HEARING LOSS

DUSTIN L. WARE · 2026 · Case ID: A26040600

MIXED

Summary

The Veteran, an Army infantryman who served from March 1974 to August 1975, appeals the denial of service connection for bilateral hearing loss and tinnitus, and the remand of claims for obstructive sleep apnea, a gastrointestinal (GI) disability including acid reflux, and vertigo. The Board conceded the Veteran's exposure to hazardous military noise due to his infantry MOS, finding he experienced acoustic trauma in service. For bilateral hearing loss, the Board found the Veteran's private nurse practitioner's opinion, which linked the condition to in-service noise exposure, to be more probative than the VA examiner's negative opinion, which was deemed inadequate for failing to address the noise exposure. The Board resolved doubt in the Veteran's favor, granting service connection for bilateral hearing loss. For tinnitus, the Board noted it can be established by lay evidence alone and that the Veteran had a current diagnosis. Balancing the negative VA opinion against the private opinion linking tinnitus to noise exposure and the Veteran's own testimony, the Board found the evidence in approximate balance and granted service connection for tinnitus, applying the benefit of the doubt. The claims for obstructive sleep apnea, GI disability (acid reflux), and vertigo were remanded due to a pre-decisional duty to assist error, as the Veteran had not yet received a VA examination or medical opinion to assess the nature and etiology of these conditions.

Rationale

Conceded exposure to hazardous military noise; Found acoustic trauma in service; Private opinion more probative than negative VA opinion; Resolved doubt in Veteran's favor

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251106-605314

Full Decision Text

Citation Nr: A26040600
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 251106-605314
DATE: April 30, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is granted.

Entitlement to service connection for tinnitus is granted.

REMANDED

Entitlement to service connection for obstructive sleep apnea is remanded.

Entitlement to service connection for a gastrointestinal (GI) disability, to include acid reflux, is remanded.

Entitlement to service connection for vertigo is remanded.

FINDINGS OF FACT

1. Resolving all reasonable doubt in favor of the Veteran, his bilateral hearing loss is etiologically related to military noise exposure.

2. Resolving all reasonable doubt in favor of the Veteran, his tinnitus is etiologically related to military noise exposure.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from March 1974 to August 1975.

These matters are before the Board of Veterans' Appeal (Board) on appeal from an April 2025 rating decision of the agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA).

In November 2025, the Veteran filed a timely VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), in which he expressed disagreement with the decision on appeal. The Veteran elected the Direct Review option. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38 C.F.R. § 20.301.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires: (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

For certain chronic disorders, to include sensorineural hearing loss and tinnitus, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In such cases, the disease is presumed under the law to have had its onset in service even if there is no evidence of such disease during service. 38 C.F.R. § 3.307(a); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker, 708 F.3d at 1331.

When the evidence is evenly balanced or approximately so with regard to whether service connection is warranted, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; Lynch v. McDon
service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker, 708 F.3d at 1331.

When the evidence is evenly balanced or approximately so with regard to whether service connection is warranted, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). To deny a claim on its merits, the evidence must persuasively weigh against the claim. Id. (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

1. Entitlement to service connection for bilateral hearing loss

The Veteran seeks entitlement to service connection for bilateral hearing loss, which he contends developed due to his in-service exposure to noise. See December 2024 Claim for Benefits.

The Veteran's DD-214 shows that his military occupational specialty (MOS) was an infantryman, an MOS that is highly probable for noise exposure. As such, the Board concedes exposure to hazardous military noise during service. Accordingly, the Board finds that the Veteran experienced acoustic trauma during his active-duty service.

The Veteran was diagnosed with bilateral sensorineural hearing loss considered to be disabling for VA purposes during his April 2025 VA audiological examination. 38 C.F.R. § 3.385.

Therefore, the question in this case is whether a causal relationship or nexus exists between the Veteran's bilateral hearing loss and military noise exposure. Based on a careful review of the subjective and clinical evidence of record, the Board resolves all reasonable doubt in favor of the Veteran and finds that service connection for bilateral hearing loss is warranted.

As noted above, in April 2025, the Veteran underwent a VA audiology examination to determine the nature and etiology of his bilateral hearing loss. Following examination and review of the Veteran's record, the Veteran was diagnosed with bilateral sensorineural hearing loss considered to be disabling for VA purposes. 38 C.F.R. § 3.385.

The VA examiner provided a negative nexus opinion with regard to the Veteran's bilateral hearing loss, finding that the Veteran's audiometric thresholds were within normal limits on separation examination, with no findings related to shifts in audiometric thresholds, and therefore there was no evidence that his hearing loss was related to noise exposure in service. However, the fact that there was no hearing loss in service is not dispositive of the issue and an opinion based on this fact is inadequate. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993); Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992) (the absence of a hearing loss disability in service is not in and of itself fatal to a claim for service connection).

The Veteran submitted an opinion from a private family nurse practitioner, A.E., FNP., in December 2024 that stated that the bilateral hearing loss is at least as likely as not the result of the Veteran's active service. The private physician provided a conclusion adequately supported by medical rationale based on the Veteran's noise exposure in service. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008) (holding that conclusions that are factually accurate, fully articulated, and contain sound reasoning contribute to the probative value of a medical opinion).

Based on the foregoing, the evidence of record supports a finding that the Veteran's bilateral hearing loss is causally related to his active service. The April 2025 VA opinion of record is of minimal probative weight as it did not provide an adequate rationale to support the negative nexus opinion. On the other hand, the private opinion links the Veteran's bilateral hearing loss to in-service noise exposure and the Veteran's statements both establish that he had noise exposure in service and has had hearing loss since service. When read together, and in the interest of providing the Veteran with the full benefit of the doubt, the Board finds that the evidence establishes that the current bilateral hearing loss disability is causally related to the Veteran's active service. Therefore, by resolving all reasonable doubt in favor of the Veteran, service connection for a bilateral hearing loss disability is granted. 38 C.F.R. §§ 3.102, 3.303.

2. Entitlement to service connection for tinnitus

The Veteran seeks entitlement to service connection for tinnitus, which he contends was incurred
the private opinion links the Veteran's bilateral hearing loss to in-service noise exposure and the Veteran's statements both establish that he had noise exposure in service and has had hearing loss since service. When read together, and in the interest of providing the Veteran with the full benefit of the doubt, the Board finds that the evidence establishes that the current bilateral hearing loss disability is causally related to the Veteran's active service. Therefore, by resolving all reasonable doubt in favor of the Veteran, service connection for a bilateral hearing loss disability is granted. 38 C.F.R. §§ 3.102, 3.303.

2. Entitlement to service connection for tinnitus

The Veteran seeks entitlement to service connection for tinnitus, which he contends was incurred in or caused by military noise exposure.

As noted above, VA has conceded exposure to hazardous military noise during service. Moreover, the Board notes that tinnitus is a type of disability that may be established on the basis of lay evidence alone. Charles v. Principi, 16 Vet. App. 370 (2002). As such, there is no dispute that the Veteran has a current diagnosis of tinnitus.

The question remaining before the Board is whether the Veteran's tinnitus is etiologically related to his in-service noise exposure. Based on a careful review of the subjective and clinical evidence of record, the Board resolves all reasonable doubt in favor of the Veteran and finds that service connection for tinnitus is warranted.

The Veteran underwent a VA audiology examination in April 2025 in which the examiner provided a negative nexus opinion.

Conversely, The Veteran submitted an opinion from a private family nurse practitioner, A.E., FNP., in December 2024 that stated that the Veteran's tinnitus is at least as likely as not the result of the Veteran's active service. The private audiologist provided a conclusion adequately supported by medical rationale based on the Veteran's noise exposure in service. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008) (holding that conclusions that are factually accurate, fully articulated, and contain sound reasoning contribute to the probative value of a medical opinion).

In light of the foregoing, the Board concludes that there is an approximate balance of positive and negative evidence regarding the merits of the issue, and the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When the evidence is in approximate balance or nearly equal, the claim is to be granted. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Accordingly, service connection for the Veteran's tinnitus is granted.

REASONS FOR REMAND

1. Entitlement to service connection for obstructive sleep apnea is remanded.

The Veteran seeks entitlement to service connection for obstructive sleep apnea which he contends was incurred in or caused by service.

Private treatment records document that the Veteran was diagnosed with obstructive sleep apnea. See December 2024 Private Treatment Record.

To date, the Veteran has not been afforded a VA examination or medical opinion to assess the nature and etiology of his diagnosed obstructive sleep apnea. This constitutes a pre-decisional duty to assist error, and the claim must be remanded so that the Veteran can be afforded the appropriate examination and medical opinion prior to adjudication. 38 C.F.R. § 20.802(a); McLendon v. Nicholson, 20 Vet. App. 79 (2006).

2. Entitlement to service connection for a gastrointestinal (GI) disability, to include acid reflux, is remanded.

The Veteran seeks entitlement to service connection for a gastrointestinal disability which he contends was incurred in or caused by service.

As an initial matter, the Veteran claimed entitlement to service connection for gastroesophageal reflux disease (GERD). The Veteran does not have a diagnosis for GERD, but he has symptoms of acid reflux. Therefore, the Board has recharacterized the Veteran's claim pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009), as one for entitlement to service connection for a gastrointestinal disability, to include acid reflux.

Private treatment records document that the Veteran was diagnosed with acid reflux. See December 2024 Private Treatment Record.

To date, the Veteran has not been afforded a VA examination or medical opinion to assess the nature and etiology of his diagnosed gastrointestinal disability. This constitutes a pre-decisional duty to assist error, and the claim must be remanded so that the Veteran can be afforded the appropriate examination and medical opinion prior to adjudication. 38 C.F.R. § 20.802(a); McLendon v. Nicholson, 20 Vet. App. 79 (2006).

3. Entitlement to
Vet. App. 1 (2009), as one for entitlement to service connection for a gastrointestinal disability, to include acid reflux.

Private treatment records document that the Veteran was diagnosed with acid reflux. See December 2024 Private Treatment Record.

3. Entitlement to service connection for vertigo is remanded.

The Veteran seeks entitlement to service connection for vertigo which he contends was incurred in or caused by service.

There is no diagnosis of dizziness or vertigo of record, but as this condition is lay observable, the Veteran is competent to report it.

To date, the Veteran has not been afforded a VA examination or medical opinion to assess the nature and etiology of his diagnosed vertigo. This constitutes a pre-decisional duty to assist error, and the claim must be remanded so that the Veteran can be afforded the appropriate examination and medical opinion prior to adjudication. 38 C.F.R. § 20.802(a); McLendon v. Nicholson, 20 Vet. App. 79 (2006).

Accordingly, the matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination with a medical professional of appropriate expertise to address the nature and etiology of his current obstructive sleep apnea. The examiner must review the Veteran's entire claims file and that review must be noted in the report. A complete history of symptoms should be elicited from the Veteran. All clinical findings should be reported in detail.

Thereafter, the examiner is asked to fully respond to the following:

(a) Whether the Veteran's obstructive sleep apnea was incurred in or otherwise related to the Veteran's service?

The examiner is remined that the Veteran is considered competent to report the events that occurred during service, as well as the symptoms he experienced, including when those symptoms had their onset and how long they have persisted.

The examiner must set forth a complete rationale for any conclusions reached. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so.

2. Schedule the Veteran for a VA examination with a medical professional of appropriate expertise to address the nature and etiology of his current gastrointestinal disability. The examiner must review the Veteran's entire claims file and that review must be noted in the report. A complete history of symptoms should be elicited from the Veteran. All clinical findings should be reported in detail.

Thereafter, the examiner is asked to fully respond to the following:

(a) Whether the Veteran's gastrointestinal disability, diagnosed as acid reflux, was incurred in or otherwise related to the Veteran's service?

The examiner must set forth a complete rationale for any conclusions reached. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so.

3. Schedule the Veteran for a VA examination with a medical professional of appropriate expertise to address the nature and etiology of his current vestibular disability. The examiner must review the Veteran's entire claims file and that review must be noted in the report. A complete history of symptoms should be elicited from the Veteran. All clinical findings should be reported in detail.

Thereafter, the examiner is asked to fully respond to the following:

(a) Whether the Veteran's vertigo was incurred in or otherwise related to the Veteran's service?

The examiner must set forth a complete rationale for any conclusions reached. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so.

DUSTIN L. WARE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Rosenthal, Ariana

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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