Citation Nr: 0810067 Decision Date: 03/26/08 Archive Date: 04/09/08 DOCKET NO. 00-13 842 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Whether new and material evidence to reopen a claim for service connection for chronic otitis media has been received. 2. Whether new and material evidence to reopen a claim for service connection for tinnitus has been received. 3. Entitlement to service connection for tinnitus. 4. Entitlement to service connection for a bilateral hearing loss. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Timothy D. Rudy, Associate Counsel INTRODUCTION The veteran served on active duty from May 1953 to March 1955. In October 1969, the RO denied the veteran's claims for service connection for tinnitus and an ear disorder. The veteran appealed and the Board of Veterans' Appeals (Board) continued the denial in a decision dated in March 1971. These matters come before the Board on appeal from a March 1999 rating decision in which the RO declined to reopen the veteran's claims for service connection for chronic otitis media and for tinnitus, as well as denied the veteran's claim of service connection for hearing loss. In March 2000, the veteran filed a notice of disagreement (NOD). A statement of the case (SOC) was issued in April 2000, and the veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) in June 2000. In August 2002, the veteran testified during a video conference hearing before an Acting Veterans Law Judge (VLJ); a transcript of that hearing is of record. In April 2003, the Board undertook additional development of the claims under the provisions of 38 C.F.R. § 19.9 (2002) and Board procedures then in effect. However, the provisions of 38 C.F.R. § 19.9 essentially conferring upon the Board jurisdiction to adjudicate claims on the basis of evidence developed by the Board, but not reviewed by the RO, was later held to be invalid. See Disabled American Veterans (DAV) v. Secretary of Veterans Affairs (Secretary), 327 F.3d 1339 (Fed. Cir. 2003). Hence, in November 2003, the Board remanded these matters (although mistakenly only one of the issues was listed on the title page) to the RO for completion of the requested development. In a January 2007 supplemental SOC (SSOC), the Appeals Management Center (AMC) in Washington, D.C. continued the denial of the claim for service connection for bilateral hearing loss. In response to the Board's April 2007 letter apprising the appellant that the acting VLJ who presided at his August 2002 hearing was no longer employed with the Board, and informing him of his right to another hearing, the veteran indicated the following month that he wanted another hearing before a Veterans Law Judge at the RO. In June 2007, the Board again remanded these matters to the RO for further action, to include scheduling another Board hearing at the RO and the issuance of an SSOC on the issues of whether new and material evidence had been presented to reopen claims for service connection for chronic otitis media and tinnitus. After accomplishing the requested action, the RO continued the denial of the petition to reopen claims for service connection for chronic otitis media and tinnitus (as reflected in a July 2007 SSOC) and returned these matters to the Board for further appellate consideration. In February 2008, the veteran testified during a hearing before the undersigned held at the RO; a transcript of that hearing is of record. After the hearing, the veteran submitted additional evidence, including definitions of different ear disorders and private medical records of treatment for his hearing, along with a waiver of initial RO consideration of the additional evidence. The Board accepts this additional evidence for inclusion in the record. See 38 C.F.R. § 20.800 (2007). FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate each claim on appeal has been accomplished. 2. In March 1971, the Board denied the veteran ervice connection for a nervous disorder, pharyngitis, tinnitus and an ear disorder. 3. Although some of the additional evidence associated with the claims file since the Board's March 1971 denial was not previously before agency decision makers, none of it is so significant that it must be considered in order to fairly decide the merits of the claim for service connection for chronic otitis media. 4. New evidence added to the record since the March 1971 Board decision, when considered by itself or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim for service connection for tinnitus. 5. No tinnitus was shown in service, and competent evidence does not establish a medical nexus between tinnitus and the appellant's service. 6. Although the veteran has alleged experiencing significant in-service noise exposure, there is no evidence of bilateral hearing loss for many years after service, and the only competent, objective opinion to address the question of whether there exists a nexus between alleged in-service noise exposure and any current hearing loss disability is not supportive of the claim. CONCLUSIONS OF LAW 1. The Board's March 1971 denial of the veteran's claim for service connection for a nervous disorder, pharyngitis, tinnitus and an ear disorder is final. 38 U.S.C.A. § 7104(b) (West 2002); 38 C.F.R. § 20.1100 (2007). 2. As new and material evidence has not been received, the criteria for reopening the claim for service connection for chronic otitis media are not met. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (as in effect prior to August 29, 2001)). 3. Pertinent to the claim for service connection for tinnitus, new and material evidence has been received since the Board's March 1971 denial; hence, the criteria for reopening that claim are met. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (as in effect prior to August 29, 2001). 4. The criteria for service connection for tinnitus are not met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107(b) (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007). 5. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2007)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA have been codified, as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2007). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claims, as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claims; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claims, in accordance with 38 C.F.R. § 3.159(b)(1). VA's notice requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). With respect to requests to reopen previously denied claims, a claimant must be notified of both what is needed to reopen the claim and what is needed to establish the underlying claim for service connection. See Kent v. Nicholson, 20 Vet. App. 1 (2006). VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include via the AMC). Id; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In the matters now before the Board, most of the documents meeting the VCAA's notice requirements were provided to the veteran after the March 1999 rating action on appeal. In this case, such makes sense, inasmuch as the March 1999 rating decision on appeal was issued prior to the enactment of the VCAA in November 2000. A June 2002 post-rating letter provided notice to the appellant regarding what information and evidence was needed to substantiate the petition to reopen his claims for service connection for chronic otitis media and tinnitus and what information and evidence was needed to substantiate those claims on the merits. An April 2004 post-rating letter provided notice to the appellant regarding what information and evidence was needed to substantiate the claim for service connection for hearing loss. Both letters provided notice to the appellant regarding what information and evidence must be submitted by the appellant and what information and evidence would be obtained by VA. While the June 2002 letter did not provide notice of the need for the appellant to advise VA of and to submit any further evidence that is relevant to the claims, the April 2004 letter provided such notice to the appellant. Further, while the June 2002 letter did not provide the appellant with the then statutory definition of what constitutes new and material evidence, the Board notes that, consistent with Kent, a January 1999 letter from the RO had explained what constitutes new and material evidence to reopen his claims for service connection for chronic otitis media and tinnitus and notified the veteran of the basis for the Board's previous denial. A March 2006 letter also informed the appellant how disability ratings and effective dates are assigned and the type of evidence that impacts those determinations. After issuance of each notice described above, and opportunity for the appellant to respond, the January 2007 SSOC and the July 2007 SSOC reflect readjudication of all three claims on appeal. Hence, the appellant is not shown to be prejudiced by the timing of VCAA-compliant notice. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006); see also, Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in a SOC or SSOC, is sufficient to cure a timing defect). As regards VA's duty to assist a claimant, the record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matters on appeal. Pertinent evidence associated with the claims file consists of the veteran's service medical records; post-service private medical records; VA inpatient treatment records from a VA hospital in Chicago; as well as reports of VA examinations. Also of record and considered in connection with these claims are the transcripts of the veteran's August 2002 and February 2008 Board hearings, as well as various written statements by the veteran and his representative, on his behalf. The Board notes that the AMC, in an April 2004 letter to the appellant, attempted to obtain the addresses of several private physicians who treated the veteran in the 1950s and 1960s. However, the record also shows that the veteran responded in October 2005 that he had no further information about those physicians. In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO, the appellant has been notified and made aware of the evidence needed to substantiate these claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with any of these claims. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the appellant or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matters on appeal, at this juncture. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Service Connection Under the applicable criteria, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Such a determination requires a finding of a current disability that is related to an injury or disease incurred in service. Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for any disease 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). A. Petition to Reopen Claims for Service Connection for Chronic Otitis Media and for Tinnitus The veteran's claims for service connection for chronic otitis media and tinnitus previously were considered and denied. In an October 1969 decision, the RO denied the veteran's claim for service connection for a nervous disorder, pharyngitis, tinnitus and ear disorder. The Board affirmed that denial in its decision dated in March 1971. The evidence of record then consisted of the veteran's service medical records, VA inpatient medical records, the report of a VA examination, and three signed statements from private physicians. The service medical records show that in November 1953 the veteran was given eardrops when treated, apparently, for a sore throat and a cold. A December 1953 record refer to a diagnosis of otitis media in the veteran's right ear and use of ear drops in that ear after an episode of right ear discharge. January 1954 records note treatment, such as irrigating the ear, and chronic otitis media (with the rest of the record illegible). May 1955 VA inpatient treatment records reflect treatment for a possible appendicitis or ulcer without any notations related to the issues on appeal. The report of the July 1969 VA ear, nose and throat examination notes that the veteran complained of bilateral tinnitus, but mostly to the right side. It was noted that the veteran could hear well. The impression of the VA examiner was tinnitus aurium and chronic pharyngitis. An April 1970 statement signed by a physician at a Puerto Rican hospital reveals that the veteran had received medical treatment there for three years and was diagnosed with an episode of otitis and an episode termed a nervous breakdown. In an April 1970 signed statement, I.M., M.D., a private physician in Puerto Rico, certified that he had treated the veteran since 1966 for tinnitus, ear aches, severe headaches and extreme nervousness. The statement notes that the veteran said he felt occasional dizziness while in service after a few injections of probably penicillin and streptomycin. In an April 1970 signed statement by A.T.-M., M.D., another private physician in Puerto Rico, indicated that he had treated the veteran since 1967 for chronic pharnyngitis, which affected the Eustachian tubes causing the veteran's tinnitus. In its March 1971 decision, the Board denied the veteran's claim for service connection for a nervous disorder, pharyngitis, tinnitus and ear disorder on the basis that service medical records did not refer to tinnitus and that the veteran had recovered from acute and transitory episodes of otitis media and otitis externa in service. The Board held that tinnitus and any ear disorder were not incurred in or aggravated during a period of service. When the Board disallows a claim, the disallowance is final unless the Chairman determines that reconsideration is warranted, or another exception to finality applies. Otherwise, no claim based upon the same factual basis shall be considered. See 38 U.S.C.A. §§ 7103, 7104 (West 2002 & Supp. 2007); 38 C.F.R. § 20.1100. As reconsideration of the March 1971 Board denial has not been ordered, and no other exception to finality applies, that decision is final as to the evidence then of record. However, under pertinent legal authority, VA may reopen and review a claim, which has been previously denied, if new and material evidence is submitted by or on behalf of the veteran. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a); see also Hodge v. West, 155 F.3rd 1356 (Fed. Cir. 1998). The veteran filed his current claims for service connection for chronic otitis media and for tinnitus in November 1998. Regarding petitions to reopen received prior to August 29, 2001, as in this case, new and material evidence means evidence not previously submitted to agency decision makers that bears directly and substantially on the specific matter under consideration, that is neither cumulative nor redundant, and that is, by itself or in combination with other evidence, so significant that it must be considered in order to fairly adjudicate the claim. 38 C.F.R. § 3.156(a) (2001). In determining whether new and material evidence has been received, VA must initially decide whether evidence associated with the claims file since the last final denial is, in fact, new. As indicated by the regulation cited above, and by judicial case law, new evidence is that which was not of record at the time of the last final disallowance (on any basis) of the claim, and is not duplicative or merely cumulative of other evidence then of record. This analysis is undertaken by comparing the newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis (here in March 1971). See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). Furthermore, for purposes of the new and material analysis, the credibility of the evidence is presumed, unless it is inherently false or untrue, or is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216 (1995); Justus v. Principi, 3 Vet. App. 510, 513 (1992). Since the March 1971 Board decision, evidence added to the claims file pertinent to the veteran's claims for service connection for chronic otitis media and for tinnitus primarily consist of: private medical records dated between January 1972 and January 1999, especially audiograms from the veteran's employer; private medical records from the Speech and Hearing Center in San Juan dated in October 1990 which state the veteran complained of hearing loss and tinnitus from his time in service; a January 1997 written statement and records from Dr. A.N.B. which note hearing loss, vertigo, and tinnitus developed from exposure to high frequency noise during service training; private medical records dated between June 2003 and January 2006 from Dr. A.P.V., which show treatment for vertigo but do not include any audiological findings; the report of a December 2006 VA examination for hearing loss; information about ear diseases from an unidentified treatise; private medical records dated in May 2001, December 2001 and February 2008 (some in Spanish) concerning treatment for hearing loss; and transcripts of his Board hearings dated in August 2002 and February 2008. As regards the claim for tinnitus, clearly, the evidence received into the claims file since 1971 is new in the sense that it was not previously before agency decision makers. The Board also finds that Dr. A.N.B.'s January 1997 written statement that the veteran developed tinnitus as a result of his exposure to high frequency noise in service is material for purposes of reopening. The new evidence suggests a possible nexus between current symptoms and service. The Board points out that, with respect to claims to reopen filed prior to August 29, 2001, the evidence to reopen must, at a minimum, "contribute to a more complete picture of the circumstances surrounding the origin of the appellant's injury or disability," even where it will not eventually convince VA to alter its decision. See Hodge, 155 F.3d at 1363; 38 C.F.R. § 3.156. As the Board finds that the newly received evidence, discussed above, meets this requirement, the Board, in turn, finds that new and material evidence to reopen the claim for service connection for tinnitus has been received. The claim for service connection, on the merits, is addressed below. As regards the claim for chronic otitis media, clearly, as indicated above, the medical evidence received since the March 1971 Board denial includes no medical comment or opinion that the veteran's chronic otitis media was incurred in or aggravated by service. As such, while new in the sense that it was not previously considered by adjudicators, the evidence is not so significant that it must be considered in order to fairly adjudicate the merits of the claim for service connection for chronic otitis media. There simply is no indication that the veteran's chronic otitis media is related to his service. The only other evidence added to the record consists of the veteran's assertions during his August 2002 and February 2008 Board hearings. However, the veteran is not shown to possess the appropriate medical expertise and training to competently offer a probative opinion as to whether his otitis media is medically related to service. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). As such, any statements purporting to do so cannot constitute material evidence. Where, as here, the claims turn on a medical matter, unsupported lay statements without more, even if new, can never serve as a predicate to reopen a previously-disallowed claim. See Moray v. Brown, 5 Vet. App. 211, 214 (1993). Under these circumstances, the Board concludes that none of the additional evidence added to the claims file since the March 1971 denial constitutes new and material evidence to reopen the claim for service connection for chronic otitis media. As such, the Board's March 1971 decision remains final, and the appeal must be denied. As the veteran has not fulfilled the threshold burden of submitting new and material evidence to reopen the finally-disallowed claim, the benefit- of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). B. Service Connection for Tinnitus and for Bilateral Hearing Loss Specific to claims for service connection, impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; the thresholds for at least three of these frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2007). The veteran and his representative contend that the veteran has tinnitus and hearing loss due to in-service noise exposure in training and while stationed in Germany. The veteran testified in both of his Board hearings that firing rifles and machine guns in service led to ear pains and loss of hearing. Considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that the record presents no basis for a grant of service connection for tinnitus or for bilateral hearing loss. The veteran's service medical records show that on January 1952 and April 1953 preinduction examinations and his March 1955 discharge examination, whisper testing results were 15/15, bilaterally. Therefore, the veteran was not found to have right or left ear hearing loss in service. The service medical records are negative for any complaints of tinnitus. However, the absence of in-service evidence of hearing loss is not fatal to the claim, see Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of section 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). In this case, the post-service evidence does not reflect evidence of tinnitus or bilateral hearing loss for several years after discharge. As noted above, the report of the July 1969 VA examination showed tinnitus aurium and two April 1970 statements signed by physicians showed treatment for tinnitus since 1966 and 1967. An employer medical record dated in March 1971 notes that the veteran had noise exposure while in service for 18 months and 12 years of noise exposure in post service employment. The first documented medical evidence of any hearing loss is reflected in a private May 1972 audiogram taken by his employer. Audiogram findings, in pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 15 10 15 LEFT 25 15 15 25 45 Audiological findings from the veteran's employer between 1972 and 1994 show progressive hearing loss in both ears under the criteria of 38 C.F.R. § 3.385. In October 1990, the veteran underwent an audiological evaluation at the private Speech and Hearing Center of San Juan. Audiogram findings, in pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 5 No report 0 LEFT 5 10 35 45 60 A patient history from this October 1990 treatment notes that the veteran also complained of tinnitus dating from his time in service. Audiogram findings, in pure tone thresholds, in decibels, were not remarkable in a January 1997 audiogram conducted for Dr. A.N.B., one of the veteran's private physicians. In a January 1997 statement, Dr. A.N.B. stated that the veteran developed tinnitus and hearing loss as a result of his exposure to high frequency noise during Army training. However, a medical record dated earlier that month indicates that the veteran's right ear intermittent tinnitus began with a severe attack of vertigo which began within the previous month. According to the report of a December 2006 VA audiological evaluation, the examiner noted a history of bilateral recurrent tinnitus. The veteran told the examiner that he had difficulty hearing in noisy environments and crowds beginning in 1996. He told the examiner that he had 5 to 6 months of noise exposure in service in training and as a gunner, that he had occupational noise exposure at work from 1971 to 1998, and no recreational noise exposure. Audiogram findings, in pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 20 20 20 45 LEFT 25 25 55 45 75 Speech recognition scores on the Maryland CNC Word List were 96 percent in both of the veteran's ears. The examiner diagnosed normal hearing in the right ear from 500 to 3000 Hz with a moderate sensorineural hearing loss at 4000 Hz, and normal hearing in the left ear from 500 to 1000 Hz with a moderate to profound sensorineural hearing loss from 2000 to 4000 Hz. The audiologist examiner, after a review of the claims file, found that hearing loss was less likely as not incurred in or aggravated by military service. The audiologist noted the progressive high frequency sensorineural hearing loss above 3000 Hz in the employer audiological examinations between 1972 and 1997 and the veteran's noise exposure in service, work, and at leisure. Private treatment records submitted in March 2008 show an audiological evaluation in May 2001 that reveals current hearing loss and audiological evaluations dated in December 2001 and February 2008 in graphical form without numerical interpretation. The Board is precluded from applying these graphic results to the criteria of 38 C.F.R. § 3.385 (2007) in order to determine the severity of the veteran's bilateral hearing loss disability. See Kelly v. Brown, 7 Vet. App. 471 (1995) (holding that neither the Board nor the RO may interpret graphical representations of audiometric data). Another of the February 2008 private records shows a recommendation the veteran wear hearing aids. A February 2008 private medical record printed in Spanish provides an audiologist's description of current hearing loss in each of the veteran's ears. Audiological findings of record clearly show that the veteran has current hearing loss disability for VA purposes, as defined by 38 C.F.R. § 3.385. Further, the medical evidence documents the veteran's continued complaints of tinnitus; given the nature of the disability, the veteran is competent to assert the existence of such disability-specifically, ringing in the ears-on the basis of his assertions, alone. See, e.g., Falzone v. Brown, 8 Vet. App. 398, 403 (citing Harvey v. Brown, 6 Vet. App. 390, 393 (1994)). Hence, the only questions remaining for resolution are whether the evidence establishes a medical relationship between current tinnitus and service and whether there is a medically sound basis for attributing the veteran's current bilateral hearing loss disability to service. The first documented evidence of tinnitus, according to Dr. I.M.'s April 1970 statement, would be 1966 when he began to treat the veteran and the first documented evidence of hearing loss is shown in the veteran's May 1972 audiogram taken by his civilian employer. As noted above, the veteran was discharged from service in March 1955. The Board points out that the passage of so many years between discharge from active service and the objective documentation of a claimed disability is a factor that weighs against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Finally, the Board notes that there is no competent and persuasive evidence of a nexus between either the veteran's tinnitus or his bilateral hearing loss and service. Despite Dr. A.N.B.'s statement, the claims for service connection still must be denied because there is no competent evidence whatsoever of a medical relationship between tinnitus or hearing loss and the veteran's period of service. The Board finds that Dr. A.N.B.'s January 1997 opinion is not persuasive. The doctor did not actually provide a medical opinion as to the relationship, if any, between the veteran's current tinnitus or bilateral hearing loss and his service; rather, it is clear that the doctor simply reiterated the veteran's assertion concerning a medical relationship between his claimed disabilities and his active service. As such, Dr. A.N.B.'s statement does not constitute a medical opinion in support of the claim. See LeShore v. Brown, 8 Vet. App. 406 (1995) (a transcription of a lay history is not transformed into competent evidence merely because the transcriber happens to be a medical professional). The Board further finds that the January 1997 statement provided by Dr. A.N.B. also provides no persuasive support for either claim. Not only is the January 1997 statement clearly speculative in nature, but Dr. A.N.B. did not provide a stated rationale for his opinion, to include identification of the evidence relied upon in reaching the conclusion expressed. Medical opinions expressed in speculative language do not provide the degree of certainty required for medical nexus evidence. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992); Bostain v. West, 11 Vet. App. 124, 127- 28 (1998), quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993). Significantly, Dr. A.N.B. did not indicate that he had reviewed any of the veteran's records in rendering his opinion. The Board further notes that, while the December 2006 VA examiner diagnosed moderate sensorineural hearing loss and offered his suspicion that the veteran's hearing loss might be noise-induced, he opined that the evidence cannot be interpreted as even suggesting a medical nexus between any in-service noise exposure and service, given the veteran's report that he had first noticed bilateral hearing loss about 10 years before the examination, or in approximately 1996. As noted above, the veteran was discharged from service in March 1955. As for assertions advanced by the veteran and his representative, to whatever extent they are being advanced to establish a relationship, or nexus, between the veteran's claimed in-service noise exposure (associated with his work in basic training and as a gunner) and current tinnitus and bilateral hearing loss, such is a matter within the province of trained professionals See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As each is a layperson without the appropriate training and expertise, neither the veteran nor his representative is competent to provide a probative (persuasive) opinion on a medical matter. See Bostain v. West, 11 Vet. App. 124, 127 (1998) (citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992)). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). For these reasons, the lay assertions in this regard have no probative value. For all the foregoing reasons, the claims for service connection for tinnitus and for bilateral hearing loss must be denied. In reaching each conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as no competent and persuasive evidence supports either claim, that doctrine is not for application. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2007); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER As new and material evidence to reopen the claim for service connection for chronic otitis media has not been received, the appeal as to this matter is denied. As new and material evidence to reopen the claim for service connection for tinnitus has been received, the appeal as to this matter is granted. Service connection for tinnitus is denied. Service connection for hearing loss is denied. ____________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs