Citation Nr: 18160382
Decision Date: 12/27/18	Archive Date: 12/26/18

DOCKET NO. 16-33 233
DATE:	December 27, 2018
Entitlement to service connection for tinnitus is remanded.
Entitlement to service connection for sleep difficulty, to include sleep apnea, claimed as secondary to tinnitus, is remanded.
The Veteran served on active duty from May 1990 to July 1993.  He had a period of active duty for training (ACDUTRA) from September 1988 to December 1989 and an unverified period of service from July 1981 to February 1982. 
The Veteran was notified of his scheduled November 2018 Board hearing in October and November 2018; however, he failed to report for his scheduled hearing without showing a good cause.  Therefore, his hearing request is considered to have been withdrawn.  See 38 C.F.R. § 20.704(d) (2017).
The Board finds that a remand is necessary to obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s tinnitus.  
The Veteran asserts that his tinnitus is due to in-service acoustic trauma, specifically exposure to hazardous noise from spending six weeks on the USS McCandless in a bunk adjacent to the engine room during his active duty service in the 1990s.
In January 2016, he underwent a VA audiology examination, at which time he reported bilateral, constant, recurrent tinnitus that started in service and affected his sleep.  The examiner opined that the Veteran’s tinnitus was not related to service because the Veteran had no history of noise exposure in service.  Furthermore, the examiner stated that there was no evidence of hearing loss, and as such, tinnitus could not be linked to it. 
In his February 2016 notice of disagreement, the Veteran argued that the January 2016 VA examiner never asked why or how he had tinnitus, but just asked what was his job title in the Navy, and when he said lawyer/JAG, the examiner smiled and conducted the hearing examination.  He further stated that if the examiner asked, he would have said that he spent six-weeks on the USS McCandless (fast frigate) out of GITMO in 1990, and they had no berthing left, so he was placed in a bunk-head adjacent to the engine room.  He further noted that while on board, he suffered from nausea, diarrhea, and headaches, and had to receive bottles of IV fluids as a result of balance and dehydration issues.  He also stated that while stationed at the naval submarine base in New London/Groton, he went to the base hospital twice due to dizziness and balance issues, and both times he was given Dramamine/motion sickness medicine and sent home.  Additionally, he noted that he visited the Great Lakes, IL Naval Clinic in 1990 for motion sickness or what he thought was balance issues.  Lastly, he stated that he was not diagnosed with tinnitus and associated sleep issues until 2012-2013 when he saw a specialist, and stated that he suffered from it since his “shipboard experience.” 
In his July 2016 substantive appeal, the Veteran again challenged the adequacy of the January 2016 VA examination, since the examiner failed to consider his six-weeks of military noise exposure.  
Therefore, given the Veteran’s competent reports of acoustic trauma in service that were not considered by the VA examiner, a remand is necessary to ensure that his lay assertions are properly addressed. 
The Board finds that the service connection claim for sleep difficulty is intertwined with the service connection claim for tinnitus being remanded here.  The Board must defer its decision on the sleep claim, which is claimed as secondary to tinnitus, until the requested development is undertaken.
The matters are REMANDED for the following action:
1.  Obtain an addendum opinion regarding the nature and etiology of the Veteran’s tinnitus.  The claims file and a copy of this Remand must be made available to the reviewing examiner, and the examiner shall indicate in the addendum report that the claims file was reviewed.  The need for another examination is left to the discretion of the medical professional offering the addendum opinion.  
After a complete review of the claims file, the examiner is asked to respond to the following: 
Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tinnitus is a result of military service, to include his competent reports of six-weeks of hazardous noise exposure while serving aboard the USS McCandless. 
Your attention is called to the following:  (a) service treatment records dated in August 1990 and January 1991 showing complaints of dizziness, lightheadedness, and nausea, which Veteran attributes to the onset of tinnitus; (b) May 2013 private treatment records indicating that the Veteran had bilateral tinnitus for approximately three weeks without dizziness or hearing loss, and stated that after he took medication for one-week, “tinnitus has started to decrease in intensity”; and, (c) the Veteran competent lay reports of noise exposure during service.  See e.g., February 2016 notice of disagreement. 
A complete rationale should be provided for all opinions.   
2.  Thereafter, readjudicate the claims on appeal.

Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Yaffe, Associate Counsel

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