13-22 855, 13-22 855

Veteran served on active duty June 1958–June 1961 as a Wireman in an artillery unit and reported in-service exposure to cannon/artillery noise and explosions.
Veteran reported onset of tinnitus in service and claims progressive hearing loss after service; lay statements from brother and a friend support onset and post-service functional hearing problems.
October 2011 VA audiometric exam showed bilateral sensorineural hearing loss meeting VA disability criteria and reported tinnitus; speech recognition intact.
Initial VA examiner (2011) declined to provide a nexus opinion due to limited entrance/exit testing; Veteran submitted medical literature on delayed noise-induced hearing loss.
April 2017 VHA otolaryngology expert reviewed records and concluded it is "more likely than not" the Veteran’s hearing loss is at least partially related to in-service noise exposure and that tinnitus is reasonably related to service-linked hearing loss.
Board found the VHA opinion persuasive, resolved doubt in the Veteran’s favor, and granted service connection for both hearing loss and tinnitus.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Service connection for hearing loss	Hearing loss caused by in-service artillery/noise exposure; onset in service	RO/initial examiner: nexus unprovable/speculative based on entrance/exit tests	Granted — hearing loss service-connected based on in-service exposure, lay statements, and VHA nexus opinion
Service connection for tinnitus	Tinnitus began in service and is associated with hearing loss from noise exposure	RO: no definitive medical nexus originally	Granted — tinnitus service-connected as related to service-connected hearing loss per VHA opinion

Holton v. Shinseki, 557 F.3d 1362 (explaining the three-part service-connection nexus requirement)
Shedden v. Principi, 381 F.3d 1163 (discussing elements required to establish service connection)
Gilbert v. Derwinski, 1 Vet. App. 49 (benefit-of-the-doubt rule when evidence is in equipoise)