Citation Nr: A25035237 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 240408-429002 DATE: April 16, 2025 ORDER Entitlement to service connection for tinnitus is denied. Entitlement to service connection for an acquired psychiatric disorder, other than already service-connected posttraumatic stress disorder (PTSD) and cannabis use disorder, is denied. FINDINGS OF FACT 1. The evidence persuasively weighs against a finding that the Veteran's tinnitus was incurred during active service, or was incurred within a year of active duty, or is otherwise related to any incident of service. 2. The Veteran's service-connected psychiatric disorder is rated based on manifestations such as depressed mood and anxiety and there is no persuasive evidence of record that there are mental health symptoms separate or distinguishable from the Veteran's already service-connected psychiatric disorder. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. § §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for an acquired psychiatric disability, other than the already service-connected PTSD and cannabis use disorder, have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 4.14, 4.125, 4.130. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 2018 to May 2021. This matter comes to the Board of Veterans' Appeals (Board) on appeal from November 2023 and March 2024 rating decisions issued by a VA Regional Office, the agency of original jurisdiction (AOJ). In the April 2024 VA Form 10182 Notice of Disagreement (NOD), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the November 2023 rating decision as it pertains to the service connection claim for an anxiety condition and the March 2024 decision as it pertains to the service connection claim for tinnitus. 38 C.F.R. § 20.301. Any evidence submitted after the respective AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service Connection Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In rendering this decision, the Board has reviewed all evidence of record whether discussed in detail. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal). To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Veteran. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal"). 1. Entitlement to service connection for tinnitus is denied. The Veteran contends that her tinnitus is related to service as she was not issued ear protection during basic training due to her small ear size and that she had to subsequently get custom made ear protection. November 2023 VA 21-526EZ. For VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002). If a veteran reports ringing in his or her ears, then a diagnosis of tinnitus is generally applied without further examination. In addition, since the diagnosis of tinnitus is so heavily reliant upon lay statements, the etiology of the disorder is similarly reliant upon them. The date that a veteran reports that the tinnitus symptoms began is generally accepted as the date that the disorder began, without further examination. Thus, while service connection for tinnitus requires a medical diagnosis of tinnitus and a medical nexus relating the diagnosis to military service, lay testimony plays an unusually important role in these determinations. Turning to the relevant evidence of record, the Veteran's service treatment records are silent as to any symptoms, diagnoses, or treatment related to tinnitus. Annual audiology testing in July 2019 and January 2020 indicated no abnormal findings. Furthermore, a February 2021 hearing exam expressly indicated no tinnitus. Post-service, a July 2023 primary care note indicates the Veteran's ears were examined and that the Veteran denied symptoms of hearing loss, tinnitus, pain or discharge. The Veteran was afforded a tinnitus only VA examination in January 2024 wherein the Veteran stated that her tinnitus had a gradual onset beginning after service in 2022. The Veteran reported intermittent tinnitus occurring daily lasting for minutes to hours and that her symptoms had worsened over time. January 2024 VA Examination. The Veteran indicated noise exposure during military service to include explosives, gunfire, and tanks. While the Veteran reported that she did not participate in combat activity during the examination, she noted in her November 2023 VA 21-526EZ that she did not have hearing protection during basic training. Post-military noise exposure to aircraft was also reported as the Veteran worked in aircraft maintenance. Hearing protection was noted to have been used. Id. The VA examiner opined that the Veteran's tinnitus was less likely than not caused by military noise exposure as the Veteran did not notice any tinnitus symptoms until after service and that her MOS of human resource specialist carries a low probability for hazardous noise exposure. Id. Based on the forgoing, the Board finds that service connection for tinnitus is not warranted as the persuasive evidence of record is against a nexus between service and her current tinnitus. The Board finds the January 2024 opinion persuasive as it is supported by the record. While the Veteran reported exposure to noise without hearing protection during basic training, the Veteran's service treatment records reflect normal hearing throughout her three years of service with no tinnitus related complaints. Furthermore, a February 2021 service treatment record towards the end of the Veteran's service expressly indicates no tinnitus. Indeed, her MOS of human resource specialist carries a low probability of noise exposure, and the Veteran did not indicate experiencing any tinnitus symptoms until after service. While the Veteran indicated during her January 2024 VA examination that a gradual onset of her tinnitus began in 2022, a July 2023 primary care note indicates the Veteran expressly denied experiencing tinnitus. With regard to the onset of the Veteran's tinnitus, the Board attaches more probative value to the contemporaneous denial of tinnitus in July 2023 than to later statements made in connection with a claim for VA monetary benefits. See Curry v. Brown, 7 Vet. App. 59 (1994). (stating that contemporaneous evidence can hold more weight than a lay statement). As such, the Board finds the persuasive weight of the evidence is against a finding that the Veteran's tinnitus is related to service. The evidence indicates the Veteran's tinnitus did not have an onset in service or within a year of separation, and the January 2024 medical opinion of record found no nexus between the Veteran's tinnitus and service. The Board acknowledges the Veteran's belief that her tinnitus is a result of active service. While the Veteran is competent to describe her tinnitus related symptoms, she is not considered competent to medically attribute her current diagnosis to a specific cause, as doing so requires medical knowledge and expertise that the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Board finds the evidence is against a finding that the Veteran's current tinnitus is related to service and, therefore, there is no benefit of the doubt to resolve in the Veteran's favor, and her appeal in this regard must be denied. 2. Entitlement to service connection for an acquired psychiatric disorder, other than already service-connected posttraumatic stress disorder (PTSD) and cannabis use disorder, is denied. This appeal stems from an October 2022 claim where the Veteran claimed that she had an anxiety condition and PTSD due to personal trauma that were related to service. October 2022 VA 21-526EZ. The Veteran was granted service connection for PTSD and cannabis use disorder and was denied service connection for an anxiety condition. November 2023 Rating Decision. The Veteran has appealed the denial of her service connection claim for an anxiety condition. April 2024 NOD. As will be outlined below, the Board finds the claimed disability is already encompassed in her PTSD and cannabis use disorder rating. In general, all psychiatric conditions are rated under the identical General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. Nonetheless, the mere fact that a claimant is service connected for one mental health disability (in this case PTSD and cannabis use disorder), does not necessarily preclude service connection for another psychiatric disability. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009) (two psychiatric conditions "could have different symptoms and it could therefore be improper in some circumstances for the VA to treat these separately diagnosed conditions as producing only the same disability"). The Veteran's service-connected psychiatric disability could moot out other mental health diagnoses if all such manifestations are already part and parcel of the rating assigned and there are no distinguishable manifestations/effects from the non-service-connected disability versus the service-connected disability. Cf. Bean v. McDonough, 66 F.4th 979 (Fed. Cir. 2023); see also Mittleider v. West, 11 Vet. App. 191, 192 (1998) (when it is not possible to separate the effects of the service-connected and non-service-connected disabilities, the benefit of the doubt doctrine dictates that such signs and symptoms be attributed to the service-connected disability or disabilities); 38 C.F.R. § 4.14 (noting the evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition). Here, the Board finds the persuasive weight of the evidence is not indicative of distinct symptoms stemming from different mental health diagnoses. Rather, it is clear the Veteran's service-connected PTSD and cannabis use disorder disability rating already encompasses the manifestations of all acquired psychiatric diagnoses. Under these circumstances, any additional compensation would constitute impermissible pyramiding. Here, the Veteran's service treatment records are replete with mental health related treatment beginning in 2020 to include diagnoses of anxiety disorder and adjustment disorder with mixed anxiety and depressed mood. See, e.g., May 2020 and April 2021 Service Treatment Records. The Veteran was afforded a VA examination in October 2023 wherein the Veteran was diagnosed with PTSD and cannabis use disorder. The examiner also expressly listed and considered the Veteran's in-service diagnoses of anxiety disorder and adjustment disorder with mixed anxiety and depressed mood in the evaluation and significantly, did not render a separate anxiety condition diagnosis. October 2023 VA Examination. The October 2023 examiner indicated that all the Veteran's symptoms are due to PTSD and cannabis use disorder and specifically indicated that the Veteran's anxiety and depressed mood applied to the Veteran's diagnoses. Id. Where, as here, there is no evidence that there are symptoms of mental health manifestations separate from the already service-connected psychiatric disability, service connection need not be discussed and, indeed, is moot. See Dollison v. Wilkie, 750 F. App'x 986, 989 (Fed. Cir. 2018) (dismissing, for lack of standing, an appeal from a Court affirmance of a Board decision that denied service connection for PTSD and granted service connection for MDD because the appellant did not "establish that he suffers from symptoms of PTSD that are not also symptoms of MDD or that a diagnosis of PTSD would result in some other greater benefit to" him). Accordingly, the appeal seeking service connection for an acquired psychiatric disability, other than the Veteran's already service-connected PTSD and cannabis use disorder, is denied as moot. (Continued on the next page) ? (continued on next page) SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Knopp, Derek A. 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.