Citation Nr: 22019846 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 18-07 664 DATE: April 3, 2022 ORDER Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for a heart disability is remanded. FINDING OF FACT The Veteran's tinnitus began during service and has continued since that time. CONCLUSION OF LAW The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 1975 to June 1978 and the Coast Guard from January 1983 to June 1984. This matter comes before the Board of Veterans' Appeals (Board) from a July 2017 rating decision by the Agency of Original Jurisdiction (AOJ) that denied service connection for a cardiological condition and tinnitus. A Board hearing was held in November 2021. A transcript is of record. Upon request from the Veteran's representative, the record was held open for 90 days following the hearing to allow for submission of additional evidence, to include treatment records. The Veteran waived initial AOJ consideration of such evidence. See Hearing Transcript at 15. 1. Entitlement to service connection for tinnitus. The Veteran contends that his tinnitus began during service and has continued since that time. Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran testified that his military occupation specialty (MOS) in both the Army and Coast Guard had a high probability of exposure to acoustic hazard. Specifically, he testified that during service, he constantly operated heavy equipment, to include D9 graders, built roads and dams, and was active in the motor pool wherein he would work on engines. He further testified that he did not wear hearing protection at that time. Additionally, he testified that he experienced ringing or buzzing in his ears during service, and that it has continued since such time. See November 2021 Hearing Tr. at 3-4. The Board notes that the Veteran is competent to testify to factual matters of which he has first-hand knowledge. See Washington v. Nicholson, 19 Vet. App. 362 (2005). Tinnitus is capable of lay observation. Pursuant to Buchanan v. Nicholson, 451 F. 3d. 1331 (2006), competent lay evidence is sufficient in a of itself to establish service connection. As he is competent to describe the symptoms of tinnitus, and tinnitus is a disease which is capable of self-diagnosis, the Board finds that he has tinnitus and the first element is met. Additionally, military noise exposure is now conceded based on the Veteran's testimony regarding his duties during military service, which involved constant exposure to hazardous noise. See November 2021 Hearing Transcript at 3 to 4. Therefore, the evidence shows that a qualifying event, injury, or disease had its onset during your service, and the second element of service connection is met. Finally, the Veteran testified that his tinnitus began during service and has continued until the present, and the Board finds his statements regarding onset and continuity since service to be credible. As such, the third element of service connection is met. Therefore, the claim is granted on this basis. 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS FOR REMAND 2. Entitlement to service connection for a heart disability is remanded. The Veteran contends that his heart disability is related to service. His representative argues that the Veteran's record demonstrates in-service treatment and chronic treatment for the heart condition. The Veteran testified that his heart disability was identified following an episode wherein he fainted while serving in the Coast Guard. He also attributes his heart disability to stress resulting from the conditions of his service. He further testified that he underwent treatment at VA and those records show a diagnosis of a mitral valve condition. However, those records have not been associated with his claims file. He testified that his Coast Guard records indicate that there was a heart issue that existed during his service. He testified that private medical records from 2018 show that he is currently diagnosed with and treated for cardiomyopathy. See November 2021 Hearing Transcript at 5. He testified that during his Coast Guard service, while sand blasting a lighthouse in Cape Cod, he began experiencing severe back and chest pain, after which, he fainted and awoke in intensive care at Cape Cod Hospital, Hyannis Port. See Id at 6. He and his wife testified that he was transferred to Rhode Island Naval Hospital, wherein he was diagnosed with Mitral valve prolapse and treated with stabilizers for 30 days. See Id at 11. He was then transferred to Bethesda Naval Hospital, wherein it was noted that there were highly variable TEDs, an MB fraction suggestive of mitral valve prolapse. Id at 12. Following his release, a few years later in 1989, the Veteran sought treatment from Dr. S.S. at Colorado Springs Memorial Hospital, wherein it was confirmed that he had a "bad mitral valve." Id at 13. He stated that his records from Colorado Springs Cardiology only date back to 2017. Id at 14. The Veteran also testified that his heart condition resulted from stress suffered while serving in the Coast Guard, to include limited housing, limited food allowance, inadequate compensation to care for a family, and lack of promotion within his station. Id at 15 to 16. He testified that because of the stress of trying to provide for his family on so little, he requested a hardship release from the Coast Guard. Id at 17. He contends that his heart issues began while in the Coast Guard and have continued since such time. Id at 18. He stated that he is currently treated by a private physician in Colorado Springs. Id at 20. The Board regrets the further delay but finds that a remand is necessary in this appeal to afford the Veteran full consideration of his claim. Upon remand, the Veteran's treatment records should be updated to specifically include those from Bethesda Naval Hospital, Cape Cod Hospital, Rhode Island Naval Hospital, and Colorado Springs Memorial Hospital. Additionally, following a review of the updated records, a new examination with medical opinion is needed to address the etiology of the Veteran's heart condition. Accordingly, the matter is REMANDED for the following action: 1. Obtain VA treatment records related to a heart condition from Bethesda Naval Hospital, Cape Cod Hospital in Hyannis Port, Rhode Island Naval Hospital, and Colorado Springs Memorial Hospital starting from 1989, and associate such records with the claims file. 2. Then, obtain an additional medical opinion from an appropriate clinician. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the examiner. After the record review, the reviewing clinician is asked to respond to the following: Is it at least as likely as not (a 50 percent probability or more) that the Veteran's heart condition was incurred in or aggravated by his service, to include stressful circumstances therein? A complete rationale for the opinion should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. (Continued on the next page) 2. Then, readjudicate the Veteran's claim. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Wilson, 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.