Citation Nr: 21010811 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 15-29 905 DATE: February 25, 2021 ORDER Entitlement to service connection for Meniere’s disease is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s Meniere’s disease began during active service or is otherwise related to an in-service injury or disease. There is no indication that vertigo manifested to a compensable degree during the one-year period following the Veteran’s discharge from service. CONCLUSION OF LAW The criteria for service connection for Meniere’s disease are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had a period of active service from May 1972 to January 1997. In August 2018, the Board most recently remanded the Veteran’s claims for additional development. The Board finds that there was substantial compliance with the remand directives for the issue on appeal as discussed below. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present 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 or aggravated during service”—the so-called “nexus requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information lay and medical evidence of record in a case and when 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. 38U.S.C. §5107; 38C.F.R. §3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, a preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). For Veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases may be presumed to have been incurred in service if they manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Meniere’s Disease may be considered on the list as a disease of the nervous system.. Entitlement to service connection for Meniere’s disease. The Veteran contends that his Meniere’s disease is related to his time in-service. More specifically, the Veteran reported in a recent Appellants Brief that he suffered from Meniere’s disease in-service but was misdiagnosed with sea-sickness. The Veteran also reports that he continued to experience similar dizzy spells post-service. STRs are negative for any complaints, diagnoses, or treatments for Meniere’s disease in-service. However, November 1972 STRs reveal that the Veteran reported to the medic with headache symptoms. 1973 STRs reveal that the Veteran was treated several times for seasickness. June 1974 STRs reveal that the Veteran was treated in-service for head trauma when he was struck over the left frontal lobe by a pipe. August 1984 STR’s reveal that the Veteran reported to the medic for headache symptoms. May 1994 STRs reveal that the Veteran was diagnosed with tinnitus, but no diagnosis of vertigo was made by the examiner. April 1996 STRs reveal that the Veteran was diagnosed again for bilateral tinnitus; however, during the examination, the Veteran reported negative for any symptoms related to dizziness. In an August 1996 retirement examination, the Veteran reported negative for dizzy spells or fainting; however, the Veteran complained of hearing loss. In an August 1998 VA hearing loss examination, the examiner diagnosed the Veteran with hearing loss, but did not diagnose the Veteran with Meniere’s disease or any symptoms of vertigo. July 2010 private treatment records reveal that the Veteran was diagnosed with tinnitus. The examiner also noted that the Veteran’s tinnitus causes him to experience imbalances. September 2010 private treatment records reveal that the Veteran underwent a videonystagmography (VGN). The examiner diagnosed the Veteran with vertigo and slight dizziness. October 2010 private treatment records reveal a diagnose of worsening tinnitus with vertigo. The examiner diagnosed the Veteran with probable Meniere’s disease. In an October 2010 otolaryngology consultation, the ear, nose, and throat examiner diagnosed the Veteran with a history suggestive of Meniere’s disease. In a June 2015 VA hearing loss examination, the examiner noted that the Veteran’s hearing loss in his left ear and, his report of episodes of dizziness are consistent with Meniere’s disease. However, the examiner noted that an accurate diagnosis of the disease and its onset require further medical testing by an ear, nose, and throat examiner to clarify whether the Veteran has a diagnosis of Meniere’s disease. The Veteran has also claimed a disability pattern related to Meniere’s disease with vertigo due to Gulf War exposure. In a June 2015 VA ear conditions examination, the examiner diagnosed the Veteran with Meniere’s syndrome. The examiner opined that it is less likely than not that the Veteran’s Meniere’s disease was incurred in or caused by Gulf War exposure or an in-service injury, event, or illness. The examiner explained that Meniere’s disease is a disorder of the inner ear that causes spontaneous episodes of vertigo coupled with a sensation of a spinning motion along with fluctuating hearing loss, tinnitus, and sometimes a feeling of fullness or pressure in the ear. The examiner noted that the Veteran reported treatment for seasickness due to episodes of dizziness in-service and episodes of vertigo post-service; however, the examiner reported that at the time of his opinion, the Veteran’s STRs were not available to support the Veteran’s statements. The examiner also noted that VA and private treatment records did not support findings of vertigo and dizziness related to the possible onset of Meniere’s disease until around 2010. In an October 2019 VA examiner opinion, the examiner opined that it is less likely than not that the Veteran’s Meniere’s disease was incurred in, caused by, or related to an injury in-service. The examiner explained that the Veteran reported episodes of seasickness in the military, but not a history of true Vertigo lasting for more than 20 minutes. The examiner noted that it was not until 2010 that the Veteran began to complain of fluctuating hearing loss with aural fullness and vertigo. Moreover, the Veteran’s audiogram in 2010 revealed vestibular testing with unilateral weakness of the left side which is consistent with a diagnosis of Meniere’s disease. The examiner also explained that the Veteran did not develop Meniere’s disease until 13 years after discharge from service. Lastly, the examiner explained that Meniere’s disease is not caused by acoustic trauma, but rather the result of fluctuating swelling of the endolymph within the ear causing periodic symptoms. In a May 2020 VA examiner addendum opinion, the examiner was asked to address whether the Veteran’s Meniere’s disease is related to the following: an undiagnosed illness; a diagnosable, but medically unexplained chronic multi-symptom illness of unknown etiology; a chronic multi-symptom illness with a partially explained etiology; or a disease with a clear and specific etiology and diagnosis related to service in the Persian Gulf. The examiner explained that Meniere’s disease is not known to be associated with any exposures. The examiner also noted that Meniere’s disease is caused by cycling episodes of increased pressure within the endolymph causing episodes of severe vertigo with hearing loss from an unclear etiology. The examiner determined that there is no increased incidence of this disease in those in the military or in those in the Persian Gulf states. The examiner opined that it is less likely than not that the Veteran’s Meniere’s disease is related to any exposures, chemical, toxic, or acoustic while in-service. In an August 2020 VA addendum opinion, the previous addendum opinion established that the Veteran did have acoustic trauma in-service, but his Meniere’s disease was not caused by military service given the history of delayed onset after discharge. The examiner noted that Meniere’s disease is a disease of recurrent swelling of the endolymph. The examiner explained that when it swells it causes a leak that allows mixing of the endolymph and perilymph. The mixing creates ion fluctuations which leads to damage to the inner ear which manifests as unilateral hearing loss, roaring tinnitus, and severe vertigo lasting for at least twenty minutes. As the pressure of the endolymph decreases, the membranes seal, the mixing stops, and the symptoms subside. However, with repeated bouts it causes a low frequency hearing loss and unilateral vestibular weakness. The examiner noted that Meniere’s disease has not been shown to be caused by acoustic trauma or environmental exposures; however, high salt diets tend to worsen the disease, but is not the etiology of Meniere’s disease. The examiner explained that the Veteran did not develop symptoms until approximately twelve years after military service. Moreover, the hearing loss and tinnitus he showed in the military was caused by acoustic trauma, which has no impact on the Veteran’s Meniere’s disease. As such, the examiner opined that the Veteran’s Meniere’s disease did not manifest during his military service, nor did it worsen as a result of service. Moreover, the examiner noted that the Veteran’s Meniere’s disease was not caused by any exposures he may have had in the service. The foregoing summary of the treatment record reveals no possibility for service connection for Meniere’s disease. Although the Veteran contends that he experienced dizzy spells in-service, his STRs do not report any complaints, diagnosis, or treatments for Meniere’s disease. He specifically denied dizziness on his retirement examination. Furthermore, the June 2015 examiner noted that the Veteran’s Meniere’s disease is less likely than not due to Gulf War exposure. Moreover, in the Veteran’s most recent August 2020 VA examiner opinion, the examiner did not find a nexus between the Veteran’s Meniere’s disease and his time in-service. Significantly, there is no examiner opinion to the contrary. The Board also reviewed the Veteran’s lay statements asserting that his Meniere’s disease is connected to his loud noise exposure in-service. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to Meniere’s disease as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2020). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). While the Veteran has reported that his Meniere’s disease has been present since service, this is not found to be probative considering the other evidence of the record. It has been determined by the Board, that the onset of the Veteran’s Meniere’s disease occurred many years after discharge from service. Although the Veteran experienced symptoms of dizziness in-service, his STRs do not report any complaints, diagnosis, or treatments for Meniere’s disease at an examination prior to discharge. In-fact, the in-service medic attributed the Veteran’s in-service dizzy spells to seasickness. Furthermore, the VA examiner explained that the Veteran reported episodes of seasickness in the military, but not a history of true Vertigo lasting for more than 20 minutes. The examiner also noted that it was not until 2010 that the Veteran began to complain of fluctuating hearing loss with aural fullness and vertigo. Moreover, the examiner noted that it was not until 2010 that the Veteran’s audiogram revealed vestibular testing with unilateral weakness of the left side which is consistent with a diagnosis of Meniere’s disease. Lastly, as a pathology of Meniere’s disease was not shown until many years after separation, the Board finds no evidence to support the Veteran’s contentions. Based on this evidence, the Board finds service connection is not warranted. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 4.3 (2020) MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Elliot Harris 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.