CAVC) held in Fountain v. McDonald, 27 Vet. App. 258, 273 (2015), that under VA regulations tinnitus is a disease, rather than merely a symptom, and that 38 C.F.R. § 3.309(a) "includes tinnitus, at a minimum where there is evidence of acoustic trauma, as an 'organic disease of the nervous system.'" As CAVC held that tinnitus is a chronic disease subject to applicable presumptions, the disease falls within the parameters of 38 C.F.R. § 3.303(b). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (holding that the provisions of § 3.303(b) pertaining to continuity of symptomatology only applies to chronic diseases contemplated under § 3.309(a)).

Tinnitus may be subject to service connection on a presumptive basis as an "organic disease of the nervous system" under 38 C.F.R. § 3.309(a) where there is evidence of in-service acoustic trauma and a continuity of symptomatology from service. See Fountain, 27 Vet. App. at 273; see also Walker, supra.

Tinnitus is a condition that may be diagnosed by its unique and readily identifiable features, and the presence of the disorder is not a determination that is medical in nature and is capable of lay observation. Charles v. Principi, 16 Vet. App. 370 (2002). The Veteran is competent to discuss observed physical symptoms, such as a whooshing or roaring noise in the ears. See Layno v. Brown, 6 Vet. App. 465 (1994). Tinnitus, moreover, is a disorder uniquely ascertainable by the senses. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). That is, tinnitus is defined as a noise in the ears, a finding that can only be determined by the Veteran's reporting of the condition.

The AOJ favorably found that (1) the Veteran has a diagnosis of tinnitus; (2) hazardous noise exposure from explosives and bombs during his period of service; (3) the Veteran's military service from November 2003 to November 2006 meets the requirement for presumptive service connection, and (4) he was exposed to toxins during service.  See December 2024, February 2025, and March 2025 rating decisions. Favorable findings made by the AOJ are generally binding on the Board, unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. See 38 U.S.C. § 5104A; 38 C.F.R. §§ 3.104(c); 20.801(a). Such evidence is not present in this case. Accordingly, the first and second elements of Shedden are satisfied. See Shedden, supra.

The Veteran asserts that he first started noticing ringing in his ears during training for his military occupation specialty (MOS) during artillery mortar training; he noticed a worsening while deployed in Iraq due to being routinely exposed to live fire artillery, mortars, and bombs; and has continued to the present. See VA Form 21-4138, April 4, 2024. The Veteran's DD-214 reflects that his MOS was a 13F-Fire Support Specialist. 

In August 2024, the Veteran was afforded a VA tinnitus examination. The Veteran reported experiencing recurrent bilateral tinnitus. He reported that his tinnitus began gradually during service and worsened over time becoming more constant. He reported experiencing constant ringing with fluctuating periods of loud high pitch sounds. The clinician opined that it was less likely that the Veteran's tinnitus was caused by or a result of military noise exposure. The clinician noted that the Veteran's MOS suggests a high probability of hazardous noise exposure but also noted the Veteran's enlistment and separation exams showed normal hearing, and there were no complaints of tinnitus found in his service treatment records and at separation. The examiner reasoned in the absence of objectively verifiable noise injury, the association between claimed tinnitus and noise exposure could not be assumed to exist. The clinician further explained tinnitus is considered a symptom rather than an illness and is associated with many conditions, including noise exposure and noise-induced hearing loss. 

The August 2024 VA opinion has some probative value in establishing that the Veteran
 that it was less likely that the Veteran's tinnitus was caused by or a result of military noise exposure. The clinician noted that the Veteran's MOS suggests a high probability of hazardous noise exposure but also noted the Veteran's enlistment and separation exams showed normal hearing, and there were no complaints of tinnitus found in his service treatment records and at separation. The examiner reasoned in the absence of objectively verifiable noise injury, the association between claimed tinnitus and noise exposure could not be assumed to exist. The clinician further explained tinnitus is considered a symptom rather than an illness and is associated with many conditions, including noise exposure and noise-induced hearing loss. 

The August 2024 VA opinion has some probative value in establishing that the Veteran experiences tinnitus and that his MOS suggests a high probability of hazardous noise exposure. Unfortunately, the opinion is inadequate as the clinician's opinion is based on the premise that tinnitus is a symptom rather than an illness. As previously noted, under VA regulations tinnitus is a disease, rather than merely a symptom. See Fountain, supra. Further, the clinician based the opinion on the absence of evidence and failed to address the Veteran's lay statements as to symptom onset and continuity of symptomatology. An opinion based on the absence of treatment records without consideration of a Veteran's competent lay statements is inadequate. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). A medical opinion must explicitly discuss a Veteran's statements; hence, premises relying on the "objective" evidence and lack of records to justify a conclusion cannot be assumed to have considered a veteran's lay statements where those statements were not explicitly addressed. Smith v. Wilkie, 32 Vet. App. 332, 340 (2020).

The Veteran is competent to discuss observed symptoms, such as a ringing in the ears. See Layno, supra. To the extent the Veteran asserts continuity of symptomatology beginning during service, the Veteran is competent to give evidence where he has knowledge of facts or circumstances and where he conveys matters that can be observed and described by a lay person. He is therefore competent to report continuous tinnitus symptoms since service. 

A special review of the Veteran's file was mandated based on potential toxic exposure risk activity (TERA).  VA Memo dated in April 2024 reveals the Veteran was exposed to solvents, exhaust, and fuel during service.  The Veteran was afforded an additional VA examination in January 2025.  The examiner opined that since the Veteran's tinnitus was not diagnosed in service and "started after the military," it was less likely than not caused by his TERA in service after considering the total potential exposure through all applicable military deployments of the Veteran the combined synergistic effect of all toxic exposure risk activities of the Veteran.  As the presence of tinnitus is not necessary for the finding of service connection, the opinion is not probative of the matter on appeal.  38 C.F.R. § 3.303; see also Ledford, 3 Vet. App. at 89; Hensley, 5 Vet. App. at 159.

An addendum opinion was issued in March 2025, the examiner indicated tinnitus was less likely due to toxic exposure during service as tinnitus was not presumed by regulation to result from burn pit or dust exposure. The examiner further found that there was no competent evidence that tinnitus was related to such exposure. The examiner failed to consider the Veteran's exposure to solvents, exhaust, and fuel.

Nevertheless, the Veteran does not contend his tinnitus is due to toxic exposure during service.  While tinnitus is not a disease presumed to be due to such exposure, it does not preclude consideration on a direct causation basis. Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994).

In the instant case, in-service noise exposure has been conceded.  The Veteran's diagnosed tinnitus is a recognized chronic condition for which a layperson's testimony is competent to report symptomatology.  After reviewing all the evidence, the Board shall resolve reasonable doubt in the Veteran's favor. The Veteran's reports as to the onset of tinnitus in service, as well as the continuity of his symptoms since service, are credible and support the finding of continuity of symptomatology. See Shedden, supra; Walker, supra. Accordingly, the Board finds that service connection for tinnitus is warranted; the claim is granted. See Lynch v. McDonough, 21 F.4th  776 (Fed. Cir. 2021); 38 U.S.C. § 5107; 38 C.F.R. 3.102.

 

K. L. Wallin

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Camille
 reasonable doubt in the Veteran's favor. The Veteran's reports as to the onset of tinnitus in service, as well as the continuity of his symptoms since service, are credible and support the finding of continuity of symptomatology. See Shedden, supra; Walker, supra. Accordingly, the Board finds that service connection for tinnitus is warranted; the claim is granted. See Lynch v. McDonough, 21 F.4th  776 (Fed. Cir. 2021); 38 U.S.C. § 5107; 38 C.F.R. 3.102.

 

K. L. Wallin

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Camille NeSmith

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.