Citation Nr: 1105374 Decision Date: 02/09/11 Archive Date: 02/18/11 DOCKET NO. 09-00 914 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Fargo, North Dakota THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for tinnitus. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD Patrick J. Costello, Counsel INTRODUCTION The Veteran had active service from November 1961 to November 1963. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2008 rating decision of the Fargo, North Dakota, Regional Office (RO) of the Department of Veterans Affairs (VA). Subsequent to that action, the appellant and his wife provided testimony before the undersigned Acting Veterans Law Judge (AVLJ) in June 2009. A transcript of that hearing was prepared and has been included in the claims folder for review. Upon reviewing the claims folder, the Board referred the matter to the Veterans Health Administration (VHA) for an advisory opinion concerning the service member's claim involving bilateral hearing loss and tinnitus. This occurred in August 2010. See 38 U.S.C.A. § 7109(a) (West 2002) and 38 C.F.R. § 20.901 (2010). See generally Wray v. Brown, 7 Vet. App. 488, 493 (1995). The advisory opinion has been obtained and has been included in the claims folder for review. It is noted that the appellant, along with his representative, were given the opportunity to provide any comments with respect to the opinion and those comments have also been included in the claims folder for review. FINDINGS OF FACT 1. The Veteran's contention that he provided false responses at the time of his service separation audiology examination so that his hearing loss would not be identified in service is deemed as not being credible. 2. The Veteran's statements that he had tinnitus chronically and continuously following service are deemed as not being credible. 3. The objective and probative medical and other evidence of record preponderates against a finding that the Veteran has bilateral hearing loss and tinnitus related to his active military service and a sensorineural hearing loss was not shown to be compensably disabling within one year of separation from active duty. CONCLUSIONS OF LAW 1. Bilateral hearing loss was not incurred in or aggravated by the Veteran's active military service, and a sensorineural hearing loss may not be presumed to be so incurred. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385 (2010). 2. Tinnitus was not incurred in or aggravated by the Veteran's active military service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) specifies VA's duties 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. 2010); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2010). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183 (2002). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (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. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. Following the receipt of the Veteran's February 2008 claims, the RO issued a March 2008 letter which advised the Veteran of the criteria for service connection, among other information. A March 2008 notice also provided information concerning the criteria governing assignment of an evaluation and the effective date that could be assigned, should service connection be granted. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The record establishes that the Veteran has had a full and fair opportunity to participate in the adjudication of his claims. Moreover, the evidence submitted by the Veteran in July 2008, along with his testimony at the 2009 hearing before the undersigned Acting Veterans Law Judge, establishes that he received notice of each element required to substantiate the claims for service connection. The Board concludes that the appeal may be adjudicated without a remand for further notification. Additionally, a review of the claims folder indicates that the appellant's service treatment records were associated with the claims file and he has submitted private clinical records. The Veteran has not indicated that he has applied for or is receiving Social Security Administration (SSA) benefits of any type. Additionally, VA has a duty to obtain a medical examination or opinion when such examination or opinion is necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d). The record reflects that in conjunction with this claim, the appellant underwent a VA audiological examination in April 2008, a copy of which is contained in the claims folder. A review of that examination report notes that a thorough examination of the appellant was accomplished and the opinion provided was supported by sufficient rationale. Therefore, the Board finds that the VA examination is adequate for rating purposes. See Barr v. Nicholson, 21 Vet. App. 303, 311 (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). Moreover, the appellant was given the opportunity to present evidence and testimony before the Board. He provided testimony before the undersigned in June 2009. During that hearing, the appellant described his current conditions and then explained why he believed his current hearing loss and tinnitus were the result of his military service. The appellant was given notice that the VA would help him obtain evidence but that it was up to him to inform the VA of that evidence. During the course of this appeal, the appellant proffered documents and statements in support of his claim. In sum, VA has given the appellant every opportunity to express his opinions with respect to the issues now before the Board and the VA has obtained all known documents that would substantiate the appellant's assertions. 