Citation Nr: 1322347 Decision Date: 07/12/13 Archive Date: 07/18/13 DOCKET NO. 13-00 678 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for myasthenia gravis. 2. Entitlement to service connection for tinnitus. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Counsel INTRODUCTION Pursuant to 38 C.F.R. § 20.900(c), this appeal has been advanced on the Board's docket. The Veteran served on active duty from January 1947 to May 1948, and from October 1948 to June 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal of a December 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). FINDINGS OF FACT 1. Myasthenia gravis had its onset during the Veteran's period of active service. 2. Tinnitus had its onset during the Veteran's period of active service. CONCLUSIONS OF LAW 1. The criteria for service connection for myasthenia gravis have been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). 2. The criteria for service connection for tinnitus have been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Notice and Assistance VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. The Board is granting in full the benefits sought on appeal. Accordingly, any error committed with respect to either the duty to notify or the duty to assist was harmless and will not be further discussed. Service Connection Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury 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 an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (1995). Myasthenia Gravis The Veteran contends that he has myasthenia gravis that he believes began during his final year of active duty. He testified at his personal hearing in September 2011 that during the fall of 1966 he began experiencing symptoms of physical exhaustion and muscle weakness. He reported that he did not seek medical treatment at that time because he believed his symptoms may have been related to what was later diagnosed as posttraumatic stress disorder (PTSD) and he was concerned about adverse career consequences if he reported such. He reported that the condition reappeared off and on including in 1981 when he was treated for colon cancer and then again in the early 1990s. The record shows that he was officially diagnosed with myasthenia gravis in 1998. The Veteran submitted information from the internet, including an article from the Mayo Clinic, regarding myasthenia gravis. This evidence indicated that myasthenia gravis could be manifested by spontaneous remissions during which symptoms and signs of illness would disappear. A VA examination in November 2011 diagnosed myasthenia gravis that was being treated with Prednisone, Imuran, and pyridostigmine. The examiner noted that myasthenia gravis had been diagnosed in 1998, but did not provide an opinion as to whether the Veteran reported inservice symptoms were related to the later diagnosis. The Veteran is competent to report the onset and continuity of his symptoms of weakness and fatigue. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). The Veteran's report of the onset of his symptoms during service is deemed credible as his testimony is detailed and specific as to his recollections and their timing, and his report of experiencing periods of abatement of symptoms is consistent with the profile of the later diagnosed myasthenia gravis. The Veteran's report of experiencing symptoms of what was eventually diagnosed as myasthenia gravis beginning during the final year of service is deemed credible, as his report is uncontroverted by any evidence of record. Cf. Cromer v. Nicholson, 19 Vet. App. 215 (2005). As the Veteran has a current diagnosis of myasthenia gravis and has provided a credible history of inservice onset of such, service connection for myasthenia gravis is warranted. See 38 C.F.R. § 3.303(b), (d). Tinnitus The Veteran reports acoustic trauma exposure during service in Vietnam, where he served in combat in field artillery and earned medals including the Bronze Star and Purple Heart. At his personal hearing in September 2011 the Veteran reported that he served for 18 years in artillery and spent one year in Vietnam as a sergeant in a howitzer battalion firing thousands of artillery rounds. He testified that he has experienced ringing in his ears since Vietnam. The Veteran testified that he did not seek medical attention for tinnitus during service because "it was something that happened to everybody." He testified that after service he owned a service station/garage but that he did not have significant noise exposure in that occupation as he had someone run the garage for him. The Veteran underwent a VA audiological examination in October 2010 during which he reported an onset of tinnitus in his 30s or 40s. The examiner diagnosed tinnitus. The examiner found it less likely as not related to military service because there were no documented complaints of tinnitus during service and since the Veteran's "subjective onset of his tinnitus is probably just subsequent to his military service." The Veteran underwent another VA audiological examination in August 2012 during which he reported that his tinnitus had been "going on forever," but had become particularly irritating in Vietnam. The Veteran reported that while in Vietnam his artillery battery would fire more than 600 rounds in a 24 hour period and that he would be in close proximity to these artillery weapons. The examiner diagnosed tinnitus. The examiner found it less likely as not related to military service because there were no documented complaints of tinnitus during service and no documented change of hearing in service. The Veteran is competent to report the onset and continuity of his tinnitus symptoms, as tinnitus is a disease that is capable of lay observation. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). Indeed, tinnitus is diagnosed based on an individual's subjective complaints. The Veteran's report of the onset of his tinnitus during service is deemed credible, as his report is consistent with his duties in service in field artillery in Vietnam. The Veteran's report of experiencing tinnitus since service is deemed credible, as his report is uncontroverted by any evidence of record. Cf. Cromer v. Nicholson, 19 Vet. App. 215 (2005). As the Veteran has a current diagnosis of tinnitus and has provided a credible history of inservice onset of such, service connection for tinnitus is warranted. See 38 C.F.R. § 3.303(b), (d). ORDER Service connection for myasthenia gravis is granted. Service connection for tinnitus is granted. ____________________________________________ RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs