Citation Nr: 0812309 Decision Date: 04/14/08 Archive Date: 05/01/08 DOCKET NO. 07-18 379 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for tinnitus. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Rory E. Riley, Associate Counsel INTRODUCTION The veteran served on active duty from July 1953 to July 1955. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a July 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, which denied the benefits sought on appeal. The veteran appealed that decision to BVA, and the case was referred to the Board for appellate review. In January 2008, the veteran's representative filed a motion to advance this case on the docket due to the veteran's advanced age. The Board granted the motion in March 2008, pursuant to 38 U.S.C.A. § 7107 (West 2002 & Supplement 2007) and 38 C.F.R. § 20.900(c) (2007). FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran's bilateral hearing loss was not manifested during service or within one year thereafter and has not been shown to be casually or etiologically related to service. 3. The veteran's tinnitus was not manifested during service and has not been shown to be casually or etiologically related to service. CONCLUSIONS OF LAW 1. Bilateral hearing loss was not incurred in active service, nor may it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307(a)(3), 3.309(a), 3.385 (2007). 2. Tinnitus was not incurred in active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Upon receipt of a substantially complete application for benefits, VA must notify the claimant what information or evidence is needed in order to substantiate the claim and it must assist the claimant by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The notice required must be provided to the claimant before the initial unfavorable decision on a claim for VA benefits, and it must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; (3) inform the claimant about the information and evidence the claimant is expected to provide; and (4) request or tell the claimant to provide any evidence in the claimant's possession that pertains to the claim. 38 U.S.C.A. §§ 5103(a); 38 C.F.R. § 3.159(b)(1); Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). In this case, in a letter dated November 2005, the RO provided the veteran with notice of the information or evidence needed to substantiate his claims, including that which he was to provide and that which VA would provide, prior to the initial decision on the claims in July 2006. Therefore, the timing requirement of the notice as set forth in Pelegrini has been met in this case. Moreover, the requirements with respect to the content of the notice were met in this case. The RO informed the veteran in the notice letter about the information and evidence that is necessary to substantiate his claims for service connection. Specifically, the November 2005 letter stated that the evidence must show that he had an injury in military service or a disease that began in, or was made worse during military service, or that there was an event in service that caused injury or disease; that he has a current physical or mental disability; and, that there is a relationship between his current disability and an injury, disease, or event in military service. Additionally, the May 2007 statement of the case (SOC) and the July 2007 supplemental statement of the case (SSOC) notified the veteran of the reasons for the denial of his application and, in so doing, informed him of the evidence that was needed to substantiate his claims. In addition, the RO notified the veteran in the notice letter about the information and evidence that VA will seek to provide. In particular, the November 2005 letter indicated that reasonable efforts would be made to help him obtain evidence necessary to support his claims, including that VA would request all pertinent records held by Federal agencies, such as service medical records, military records, and VA medical records. The veteran was also informed that a medical examination would be provided or that a medical opinion would be obtained if it was determined that such evidence was necessary to make a decision on his claims. The RO also informed the veteran about the information and evidence that he was expected to provide. Specifically, the November 2005 letter notified him that he must provide enough information about his records so that they could be requested from the agency or person that has them. It was also requested that he complete and return the enclosed VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, if there were any private medical records that he would like VA to obtain on his behalf. In addition, the November 2005 letter stated that it was the veteran's responsibility to ensure that that VA received all requested records that are not in the possession of a Federal department or agency. Finally, the November 2005 letter specifically notified the claimant that he should submit any evidence or information in his possession that pertains to the claims. During the pendency of this appeal, on March 3, 2006, the United States Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473, noted above, which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. The Court held that upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Additionally, this notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. In the present appeal, the veteran was provided with notice of the type of evidence necessary to establish a disability rating or effective date for the disabilities on appeal. In this regard, the Board notes that a March 2006 letter informed him that a disability rating was assigned when a disability was determined to be service connected and that such a rating could be changed if there were changes in his condition. The letter also explained how disability ratings and effective dates were determined. In addition, the duty to assist the veteran has also been satisfied in this case. The veteran's available service medical records, VA medical records and private medical records pertinent to the years after service are in the claims file and were reviewed by both the RO and the Board in connection with the veteran's claims. The veteran was also afforded a VA examination in July 2006 in connection with these claims. The Board does observe that the veteran's complete service medical records are not associated with the claims file. When a claimant's medical records are lost or destroyed, the VA has a "heightened" duty to assist in the development of the claims. Washington v. Nicholson, 19 Vet. App. 362, 369- 70 (2005). Thus, in accordance with the law and implementing regulations, the RO continued its efforts to obtain all relevant medical records until it was reasonably certain that such records did not exist or that further efforts to obtain those records would be futile. See 38 C.F.R. § 3.159(c). In this regard, the veteran received a letter in November 2005 specifically requesting that he provide any military records, such as his service medical records, that were in his possession. The RO also requested in November 2005 that the National Personnel Records Center (NPRC) furnish the veteran's complete medical and dental service medical records. However, a response was received that same month indicating the veteran's records were presumed destroyed by the fire at the NPRC in St. Louis, Missouri in 1973 and that there were no service medical records or surgeon general office (SGO) records available. In addition, the veteran filled out NA Form 13055 request for information to reconstruct medical data in November 2005. Because the veteran did not provide enough information on this form to complete the request, the RO called the veteran in January 2006 to obtain a narrower time frame for dates that he was seen for ear problems while in service. The veteran provided a more specific timeframe and the request was resubmitted immediately thereafter. In May 2006, the RO received a response from the NPRC indicating that the veteran's allegations had been investigated. The morning reports of his unit were searched for the dates specified, but no remarks were located as to the veteran's allegations. It was also noted in the response that the army discontinued sick reports after March 1953. The veteran received a letter in June 2006 summarizing these efforts and formally notifying him that his service records were unavailable. Considering the aforementioned, the Board concludes that the RO's actions constitute a "reasonably exhaustive search" of all available options. See Dixon v. Derwinski, 3 Vet. App. 261, 263 (1992). The RO has satisfied the duty to assist the veteran with regard to obtaining his service medical records through its actions. See also Layno v. Brown, 6 Vet. App. 465, 469 (1994); Garlejo v. Derwinski, 2 Vet. App. 619, 620 (1992). The veteran and his representative have not made the Board aware of any additional evidence that needs to be obtained prior to appellate review. In fact, the June 2006 report of contact shows that the veteran indicated that he had no other information or evidence to give VA to substantiate his claims. Thus, the Board finds that there is no indication that there is additional available evidence to substantiate the veteran's claims that has not been obtained and associated with the claims folder. VA has further assisted the veteran and his representative throughout the course of this appeal by providing them with a SOC and SSOC, which informed them of the laws and regulations relevant to the veteran's claims. For these reasons, the Board concludes that VA has fulfilled the duty to assist the veteran in this case. Law and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C.A. § 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection for organic diseases of the nervous system, such as bilateral hearing loss, may also be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("Although interest may affect the credibility of testimony, it does not affect competency to testify."). I. Hearing Loss VA has specifically defined the term "disability" for service connection claims involving impaired hearing. 38 C.F.R. § 3.385. "[I]mpaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent." 38 C.F.R. § 3.385. The Board notes that the veteran currently meets the criteria for bilateral hearing loss. As part of the veteran's VA examination in July 2006, an authorized audiological evaluation pure tone thresholds, in decibels, was performed, and the results were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 25 30 35 60 LEFT 10 25 30 30 50 Speech audiometry revealed speech recognition ability of 92 percent in the right ear and of 94 percent in the left ear. To qualify for a hearing loss disability, all that is needed is at least one auditory threshold reading of 40 decibels or greater, which the veteran has for each ear. 38 C.F.R. § 3.385. Additionally, his speech recognition was 92 percent in the right ear and 94 percent in the left ear. The Board notes that the speech recognition scores of 92 percent establishes hearing loss in the veteran's right ear, but a score of 94 percent does not establish hearing loss in the veteran's left ear pursuant to VA regulations. 38 C.F.R. § 3.385. However, the veteran's auditory threshold findings are sufficient standing alone to establish bilateral hearing loss for VA purposes. 38 C.F.R. § 3.385. Nonetheless, in considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the veteran is not entitled to service connection for hearing loss. In his July 2005 statement, the veteran contends he was exposed to acoustic trauma in service as an instructor at a rifle range, instructing mortar firing, and combat simulated training courses. The veteran is considered competent to relate a history of noise exposure during service. See 38 C.F.R. § 3.159(a)(2). As previously discussed, the veteran's complete service medical records are not available for review. However, the veteran's June 1955 separation examination is available for review as part of the veteran's claims file. The June 1955 separation examination documents the veteran's ears and drums as clinically normal. Although the authorized audiological evaluation was not conducted as part of this examination, the veteran was given whisper voice tests, and the examination documents the veteran's performance on these tests as 15/15 bilaterally. In his November 2005 statement, the veteran contends that he sought treatment while in service because his ears bothered him, and that he was told to go back to work and the problem would go away. In his May 2007 Form 9 statement, the veteran also contended that he has had hearing loss since the service. Unfortunately, the veteran's service records could not be located to verify this information. Although the veteran was notified that he should submit all other evidence related to his claim, the veteran did not submit any additional evidence indicating that he had sought treatment for his hearing loss during service, or in the years immediately thereafter. An award of service connection must be based on reliable competent medical evidence and may not be based on a resort to pure speculation or even remote possibility. See 38 C.F.R. § 3.102. Moreover, the medical evidence of record shows that the veteran did not seek treatment for hearing loss until many years after his separation from service. Therefore, the Board finds that hearing loss did not manifest during service or for many years thereafter. Service connection for hearing loss may also be granted on a presumptive basis if it manifests itself to a degree of 10 percent or more within one year after discharge. 38 C.F.R. § 3.307, 3.309(a). However, there is no evidence of such manifestation in this case, nor does the veteran contend that his hearing loss manifested to that degree at that time. Id. Therefore, the Board finds that the veteran's hearing loss may not be presumed to have been incurred in active service. With regard to the decades-long evidentiary gap in this case between active service and the earliest complaints of hearing loss, the Board notes that this absence of evidence constitutes negative evidence tending to disprove the claim that the veteran had an injury or disease in service which resulted in chronic disability or persistent symptoms thereafter. See Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (noting that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact); see also 38 C.F.R. § 3.102 (noting that reasonable doubt exists because of an approximate balance of positive and "negative" evidence). Thus, the lack of any objective evidence of continuing complaints, symptoms, or findings for many decades between the period of active duty and the first complaints or symptoms of hearing loss is itself evidence which tends to show that hearing loss did not have its onset in service or for many years thereafter. A prolonged period without medical complaint can be considered, along with other factors concerning a veteran's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board must consider all the evidence including the availability of medical records, the nature and course of the disease or disability, the amount of time that elapsed since military service, and any other relevant facts in considering a claim for service connection. Id.; cf. Dambach v. Gober, 223 F.3d 1376, 1380-81 (Fed. Cir. 2000) (holding that the absence of medical records during combat conditions does not establish absence of disability and thus suggesting that the absence of medical evidence may establish the absence of disability in other circumstances). Thus, when appropriate, the Board may consider the absence of evidence when engaging in a fact finding role. See Jordan v. Principi, 17 Vet. App. 261 (2003) (Steinberg, J., writing separately) (noting that the absence of evidence may be considered as one factor in rebutting the aggravation part of the section 1111 presumption of soundness). In addition to the lack of evidence establishing that hearing loss manifested during service or for many years thereafter, the medical evidence does not show the veteran to currently have such a disorder that is related to his military service. The July 2006 VA examiner stated that the veteran's current hearing loss was not significantly different than that predicted by aging alone. He further opined that it was not as likely as not that his hearing loss occurred during or as a result of military service. The Board also observes the veteran's contention in his September 2006 notice of disagreement, and his representative's contention in his June 2007 statement that the July 2006 VA examiner's opinion was inadequate because it was based on the fact that the veteran waited 51 years to file his claim. The value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). Thus, a medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). See also Knightly v. Brown, 6 Vet. App. 200 (1994); Miller v. West, 11 Vet. App. 345, 348 (1998) (medical opinions must be supported by clinical findings in the record and conclusions of medical professionals which are not accompanied by a factual predicate in the record are not probative medical opinions). The July 2006 VA examiner reasoned that the veteran did not serve in combat, the veteran's June 1955 separation examination documented his ears as clinically normal, and most importantly, that the veteran's hearing loss is not significantly different than that predicted by aging alone. In reaching this conclusion, the July 2006 VA examiner noted the veteran's contentions that he had a history of noise exposure during military service as an instructor in assimilated battle situations, and that he denied any post-military noise exposure. The Board concedes that the veteran was exposed to acoustic trauma during military service given his MOS in antitank mine platoon and as a squad sergeant. However, even when taking these factors into consideration, the July 2006 VA examiner still concluded that the veteran's hearing loss was due to aging rather than military service. Therefore, the Board finds that the July 2006 VA examiner reviewed the claims file and rendered an opinion that is supported by the evidence of record. Accordingly, the Board finds the July 2006 opinion to be adequate. Although in his May 2007 statement, the veteran contended that he has had hearing loss since the service, the veteran, as a layperson, is not qualified to render a medical opinion as to etiology or diagnosis. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Therefore, the veteran's statements regarding etiology do not constitute competent medical evidence on which the Board can make a service connection determination. The Board does observe a private medical record dated in September 2006 indicating that the veteran has hearing loss and tinnitus. Additionally, an audiogram was performed, yet the Board also notes that the audiological examination report did not provide an interpretation of the audiometric readings contained on the graphs. Moreover, the report did not indicate what sort of speech audiometry testing was done. For VA purposes, the Maryland CNC Test must be used, as noted above. 38 C.F.R. § 3.385. The Board notes that it is precluded from interpreting pure tone threshold results in order to determine the severity of the veteran's current hearing loss disability. See Kelly v. Brown, 7 Vet. App. 471, 474 (1995) (finding that neither the Board nor the RO may not interpret graphical representations of audiometric data). Furthermore, the private medical record does not provide any medical evidence that the veteran's current hearing loss is connected to military service. In sum, the Board acknowledges that the veteran has a current diagnosis of bilateral hearing loss. Specifically, the July 2006 audiological evaluation report reflects that the veteran currently meets the diagnostic criteria for hearing loss. 38 C.F.R. § 3.385. However, in order to establish service connection, there must be competent evidence establishing an etiological relationship between an injury in service and the current disability. After considering all the evidence under the laws and regulations set forth above, the Board concludes that the veteran is not entitled to service connection for bilateral hearing loss because the competent medical evidence does not reveal a nexus to an injury or disease occurring in service. Additionally, the evidence does not support service connection by a presumptive basis because there is no competent medical evidence showing that his hearing loss manifested itself to a degree of 10 percent or more within one year from the date of the veteran's separation from service. Absent such a nexus, service connection for hearing loss may not be granted. 38 C.F.R. § 3.303. For these reasons, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for hearing loss. Because the preponderance of the evidence is against the veteran's claim, the benefit of the doubt provision does not apply. Accordingly, the Board concludes that service connection for hearing loss is not warranted. See 38 U.S.C.A. § 5107(b) (West 2002 & Supplement 2007); 38 C.F.R. § § 3.102, 3.303 3.307(a)(3), 3.309(a) (2007). II. Tinnitus In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the veteran is not entitled to service connection for tinnitus. As previously noted, the veteran's complete service medical records are unavailable for review. However, the veteran's June 1955 separation examination documents the veteran's ears and drums as normal, and is absent of any complaints of tinnitus. In his November 2005 statement, the veteran contends that he sought treatment while in service because his ears bothered him, and that he was told to go back to work and the problem would go away. In September 2006, the veteran filled out NA Form 13055 indicating that he was never treated in the military for tinnitus. In his May 2007 statement, the veteran also contended that he has had tinnitus since the service but it has gotten worse in the past 10 - 15 years. However, the veteran's service records could not be located to verify this information. Although the veteran was notified that he should submit all other evidence related to his claim, the veteran did not submit any additional evidence indicating that he had sought treatment for his tinnitus during service, or in the years immediately thereafter. See Curry v. Brown, 7 Vet. App. 59, 68 (1994). An award of service connection must be based on reliable competent medical evidence and may not be based on a resort to pure speculation or even remote possibility. See 38 C.F.R. § 3.102. Moreover, the medical evidence of record shows that the veteran did not report symptoms of tinnitus for many years following his separation from service. Therefore, the Board finds that tinnitus did not manifest during service or for many years thereafter. A prolonged period without medical complaint can be considered, along with other factors concerning a veteran's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board must consider all the evidence including the availability of medical records, the nature and course of the disease or disability, the amount of time that elapsed since military service, and any other relevant facts in considering a claim for service connection. Id.; cf. Dambach v. Gober, 223 F.3d 1376, 1380-81 (Fed. Cir. 2000) (holding that the absence of medical records during combat conditions does not establish absence of disability and thus suggesting that the absence of medical evidence may establish the absence of disability in other circumstances). Thus, when appropriate, the Board may consider the absence of evidence when engaging in a fact finding role. See Jordan v. Principi, 17 Vet. App. 261 (2003) (Steinberg, J., writing separately) (noting that the absence of evidence may be considered as one factor in rebutting the aggravation part of the section 1111 presumption of soundness). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007), see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2007). In his May 2007 statement, the veteran contended that he has had tinnitus since the service. Regarding the veteran's statements that he has had tinnitus since the service, the Board acknowledges that he is competent to give evidence about what he experienced; i.e., he is competent to report that he has experienced ringing in his ears. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (finding veteran competent to testify to symptomatology capable of lay observation); Layno v. Brown, 6 Vet. App. 465, 469 (1994) (noting competent lay evidence requires facts perceived through the use of the five senses). To the extent that the veteran has attested to having chronic/continuous symptomatology of tinnitus since service, the Board has considered the provisions of 38 C.F.R. § 3.303(b). In Savage v. Gober, 10 Vet. App. 488 (1997), it was noted that while the concept of continuity of symptomatology focuses on continuity of symptoms, not treatment, in a merits context, the lack of evidence of treatment may bear upon the credibility of the evidence of continuity. The record here discloses a span of approximately 50 years without any clinical evidence to support any assertion of a continuity of symptomatology. The fact that the contemporaneous records do not provide subjective or objective evidence that supports any recent contention that the veteran experienced continuous symptomatology since service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board decision in a case involving an injury in service, normal medical findings at the time of separation, and the absence of any medical records of a diagnosis or treatment for many years after service, where the Board found that veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Savage, 10 Vet. App. at 497-98 (holding that, notwithstanding a showing of post-service continuity of symptomatology, medical expertise was required to relate present disability etiologically to post-service symptoms). In addition to the lack of evidence establishing that tinnitus manifested during service or for many years thereafter, the medical evidence does not show the veteran to currently have such a disorder that is related to his military service. The July 2006 VA examiner stated that the veteran's current tinnitus is not timelocked to acoustic trauma or military service. He further opined that it was not as likely as not that his tinnitus occurred during or as a result of military service. The Board also observes the veteran's contention in his September 2006 notice of disagreement, and his representative's contention in his June 2007 statement that the July 2006 VA examiner's opinion was inadequate because it was based on the fact that the veteran waited 51 years to file his claim. The value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). Thus, a medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). See also Knightly v. Brown, 6 Vet. App. 200 (1994); Miller v. West, 11 Vet. App. 345, 348 (1998) (medical opinions must be supported by clinical findings in the record and conclusions of medical professionals which are not accompanied by a factual predicate in the record are not probative medical opinions). After a thorough review of the claims file, including the veteran's statements, the July 2006 VA examiner reasoned that the veteran's current tinnitus is not timelocked to acoustic trauma or military service, and the approximately 50 year gap between service and the first sought treatment for tinnitus weighed against the veteran's claim that the onset of tinnitus was during service. Therefore, the Board finds that the July 2006 VA examiner reviewed the claims file and rendered an opinion that is supported by the evidence of record. Accordingly, the Board finds the July 2006 opinion to be adequate. The Board does observe a private medical record dated September 2006 indicating that the veteran has hearing loss and tinnitus. However, the private medical record does not provide any medical evidence that the veteran's current tinnitus is connected to military service. Although the veteran might sincerely believe that his tinnitus is related to his service, the veteran, as a lay person, is not competent to testify that his tinnitus was caused by acoustic trauma in service. Where a determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). There is no indication in the record that the veteran is a physician or other health care professional. Therefore, as a layperson, he is not competent to provide evidence that requires medical knowledge because he lacks the requisite professional medical training, certification and expertise to present opinions regarding diagnosis and etiology. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992).. Therefore, the veteran's statements regarding etiology do not constitute competent medical evidence on which the Board can make a service connection determination. In sum, after considering the credibility and probative value of the evidence in this case, the Board finds the evidence against the veteran's claim for service connection for tinnitus to be more persuasive than the evidence in favor of the claim. Although the veteran currently has tinnitus and reports having had the condition since active service, the veteran's separation exam does not reflect any reports of tinnitus. In addition, the veteran's first complaints of tinnitus were not until 2005, approximately 50 years after his separation from service. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the veteran); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Furthermore, after a thorough review of the claims file and an adequate medical examination, the July 2006 VA examiner found that the veteran's tinnitus was not as likely as not a result of military service. Thus, after careful consideration, the Board concludes that the clinical and objective medical evidence in this case is more accurate and far more probative than the statements of the veteran, offered more than 50 years after his discharge from service. See Curry, 7 Vet. App. at 68. Therefore, the Board finds that the preponderance of the evidence is against the veteran's claim for service connection for tinnitus. Because the preponderance of the evidence is against the veteran's claim, the benefit of the doubt provision does not apply. Accordingly, the Board concludes that service connection for tinnitus is not warranted. See 38 U.S.C.A. § 5107(b) (West 2002 & Supplement 2007); 38 C.F.R. § § 3.102, 3.303 (2007). ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. ____________________________________________ KATHLEEN K. GALLAGHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs