Citation Nr: 1027337 Decision Date: 07/22/10 Archive Date: 08/02/10 DOCKET NO. 07-15 001 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for urinary incontinence (claimed as urinary tract infections (UTIs) or sexually transmitted diseases (STDs)). 2. Entitlement to service connection for peripheral neuropathy of the right lower extremity. 3. Entitlement to service connection for peripheral neuropathy of the left lower extremity. 4. Entitlement to service connection for tinnitus. 5. Entitlement to service connection for right ear hearing loss. 6. Entitlement to service connection for left ear hearing loss. 7. Entitlement to service connection for interstitial pneumonitis, idiopathic pulmonary fibrosis, to include as secondary to asbestos exposure. 8. Entitlement to service connection for residuals of torn tendons of the right ankle, claimed as a foot disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Jason R. Davitian, Counsel INTRODUCTION The Veteran served on active duty from September 1952 to July 1954, and from August 1965 to August 1967, with additional service in the Naval Reserve. This case is before the Board of Veterans' Appeals (BVA or Board) on appeal from a January 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky, which denied the benefits sought on appeal. The Board observes that the RO addressed the issue of entitlement to service connection for bilateral hearing loss. However, in light of the fact that the Veteran does not have right ear hearing loss for VA purposes, as explained more below, the Board will address each ear's hearing loss separately. The issue of entitlement to service connection for residuals of torn tendons of the right ankle, claimed as a foot disorder, is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The competent clinical evidence does not show that the Veteran has urinary incontinence (claimed as UTIs or STDs). 2. The competent clinical evidence does not show that the Veteran has peripheral neuropathy of the right lower extremity. 3. The competent clinical evidence does not show that the Veteran has peripheral neuropathy of the left lower extremity. 4. The competent clinical, or credible lay, evidence does not show that the Veteran has tinnitus. 5. The competent clinical, or credible lay, evidence does not show that the Veteran has right ear hearing loss for VA purposes. 6. Left ear hearing loss was initially demonstrated years after service, and has not been shown by competent clinical, or credible lay, evidence of record to be related to active service. 7. Interstitial pneumonitis, idiopathic pulmonary fibrosis, was initially demonstrated years after service, and has not been shown by competent clinical evidence of record to be related to active service or asbestos exposure during active service. CONCLUSIONS OF LAW 1. Urinary incontinence (claimed as UTIs or STDs) was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304 (2009). 2. Peripheral neuropathy of the right lower extremity was not incurred in or aggravated by active service, and may not be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 1112, 1131, 1133, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2009). 3. Peripheral neuropathy of the left lower extremity was not incurred in or aggravated by active service, and may not be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 1112, 1131, 1133, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2009). 4. Tinnitus was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304 (2009). 5. Right ear hearing loss was not incurred in or aggravated by active service, and may not be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 1112, 1131, 1133, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2009). 6. Left ear hearing loss was not incurred in or aggravated by active service, and may not be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 1112, 1131, 1133, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2009). 7. Interstitial pneumonitis, idiopathic pulmonary fibrosis, was not incurred in or aggravated by active service, and may not be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1110, 1112, 1131, 1133, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) As provided for by the VCAA, VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2009). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (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 in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). For claims pending before VA on or after May 30, 2008, 38 C.F.R. § 3.159 was amended to eliminate the requirement that VA request that a claimant submit any evidence in his or her possession that might substantiate the claim. See 73 FR 23353 (Apr. 30, 2008). Here, the VCAA duty to notify was satisfied by an August 2005 letter that fully addressed all necessary notice elements and was sent prior to the initial AOJ decision in this matter. The letter informed the appellant of what evidence was required to substantiate the claims and of the appellant's and VA's respective duties for obtaining evidence. The criteria for assignment of an effective date and disability rating in the event of award of the benefit sought were provided in a May 2007 letter. See Dingess v. Nicholson, 19 Vet. App. 473 (2006); 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting the Veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained VA treatment records. The Veteran has submitted private medical evidence. VA has a duty to provide a VA examination when the record lacks sufficient evidence to decide the veteran's claim, but contains evidence of (1) a current disability, (2) an in-service event, injury, or disease, and (3) some indication that the claimed disability may be associated with the established event, injury, or disease. See 38 C.F.R. § 3.159(c)(4) (2009); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). As discussed below, the Veteran's claims for service connection for urinary incontinence (claimed as UTIs or STDs), peripheral neuropathy of the right lower extremity, peripheral neuropathy of the left lower extremity, tinnitus and right ear hearing loss are being denied because there is no clinical evidence of a current disability for VA purposes. Thus, these claims do not warrant VA examinations. Id. VA examinations and opinions with respect to the Veteran's hearing loss and interstitial pneumonitis claims were obtained in June 2007 and January 2009. 38 C.F.R. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA opinions obtained in this case are more than adequate, as they are predicated on a reading of the Veteran's claims file, medical records and the results of physical examination. They consider all of the pertinent evidence of record, to include the statements of the Veteran, and provide rationales for the opinions offered. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to these issues has been met. 38 C.F.R. § 3.159(c) (4); Nieves-Rodriguez v. Peake, 22 Vet App 295 (2008). Significantly, neither the appellant nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. In this regard, while a June 2007 VA audiology examination report refers to a private hearing examination several years earlier, the report of which is not of record, the Board points out that the Veteran failed to submit such report or request that VA obtain it. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio, supra. Relevant Laws A veteran is entitled to service connection for a disability resulting from a disease or injury incurred or aggravated during active service. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection also is permissible for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). If there is no evidence of a chronic condition during service, or during an applicable presumptive period, then a showing of continuity of symptomatology after service is required to support the claim. See 38 C.F.R. § 3.303(b). Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. See Savage v. Gober, 10 Vet. App. 488, 495-498 (1997). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). Acute and subacute peripheral neuropathy are listed at 38 C.F.R. § 3.309(e). They must become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). The Secretary of VA (Secretary) has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 59 Fed. Reg. 341-346 (1994); see also 61 Fed. Reg. 57586- 57589 (1996). Notwithstanding the foregoing presumptive provisions, the Court of Appeals for the Federal Circuit (Federal Circuit) has held that a claimant is not precluded from establishing service connection for a disease averred to be related to herbicide exposure, as long as there is proof of such direct causation. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). See also Brock v. Brown, 10 Vet. App. 155, 160-61 (1997), vacated on other grounds (Fed. Cir. Dec. 15, 2000). In this case, the Veteran's service personnel records reflect active military service in the Republic of Vietnam during the Vietnam Era. Thus exposure to herbicides is presumed. 38 C.F.R. § 3.307(a)(6)(iii). Certain chronic diseases, including sensorineural hearing loss and bronchiectasis, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Hearing loss disability for VA purposes is defined by regulation, and may be shown by the following: (1) when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hz is 40 decibels or greater, or (2) when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hz are 26 decibels or greater; or (3) when speech recognition using the Maryland CNC Test is less than 94% correct. 38 C.F.R. § 3.385 (2009). When audiometric test results at separation from service do not meet the regulatory requirements for establishing a disability within the meaning of 38 C.F.R. § 3.385 at that time, a veteran may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 160 (1993). There is no specific statutory guidance with regard to asbestos- related claims, nor has the Secretary of VA promulgated any regulations in regard to such claims. However, VA has provided adjudicators with some guidelines in addressing claims involving asbestos exposure, as set forth in the Veteran's Benefits Administration Manual M21-1, Part IV, 7.21 (Manual). The Court of Appeals for Veterans Claims (Court) has held that VA must analyze an appellant's claim for service connection for asbestosis or asbestos-related disabilities under the appropriate administrative guidelines. Ennis v. Brown, 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). The Manual notes that asbestos particles have a tendency to break easily into tiny dust particles that can float in the air and stick to clothes, and may be inhaled or swallowed. Inhalation of asbestos fibers may produce fibrosis (the most commonly occurring of which is interstitial pulmonary fibrosis or asbestosis), tumors, pleural effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, and cancers of the lung, bronchus, gastrointestinal tract, larynx, pharynx, and urogenital system (except prostate). Occupations involving asbestos exposure include mining, milling, shipyard work, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products (such as clutch facings and brake linings), and manufacture and installation of products such as roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. High exposure to asbestos and a high prevalence of disease have been noted in insulation and shipyard workers. The latent period for development of disease due to exposure to asbestos ranges from 10 to 45 or more years (between first exposure and the development of the disease). Clinical diagnosis of asbestosis requires a history of asbestos exposure and radiographic evidence of parenchymal lung disease. The adjudication of a claim for service connection for a disability resulting from asbestos exposure should include a determination as to whether or not (1) service records demonstrate the veteran was exposed to asbestos during service; (2) development has been accomplished sufficient to determine whether or not the veteran was exposed to asbestos either before or after service; and (3) a relationship exists between exposure to asbestos and the claimed disease in light of the latency and exposure factors. See Manual M21-1, Part VI, 7.21. It should be noted that the pertinent part of the Manual guidelines on service connection in asbestos-related cases are not substantive rules, and there is no presumption that a veteran was exposed to asbestos in service. Dyment v. West, 13 Vet. App. 141 (1999), aff'd, Dymet v. Principi, 287 F.3d 1377 (Fed. Cir. 2002); VAOPGCPREC 4-2000. In each case where a veteran is seeking service connection for any disability, due consideration shall be given to the places, types, and circumstances of such veteran's service as shown by such veteran's service record, the official history of each organization in which such veteran served, such veteran's medical records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 38 U.S.C.A. § 5107(b). Analysis Based on a thorough review of the record, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for urinary incontinence (claimed as UTIs or STDs), peripheral neuropathy of the right lower extremity, peripheral neuropathy of the left lower extremity, tinnitus and right ear hearing loss. The Veteran's post-service medical records are negative for clinical findings or diagnoses of urinary incontinence, peripheral neuropathy of the right or left lower extremity, tinnitus or right ear hearing loss. The report of a June 2007 VA audiology examination provides that the Veteran's chief complaint was hearing loss. Current pure tone thresholds, in decibels, were: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 15 20 30 Speech audiometry revealed speech recognition ability of 96 percent in the right ear. These audiometric findings do not represent right ear hearing loss for VA purposes. 38 C.F.R. § 3.385. The report also provides there was no history of tinnitus, and that the Veteran denied tinnitus during the appointment. The examiner offered a medical opinion that the Veteran denied clinically significant tinnitus at that day's appointment. This VA examination report is highly probative evidence that the Veteran does not have right ear hearing loss or tinnitus, as it was based on current audiological testing and reflects the Veteran's own denial of tinnitus. The Board recognizes the Veteran's general claims that he has urinary incontinence, peripheral neuropathy of the right and left lower extremities, tinnitus and right ear hearing loss. Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). As such, the Board notes that the Veteran is competent to provide testimony concerning factual matters of which he has first hand knowledge, such as symptoms. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). As a layperson, however, the Veteran is not competent to provide an opinion requiring medical knowledge, such as a medical diagnosis. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492, 494 (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"). Thus, his own contentions do not constitute competent medical evidence that he has urinary incontinence, peripheral neuropathy of the right or left lower extremity, tinnitus or right ear hearing loss. In this regard, the Board also points out that the Veteran denied tinnitus during the June 2007 VA examination. The Board does not doubt the Veteran's credibility as to his reported symptoms. Nevertheless, the medical record before the Board, including VA treatment and examination reports, provides no clinical confirmation that he has the claimed disorders. "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C.A. § 1110 (formerly § 310). In the absence of proof of a present disability, there can be no valid claim. The Board's perusal of the record in this case shows no competent proof of present disability. Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992)." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As there is no clinical confirmation of urinary incontinence (claimed as UTI or STD), peripheral neuropathy of the right lower extremity, peripheral neuropathy of the left lower extremity, tinnitus or right ear hearing loss, service connection must be denied. Turning to the Veteran's claim for service connection for left ear hearing loss, the Veteran contends that he has this disorder as a result of noise exposure during active duty. Based on a thorough review of the record, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for left ear hearing loss. The Veteran's service treatment records are negative for complaints, symptoms, findings or diagnoses of left ear hearing loss during either period of active duty. Because hearing loss was not seen during either period of active duty, service connection may not be established based on chronicity in service or continuity of symptomatology thereafter. 38 C.F.R. § 3.303; Savage v. Gober, 10 Vet. App. 488, 494- 97 (1997). Because hearing loss was not seen within one year of either of the Veteran's separations from service, presumptive service connection is not warranted. 38 C.F.R. §§ 3.307 and 3.309. The Veteran's post-service medical records do not show left ear hearing loss for decades after his separation from his second period of active duty. The Federal Circuit has determined that a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The report of a June 2007 VA examination reflects that the examiner reviewed the Veteran's claims file, and sets forth the Veteran's subjective complaints, noise exposure history, and medical history. The Veteran reported noise exposure from utilizing paint chippers, power sanders and paint guns without hearing protection during his first period of active duty. The Veteran reported noise exposure during his second period of active duty due to his regular duties on a landing/docking ship in Vietnam. He was also exposed to noise from operating small PBR patrol boats around the ship when it was anchored, and from M60 machine gun fire while ferrying supplies upriver on patrol boats. He was also exposed to noisy diesel engine sounds. The Veteran reported significant civilian occupational noise during 17 years of fabricating metal parts at metal companies. He also reported a significant amount of hunting over the years with guns. Current pure tone thresholds, in decibels, were: HERTZ 500 1000 2000 3000 4000 LEFT 25 30 35 45 50 Speech audiometry revealed speech recognition ability of 92 percent in the left ear. These audiometric findings represent left ear hearing loss for VA purposes. 38 C.F.R. § 3.385. The examiner diagnosed mild to moderate to left sensorineural hearing loss. The examiner expressed the opinion that the Veteran's current bilateral hearing loss was less likely as not (less than 50/50 probability) caused by or a result of noise exposure in the military. As a rationale, the examiner pointed out that the military physicals for the Veteran's enlistments and separations showed normal whispered voice testing results. The service treatment records contained no complaint or treatment of hearing loss. The first medical evidence of hearing loss was at that examination. The Board finds that this opinion is highly probative evidence against service connection. It was based on current examination results and an accurate review of the medical record. It is supported by reference to audiometric findings in the medical record. This fact is particularly important, in the Board's judgment, as the reference makes for a more convincing rationale. The Board also notes that there is no competent medical evidence to the contrary. Further, with respect to Hensley, the Board finds it significant that the Veteran's normal separation whispered voice testing results were not the sole rationale for the negative opinion. The examiner also referred to the long period of time between the Veteran's active duty and the initial complaint or treatment for hearing loss. The Board is aware of the Veteran's own contentions. However, the Veteran himself is not competent to diagnose the etiology of his own disability. See Bostain, supra, citing Espiritu, supra. See also Routen, supra ("a layperson is generally not capable of opining on matters requiring medical knowledge"). As a result, his assertions cannot constitute competent medical evidence that he has left ear hearing loss disability due to active duty. The Board is aware that lay testimony is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr, supra. 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, supra. Nevertheless, while the Veteran is competent to observe continuity of left ear hearing loss since service, his opinion is outweighed by the lack of probative medical evidence in support of his claim. In this regard, while the Board acknowledges that the absence of any corroborating medical evidence supporting the Veteran's assertions, in and of itself, does not render the statements incredible, such absence is for consideration in determining credibility. See Buchanan, supra (noting that the absence of contemporaneous medical documentation may go to the credibility and weight of veteran's lay testimony, but the lack of such evidence does not, in and of itself, render the lay testimony incredible). Simply stated, the Board finds that the service treatment records (containing no complaints of left ear hearing loss) and post-service medical records (containing medical evidence that the Veteran's post-service left ear hearing loss was not incurred or aggravated during service) outweigh the Veteran's contentions. In sum, the medical evidence demonstrates that the Veteran is not entitled to service connection for left ear hearing loss. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). Turning to the Veteran's claim for service connection for interstitial pneumonitis, idiopathic pulmonary fibrosis, the Veteran contends that he has this disability due to asbestos exposure during active duty. He asserts that while on ship he slept in compartments with pipes wrapped in asbestos. Based on a thorough review of the record, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for interstitial pneumonitis, idiopathic pulmonary fibrosis, to include as due to exposure to asbestos. As the evidence discussed below shows, there is simply no evidence that the Veteran had interstitial pneumonitis, idiopathic pulmonary fibrosis, during active duty, or that his current interstitial pneumonitis, idiopathic pulmonary fibrosis, is related to his active duty or to exposure to asbestos therein. The Veteran's service personnel records reflect that he served as a Boatswain's Mate during his second period of active duty. The Veteran's service treatment records are negative for complaints, symptoms, findings or diagnoses related to interstitial pneumonitis, idiopathic pulmonary fibrosis. Because interstitial pneumonitis, idiopathic pulmonary fibrosis, was not seen during either period of active duty, service connection may not be established based on chronicity in service or continuity of symptomatology thereafter. 38 C.F.R. § 3.303; Savage v. Gober, 10 Vet. App. 488, 494- 97 (1997). Because bronchiectasis was not seen within one year of either of the Veteran's separations from service, presumptive service connection is not warranted. 38 C.F.R. §§ 3.307 and 3.309. In a November 2005 medical report, a private physician states that he had treated the Veteran since April 2005. The Veteran had severe interstitial lung disease. His biopsy was consistent with a diagnosis of usual interstitial pneumonitis, which was a form of idiopathic pulmonary fibrosis. This report does not provide any medical opinion or evidence linking the Veteran's interstitial pneumonitis, idiopathic pulmonary fibrosis, to his military service, or to asbestos exposure therein. The report of a January 2009 VA respiratory examination relates that the examiner reviewed the Veteran's service treatment records, VA medical records and private medical records. The Veteran's onset of shortness of breath was in 1993. The Veteran was a Boatswain's Mate and slept in compartments with pipes wrapped in asbestos. He was in the Reserves for 21 years. He was a fire inspector at LD from 1974 to 1978, and was exposed to asbestos as LDD was converted to central air. The report reviews the Veteran's medical history and the results of current physical, radiographic and pulmonary functioning examination. The diagnosis was idiopathic pulmonary fibrosis or asbestosis. The examiner stated that this diagnosis was less likely as not (less than 50/50 probability) caused by or a result of the inservice exposure to asbestos. As a rationale, the examiner explained that he had reviewed the Veteran's records, pulmonary function tests and chest X-ray. He related that the Veteran had severe pulmonary fibrosis but he could find no evidence in the Veteran's service treatment records that he had significant exposure to asbestos. He noted that the Veteran was exposed to it later, in civilian life. The Board finds that this VA medical opinion is highly probative evidence against service connection for interstitial pneumonitis, idiopathic pulmonary fibrosis. It is based on current examination results and a review of the medical record. It is supported by reference to the Veteran's own reported exposure to asbestos. There is no competent medical evidence to the contrary. The Board is aware of the Veteran's own assertions linking his current interstitial pneumonitis, idiopathic pulmonary fibrosis, to his service. These contentions do not support his claim. As a general matter, lay statements are considered to be competent evidence when describing the features or symptoms of an injury or illness. See Falzone v. Brown, 8 Vet. App. 398, 405 (1995). The Veteran himself, as a layperson, is not competent to provide an opinion requiring medical knowledge or a clinical examination by a medical professional, such as an opinion addressing the etiology of a condition. See Bostain, supra, citing Espiritu, supra. See also Routen, supra ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Turning to asbestos exposure, there is no evidence, other than the Veteran's own lay assertions, that he was exposed to asbestos while on active duty. He has not demonstrated that he has the competence to classify any particulate matter with which he came in contact as asbestos, or to relate that such exposure resulted in his current interstitial pneumonitis, idiopathic pulmonary fibrosis. See Espiritu, supra. Indeed, there is no evidence corroborating the Veteran's claimed exposure. His MOS of Boatswain's Mate is not noted by VA as involving asbestos exposure. See M-21, part VI, para. 7.21(b). In short, other than his own belief that he was exposed to asbestos, there is nothing in the record to suggest that he was. In sum, the medical evidence demonstrates that the Veteran is not entitled to service connection for interstitial pneumonitis, idiopathic pulmonary fibrosis, to include as secondary to exposure to asbestos. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See generally Gilbert, supra; Ortiz, supra. ORDER Service connection for urinary incontinence (claimed as UTIs or STDs is denied. Service connection for peripheral neuropathy of the right lower extremity is denied. Service connection for peripheral neuropathy of the left lower extremity is denied. Service connection for tinnitus is denied. Service connection for right ear hearing loss is denied. Service connection for left ear hearing loss is denied. Service connection for interstitial pneumonitis, idiopathic pulmonary fibrosis, to include as secondary to asbestos exposure, is denied. REMAND The Board finds that the issue of entitlement to service connection for residuals of torn tendons of the right ankle, claimed as a foot disorder, requires additional development. In the report of a June 2007 VA orthopedic examination, the VA examiner noted that he was asked to provide an opinion as to the etiology of the Veteran's right ankle disability, and whether it was due to or a result of an ankle injury during active duty. The VA examiner stated that he could not resolve this issue without resorting to mere speculation, and offered a rationale. The VA examiner concluded that he was "unable to state that his [the Veteran's] right ankle injury is due to his ankle sprain in the military, and cannot give a definitive etiology at this time." The Board finds that this opinion is inadequate because the VA examiner failed to use the proper standard. The VA examiner addressed the issue of etiology as requiring a "definitive" answer. However, the correct standard is whether it is at least as likely as not (50 percent or more likelihood) that the Veteran's right ankle disability is due to or a result of an ankle injury during active duty. The law is clear that when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b) (West 2002). Stated another way, VA has an equipoise standard akin to the rule in baseball that "the tie goes to the runner." Gilbert, supra. The Court has held that once the Secretary undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, he must provide an adequate one. See Barr, supra; see also 38 C.F.R. § 4.2 (2009) (noting that if the examination report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes). In light of the foregoing, a VA medical opinion is still required to address the likelihood that the Veteran's right ankle disability is due to or a result of an ankle injury during active duty. See McLendon, supra. Accordingly, the case is REMANDED for the following action: 1. Provide the claims folder to an appropriate VA examiner to determine the nature, extent and etiology of the Veteran's right ankle disability. The claims file must be made available to the examiner. Following a review of the relevant evidence in the claims file, including the Veteran's service treatment records, the June 2007 VA examination report and the Veteran's own contentions, the examiner is asked to opine whether it is at least as likely as not (50 percent or more likelihood) that any current right ankle disability is causally related to the Veteran's active duty. The examiner is requested to offer a complete rationale for any opinion provided. An additional examination of the Veteran should be scheduled only if deemed necessary to provide the requested opinion. 2. Then, readjudicate the Veteran's claim. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided a supplemental statement of the case and afforded an opportunity to respond. The case should be returned to the Board for appellate review. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ____________________________________________ ROBERT E. SULLIVAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs