HEARING LOSS

Summary

The Veteran, an Army track vehicle repairman attached to an artillery unit, served from December 1972 to November 1977. He appeals the denial of service connection for bilateral hearing loss and tinnitus, claiming both conditions resulted from in-service exposure to hazardous noise, including gunfire, artillery, jet engines, and heavy machinery without hearing protection. The Veteran testified that his symptoms began during service and have persisted, impacting his daily life. He also noted that hearing protection was often unavailable during training and field exercises. The Board found the Veteran's lay statements and his wife's statement credible and probative, describing observable symptoms during service and their continuity and worsening since. The Board assigned significant weight to these statements, noting that the absence of medical complaints or diagnoses in service treatment records (STRs) does not preclude service connection when supported by credible lay evidence and a plausible nexus. The Board found the VA examiners' opinions, which denied a service connection based on a lack of threshold shifts in audiograms and absence of complaints in STRs, to be contrary to VA policy and caselaw, as they failed to adequately address the documented in-service noise exposure and the continuity of symptoms. The Board concluded that the evidence established a causal link for both disabilities. Service connection for bilateral hearing loss and tinnitus was granted.

Rationale

Favorable findings of current disability and exposure to hazardous noise conceded by AOJ.; VA examiner opinions denying nexus were found contrary to policy and caselaw.; Credible lay statements from Veteran and spouse regarding observable symptoms and continuity of symptoms since service were given significant weight.; Absence of medical complaints in service treatment records does not preclude service connection when supported by credible lay evidence and plausible nexus.

Full Decision Text

Citation Nr: A26040225
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210225-143018
DATE: April 29, 2026

ORDER

Service connection for bilateral hearing loss is granted.

Service connection for tinnitus is granted.

FINDINGS OF FACT

1. The evidence reflects that the Veteran's currently diagnosed bilateral hearing loss disability (as defined for VA benefits purposes) was caused by his established in-service exposure to hazardous noise because observable symptoms of some level of bilateral hearing loss began during service or very shortly thereafter and continued since that time, thereby establishing a causal link (nexus) between his military service and his current bilateral hearing loss disability.

2. The evidence reflects that the Veteran's currently diagnosed tinnitus was caused by his established in-service exposure to hazardous noise because observable symptoms of ringing in the ears began during service and continued since service, thereby establishing a causal link (nexus) between his military service and his current tinnitus disability.

CONCLUSIONS OF LAW

1. The criteria are met for service connection for bilateral hearing loss. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.385.

2. The criteria are met for service connection for tinnitus. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army during both the Vietnam War Era and Peacetime from December 1972 to November 1977.

In August 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act of 2017 (Appeals Modernization Act or AMA), Pub. Law 115-55, which created a new claims and appeals process for pursuing VA benefits. All initial rating decisions issued after February 19, 2019, are promulgated under the AMA. The rating decision on appeal was issued in March 2020 and constitutes an initial decision; therefore, the AMA applies.

In his timely February 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. By law, for claims appealed in this docket, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the March 2020 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence presented at the July 2024 hearing (including testimony) or submitted by the Veteran or his representative within 90 days of the hearing. 38 C.F.R. § 20.302. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the hearing, or (2) more than 90 days following the date the hearing was held, then, by law, the Board was not permitted to consider that evidence in this decision. 38 C.F.R. §§ 20.300, 20.302, 20.801. However, because the Veteran's appeal is resolved fully in his favor, there is no need for the Board to consider any additional evidence on this issue.

1. Service connection for bilateral hearing loss

2. Service connection for tinnitus

The Veteran asserts that his current tinnitus and bilateral hearing loss disabilities were incurred during active-duty service due to acoustic trauma caused by hazardous noise exposure.

These claims will be addressed together in this opinion because they are closely related and based on the same or similar facts and law. 

Legal Criteria

Service connection may be established for a disability that results from personal injury that is suffered, or disease contracted, in the line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. 

Generally, to establish service connection for a disability resulting from a disease or injury incurred in service, there must be competent evidence of (1) the current existence of the disability for which service connection is being claimed; (2) incurrence of a disease or injury in active service; and (3) a causal link or connection (nexus) between the current disability and the disease or injury incurred in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed Cir. 2004). 

Certain chronic diseases (including tinnitus and hearing loss) will be presumed related to service if they (1) were shown as chronic in service; (2) manifested to a compensable degree within a presumptive period
 for a disability resulting from a disease or injury incurred in service, there must be competent evidence of (1) the current existence of the disability for which service connection is being claimed; (2) incurrence of a disease or injury in active service; and (3) a causal link or connection (nexus) between the current disability and the disease or injury incurred in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed Cir. 2004). 

Certain chronic diseases (including tinnitus and hearing loss) will be presumed related to service if they (1) were shown as chronic in service; (2) manifested to a compensable degree within a presumptive period following separation from service; or (3) were noted in service, with continuity of symptoms 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); see Fountain v. McDonald, 27 Vet. App. 258 (2015).

Specific to claims for service connection for hearing loss, impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000 or 4000 Hertz (Hz) is 40 decibels or greater; the threshold for at least three of these frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC test are less than 94 percent. 38 C.F.R. § 3.385.

When there is no diagnosis of hearing loss in service, the absence of documented hearing loss in service is not fatal to a service connection claim for that disability, especially if service records indicate a significant in-service threshold shift. Ledford v. Derwinski, 3 Vet. App. 87 (1992); Hensley v. Brown, 5 Vet. App. 155 (1993). Establishing service connection is possible if the current hearing loss can be adequately linked to service. Ledford, 3 Vet. App. at 89. Thus, a claimant who seeks to establish service connection for a current hearing disability must show, as is required in a claim for service connection for any disability, that the current disability is the result of an injury or disease incurred in service; the determination of which depends on a review of all of the evidence of record. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304.

Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

When there is an approximate balance (nearly equal) of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

Factual Background

During service the Veteran's military occupational specialty (MOS) was as a track vehicle repairman attached to an artillery unit. In January 2019, the Veteran first submitted a VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits (Benefits Claim) for bilateral hearing loss and tinnitus. The Veteran attended a VA examination in March 2019 to assess his tinnitus and bilateral hearing loss claims.

The Veteran reported that his hearing loss began during military service due to frequent exposure to gunfire, artillery, jet engines, generators, motor pools, and heavy machinery trucks without hearing protection. He explained that he has difficulty hearing people talking and that he does not hear full conversations clearly; thus, impacting the ordinary conditions of his daily life. While his hearing aids help, he has trouble without them. The Veteran denied occupational noise exposure prior to the service as a migrant worker and post-service as a cable installation and repair technician. He also denied recreational noise exposure both pre- and post-service. 

The audiogram report reflects his Puretone thresholds, in decibels, as follows:

Ear	500Hz	1000Hz	2000Hz	3000Hz	
 reported that his hearing loss began during military service due to frequent exposure to gunfire, artillery, jet engines, generators, motor pools, and heavy machinery trucks without hearing protection. He explained that he has difficulty hearing people talking and that he does not hear full conversations clearly; thus, impacting the ordinary conditions of his daily life. While his hearing aids help, he has trouble without them. The Veteran denied occupational noise exposure prior to the service as a migrant worker and post-service as a cable installation and repair technician. He also denied recreational noise exposure both pre- and post-service. 

The audiogram report reflects his Puretone thresholds, in decibels, as follows:

Ear	500Hz	1000Hz	2000Hz	3000Hz	4000Hz

Right	30	35	40	40	45

Left 	40	40	45	45	50

Speech audiometry using the Maryland CNC test revealed speech recognition ability of 86 percent in the right ear and 92 percent in the left ear. 

The VA examiner diagnosed the Veteran with bilateral sensorineural hearing loss meeting the disability threshold for VA purposes under 38 C.F.R. § 3.385. The VA examiner concluded that no causal link existed, however, relying on a lack of any significant threshold shifts between his entrance and separation examinations and a lack of hearing loss complaints or treatment in his service treatment records (STRs), including at separation.

During the examination the Veteran also reported recurrent tinnitus. He stated that the ringing started following close proximity to artillery noise during service, but he did not recall an isolated onset incident. The Veteran reported his current symptom as a constant high pitch ringing sound in both ears ("the ringing is there all the time"), with the right ear being louder, and can block out the television or what people are saying. The VA examiner concluded that no causal link existed, again relying on a lack of any significant threshold shifts between his entrance and separation examinations and a lack of hearing loss complaints or treatment in his STRs, including at separation.

In March 2019 the AOJ issued a rating decision denying service connection for both claims based on the VA opinions. In January 2020 the Veteran submitted a VA Form 20-0995 Supplemental Claim appealing this decision. The Veteran submitted a statement in support of his appeal reiterating the hazardous noise exposure he endured due to his MOS. "I was a mechanic for an artillery unit and that [entailed] having to provide maintenance for the howitzer and having to go to the [field] with them when they were conducting [field] exercise[s]." See January 2020 VA Form 21-4138.

The Veteran was provided with a second VA examination in March 2020 with a different audiologist. The audiogram report reflects his Puretone thresholds, in decibels, as follows:

Ear	500Hz	1000Hz	2000Hz	3000Hz	4000Hz

Right	30	35	35	40	35

Left 	30	30	30	30	30

Speech audiometry using the Maryland CNC test revealed speech recognition ability of 88 percent in the right ear and 90 percent in the left ear. 

The VA examiner diagnosed the Veteran with tinnitus and bilateral sensorineural hearing loss meeting the disability threshold for VA purposes under 38 C.F.R. § 3.385. However, the VA examiner concluded that no causal link existed for either disability, relying on the same rationale as the previous VA examiner (a lack of any significant threshold shifts between his entrance and separation examinations and a lack of complaints or treatment in his STRs, including at separation.)

In the March 2020 rating decision on appeal, service connection for both disabilities were again denied based upon the VA examiner's negative causal linkage opinion. However, the AOJ made favorable findings in both the original rating decision and the rating decision on appeal that the Veteran has current diagnoses of tinnitus and bilateral hearing loss for VA disability compensation purposes and conceded exposure to hazardous noise for both disabilities.

The Veteran submitted his Board appeal in February 2021, requesting a hearing before a Veterans Law Judge. A hearing was held in July 2024, and the Veteran's testimony was consistent with his prior statements and other evidence of record. The Veteran testified that he had no issues with his hearing or ringing in his ears prior to military service. See transcript at pg. 4. The first time the Veteran fired a weapon was in the service, where he was required to qualify on various rifles, and most of the time hearing protection was not provided. Id. at pgs. 4-5. The Veteran was a track vehicle mechanic attached to an ordinance company, which required him to attend exercises in the field supporting artillery units for up to five or six days without hearing protection. Id. at pgs. 5-6. Most of the time he
 held in July 2024, and the Veteran's testimony was consistent with his prior statements and other evidence of record. The Veteran testified that he had no issues with his hearing or ringing in his ears prior to military service. See transcript at pg. 4. The first time the Veteran fired a weapon was in the service, where he was required to qualify on various rifles, and most of the time hearing protection was not provided. Id. at pgs. 4-5. The Veteran was a track vehicle mechanic attached to an ordinance company, which required him to attend exercises in the field supporting artillery units for up to five or six days without hearing protection. Id. at pgs. 5-6. Most of the time he spent in the field was supporting heavy artillery pieces (e.g., various Howitzers). "It was not a small cannon that you would pull around on a Jeep or anything like that. It was all heavy equipment." Also, while deployed to Rammstein Air Force Base in Germany, he was exposed to M-16 rifle fire and various aircraft noise, including from fighter jets, without being afforded hearing protection. Id. at pg. 6.

The Veteran also testified that his tinnitus symptoms began in service, have persisted since that time, and are constant ("it is 24/7"). Id. at pgs. 8-9. He also described that he experienced hearing loss during service. "Every time that I came back [from the firing range], my hearing was not that good. Id. at pg. 9. Following separation, he still experienced diminished hearing, which he first noticed with the level of volume he needed to watch the television. Id. at 10. 

The Veteran reported no hazardous noise exposure prior to service, and that he was in the cable business for a local utility company for 20 years following service where he mostly walked around reading meters. Id. He explained that when he was in service, he did not understand what was happening [regarding his symptoms], but as he grew older, he realized that what he was experiencing was not normal. "...[W]hen you are young, you don't think about the ringing. Now that I am older and it started affecting me, and I could hear the ringing back then. But to me, I didn't know. It was something new to me." Id. at 15.

Following the July 2024 Board hearing the Veteran submitted a statement from a private medical provider, who discussed the impact of his tinnitus and bilateral hearing loss disabilities on the Veteran. "It seems like it is starting to affect his quality of life. He has secluded himself from doing anything social as the ringing gets extreme whenever he is around people. He does wear hearing aids, but it does not help with the ringing at all. See August 2020 medical note.

In August 2024 the Veteran also submitted a statement from his wife describing her observations of his disabilities and their symptoms. "He started complaining of ringing in his ears and hearing loss when he would go training with his unit, which was an artillery unit. Usually, his ringing and hearing loss would not last. Now that he is older, the ringing will not stop, and he does not hear very well. Sometimes I see him put his hands over his ears and I know it is because the ringing is causing him pain." 

Analysis

The record appears silent for any complaints, treatment, or diagnoses related to tinnitus or hearing loss during the Veteran's service or within his first post-service year. Thus, there is no basis for awarding service connection on a presumptive basis as a chronic disease. What remains for consideration is whether these disabilities might otherwise be related to service.

The Board has no reason to disturb the favorable findings of the AOJ conceding the first two elements for service connection on appeal. Therefore, the crux of the Veteran's appeal is whether a causal link exists between his in-service noise exposure and his current tinnitus and bilateral hearing loss disabilities.

Turning to the medical evidence, the Board cannot assign significant probative weight to either the March 2019 or March 2020 VA opinions. Both VA examiners rationales that the Veteran's bilateral hearing loss and tinnitus were less likely than not related to his in-service noise exposure based on a lack of evidence showing "threshold shifts" between his entrance and separation audiograms, and because his STRs are absent of evidence of hearing loss or complaints of tinnitus, are contrary to VA's policies as interpreted by relevant legal caselaw on this topic. See Ledford, 3 Vet. App. at 89; Hensley, 5 Vet. App. at 159.

The Board assigns significant weight to the competent (that is, medically qualified) and credible lay statements and testimony from the Veteran and his spouse describing the observable symptoms of his disabilities during service and their continuity and
 VA examiners rationales that the Veteran's bilateral hearing loss and tinnitus were less likely than not related to his in-service noise exposure based on a lack of evidence showing "threshold shifts" between his entrance and separation audiograms, and because his STRs are absent of evidence of hearing loss or complaints of tinnitus, are contrary to VA's policies as interpreted by relevant legal caselaw on this topic. See Ledford, 3 Vet. App. at 89; Hensley, 5 Vet. App. at 159.

The Board assigns significant weight to the competent (that is, medically qualified) and credible lay statements and testimony from the Veteran and his spouse describing the observable symptoms of his disabilities during service and their continuity and progressive worsening since service. These statements are competent: that is, the parties submitting them are qualified to report this information because it does not require medical training or expertise to accurately report these observable events. The Board finds no reason to discount these statements. 

The Veteran clearly described continuing observable symptoms since service for both disabilities at issue. By law, a continuity of symptoms since service may be sufficient to establish a causal link, absent clear and convincing medical evidence to the contrary. A lack of medical evidence is not clear and convincing. See Horn v. Shinseki, 25 Vet. App. 231, 239 n.7 (2012) (Absence of evidence cannot be substantive negative evidence without "a proper foundation... to demonstrate that such silence has a tendency to prove or disprove a relevant fact"). The March 2019 and March 2020 VA medical opinions fail to constitute "clear and convincing medical evidence to the contrary" given their deficiencies discussed herein. 

Further, the Veteran clearly explained at the Board hearing the reasons for the absence of any complaints, treatment, or diagnoses of these disabilities during or initially after service, (which absence the VA examiners heavily relied on in concluding that a causal link had not been established for either disability). Moreover, there is no persuasive evidence suggesting that the Veteran was exposed to noise so severe and pervasive that it could be considered an intervening trauma or intercurrent post-service cause. Thus, the final element for service connection has been established.

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Accordingly, based on a totality of evidence described above, including the probative weight assigned to each piece of evidence, and affording the Veteran the maximum benefit sought, the Board concludes that service connection for the Veteran's tinnitus and bilateral hearing loss disabilities is warranted. Thus, the Veteran's appealed issues are granted.

 

VICTORIA MOSHIASHWILI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Meadows, Samantha A.

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.