Citation Nr: 1328487 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 10-44 435 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Whether new and material evidence has been received to reopen the claim of service connection for right ear hearing loss. 2. Whether new and material evidence has been received to reopen the claim of service connection for tinnitus. 3. Entitlement to service connection for tinnitus. 4. Entitlement to service connection for a bilateral hearing loss disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD T. S. Kelly, Counsel INTRODUCTION The Veteran, who is also the appellant, had active service from February 1969 to January 1971 and from August 1971 to August 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2009 rating determination of the Department of Veterans Affairs (VA) Regional Office (RO) located in Waco, Texas, that denied service connection for tinnitus and right ear hearing loss on the basis that new and material evidence had not been received and denied service connection for left ear hearing loss on a direct and presumptive basis. In March 2012, the Veteran appeared at a Travel Board hearing before the undersigned Veterans Law Judge at the RO. A transcript of the hearing is of record. With regard to the tinnitus and right ear hearing loss, although the Board notes that the RO reopened the claims, the question of whether new and material evidence has been received is one that must be addressed by the Board, notwithstanding any favorable decisions as to these matters which may have been rendered by the RO. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996) [before considering a previously adjudicated claim, the Board must determine that new and material evidence was presented or secured for the claim, making RO determination in that regard irrelevant]; see also Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001) [the Board has a jurisdictional responsibility to consider whether it was proper for the RO to reopen a previously denied claim]. As such, the Board has listed the issue as such on the title page of this decision. FINDINGS OF FACT 1. The RO denied service connection for right ear hearing loss in September 2007. While the Veteran filed a notice of disagreement and a statement of the case was issued, he did not perfect his appeal in the one year period nor was any evidence received within the one year period which would have allowed the claim to remain open. 2. The RO denied service connection for tinnitus in September 2007. While the Veteran filed a notice of disagreement and a statement of the case was issued, he did not perfect his appeal in the one year period nor was any evidence received within the one year period which would have allowed the claim to remain open. 3. Evidence received since the denial of service connection for right ear hearing loss raises a reasonable possibility of substantiating the claim. 4. Evidence received since the denial of service connection for tinnitus raises a reasonable possibility of substantiating the claim. 5. The Veteran was exposed to acoustic trauma in service. 6. The Veteran has provided credible lay evidence of in- service onset of tinnitus and unremitting tinnitus since service. 7. Tinnitus had its onset in service. 8. The Veteran has provided credible lay evidence of continuity of bilateral hearing loss symptoms in service and since service. 9. The Veteran's bilateral hearing loss had its onset in service. CONCLUSIONS OF LAW 1. The September 2007 rating determination denying service connection for right ear hearing loss became final. 38 U.S.C.A. § 7105 (c) (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2012). 2. New and material evidence sufficient to reopen the claim of entitlement to service connection for right ear hearing loss has been received. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156 (2012). 3. The September 2007 rating determination denying service connection for tinnitus became final. 38 U.S.C.A. § 7105 (c) (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2012). 4. New and material evidence sufficient to reopen the claim of entitlement to service connection for tinnitus has been received. 38 U.S.C.A. §§ 5108, 7105 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156 (2012). 5. The criteria for service connection for tinnitus are met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102 , 3.159, 3.303 (2012). 6. The criteria for service connection for bilateral hearing loss are met. 38 U.S.C.A. §§ 1101, 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Assist and Notify The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) and that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). For claims pending before VA on or after May 30, 2008, 38 C.F.R. § 3.159 has been amended to eliminate the requirement that VA request that a claimant submit any evidence in his or her possession that might substantiate the claim. 73 Fed. Reg. 23,353 (Apr. 30, 2008). The Court has also held that that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The VCAA is not applicable where further assistance would not aid the appellant in substantiating his claim. Wensch v. Principi, 15 Vet App 362 (2001); see 38 U.S.C.A. § 5103A(a)(2) (Secretary not required to provide assistance "if no reasonable possibility exists that such assistance would aid in substantiating the claim"); see also VAOPGCPREC 5-2004 (the notice and duty to assist provisions of the VCAA do not apply to claims that could not be substantiated through such notice and assistance). In view of the Board's favorable decision on this claim as it relates to the issues of whether new and material evidence has been received to reopen the claims of service connection for tinnitus and right ear hearing loss and the actual grants of service connection for bilateral hearing loss and tinnitus, further assistance is not required to substantiate that element of the claims. New and Material Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C.A § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). "New" evidence means evidence "not previously submitted to agency decisionmakers." 38 C.F.R. § 3.156(a) (2012). "Material" evidence means "evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim." Id. The Court has elaborated that material evidence is: (1) evidence on an element where the claimant initially failed to submit any competent evidence; (2) evidence on an element where the previously submitted evidence was found to be insufficient; (3) evidence on an element where the appellant did not have to submit evidence until a decision of the Secretary determined that an evidentiary presumption had been rebutted; or (4) some combination or variation of the above three situations. Kent v. Nicholson, 20 Vet. App. 1 2006). In order to be "new and material" evidence, the evidence must not be cumulative or redundant, and "must raise a reasonable possibility of substantiating the claim," which has been found to be enabling, not preclusive. See Shade v. Shinseki, 24 Vet. App. 110 (2010). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). Further, RO decisions become final "only after the period for appeal has run," and "[a]ny interim submissions before finality must be considered by the VA as part of the original claim." Jennings v. Mansfield, 509 F.3d 1362, 1368 (Fed. Cir. 2007). If new and material evidence is received within one year after the date of mailing of an RO decision, it may be "considered as having been filed in connection with the claim which was pending at the beginning of the appeal period that prevents an initial determination from becoming final." King v. Shinseki, 23 Vet. App. 464, 466-67 (2010). When VA fails to consider new and material evidence submitted within the one-year appeal period pursuant to § 3.156(b), and that evidence establishes entitlement to the benefit sought, the underlying RO decision does not become final. Young v. Shinseki, 22 Vet. App. 461, 466 (2009); see also Buie v. Shinseki, 24 Vet. App. 242, 252 (2011) (remanding for the Board to consider the application of 38 C.F.R. § 3.156(b) and whether the regional office correctly viewed the statements in question "as new claims"). In Buie, the Court explained that, when statements are received within one year of the rating decision, the Board's inquiry is not limited to whether those statements constitute notices of disagreement but whether those statements include the submission of new and material evidence under 38 C.F.R. § 3.156(b). Id. As it relates to the right ear, the RO denied service connection for right ear hearing loss on the basis that review of the Veteran's service medical records was negative for hearing loss to the right ear. The RO indicated that on the Veteran's induction examination "intermittent hearing loss" was noted in the physician's summary section. The RO also indicated that the July 2007 VA examiner noted the findings of examinations performed in 1969, 1970, 1971, and 1974. The examiner further noted that the Veteran was treated for sand irritation in the external canal. The examiner stated that this type of condition would not result in hearing loss. The examiner opined that it was less likely than not that the Veteran's current conditions were related to service noise. The RO denied service connection on the basis that condition neither occurred in nor was caused by service. When denying service connection for tinnitus, the RO observed that the Veteran's service medical records were negative for diagnosis, treatment, or other findings of tinnitus, nor was there evidence to show treatment for ringing to the ears. The RO further indicated that the July 2007 VA examiner noted that there was no documentation in the Veteran's service medical records of tinnitus and that the examiner provided a medical opinion that any current tinnitus was less likely than not related to service noise. The RO denied service connection for tinnitus as there was no objective evidence to link the claimed condition to military service. While a statement of the case was issued in December 2008, the Veteran did not perfect his appeal nor was evidence received which would have allowed the claim to remain open. Thus, the decision became final as it relates to both issues. In June 2009, the Veteran requested that service connection be awarded for tinnitus and bilateral hearing loss. Evidence added to the record includes a June 2009 treatment record from the Veteran's private physician, M. L., M.D., who stated that the Veteran had had significant noise exposure throughout his lifetime, including in the military and through occupational noise exposure, with an audiogram performed at that time demonstrating moderate to severe bilateral sensorineural hearing loss, and concluded that the etiology of the hearing loss was probably secondary to presbycusis and noise exposure. Also added to the record were the results of an August 2010 VA examination, wherein the examiner rendered diagnoses of normal to moderately severe sensorineural hearing loss in the right ear and mild to moderately severe sensorineural hearing loss in the left ear, along with tinnitus, which was as likely as not a symptom associated with the hearing loss. The examiner opined that it was less likely as not (less than 50/50 probability) that the Veteran's hearing loss and tinnitus were caused by or as a result of military noise exposure, noting that the service medical records documented normal hearing during military service with no permanent hearing threshold shift and that the low normal to mild hearing loss reported in the left ear at the August 1971 enlistment examination was likely due to a temporary condition such as otitis externa or wax impaction, which the Veteran has a history of, as hearing loss was within normal limits at final discharge physical in 1974. The examiner also observed that the Veteran denied hearing loss on report medical history forms from 1970 to 1974. She further noted that service treatment records were negative for tinnitus. Also added to the record by the Veteran's representative in February 2012 was an October 1993 report from Fort Sam Houston regarding their hearing conservation program. In the report, a partial listing of military and civilian occupations involving routine exposures to hazardous noise was set forth. Among the occupations listed was a photo and layout specialist. In addition to his testimony at the time of the March 2012 hearing, the Veteran also submitted an April 2012 letter from his audiologist who indicated that his present hearing loss was as a result of the noise exposure he experienced while serving in his MOS. She noted that at the time of separation from service, the Veteran's hearing was considerably worse than at the time of induction and had worsened to the point that he now suffered from severe to profound hearing loss in both ears along with tinnitus. Finally, in conjunction with an April 2013 VHA medical request as to whether it was at least as likely as not (50 percent probability or greater) that the Veteran's current hearing loss and tinnitus were related to his period of service, to include any acoustic trauma experienced in service and/or noise exposure resulting from his in-service duties/military occupational specialty, a May 2013 opinion was received from a physician from the Portland VAMC. In his report, the physician noted that the claims folder had been provided and reviewed and showed that his hearing tests at the beginning of his service time in 1968 and when he left service were all within normal limits. He stated that it should be noted that hearing tests were not completed beyond the 4000 Hertz frequencies which were often affected in noise-induced hearing loss. The examiner noted that upon review of the records, it was evident that the Veteran had extensive acoustic trauma in service and also reported acoustic trauma after service. The examiner indicated that the Veteran apparently told one examiner that his tinnitus began in service. The Veteran also reported that he had some ear infections in the service but there was no ear surgery. The examiner stated that the Veteran now only had sensorineural hearing loss with no indication of conductive hearing loss. The examiner noted that upon reviewing the records, since the Veteran had acoustic trauma from both in service and out of service, it appeared more likely than not that the tinnitus the Veteran had been experiencing, which he noted began during service, more likely than not began during the service as he did have extensive acoustic trauma in the service. He stated that the tinnitus more likely than not was aggravated by acoustic trauma after service. The examiner further indicated that although the Veteran's hearing tests did not show any permanent threshold shift during his active time service, the highest frequencies were not tested and based on that fact that there were no complete audiograms during the period, and the fact that he had extensive acoustic trauma during the time indicated that it was more likely than not that there was some effect on his hearing loss from acoustic trauma during his active service time. However, it appeared that it was aggravated more likely than not by his acoustic trauma after the service. The examiner stated that based upon the incomplete audiometric data that were filed during his service time, he could not determine the percentage of the hearing loss that the Veteran had during service versus after service, but it was clear that there were sources of acoustic trauma from both in service during his military time as well as after service during his occupational noise exposure. The Board finds that new and material evidence has been received to reopen the previously denied claims of service connection for right ear hearing loss and tinnitus. Subsequent to the prior denial, the Veteran has submitted letters from his private treatment providers relating his hearing loss to his in-service noise exposure. Moreover, the April 2013 VHA reviewer has indicated that at least a portion of the Veteran's hearing loss was related to his period of service. The basis for the prior denial was that the condition neither occurred in nor was caused by service. Evidence received, in the form of several opinions noted above, specifically indicates that the Veteran's hearing loss was related to his in-service noise exposure. As to the claim of service connection for tinnitus, the basis for the prior denial was that there was no objective evidence to link the claimed condition to military service. As noted above, several opinions have been provided since the time of the prior denial relating the Veteran's tinnitus to his in- service noise exposure. The above evidence relates to previously unestablished elements of the claims, which were not of record at the time of the prior denial, and provides a reasonable possibility of substantiating the claims. 38 C.F.R. § 3.156(a). Therefore, the claims for service connection for right ear hearing loss and tinnitus are reopened. As the claim for service connection for right ear hearing loss and tinnitus have been reopened, the Board will now address the issues of service connection for tinnitus and bilateral hearing loss (as service connection for left ear hearing loss was also perfected) on a de novo basis. Service Connection for Bilateral Hearing Loss and Tinnitus Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303(a) (2012). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Tinnitus is not a "chronic disease" listed under 38 C.F.R. § 3.309(a) and thus, as discussed in further detail below, 38 C.F.R. § 3.303(b) does not apply to the Veteran's claim. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Hearing loss, if sensorineural in nature, is a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases, such as sensorineural hearing loss, 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. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). 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. Id. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is between 0 and 20 decibels, and higher threshold shows some degree of hearing loss. The provisions of 38 C.F.R. § 3.385 do not require that hearing loss be shown as defined in that regulation at the time of separation from service, if there is sufficient evidence to demonstrate a relationship between the veteran's service and his current disability. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. Generally, lay evidence is competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Notwithstanding the above, however, a veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). See 38 C.F.R. § 3.159(a)(2); see also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Lay evidence can be competent and sufficient evidence of a diagnosis if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When there is an approximate balance 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 veteran. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2012). The Veteran contends that his current bilateral hearing loss and tinnitus are due to noise exposure during service. On his DD Form 214, the Veteran's military occupational specialty was noted to be that of a plate maker. At the time of his June 1968 pre-induction examination, the Veteran was noted to have decibel level readings of 0, 0, 5, 10, and 10 in the right ear and 0, 0, 5, 5, and 10 in the left ear at 500, 1000, 2000, 3000, and 4000 Hertz. Normal general findings for the ears were reported at that time. On his June 1968 pre-induction report of medical history, the Veteran checked the "yes" box when asked if he had ear, nose, or throat trouble. In the physician summary section of the report, it was indicated that the Veteran reported having intermittent hearing loss. At the time of a June 1970 periodical physical examination, the Veteran was noted to have acute left otitis externa. At the time of his December 1970 service separation examination for the first period of service, normal general findings were reported for the Veteran's ears. Audiological testing performed at that time revealed decibel level readings of 15, 10, 15, -, 5 in the right ear and 15, 10, 15, -, and 10 in the left ear at 500, 1000, 2000, 3000, and 4000 Hertz. On his December 1970 service separation report of medical history, the Veteran checked the "no" box when asked if he had had or was having ear, nose, or throat trouble. At the time of the Veteran's August 1971 service entrance examination, normal general findings were reported for the Veteran's ears. Audiological testing performed at that time revealed decibel level readings of 15, 15, 15, 10, and 20 in the right ear and 30, 25, 15, 25, and 25 in the left ear at 500, 1000, 2000, 3000, and 4000 Hertz. On his August 1971 report of medical history, the Veteran checked the "no" box when asked if he had had or was having ear, nose, or throat trouble. In December 1971, the Veteran was seen with complaints of a left earache and discharge from his left ear for one week. Following examination, a diagnosis of otitis externa was rendered. In April 1973, the Veteran was noted to have regular hearing for the right and left ear as part of a hearing conservation program. At the time of the Veteran's July 1974 service separation examination, normal general findings were reported for the ears. Audiological testing performed at that time revealed decibel level readings of 0, 0, 0, -, and 0 in the right ear and 0, 0, 0, -, and 0 in the left ear at 500, 1000, 2000, 3000, and 4000 Hertz. On his July 1974 report of medical history, the Veteran checked the "no" box when asked if he had had or was having ear, nose, or throat trouble. At the time of a December 1974 VA examination, physical inspection of the ears was normal and the Veteran was not noted to have a hearing loss. At the time of a December 2006 VA outpatient visit, audiological testing revealed decibel level readings of 10, 20, 50, 50, and 45 in the right ear and 20, 30, 55, 55, and 45 in the left ear at 500, 1000, 2000, 3000, and 4000 Hertz. The examiner indicated that the Veteran exhibited a high frequency hearing loss and tinnitus highly indicative of past acoustic trauma. At the time of the Veteran's July 2007 VA examination, the examiner noted the Veteran's occupational noise exposure of artillery use and machine guns during two periods of active service along with his reporting having progressive difficulty understanding speech and moderate tinnitus since 1969. At the time of his March 2012 hearing, the Veteran testified that his MOS in service was topographic print shop work. The Veteran stated he was exposed to loud military weaponry noises, loud vocalized commands, airplane hangar noises, violent physical combat, and print shop noises. He stated that he worked in the print press shop and was exposed to all types of noise. The Veteran indicated that he did not wear ear protection while in the service. He stated that he had been having problems with hearing between 1974 and 2001, when he was first tested. He indicated that he had had hissing in his ears throughout this time period. He reported that following service he was a fabricator/traffic engineer, pretty much in a supervisory role. The Veteran stated that his barracks were an airplane hangar for 22 months with all kinds of noise occurring during this time period. The Veteran is competent to describe being exposed to loud noise and is competent to describe observable symptoms such as ringing in the ears and loss of hearing as these are observable symptoms. See Jandreau v. Nicholson, 492 F.3d at 1376-77; Charles v. Principi, 16 Vet. App. at 374 (a veteran is competent to testify that he experienced ringing in his ears in service and had experienced ringing in his ears ever since service). The Veteran's lay statements regarding exposure to noise in service are found to be credible to the extent that they have been internally consistent and are also consistent with the circumstances of his service. The Board finds that tinnitus was incurred in and is attributable to service. Entitlement to service connection for tinnitus cannot be established through application of 38 C.F.R. § 3.303(b); however, 38 C.F.R. § 3.303(d) affords that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. The Veteran has provided credible evidence of in-service acoustic trauma, he has stated that he experienced symptoms during service, and he has endorsed symptoms of tinnitus since service. To the extent that the Veteran denied "ear troubles" at separation, the Board finds this so be an overly general statement of denial and of limited probative value when compared to his current specific and consistent statements endorsing ringing/hissing in the ears. With regard to the various opinions received relating to the relationship between the Veteran's current tinnitus and his in-service noise exposure, the Board finds the opinions to be in at least equipoise, with the VHA examiner indicating that the Veteran's tinnitus more likely than not began in service as he did have extensive acoustic trauma in service. In such a case, reasonable doubt must be resolved in favor of the Veteran. The Veteran has reported experiencing recurrent tinnitus symptomatology since service and, despite some inconsistencies, the Board finds his lay accounts to be credible. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the duty to assess the credibility and weight to be given to the evidence). Therefore, as the evidence is in relative equipoise, the Board finds that the Veteran experienced recurrent tinnitus symptomatology since service discharge. Therefore, the evidence demonstrates credible evidence of in-service acoustic trauma, in-service onset of ringing in the ears and unremitting tinnitus since service, at least in equipoise medical nexus opinions concerning the relationship between the Veteran's current tinnitus and service, and that the Veteran currently has tinnitus. For these reasons, and resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for tinnitus is warranted. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. As to bilateral hearing loss, as noted above, exposure to in-service acoustic trauma has been shown. The Veteran's lay statements regarding exposure to noise in service and loss of hearing in service are found to be credible to the extent that they have been internally consistent and are also consistent with the circumstances of his service as a plate maker. With regard to the various opinions expressed above, the Board finds that they are at least in equipoise as to relationship between the Veteran's current sensorineural hearing loss and in-service noise exposure. Moreover, the VHA examiner, while noting that the Veteran's hearing loss was aggravated more likely than not by his acoustic trauma after service, indicated that the Veteran did have acoustic trauma during his period of service and that more likely than not that there was some effect on the Veteran's hearing loss from acoustic trauma during his active service time. He further stated that there were sources of acoustic trauma from both his military time and after service during occupational noise exposure and the percentage of hearing loss that the Veteran had in service versus after service could not be determined. As such, the medical opinions are at least in equipoise as to whether the Veteran's current hearing loss had its onset in service. Therefore, the evidence demonstrates credible evidence of in-service acoustic trauma, continuous hearing problems since service, medical nexus opinions that are in equipoise as to the relationship between the Veteran's current hearing loss and service, and that the Veteran currently has bilateral sensorineural hearing loss. For these reasons, and resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for bilateral hearing loss is warranted. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER New and material evidence having been received, the claim of entitlement to service connection for right ear hearing loss is reopened. New and material evidence having been received, the claim of entitlement to service connection for tinnitus is reopened. Service connection for tinnitus is granted. Service connection for bilateral hearing loss is granted. ____________________________________________ K. J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs