Citation Nr: 21027620 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 17-44 676 DATE: May 6, 2021 ORDER Entitlement to service connection for a peripheral vestibular disorder (claimed as vertigo) as secondary to a service-connected disability is granted. FINDING OF FACT Competent medical evidence establishes that the Veteran's peripheral vestibular disorder was, at least in part, caused by his service-connected hearing loss and/or tinnitus. CONCLUSION OF LAW Secondary service connection for a peripheral vestibular disorder is warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1962 to August 1965. He died in July 2018. The appellant is his surviving spouse and has been substituted for him as claimant/appellant for claims pending before VA when he died. This matter is before the Board on appeal from an August 2015 Department of Veterans Affairs (VA) rating decision. In January 2021, a videoconference hearing was held before the undersigned; a transcript is in the record. At the hearing the appellant requested, and was granted, a 90-day abeyance period for submission of additional evidence; such evidence was received. [At the January 2021 hearing the appellant offered testimony regarding a claim for an earlier effective date for the grant of service connection for bilateral hearing loss and tinnitus. She contended that the Veteran had perfected an appeal in the matter from a September 2010 rating decision, and that the appeal remained pending. Upon detailed review of the record, however, the Board found that, in response to a May 2015 Supplemental Statement of the Case (SSOC) readjudicating the matter, the Veteran submitted an SSOC Expedited Action Attachment wherein he had checked the box for "I am satisfied with the decision regarding my appeal and wish to withdraw my appeal." The claims file also includes a June 2015 deferred rating noting the Veteran's submitted correspondence that he wished to withdraw his appeal. Therefore, the appeal was dismissed before it was certified to the Board, and the matter is not before the Board.] Secondary service connection for a peripheral vestibular disorder is granted. The appellant contends that the Veteran's peripheral vestibular disorder, diagnosed as vertigo, was related to exposure to hazardous noise in service that resulted in [service-connected] bilateral hearing loss and tinnitus. His STRs are unavailable for review. On January 2013 evaluation, the Veteran reported that approximately 6 months earlier he noticed worsening of his balance and difficulty walking due to pain. He reported dizziness, imbalance, motion sensitivity, and bilateral tinnitus. He reported constant unsteadiness and dizziness with all transitions. On February 2013 treatment, a balance performance evaluation noted that the Veteran's center of gravity (COG) position was in the abnormal range, though his vestibular response had improved significantly since he began balance training therapy the previous month. May 2013 VNG report notes test results of abnormal saccades and optokinetics with a 28.46% right unilateral weakness. On April 2014 audiological evaluation, the Veteran complained of persistent balance issues. On April 2014 VA ear conditions examination, the diagnoses included a peripheral vestibular disorder, bilateral sensorineural hearing loss, and subjective tinnitus. The Veteran reported the onset of vertigo symptoms was in 2004, and that his tinnitus began in 1965. He reported the vertigo had gradually worsened and become more severe, to the point of his falling. He was noted to have hearing impairment with vertigo occurring more than once weekly with duration of 1 to 24 hours; tinnitus occurring more than once weekly with duration of over 24 hours; and vertigo occurring more than once weekly with duration of 1 to 24 hours. The examiner opined that the claimed vertigo condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness; the examiner's rationale was, "Hearing loss does not cause vertigo, or imbalance (not the same thing)." Regarding secondary service connection, the examiner opined that the Veteran's claimed vertigo is less likely than not proximately due to or the result of his service-connected bilateral hearing loss; the rationale was that it is less likely than not that the high frequency hearing loss is in any way related to vertigo. In a July 2015 medical statement, the Veteran's treating neurologist stated that he had a long history of vertigo and subsequent poor balance. Over the years, the provider had treated the Veteran's vertigo and subsequent balance issues with courses of physical therapy and medication. On August 2015 VA examination, the examiner [an audiologist] opined that the Veteran's claimed vertigo condition is less likely than not proximately due to or the result of his service-connected tinnitus. The examiner noted that the Veteran served as an air policeman in the Air Force, and his military medical records were reportedly destroyed in a fire or lost/not available for review. The examiner noted that on 2014 VA examination, the Veteran reported the onset of his vertigo began in 2004, and that "his claim for hearing loss causing vertigo was denied as hearing loss does not cause vertigo, or imbalance (not the same thing)." The examiner noted that there was no report of dizziness, vertigo, or lightheadedness on an October 2009 ENT evaluation, when tinnitus, hearing loss, and peripheral neuropathy were diagnosed. The examiner noted that ENG testing in May 2013 indicated abnormal saccades, optokinetic tests, and a borderline right side unilateral weakness; a mild to severe bilateral sensorineural hearing loss was then shown. Th examiner noted that a January 2013 sensory organization test revealed abnormalities in the VEST scores, SOM score, VIS score, composite score of 30, and center of gravity position. The examiner stated that tinnitus, dizziness, and vertigo are symptoms, and opined that tinnitus does not cause vertigo nor does tinnitus aggravate vertigo beyond its natural progression. The examiner stated that evidence in human and animal studies show noise blasts may affect the otolith organs of the vestibular system; however, the testing the Veteran had completed to date did not test the otolith organs; the examiner opined that consideration of a VEMP testing was warranted. The examiner stated that it is not within her scope of practice to determine the current status of the Veteran's history of vestibular pathology outside of the aforementioned hearing loss, and opined that a medical opinion by an otolaryngologist was warranted. At the January 2021 Board hearing, the appellant testified that she first noticed the Veteran having issues with vertigo in the late 1960s, within one year following his separation from service, and it increased throughout his life; she testified that he self-treated until 1970 when he sought non-VA treatment. The appellant's adult daughter testified that her father was often dizzy throughout her life; she testified that records from Coastal Carolina ENT indicate that his vertigo was related to his service-connected hearing loss and tinnitus. In a March 2021 medical opinion statement, the Veteran's treating otolaryngologist (ENT doctor) stated that the Veteran had been his patient from 2008 until his passing. The provider noted that the Veteran had a history of severe sensorineural loss that was service connected, in addition to significant bothersome tinnitus, which was also service connected. The provider stated that the Veteran had vertigo, which for him was a spinning sensation, constantly. The provider opined that the vertigo was from multiple causes. The provider noted the Veteran's report that the vertigo occurred after his years in the military and progressively worsened; he was on the jet runway in service and was not required to and was told not to wear ear protection, which the provider opined resulted in significant damage. The provider noted the Veteran's report of being on the right side of most of the jet engine noises, and he was a right handed shooter; his vertigo occurred especially when he heard loud noises and he had hyperacusis and pain from his ears. The provider stated that an August 2016 VNG performed at his office demonstrated the right peripheral hypofunction, confirming that the vertigo was, in fact, an inner ear disorder and affected his right ear. The provider further noted that the Veteran had significant sensorineural loss and tinnitus in the right ear as well. The provider opined that it is more likely than not that the Veteran's vertigo was vestibular in origin and more likely than not was caused from the loud noise exposure in the military, given the evidence of symptoms presented as well as the Veteran's report that the vertigo occurred after his years in the service. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection is warranted for a disability that was caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310. It is not in dispute that the Veteran had a diagnosed vertigo disability, as such is shown in VA and private treatment records and was diagnosed on examination. As noted above, he had established service connection for bilateral hearing loss and tinnitus. The appellant contends that the Veteran's vertigo was secondary to (was caused or aggravated by) his service-connected hearing loss and/or tinnitus disabilities. The medical opinions of record in this matter are conflicting. However, the only medical opinion of record that is supported by adequate rationale, and is not merely conclusory, is the March 2021 opinion by the Veteran's own treating ENT doctor. The Board finds that the March 2021 treating provider's opinion places the probative value of the evidence supporting the claim at least in equipoise with the opinions against the claim. The provider expressed familiarity with the nature and history of the Veteran's vertigo, as well as his lay statements and contentions, and explained the manner in which the Veteran's hazardous noise exposure in service, hearing loss and tinnitus, impacted on his vertigo, contributing to cause such disability, indicating that medical literature supported the explanation of how the service-connected audiological disabilities contribute to vertigo. Resolving any remaining reasonable doubt in the appellant's favor as required (see 38 U.S.C. § 5107; 38 C.F.R. § 3.102), the Board finds that the evidence shows that the Veteran's vertigo was, at least in part, caused by his service-connected hearing loss and tinnitus. The requirements for establishing secondary service connection are met; service connection for a peripheral vestibular disability is warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechner, 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.