Citation Nr: 18142518 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 15-35 948 DATE: October 16, 2018 ORDER Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT Resolving all reasonable doubt in the Veteran’s favor, his tinnitus had its onset in service. CONCLUSION OF LAW The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty in the United States Army from February 1968 to December 1969. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2014 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). Entitlement to service connection for tinnitus Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). At the outset, the Board finds that there is conclusive and probative evidence of a current disability of tinnitus. This disability was diagnosed at a private audiological examination in January 2014 and was confirmed by the VA audiologist who examined the claims file later that month. As such, the Board will turn to the central question of whether this disability arose in or is otherwise etiologically related to the Veteran’s active duty service. The Veteran contends that this tinnitus arose after he was exposed to significant in-service noise, including the firing of tanks and at least one instance while stationed in the Republic of Vietnam where he was exposed to significant machine gun fire. A response from the Defense Personnel Records Information Retrieval System (DPRIS) received in February 2016 confirmed that there was counter-fire in June 1969 at the location at which the Veteran was stationed in Vietnam after that post had received three rounds of rocket attacks. As such, the Board finds that there is credible, competent, and probative evidence that the Veteran was exposed to significant noise while in service. The final question to resolve is whether the Veteran’s tinnitus is related to that in-service event or whether it otherwise arose during his active duty service. There is inconsistent information with respect to this issue. In an attempt to answer this question, VA obtained opinions from a VA audiologist in January 2014 and again in April 2016. After reviewing the claims file, the examiner ultimately found that it was less likely than not that tinnitus was related to the Veteran’s service. In support of this opinion, the examiner stated that the Veteran’s hearing loss was normal at the time of his separation from service and the service treatment records did not contain any complaints of tinnitus. The examiner also indicated that there had been more than 40 years since the Veteran had been separated from service before he sought treatment or complained of tinnitus-related symptoms. Finally, the examiner appears to have included excerpts of various medical studies relating to tinnitus in support of the opinion, including one in which it was found that noise doses associated with hearing loss are likely to be associated with tinnitus and that hearing loss is associated with a higher prevalence of tinnitus. While the examiner cited the lack of objective or independent complaints of tinnitus in the record for many years after the Veteran’s separation from service as a factor in forming his negative nexus opinion, a lack of contemporaneous records alone is not fatal to a claim for service connection and the Board may not rely solely on the lack of such records to deny a claim for service connection. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Although the record does not contain clinical reports of complaints of tinnitus for many years after service, the Veteran has been consistent in his reports of the onset and course of his tinnitus-related symptoms. In correspondence from September 2015, the Veteran explained that he has had tinnitus or ringing in his ears ever since his service in Vietnam, despite an initial improvement in symptoms shortly after being exposed to significant machine gun fire. The Veteran similarly stated to a private audiologist at an examination in November 2013 that his tinnitus symptoms began when he was 20 years old, which corresponds roughly with the Veteran’s period of active duty service and in-service noise exposure. The record also contains additional lay evidence in the form of a September 2015 statement from the Veteran’s wife. In that correspondence, the Veteran’s spouse explained that she has known the Veteran since 1966 and that the Veteran had buzzing and ringing in his ears ever since his return from Vietnam but had never complained of ringing before service. These statements regarding the course and onset of the Veteran’s tinnitus represent probative evidence that this condition first arose in and has continued since service. The Board also finds it notable that, in contrast to the medical articles cited by the VA audiologist that it is unlikely that acoustic trauma could cause a delay in the onset of hearing loss, the articles relating to tinnitus do not appear to discuss or discount the possibility that acoustic trauma which may not cause hearing loss might nonetheless cause tinnitus or that tinnitus could develop after some extended period after noise exposure or acoustic trauma. Taken with the report of medical history from the Veteran’s separation examination in which he reported ear, nose, or throat trouble, the Board finds that the evidence is at least in equipoise with respect to the question of whether the Veteran’s tinnitus arose in active duty service. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the criteria for service connection for tinnitus have been met. REASONS FOR REMAND Entitlement to service connection for bilateral hearing loss is remanded. As explained above, the VA obtained etiological opinions regarding the Veteran’s tinnitus in January 2014 and April 2016. That examiner also provided a negative nexus opinion regarding the etiology of the Veteran’s hearing loss. In support of this opinion, the examiner provided excerpts of medical literature which appear to discount the proposition that a delay in the onset of hearing loss is likely to occur after exposure to acoustic trauma. However, the examiner did not explicitly interpret that data or those studies in terms of the Veteran’s specific situation to explain how the Veteran’s exposure to significant in-service noise might or might not have caused the subsequent development of a hearing loss disability. In addition, the record also contains a September 2018 appellate brief in which the Veteran’s representative also raised the possibility that his in-service use of chloroquine could have contributed to the development of the Veteran’s hearing loss. In support, the representative cited internet articles regarding the side effects of this drug and a list of potential causes of hearing loss. The Board is precluded from making its own unsubstantiated medical assessment of this evidence and the Board finds that an additional addendum opinion must be obtained in this claim. Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991). The matter is REMANDED for the following action: (Continued on the next page)   Obtain an addendum opinion regarding the etiology of the Veteran’s hearing loss. If the examiner cites to medical literature in support of any opinion, the examiner should explain how the theories or data of the medical literature cited specifically apply to the Veteran’s claim. The examiner is also asked to comment on the representative’s contention that the Veteran’s use of chloroquine could have caused the Veteran’s hearing loss. M. TENNER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Whitelaw, Associate Counsel