Citation Nr: 21065010 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 18-47 155 DATE: October 22, 2021 ORDER Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for thyroid disease is remanded. Entitlement to service connection for bladder cancer is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT The Veteran has experienced ringing in her ears related to tinnitus since her active service. CONCLUSION OF LAW The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303 REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Air Force from October 1977 to November 1981 with an additional period of lengthy Reserve service following her release from active duty. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision. In June 2021, the Veteran testified at a Board hearing before the undersigned Veterans' Law Judge. A transcript of the hearing is of record. Service Connection Service connection will be granted for disability resulting from an injury or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for tinnitus The Board finds that entitlement to service connection for tinnitus is warranted. The Veteran reported noise exposure as a nuclear mission maintenance officer. She also reported being near flight line noise as well as maintenance shop noise. The Board concedes exposure to loud military noise during service. She reports noticing tinnitus during service which has worsened and become more constant over time. The Veteran is considered competent to provide evidence regarding symptoms she has experienced, such as ringing in the ears for many years. Her statements as to noise exposure are consistent with the circumstances of her service and the Board finds such statements credible. Moreover, an April 2015 private audiologist provided a positive opinion finding that the Veteran's tinnitus is related to service. Therefore, considering the totality of the evidence, the Board finds that the evidence is at least in equipoise on the question of a nexus between service and the Veteran's current tinnitus. Resolving reasonable doubt in the Veteran's favor, the claim of service connection for tinnitus is granted. REASONS FOR REMAND Initially, the Board notes that a remand is required to verify all the Veteran's periods of service as the available records provide an incomplete report of the Veteran's periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). 1. Entitlement to service connection for thyroid disease is remanded. 2. Entitlement to service connection for bladder cancer is remanded. The Veteran contends that her thyroid disease and bladder cancer are due to exposure to various chemicals such as jet fuels, solvents and radiation, as a result of her MOS as a nuclear weapons maintenance officer during active duty service. The Board notes that bladder cancer is a presumptive disease for radiation-exposed veterans. The Veteran submitted statements from private physicians in September and December 2015 indicating that her hypothyroidism and bladder cancer may be due to exposure to risks factors associated with her military duties. A remand is warranted to obtain and forward all records concerning the Veteran's exposure to radiation to the Under Secretary for Health, for preparation of a dose estimate, to the extent feasible, based on available methodologies. Moreover, the Veteran should be afforded a VA examination regarding her claims for thyroid disease and bladder cancer and whether either disorder is related to service, to include ionizing radiation. 3. Entitlement to service connection for a cervical spine disability is remanded. 4. Entitlement to service connection for sleep apnea is remanded. The Veteran reports that she has had neck pain and sleep problems since active duty service but that a neck strain and sleep apnea were not diagnosed until a period of Reserve service. Reserve service treatment records show that the Veteran was diagnosed with obstructive sleep apnea in September 2012 and that she was treated for neck pain in October 2012. In view of the evidence and the Veteran's assertions, VA examinations are warranted with respect to the nature and etiology of any current cervical spine disability and sleep apnea. 5. Entitlement to service connection for bilateral hearing loss is remanded. As noted above, the Veteran's exposure to loud military noise has been conceded by the Board. A private audiogram conducted in April 2015 indicates that the Veteran did not meet the VA requirements for a hearing loss disability in either ear. The Veteran, however, testified at the June 2021 Board hearing that she felt that her hearing had worsened since that examination. Based on the foregoing, the Board finds that further examination is warranted. The matters are REMANDED for the following action: 1. Verify all of the Veteran's periods of ACDUTRA and INACDUTRA. Associated documentation should be associated with the claims file. 2. Forward the Veteran's personnel records and other pertinent documents to the VA Under Secretary of Health for a radiation dose estimate, in accordance with 38 C.F.R. § 3.311(a)(2)(iii). 3. Schedule the Veteran for a VA examination to determine the nature and etiology of her hypothyroidism and bladder cancer. The claims folder must be made available for review. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's hypothyroidism and/or bladder cancer is related to an in-service injury, event, or disease, to include any identified radiation exposure. The examiner should provide a complete rationale for any opinions expressed. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. 4. Schedule the Veteran for VA examinations by appropriate providers as to her claims for a cervical spine disability and sleep apnea. The claims file, to include a copy of this remand, should be made available to the examiner for review in conjunction with the examinations, and the examiners should note such review. All indicated tests and studies should be completed. The examiners should be provided with the Veteran's enumerated periods of ACDUTRA and INACDUTRA, in addition to her period of active duty service. The examiners should opine as to whether it is at least as likely as not (at least a 50 percent probability) that a cervical spine disability and sleep apnea had its clinical onset during any period of ACDUTRA or INACDUTRA or is related to any incident of service. In rendering the requested opinions, the examiner is advised that the Veteran is competent to report in-service injuries, her symptoms, and history. Such reports must be specifically acknowledged and considered in formulating any opinions. The examiner should provide a complete rationale for any opinions expressed. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. 5. Schedule the Veteran for a VA examination to assess the nature and etiology of her bilateral hearing loss disability. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and statements. It should be noted that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The examiner should state whether it is at least as likely as not (50 percent probability or higher) that hearing loss in either ear (if it meets criteria for hearing loss for VA purposes) is causally or etiologically related to her military service. A complete rationale must be given for all opinions and conclusions expressed. (Continued on next page) If the examiner is unable to provide the requested opinion without resorting to speculation, the examiner must provide an explanation for the basis of that determination. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Henriquez, Counsel 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.