Citation Nr: 23014841 Decision Date: 03/11/23 Archive Date: 03/11/23 DOCKET NO. 17-13 999A DATE: March 11, 2023 ORDER Service connection for endolymphatic hydrops is granted. FINDING OF FACT The Veteran's endolymphatic hydrops were the result of in-service acoustic trauma. CONCLUSION OF LAW The criteria for service connection for endolymphatic hydrops are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1966 to October 1968. This appeal is before the Board of Veterans' Appeals (Board) from an April 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office. In October 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. The Board remanded the matter on appeal in April 2022 and October 2022. Service connection may be granted for a 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 requires: (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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310. The Veteran generally contends that he has a disability manifested by dizziness and imbalance, claimed as Meniere's disease, that is related to service or is secondary to a service-connected disability, specifically his service-connected bilateral hearing loss, tinnitus, healed ruptured left tympanic membrane with residual scarring, and/or type II diabetes mellitus. VA treatment records dated from 2015 to 2022 reflect that, while the Veteran was initially found not to have met the clinical criteria for Meniere's syndrome, he had complaints of dizziness and imbalance, and was subsequently diagnosed with endolymphatic hydrops. See 38 C.F.R. § 4.87, Diagnostic Code 6205 (Meniere's syndrome and endolymphatic hydrops are treated as the same disability for VA service-connected compensation purposes). In its October 2022 remand, the Board noted that the Veteran's representative, in a September 2022 brief, argued that VA treatment records reflecting a history of chronic dizziness also show the VA providers "imply[ing] a relationship to, at least in part, service-connected manifestations." The representative pointed to an October 2020 VA treatment record, which states: "Dizziness, multifactorial. History of endolymphatic hydrops as well as diabetic neuropathy, balance improved following physical therapy." The representative also pointed to a November 2021 VA note reflecting that the Veteran had a "history of multifactorial dizziness (endolymphatic hydrops as well as diabetic neuropathy), hearing loss, and allergic rhinitis." The Board determined that, while the Veteran's representative did not point to persuasive evidence that the Veteran's dizziness or balance problems had been related by medical evidence to his hearing loss or tinnitus, the record did reflect medical evidence suggesting that his service-connected diabetes might be a causal factor in such problems. Therefore, the Board remanded the matter on appeal for a medical opinion on the question of whether the Veteran had any disability manifested by dizziness or imbalance, to include Meniere's disease, caused or aggravated by a service-connected disability. A VA physician addressed the Board's questions in an October 2022 opinion and December 2022 addendum. In these opinions, the examiner determined that the Veteran's disability manifested by dizziness or imbalance, which had been diagnosed as "Meniere's disease," was likely caused by endolymphatic hydrops of the labyrinthine system of the inner ear, and explained why it was unlikely that such disability was caused or aggravated by the Veteran's service-connected hearing loss, tinnitus, and type II diabetes. However, the examiner noted that, while most patients with endolymphatic hydrops have no identifiable additional otologic disease, and lack of a single etiologic cause may reflect underlying clinical and genetic heterogeneity in Meniere's disease, multiple potential causes for endolymphatic hydrops had been proposed, which the examiner listed. The first potential cause listed was "[a]coustic trauma." The examiner did not elaborate on which, if any, of the potential causes of endolymphatic hydrops was most likely or unlikely in the Veteran's specific case. The Board, in its April 2022 decision granting service connection for bilateral hearing loss and tinnitus, noted that the in-service "acoustic trauma the Veteran experienced," and claimed was related to his present tinnitus and hearing loss, "[was not] contested." Also, the agency of original jurisdiction, in its July 2022 rating decision granting service connection for healed ruptured left tympanic membrane with residual scarring, based on a July 2022 VA medical opinion that the Veteran's ruptured left ear drum and residuals were at least as likely as not incurred or caused by in-service exposure to blasts from mortar fire. Given this, the October 2022 VA examiner's assessment of endolymphatic hydrops as the likely cause of the Veteran's dizziness and imbalance disability, along with the examiner's notation that acoustic traumaan injury VA has recognized to have been incurred by the Veteran in servicewas a known potential cause of endolymphatic hydrops, provides medical evidence in favor of the Veteran's claim, rather than against it. Considering this medical report and the record as a whole, the evidence for and against the Veteran's claim is at least in approximate balance. Affording the Veteran the benefit of the doubt, the Board finds that his endolymphatic hydrops were the result of in-service acoustic trauma. Accordingly, service connection for endolymphatic hydrops must be granted. See 38 U.S.C. § 5107. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Andrew Mack, 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.