TINNITUS

MICHAEL A. PAPPAS · 2026 · Case ID: A26040574

MIXED

Summary

The veteran, who served from September 1966 to August 1968, appeals the denial of service connection for tinnitus and bilateral hearing loss. The Board found that the veteran's field artillery MOS and conceded hazardous noise exposure during service were relevant to both claims. For tinnitus, the Board noted a discrepancy in the VA examiner's opinion regarding symptom onset, finding the examiner's rationale weak. The veteran's testimony about intermittent tinnitus symptoms since service, coupled with the conceded noise exposure, led the Board to find the evidence in approximate balance. Applying the benefit of the doubt, service connection for tinnitus was granted. For bilateral hearing loss, the Board found the VA examination inadequate. The examiner's negative opinion relied heavily on normal in-service hearing tests and an incomplete interpretation of the Institute of Medicine study on noise-induced hearing loss. The Board remanded the hearing loss claim for a new, adequate audiological examination to determine the nature and etiology of the disability, specifically asking the examiner to consider the veteran's testimony, the conceded noise exposure, and the nuances of the Institute of Medicine study.

Rationale

Conceded in-service hazardous noise exposure due to field artillery MOS; Veteran testimony of symptom onset during service and continuity; Inadequate VA examination due to conflicting symptom onset and overreliance on Institute of Medicine study

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250904-581423

Full Decision Text

Citation Nr: A26040574
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250904-581423
DATE: April 30, 2026

ISSUES

1. Entitlement to service connection for tinnitus.

2. Entitlement to service connection for a bilateral hearing loss disability.

ORDER

Entitlement to service connection for tinnitus is granted.

REMANDED

Entitlement to service connection for a bilateral hearing loss disability is remanded.

FINDING OF FACT

The evidence is in approximate balance whether 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 has been met or approximated. 38 U.S.C. §§ 1101, 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1966 to August 1968.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2024 rating decision by a Department of Veteran's Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ).

By way of background, following an April 2024 rating decision in which the AOJ denied the present claims, the Veteran filed an August 2024 Higher-Level Review (HLR) request. Following a December 2024 HLR rating decision in which the AOJ again denied the claims, the Veteran filed a timely September 2025 VA Form 10182, Decision Review Request: Board Appeal, Notice of Disagreement (VA Form 10182) appealing the December 2024 rating decision and selecting the Hearing docket.

The Veteran testified at a Board hearing in January 2026 before the undersigned Veterans Law Judge (VLJ). A transcript of the proceeding is associated with the claims file.

The Board may only consider the evidence of record at the time of the April 2024 rating decision, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) after the April 2024 rating decision and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran or his representative 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 with this decision.

For the bilateral hearing loss disability claim the Board is remanding, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claims. 38 C.F.R. § 3.103(c)(2)(ii).

Entitlement to service connection for tinnitus.

The Veteran claims entitlement to service connection for tinnitus. He contends that the symptoms of tinnitus started while on active duty serving in field artillery and have continued since. See DD-214; September 2023 VA Form 526EZ; January 2026 Board hearing.

In order to obtain service connection under 38 U.S.C. §§ 1110, 1131 and 38 C.F.R. § 3.303(a) a Veteran must satisfy a three-element test: (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, the so called 'nexus' requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

The Board further notes that 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 v. McDonald, 27 Vet. App. 258 (2015); see also Walker v.
a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so called 'nexus' requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

As an initial matter, in the April 2024 rating decision the AOJ found that the Veteran has a current tinnitus disability and that a qualifying event, injury, or disease had it onset during active duty service due to his field artillery military occupational specialty (MOS). The Board is bound by these prior favorable findings, which were not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c).

Therefore, this appeal primarily hinges on whether a nexus may be established, i.e., whether the Veteran's current tinnitus is etiologically related to the conceded active duty service noise exposure.

In that regard, in the April 2024 VA Hearing Loss and Tinnitus examination the examiner opined that it was less likely than not that the Veteran's tinnitus was caused by or related to active duty service. In large part the rationale provided was that there was no hearing loss during active duty service and the Veteran only reported that tinnitus began, as noted by the examiner, 5-6 years ago. The Board notes that the examiner's reporting of when the Veteran's tinnitus symptoms began is at odds with the Veteran's September 2023 VA Form 526EZ in which he stated the disability began in 1967, during active duty service, as a result of MOS-related damage.

Given the disconnect or confusion as to when the Veteran's tinnitus symptoms first occurred, and that symptom onset was the linchpin rationale for the examiner's conclusion, the Board finds this examination of little probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (an adequate and thorough examination must consider all other relevant evidence of record, including lay statements); see also Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service).

The Board notes that in the January 2026 Board hearing the Veteran confirmed that tinnitus-type symptoms occurred during active duty service, and continued, at the least, intermittently since then.

To that point, tinnitus is unlike hearing loss in that it is capable of lay observation. The Veteran is competent to report factually observable occurrences in service and the timing of the observable symptoms of his disability, that is, as noted, that he began having symptoms of tinnitus while on active duty, while being exposed to hazardous noise, namely field artillery, and those symptoms have continued. In other words, that there was a continuity of tinnitus symptomatology from active duty onward. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (a Veteran is competent to provide evidence of that which he experiences, including his symptomatology and medical history). The notations/statements made by the Veteran before and after the VA examination supports his credibility as to in-service symptom onset, as does the confirmation of his duties in field artillery and commensurate conceded hazardous noise exposure for such, as noted above.

Therefore, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's current tinnitus disability is related to his in-service hazardous noise exposure. Affording the benefit of the doubt to the Veteran, entitlement to service connection for tinnitus is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303(a); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).

REASONS FOR REMAND

Entitlement to service connection for a bilateral hearing loss disability.

The Veteran claims entitlement to service connection for a bilateral hearing loss disability. Specifically, he contends that his current bilateral hearing loss is due to his in-service hazardous noise exposure, namely as noted, his field artillery MOS. See September 2023 VA Form 526EZ; January 2026 Board hearing.

As an initial matter, in the
connection for tinnitus is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303(a); Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).

REASONS FOR REMAND

Entitlement to service connection for a bilateral hearing loss disability.

As an initial matter, in the April 2024 rating decision the AOJ found that the Veteran has a current hearing loss disability for VA purposes and as noted, that a qualifying event, injury, or disease had it onset during active duty service due to his field artillery MOS. The Board is bound by these prior favorable findings, which were not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c).

In the April 2024 VA Hearing Loss and Tinnitus examination, the examiner, after diagnosing the Veteran with bilateral sensorineural hearing loss, opined that it was less likely than not that the Veteran's bilateral hearing loss was caused by or related to active service. As rationale, the examiner noted that in-service enlistment and separation examinations were consistent with normal hearing and negative for permanent significant (threshold) shifts during military service, and that the Institute of Medicine's 'Noise and Military Service: Implications for Hearing Loss and Tinnitus' study concluded that, based on current knowledge noise-induced hearing loss occurred immediately and that there was no evidence to support delayed onset of noise-induced hearing loss years after exposure. The examiner also noted that the Veteran's extensive recreational and occupational noise exposure post-service was a factor in the determination that the Veteran's current hearing loss disability was not related to active duty service hazardous noise exposure.

The Board finds this VA examination inadequate at the very least for in part relying on in-service testing to support the negative conclusion. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993) (it is well-established that service connection for a hearing loss disability can still be warranted even where a veteran had normal audiometric tests in service.). Moreover, it appears that the examiner overstated the conclusions of the Institute of Medicine study. The Court of Appeals for Veterans Claims (Court) has noted that this study was ultimately inconclusive as to the possibility of delayed onset hearing loss, explaining that such a pattern of hearing loss was "extremely unlikely" but that there was little evidence and no conclusive results from longitudinal studies of older adults. See McCray v. Wilkie, 31 Vet. App. 243, 253-54 (2019). It would have been helpful if the examiner had discussed these qualifying statements in relying on the study. Additionally, in discussing the Veteran's post-service noise exposure as a factor in determining that the Veteran's current hearing loss disability was not a result of his in-service noise exposure, it would have been helpful if the examiner had further discussed, as the Veteran had reported, that he had ear protection at work, and wore a full helmet while driving his motorcycle.

Ultimately, if an examination report does not contain sufficient detail, as is the case here, "it is incumbent upon the rating board to return the report as inadequate for evaluation purposes." 38 C.F.R. § 4.2; see Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return inadequate examination reports).

As such, a remand is required to cure this pre-decisional duty to assist error and obtain an adequate VA medical examination to determine the nature and etiology of the Veteran's diagnosed bilateral hearing loss disability.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an audiological examination with a different examiner to determine the nature and etiology of his claimed bilateral hearing loss disability. The entire claims file, including prior audiological examinations/opinions and this Remand, must be made available to the examiner for review in connection with the examination. The examiner should note that the claims file has been reviewed.

After reviewing the claims file and examining the Veteran, the examiner is asked to answer the following question:

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 diagnosed bilateral hearing loss disability had its onset in service or is otherwise related to any in-service disease, event, or injury. The examiner is reminded that VA has conceded the Veteran's exposure to hazardous noise during active duty service, and that his field artillery MOS
claimed bilateral hearing loss disability. The entire claims file, including prior audiological examinations/opinions and this Remand, must be made available to the examiner for review in connection with the examination. The examiner should note that the claims file has been reviewed.

After reviewing the claims file and examining the Veteran, the examiner is asked to answer the following question:

In rendering the above opinion, the examiner is also advised that the absence of in-service evidence of a hearing loss disability is not always fatal to a service connection claim. Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service. See Hensley, 5 Vet. App. at 159.

If the examiner relies on the aforementioned Institute of Medicine's 'Noise and Military Service: Implications for Hearing Loss and Tinnitus' study, the examiner must explain how the qualifying and contradictory statements in this study impact the examiner's etiology opinion. Reliance solely on the Institute of Medicine study regarding delayed-onset hearing loss is not an adequate rationale. See McCray, 31 Vet. App. at 253-54.

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Matthew Leahy, Associate 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.

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