If the hearing loss is service-connected and the examiner states that the veteran's tinnitus is a symptom of the hearing loss, the VA concedes that the hearing loss and tinnitus result from the same etiology. Therefore, service connection is warranted for tinnitus on a direct basis in these cases. See VA Adjudication Manual, M21-1MR, III.iv.4.D.3.c (April 9, 2019). | | ◦ tinnitus is not related to hearing loss

or   ◦ is unable to determine the etiology within a reasonable degree of certainty

or   ◦ there is no hearing loss | determine, based on all the evidence of record, whether or not the etiology of tinnitus requires further assessment by one of more additional examinations.   Note:  The type and need for any additional examination(s) will depend on the Veteran’s claim as to the cause of tinnitus.   Examples:

• If the Veteran claims tinnitus due to hearing loss, and the examiner says they are not related, no further action is needed.
• If Veteran claims tinnitus due to another condition (such as head injury, hypertension, and so on, which would be outside the scope of the audiologist), it might be appropriate to request a general medical, ears/nose/throat (ENT), or other examination, and an opinion as to the causation of tinnitus. | | tinnitus is related to noise exposure or an event, injury, or illness in service (direct SC) | evaluate all the evidence of record to determine if the examiner’s opinion is consistent with the evidence, and • If the examiner's opinion is consistent with the evidence of record - award service connection on a direct basis • If the examiner's opinion is inconsistent with the evidence of record - return the exam for clarification |