Citation Nr: 18149955 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 13-14 974 DATE: November 14, 2018 ORDER Entitlement to service connection for tinnitus as secondary to service connection coronary artery disease is granted. FINDING OF FACT The Veteran has tinnitus that is a result of his service connected coronary artery disease. CONCLUSION OF LAW Resolving all reasonable doubt in his favor, tinnitus is secondary to the Veteran’s coronary artery disease. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1153, 1154, 5107 (West 2014); 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.159, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION 1. Entitlement to service connection for tinnitus as secondary to service connected coronary artery disease The Veteran seeks entitlement to service connection for tinnitus, which he asserts was caused or aggravated by his service connected coronary artery disease. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d) (2017). Service connection may also be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2017). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a 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. In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Tinnitus is noise in the ear, such as ringing, buzzing, roaring, or clicking, that is usually subjective in type. Dorland’s Illustrated Medical Dictionary 1956 (31st ed. 2007). Due to the inherently subjective nature of tinnitus, it is readily capable of lay diagnosis. Charles v. Principi, 16 Vet. App. 370 (2014). A veteran is competent to report exposure to hazardous noise, when symptoms of hearing loss and tinnitus first manifested, and that the symptoms have continued since service. Layno v. Brown, 6 Vet. App. 465 (1994). The record reflects that the Veteran reported experiencing worsening bilateral tinnitus during his September 2012 VA tinnitus examination. Therefore, the Veteran fulfills the first element of service connection, because he has current diagnosis of tinnitus. Furthermore, the Veteran was afforded a supplemental medical in July 2017. Upon a review of the Veteran’s claims file the VA audiologist determined that it was at least as likely as not (50 percent probability or greater) that his currently diagnosed tinnitus was caused by his service connected coronary heart disease. The VA audiologist reasoned that research shows significant links between reduced blood flow due to coronary heart disease and onset and/or exacerbation of tinnitus due to insufficient autoregulatory mechanism at the level of the circulation in the inner ear. Therefore, despite there being no reports of tinnitus directly related to the Veteran’s treatment for coronary artery disease recorded in the Veteran’s electronic file or medical records, there is evidence presented in medical reviews which provide reasonable nexus between the Veteran’s service connected coronary artery disease and his current tinnitus. Thus, given the totality of the evidence, to include the uncontradicted opinion noted above, and resolving all reasonable doubt on the question of medical nexus in the Veteran’s favor (see 38 U.S.C. § 5107 (b), 38 C.F.R. § 3.102), the Board   likewise concludes that the criteria for service connection for tinnitus, as secondary to service-connected coronary artery disease disability, are met. 38 C.F.R. § 3.310. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Nelson, Associate Counsel