Service connection for tinnitus is granted. Service connection for a right ear hearing loss disability is denied. Service connection for left ear sensorineural hearing loss is granted. REMANDED The issue of entitlement…

Citation Nr: A26069983 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 250729-567904 DATE: July 30, 2026 ORDER Service connection for tinnitus is granted. Service connection for a right ear hearing loss disability is denied. Service connection for left ear sensorineural hearing loss is granted. REMANDED The issue of entitlement to an initial rating higher than 10 percent for left ankle lateral collateral ligament sprain is remanded. The issue of entitlement to an initial rating higher than 20 percent for right shoulder acromioclavicular joint separation is remanded. FINDINGS OF FACT 1. It is at least as likely as not that the currently diagnosed tinnitus was incurred in service following exposure to hazardous noise, and that symptoms of tinnitus existed chronically since the in-service onset. 2. The evidence does not show a right ear hearing loss disability for VA purposes during the period on appeal. 3. It is at least as likely as not that symptoms of a left ear hearing loss disability were incurred in service following exposure to hazardous noise and that those symptoms gradually worsened over time until the Veteran was diagnosed with left ear sensorineural hearing loss. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for tinnitus are met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 3. The criteria for entitlement to service connection for left ear sensorineural hearing loss are met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the United States Army from April 1984 until March 1988. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2025 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In the July 29, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the June 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran with or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. For the claims of entitlement to service connection for bilateral hearing loss and tinnitus, 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. If the evidence is new and relevant, VA will issue another decision on the related claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Because the Board is remanding the claims for higher ratings for the left ankle and right shoulder disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection for certain chronic diseases, including sensorineural hearing loss and tinnitus, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Service connection for tinnitus is granted. The Veteran seeks service connection for tinnitus, which he asserts began in service due to exposure to acoustic trauma and then progressively worsened over time. See July 2025 Correspondence. The AOJ already favorably found that the Veteran is diagnosed with tinnitus. Tinnitus is defined as a noise in the ear, such as ringing, buzzing, roaring, or clicking, that is usually subjective in type. See Dorland's Illustrated Medical Dictionary 1900 (33rd ed. 2020). Due to the inherently subjective nature of tinnitus, it is readily capable of lay diagnosis. See Charles v. Principi, 16 Vet. App. 370 (2014). The Board also finds that the Veteran was exposed to hazardous noise in service. The Veteran's personnel records show that he served as a mortar carrier driver and mortar gunner. The Veteran has testified that during service, he was exposed to close range mortar fire, machine guns, and diesel engines. See July 2025 Correspondence. That lay testimony is consistent with the nature of the Veteran's documented service in the Army and is credible. Thus, there is evidence of in-service exposure to hazardous noise. It is also at least as likely as not that tinnitus was incurred in service. In a July 2025 statement received during a permissible evidentiary window, the Veteran recalled an incident in service when the largest possible mortar round was fired around 18 inches from his head. He reported that he immediately experienced an intense ringing in his ears. He wrote that following that event, "and others like it," he experienced persistent ringing in his ears. He stated that he did not seek any treatment for his symptoms in service, and that his symptoms continued and worsened over time. He made similar statements regarding chronic tinnitus symptoms since service to a private chiropractor in February 2025, and to a VA examiner in April 2025. As a lay person, the Veteran is competent to report the symptoms of ringing in the ears and to self-diagnose tinnitus in service. Further, his testimony has been consistent, so the Board also finds it credible. That probative lay testimony weighs in support of a finding that tinnitus was incurred in service and has existed chronically since that time. The April 2025 VA examiner opined that the Veteran's current tinnitus was not due to his period of service. In support of that opinion, the examiner stated that the Veteran reported his tinnitus began in the past 10 years. That statement is not consistent with the Veteran's medical history documented elsewhere in the report, where the examiner noted the Veteran's report of chronic tinnitus "for over 10 years," after occurring spontaneously following a mortar blast. Because the examiner's rationale misstated key facts, the opinion is not adequate or afforded probative weight. Instead, the Board finds that the Veteran's competent and credible testimony of chronic tinnitus since service is probative and shows that a currently diagnosed chronic disease was first incurred in service. As a result, the criteria for presumptive service connection for chronic tinnitus are met, and the claim is granted. 2. Service connection for right ear hearing loss is denied. The Veteran seeks entitlement to service connection for bilateral hearing loss, which he also asserts was incurred in service due to exposure to hazardous noise. For this issue, the threshold requirement for service connection is not met because a right ear hearing loss disability has not been clinically diagnosed during the appeal period or concurrent to the filing of the claim. VA regulations provide that impaired hearing will be considered a disability for rating purposes when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or, when speech recognition scores using the Maryland CNC Test are less than 94 percent. See 38 C.F.R. § 3.385. The Veteran submitted a private medical report dated February 2025 from MT, Doctor of Chiropractic. Dr. MT stated the Veteran's hearing was tested in a room with normal noise levels, and that "256 cps, 512 cps stimuli" were employed "along with spoken words at a distance of 5 feet." Dr. MT concluded that the testing revealed an estimated hearing loss disability of 30 percent in the right ear. Dr. MT then recommended that the Veteran receive a puretone audiogram. The Veteran underwent a VA audiology evaluation in April 2025. Puretone testing revealed the following auditory thresholds, in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 15 20 25 LEFT 15 15 20 30 45 The word recognition score for the right ear, using the Maryland CNC test, was 100 percent. The April 2025 VA report contains all audiometric findings necessary to allow the Board to conclude the Veteran does not have a right ear hearing loss disability for VA purposes. Those findings do not show that the auditory threshold in any of the relevant right ear frequencies was 40 decibels or greater; that the auditory thresholds for at least three of the frequencies was 26 decibels or greater; or that the speech recognition score using the Maryland CNC Test was less than 94 percent. Those objective findings persuasively show the Veteran does not have a right ear hearing loss disability for VA purposes. The Veteran is competent to report symptoms of hearing loss; however, the objective evidence shows that his right ear hearing loss is not severe enough to be considered a disability for VA purposes. The Board does not find Dr. MT's examination and opinion regarding the right ear hearing loss to be adequate or probative. As a chiropractor and not a medical doctor, Dr. MT has not demonstrated any special medical knowledge or training regarding a chronic auditory disability such as sensorineural hearing loss. The Board is not bound by any state statute that permits chiropractors to have full diagnostic authority over the "human living body and its diseases." See February 2025 Report of Consultation and Examination, Disclosure (1). Because the evidence does not show that Dr. MT has the necessary medical training or expertise, their findings and conclusions regarding the right ear hearing loss are not afforded probative weight. Further, the February 2025 report does not contain audiometric findings sufficient to show a right ear hearing loss disability for VA purposes. Last, even if Dr. MT did have the medical expertise necessary to provide an opinion on sensorineural hearing loss, their opinion was a conclusory statement without any supporting rationale. As a result, that opinion is not adequate. For these reasons, the Board concludes that a right ear hearing loss disability for VA purposes has not existed during the appeal period. Because there is no current disability, the criteria for service connection for right ear hearing loss are not met, and the claim must be denied. Because the evidence of record persuasively weighs the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 3. Service connection for left ear sensorineural hearing loss is granted. Resolving any reasonable doubt in the Veteran's favor, the criteria for left ear sensorineural hearing loss are met. First, the Veteran has been diagnosed with a left ear hearing loss disability for VA purposes during the period on appeal. At the April 2025 VA examination, the Veteran's left ear auditory threshold was 45 decibels at 4000 Hertz, which meets the criteria for a hearing loss disability for VA purposes. The April 2025 examiner also diagnosed left ear sensorineural hearing loss. Thus, there is a current diagnosed chronic left ear hearing loss disability. Second, there was an in-service event/incurrence. The Board has already found that the Veteran was exposed to hazardous noise and acoustic trauma in service. The Veteran has also competently and credibly reported experiencing hearing loss symptoms in service. The Veteran's April 1984 entrance examination shows the left ear auditory thresholds from 500 to 4000 Hertz measured 5, 10, 0, 0, and 5 decibels respectively. The February 1988 separation exam shows the left ear auditory thresholds from 500 to 4000 Hertz measured 10, 10, 5, 10, 10. Although those findings do not show a left ear hearing loss disability for VA purposes in service, they do show the Veteran's left ear hearing acuity was slightly worse upon separation when compared to entrance. Thus, there is evidence of in-service events and symptoms of hearing loss. Third, and resolving any reasonable doubt in the Veteran's favor, symptoms of a chronic left ear hearing loss disability were incurred in service and existed chronically until being diagnosed as sensorineural hearing loss. In July 2025, the Veteran wrote that he experienced "temporary hearing disorientation" immediately following the incident where a large mortar round was fired 18 inches from his head. After that event, he reported experiencing noticeable hearing difficulties that continued and worsened over time. In particular, he reported a marked decrease in hearing acuity in the left ear over time. The Veteran is competent to report experiencing repeated exposure to hazardous noise in service, to include the instance of acoustic trauma from a mortar round. He is also competent to report symptoms of progressive, gradually worsening left ear hearing loss since that in-service noise exposure and acoustic trauma. Further, the Veteran's description of left ear symptoms over time is generally consistent with the slight decrease in left ear hearing acuity noted in service, as well as the current diagnosis of a left ear hearing loss disability. Neither Dr. MT nor the VA examiner provided specific information regarding the onset of hearing loss symptoms. Dr. MT only discussed the in-service noise exposure, and the VA examiner only reported that the onset of hearing loss occurred "over years." The April 2025 VA examiner opined that the left ear hearing loss was not due to the Veteran's period of service. In support of that opinion, the examiner only stated that the STRs did not show a significant threshold shift or hearing loss in service. Because the opinion is based on a lack of in-service treatment or diagnosis alone, without any discussion of the Veteran's lay testimony regarding the onset of the hearing loss symptoms, the opinion is not adequate. Resolving any reasonable doubt in the Veteran's favor, the lay testimony supports a finding that symptoms of left ear hearing loss were incurred in service and that those symptoms gradually worsened over time until developing into a left ear sensorineural hearing loss disability for VA purposes. Thus, the criteria for presumptive service connection for left ear sensorineural hearing loss are met, and the claim is granted. REASONS FOR REMAND The Board must remand an appeal to the AOJ for correction of an error on the part of the AOJ to satisfy its duties under 38 U.S.C. § 5103A if the error occurred prior to the date of the AOJ decision on appeal. 38 C.F.R. § 20.802. These claims must be remanded for correction of the following pre-decisional duty to assist errors. 1. The issue of entitlement to an initial rating higher than 10 percent for left ankle lateral collateral ligament sprain is remanded. 2. The issue of entitlement to an initial rating higher than 20 percent for right shoulder acromioclavicular joint separation is remanded. VA's duty to assist includes providing an examination and/or opinion when necessary to make a decision in a disability claim. See 38 C.F.R. § 3.159(c)(4). Where VA provides the veteran with an examination or opinion in connection with a disability claim, that examination and/or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). For increased rating claims, an adequate medical examination should contain all findings necessary to rate the disability. Further, in increased rating claims when a VA diagnostic code does not reference medication, the Board is required to discount any beneficial effects of medication taken by the Veteran to treat a disability and evaluate the baseline severity of the disability when assigning an evaluation. See Ingram v. Collins, 38 Vet. App. 130, 132 (2025) (citing Jones v. Shinseki, 26 Vet. App. 56 (2012)). The Veteran underwent VA shoulder and ankle condition examinations in April 2025. At both exams, the Veteran reported pain with functional impairment and that he took nonprescription pain medication as needed for left ankle and right shoulder symptoms. The April 2025 VA examination reports failed to address whether any ameliorative effects of medication were considered in the examination report and whether the Veteran's range of motion or other symptoms would be more severe without the medication. As a result, the April 2025 examinations were not fully adequate for decision-making purposes. Barr, 21 Vet. App. at 312. Because the AOJ failed to secure adequate examinations for the left ankle and right shoulder increased rating claims prior to issuing the decision on appeal, new VA examinations are necessary on remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected left ankle disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner should document any ameliorative effects of the medication taken by the Veteran for his disability and provide an estimate of the Veteran's functional impairment in the absence of those medications. In doing so, the examiner should obtain information from the Veteran regarding his limitations absent medication. The examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected right shoulder disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner should document any ameliorative effects of the medication taken by the Veteran for his disability and provide an estimate of the Veteran's functional impairment in the absence of those medications. In doing so, the examiner should obtain information from the Veteran regarding his limitations absent medication. (Continued on the next page) ? The examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). L. STEPANICK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Smith, 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.