Citation Nr: 21077638 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 18-47 074 DATE: December 30, 2021 ORDER Service connection for tinnitus is granted. REMANDED Service connection for head injury. Service connection for scar above the left eye. Service connection for anal fissure. FINDINGS OF FACT 1. The Veteran served on active duty from November 1992 to April 2002. 2. Tinnitus has been continuous since service. CONCLUSION OF LAW Tinnitus was incurred in service. 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran testified at a July 2021 hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a current 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 in or aggravated by service. See 38 C.F.R. §§ 3.303 (a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Tinnitus is recognized by VA as a "chronic disease" under 38 C.F.R. § 3.309 (a); therefore, the presumptive provisions of 38 C.F.R. §§ 3.303 (b), 3.307, and 3.309 apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). Turning to the medical evidence, tinnitus has been diagnosed. Specifically, tinnitus was found at a January 2017 VA examination. As such, a current disorder has been shown and the first element of service connection has been met. As to an in-service incurrence, the Veteran's military occupational specialty (MOS) was submarine nuclear propulsion plant operator. He has stated that he worked in the engine room where the machinery put out an incredible amount of noise. Additionally, he noted that he wore hearing plugs in the engine room, but between the loud noise and the daily pressure popping from ventilating through the periscope, he began to hear a ringing in his ears. While the service treatment records (STRs) do not document complaints, diagnoses, or treatment for recurrent tinnitus for purposes of eligibility for VA benefits, the Veteran has asserted noise exposure from multiple sources during his service. Based on this evidence, in-service noise exposure is conceded. Next, as to continuity, the Veteran reported in the VA examination as well as during the Board hearing that tinnitus had been constant and stemmed from in-service noise exposure. He is competent to assert that he has experienced the symptoms of tinnitus continuously since service. Therefore, his competent and credible lay statements establish continuity of symptomatology. While there is an absence of complaints of or treatment for tinnitus for many years after separation from service, the Board has resolved reasonable doubt in the Veteran's favor and finds that he had continuous symptoms of tinnitus since service separation and meets the requirements of presumptive service connection under 38 C.F.R. § 3.303 (b). Although a January 2017 examiner opined that tinnitus was less likely than not incurred in or caused by noise exposure while on active duty, the Board does not need to reach the weight assignable to the VA opinions because service connection is granted on a presumptive basis under 38 C.F.R. § 3.303 (b) for the "chronic" disease of tinnitus based on a finding of "continuous" symptoms since service. In sum, resolving reasonable doubt in the Veteran's favor, there is evidence of in-service acoustic trauma and continuous symptoms of tinnitus since service; therefore, tinnitus is presumed to have been incurred in service and the medical evidence supports service connection for tinnitus. Because the Board is granting service connection on a presumptive basis based on continuous symptoms of tinnitus since separation, all other theories of service connection are rendered moot. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND The Veteran contends that he experienced a head injury after being hit in the head with a can in service. He testified that he was treated with stitches resulting in a scar above the left eye. He further testified that he experienced occasional headaches from the head injury and discomfort from the scar. To date, he has not been afforded VA examinations for the claimed head injury and scar above the left eye. As such remand is warranted for VA examinations and etiology opinions regarding the Veteran's claimed head injury and scar above the left eye. With regards to the claim for anal fissure, the Veteran testified that he was misdiagnosed with a hemorrhoid in service. He further testified that anal fissure symptoms have continued since service. To date, he has not been afforded a VA examination for an anal fissure. Accordingly, remand is warranted for a VA examination and etiology opinion regarding the anal fissure. The matters are REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private treatment records not already of record and associate them with the claims file. 2. Schedule the Veteran for an examination to determine the nature and etiology of a claimed head injury. The claims file must be made available to and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and review of the record, the examiner is asked to provide an opinion as to the following: whether it is at least as likely as not (50 percent probability or greater) that the Veteran has a head injury and, if so, is it etiologically related to service, to include being hit on the head in-service. A rationale for all opinions must be provided. 3. Schedule the Veteran for an examination to determine the nature and etiology of a scar above the left eye. The claims file must be made available to and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and review of the record, the examiner is asked to provide an opinion as to the following: whether it is at least as likely as not (a 50 percent probability or greater) that a scar above the left eye, if present, is etiologically related to an in-service injury, event or disease, to include being hit in the head in-service. A rationale for all opinions must be provided. 4. Schedule the Veteran for an examination to determine the nature and etiology of an anal fissure. The claims file must be made available to and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and review of the record, the examiner is asked to provide an opinion as to the following: whether it is at least as likely as not (a 50 percent probability or greater) that an anal fissure, if present, is etiologically related to an in-service injury, event or disease, to include self-treatment for hemorrhoids in service. A rationale for all opinions must be provided. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Grzeczkowicz 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.