Citation Nr: A25035584 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 241030-487775 DATE: April 17, 2025 ORDER Entitlement to service connection for tinnitus is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his tinnitus?is at least as likely as not related to noise exposure in service. CONCLUSION OF LAW The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 2010 to January 2018. This matter is on appeal to the?Board of Veterans' Appeals?(Board) from a May 2024 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which is also the agency of original jurisdiction (AOJ). In October 2023, the AOJ denied the Veteran's claim for service connection for tinnitus. In January 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), seeking review of the October 2023 decision. In May 2024, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior October 2023 decision. In the October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement or NOD), the Veteran elected Direct Review. Therefore, the Board may only consider the evidence of record at the time of the October 2023 decision, which was subsequently subject to HLR in the May 2024 rating decision on appeal.?38 C.F.R. § 20.301. Any evidence that was submitted after the AOJ issued the October 2023 rating decision was not considered by the Board in its decision.?38 C.F.R. §§ 20.300, 20.301, 20.801. Service connection for tinnitus The Veteran contends that his tinnitus was incurred during his service as a tactical aircraft mechanic. He asserts that it was caused by acoustic trauma from operating and being around loud aircraft and equipment and firearms for long periods of time. He has stated that his tinnitus incurred in service has continued to the present. June 2023 VA examination. The Board acknowledges that the Veteran may have asserted a secondary service-connection theory of entitlement regarding migraines in his October 2024 VA Form 10182. However, as the Board is granting service connection on a direct basis herein, it need not address secondary service connection, or any other theories for service connection. Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by service. 38?U.S.C. §§?1110, 1131, 5107; 38?C.F.R. §?3.303. A grant of service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of an injury; and (3) a causal relationship ("nexus") between the present disability and the in-service event or injury. Shedden v. Principi, 381 F.3d 1163, 1166 (Fed. Cir. 2004).? Certain chronic diseases, including?tinnitus as an organic disease of the nervous system, will be presumed related to service 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, 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).? Tinnitus?may be diagnosed by its unique and readily identifiable features, and the presence of the disorder is not a determination that is medical in nature; it is capable of lay observation. Charles v. Principi,?16?Vet. App.?370?(2002). A layperson is competent to testify as to the onset and continuity of symptomatology. Heuer v. Brown,?7?Vet. App.?379, 384?(1995).? VA must consider all the evidence of record and its relative weight. If the evidence is in approximate balance, the benefit of the doubt will be resolved in favor of the Veteran.?38 U.S.C. § 5107?(b);?38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). Initially, the Board notes that the AOJ made favorable findings that the Veteran has a current diagnosis of tinnitus and that a qualifying injury had its onset during service. In this regard, the AOJ found that the Veteran was exposed to acoustic trauma during service as an aircraft mechanic, which has a high probability of hazardous noise exposure. The Board is bound by those favorable?findings?and the first two elements of service connection have been met.? 38 C.F.R. § 3.104 (c) At issue is whether the evidence of record establishes a nexus between the Veteran's noise exposure during military service and his current disability. The Board?finds?that a nexus has been established.? The Veteran has provided details about his in-service noise exposure, describing it as a consistent ringing in his ears, which is made worse by high-pitched noises. It disturbs his sleep and thought processes and is more prominent when the surroundings are quiet. The symptoms are worsening over time. The Veteran has described the nature of his tinnitus symptoms, their recurrence, and continuity up to the present. See September 2022 VA examination; May 2024 HLR Informal Conference. The Board finds the Veteran competent and credible in these statements. The Board has also considered the negative conclusions of two VA examinations that the Veteran's tinnitus is less likely than not caused by military noise exposure. The June 2023 VA examination opinion was based on the lack of in-service evidence of tinnitus and on an audiology evaluation showing the Veteran's hearing was normal. In addition, the examiner noted that the Veteran's symptoms did not begin until 2022, several years after service, and there is no valid current evidence that noise exposure can cause late-onset tinnitus. June 2023 VA examination. The October 2023 VA examination offered a similar rationale and further concluded that the Veteran's hearing was not related to his toxic exposure risk activities (TERAs) during service. October VA examination. The Board finds the examinations have little probative value regarding the etiology of the Veteran's tinnitus. Both examiners based their opinions on general principles and the absence of evidence of in-service incurrence. They offered conclusory explanations for the negative nexus findings without a reasoned analysis of other possible explanations for the Veteran's symptoms. As the Veteran's in-service military noise exposure has been conceded and because he has provided credible and consistent lay testimony that symptoms began during service and have continued to the present, the Board finds the evidence is in approximate balance as to whether the Veteran's current?tinnitus?disability is as likely as not due to his exposure to excessive noise levels during active service. See?38 C.F.R. §§ 3.303, 3.309; Fountain v. McDonald,?27?Vet. App.?258?(2015). (CONTINUED ON NEXT PAGE)? Accordingly, resolving all doubt in the Veteran's favor, the Board finds service connection for?tinnitus?is warranted. A. Dean Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jaeger, L 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.