Citation Nr: 18156893 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 16-49 990 DATE: December 11, 2018 REMANDED Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran had active duty service from October 2000 to October 2004. He was awarded the Navy and Marine Corps Achievement Medal (w/ Combat V), Marine Corps Good Conduct Medal, and Combat Action Ribbon amongst his awards and decorations. In April 2016, the Veteran participated in a Decision Review Officer (DRO) hearing at the San Diego, California Regional Office (RO). A summary of the conference is of record. Entitlement to service connection for tinnitus is remanded. Initially, the Board observes that the Veteran’s service records are silent as to any complaints of treatment for tinnitus. The Veteran’s DD-214 lists his primary specialty as a rifleman. It is further observed that the evidence of record establishes that the Veteran engaged in combat. Therefore, in-service noise exposure has been conceded. The Veteran was first afforded a VA audiological examination in May 2015. The Veteran reported a history of in-service acoustic trauma, including exposure to cruise missiles, tanks, bombs, artillery, mortars, grenades, and small-arms fire. He also reported episodes of tinnitus that occurred three times per week, lasting approximately 10-15 seconds. He stated that his tinnitus “seems to be caused by loud noises. I feel intense pain when it happens, like my ears are bleeding. Onset was since 2004 with escalating discomfort.” The VA examiner diagnosed the Veteran with tinnitus, but determined that his tinnitus is less likely than not caused by or a result of service. Curiously, the examiner remarked that “it is not possible to make a statement at this time regarding the Veteran’s hearing status or tinnitus.” The Veteran underwent another VA audiological examination in April 2016. The Veteran was again diagnosed with tinnitus. The VA examiner determined that the Veteran’s tinnitus is less likely than not caused by or a result of service. The examiner explained that: Veteran’s hearing is normal. The evidence in this case therefore shows that the veteran did not have hearing injury while in-service. In the absence of an objectively verifiable noise injury, the association between claimed tinnitus and noise exposure cannot be assumed to exist. There is no evidence of complaints of tinnitus while Veteran was in military service. Veteran reports intermittent tinnitus, occurring 2-3 times a week and lasting 10 seconds. An addendum opinion was obtained in June 2016. The examiner provided the following remarks: Tinnitus is less likely as not a caused by or a result of military noise exposure based upon normal hearing bilaterally. Veteran's hearing is normal. The evidence in this case therefore shows that the veteran did not have hearing injury while in-service. In the absence of an objectively verifiable noise injury, the association between claimed tinnitus and noise exposure cannot be assumed to exist. There are no records of complaints of tinnitus while veteran was in military service. In a June 2018 Informal Hearing Presentation (IHP), the Veteran and his representative challenged the adequacy of the previous VA examinations, reasoning that there is insufficient rationale and conflicting information. It is also alleged that the prior VA examiners did not acknowledge the Veteran’s subjective complaints of tinnitus. Given the Veteran’s statements and the significant time period since the Veteran’s previous VA examination, the Board finds that a new VA audiological examination would be of considerable assistance in determining his claim. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an audiologist who has not previously examined the Veteran to determine the nature and etiology of the Veteran’s claimed tinnitus. The audiologist is to be provided access to the Veteran’s electronic claims file. The audiologist is requested to review all pertinent records associated with the claims file, the Veteran’s service treatment records, post-service medical records, and the Veteran’s own assertions. Any indicated diagnostic tests and studies should also be accomplished. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology and conceded in-service noise exposure. If there is a medical basis to support or doubt the history provided by the Veteran, the audiologist should provide a fully reasoned explanation. The VA audiologist must opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tinnitus manifested in-service or is otherwise causally or etiologically related to his military service, to include conceded in-service noise exposure. It should also be indicated whether tinnitus is the type typically seen in cases of acoustic trauma, or is more likely due to advancing age, infection, or other cause. All prior reports should be reconciled, as necessary. All examination findings and testing results, along with complete, clearly-stated rationale for the conclusions reached, must be provided. 2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Miller, Associate Counsel