Citation Nr: 1237654 Decision Date: 11/02/12 Archive Date: 11/09/12 DOCKET NO. 04-19 965 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a skin disorder. 2. Entitlement to service connection for bilateral hearing loss. REPRESENTATION Appellant represented by: Virginia A. Girard-Brady, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James R. Siegel, Counsel INTRODUCTION The Veteran served on active duty from November 1965 to October 1968 and from May 1974 to May 1978. These matters come to the Board of Veterans' Appeals (Board) on appeal from a September 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) that concluded new and material evidence had not been received to reopen claims for service connection for a skin disorder and for bilateral hearing loss. When this case was originally before the Board in August 2005, it found new and material evidence had been presented and the claims were reopened. Additional development was directed. By decision dated September 2006, the Board denied service connection for a skin disorder and bilateral hearing loss. The Veteran appealed these determinations to the United States Court of Appeals for Veterans Claims (Court) which, by decision dated February 2009, vacated the Board's September 2006 decision. In September 2009, the Board remanded the claim in order to ensure due process and for additional development of the record. The issue of service connection for a back disability was most recently before the Board in September 2009. Based on the receipt of additional evidence, the RO, by rating action dated September 2010, granted service connection for degenerative joint disease and degenerative disc disease of the lumbar spine. The Board also notes that a statement of the case addressing claims for an earlier effective date for an award of service connection for a low back disability, an earlier effective date for an award of a total rating based on individual unemployability due to service-connected disability; and an earlier effective date for an award of Dependents Educational Assistance under 38 U.S.C.A. Chapter 35 was issued in May 2012. A substantive appeal has not been received as to these matters. By letter dated June 2012, the Board informed the Veteran that the Veterans Law Judge who conducted his hearing in May 2005, is no longer employed with the Board. He was afforded the opportunity to have another hearing, but by letter dated later that month, declined the offer. FINDINGS OF FACT 1. There has been no demonstration by competent medical, or competent and credible lay, evidence of record that the Veteran has a skin disorder that is etiologically related to military service. 2. The Veteran's preexisting hearing loss in the left ear did not increase in severity during service. 3. There has been no demonstration by competent medical, or competent and credible lay, evidence of record that the Veteran has hearing loss disability in the right ear that is etiologically related to military service. CONCLUSIONS OF LAW 1. A skin disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 55107 (West 2002); 38 C.F.R. § 3.303(b). 2. Pre-existing left ear hearing loss was not aggravated by active service, and may not be presumed (as an organic disease of the nervous system, to have been so aggravated. §§ 1110, 1131, 1153, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.306 (2011). 3. Hearing loss disability in the right ear was not incurred in or aggravated by active service, nor may sensorineural hearing loss be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2011). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act The Veterans Claims Assistance Act (VCAA) redefined VA's duty to assist the appellant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2011). Duty to Notify The notice requirements of the VCAA require VA to notify a Veteran of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2011). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA 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 v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule). In any event, where complete notice is not timely accomplished, such error may be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). By letters dated in August 2005 and December 2009, issued subsequent to the rating decision on appeal, the RO provided notice to the Veteran regarding what information and evidence were needed to substantiate his claims for service connection, as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. The December 2009 letter advised the Veteran of how the VA assigns a disability rating and an effective date, and the type of evidence which impacts such. Although VCAA notice was provided after the initial rating decision denying the claims, the Veteran has not been prejudiced thereby. Subsequent thereto, the claims were readjudicated in a supplemental statement of the case issued in September 2010. Duty to Assist The record reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the appellant. Specifically, the information and evidence that have been associated with the claims file include the service treatment records, service personnel records, Social Security Administration records, private and VA medical records, the reports of VA examinations, a statement from a nurse, letters from the Veteran's siblings, and the testimony of the Veteran at a hearing before a Veterans Law Judge. The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. McLendon