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 v. Principi, supra. II. Factual Background and Legal Analysis The Board has thoroughly reviewed all the evidence in the appellant's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the appellant or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the appellant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As previously indicated, the appellant has come before the VA asking that service connection be granted for bilateral hearing loss and tinnitus. Service connection may be granted for a disability due to a disease or injury which was incurred in or aggravated by active duty. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection may be awarded for a "chronic" condition when a disease defined by statute or regulation as a chronic disease manifests itself and is identified as such in service (or within the presumption period under 38 C.F.R. § 3.307, and the service member presently has the same condition. Organic disease of the nervous system such as sensorineural hearing loss will be presumed to have been incurred in or aggravated by service if it had become manifest to a degree of 10 percent or more within one year of the service member's separation from active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. This presumption is rebuttable by affirmative evidence to the contrary. Id. Service connection may be granted when a disease manifests itself during service (or during the presumptive period) but is not identified until later, there is a showing of continuity of symptomatology after discharge, and medical evidence relates the symptomatology to the service member's present condition. 38 C.F.R. § 3.303; see Savage v. Gober, 10 Vet. App. 488, 495-98 (1997). With respect to the first requirement of a current disability, before service connection may be granted for hearing loss, that loss must be of a particular level of severity. For the purposes of applying the laws administered by the VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory threshold for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz 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. Even though disabling hearing loss may not be demonstrated at separation, a service member may nevertheless establish service connection for a current hearing loss disability by submitting evidence that the current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). The threshold for normal hearing is from zero to 20 decibels and higher threshold levels indicate some degree of hearing loss. Id. (citing Current Medical Diagnosis & Treatment, Stephen A. Schroeder, et. al. eds., at 110-11 (1988)). The record reflects that the appellant served on active duty from November 1961 to November 1963. His service treatment records disclose that auditory thresholds were tested at 500 Hertz (Hz), 1000 Hz, 2000 Hz, and 4000 Hz. The auditory thresholds were 15 decibels (dB) at all tested frequencies, in each ear, at the time of his service entrance examination in September 1961. A service separation examination conducted in August 1963 discloses auditory thresholds of 10 dB at 500 Hz, 10 dB at 1000 Hz, 15 dB at 2000 Hz, and 20 dB at 4000 Hz in the right ear; the auditory thresholds in the left ear were 10 dB at 500 Hz, 10 dB at 1000 Hz, 10 dB at 2000 Hz, and 15 dB at 4000 Hz. Post service, the Veteran submitted records of private audiologic examinations conducted in 1992 and 2000. The January 1992 private audiology examination discloses that he complained of ringing in both ears. In February 2008, the appellant submitted claims for service connection for hearing loss and tinnitus. During his April 2008 VA examination, the appellant reported that he fired 50-caliber machine guns in service. He drove a tractor and worked for Arctic Cat, where he wore hearing protection. He reported that he first sought medical evaluation for hearing loss in 1990. The examination report states that the appellant first noticed hearing loss in 1990, and noticed tinnitus a few years later. The examiner concluded that hearing loss noted in 1990, some thirty years after the appellant's active duty service, and tinnitus noted later, some forty years after his service discharge, were not related to the appellant's military service. In July 2008, the appellant submitted a signed statement from M.T.F., a private clinical audiologist. At the time of private evaluation in July 2008, the appellant reported that there were periods in service during which he was unable to hear inside the armored personnel carrier he drove. He reported that the machine gun mounted on the armored personnel carrier fired very near his head. After the machine gun was fired, the tank commander would have to rap him on the head to get his attention, because the service member could not hear. He reported tinnitus associated with these periods of not being able to hear in service. The Veteran testified that the hearing loss and tinnitus would go away a few hours after the machine gun noise stopped, but recurred intermittently. After the appellant stopped working at Arctic Cat, where he wore noise protection, he reported working worked on a diary farm, where he was not exposed to hazardous noise. He reported that he "faked" the separation examination to show normal hearing because he did not want to delay his service separation. The July 2008 private audiologist stated that the appellant's unprotected noise exposure in service "certainly could have" contributed to or initiated the symptoms of hearing loss and tinnitus. The private provider concluded that, considering the unprotected noise exposure, and the reports of temporary threshold shifts, it was at least as likely as not that the appellant's current hearing loss and tinnitus are related to military service. During his June 2009 Board hearing, the service member testified that he "faked" normal hearing at the time of service separation by watching the examiner and, when the examiner depressed a button, the Veteran said he heard a tone. The Veteran explained that he faked better hearing than he had so that his service discharge would not be delayed by identification of poor hearing. The Veteran testified regarding an incident in 1976 which reminded him of how poor his hearing was, when he could not hear a passenger in his car talking to him. Following the appellant's June 2009 hearing and, upon reviewing the claims folder, the Board determined that additional information was needed with respect to the claim. As referenced above, the claim was forwarded to VHA for the purpose of obtaining an expert otolaryngology opinion with respect to the appellant's assertions. Such an opinion was accomplished in September 2010 - the results of which are provided below. Specifically, the Board requested that the VHA medical expert address the following: Is it at least as likely as not (probability of 50 percent or greater) that any current bilateral hearing loss and tinnitus had its clinical onset during active service or is related to any in- service disease, event, or injury, to include exposure to acoustic trauma such as described by the Veteran? In the September 2010 VHA medical opinion, a VA ear, nose, and throat (ENT) specialist provided the following response: . . . I have reviewed the [Veteran's] induction audiogram from September 1961 which showed completely normal hearing at 500, 1000, 2000 and 4000 Hertz (Hz) and also reviewed the separation audiogram from August 1963 which again showed normal hearing at those same four frequencies. In a letter from [M.F., AuD], in July 2008, the [Veteran] commented that he "faked" a normal separation audiogram so that his discharge would not be delayed. It is impossible for anyone to fake normal hearing when they have a hearing loss, just as it would be impossible for someone to fake normal vision if they had vision loss. Therefore, it is my opinion the separation audiogram is valid. If the acoustic trauma that the Veteran experienced while he was on active military service was significant, there should have been evidence for this as indicated by hearing loss on the separation audiogram. The VHA ENT specialist further stated that, In April 2008, the patient had a compensation and pension (C&P) examination and at that time he stated he first noticed hearing loss in approximately in 1990 and first noticed tinnitus around 1993. Therefore, he did not note hearing loss and tinnitus until 40 years after discharge from active military service, supporting the examiner's opinion that the tinnitus and hearing loss were not related to his military service. On review of the audiometric results on both the audiogram performed by the VA examiner and also performed by Dr. [M.F.], the configuration of the [Veteran's] hearing loss is sloping and consistent with hearing loss secondary to aging. I do not note any significant notching or significant improvement in hearing at 8000 Hz, which would be indicative of a noise induced hearing loss. I feel this is one more piece of evidence the hearing loss is due to aging and not noise exposure. Then, the VHA ENT specialist said that, . . . In summary, this Veteran was on active military service from 1961 to 1963. He insists he was exposed to noise but his induction and separation audiograms reveal normal hearing. He did not complain of hearing loss or tinnitus until 40 years later. Audiograms in 2008 are consistent with hearing loss, secondary to aging and not noise exposure. In addition, as I mentioned earlier, one cannot "fake" normal hearing, so I believe the separation audiogram is valid. A. Hearing Loss The service treatment records establish that the Veteran did not seek medical evaluation for hearing loss during active duty. The Veteran has also testified that he did not seek medical evaluation for hearing loss until 1990 nor is there medical evidence documenting such treatment prior to 1992. This establishes that there is no objective evidence that the Veteran manifested hearing loss disability, as defined for VA purposes, within one year following service separation. Thus, service connection on the basis of a presumption of service connection is not warranted. 38 C.F.R. §§ 3.307, 3.309. The only evidence favorable to the Veteran's contention that he incurred chronic hearing loss during service is the lay evidence provided by him. The Board assumes, for purposes of this decision, that the Veteran is competent to state that he experienced a decrease in his hearing acuity. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Nevertheless, the Board must determine the credibility of the Veteran's lay statement that he experienced this decrease intermittently in service and thereafter. The Veteran contends that the 1963 service separation examination, which discloses that he had normal hearing in both ears, was not accurate. He testified that he deliberately made his hearing test results normal so that his service separation would not be delayed by identification of poor hearing. In support of his contention that hearing loss was present in service, the Veteran testified that he knew he might have hearing loss at the time of his separation examination, but did not want his separation to be delayed if hearing loss was found. Therefore, the Veteran testified, he watched the individual who administered the audiology examination and, whenever the examiner pressed the button to cause a sound, the Veteran indicated that he heard the sound. Thus, the Veteran contends, although the service separation examination appears to show that his hearing was normal, the results of the hearing examination are inaccurate. However, despite the appellant's assertions, in September 2010, a VA ENT medical specialist has, without hesitation and reservation, concluded that "faking" an audiological examination is an impossibility and results of the Veteran's 1963 separation examination are valid. The Veteran also testified that he did not seek medical evaluation of his hearing after service until 1990. A 1992 examination of hearing discloses that he required hearing aids and had tinnitus in both ears by 1992. However, it appears to the Board that, if the Veteran knew in 1963 that his hearing was so poor that he needed to "fake" the hearing test results so that it appeared that his hearing was more normal than it actually was, surely the Veteran would have obtained evaluation of his hearing before 1990, when nearly 30 years had elapsed following his service discharge. The Board further notes that the Veteran's 1963 separation examination audiology results are quite similar to his induction audiology results. In particular, the entrance examination disclosed auditory thresholds of 15 in both ears at all frequencies. The results of his exit examination were quite consistent with the results of entrance examination, since the lowest auditory threshold at separation for either ear, at the frequencies from 250 Hz to 4000 Hz, was 10 dB, and the highest auditory threshold, at those same frequencies, varied only to 20 dB. The Board notes that the only hearing threshold above 20 dB on separation audiology examination was at 8000 Hz. At that frequency, the Veteran's auditory threshold was 30 dB in the right ear. The Veteran testified that his left ear has always been the ear in which his hearing is worst because the machine guns were fired next to his left ear. The Board finds the Veteran's testimony that he faked normal hearing inconsistent his actions after discharge from active service. In particular, the Board notes that the Veteran sought VA dental treatment in 1964, but did not seek evaluation of his hearing until 1990, and did not file a claim for VA compensation for hearing loss until 18 years later. The Board also notes that the Veteran has never indicated that any problems with his hearing were identified while he worked for Arctic Cat. The Veteran has clearly testified that he was required to use hearing protection while working for Arctic Cat. (For purposes of information only, and without reliance thereon, the Board notes that Arctic Cat is a manufacturer of snowmobiles and other cold-weather equipment). Although the Veteran testified that he had little exposure to hazardous noise after service, the record establishes that the Veteran reported post-service employment driving a tractor and working on a dairy farm. While the cows themselves may be quiet, as the Veteran testified, the Veteran did not testify about exposure to noise due to use of machinery, such as tractors and machines required to mix, load, and transport dairy animal and feed, as would be expected on a dairy farm. The Board finds the Veteran's report to the VA and private medical providers that he had no exposure to hazardous noise after service somewhat less than completely credible. In sum, the Veteran's contention that his service separation audiology examination should be considered inaccurate because he faked the examination results appears less than credible. The Veteran's contention that he had hearing loss chronically and continuously following service separation in 1963 seems inconsistent with his failure to seek medical evaluation for his hearing until 1990. The Veteran's testimony and statements that he had no exposure to hazardous noise after his service discharge seems somewhat inconsistent with his occupations in manufacturing, driving a tractor, and farm work. The Board concludes that the Veteran's testimony and statements about poor hearing at service discharge, chronic and continuous hearing loss and tinnitus following service, and lack of exposure to hazardous noise after service, are not credible. The Veteran is competent to state what he experienced, such as experiencing hearing loss. Jandreau v. Nicholson. However, the Board is not required to accept as competent the Veteran's assertions as to the etiology of the noted hearing loss. In this case, the Board finds that the Veteran reports that he experienced hearing loss intermittently but continuously since his discharge from active service less than credible. The Board notes that July 2008 private examination report is favorable to the Veteran's claim for service connection for hearing loss, but that medical statement is based on the Veteran's report to the provider. The Board finds that, since the Veteran's reports are not credible, the Board need not accept as accurate a provider opinion based on the Veteran's statements. The Board is not bound to accept medical opinions that are based on history supplied by the Veteran, where that history is unsupported by the medical evidence or based upon an inaccurate factual background. Black v. Brown, 5 Vet. App. 177 (1993); Swann v. Brown, 5 Vet. App. 229 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993). The Board must weigh the credibility and probative value of the medical opinions, and in so doing, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998) (citing Owens v. Brown, 7 Vet. App. 429, 433 (1995)); see also Wensch v. Principi, 15 Vet. App. 362, 368 (2001) (it is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons and bases for doing so). The Board must account for the evidence it finds persuasive or unpersuasive, and provide reasons for rejecting material evidence favorable to the claim. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). In determining the weight assigned to this evidence, the Board also looks at factors such as the health care provider's knowledge and skill in analyzing the medical data. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993); see also Black v. Brown, 10 Vet. App. 279, 284 (1997). In Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), the United States Court of Appeals for Veterans Claims (Court) held that a claims file review, as it pertains to obtaining an overview of a service member's medical history, is not a requirement for private medical opinions. A review of the claims file by a VA examiner, without more, does not automatically render the VA examiner's opinion competent or persuasive since the claims file is a tool to assist in familiarity for the physician with the claims file, and conversely a private medical opinion may not be discounted solely because the opining clinician did not review the claims file as there are other means by which a physician can become aware of critical medical facts, such as a history of treating the service member for an extended period of time and/or reviewing pertinent medical literature. The relevant focus is not on whether the clinician had access to the claims file, but instead on whether the clinician was "informed of the relevant facts" in rendering a medical opinion. Thus, when VA refers to facts obtained from review of the claims file as a basis for crediting one expert opinion over another, it is incumbent upon VA to point out those facts and explain why they were necessary or important in forming the appropriate medical judgment. Certainly, the particular medical information contained in a claims file may have significance to the process of formulating a medically valid and well-reasoned opinion. The Court further held that a medical opinion that contains only data and conclusions is not entitled to any weight and a review of the claims file cannot compensate for lack of the reasoned analysis required in a medical opinion, which is where most of the probative value of a medical opinion comes is derived. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). In sum, in Nieves-Rodriguez, the Court indicated that it is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion. In this instance, there are three medical opinions of record. One, from a VA examiner, another from a private audiologist, and a third from the VHA ENT specialist. With respect to the private audiologist's hypothesis, that audiologist couched his opinion with the words "could have" whereas the VA examiner's opinion was not equivocal. That examiner was very specific and direct in the opinion he provided. While the private audiologist's opinion could be considered speculative, based on the clarity and specificity provided in the VHA opinion, the VA examiner's opinion does not appear speculative. See generally Bloom v. West, 12 Vet. App. 185 (1999) (a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty). See also 38 C.F.R. § 3.102 (when considering application of the benefit- of-the-doubt doctrine, reasonable doubt is one within the range of probability, as distinguished from pure speculation or remote possibility). The Board would further point to the opinion provided by the VHA ENT physician. This medical specialist was not equivocal, vague, or ambiguous with his assertions and, with respect to the contrary assertion provided by the appellant, he discussed his reasoning as to why that opinion was faulty and without merit. In other words, the Board believes that the VHA physician provided sound reasoning in his analysis of the situation. In other words, the ENT medical specialist reviewed in detail the pertinent medical records, discussed the salient facts, and provided a complete rationale for all conclusions presented, as noted in the discussion above. The Board believes that the private audiologist did not do this. Here, a medical expert has fairly considered all the evidence and his opinion may be accepted as an adequate statement of the reasons and bases for a decision when the Board adopts such an opinion. Wray v. Brown, 7 Vet. App. at 493. The Board does, in fact, adopt the VHA specialist's opinion on which it bases its determination that service connection for bilateral hearing loss is not warranted. The Board attaches the most significant probative value to the VHA doctor's opinion as it is well reasoned, detailed, consistent with other evidence of record, and included an access to the accurate background of the service member. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Thus, the Board finds that the preponderance of the credible, competent evidence is against the Veteran's claim for service connection for bilateral hearing loss. The provisions of 38 U.S.C.A. § 5107(b) regarding reasonable doubt are not applicable. The claim must be denied. B. Tinnitus The service treatment records are devoid of notation of complaints or diagnosis of tinnitus. The post-service private clinical records beginning in 1992 disclose that the Veteran reported tinnitus in both ears. This report, unfortunately, does not indicate the date of onset of tinnitus. The report of the February 2008 VA examination reflects that the Veteran stated that he first noticed hearing loss in 1990, then noticed tinnitus a few years later. This report does not reflect that the Veteran reported that both hearing loss and tinnitus first began in service and continued chronically and continuously thereafter. Thus, the report of the VA examination conflicts in at least two details related to tinnitus with the Veteran's testimony before the Board in June 2009. The Veteran has provided statements and testimony that he had tinnitus chronically and continuously after service. A Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Bruce v. West, 11 Vet. App. 405, 410-11 (1998) (finding Veteran competent to describe dry, itchy, scaling skin); but see Layno v. Brown, 6 Vet. App. 465 (1994) (cautioning that lay testimony that Veteran suffered a particular illness (bronchial asthma) was not competent evidence because matter required medical expertise); see also Jandreau v. Nicholson, supra. The Veteran is competent to state that he experiences ringing in the ears. However, the Board must still weigh the credibility of the Veteran's competent lay testimony that he had tinnitus beginning in service. As noted above, the VA examiner who conducted February 2008 audiologic examination stated that the Veteran reported hearing loss beginning in about 1990, and onset of tinnitus thereafter. The Board notes that this report is more persuasive than the Veteran's later testimony in June 2009. Given that the Veteran's lay statements and testimony are not credible as to onset of hearing loss prior to 1976, the Board finds that the testimony that tinnitus has its onset in service and was chronic and continuous thereafter is not credible. The only evidence favorable to the Veteran's contention that his tinnitus is attributable to his military service is evidence provided by the Veteran himself. The etiology of tinnitus is not a fact readily observable by or within the knowledge of a lay person. See Barr v. Nicholson; Bruce v. West, Layno v. Brown, supra. The Board finds that the Veteran's statements that tinnitus started in service is not credible. The Veteran's discussion of the onset of noticeable hearing loss in 1976 or 1977 is credible evidence that he did not notice tinnitus prior to that date. As that was approximately 15 years after the Veteran's service discharge, his testimony that tinnitus has been constant since service, even if intermittent, is not credible. In this instance, and as discussed above, there are three medical opinions of record. One is from a VA examiner, another is from a private audiologist, and the third from the VHA ENT specialist. Here, a medical expert has fairly considered all the evidence and his opinion may be accepted as an adequate statement of the reasons and bases for a decision when the Board adopts such an opinion. Wray v. Brown, supra. As such, the Board attaches the most significant probative value to the VHA doctor's opinion as it is well reasoned, detailed, consistent with other evidence of record, and included an access to the accurate background of the service member. See Prejean v. West, supra. The Board does, in fact, adopt the VHA specialist's opinion on which it bases its determination that service connection for tinnitus is not warranted While the Veteran maintains that he has bilateral hearing loss and tinnitus related to his active service, as a lay person he has not been shown to be capable of making medical conclusions, thus, his statements regarding diagnosis and causation are not competent. Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997); see also Bostain v. West, 11 Vet. App. 124, 127 (1998). While the Veteran is competent to report what comes to him through his senses, he does not have medical expertise. See Layno v. Brown, 6 Vet. App. at 465. And although the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as decreased hearing, a broken leg, or varicose veins, he is not competent to provide evidence as to more complex medical questions, as is the case here. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The evidence in this case is not so evenly balanced as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The preponderance of the objective and probative medical and other evidence of record is against the Veteran's claims for service connection for bilateral hearing loss and tinnitus and they must be denied. ORDER Service connection for bilateral hearing loss is denied. Service connection for tinnitus is denied. ____________________________________________ D. J. DRUCKER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs