Citation Nr: 21076102 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 17-10 937 DATE: December 22, 2021 ORDER Entitlement to service connection for tinnitus is granted. FINDING OF FACT The evidence is at least in relative equipoise as to whether the Veteran's tinnitus is related to his active service. CONCLUSION OF LAW The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1974 to January 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a virtual hearing before the undersigned in July 2021. A transcript of that hearing is of record. Entitlement to service connection for tinnitus is granted. Establishing service connection generally requires (1) evidence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Because tinnitus is largely "subjective," its existence is generally determined by whether or not the appellant claims to experience it. For VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002). The Veteran contends that his tinnitus is directly related to his active duty military service. Specifically, at his Board hearing, the Veteran testified that he worked most of his military career on the flight line, and while he was provided over-the-ear hearing protection, it was not as effective; he indicated that, although he did not seek treatment in service for tinnitus, he heard screeching and static noises, which he now attributes to tinnitus. Service treatment records are silent for any complaints, treatment, diagnosis related to tinnitus. Medical treatment records reflect complaints and treatment for tinnitus and ringing in the ears as early as June 2009. An October 2015 VA examination notes diagnoses of hearing loss and tinnitus. The examination notes that the Veteran reported experiencing tinnitus for 30 years, which he described as a high pitched ringing in his ears. The examiner opined that it was at least as likely as not that his tinnitus was associated with his hearing loss, but the examiner did not provide an etiology opinion with regard to whether tinnitus was related to service. A September 2016 VA examination notes that the Veteran reported constant left ear tinnitus and rare right ear tinnitus since 2005; onset was not linked to a specific injury or acoustic trauma. The examiner indicated that the Veteran had a diagnosis of clinical hearing loss and opined that his tinnitus is at least as likely as not a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. Thus, the examiner opined that the Veteran's tinnitus was less likely than not caused by or a result of his military noise exposure. The examiner reasoned that the Veteran had normal hearing bilaterally at separation from military service; the record reflects that onset was 10 years after separation from military service, thus there are no objective factors for linking his tinnitus to military service. Further, the examiner indicated that the current complaint of tinnitus is not a result of or aggravation of military noise exposure since tinnitus is more likely as not found in association with hearing loss, which the Veteran did not exhibit on the discharge examination. The examiner also noted that there is no evidence in the record that the Veteran sustained noise injuries based on audiograms. In support for these opinions, the examiner cited to a text which indicated that epidemiologic studies show that presbycusis (genetic/age related hearing loss) is the most prevalent cause of tinnitus followed by excessive noise exposure. A March 2017 medical treatment record notes that the Veteran was referred to audiology by his primary care provider for tinnitus and hearing loss in the left ear for eight years. The audiological record notes that the Veteran had longstanding left ear hearing loss and left ear non-pulsatile constant tinnitus. It further indicates that the Veteran had a significant history of hazardous noise exposure during his military service due to jet engine noise and headset noise in the left ear. The Veteran reported that he was unaware that he could file for tinnitus at service separation, and he was never asked if he had ringing in his ears prior to separating from service. The record notes an assessment of left ear tinnitus. At his July 2021 Board hearing, the Veteran testified that he realized he was experiencing tinnitus shortly after he retired from active service and he sought treatment within four or five years after his separation. After carefully reviewing and weighing the competent evidence of record, the Board is satisfied that the evidence is at least in approximate balance as to whether the Veteran's tinnitus is related to service. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The unfavorable evidence in this case consists of the lack of treatment records for tinnitus for a little more than a decade after his active service and the September 206 VA examiner's negative direct service connection opinion. The record contains favorable evidence in the form of the Veteran's credible account of his likely exposure to some degree of acoustic trauma during service and his competent description of screeching, static, or ringing which he reports began as much as 30 years prior, which would have been just before his separation from active service. Additionally, the Veteran competently and credibly reported that he sought treatment shortly after his separation from service. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Given the nature of tinnitus, the Veteran is uniquely situated to competently identify and report on its onset and duration. Here, affording the Veteran the benefit of the doubt, the Board finds that the Veteran's reports of onset and continuity of symptoms of tinnitus both competent and credible, and thus is positive evidence that supports a finding of nexus in this case. For these reasons, the Board resolves reasonable doubt in favor of the Veteran and grants service connection for tinnitus. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hite, Associate 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.