v. Nicholson, 20 Vet. App. 79 (2006). If VA provides a claimant with an examination in accordance with the duty to assist, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). VA examinations were conducted, and opinions regarding the etiology of the Veteran's skin disability and bilateral hearing loss were obtained. The VA opinions were rendered by medical professionals and a factual foundation for the conclusions that were reached has been set forth. Therefore, the Board finds that the opinions are adequate. See Nieves-Rodriguez, 22 Vet. App. at 304. As discussed above, the appellant was notified and made aware of the evidence needed to substantiate his claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. The Veteran has been an active participant in the claims process by submitting evidence and providing testimony. Thus, he has been provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notice is not shown to have affected the essential fairness of the adjudication or to cause injury to the claimant. Therefore, any such error is harmless and does not prohibit consideration of these matters. See Conway, supra; Dingess, supra; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). Analysis The Board has reviewed all the evidence in the appellant's claims file. Although there is an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection on a direct-incurrence basis there must be medical evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Barr v. Nicholson, 21 Vet. App. 303 (2007); Pond v. West, 12 Vet App. 341, 346 (1999). I. Skin disorder The evidence supporting the Veteran's claim includes his statements and some of the findings of record. On VA general medical examination in August 1969, the Veteran reported an eruption of bumps on his chest appeared in 1966. An examination of the skin disclosed 20-30 pinpoint lesions in the central region of the chest at the lower sternal region and upper epigastric area. The assessment was chronic folliculitis in the lower central chest and upper abdomen. The service treatment records show the Veteran was seen in March 1975 for a boil on his chest which he said had been present since 1967. He related it occurred yearly, comes to a head, then pops by itself or the Veteran pops it himself. An examination revealed a large lesion at the base of the sternum and the medial chest. It was tender and there was some discoloration. The assessment was possible cyst. The next day, it was noted he had a recurring boil which was injected. The Veteran reported in October 1975 that he had a history of a rash in his groin. The assessment was tinea. It was noted he had a rash on his body in February 1977. The Veteran complained of a rash in his groin for seven days in May 1977. The assessment was jock itch. The Veteran was afforded a VA Agent Orange examination in August 1989. He asserted he had a constant rash on his chest since Vietnam. An examination disclosed pitted lesions on his chest. VA medical records show the Veteran was referred to the dermatology clinic in April 1989 for pitting scars on his anterior chest. It was noted he had previously been seen by dermatology. When seen in May 1989, the Veteran reported a history of an eruption on his chest from 1966 to 1971. Following an examination, the assessment was history of folliculitis without facial acne, possibly secondary to Agent Orange, now resolved. A skin tag on the nape of his neck was noted in November 1996. Additional VA outpatient treatment records reveal the Veteran was seen from 2000 to 2001 for complaints related to a rash. In a January 2003 letter, R.R. wrote that she is a registered nurse. She stated she reviewed the Veteran's medical records from service and asserted there was sufficient documentation to validate the Veteran's compensation claims. She believed there was documentation he was affected by Agent Orange and that he was still receiving treatment to help relieve his discomfort due to a skin condition. In statements dated in February 2003, the Veteran's siblings wrote he was healthy prior to service and that he had been experiencing a lot of medical conditions since 1967. The evidence against the Veteran's claim includes the service treatment records and the post-service findings. The service treatment records from the Veteran's first period of active duty are negative for complaints or findings pertaining to a skin disability. A report of medical history in September 1968 shows he denied a history of skin disease. On the separation examination in September 1968, the skin was evaluated as normal. The Veteran again denied skin disease on the report of medical history at the time of his entrance examination prior to his second period of service. The skin was normal on examination at that time. On the separation examination in January 1978, the skin was evaluated as normal. The skin was again clinically normal on an examination for the Reserves in December 1982. The Veteran was seen in a VA dermatology clinic in March 2000. He described an itchy rash on his chest he had since January 2000 after trying a new cologne. The assessment was probable irritant contact dermatology with secondary changes. It was noted he had a one year history of eczematous dermatitis in April 2001. The Veteran was afforded a VA examination for the skin in January 2006. The examiner noted he reviewed the claims folder. The Veteran said his skin was drier in the summer and he used moisturizing agents. It was indicated that any folliculitis or localized cellulitis such as a furuncle occurred very infrequently and, at most, once a year and generally over the anterior thoracic area. The diagnosis was folliculitis, cleared, anterior chest wall. The examiner stated this was noted in March 1975 and by description and in association with his examination findings that day, he believed it represented the same areas of involvement long having cleared. There was no evidence of current or recent activity of folliculitis in the parasternal area. The examiner added that the eczematous dermatitis for which the Veteran was treated in 2001 is a new development and not related to service. Thus, he opined it was less likely as not that the Veteran had a cutaneous affliction currently or in the past that was related to service. The record is devoid of any complaint or finding relative to skin problems for many years following his second period of service. Evidence of a prolonged period without medical complaint is for consideration. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed.Cir.2000). While the fact that a skin disorder was initially documented many years after service is not dispositive, it is crucial evidence and, combined with the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition). In light of the absence of any skin problems for so many years after service, the Board finds that the objective medical evidence of record outweighs the credibility of his reported onset and continuity of symptomatology. Such records are more reliable, in the Board's view, than the Veteran's unsupported and contradictory assertions of the onset of his symptomatology. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) [VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence]; see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) [contemporaneous evidence has greater probative value than history as reported by the veteran]. The Veteran's allegations that he has had a rash constantly since his service in Vietnam is contradicted by findings in the record showing he denied skin problems in January 1978 and December 1982. It is also significant to point out that the VA examiner concluded, following a review of the record, that a skin problem, if present, was not related to service. He specifically concluded that the skin problem for which the Veteran received treatment in 2001 was distinct from the condition he was treated for in service. The Board acknowledges that a nurse stated the Veteran was being treated for a skin condition. She also related she reviewed his service treatment records and thought his claim was validated. The Board observes she provided no rationale for her opinion. The Board finds the opinion of the VA physician is entitled to greater probative value as he summarized the relevant in-service and post-service findings and furnished an explanation for his conclusions. The Board also acknowledges the Veteran's assertions that he has a skin disorder that is related to service. However, as a lay person, he is not competent to diagnose skin disease, or render an opinion as to its cause or etiology, as that requires medical expertise which he is not shown to possess. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed.Cir.2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Although the Veteran is competent to testify as to the fact he had skin problems in service, where the determinative issue involves a question of medical diagnosis or causation, only individuals possessing specialized medical training and knowledge are competent to render such an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The evidence does not reflect that the Veteran currently possesses a recognized degree of medical knowledge that would render his opinions on medical diagnosis or causation competent. The Board concludes, therefore, that the medical findings are of greater probative value than the Veteran's allegations regarding the etiology of any current skin disorder. Accordingly, the Board finds the preponderance of the evidence is against the claim for service connection for a skin disability. II. Bilateral hearing loss Under the governing criteria, every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by service. 38 U.S.C.A. § 1111. For purposes of aggravation of a preexisting injury, such aggravation will be said to have occurred where there is an increase of disability during active military, naval or air service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306; Paulson v. Brown, 7 Vet. App. 466, 468 (1995). Clear and unmistakable evidence is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. Aggravation may not be conceded, however, where the disability underwent no increase in severity during service. 38 C.F.R. § 3.306(b). See Falzone v. Brown, 8 Vet. App. 398, 402 (1995) (holding that the presumption of aggravation created by section 3.306 applies only if there is an increase in severity during service); Akins v. Derwinski, 1 Vet. App. 228, 232 (1991). In addition, temporary flare-ups, even in service, will not be considered sufficient to establish an increase in severity unless the underlying condition, as contrasted to the symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292, 295 (1991), Browder v. Brown, 5 Vet. App. 268, 271 (1993). See also Daniels v. Gober, 10 Vet. App. 474, 479 (1997). If a preexisting disorder is noted upon entry into service, the Veteran cannot bring a claim for service connection for that disorder, but the Veteran may bring a claim for service-connected aggravation of that disorder. In that case, section 1153 applies and the burden falls on the Veteran to establish aggravation. See Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). If the presumption of aggravation under section 1153 arises, the burden shifts to the government to show a lack of aggravation by establishing "that the increase in disability is due to the natural progress of the disease." 38 U.S.C.A. § 1153; see also 38 C.F.R. § 3.306; Jensen, 19 F.3d at 1417. Where a veteran served 90 days or more during a period of war, or during peacetime service after December 31, 1946, and sensorineural hearing loss becomes manifest to a degree of 10 percent or more within one year from date of termination of such service, such disease shall be presumed to have been incurred in or aggravated by 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. 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 of 500, 1,000, 2,000, 3,000 and 4,000 Hertz is 40 decibels or greater; or when the thresholds for at least three of these frequencies 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 (2009). With regard to hearing loss, 38 C.F.R. § 3.385 defines what constitutes the existence of a hearing loss disability. For service connection, it is not required that a hearing loss disability by the standards of 38 C.F.R. § 3.385 be demonstrated during service, although a hearing loss disability by such standards must be currently present, and service connection is possible if a current hearing loss disability can be adequately linked to service. Ledford v. Derwinski, 3 Vet. App. 87 (1992). In Hensley v. Brown, 5 Vet. App. 155, the United States Court of Appeals for Veterans Claims held that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. The service treatment records from the Veteran's first period of service are negative for complaints or findings concerning hearing loss. An audiometric evaluation on the enlistment examination in April 1974 revealed that the hearing threshold levels in decibels in the right ear were 5, 5, 10, 15 and 15, at 500, 1,000, 2,000, 3,000 and 4,000 Hertz, respectively. At corresponding frequencies in the left ear, the hearing threshold levels were 10, 5, 10, 15 and 30. The ears were evaluationed as clinically normal on the separation examination in January 1978. An audiogram showed the hearing threshold levels in decibels in the right ear were 10, 10, 10 and 15, at 500, 1,000, 2,000 and 4,000 Hertz, respectively. At corresponding frequencies in the left ear, the hearing threshold levels were 15, 10, 10 and 30. The discharge certificates show the Veteran was a heavy equipment repairman during his first period of service, and an infantryman in his second period of service. A report of medical history for the Reserves in December 1982 discloses the Veteran denied ear trouble or hearing loss. An audiogram revealed the hearing threshold levels in decibels in the right ear were 15, 5, 10, 20, and 20 at 500, 1,000, 2,000, 3,000 and 4,000 Hertz, respectively. At corresponding frequencies in the left ear, the hearing threshold levels were 20, 5, 5, 20 and 25. The Veteran filed a claim for service connection for several disabilities in December 1988, but did not raise a claim involving hearing loss. On Agent Orange examination in August 1989, it was indicated that auditory acuity was normal. An audiogram at a VA facility in May 1990 showed that the Veteran's hearing was within normal limits through 2,000 Hertz, but there was a mild sensorineural hearing loss present above that point. When he was seen in October 2002, the Veteran reported a hearing loss in his left ear since 1974. He said he now had bilateral hearing loss. It was stated that he had a bilateral sensorineural hearing loss. In her January 2003 statement, R.R. indicated she had reviewed the Veteran's medical records from service. She noted she was a registered nurse and that the Veteran had hearing loss due to the fact that no safety equipment was provided for the loud sounds of tanks and other ordinance used during battles. Statements from the Veteran's siblings dated February 2003 reflect he had a lot of medical problems since 1967. The Veteran was afforded an audiometric examination by the VA in January 2006. He stated he served in the infantry in Vietnam and worked on tanks and heavy equipment. He maintained that soon after service, he received "drops" for his ears and they were for the ringing in them. Otherwise, he denied a history of medical problems with his ears. He noted he had to qualify with firearms for his employment with the Department of Corrections. He also related that he started hunting as a teenager and the still hunted occasionally. Following audiometric testing, the diagnosis was bilateral mild to moderate sensorineural hearing loss. The examiner noted that a review of the claims folder showed the Veteran had normal hearing bilaterally when he entered service in 1965. His hearing was also normal on the September 1968 separation examination. He noted the Veteran had normal hearing in the right ear and a mild hearing loss at 4,000 Hertz in the left ear in April 1974. The examiner observed that other frequencies were better than at the time of the September 1968 audiometric test. He added that the exit physical in January 1978 was similar to the entrance examination in April 1974. He also pointed out that the audiometric test for the Reserves in December 1982 revealed normal hearing for all frequencies tested. He commented he found no entries regarding hearing loss even four years after service. He also indicated the Veteran had a personal history of noise exposure from hunting and as a corrections officer after service to account for the hearing loss. He opined it was not as likely as not that the Veteran's hearing loss was related to service. Since the entrance examination in April 1974 demonstrates the Veteran had a hearing loss in the left ear, the presumption of soundness at entrance does not attach in this case. See Wagner v. Principi, 370 F. 3d 1089 (Fed. Cir. 2004). Since there is no presumption of soundness in this case, the issue in this case is whether the Veteran's preexisting hearing loss in the left ear chronically increased in severity during service. In order to support a finding of aggravation, the evidence must establish that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306(a). There is nothing in the clinical record to suggest the Veteran's preexisting hearing loss in his left ear increased in severity during service. The service treatment records show no complaints or findings concerning a hearing loss during the Veteran's second period of service. In addition, the audiometric test conducted on the discharge examination in January 1978 revealed the same threshold level at 4,000 Hertz (30) as was present on the enlistment examination. Thus, the same degree of hearing loss in the left ear was noted on entrance and separation examinations. In this regard, the Board emphasizes that the VA examiner observed the entrance and separation examinations were similar. It is clear from this opinion that the VA examiner concluded the Veteran's preexisting hearing loss in his left ear did not increase in severity in service. Further, the record is devoid of any complaint or finding relative to a hearing loss in either ear for many years following service. This is highly probative evidence against the Veteran's allegation that the hearing loss in his left ear increased in severity during service, or that a hearing loss was present in the right ear. The record is devoid of any complaint or finding relative to hearing loss in the right ear for many years following service. Evidence of a prolonged period without medical complaint is for consideration. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed.Cir.2000). While the fact that right ear hearing loss was initially documented many years after service is not dispositive, it is crucial evidence and, combined with the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition). In light of the absence of hearing loss for so many years after service, the Board finds that the objective medical evidence of record outweighs the credibility of his reported onset and continuity of symptomatology. Such records are more reliable, in the Board's view, than the Veteran's unsupported and contradictory assertions of the onset of his symptomatology. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) [VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence]; see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) [contemporaneous evidence has greater probative value than history as reported by the veteran]. The Board also acknowledges the Veteran's assertions that his left ear hearing loss was aggravated in service, or that the hearing loss in his right ear is related in any way to service. However, as a lay person, he is not competent to diagnose a disability or render an opinion as to the cause or etiology of such disorder as that requires medical expertise which he is not shown to possess. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed.Cir.2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Although the Veteran is competent to testify as to the fact he was subjected to acoustic trauma, where the determinative issue involves a question of medical diagnosis or causation, only individuals possessing specialized medical training and knowledge are competent to render such an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The evidence does not reflect that the Veteran currently possesses a recognized degree of medical knowledge that would render his opinions on medical diagnosis or causation competent. To the extent the Veteran alleges the VA examination of January 2006 was inadequate because it failed to consider he was subjected to acoustic trauma in service, the Court already rejected this argument in its February 2009 decision, noting the examiner predicated his opinion on the fact the Veteran had normal hearing during and after service. The Board also notes that contrary to his assertion his hearing loss has been present since service, the Veteran specifically denied hearing loss in December 1982, four years after service. Thus, the Board finds his claim is not credible. The Board concludes, therefore, that the medical findings are of greater probative value than the Veteran's allegations regarding the etiology of a bilateral hearing loss. Accordingly, the Board finds the preponderance of the evidence is against the claim for service connection for bilateral hearing loss. Additional considerations In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER Service connection for a skin disorder is denied. Service connection for bilateral hearing loss is denied. ____________________________________________ U. R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs