TINNITUS

Summary

The veteran, an Army Infantryman who served from July 1995 to November 1998, appeals the denial of service connection for tinnitus. The claim is being adjudicated under the Appeals Modernization Act on a Direct Review docket. The veteran reported experiencing tinnitus after noise exposure on the firing range in 1995/1996, with symptoms being persistent. The AOJ previously made favorable findings regarding the current diagnosis of tinnitus and the likelihood of a qualifying in-service event due to the veteran's MOS. Service treatment records were negative for tinnitus complaints. The Board considered two medical opinions. A December 2024 opinion from an APRN found it more likely than not that the veteran experienced high-level noise exposure leading to acoustic trauma and chronic tinnitus, providing a thorough rationale and relying on expertise. A January 2025 VA examination opined that tinnitus was associated with hearing loss but was less likely than not caused by military noise exposure, reasoning that the onset was post-service and not documented in service treatment records. The Board found the VA opinion inadequate, noting its reliance on the absence of treatment and failure to address the veteran's statements about firing range noise exposure and the AOJ's concession of noise exposure. The Board afforded high probative value to the APRN's opinion, finding it adequate and well-reasoned, and found the VA opinion inadequate. Therefore, service connection for tinnitus was granted.

Rationale

Veteran has current diagnosis of tinnitus.; MOS as Infantryman indicates high probability of noise exposure.; Probative private opinion found tinnitus more likely than not related to service.; Inadequate VA opinion found negative nexus based on absence of treatment.

Full Decision Text

Citation Nr: A26040196
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 250911-587537
DATE: April 29, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

FINDING OF FACT

The Veteran's tinnitus is etiologically related to his active 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. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from July 1995 to November 1998.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision dated April 22, 2025 issued by the Department of Veterans Affairs (VA) Regional Office (RO).  The rating decision on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In the September 2025 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 April 2025 agency of original jurisdiction (AOJ) decision 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[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.  

The Board is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). In this case, a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2) as it is more than one year from the date that the AOJ mailed notice of the decision on appeal, and it is more than 60 days of the date that the Board received the September 2025 VA Form 10182. Therefore, the Board shall proceed with adjudication.

Service Connection Criteria

Generally, service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 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).

Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases such as an organic disease of the nervous system become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 C.F.R. §§ 3.307, 3.309(a).  

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App
 shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 C.F.R. §§ 3.307, 3.309(a).  

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1.   Entitlement to service connection for tinnitus is granted.

The Veteran seeks entitlement to service connection for tinnitus which he developed as a result of his exposure to acoustic trauma while serving in the military. See December 2024 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ).  At a January 2025 VA examination, the Veteran indicated that he began experiencing tinnitus after noise exposure on the firing range in 1995/1996; he stated that he was unsure as to when the tinnitus became recurrent, but it has "always been there."  

The April 2025 rating decision made favorable findings that the Veteran was diagnosed with a disability as a January 2025 VA examination showed a diagnosis of tinnitus, and that the evidence shows that a qualifying event, injury, or disease had its onset during service as the Veteran's military occupational specialty (MOS) was reflected as an Infantryman, which has a high probability of noise exposure; the Board is bound by these favorable findings.  

Service treatment records are negative for complaints, treatments or diagnoses related to tinnitus.

Turning to the question of whether there is an etiological relationship between the Veteran's service and his diagnosed tinnitus, the Board notes that the record contains two etiology opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998). The Board will consider each of these opinions below.

A December 2024 opinion from K.M., an advanced practice registered nurse, indicated that they had reviewed the Veteran's medical history, the onset of tinnitus symptoms, progression and current symptoms with the Veteran. The provider noted that this documentation shows that the tinnitus symptoms chronologically began after the acoustic trauma he experiencing while serving the military, and the findings are consistent with chronic tinnitus. The provider opined that, based on their knowledge, training and clinical experience as well as a review of the clinical evidence and the body of the medical literature, it is more likely than not that the Veteran encountered high level of noise exposure which resulted in acoustic trauma damaging the cochlea. The provider further opined that this ultimately lead to reduced auditory nerve input and renormalization of the neuronal response, resulting in a chronic tinnitus condition.

The December 2024 provider conducted a thorough review of the claims file, medical literature, and relied on their expertise when rendering the opinion. This provider noted the Veteran's statements and contentions regarding the onset and continuity of her symptoms and the current diagnosis and symptoms as it related to this particular Veteran. The Board finds this opinion to be adequate as it provides a thorough rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). In addition, this provider relied on their expertise, conducted a thorough review of the claims file, and related the particular circumstances
 and relied on their expertise when rendering the opinion. This provider noted the Veteran's statements and contentions regarding the onset and continuity of her symptoms and the current diagnosis and symptoms as it related to this particular Veteran. The Board finds this opinion to be adequate as it provides a thorough rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). In addition, this provider relied on their expertise, conducted a thorough review of the claims file, and related the particular circumstances of this Veteran when rendering the opinion. Thus, this opinion is afforded high probative value.

A January 2025 VA examiner opined that the Veteran's tinnitus was at least as likely as not a symptom associated with hearing loss as tinnitus is known to be a symptom associated with hearing loss.  However, the examiner stated that the tinnitus is not at least as likely as not caused by or a result of military noise exposure.  The examiner reasoned that the onset of permanent and recurrent tinnitus is reported by the Veteran to be post-separation.  The examiner noted that there is no report of tinnitus in the service treatment records, at separation or in the medical records until the claim.  The examiner further noted that the current literature did not support late onset of noise-induced tinnitus. The Board finds that the January 2025 VA medical opinion to be inadequate for adjudicative purposes.  Specifically, the examiner impermissibly relied on the absence of treatment for or diagnoses of tinnitus during active service in providing a negative nexus opinion.  See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner did not comment on a veteran's reports of in-service injury and instead relied on the absence of evidence in a veteran's service treatment records to provide a negative opinion).  Additionally, the examiner did not address the Veteran's statement about his noise exposure on the firing range as well as the fact that the AOJ conceded to noise exposure.  Finally, the VA examiner did not cite the medical literature she relied on for the premise that late onset of noise-induced tinnitus was not supported.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2009); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion...must support its conclusion with an analysis the Board can consider and weight against contrary opinion"). Finally, the Board notes that the Veteran has not been awarded service connection for bilateral hearing loss.

In sum, the Veteran has a current diagnosis of tinnitus. The only probative opinion of record is in support of the Veteran's claim for entitlement to service connection for tinnitus. Moreover, there is no sufficient basis for the Board to reject this supportive opinion and to further develop the claim. Cf. Mariano v. Principi, supra. 

Accordingly, the Board finds that service connection for tinnitus is warranted. The appeal is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

 

 

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Suzie Gaston, 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.