Citation Nr: 21040331 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 14-03 635 DATE: July 3, 2021 ORDER Entitlement to service connection for tinnitus is denied. FINDING OF FACT There is no persuasive evidence that the Veteran has tinnitus that is etiologically related to any disease, injury, or incident in service. CONCLUSION OF LAW The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1101, 1111, 1112, 1131, 1137, 1153, 1154, 5107(b); 38 C.F.R. §§ 3.303, 3.307(a), 3.309(a), 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from May 1987 to September 1987, October 1990 to July 1991, February 2003 to June 2003, and from June 2010 to June 2011, with more than 19 years of inactive service. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for tinnitus The Veteran contends that his current tinnitus is related to his service. A review of the Veteran's military personnel records shows his occupational specialty as a vehicle mechanic, and ammunition specialist, and automated logistical specialist. His service entailed work in positions in which noise exposure would be expected. A review of the Veteran's service treatment records (STRs) reveals no discussion of complaints, treatments, or diagnoses of any hearing problems. At a January 2009 visit, he reported dizzy spells, where he feels pressure in and ringing in his ears. In March 2009, he underwent an examination. He reported being exposed to noise as a result of his role as a mechanic during service. He reported tinnitus in the right ear only, which had started a year prior to the examination. He reported serving in a civilian capacity as a federal technician for the Army Reserves (as a mechanic). The examiner opined the Veteran's tinnitus is not likely related to military service, based on the delayed onset. Notably, the Veteran's hearing was well within normal limits. In a November 2013 statement, he reported he was exposed to hazardous noise exposure that led to tinnitus. In November 2014, the Veteran submitted articles that indicate noise exposure leads to tinnitus. The Veteran argued medical studies demonstrate tinnitus may have delayed onset. The Veteran's right ear tinnitus clearly and unmistakably existed prior to his period of active duty from June 2010 to June 2011. This is documented in the March 2009 and October 2019 examiners. He did not report tinnitus of the left ear until October 2013. The Veteran underwent an examination in October 2019. The examiner opined tinnitus was less likely than not incurred in or caused by an in-service injury, event, or illness. The Veteran was exposed to excessive noise during service as indicated by conceded noise on active duty. The Veteran has a date reported of 2007 for tinnitus, which was not during a period of active duty. The examiner opined the Veteran's tinnitus, which existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner indicated there is a lack of evidence to support that there was any aggravation of tinnitus during the period of June 2010 to June 2011. In December 2020, the Veteran underwent another examination. During service the Veteran worked as a light wheel mechanic, heavy equipment operator, and material storage handling specialist. He reported exposure to gunfire, and loud generators. Post-service, he worked as a car mechanic, and was also exposed to some recreational hunting noise exposure. The examiner indicated there was no diagnosis of hearing loss on examination, and therefore a nexus between hearing loss and tinnitus could not be established. Further, the examiner opined it is less likely than not that tinnitus was caused by or a result of military noise exposure. STRs indicate no permanent shift in hearing thresholds from entrance to separation. Though there was excessive noise exposure on active duty, there is no nexus of auditory damage on active service to relate to the Veteran's current report of tinnitus. The examiner indicated, taking into consideration the Veteran's medical history, clinical findings, and onset and duration of tinnitus, the examiner was unable to determine the etiology of tinnitus without resorting to mere speculation. In May 2021, an addendum opinion was rendered. The examiner stated the Veteran's tinnitus is less likely than not incurred in or caused by anti-malarial medication taken in 2003. The examiner noted that although tinnitus is a known symptom of quinine-based anti-malarial medications, tinnitus occurs at the time of ingesting the medication and does not present with latent onset. The Veteran reported onset of tinnitus in 2007 which post-dates him taking the medication by 4 years. The Board notes that the Veteran is competent to attest to being exposed to noise during military training as well as to experiencing symptoms such as ringing in his ears. Charles v. Principi, 16 Vet. App. 370, 374 (2002). He is not competent to determine whether the level of noise exposure during service caused him to develop tinnitus or aggravate preexisting tinnitus. His assertion that he has tinnitus as a result of noise exposure is noted; however, there remains no evidence for several years of hearing-related complaints, nor are there any positive opinions of record linking his tinnitus to noise exposure during service or aggravation of tinnitus during his final period of active duty. Determining the precise etiology of this Veteran's tinnitus is not a simple question as there are conceivably multiple potential etiologies of his tinnitus. Ascertaining the etiology of tinnitus involves considering multiple factors and knowledge of how those factors interact with the mechanics of human hearing. In this case, the facts are complex enough that the Veteran's intuition about the cause of his tinnitus is not sufficient to substantiate the claim. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (Lance, J., concurring) ("The question of whether a particular medical issue is beyond the competence of a laypersonincluding both claimants and Board membersmust be determined on a case-by-case basis.") Indeed, any relationship between the current tinnitus, symptoms of tinnitus during service, and symptoms experienced over the years must be established by medical evidence because ringing in the ears may be due to many different causes, thereby rendering the question of causation a matter of medical complexity requiring medical expertise to resolve. Here, there is no competent evidence that relates a current condition to any symptomatology noted in service. Further, as was explained by the 2019 examiner, the Veteran's right ear tinnitus, which existed prior to service, was not aggravated during the period of active duty from June 2010 to June 2011. The 2021 examiner explained there is no indication anti-malarial medication led to the Veteran's complaints of tinnitus as these medications would cause tinnitus during the period of ingestion. The examiners explained there was no indication of a link between service and his current complaints of tinnitus, nor was there an aggravation of pre-existing tinnitus during his final period of active duty. There are no competent opinions to the contrary. The VA examiners reviewed the records and considered the Veteran's lay statements regarding his disabilities and still found no link to military service or aggravation. In the absence of medical evidence of tinnitus in service, persuasive lay evidence of continuous tinnitus since service, and a medical opinion relating the current tinnitus to service or aggravation during service, the preponderance of the evidence is against the claim. Accordingly, service connection for tinnitus is not warranted. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Skiouris, 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.