Citation Nr: 18140844 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 16-14 573 DATE: ORDER Entitlement to service connection for tinnitus is granted. FINDING OF FACT The evidence is at least in equipoise that the Veteran’s current tinnitus is causally related to acoustic trauma in service. CONCLUSION OF LAW The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1969 to December 1971. This case comes to the Board of Veterans’ Appeals (Board) from a May 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York. The Veteran appeals the denial of entitlement to service connection for tinnitus. He contends that the medical examiner on whose opinion the RO relied in denying his claim incorrectly understood his tinnitus to have begun much longer after service than it had in fact begun. Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. Service connection may also be granted for any injury or disease diagnosed after discharge, 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). 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. As organic diseases of the nervous system are considered to be chronic diseases for VA compensation purposes, if chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including organic diseases of the nervous system, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309; Fountain v. McDonald, 27 Vet. App. 258 (2015) (holding that the presumptive provisions of 38 C.F.R. § 3.309 (a) include tinnitus as an organic disease of the nervous system). The Veteran’s service personnel records confirm his service during the Vietnam Era as an aircraft radio repairman in the Air Force. The Veteran recounts that he worked on the flight line—a high-noise environment—during most of his enlistment. Up until the 2015 VA examination afforded to the Veteran upon his claim for compensation benefits for hearing loss and tinnitus there was no evidence of record documenting a complaint from the Veteran about tinnitus; however, the Veteran’s service separation examination did note “[h]igh frequen[cy] hearing loss,” and the Veteran’s bilateral hearing loss was ultimately adjudicated service-connected by the RO. One of the Veteran’s private medical examiners indicates that the Veteran’s post-service career with a telecommunications company involved office work that did not involve exposure to high levels of noise. The April 2015 VA examination notes the absence in the record of a documented complaint of tinnitus, and relates that the Veteran stated his tinnitus began approximately five to six years before the April 2015 examination. The examiner, remarking that this would make the onset period roughly 38 years after service, found that the timing of the onset of the Veteran’s tinnitus better matched with the Veteran’s 35-year post-service career with the telecommunication company. On this basis, the examiner concluded that the Veteran’s tinnitus less likely than not was caused by or a result of exposure to acoustic trauma during his service in the Air Force. In a January 2016 private medical opinion, the Veteran’s primary care physician states that since 1987 he has periodically treated the Veteran for tinnitus, eventually referring the Veteran to an audiology center. The primary care physician reviewed the Veteran’s service and post-service history and concluded that it is highly likely that the Veteran’s tinnitus was caused from his service on the flight line. In a February 2016 medical examination, an audiologist examined and tested the Veteran, asked him questions, and reviewed his records. Relying on the Veteran’s statement that he has experienced tinnitus since 1985, that he was exposed to exceptionally high noise levels on the flight line, and that he was exposed to no high noise levels in his post-service career, the audiologist concluded that it is more likely than not that his tinnitus is caused by the noise exposure that he experienced in service. This echoed the audiologist’s consultation report in September 2013 finding that the Veteran’s “hearing loss and tinnitus are consistent with his history of noise exposure in the military.” Tinnitus by definition is “a noise in the ears, such as ringing, buzzing, roaring, or clicking. It is usually subjective in type.” See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY, 1914 (30th ed. 2003). The Veteran is competent to describe observable symptoms such as ringing in the ears, as well as to describe exposure to loud noise in service. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Charles v. Principi, 16 Vet. App. 370, 374 (2002). The Veteran’s statements that he was exposed to excessive noise levels while in service are credible given his service on the flight line as an aircraft radio repairman, and are consistent with his service-connected bilateral hearing loss. The evidence conflicts as to whether the Veteran’s tinnitus is causally related to his exposure to excessive noise levels while in service or to some other explanation, such as his post-service career. While the January 2015 opinion, April 2015 examination report, and February 2016 examination report are all probative, the April 2015 examination omitted the pertinent fact that the Veteran’s post-service career was in an office setting and did not involve noise exposure. In contrast, the January 2015 opinion and February 2016 examination both expressly account for this information and are therefore more reliably probative than the April 2015 examination regarding the issue of whether the Veteran’s tinnitus is etiologically related to his service. On glance, the evidence appears also to be in tension concerning when the Veteran began experiencing tinnitus. The April 2015 VA examiner was under the impression that the Veteran’s tinnitus began sometime between 2007 and 2008, and it was the proximity of this onset to the Veteran’s post-service career that the examiner indicated she relied upon in concluding a less-likely-than-not link between the tinnitus and the Veteran’s military service. Yet, the Veteran’s primary care physician since 1987 mentioned in the January 2016 opinion that he has periodically treated the Veteran for tinnitus, and in the February 2016 opinion the audiologist reports that the Veteran told the audiologist he has experienced tinnitus as far back as 1985, a fact which would undermine a key premise of the April 2015 examination’s attribution of a nexus with the Veteran’s post-service career. The Veteran's descriptions of his in-service noise exposure are consistent with his circumstances of service and are competent and credible. In light of the positive and negative evidence of record, including the Veteran's competent and credible lay statements, the evidence is at least in equipoise regarding whether his current tinnitus was incurred in service. Thus, resolving all doubt in his favor, service connection is granted. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Davis, Associate Counsel