Citation Nr: A19001573 Decision Date: 09/25/19 Archive Date: 09/25/19 DOCKET NO. 190322-6616 DATE: September 25, 2019 ORDER Entitlement to service connection for bilateral hearing loss is granted. Entitlement to service connection for bilateral tinnitus is granted. FINDINGS OF FACT 1. Granting the Veteran all reasonable doubt, the Veteran’s hearing loss manifested during active service. 2. Granting the Veteran all reasonable doubt, the Veteran’s tinnitus manifested during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for bilateral tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from July 1964 to July 1970 in the United States Navy. The Board notes that the rating decision on appeal was issued in December 2017. In March 2018, the Veteran elected the modernized review system. In June 2018, a new rating decision was issued under that system. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2(d)). The Veteran selected the Higher-Level Review lane when he opted in to the Appeals Modernization Act (AMA) review system by submitting a Rapid Appeals Modernization Program (RAMP) election form. Accordingly, the June 2018 AMA rating decision considered the evidence of record as of the date VA received the RAMP election form. The Veteran timely appealed this rating decision to the Board and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ). Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in 38 C.F.R. § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b)). 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). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for bilateral hearing loss 2. Entitlement to service connection for bilateral tinnitus The Veteran contends that his bilateral hearing loss and bilateral tinnitus are causally related to noise exposure during service. The AOJ found that the Veteran had significant noise exposure during service while serving as a Machinist’s Mate. The AOJ also found that the Veteran has hearing loss for VA purposes, as well as a current tinnitus diagnosis. The question in this case is whether the Veteran’s hearing loss and tinnitus were incurred in or are causally related to his active service. The Board finds that, resolving all reasonable doubt in favor of the Veteran, a causal relationship or nexus exists. Lay evidence shows that the symptoms currently attributable to the Veteran’s hearing loss began and tinnitus during his active service and no medical evidence of record contradicts the Veteran’s statements. The Board notes that the separation examination in July 1970 did not include a medical history provided by the Veteran and did not include an audiogram. The Veteran’s lay statements describe his significant noise exposure during service and note that the Veteran has experienced hearing loss and tinnitus since that time. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In November 2017, the Veteran was afforded a VA examination. The examiner reviewed the claims folder and performed an in-person examination. The examiner could not provide a medical opinion regarding the etiology of the Veteran’s hearing loss. The examiner noted some hearing loss in the right ear, which could be a combination of noise exposure during service and after. There are no separation audiograms to compare threshold shifts. The examiner noted the Veteran had significant high frequency hearing loss in the left ear compared to the right ear, but highlighted that the Veteran was not exposed to single-sided noise in the military that would explain this asymmetry. The Veteran reported that he did a lot of hunting, an activity which the examiner commented could contribute to this asymmetry. Regarding the tinnitus, the Veteran reported that his tinnitus starting in the mid-1970s, which the examiner opined could have been from his hunting and farming prior to service and added to during service due to the loud noises he was exposed to on the submarine. The examiner, however, was unable to provide an etiology without speculation and without an exit audiogram. Although the VA examiner’s opinion is not definitive, the Board finds that remanding for an addendum opinion would not provide any additional clarity to the examiner’s opinion given the lack of a medical history or audiogram at separation. (Continued on the next page)   Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current bilateral hearing loss and tinnitus are causally related to his noise exposure during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral hearing loss and tinnitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. DELYVONNE M. WHITEHEAD Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Patricia Veresink The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.