Citation Nr: 0809921 Decision Date: 03/26/08 Archive Date: 04/09/08 DOCKET NO. 04-31 784 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to an initial rating greater than 10 percent for gastroesophageal reflux disease (GERD). 2. Entitlement to service connection for bilateral pes planus. 3. Entitlement to service connection for right ventricular conduction relay. 4. Entitlement to service connection for bilateral hearing loss. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel INTRODUCTION The veteran had active service from October 1982 to February 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an April 2003 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which granted, in pertinent part, the veteran's claim of service connection for GERD, assigning a zero percent rating effective February 1, 2003, and also denied the veteran's claims of service connection for bilateral pes planus, right ventricular conduction relay, and for bilateral hearing loss. The veteran disagreed with this decision in May 2003. In July 2003, the veteran notified VA that he had moved to the jurisdiction of the RO in Waco, Texas; this RO retains jurisdiction over the veteran's appeal. He perfected a timely appeal in August 2004. In an April 2007 rating decision, the RO, in pertinent part, assigned a higher 10 percent rating to the veteran's service- connected GERD effective February 1, 2003. Because the initial rating assigned to the veteran's service-connected GERD is not the maximum rating available for this disability, this claim remains in appellate status. See AB v. Brown, 6 Vet. App. 35 (1993). FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran's service-connected GERD is not manifested by persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, and is not productive of considerable health impairment. 3. The veteran's currently diagnosed bilateral pes planus is not related to active service. 4. The veteran does not experience any current disability due to his claimed right ventricular conduction relay. 5. The veteran has normal hearing in his right ear 6. The veteran's high frequency hearing loss in the left ear is not a disability for VA compensation purposes. CONCLUSIONS OF LAW 1. The criteria for an initial rating greater than 10 percent for GERD have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.114, Diagnostic Code (DC) 7346 (2007). 2. Bilateral pes planus was not incurred during active service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.304, 3.305 (2007). 3. The veteran's claimed right ventricular conduction relay was not incurred during active service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2007). 4. Bilateral hearing loss was not incurred during active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.385 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Before assessing the merits of the appeal, VA's duties under the Veterans Claims Assistance Act of 2000 (VCAA) must be examined. The VCAA provides that VA shall apprise a claimant of the evidence necessary to substantiate his claim for benefits and that VA shall make reasonable efforts to assist a claimant in obtaining evidence unless no reasonable possibility exists that such assistance will aid in substantiating the claim. The veteran's higher initial rating claim for GERD is a "downstream" element of the RO's grant of service connection for GERD in the currently appealed rating decision issued in April 2003. For such downstream issues, notice under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159 is not required in cases where such notice was afforded for the originating issue of service connection. See VAOPGCPREC 8- 2003 (Dec. 22, 2003). In a letter issued in May 2003, VA notified the veteran of the information and evidence needed to substantiate and complete his claims, including what part of that evidence he was to provide and what part VA would attempt to obtain for him. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The letter informed the veteran to submit medical evidence, statements from persons who knew the veteran and had knowledge of his disabilities during service, and noted other types of evidence the veteran could submit in support of his claims. In addition, the veteran was informed of when and where to send the evidence. In response, the veteran notified VA in May 2007 that he had no further information or evidence to submit in support of his claims. VA also provided the veteran with additional VCAA notice, including notice of the Dingess requirements, in June 2007. Although complete content-complying VCAA notice was not provided before the April 2003 rating decision, the claimant has had the opportunity to submit additional argument and evidence and to participate meaningfully in the adjudication process. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The veteran has not alleged any prejudice as a result of the untimely notification, nor has any been shown. To the extent that Dingess requires more extensive notice as to potential downstream issues such as disability rating and effective date, because the April 2003 rating decision was fully favorable to the veteran on the issue of service connection for GERD, and because the veteran's service connection claims for bilateral pes planus and for bilateral hearing loss are being denied in this decision, the Board finds no prejudice to the veteran in proceeding with the present decision and any defect with respect to that aspect of the notice requirement is rendered moot. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In Dingess, the United States Court of Appeals for Veterans Claims (Veterans Court) held that, in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. See Dingess, 19 Vet. App. at 490-91. The Board notes that the Veterans Court, in Vazquez-Flores v. Peake, No. 05-0355 (U.S. Vet. App. Jan. 30, 2008) clarified VA's notice obligations in increased rating claims. The appeal for a higher initial rating for GERD originates, however, from the grant of service connection for GERD. Consequently, Vazquez-Flores is inapplicable. With respect to the veteran's service connection claim for right ventricular conduction relay, although complete content-complying VCAA notice was not provided prior to the April 2003 rating decision which denied the benefit sought on appeal, the Board observes that VCAA notice is not required because the issue presented involves a claim that cannot be substantiated as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive the Board should deny the claim on the ground of the lack of legal merit or the lack of entitlement under the law); VAOPGCPREC 5-2004 (June 23, 2004) (VA is not required to provide notice of the information and evidence necessary to substantiate a claim where that claim cannot be substantiated because there is no legal basis for the claim or because undisputed facts render the claimant ineligible for the claimed benefit). In this case, the veteran is seeking service connection for a symptom-right ventricular conduction relay-and not for any underlying cardiovascular disability. See generally Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), vacated in part and remanded on other grounds sub nom., Sanchez-Benitez v. Principi, 239 F.3d 1356 (Fed. Cir. 2001). The Board also finds that VA has complied with the VCAA's duty to assist by aiding the veteran in obtaining evidence and affording him the opportunity to give testimony before the RO and the Board, although he declined to do so. It appears that all known and available records relevant to the issues here on appeal have been obtained and are associated with the veteran's claims file; the veteran does not contend otherwise. VA also provided the veteran with examinations to determine the current nature and severity of his service- connected GERD and to address the contended causal relationship between active service and his bilateral pes planus, claimed right ventricular conduction relay, and bilateral hearing loss. Thus, the Board finds that VA has done everything reasonably possible to notify and to assist the veteran and that no further action is necessary to meet the requirements of the VCAA. The veteran contends that he is entitled to an initial rating greater than 10 percent for service-connected GERD. In general, disability evaluations are assigned by applying a schedule of ratings that represent, as far as can be determined, the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2007). Separate diagnostic codes identify the various disabilities and the criteria that must be met for specific ratings. The regulations require that, in evaluating a given disability, the disability be viewed in relation to its whole recorded history. 38 C.F.R. § 4.2 (2007); see also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, No. 05-2424 (U.S. Vet. App. November 19, 2007). The veteran's service-connected GERD is currently evaluated as 10 percent disabling by analogy to 38 C.F.R. § 4.114, DC 7346 (hiatal hernia). See 38 C.F.R. § 4.114, DC 7346 (2007). A 10 percent rating is available under DC 7346 for a hiatal hernia with two or more of the symptoms for the 30 percent rating of less severity. A 30 percent rating is available under DC 7346 for a hiatal hernia with persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, and productive of considerable health impairment. A maximum 60 percent rating is available under DC 7346 for a hiatal hernia with symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia or other symptom combinations productive of severe health impairment. Id. A review of the veteran's service medical records indicates that he denied any medical history at his enlistment physical examination in November 1981. The veteran reported that he was in excellent health on a medical history form completed in June 1990. An upper gastrointestinal (UGI) series in May 1999 showed a normal esophagus without gastroesophageal reflux. The impression was a normal UGI. X-rays of the veteran's abdomen in July 1999 were normal. In July 2000, the veteran's complaints included reflux and occasional nausea. He denied any vomiting. Objective examination showed a soft, non-tender abdomen with positive bowel sounds. The assessment included GERD. In August 2002, the veteran complained of acid reflux for the past 2 years that had worsened progressively in the last few months. He awakened at night with a burning sensation in the epigastric region up in to his throat. He also experienced an "acidy taste" at night. He denied any dysphagia. The veteran's medical history included GERD. Objective examination showed a soft, non-tender, non-distended abdomen with normal bowel sounds. The assessment was GERD. In September 2002, the veteran complained of slight pain in the kidney area. He reported that, after taking medication to treat his GERD for 30 days, he had markedly decreased acid reflux symptoms with no adverse side effects. He also denied any epigastric distress in the past. His bowel movements occurred every 3 days of normal caliber with no hematochezia or diarrhea. Objective examination showed a soft, non-tender abdomen with normal bowel sounds. The assessment included GERD. At his separation physical examination in December 2002, the in-service examiner noted that the veteran had a history of reflux symptoms that was relieved with medication. The post-service medical records show that, on VA examination in January 2003, the veteran's complaints included GERD. The veteran reported that an in-service upper GI series and gastroscopy showed GERD. Physical examination showed a soft abdomen. The impressions included GERD, substantiated by gastroscopy and upper GI series. On VA general surgical examination in March 2007, the veteran complained of pyrosis and reflux once a month if he took his medication and followed his diet. However, if he did not take his medication, the veteran experienced pyrosis and reflux once or twice a week. The VA examiner reviewed the veteran's claims file, including his service medical records. The veteran denied any nausea, vomiting, anemia, weight loss, gastrointestinal malignancy, peritoneal tuberculosis, ventral hernias, or recurrence of inguinal hernias. Physical examination showed no signs of anemia and no evidence of bleeding. The VA examiner stated that the severity of the veteran's esophageal reflux had decreased with medication and a bland diet. The impressions included hiatal hernia and esophageal reflux once a month when the veteran took his medication or twice a week when he did not take his medication. The Board finds that the preponderance of the evidence is against the veteran's claim for an initial rating greater than 10 percent for GERD. The veteran's service-connected GERD is not manifested by persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, and is not productive of considerable health impairment such that a higher initial rating is warranted under DC 7346. See 38 C.F.R. § 4.114, DC 7346 (2007). Instead, the medical evidence shows continuing treatment for GERD which the veteran experiences once a month when taking his medication or twice a week when he is not on medication. The VA examiner noted in March 2007 that the severity of the veteran's service-connected GERD had decreased with medication and use of a bland diet. As noted above, there is no evidence that the veteran's GERD should be increased for any other separate period based on the facts found throughout the appeal period. The evidence of record from the day the veteran filed the claim to the present supports the conclusion that he is not entitled to additional increased compensation during any time within the appeal period. The veteran also contends that his bilateral pes planus, right ventricular conduction relay, and bilateral hearing loss were all incurred during active service. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran served ninety days or more during a period of war and certain chronic diseases, including an organic disease of the nervous system such as sensorineural hearing loss, becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Veterans will be presumed to have been accepted in sound condition when examined, accepted and enrolled for service, except as to defect, disabilities, or other disorders noted at the time of his or her enlistment. Only such disabilities as are listed on an enlistment physical examination will be considered to have been "noted" at a veteran's entry on to active service. 38 C.F.R. § 3.304(b) (2007). Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater or where the auditory thresholds for at least three of these frequencies are 26 dB or greater or when speech recognition scores are less than 94 percent. 38 C.F.R. § 3.385 (2007). If there is no evidence of a chronic condition during service or an applicable presumptive period, then a showing of continuity of symptomatology after service may serve as an alternative method of establishing the second and/or third element of a service connection claim. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. If service connection is established by continuity of symptomatology, there must be medical evidence that relates a current condition to that symptomatology. See Savage, 10 Vet. App. at 495-498. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. At the veteran's enlistment physical examination in November 1981, clinical evaluation showed moderate asymptomatic pes planus and high frequency hearing loss in the left ear in the 6000 Hertz (Hz) range that was non-progressive. An echocardiogram (ECG) in November 1981 showed sinus bradycardia that was within normal limits. The veteran was placed on a temporary physical profile in November 1981 for stress pain in the left foot. In March 1983, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 0 5 LEFT 0 0 10 10 0 In May 1983, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 0 5 LEFT 0 0 10 10 0 On periodic physical examination in June 1984, clinical evaluation was completely normal. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 10 0 LEFT 0 5 5 5 0 No significant threshold shift was noted. In July 1985, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 0 0 LEFT 0 5 5 0 0 No significant threshold shift was noted. On periodic physical examination in July 1986, clinical evaluation was completely normal except for bilateral 7 centimeter inguinal herniorrhaphy scars that were well- healed with no sequelae. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 0 0 LEFT 0 0 5 5 5 No significant threshold shift was noted. On periodic physical examination in June 1988, clinical evaluation was unremarkable. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 5 15 5 LEFT 0 0 5 5 0 No significant threshold shift was noted. In July 1989, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 0 0 LEFT 5 5 10 15 10 No significant threshold shift was noted. On periodic physical examination in June 1990, clinical evaluation was unchanged. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 10 10 LEFT 0 0 10 10 5 The in-service examiner noted that the veteran had high frequency hearing loss in the left ear that was considered non-progressive. In June 1991, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 0 10 LEFT 0 5 5 10 5 No significant threshold shift was noted. In August 1992, the veteran complained of increased heel pain in the past year when running. Objective examination of the feet showed bilateral flat arches. The assessment included bilateral pes planus. On periodic physical examination in August 1992, clinical evaluation was completely normal. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 5 5 5 10 LEFT 5 0 0 5 10 The veteran was prescribed orthotics in December 1992, at which time it was noted that his complaints of bilateral heel pain appeared to be resolving with treatment. In July 1993, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 5 0 5 10 LEFT 0 0 0 0 0 No significant threshold shift was noted. In June 1994, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 0 10 5 LEFT 5 5 10 10 5 No significant threshold shift was noted. On periodic physical examination in August 1995, clinical evaluation was unremarkable. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 0 0 10 10 LEFT 0 0 5 5 5 The in-service examiner stated that the veteran's sinus bradycardia suggested right ventricular conduction delay. The veteran's ECG was "borderline." He also had asymmetric hearing loss at 6000 Hz. In August 1995, it was noted that the veteran had experienced asymmetric hearing loss (less than 15 dB) in the left ear since 1986. The provisional diagnosis was asymmetric hearing loss in the left ear. On audiology consult, objective examination showed that the veteran's ears were normal. Audiology testing showed no progression in the veteran's acknowledged left ear hearing loss. In June 1996, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 10 5 0 LEFT 0 0 10 10 10 The audiologist's assessment was stable audiogram with asymmetry above 6000 Hz and excellent speech discrimination bilaterally. In July 1997, objective examination showed normal hearing in the right ear and mild hearing los in the left ear at 6000 Hz only. The veteran's tympanometry, reflexes, and decay were all within normal limits bilaterally. The veteran's word recognition scores also were excellent. The assessment was unilateral mild loss at 6000 Hz only in the left ear, which the audiologist noted was consistent with previous audiometric testing completed in June 1996. In August 1997, the veteran complained of congestion in both ears for the past 36 hours. He also reported waking up two nights earlier with sharp substernal chest pain without radiation that resolved 30-45 minutes later. Objective examination showed normal tympanic membranes bilaterally, a regular heart rate and rhythm without murmurs, rubs, or gallops, and a soft, non-tender abdomen with normal bowel sounds. An ECG showed normal sinus rhythm. The assessment included chest pain that was likely gastrointestinal with very low suspicion of cardiac etiology. On periodic physical examination in June 1998, clinical evaluation showed moderate-severe pes planus without symptoms. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 5 5 5 LEFT 0 0 5 0 5 The in-service examiner noted that the veteran had sinus bradycardia which was unchanged from August 1995 and elevated hearing loss in the left ear above 6000 Hz. In June 1999, the veteran complained of bilateral foot pain. His history included pes planus. Objective examination of the right foot showed a bunion and mild tenderness and scaling over the medial instep. Objective examination of the left foot showed a small bunion and cracking between the toes. The assessment included bilateral pes planus. An ECG in September 1999 was abnormal with non-specific changes to the S1 heart rhythm. In September 2000, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 5 0 0 LEFT 0 0 5 5 10 In June 2001, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 5 10 LEFT 5 0 5 5 10 No significant threshold shift was noted. On August 19, 2002, the veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 5 0 10 0 LEFT 15 5 10 10 15 A significant threshold shift was noted at 4000 Hz. However, following subsequent audiological evaluation on August 21, 2002, no significant threshold shift was noted. At his separation physical examination in December 2002, the veteran reported a history of "some recurring foot problems." On VA examination in June 2005, the VA examiner stated that the veteran's claims file was not available for review. Physical examination showed no relevant pain, weakness, fatigability, problematic motion, edema, instability, or tenderness. The veteran had a full range of motion in both feet without limitation, including the first metatarsophalangeal joints. There was minimal decreased light touch sensation in the right foot. Standing demonstrated pes planus valgus feet with moderate symmetric collapse of the longitudinal arches bilaterally. The assessment included pes planovalgus (hereditary/congenital) that was not related to active service. On VA podiatry examination in March 2007, the veteran complained of a history of plantar calcaneal heel pain. The VA examiner reviewed the veteran's claims file, including his service medical records. Physical examination showed no relevant pain, weakness, fatigability, problematic motion, edema, instability, or tenderness. There was moderate to severe bilateral pes planovalgus feet with collapse of the longitudinal arch, more so on the right foot than the left foot without impaired form or function of the tibialis posterior or tendo Achillis. There was no pain on manipulation of either foot. The veteran was mild tenderness to palpation in the bilateral plantar calcaneal tubercle regions and both first metatarsophalangeal joint lines without limitation of motion in either of these joints. There is no painful motion, edema, weakness, or instability in either foot. The veteran had a normal gait and weightbearing without abnormal shoe wear pattern or callosities. The veteran's walking ability, standing ability, and distance tolerance were normal and unimpaired. There was limitation of motion in any range of motion for either foot. The assessment included pes planus, right foot more so than left foot, of hereditary origin that was not related to active service and was at least as likely not aggravated by active service beyond normal progression in any way. On VA examination in March 2007, the veteran complained of a cardiovascular disability manifested by right ventricular conduction relay. The VA examiner reviewed the veteran's claims file, including his service medical records, and noted that no heart disease or heart disability was seen in these records. The veteran denied any chest pain, heart palpitation, or shortness of breath. He was quite active, riding a bicycle 30 minutes a day and doing yard work at home. He denied any elevated cholesterol. Physical examination showed that carotid arteries pulsated equally well, no bruits, a regular heart rate and rhythm. After obtaining an ECG, the VA examiner noted that this showed a sinus arrhythmia which was a normal phenomena and an incomplete right bundle branch block which was not heart disease. These findings were not significant. The veteran denied that his heart interfered with his work and activity. Therefore, the VA examiner determined that there was no evidence of heart disease. On VA audiology examination in March 2007, the veteran complained of progressive bilateral hearing loss which had developed gradually since the mid-1980's. He denied ear infections, ear surgery, or dizzy spells. His noise history included exposure to aircraft and ground power units as well as flight line noise. The VA examiner reviewed the veteran's claims file, including his service medical records. The veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 10 15 5 LEFT 15 10 15 15 25 Speech audiometry revealed speech recognition ability of 98 percent in the right ear and of 96 percent in the left ear. The VA examiner noted that, although the veteran presented with asymmetric hearing loss, it was of longstanding origin. Audiologic test results showed hearing within normal limits in the right ear and within normal limits through 4000 Hz in the left ear. The VA examiner opined that it was at least as likely as not that the veteran's high-frequency hearing loss in the left ear was related to in-service noise exposure and that the veteran had normal hearing through 4000 Hz in both ears. The Board finds that the preponderance of the evidence is against the veteran's claim of service connection for bilateral pes planus. The veteran's enlistment physical examination shows that he was in sound condition at his entry on to active service except for moderate asymptomatic pes planus. Thus, pes planus was noted at the veteran's entrance on to active service. See 38 C.F.R. § 3.304(b) (2007). Repeated periodic physical examinations during service were negative for bilateral pes planus until the veteran was diagnosed as having bilateral pes planus in August 1992. After being prescribed orthotics, it was noted that his bilateral heel pain was resolving in December 1992. Periodic physical examination in June 1998 showed moderate-severe pes planus without symptoms. The veteran was again diagnosed with bilateral pes planus in June 1999. He reported a history of recurring foot problems at his separation physical examination in December 2002. The post-service medical evidence shows that, following VA examination in June 2005, the VA examiner determined that the veteran's bilateral pes planus was not related to active service. Additionally, after reviewing the veteran's claims file and thoroughly examining him in March 2007, a different VA examiner concluded that the veteran's pes planus, right foot more so than left foot, was hereditary in nature and was not related to active service. This VA examiner also determined that the veteran's bilateral pes planus was not aggravated by active service beyond normal progression in any way. Thus, the Board finds that these VA examiner's opinions are more than probative on the issue of whether the veteran's bilateral pes planus is related to active service. The Board also finds that the preponderance of the evidence is against the veteran's claim of service connection for right ventricular conduction relay. The Board acknowledges that the veteran's in-service ECG in November 1981 and August 1995 showed sinus bradycardia. The in-service examiner also noted in August 1995 that the veteran's ECG was "borderline" and that his sinus bradycardia suggested right ventricular conduction relay. A different in-service examiner determined in August 1997 that the veteran's complaint of chest pain was likely gastrointestinal in origin; this examiner also had a very low suspicion that the veteran's chest pain was of cardiac etiology. Finally, a September 1999 ECG was abnormal with non-specific changes to S1 heart rhythm. The presence of a mere symptom alone, absent evidence of a diagnosed medical pathology or other identifiable underlying malady or condition that causes the symptom, does not qualify as disability for which service connection is available. See generally Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999); vacated in part and remanded on other grounds sub nom., Sanchez-Benitez v. Principi, 239 F.3d 1356 (Fed. Cir. 2001). Further, on VA examination in March 2007, the VA examiner stated that the veteran's sinus arrhythmia was a normal phenomena and was not significant; this VA examiner also found no evidence of heart disease. Thus, there is no diagnosis of an underlying disability based on the veteran's complaint of right ventricular conduction relay. Finally, there is no evidence that the veteran currently experiences any disability as a result of his claimed right ventricular conduction relay. With respect to negative evidence, the fact that there was no record of any complaint, let alone treatment, involving the veteran's condition for many years is significant. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that it was proper to consider the veteran's entire medical history, including a lengthy period of absence of complaints). A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Simply put, service connection is not warranted in the absence of proof of a present disability. The Board further finds that the preponderance of the evidence is against the veteran's claim of service connection for bilateral hearing loss. The veteran's non-progressive high frequency hearing loss in the left ear was noted at his enlistment physical examination; thus, he was accepted for active service in sound condition except for left ear hearing loss. See 38 C.F.R. § 3.304(b) (2007). Repeated audiometric testing during active service noted this asymmetric left ear hearing loss but otherwise noted no significant threshold shift in the veteran's hearing. For example, in August 1995, an in-service audiologist concluded that there had been no progression in the veteran's acknowledged left ear hearing loss. A different in-service audiologist reach the same conclusions in June 1998. The post-service medical evidence shows that, following VA audiology examination in March 2007, a VA audiologist determined that the veteran's high frequency hearing loss above 4000 Hz in the left ear was at least as likely as not related to active service. However, as noted above, impaired hearing is considered a disability for VA purposes based on the auditory thresholds in any of the frequencies 500, 1000, 2000, 3000, and 4000 or when speech recognition scores are less than 94 percent. Thus, the audiometric results in March 2007 showing normal hearing through 4000 Hz and speech recognition scores higher than 94 percent in each ear do not constitute impaired hearing for purposes of VA compensation. See 38 C.F.R. § 3.385 (2007). Although the Board acknowledges the veteran's continuing complaints of hearing loss, the hearing loss that he currently experiences is not a disability for VA purposes and service connection is not warranted. As the preponderance of the evidence is against the veteran's claims, the benefit-of- the-doubt doctrine does not apply. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App 49, 55-57 (1990). (CONTINUED ON NEXT PAGE) ORDER Entitlement to an initial rating greater than 10 percent for GERD is denied. Entitlement to service connection for bilateral pes planus is denied. Entitlement to service connection for right ventricular conduction relay is denied. Entitlement to service connection for bilateral hearing loss is denied. ____________________________________________ JAMES L. MARCH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs