Citation Nr: 22016369 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 16-38 697 DATE: March 22, 2022 ORDER Entitlement to service connection for Meniere's disease/syndrome (peripheral vestibular disorder), to include as secondary to the service-connected hearing loss and the service-connected tinnitus, is denied. FINDING OF FACT The totality of the evidence persuasively weight against finding that the Veteran's Meniere's syndrome is etiologically related to his active service, or that it was caused or aggravated by his service-connected hearing loss or tinnitus. CONCLUSION OF LAW The criteria for service connection for Meniere's disease/syndrome, to include as secondary to service-connected hearing loss or tinnitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1969 to July 1971. The current appeal before the Board of Veterans' Appeals (Board) arose from a May 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2016, the Veteran withdrew a request to be scheduled for a Board hearing in this appeal. In August 2019 and May 2021, the Board remanded this appeal to the Agency of Original Jurisdiction (AOJ) for further evidentiary development. Service Connection for Meniere's Disease/Syndrome At the outset, the Board is satisfied that all notification and development actions needed to adjudicate fairly the Veteran's claim for service connection for Meniere's disease/syndrome have been accomplished, to the extent possible. He has been notified of what is needed to substantiate the claim, and relevant VA examination reports, and VA and private treatment records have been associated with the claims file. These reports also document the Veteran's lay statements regarding the nature and etiology of his Meniere's disease/syndrome. The AOJ substantially complied with the Board's May 2021 remand directives insofar as it sent a letter requesting that the provide VA with new authorization to obtain outstanding private treatment records. In response to the request from the AOJ, the Veteran submitted private treatment records directly to VA. There is no other identified evidence for which he has provided appropriate authorization to obtain, or other indication of existing outstanding evidence relevant to this claim that VA has not attempted to obtain. Further, he has not alleged any error or omission in the assistance provided. He is, thus, not prejudiced by the Board proceeding to a decision on this service connection claim at this juncture. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury, event, or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. See id., see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be established on a secondary basis for disability that is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disability, and not due to the natural progress of the nonservice-connected disease or injury, will be service connected. 38 C.F.R. § 3.310(b). Thus, service connection is permitted not only for disability caused by a service-connected disability, but also for the degree of disability resulting from aggravation by a service-connected disability. In adjudicating a claim for VA benefits, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990); 38 C.F.R. § 3.102. The Veteran specifically asserts that he developed Meniere's disease/syndrome as secondary to service-connected bilateral hearing loss and/or service-connected tinnitus. Development has also been conducted in this appeal to determine whether Meniere's disease/syndrome was incurred during, or as a result of, the Veteran's active service. With respect to the current disability requirement for service connection, the evidence, including a May 2019 VA-contracted examination report, clearly notes the Veteran's diagnosed Meniere's disease affecting his left ear. As for the in-service injury or disease requirement for the claimed Meniere's disease/syndrome, review of the Veteran's service treatment records (STRs) reveals that they are devoid of any indication that he complained of, was treated for, or was found to have any signs or symptoms indicative of Meniere's disease/syndrome. While he was exposed hazardous military noise and acoustic trauma during service, resulting in service connection being granted for bilateral hearing loss and tinnitus, there is simply no indication of an onset of Meniere's disease/syndrome during service. During an ENT consultation in December 2019 which confirmed a diagnosis of Meniere's disease/syndrome, the physician determined that, with the presence of low frequency sensorineural hearing loss on the left and reported episodes of vertigo, Meniere's syndrome was a reasonable diagnosis. The Veteran had previously reported to the physician that an ENT physician in Seattle had told him that he had Meniere's syndrome four year previously. With respect to the etiology of the Veteran's Meniere's syndrome, in a July 2021 VA examination report, the examiner opined that the Veteran's Meniere's disease was less likely than not incurred in, or caused by, a claimed in-service injury, event, or illness. In providing this opinion, the examiner noted that there was no evidence that Veteran had Meniere's disease during service. While the Veteran apparently reported that an ENT physician told him sometime in the 1970s, after his separation from service, that he was "setup" to develop Meniere's, the examiner concluded that there was no known basis for the physician to make such a comment. The examiner also noted that the Veteran did not develop actual symptoms of Meniere's until 2009, but acknowledged that a 2010 private medical report indicated that a diagnosis may have been made four years earlier. The examiner also noted that, although the Veteran's separation examination report indicated that only a whisper/speech type test was conducted (which showed normal hearing at 15 decibels), this was an important matter since low frequency hearing loss was commonly associated with Meniere's. The examiner also noted that Meniere's syndrome-related hearing loss often occurred after an onset of vertigo and that the Veteran's STRs were silent for any vertigo. In the Veteran's case, the first time he recalled having vertigo was in 2009, and his 2010 hearing test showed left ear low frequency hearing loss, together with bilateral high frequency hearing loss (which is the type commonly due to prior acoustic trauma). The examiner commented that, while the etiology of Meniere's disease was unclear and had been postulated to be related possibly to an immune response, or some form of blockage of the inner ear lymph flow, or recent viral infections, and/or genetic predispositions, it was not believed to be due to prior acoustic trauma. The Board finds the July 2021 VA examiner's opinion to be of significant probative value. Clearly, the examiner reviewed the Veteran's medical history, considered his lay assertions of record, and provided a clear explanation based on review of the Veteran's medical history (which did not document any findings indicative of Meniere's disease, to include vertigo and low frequency hearing loss, until beginning in 2009, many years after his separation from active service), that the Veteran's Meniere's syndrome was less likely than not incurred during, or otherwise etiologically related to, his active service. Further, the examiner noted that medical literature did not support a connection between Meniere's disease/syndrome and prior acoustic trauma. Most notably, neither the Veteran nor his representative have provided any evidence contrary to the examiner's findings. As such, the Board accepts the examiner's conclusion as probative evidence on a matter upon which this claim turns. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). As for the question of secondary service connection for the Veteran's claimed Meniere's disease/syndrome, while service connection is in effect for bilateral hearing loss and tinnitus, in a March 2020 VA examination report, the examiner opined that the Meniere's disease/syndrome was not secondary to, or aggravated by, the service-connected hearing loss or service-connected tinnitus. In providing this opinion, the examiner explained that Meniere's disease is a medical condition in which there is overproduction of endolymphatic fluid and that such fluid production is not the result of hearing loss or tinnitus. The examiner further noted that chronic tobacco use disorder was an identified risk factor for Meniere's. (The examiner had previously noted in the report that the Veteran had a history of tobacco use disorder that began at age of 15 and that had continued until the year 2002.) The Board also finds the March 2020 VA examiner's opinion to be of significant probative value. The examiner considered the Veteran's medical history and his lay assertions of record and provided a clear explanation that Meniere's disease resulted from overproduction of endolymphatic fluid and was not related to hearing loss or tinnitus. Further, the examiner noted an alternate potential etiology of the Veteran's Meniere's syndrome, supported by medical literature, where he had a history of tobacco use disorder over a period of many years. Also, again, neither the Veteran nor his representative have provided any evidence contrary to the examiner's findings. As such, the Board also accepts the March 2020 VA examiner's conclusion as probative evidence on a matter upon which this claim turns. See, e.g., Nieves-Rodriguez, Stefl, supra. As for any lay assertions that the Veteran's Meniere's disease/syndrome is etiologically related to his service-connected hearing loss and service-connected tinnitus, or was otherwise the result of his active service, the Board finds that the lay assertions of record lack probative value, especially in light of the fact that the Veteran has not made any specific argument or provided evidence to support his assertions. Moreover, matters of etiology of medical disabilities typically are within the province of trained medical professionals. Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to provide opinions on some simple medical issues (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), the specific matter of the etiology of the Veteran's Meniere's disease/syndrome is a complex medical matter that falls outside the realm of common knowledge of a lay person. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As neither the Veteran nor his representative is shown to be other than a layperson, without appropriate medical training and expertise, neither is competent to render a probative (persuasive) opinion on any medical matter upon which this claim turns. See id. Hence, the lay assertions in this regard have no probative value. Overall, there is no competent, probative evidence of record to establish that the Veteran's Meniere's disease/syndrome was at least as likely as not incurred during, or as a result of, his active dutyor that it was at least as likely as not caused, or aggravated, by his service-connected hearing loss or service-connected tinnitus. Rather, the totality of the competent, probative evidence on these points persuasively weighs against the claim. Therefore, the Board cannot make a finding that service connection is warranted for the Meniere's disease/syndrome. For these foregoing reasons, the Board finds that the claim for service connection for Meniere's disease/syndrome must be denied. In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the totality of the probative evidence persuasively weighs against the service connection claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Wilson, 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.