Citation Nr: 1304347 Decision Date: 02/07/13 Archive Date: 02/19/13 DOCKET NO. 08-33 519 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for diabetes. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for a skin disability, including as a result of exposure to asbestos. 4. Entitlement to service connection for visual problems. 5. Entitlement to service connection for bilateral hearing loss. 6. Entitlement to service connection for tinnitus. 7. Entitlement to service connection for hepatitis C. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD A. Cryan, Counsel INTRODUCTION The Veteran served on active duty from April 1978 to March 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas dated in August 2007, July 2008, and April 2009. The Board notes that additional records from the Texas Department of Corrections were received by VA in August 2011 without a waiver of review by the agency of original jurisdiction (AOJ). The records refer to treatment for diabetes, hypertension, a skin disorder, and visual complaints. Although a supplemental statement of the case was issued in February 2012 with regard to the issues of entitlement to service connection for diabetes, hypertension, and a skin disorder, the issue of entitlement to service connection for visual problems was not included on the supplemental statement of the case. Although the records include subjective complaints of cataracts, the records do not include any objective evidence of an eye disorder including cataracts. Consequently, the Veteran is not prejudiced by the Board's adjudication of the issue of entitlement to service connection for visual problems. FINDINGS OF FACT 1. The Veteran does not have diabetes that is attributable to active service. 2. The Veteran does not have hypertension that is attributable to active service. 3. The Veteran does not have an eye disability that is attributable to active service 4. The Veteran does not have bilateral hearing loss attributable to his period of active service. 5. The Veteran does not have tinnitus attributable to his period of active service. 6. The Veteran does not have hepatitis C attributable to his period of active service. CONCLUSIONS OF LAW 1. The Veteran does not have diabetes that is the result of disease or injury incurred in or aggravated during active service. 38 U.S.C.A. §§ 1131, 1133, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 2. The Veteran does not have hypertension that is the result of disease or injury incurred in or aggravated during active service. 38 U.S.C.A. §§ 1131, 1133, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 3. The Veteran does not have an eye disability that is the result of disease or injury incurred in or aggravated during active service. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 4. The Veteran does not have bilateral hearing loss that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1131, 1133, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385 (2012). 5. The Veteran does not have tinnitus that is the result of disease or injury incurred in or aggravated during active service. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 6. The Veteran does not have hepatitis C that is the result of disease or injury incurred in or aggravated during active service. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist Upon receipt of a substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. The notice must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004). If VA does not provide adequate notice of any of element necessary to substantiate the claim, or there is any deficiency in the timing of the notice, the burden is on the claimant to show that prejudice resulted from a notice error, rather than on VA to rebut presumed prejudice. Shinseki v. Sanders, 129 S.Ct. 1696 (2009). The Board finds that any defect with regard to the timing or content of the notice to the appellant is harmless because of the thorough and informative notices provided throughout the adjudication and because the appellant had a meaningful opportunity to participate effectively in the processing of the claims with an adjudication of the claims by the RO subsequent to receipt of the required notice. The record does not show prejudice to the appellant, and the Board finds that any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Specifically, the Veteran was notified in letters dated in April 2007, June 2007, January 2008, October 2008, November 2008, January 2009, and December 2009. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice provided. Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (burden of showing that an error is harmful or prejudicial falls upon the party attacking the agency determination); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Thus, VA has satisfied its duty to notify the appellant and had satisfied that duty prior to the adjudication in the September 2009 statement of the case (with regard to hepatitis C), in the November 2010 supplemental statement of the case (with regard to visual problems, bilateral hearing loss, and tinnitus), and in the February 2012 supplemental statement of the case (with regard to diabetes and hypertension). Overton v. Nicholson, 20 Vet. App. 427 (2006) (Veteran afforded a meaningful opportunity to participate effectively in adjudication of claim, and therefore notice error was harmless). The Board recognizes that assistance shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claims. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R. § 3.159(c)(4) (2012). However, VA's duty to provide a medical examination is not triggered unless the record contains competent evidence of a current disability or symptoms of a current disability; evidence establishing that an event, injury, or disease occurred in service or a disease manifesting during an applicable presumptive period; and an indication that the disability or persistent or recurrent symptoms of a disability may be associated with service or a service-connected disability. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). With respect to the claims for service connection for diabetes, hypertension, visual problems, and hepatitis C, the record is devoid of any competent lay or medical evidence that the disabilities are the result of a disease or injury incurred in or aggravated by active service. The Board is cognizant that there are instances in which lay testimony can serve to establish an association between service and the claimed disability or death for the purpose of requesting an examination. For example, a lay person may be competent to offer testimony on certain medical matters, such as describing symptoms observable to the naked eye, or diagnosing simple conditions such as a dislocated shoulder, and lay testimony as to a continuity of symptomatology can satisfy the requirements and trigger the need for an examination. Layno v. Brown, 6 Vet. App. 465 (1994). However, the Board finds that a lay person is not competent to offer an opinion on a matter clearly requiring medical expertise. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (Veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (certain disabilities are not conditions capable of lay diagnosis). VA must provide a medical examination as necessary to make a decision on a claim, where the evidence of record, taking into consideration all information and lay or medical evidence, including statements of the claimant, and where, the claimant had been diagnosed to have a disability, and had proffered competent lay evidence of continuous symptoms of the disorder, observable by a lay person, since discharge. Where there is evidence of record satisfying two of the requirements, competent evidence of a current disability and evidence indicating an association between the appellant's disability and his active service, but there is not of record, competent medical evidence addressing whether there is a nexus between the claimed disability and active service, VA is required to provide the claimant with a medical examination. Charles v. Principi, 16 Vet. App. 370 (2002); 38 U.S.C.A § 5103A(d)(2) (West 2002). However, the Veteran in this case has not reported a continuity of the symptoms of his claimed disabilities since separation. Instead, he has asserted a relationship between his claimed disabilities and his service which is outside his competence as a layperson. Moreover, the Veteran has not submitted competent evidence to support his blanket assertions in that regard. Therefore, the Board finds that examinations are not necessary in this case because the competent evidence of record does not indicate a relationship between the current disabilities and service. The Board also finds that all of the other duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. The appellant has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist provisions of law. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). II. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). In addition, certain chronic diseases, including hypertension, diabetes mellitus, and sensorineural hearing loss may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C.A. §§ 1101, 1133 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). The chronicity provisions are applicable where evidence, regardless of its date, shows that a Veteran had a chronic condition in service, or during an applicable presumptive period, and still has that disability. That evidence must be medical unless it relates to a condition as to which lay observation is competent. 38 C.F.R. § 3.303(b) (2012). Generally, service connection requires (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. Pond v. West, 12 Vet. App. 341 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995). A. Diabetes The Veteran contends that he should be granted service connection for diabetes because he must have been a diabetic in service and was unaware of this fact. See VA Form 9 dated January 1, 2009. He indicated that he is currently taking medication for diabetes. The Veteran's service treatment reports reflect that labstick glucose tests were negative at the Veteran's entrance examination in March 1978 and at the Veteran's March 1979 separation examination. On a dental health questionnaire dated in April 1978, the Veteran indicated that he did not have diabetes. Treatment records from the Texas Department of Corrections dated in November 2003 indicate that the Veteran had a diagnosis of insulin dependent diabetes, type II first observed in September 1996. The records dated through April 2011 reflect continued treatment for diabetes mellitus. After reviewing the evidence of record and the pertinent laws and regulations, the Board finds the Veteran is not entitled to service connection for diabetes. The Board finds that the competent evidence does not show a relationship between the Veteran's diabetes and his period of active service. The earliest medical evidence of a diagnosis of diabetes was dated in November 2003 when the Veteran was noted to have a diagnosis of diabetes first observed in September 1996. Consequently, the earliest indication of a diagnosis of diabetes came in 1996, more than seventeen years after the Veteran left service. A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after active service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The amount of time that passed between service and the first diagnosis of record of diabetes is also evidence that weighs against the Veteran's claim. The evidence does not reveal a showing of a relationship of the Veteran's diabetes and his period of active service. The Veteran has not submitted any competent evidence which provides a basis for the conclusion that the Veteran's diabetes is related to his period of service or manifested within one year of the Veteran's separation from service. 38 C.F.R. §§ 3.307, 3.309. Although the Veteran contends that he has diabetes related to his active service, he has submitted no competent medical evidence or opinion to corroborate that contention. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). The Veteran's opinion is not competent to provide the requisite etiology of the diabetes because that matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (2012); Duenas v. Principi, 18 Vet. App. 512 (2004); Routen v. Brown, 10 Vet. App. 183 (1997) (layperson is generally not capable of providing opinions on matters requiring medical knowledge, such as the condition causing or aggravating the symptoms); Bostain v. West, 11 Vet. App. 124 (1998); Stadin v. Brown, 8 Vet. App. 280 (1995); Woehlaert, supra. Therefore, his statements regarding his diabetes being related to service are not competent as he is not medically qualified to provide evidence regarding a matter requiring medical expertise, such as an opinion as to etiology. In short, the Board finds that the preponderance of the competent evidence is against a finding that the Veteran had diabetes during service or within a year of the Veteran's separation from service, and the file does not contain competent evidence linking diabetes to service. There is also no lay evidence of any continuity of symptomatology between active service and the Veteran's current diagnosis. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for diabetes, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). B. Hypertension The Veteran contends that he is entitled to service connection for hypertension. He has indicated that he takes medication to control his hypertension. The Veteran's service treatment reports reflect that the Veteran's blood pressure was recorded as 128/82 at his March 1978 entrance examination and as 106/64 at his March 1979 separation examination. The Veteran denied high or low blood pressure on a report of medical history form prepared in conjunction with his entrance examination and he indicated that he was in excellent health and taking no medication on a report of medical history form prepared in conjunction with his separation examination. The clinical records do not include any complaints, findings, or treatment for hypertension. Treatment reports from the Texas Department of Corrections reflect that the Veteran was treated for hypertension. The earliest entry noting a diagnosis of hypertension was in November 2003 and the entry notes that hypertension was first observed in January 1998. After reviewing the evidence of record and the pertinent laws and regulations, the Board finds the Veteran is not entitled to service connection for hypertension. The Board finds that the competent evidence does not show a relationship between the Veteran's hypertension and his period of active service. The earliest medical evidence of a diagnosis of hypertension was dated in November 2003 when the Veteran was noted to have a diagnosis of hypertension first observed in January 1998. Consequently, the earliest indication of a diagnosis of hypertension came in 1998, more than nineteen years after the Veteran left service. A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after active service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The amount of time that passed between service and the first diagnosis of record of hypertension is also evidence that weighs against the Veteran's claim. The evidence does not reveal a showing of a relationship of the Veteran's hypertension and his period of active service. The Veteran has not submitted any competent evidence which provides a basis for the conclusion that the Veteran's hypertension is related to his period of service or manifested within one year of the Veteran's separation from service. 38 C.F.R. §§ 3.307, 3.309. Although the Veteran contends that he has hypertension related to his active service, he has submitted no competent medical evidence or opinion to corroborate that contention. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). The Veteran's opinion is not competent to provide the requisite etiology of the hypertension because that matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (2012); Duenas v. Principi, 18 Vet. App. 512 (2004); Routen v. Brown, 10 Vet. App. 183 (1997) (layperson is generally not capable of providing opinions on matters requiring medical knowledge, such as the condition causing or aggravating the symptoms); Bostain v. West, 11 Vet. App. 124 (1998); Stadin v. Brown, 8 Vet. App. 280 (1995); Woehlaert, supra. Therefore, his statements regarding his hypertension being related to service are not competent as he is not medically qualified to provide evidence regarding a matter requiring medical expertise, such as an opinion as to etiology. In short, the Board finds that the preponderance of the competent evidence is against a finding that the Veteran had hypertension during service or within a year of the Veteran's separation from service, and the file does not contain competent evidence linking hypertension to service. There is also no lay evidence of any continuity of symptomatology between active service and the Veteran's current diagnosis. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for hypertension, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). C. Visual Problems The Veteran indicated that he should be granted service connection for vision problems because his vision has been poor since service and he was not administered vision tests in service. See VA Form 9 dated April 2009. Congenital or developmental defects and refractive error of the eye are not considered to be a disease or injury with the meaning of the statutes governing service connection. 38 C.F.R. §§ 3.03(c), 4.9 (2012). In-service incurrence of a disease or injury is not possible with respect to manifestations of a congenital or developmental defect. Winn v. Brown, 8 Vet. App. 510 (1996) (upholding VA regulations that distinguish a congenital or developmental defect from a disease); Terry v. Principi, 340 F.3d 1378 (Fed. Cir. 2003) (upholding VA regulation that refractive errors of the eye are a congenital defect and thus do not constitute an injury or disease incurred in service). Although a developmental defect may not be considered a disease or injury incurred during service, service connection may nevertheless be available for a disability shown to have resulted from a congenital defect which was subject to a superimposed disease or injury during service. See VAOPGCPREC 82-90 (July 18, 1990). The Veteran's service treatment reports reflect that his visual acuity was 20/20 at his entrance examination dated in March 1978 and at his separation examination dated in March 1979. He denied eye trouble on a report of medical history form prepared in conjunction with his entrance examination and he indicated that he was in excellent health and taking no medication on a report of medical history form prepared in conjunction with his separation examination. The records do not reflect any complaints, findings, or treatment for an eye disability. Treatment records from the Texas Department of Corrections note "vision" first observed in November 2003 as one of the Veteran's active health problems. Diagnosis Code 369.9 is listed with the vision problem which denotes unspecified vision loss. See ICD-9-CM Volume 2 Index. Multiple examinations of the head, eyes, ears, nose, and throat performed during the period from November 2003 to January 2009 reflect that the Veteran's pupils were equal, round, and reactive to light and accommodation and bilateral fundoscopic examination revealed no retinopathy. Optometry consultations dated in October 2000, March 2004, and August 2007 reflect that the Veteran reported near-far vision complaints and was prescribed glasses. His uncorrected visual acuity was 20/100 in the right eye and 20/125 in October 2000; 20/200 in the right eye and 20/200 in the left eye in March 2004; and 20/200 in the right eye and 20/200 in the left eye in August 2007. The Veteran was noted to have an afferent pupillary defect (APD) at those times. The Veteran reported that he was "developing cataracts" in April 2011. However, cataracts were not noted on an April 2011 visual acuity test at which the Veteran's uncorrected visual acuity was 20/400 in the right eye and 20/250 in the left eye. After reviewing the evidence of record and the pertinent laws and regulations, the Board finds the Veteran is not entitled to service connection for visual problems. The Board finds that the competent evidence does not show a relationship between the Veteran's claimed visual problems and his period of active service. The earliest medical evidence of a diagnosis of any eye disability came at the time of the optometry consultation dated in October 2000 at which time was noted to have an APD. Consequently, the earliest indication of a diagnosis of an eye disorder came in 2000, more than twenty years after the Veteran left service. A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after active service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The amount of time that passed between service and the first diagnosis of record of an eye disorder is also evidence that weighs against the Veteran's claim. None of the clinical evidence in the claims file reveals that the Veteran's diminished visual acuity is due to an eye disorder related to service. Moreover, refractive error of the eyes is not a disease for VA purposes and there is no evidence of any superimposed injury to the eyes during service. Although the Veteran contends that he has visual problems related to his active service, he has submitted no competent medical evidence or opinion to corroborate that contention. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). The Veteran's opinion is not competent to provide the requisite etiology of the claimed visual problems because that matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (2012); Duenas v. Principi, 18 Vet. App. 512 (2004); Routen v. Brown, 10 Vet. App. 183 (1997) (layperson is generally not capable of providing opinions on matters requiring medical knowledge, such as the condition causing or aggravating the symptoms); Bostain v. West, 11 Vet. App. 124 (1998); Stadin v. Brown, 8 Vet. App. 280 (1995); Woehlaert, supra. Therefore, his statements regarding his visual problems being related to service are not competent as he is not medically qualified to provide evidence regarding a matter requiring medical expertise, such as an opinion as to etiology. In short, the Board finds that the preponderance of the competent evidence is against a finding that the Veteran had an eye disability during service and the claims file does not contain competent evidence linking an eye disorder to service. There is also no lay evidence of any continuity of symptomatology of an eye disability (aside from poor vision) between active service and any eye disorder. Moreover, the Veteran's report of poor vision in service is not supported by the medical evidence of record which reveals that the Veteran's vision was 20/20 in service. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for visual problems, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). D. Bilateral Hearing Loss and Tinnitus Impaired hearing will be considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater, or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater, or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2012). The Veteran contends that he has hearing loss and tinnitus which resulted from loud noise exposure in service. The Veteran's service treatment reports include audiometric testing performed at his entrance examination dated in March 1978 which revealed puretone thresholds of 10, 10, 5, and 10 decibels in the right ear, at 500, 1000, 2000, and 4000 Hertz and 15, 15, 10, and 15 decibels in the left ear, at 5000, 1000, 2000, and 4000 Hertz. Audiometric testing performed at the Veteran's separation examination revealed puretone thresholds of 5, 5, 5, 0 and 0 decibels in the right ear, at 500, 1000, 2000, 3000, and 4000 Hertz and 5, 5, 0, 0, and 5 decibels in the left ear, at 500, 1000, 2000, 3000, and 4000 Hertz. The Veteran denied hearing loss and ear trouble on a report of medical history form prepared in conjunction with the entrance examination and he indicated that he was in excellent health and took no medication on a report of medical history form prepared in conjunction with the separation examination. Treatment records from the Texas Department of Corrections reveals that that a February 1991 audiometric examination revealed puretone thresholds of 20, 15, 25, 10, and 20 decibels in the right ear, at 500, 1000, 2000, 3000, and 4000 Hertz and 25, 25, 15, 20, and 10 decibels in the left ear, at 500, 1000, 2000, 3000, and 4000 Hertz. In February 2008, the Veteran reported constant ringing in his ears for months. The Veteran reported loud noise exposure during service at that time. At a May 2008 VA audiometric examination, the Veteran reported military noise exposure from firearms, machine guns, mortars, and the firing range with the use of hearing protection. Since service, the Veteran reported using no hearing protection while working as a truck driver. The Veteran reported progressive hearing loss since service and tinnitus for "as long as I can remember." Audiometric testing revealed puretone thresholds of 25, 25, 25, 30, and 40 decibels in the right ear, at 500, 1000, 2000, 3000, and 4000 Hertz, and 25, 25, 25, 30, and 35 decibels for the left ear, at 500, 1000, 2000, 3000, and 4000 Hertz. Speech recognition scores were 96 percent for the right ear and 98 percent for the left ear. The examiner diagnosed the Veteran with mild sensorineural hearing loss above 2000 Hertz. The examiner noted that the claims file had been reviewed and that the Veteran's hearing was normal at his enlistment and discharge from service. The examiner opined that the Veteran's hearing loss was not related to his military service. The examiner's rationale was that once exposure to noise is discontinued, there is no significant further progression of hearing loss as a result of the noise exposure per the Medical-Legal Evaluation of Hearing Loss, 2001. She concluded that any hearing loss measured in the future cannot have been caused by past exposure to high intensity noise in the military. With regard to tinnitus, the examiner indicated that the Veteran did not report a specific event related to the onset of tinnitus and as such the tinnitus is more likely related to the same etiology of the hearing loss which is unrelated to service. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for bilateral hearing loss and tinnitus. There is an absence of any report of hearing loss or tinnitus until the Veteran filed his claims in November 2007. The first diagnosis of bilateral hearing loss based on audiometric testing and a report of tinnitus came at the May 2008 VA examination, almost than thirty years after service. A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The amount of time that passed between service and the first complaint of record of hearing loss and tinnitus weighs against the Veteran's claims. The Board finds that the evidence does not include competent evidence showing a relationship between the Veteran's current hearing loss or tinnitus and his period of military service. The Board acknowledges that the Veteran is competent to report that he was exposed to acoustic trauma in service and has experienced hearing loss symptoms and tinnitus following service. Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). Competent testimony is limited to that which the witness has actually observed and is within the realm of his personal knowledge; such knowledge comes to a witness through use of his senses-that which is heard, felt, seen, smelled, or tasted. Layno v. Brown, 6 Vet. App. 465 (1994). It is within the Veteran's realm of personal knowledge whether he first developed tinnitus in service and hearing loss following service, and has experienced hearing loss symptoms and tinnitus following service. Consequently, the Board finds that the Veteran's reports that he has had hearing loss symptoms and tinnitus following service are credible. However, although the Veteran contends that he has a current hearing loss disability and tinnitus related to his military service, he has submitted no competent medical evidence or opinion to corroborate that contention. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). The Veteran's opinion is not competent to provide the requisite etiology of the hearing loss disability or tinnitus because those matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (2012); Duenas v. Principi, 18 Vet. App. 512 (2004); Routen v. Brown, 10 Vet. App. 183 (1997) (layperson is generally not capable of providing opinions on matters requiring medical knowledge, such as the condition causing or aggravating the symptoms); Bostain v. West, 11 Vet. App. 124 (1998); Stadin v. Brown, 8 Vet. App. 280 (1995); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Therefore, his statements regarding his hearing loss disability and tinnitus being related to noise trauma in his military service are not competent as he is not medically qualified to provide evidence regarding a matter requiring medical expertise, such as an opinion as to etiology. The Board finds the VA audiological evaluation performed in May 2008 to be more probative and persuasive as to the etiology of the Veteran's current hearing loss disability and tinnitus. The examiner provided a thorough rationale for her opinions and cited to medical literature to support those opinions. While the examiner noted that the Veteran had normal hearing at the time of discharge from service, which is not fatal to his claim, the examiner further found that studies supported the unlikelihood of delayed permanent induced hearing loss after cessation of noise exposure. The Board finds that to be sufficient rationale for the opinion. The Veteran has not submitted any competent evidence which provides a basis for the conclusion that bilateral hearing loss is related to his period of service or manifested within one year of his separation from service. 38 C.F.R. §§ 3.307, 3.309 (2012). The only competent medical opinion of record indicates that the Veteran's hearing loss and tinnitus are less likely than not related to military service. Consequently, the Board finds that service connection is not warranted because the medical evidence associated with the claims file does not establish that bilateral hearing loss or tinnitus are etiologically linked to the Veteran's active service. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for bilateral hearing loss and tinnitus and the claims are denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). E. Hepatitis C The Veteran contends that he contracted hepatitis C in service when he was inoculated with an air gun which was used on hundreds of other service members. The Veteran's service treatment reports do not reflect any complaints, findings, or treatment for hepatitis C or any other liver disorder. Treatment reports from the Texas Department of Corrections reveals that in November 2003, the Veteran was noted to have a diagnosis of hepatitis C first observed in October 1998. The records dated through reveal continued treatment for hepatitis C. After reviewing the evidence of record and the pertinent laws and regulations, the Board finds the Veteran is not entitled to service connection for hypertension. The Board finds that the competent evidence does not show a relationship between the Veteran's hepatitis C and his period of active service. The earliest medical evidence of a diagnosis of hepatitis C was dated in November 2003 when the Veteran was noted to have a diagnosis of hepatitis C first observed in October 1998. Consequently, the earliest indication of a diagnosis of hepatitis C came in 1998, more than nineteen years after the Veteran left service. A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after active service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The amount of time that passed between service and the first diagnosis of record of hepatitis is also evidence that weighs against the Veteran's claim. The evidence does not reveal a showing of a relationship of the Veteran's hepatitis C and his period of active service. The Veteran has not submitted any competent evidence which provides a basis for the conclusion that the Veteran's hepatitis C is related to his period of service including the use of air guns for inoculations. Although the Veteran contends that he has hepatitis C related to his active service, he has submitted no competent medical evidence or opinion to corroborate that contention. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). The Veteran's opinion is not competent to provide the requisite etiology of the hepatitis C because that matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (2012); Duenas v. Principi, 18 Vet. App. 512 (2004); Routen v. Brown, 10 Vet. App. 183 (1997) (layperson is generally not capable of providing opinions on matters requiring medical knowledge, such as the condition causing or aggravating the symptoms); Bostain v. West, 11 Vet. App. 124 (1998); Stadin v. Brown, 8 Vet. App. 280 (1995); Woehlaert, supra. Therefore, his statements regarding his hepatitis C being related to service, including the use of air guns for inoculations are not competent as he is not medically qualified to provide evidence regarding a matter requiring medical expertise, such as an opinion as to etiology. In short, the Board finds that the preponderance of the competent evidence is against a finding that the Veteran had hepatitis C during service and the file does not contain competent evidence linking hepatitis C to service. There is also no lay evidence of any continuity of symptomatology between active service and the Veteran's current diagnosis. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for hepatitis C, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). ORDER Entitlement to service connection for diabetes is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for visual problems is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for hepatitis C is denied. REMAND A review of the claims file reveals that a remand is necessary before a decision on the merits of the claim of entitlement to service connection for a skin disability can be reached. The Board acknowledges that the Veteran was scheduled by the RO for a VA examination in November 2010, and it was noted that the Veteran failed to report for that examination. When entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination, and a claimant, without good cause, fails to report for such examination, or reexamination, and the examination was scheduled in conjunction with a claim for increase, the claim shall be denied. 38 C.F.R. § 3.655 (2012). However, as is known to the RO, the Veteran has been incarcerated with the Texas Department of Corrections since January 1991, and is serving a life sentence. VA has a statutory obligation to assist veterans in the development of their claims; the duty to assist incarcerated veterans requires VA to tailor its assistance to meet the peculiar circumstances of confinement as such individuals are entitled to the same care and consideration given to their fellow veterans. 38 U.S.C.A. § 5107(a) (West 2002); Wood v. Derwinski, 1 Vet. App. 190 (1991); Bolton v. Brown, 8 Vet. App. 185 (1995). In particular, the Court of Appeals for Veterans Claims (Court) in Bolton specified that the record contained neither information concerning the efforts expended by the RO in tailoring its examination request to the appellant's incarceration nor any explanation as to why a VA examiner was not directed to perform the examination. In this case, the record contains only the examination request and the notice of failure to report. Here, there is no information provided by the RO as to any efforts made to tailor the examination request to the Veteran's incarceration. The claims file simply contains the examination request, noting that there were two different addresses in VA's system for the Veteran, and the notice of failure to report. The Veteran submitted a statement received in February 2012 and indicated that he was not provided with transportation or an escort for his VA examination. Without the specific information noted in Bolton, the Board cannot conclude that the duty to assist has been satisfied, or that good cause was not shown for the failure to report. Accordingly, the case is REMANDED for the following action: 1. Make every reasonable effort to schedule the Veteran for an examination to determine the etiology of the Veteran's claimed skin disability. If necessary, request that the correctional facility conduct the examination. The claims folders must be made available to and reviewed by the examiner. Any indicated studies should be performed. The report of examination should include a complete rationale for all opinions expressed. Any necessary tests should be obtained. The examiner should provide a diagnosis for the Veteran's claimed skin disability. Thereafter, the examiner should provide an opinion as to whether it is at least as likely that any current skin disability is related to the Veteran's active service, including treatment for pseudofolliculitis barbae treated in service and his claimed exposure to asbestos in service. In addition, the examiner should also specifically state whether there is clear and unmistakable evidence that pseudofolliculitis barbae existed prior to service and, if so, whether pseudofolliculitis barbae was aggravated beyond the natural progression of the disorder by the Veteran's active service. 2. If an examination cannot be scheduled due to the Veteran's incarceration, submit the claims folder for preparation of an opinion as to the etiology of the Veteran's claimed skin disability, based on the claims file review. Also include a memorandum in the claims file including information concerning the efforts expended in tailoring the examination request to the Veteran's incarceration and/or any explanation as to why a VA examiner was not directed to perform the examination. 3. Then, readjudicate the claim. If action remains adverse to the Veteran, issue a supplemental statement of the case, allow the appropriate time for the Veteran and his representative's response, and then return the case to the Board. The appellant has the right to submit additional evidence and argument on the matter or 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. 2012). ____________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs