Citation Nr: 0813888 Decision Date: 04/25/08 Archive Date: 05/01/08 DOCKET NO. 04-20 294 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Manchester, New Hampshire THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for bilateral tinnitus. 3. Entitlement to service connection for arthritis of the right knee. 4. Entitlement to service connection for arthritis of the left knee. 5. Entitlement to service connection for arthritis of the right ankle. 6. Entitlement to service connection for arthritis of the left ankle. REPRESENTATION Appellant represented by: New Hampshire State Veterans Council WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Vavrina, Counsel INTRODUCTION The veteran had active military service from October 1962 to October 1965. These matters came before the Board of Veterans' Appeals (Board) initially on appeal of a June 2003 rating decision in which the RO denied all of the above claims. The veteran filed a notice of disagreement (NOD) in June 2003; and the RO issued a statement of the case (SOC) in May 2004. The veteran filed a substantive appeal (via a VA Form 9, Appeal to Board of Veterans' Appeals) in June 2004. In February 2004, the veteran testified during a hearing before RO personnel. In September 2004, the veteran testified during a videoconference hearing before the undersigned Veterans Law Judge at the RO. Transcripts of both hearings are of record. In June 2006, the Board remanded the case to the RO via the Appeals Management Center (AMC), in Washington, DC, for additional notice and development. In April 2007, the RO issued a supplemental SOC (SSOC) reflecting continued denial of the claims on appeal. The case has been returned to the Board for further appellate consideration. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate each claim on appeal has been accomplished. 2. Although the veteran has alleged experiencing significant in-service noise exposure, there is no evidence of hearing loss for several years after service, and the only competent, probative opinion to address the question of whether there exists a nexus between alleged in-service noise exposure and the veteran's hearing loss is adverse to the claim. 3. The first clinical evidence reflecting complaints of tinnitus was many years after service, and the only competent, probative opinion indicates that the veteran's tinnitus is not related to service. 4. There is no competent medical evidence that the veteran has, or ever has had, arthritis of either, or both, knees; and the only competent, probative opinion indicates that the veteran's bilateral knee strain is not related to service. 5. This is no competent medical evidence that the veteran has, or ever has had, arthritis of either, or both, ankle; and the only competent, probative opinion indicates that the veteran's bilateral ankle strain is not related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are not met. 38 C.F.R. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385 (2007). 2. The criteria for service connection for bilateral 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). 3. The criteria for service connection for arthritis of the right knee are not met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2007). 4. The criteria for service connection for arthritis of the left knee are not met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2007). 5. The criteria for service connection for arthritis of the right ankle are not met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2007). 6. The criteria for service connection for arthritis of the left ankle are not met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (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) include enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim(s), 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 claim(s); (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 claim(s), in accordance with 38 C.F.R. § 3.159(b)(1). VA's notice requirement 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). Such 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). Id; see also Pelegrini, 18 Vet. App. at 119. However, 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 this appeal, in a May 2003 letter, the RO provided notice to the appellant regarding what information and evidence was needed to substantiate the claims for service connection, as well as what information and evidence must be submitted by the appellant, and what information and evidence would be obtained by VA. While the May 2003 letter did not explicitly advise the appellant to provide any evidence in his possession pertaining to his claims, the claims file reflects that the appellant has provided testimony and submitted evidence in support of his claims. Given that fact, as well as the RO's instructions to him, the Board finds that the appellant has, effectively, been put on notice to provide any evidence in his possession that pertains to the claims on appeal. Accordingly, on these facts, the RO's omission in the May 2003 letter is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006) (rejecting the argument that the Board lacks authority to consider harmless error). Further, letters dated in June 2006 and January 2007 specifically informed the appellant to submit any evidence in his possession pertinent to the claims on appeal. After issuance of the May 2003 letter, and opportunity for the appellant to respond, the May 2004 SOC and April 2007 SSOC reflect readjudication of the claims. Hence, the appellant is not shown to be prejudiced by the timing of VCAA-compliant notice. See Mayfield, 20 Vet. App. at 543; 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 an SOC or SSOC, is sufficient to cure a timing defect). While the claimant was not provided notice as to how disability ratings and effective dates are assigned (if service connection were granted), or the type of evidence that impacts these types of determinations until the June 2006 and January 2007 letters, on these facts, the RO's omission in this regard is not shown to prejudice the appellant. Because the Board's decision herein denies the veteran's claims for service connection, no disability rating or effective date is being, or is to be, assigned. Accordingly, there is no possibility of prejudice to the appellant under the notice requirements of Dingess/Hartman. 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 medical evidence associated with the claims file consists of the veteran's service treatment records, post-service private medical records, a private physician's statement, and the reports of VA examinations. The record also includes statements from the veteran and his representative that records from the Hearing Enhancement Center in Gilford and from another private physician were destroyed in a flood or are unavailable. Also of record and considered in connection with the claims are copies of the hearing testimony and various written statements provided by the veteran and by his representative, on his behalf. In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO, the claimant has been notified and made aware of the evidence needed to substantiate the 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 the 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 matter on appeal, at this juncture. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error and affirming that the provision of adequate notice followed by a readjudication "cures" any timing problem associated with inadequate notice or the lack of notice prior to an initial adjudication). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or from aggravation of a pre-existing injury suffered or disease contracted in the line of duty. See 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2007). Such a determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). A. Hearing Loss and Tinnitus 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 asserts that his exposure to loud noise while in service has caused the claimed bilateral hearing loss and tinnitus. Specifically, he asserts in-service noise exposure while serving as a tank mechanic in Germany, to include riding on a tank down on the firing line as they were firing, and on the firing range to qualify in small arms. He testified that he did not use hearing protection during his military service. The service medical records reflect no complaints, findings, or diagnosis of tinnitus or hearing loss in either ear to an extent recognized as a disability during the period of the veteran's active service. Service medical records include reports of two different hearing evaluations, neither of which show a hearing loss disability as defined by § 3.385. For example, in his September 1965 separation examination report, audiogram findings actually show an improvement in the veteran's hearing at 2,000 and 4,000 Hertz since his October 1962 enlistment audiogram. In October 1962, audiometric testing revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 10 -- 20 LEFT 5 5 15 -- 20 In September 1965, audiometric testing revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 5 15 10 LEFT 15 10 10 10 10 Therefore, the veteran was not found to have right or left ear hearing loss in service. The Board notes, however, that the absence of in-service evidence of hearing loss is not fatal to a claim for service connection. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Competent 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). Although the veteran reported that he was first evaluated for hearing loss in the 1990s (for which no records are available), the first private treatment record reflecting a diagnosis of mixed hearing loss and reported intermittent high frequency hissing tinnitus (not present at the time of evaluation) is dated in March 2003. During that evaluation, the veteran reported a history of serving as a mechanic working on armored vehicles for three years in the Army; including exposure on the firing range to qualify with small arms and riding on the turret of a tank while it was firing and feeling the impact noise of the weapon. Audiometric testing showed the presence of normal low frequency thresholds from 250 to 1,000 Hertz decreasing to mild to moderate sensorineural hearing loss from 2,000 to 8,000 Hertz in both ears. Speech discrimination testing (it is unclear whether the Maryland CNC Test was used) revealed speech recognition scores of 88 percent in the right ear and 96 percent in the left ear. The private audiologist added that the configuration of the veteran's hearing loss is consistent with those seen as a result of exposure to high intensity noise, but offered no opinion as to the onset date of the veteran's hearing loss. As noted above, tinnitus was not present at the time of evaluation. At that time, private audiometric testing revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 50 55 50 LEFT 15 15 35 55 55 During a February 2007 VA audiological evaluation, the veteran's chief complaint was that he "can hear but not understand" what people are saying if there are no visual cues. He stated that he began to notice difficulties around the time of separation from the service. The veteran also reported periodic tinnitus in both ears which he stated varies between sounding like a "high-pitched ring" to various noises. He stated that he experiences this daily for several minutes and, although it was long-standing in nature, he could not be more specific as to the exact date of onset. The veteran gave a history of being a tank mechanic in service for about two years without wearing any hearing protection and recalled two instances when he was around tanks being fired on the range without wearing any hearing protection. Post-service occupational noise exposure included working as a welder in a machine shop for about two years without wearing any hearing protection. Recreationally, the veteran stated that he has done sporadic target shooting without wearing any hearing protection and motorcycling and snowmobiling without wearing a helmet. He also reported using a chainsaw and doing car engine repairs without wearing ear protection. Audiometric testing revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 60 65 60 LEFT 15 15 40 55 55 Speech audiometry revealed speech recognition ability of 96 percent in the both ears. Diagnoses included periodic tinnitus in both ears. Hearing sensitivity in both ears was within normal limits from 250 through 1,000 Hertz, then abruptly sloping to moderately-severe sensorineural hearing loss from 2,000 Hertz through 8,000 Hertz in the right ear and sloping from mild to moderately-severe sensorineural hearing loss from 2,000 Hertz through 4,000 Hertz, recovering to moderate at 6,000 Hertz and mild at 8,000 Hertz in the left ear. After a review of the claims file and both hearing transcripts, the VA examiner noted that, although the veteran stated that his hearing loss began around the time of separation and that he was around significant noise while he was in the service, both his enlistment and separation examinations showed hearing sensitivity to be within normal limits in both ears. In addition, no worsening of hearing was noted from the time of entry to the time of separation. The examiner added that the veteran also had significant post-service noise exposure and that there is a significant asymmetry between the ears which raises the possibility of medical pathology. In view of all of this, the examiner opined it is less likely as not that the veteran's hearing loss and tinnitus are related to military service. Considering the claims for service connection for hearing loss and for tinnitus in light of the record and the governing legal authority, the Board finds that these claims must be denied. As noted above, the post-service evidence supports a finding of current hearing loss to an extent recognized as a disability in both ears as defined by § 3.385. The veteran has complained of ringing in his ears and has been diagnosed with bilateral tinnitus. In Charles v. Principi, 16 Vet. App. 370 (2002), the U. S. Court of Appeals for Veterans Claims (Court) determined that tinnitus is the type of disorder associated with symptoms capable of lay observation. However, the veteran's claims for service connection for hearing loss and tinnitus must be denied because there is no probative evidence whatsoever of a medical nexus between either disability and the veteran's period of service. As noted above, there is no evidence of complaints, findings, or diagnosis of either disability until many years after service discharge. The Board points out that 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). This is especially so here where the veteran has had significant post-service noise exposure, both recreationally and occupationally. Moreover, the only opinion addressing both the etiology and onset of the veteran's hearing loss and tinnitus weighs against the claims. The February 2007 VA examiner reviewed the veteran's complaints and description of noise exposure, both during and after service, and the medical evidence in the claims file. However, after examining the veteran, the examiner concluded that neither the veteran's hearing loss nor tinnitus was incurred in service. This opinion constitutes the only opinion to address the relationship between the veteran's current hearing loss and tinnitus and service, and neither the veteran nor his representative has identified, presented, or alluded to the existence of a contrary medical opinion-i.e., one that, in fact, establishes a relationship between hearing loss and/or tinnitus and service. In this regard, the Board notes that the March 2003 private audiologist stated that the configuration of the veteran's hearing loss is consistent with those seen as a result of exposure to high intensity noise, but offered no opinion as to the onset date of the veteran's hearing loss nor linked it to service. Finally, he noted that tinnitus was not present on evaluation. B. Arthritis of the Knees and Ankles Where a veteran served 90 days or more during a period of war or after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within 1 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. The veteran contends that he has arthritis in both his knees and his ankles related to service. During his testimony, he indicated that he had no problems with his knees or his ankles during basic training at Ft. Dix, New Jersey and that it was not until he went to Ft. Knox, Kentucky for advanced individual training that he got to a point where he could not even walk in formation or sleep at night. The veteran stated that he did not go to the medics for treatment because of pride and that his drill sergeant would let him walk at his own pace back and forth in the schools and classrooms and that he did not have to take any physical training while he was down there. He testified that he first saw a doctor for his knees and ankles either in the late 1970s or the late 1980s, but that the doctor has since moved on and he could not find any records. The veteran denied any injury in service or prior to service. He also asserts that a private doctor diagnosed him with arthritis in 2003 and that this doctor provided a statement linking his arthritis to service. However, considering the pertinent evidence of record in light of the above governing legal authority, the Board finds that service connection for arthritis of the knees and ankles is not warranted. Service medical records reflect no complaints, findings, or diagnosis pertaining to either of the veteran's knees or ankles. On both his enlistment and separation examination reports, clinical findings were noted to be normal for both his lower extremities and feet. On the medical history portions of both of these reports, the veteran had checked "Yes" for cramps in his legs. On his enlistment examination report, the examiner had annotated leg cramps are with awkward position. The separation examiner had annotated that the veteran's last leg cramps were at the age of 13 or 14 years and were described as growing pains. This examiner had noted that the veteran had reported that he had fractured his ankle prior to service at 15 years of age and had been treated at the Concord Hospital in Concord, New Hampshire. But there is no documentation in the record confirming this. Post-service medical records show that, in March 2003, the veteran reported that he has had problems with his ankles and knees since he was stationed at Fr. Knox in the mid-1960s and that he was having more difficulties with inclines and hills and that he has aching that lasts much of the day at times. Following only a physical examination that revealed full range of motion of the extremities and no edema or tenderness, the private physician provided an assessment of osteoarthritis. This physician, in a statement dated the following day, indicated that the veteran had osteoarthritis that he has suffered from for years which likely began during his active duty period, since serving at Ft. Knox. During a February 2007 VA joints examination, the veteran reported that when he was at Ft. Knox, he had ankle and knee pain but he was not seen at sick call for this. The examiner noted that there are no service medical records indicating any problems with the veteran's ankles or knees and that his separation examination notes that the lower extremities were normal. Private medical records contain a March 2003 primary care visit where the veteran did report knee and ankle pain; no other records indicate this. With regards to his ankles, the veteran complained of a chronic ache, which got intermittently worse with weather or with activity or with walking on uneven ground. He stated that occasionally they crack and pop and that, from time to time, he has lower extremity edema and weakness when in pain. However, the veteran denied any redness. With regard to his knees, the veteran found that sitting with his knees bent causes them to be more stiff and sore, especially the first thing in the morning, greater on the left than the right. He reported it is a chronic ache, intermittently worse with inactivity, with going up and down stairs or with cold or rainy weather. The veteran stated that his knees occasionally creak and pop and are weak and that he has a high tolerance for pain and just deals with it. He was unable to give a pain number on the pain scale nor was he able to state the frequency of flare- ups for either his ankles or knees. The veteran was unable to give the distance he can walk prior to his ankles and knees flaring up and stated that he has increased knee pain with driving. He has missed no days from work. On physical examination, the veteran's knees were not particularly tender and had full range of motion, with pain noted at 90 degrees when flexed. The ankles were nontender to palpation with crepitus noted with range of motion. Both dorsiflexion and plantar flexion was a little less than full on range of motion testing. X-rays taken of both knees and ankles were normal. The diagnoses were chronic bilateral knee and ankle strain. After a review of the claims file, the examiner stated that she was unable to determine the relationship of the veteran's knee and ankle conditions in regard to his military service without resorting to mere speculation. The examiner added that there are no service medical records with complaints about his knees or ankles, and only one primary care note in the claims file where the veteran complains of his knees and ankles. Moreover, there was no documentation in the chart regarding an ankle bone chip when the veteran was 15 years old. Thus, as regards the claimed arthritis of both ankles and knee, as indicated above, nothing pertaining to either the veteran's ankles or knees was shown in service. Although, on VA examination in February 2007, the VA examiner assessed chronic bilateral knee and ankle strain, there was no evidence of arthritis as x-rays of both knees and ankles were normal. There is otherwise no medical evidence of any arthritis of his knees or ankles except for a March 2003 private treatment note that was based solely on a physical examination and the veteran's self-reported history. No x- rays were taken to confirm a diagnosis of osteoarthritis. Hence, it is clear from the medical evidence of record that the veteran has never been diagnosed radiologically with arthritis in either knee or ankle, and neither he nor anyone acting on his behalf has presented or identified any contrary medical evidence. Where, as here, the competent evidence establishes that the veteran does not have the problems underlying these claims, there can be no associated disability upon which to predicate a grant of service connection on any basis. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, the claim for service connection for arthritis of the knees and ankles must be denied because the first essential criterion for a grant of service connection- evidence of the claimed disability-has not been met. The Board also finds that there is no competent and persuasive opinion on the question of nexus between the current disabilities of the veteran's knees and ankles and service. In fact, the most persuasive medical opinion on the question of whether there exists such a medical relationship weighs against the claims. The only medical evidence that tends to support the veteran's claims is the March 2003 statement of his primary care physician in which that physician opined that the veteran had osteoarthritis that likely began during his active duty period as a result of difficulties since serving at Ft. Knox. This physician did not indicate that the claims file or any pertinent medical records were reviewed and no rationale was provided for this opinion other than the veteran's self- reported history. He did not even have x-rays taken. In any event, the Board finds that this opinion is too speculative in nature to support a grant of service connection. Medical opinions expressed in speculative language do not provide the degree of certainty required for medical nexus evidence. 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). Accordingly, this opinion is not accorded any great probative weight. The probative value of that opinion is further diminished by the fact that his conclusion is not supported by any medical rationale. See Tirpak v. Derwinski, 2 Vet. App. 609 (1992) (medical possibilities and unsupported medical opinions carry negligible probative weight). By contrast, the Board accords great probative value to the February 2007 VA examiner's opinion, and finds it to be dispositive of the question of whether the veteran, in fact, suffers from arthritis of either knee or ankle. Clearly, the reviewing examiner reached her conclusions only after examination of the veteran, and review of the veteran's service and post-service records. The examiner indicated that the veteran was interviewed and his medical history and complaints were noted. Hence, the Board finds that the most persuasive medical evidence that specifically addresses the question of whether the veteran has arthritis or any other disability of the knees or ankles militates against the claims. The VA examiner was unable to determine the relationship of the veteran's knee and ankle conditions in regard to his military service without resorting to mere speculation. Even the veteran testified that he could not point to any injury in service as a precursor of his knee and ankle problems. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The Board finds the February 2007 opinion by the VA medical examiner persuasive evidence on the question of medical relationship between the currently diagnosed chronic strain of the veteran's knees and ankles and service, inasmuch as the opinion was clearly based upon both examination of the veteran and consideration of his documented medical history and assertions, and because the rationale underlying the opinion is reasonable and consistent with the evidence of record. The Board notes, in particular, that the opinion of the VA examiner is consistent with the veteran's testimony that he first sought treatment for knee and ankle complaints in the late 1970s or late 1980s and had not sought treatment while in service and the lack of x-ray findings of either arthritis or an old fracture of the ankle. As the Board accords the February 2007 opinion more probative weight, it follows that the preponderance of the evidence is against a finding that current bilateral knee and ankle disabilities are medically related to service. See Hayes, 5 Vet. App. at 69-70. See also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). C. All Disabilities In addition to the medical evidence, the Board has considered the veteran's testimony and his and his representative's written assertions; however, none of this evidence provides a basis for allowance of the claims. Matters of diagnosis and etiology are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the veteran and his representative are not shown to be other than laypersons without the appropriate medical training and expertise, neither is competent to render a probative (persuasive) opinion on a medical matter. See, e.g., 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"). Hence, the lay assertions in this regard have no probative value. Under these circumstances, the Board finds that each claim for service connection must be denied. In reaching each conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the competent, probative evidence is against each claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53- 56 (1990). ORDER Service connection for bilateral hearing loss is denied. Service connection for bilateral tinnitus is denied. Service connection for arthritis of the right knee is denied. Service connection for arthritis of the left knee is denied. Service connection for arthritis of the right ankle is denied. Service connection for arthritis of the left ankle is denied. ____________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs