Citation Nr: 21008316 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 14-19 596 DATE: February 16, 2021 ORDER Entitlement to service connection for eustachian tube dysfunction (ETD) is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s ETD is related to active service. CONCLUSION OF LAW The criteria for service connection for ETD have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served from January 1974 to November 1974. This matter comes before the Board of Veterans’ Appeals (Board) from an April 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. This issue was previously remanded by the Board in March 2018 and September 2019 in order for the Veteran to be afforded VA examinations. The requested development has been completed and the issue is before the Board for additional appellate consideration. 1. Entitlement to service connection for eustachian tube dysfunction (ETD). In this post-remand case, the Board first notes that the issue on appeal has, to this point, been reported as entitlement to service connection for ETD, to include as secondary to his service-connected tinnitus. In fact, on close examination of the Veteran’s original Form 9 filed in January 2014, the Veteran claims that his ETD developed from exposure to cold conditions during service and repeated cases of upper respiratory infections that are documented during service. He feels that his ETD actually contributes to his tinnitus. The Board has therefore recharacterized the issue on appeal to reflect that it is one of direct service connection only. By way of history, this issue was first denied by the agency of original jurisdiction (AOJ) in an April 2011 rating decision. The Veteran initiated the appeal. In a March 2018 decision, the Board remanded this issue for a new VA examination in order to reconsider whether the Veteran suffered from ETD in light of private medical records that disclosed this diagnosis. A medical opinion addressed secondary service connection but failed to address direct service connection. The issue was again remanded by the Board in a September 2019 decision in order to provide the Veteran with an additional VA examination and etiological opinion. In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999). Service connection may be granted 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. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the present of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although lay persons are considered competent to provide opinions on some medical issues, some medical issues fall outside of the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011). First, in a May 2007 medical note from VA medical center (VAMC), an audiologist diagnosed the Veteran tinnitus and ETD. Second, the Veteran was afforded a VA examination in April 2011. The reviewing examiner found no evidence to diagnose ETD and noted tinnitus is a symptom, not a disease. A May 2011 medical opinion regarding bilateral hearing loss noted “there is some evidence of ETD . . .” Lastly, a December 2019 VA examination confirmed the Veteran’s diagnosis of ETD. Therefore, the Board finds adequate evidence of a current disability for purposes of service connection. As it pertains to an in-service event or injury, the Board notes the Veteran received treatment in July 1974 for a left ear condition described as “ear feels plugged.” This condition was noted to have gone on for two weeks. The Veteran reiterated this story during his most recent VA examination. Moreover, the Veteran has also pointed to his bouts with upper respiratory infection during service as being further evidence of the cause of his ETD. The Board finds him credible to discuss the onset and symptoms of his disability. Therefore, given the evidence of an in-service complaint, the Board also finds adequate evidence of an in-service event or injury. With regard to the final element necessary, a nexus, the Board finds the evidence is at least in equipoise as to whether the Veteran’s ETD is related to active service. A VA opinion from October 2018 discusses secondary service connection. First, the examiner describes the nature of ETD to include it can be acute or chronic, common symptoms reported by patients, and how the lack of advanced equipment often leads to a diagnosis being based on symptoms described by the patient. Second, the examiner notes the etiology of ETD. The examiner notes there are multiple conditions associated with ETD that include inflammation/mucous production due to illness and allergies, obesity, reflux, degenerative disease, smoking, etc. The examiner notes the Veteran’s file shows a number of risk factors for ETD to include obesity, smoking, allergies, chronic sinus congestion, sinusitis, and a deviated septum. The examiner further explains any or all these conditions could lead to ETD. After the Board’s September 2019 remand, a second opinion regarding direct service connection was obtained. The December 2019 examiner stated the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service event, injury, or disease. The examiner first noted the Veteran was seen in 1974 for complaints of a plugged left ear. The examiner assumed that, because the medicine Actifed was ordered, the sensation was most likely due to an acute sinus or ear congestion. The examiner further presumes the symptoms resolved because there is no follow-up note found for this complaint in the Veteran’s file until 33 years later. The examiner states the Veteran was diagnosed with ETD in May 2007 and one month later the audiologist noted his tympanometry results were normal. Lastly, the examiner concluded by opining that ETD can occur for a variety of reasons, most often due to upper respiratory infection (URI)’s and allergies, and given the Veteran’s symptoms are intermittent, his tympanometry results are normal, and he takes daily Fluticasone nasal spray, and an oral antihistamine, the most likely nature and etiology of the Veteran’s ETD is URI’s and/or allergies. Simply put, although the December 2019 examiner does not find that the Veteran’s ETD is related to his plugged ear during service, the examiner does find that it is his particular ETD is most likely related to upper respiratory infections and/or allergies. Accordingly, given the documented evidence of recurring upper respiratory infections during service, the Board will give the Veteran the benefit of the doubt, and find that his ETD is directly related to his active military service. Therefore, entitlement to service connection for ETD is warranted. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. DeBoer, 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.