Citation Nr: 1304536 Decision Date: 02/07/13 Archive Date: 02/19/13 DOCKET NO. 09-07 401 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado THE ISSUES 1. Entitlement to service connection for a chronic liver disability, claimed as due to herbicide exposure. 2. Entitlement to service connection for throat nodules, claimed as due to herbicide exposure. 3. Entitlement to service connection for residuals of jungle rot of the left heel. 4. Entitlement to service connection for tinnitus. 5. Entitlement to service connection for bilateral hearing loss disability. 6. Entitlement to service connection for residuals of a left leg wound. REPRESENTATION Appellant represented by: Colorado Division of Veterans Affairs WITNESSES AT HEARING ON APPEAL The appellant and his spouse ATTORNEY FOR THE BOARD Robert E. O'Brien, Counsel INTRODUCTION The Veteran had active service from October 1963 to October 1965. He served in Vietnam from May 1964 to May 1965 and his awards include the Air Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2008 rating decision of the VARO in Phoenix, Arizona. The RO granted service connection for post-traumatic stress disorder, with the assignment of a 50 percent disability rating, effective June 24, 2006, the date of receipt of the Veteran's claim for disability benefits. The case was remanded by the Board in June 2011 for further development. Additional evidence was associated with the claims file and by rating decision dated in October 2012, service connection for migraine headaches was granted. A noncompensable evaluation was assigned. Service connection was also granted for scarring of the right forehead as a residual of a head wound. A noncompensable evaluation was assigned. The effective date for each award was July 24, 2006. FINDINGS OF FACT 1. Tinea pedis was caused by the Veteran's active service. 2. Bilateral hearing loss disability was not caused by the Veteran's active service. 3. Tinnitus was caused by acoustic trauma during the Veteran's active service. 4. The Veteran is not shown to have a current disability resulting from a claimed left leg wound sustained in service. 5. A disability manifested by nodules of the throat is not shown to be related to the Veteran's active service. 6. Elevated bilirubin is a laboratory finding and not a disability for VA compensation purposes. 7. A chronic liver disability is not shown to be related to the Veteran's active service, including herbicide exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for tinea pedis are approximated. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 2. The criteria for service connection for bilateral hearing loss disability are not met. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.385 (2012). 3. The criteria for service connection for tinnitus are approximated. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 4. The criteria for service connection of a disability of the left leg, to include residuals of a left leg wound are not met or approximated. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 5. The criteria for service connection of a chronic liver disorder are not met or approximated. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). 6. The criteria for service connection of a disability manifested by throat nodules are not met or approximated. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA The Veterans Claims Assistance Act of 2000 (VCAA) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002) defines VA's duty to assist a Veteran in the development of a claim. VA regulations for the implementation of the VCAA are codified as amended at 38 C.F.R. §§ 3.102, 3.156 (a), 3.159, 3.326 (a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159 (b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. VCAA notice should be provided to a claimant before the initial RO decision on a claim. See Pelegrini v. Principi, 18 Vet. App. 112 (2004); 38 U.S.C.A. § 5103 (a); 38 C.F.R. § 3.159 (b). The United States Court of Appeals for Veterans Claims (Court) has held the VCAA notice requirements of 38 U.S.C.A. § 5103 (a) and 38 C.F.R. § 3.159 (b) apply to all five elements of a service connection claim. Those elements are: (1) Veteran status; (2) existence of a current 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/Hartmann v. Nicholson, 19 Vet. App. 473 (2006). During a March 2011 hearing, the undersigned discussed the issues on appeal and asked questions designed to elicit relevant evidence. These actions provided an opportunity for the Veteran and his representative to introduce material evidence and pertinent arguments in compliance with 38 C.F.R. § 3.103 (c) (2) and are consistent with the duty to assist. The Veteran has received all required notice, has had a meaningful opportunity to present evidence that will help him develop his claim, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d, 1369 (Fed. Cir. 2004). The Veteran has been sent letters dated between November 2006 and August 2011 that advised him of what evidence would substantiate his claim and detailed the RO's efforts to assist him. The Veteran and his wife testified at a March 2011 hearing before the undersigned sitting at the RO in Denver, Colorado. A transcript of the proceedings is in the claims file. The case was remanded by the Board in June 2011 to obtain further information towards development of the claims. The Veteran was given the opportunity to provide evidence of current diagnoses with regard to throat nodules and other claimed disorders due to herbicide exposure in Vietnam. He was also accorded examinations with opinions pertaining to his tinea pedis. Also, information was to be obtained from the Social Security Administration with regard to a decision regarding the Veteran's eligibility for disability benefits. However, the Veteran informed the Appeals Management Center in Washington, D.C. in a statement dated in August 2011 that he was not receiving disability benefits from the Social Security Administration, but was receiving benefits based on early retirement. The RO/AMC complied with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (indicating the veteran is entitled, as a matter of law, to compliance with a remand directive and the Board itself commits error in failing to ensure this compliance); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999); and D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (discussing situations when it is acceptable to have "substantial," but not "exact" compliance with a remand directive). In sum, the Board finds "it is difficult to discern what additional guidance VA could have provided to the Veteran regarding what further evidence he should submit to substantiate his claim." See Livesay v. Principi, 15 Vet. App. 165, 178 (2001) (en banc) ; Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (observing certain circumstances as to when a remand would not result in any significant benefit to the Veteran). Pertinent Law and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in service incurrence or aggravation of a disease or injury; and (3) a causal relationship, that is, a nexus, between a claimed in service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a) (2012). In addition, sensorineural hearing loss will be presumed to have been incurred in service if it becomes manifest to a degree of 10 percent or more within one year following separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third elements is through a demonstration of continuity of symptomatology. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). A claimant can establish continuity of symptomatology with competent evidence showing: (1) that a condition was "noted" during service; (2) post service continuity of the same symptomatology; and (3) a nexus between a current disability and the post service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-96 (1997); 38 C.F.R. § 3.303 (b). Service connection may also be granted for a disease first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107 (b) West 2002). A lay person is generally incapable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997), affirmed sub nom. Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998), cert. denied, 119 S. Ct. 404 (1998). However, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a lay person is competent to identify the medical condition (e.g., a broken leg, separated shoulder, pes planus, varicose veins, tinnitus, and so forth); (2) the lay person is reporting a contemporaneous medical diagnosis; or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In essence, lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159 (a) (2). A determination as to whether medical evidence is needed to demonstrate that a Veteran currently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the Veteran's current condition (e.g., whether the Veteran's present condition is of a type that requires medical expertise notified as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). Savage, 10 Vet. App. 488, 494-97. When, for example, a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh the testimony and make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C.A. § 1154 (a). See Davidson v. Shinseki, 581 F.3d (1313) (Fed. Cir. 2009). As held in Davidson, 1154 (a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. See also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). ("The Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence" such as actual treatment records). The Veteran is competent to report what he observes or feels through his or her senses. See Layno. When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). "Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Savage, 10 Vet. App. at 496 (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)). Once evidence is determined to be competent, the Board must determine whether the evidence also is credible, as only then does it ultimately have probative value. See Layno, (distinguishing between competency ( "a legal concept determining whether testimony may be heard and considered) and credibility (a factual determination going to the probative value of the evidence to be made after the evidence has been admitted)); Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, whereas credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons or bases for rejecting any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). To this end, the Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F 3d. 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998). Indeed, in Jefferson v. Principi, 271 F.3d, 1072, (Fed. Cir. 2001, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) citing its decision in Madden, recognized that the Board had inherent fact-finding ability. Id. at 1076. The Court similarly has declared that, in adjudicating a claim, the Board has a responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing when he/she has testified. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); see also Macarubbo v. Gober, 10 Vet. App. 388 (1997) (similarly holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial plausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor). The determination as to whether these requirements for service connection are met is based on an analysis of all the relevant evidence of record, medical and lay, and the evaluation of its competency and credibility to determine its ultimate probative value in relation to other evidence. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Bilateral Hearing Loss and Tinnitus For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; or the auditory thresholds in at least three of the frequencies, 500, 1,000, 2,000, 3,000 or 4,000 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. At the time of an April 2007 VA audiological examination, pure tone thresholds, in decibels were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 25 20 40 LEFT 10 10 5 10 45 With the auditory threshold at 4,000 Hertz being 40 decibels or greater, the Veteran has established that he has a hearing loss disability consistent with VA regulations. The Veteran was also accorded an audiological evaluation by VA in May 2010. At that time the examiner reported pure tone audiometry revealed a bilateral mild high frequency sensorineural hearing loss. The Veteran has also met the current disability requirement with regard to tinnitus, as this disorder was diagnosed at the time of the 2007 examination and at the time of audiological examination accorded the Veteran by VA in 2010. The Veteran is competent to state that he has tinnitus, and the Board finds his testimony credible. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (ringing in the ears is capable of lay observation). As to in service acoustic trauma, the Veteran testified during the Board hearing that he was exposed to loud noises while participating in sustained aerial flight in support of combat operations in Vietnam. His Report of Separation from the Armed Forces (DD-Form 214) reflects that he was awarded the Air Medal and this, along with his presumed credible testimony, establishes that he engaged in combat with the enemy. Pursuant to 38 U.S.C.A. § 1154 (b), the Veteran's testimony of acoustic trauma from helicopter and weapon noise is consistent with the nature and circumstances of his service and establishes that he sustained acoustic trauma in service. The only remaining question is whether current bilateral hearing loss disability and tinnitus are related to the in service acoustic trauma. See Collette v. Brown, 82 F.3d, 389 (Fed. Cir. (1996) ((observing in part that 38 U.S.C.A. § 1154 (b) does not create a statutory presumption that a combat Veteran's alleged disease or injury is service connected)). For the following reasons, the Board finds that tinnitus is reasonably attributable to service, but bilateral hearing loss is not. The Veteran's service treatment records are without reference to complaints or findings indicative of the presence of hearing loss or tinnitus. The post service medical evidence includes the report of a VA audiological examination accorded the Veteran in April 2007. The claims file was reviewed by the examiner who stated that multiple hearing tests in service including the exam done at separation revealed normal hearing bilaterally, with no documentation of tinnitus. The Veteran reported a history of noise exposure to aircraft as a crew chief during service. He also described post service noise exposure while working in a factory for some 20 years. Following current examination, the diagnosis was bilateral high frequency sensorineural hearing loss. Also diagnosed was bilateral subjective constant severe tinnitus since service. The audiologist opined that since the Veteran's service treatment records reflected hearing within normal limits at the time of separation, "it is not likely that the hearing loss had its origins in the service." The audiologist added that there was no documentation of tinnitus in the service treatment records and therefore, it is "not likely that the tinnitus had its origins in the service." Additional evidence includes the report of VA audiology outpatient consultation in May 2010. At that time, the Veteran reporting flight and machine gun noise while in Vietnam. He also reported some occupational and recreational noise exposure. Current testing showed bilateral mild high frequency sensorineural hearing loss. With regard to tinnitus, the examiner stated that, common causes and mechanisms were explained to the Veteran and how they might relate to his history and his hearing loss. During the March 2011 hearing, the Veteran and his wife testified that he experienced tinnitus and hearing loss during and since service. The remaining question with regard to tinnitus is whether it is related to service, including whether it is related based on a continuity of symptomatology. Service connection will be granted for tinnitus on the basis of the Veteran's account of continuous symptoms. While the 2010 examiner did not address the etiology of the Veteran's hearing loss and/or tinnitus, the 2007 audiologist opined that neither hearing loss nor tinnitus is related to the Veteran's active service and her opinion is the only medical opinion of record. However, her opinion is based primarily on the fact that the separation examination from service was without indication of the presence of tinnitus or hearing loss. There are no specific inquiries in the Veteran's separation examination to tinnitus, but he is competent to testify as to his observations regarding tinnitus incurrence and continuity of symptomatology. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Charles v. Principi, 16 Vet. App. 370, 274 (2002) ("ringing in the ears is capable of lay observation"). Given the nature of the Veteran's duties in service, it is clear he was exposed to acoustic trauma. The VA examiner's opinion is in conflict with the Veteran's assertions regarding etiology, but the Board finds the evidence is at least in relative equipoise. As a result, the Board finds that service connection for tinnitus is in order. However, with regard to hearing loss, as noted above, there is no positive nexus opinion of record. The audiologist opined in 2007 that based on current examination and review of the record, any current hearing loss was not attributable to the Veteran's active service. The separation examination does not reflect any complaint or finding indicative of hearing loss. The Veteran was engaged in combat with the enemy. However, 38 U.S.C.A. § 1154 (b) does not eliminate the need for evidence of a nexus; it merely reduces, for Veterans who have engaged in combat, the burden of presenting evidence of incurrence or aggravation of an injury or disease in service, and the Veteran's claim is not being denied based on the absence of in-service incurrence or aggravation or injury. See Collette v. Brown, 82 F. 3d 389, 392 (Fed. Cir. 1996) ("Section 1154 (b) does not create a statutory presumption that a combat Veteran's alleged disease or injury is service-connected."). VA's decision to require specific audiometric readings in order to establish hearing loss disability underscores that this is the type of medical matter as to which lay testimony such as the Veteran's is not competent. See, e.g., Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis); Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) ("It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant"). To the extent that the Veteran is competent to testify regarding the diagnosis or etiology of hearing loss, the specified opinion of the audiological examiner is of greater probative weight than the general lay assertions of the Veteran made many years following service. Thus, service connection for tinnitus will be granted, and service connection for hearing loss disability will be denied. Skin Disability, to Include Residuals of Jungle Rot Of the Left Heel The service treatment records do not reflect complaints or findings indicative of the presence of a skin disorder involving the left heel or any part of the body. In his report of medical history done at the time of the discharge examination in September 1965, the Veteran denied either having or having had any type of skin abnormality. These medical records are highly probative both as to the Veteran's subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Veteran's then-state of physical fitness and are akin to statements of diagnosis or treatment. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board's decision); see also LILLY'S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (many state jurisdictions, including the federal judiciary and Federal Rule 803(4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rational that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care). The post service records reveals the Veteran was seen on a number of occasions over the years with various concerns. Hardly any reference was made to any skin disorder, particularly involving the left foot. At the time of his March 2011 hearing, the Veteran submitted additional medical evidence. That evidence included a diagnosis of tinea pedis of the left foot. A private treatment reflects in June 1990 the Veteran was seen for complaint of blisters and skin erosion of the area of the left foot. The evidence also includes the report of a private medical visit in June 2010 at which time the Veteran was seen for possible fungus of the feet. He stated he had had this "ongoing for many yrs." Following evaluation he was given a diagnosis of tinea pedis. The Veteran was accorded a skin disease examination by VA in August 2011. He reported during the examination that he had a skin rash on his left foot. He described the condition as a collection of small fluid-filled bumps on the bottom and inside portion of the left foot. He reported he would routinely lance these and they would drain and then resolve. They would generally return within a month. The examiner stated that on current examination there were no lesions present involving the skin of the left foot. This condition was described as normal throughout the left foot. The examiner opined that the Veteran had vesicular tinea pedis which was not uncommon for a fungal infection of the skin, otherwise known as Athlete's foot. He stated this could be recurring and indeed the Veteran reported it began while in service. However, the examiner noted there were no medical records to support the claim. The examiner noted the condition could be acquired at any time and in any location. It was not specific to Vietnam. Without military treatment records to support the claim that began while in service, the examiner indicated "I cannot say that this is due to military service without resorting to speculation." Medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient basis upon which to support a claim. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (finding doctor's opinion that "it is possible" "it is within the realm of medical possibility" too speculative to establish medical nexus); Goss v. Brown, 9 Vet. App. 109, 114 (1996) (using the word "could not rule out" was too speculative to establish medical nexus); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (a medical opinion framed in terms of "may or may not" is speculative and is insufficient to support an award of service connection for the cause of death); Obert v. Brown, 5 Vet. App. 30, 33 (1993) (Physician's statement that the Veteran "may be having some symptoms of multiple sclerosis for many years prior to the date of diagnosis" is insufficient to award service connection); Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996) (a generic statement about the possibility of a link between chest trauma and restrictive lung disease was "too general and inconclusive" to support an award of service connection). However, the Veteran's testimony is credible and competent enough to at least place the evidence of record in relative equipoise, and the statutory benefit of the doubt doctrine provides that the matter should be resolved in the Veteran's favor. Accordingly, the Board finds that service connection for tinea pedis of the left foot is in order. See 38 U.S.C.A. § 5107 (b); 38 C.F.R. § 3.102. See also Alemany v. Brown, 9 Vet. App. 518, 519 (1996); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board does not express any opinion as to the severity of the now service-connected left foot tinea pedis disorder for rating purposes. The RO will assign an appropriate disability rating in the first instance. Ferenc v. Nicholson, 20 Vet. App. 58 (2006) (discussing the distinction in the terms "compensation," "rating," and "service connection" as although related, each having a distinct meaning as specified by Congress). Residuals of Left Leg Wound The service treatment records do not reflect any evidence of the Veteran having sustained a wound to the left lower extremity. The Veteran has indicated that during an assault mission in Vietnam he sustained a shrapnel wound to the left lower extremity and has had problems with the left lower extremity ever since. He refers to receiving treatment for it during service. However, in discussing the status of the left lower extremity at the hearing, when asked about any kind of scarring or difficulty with the extremity, the Veteran's wife testified that "it would probably be pretty well healed." (Transcript, p. 20). Further, the post-service medical records do not document the presence of a disability involving the left lower extremity, and the private and VA treatment and evaluation records do not document the presence of a left lower extremity disability. As noted above, a necessary element for establishing entitlement to service connection is the existence of a current disability. See Degmetich v. Brown, 104, F.3d. 1328 (1997) (Section 1110 of the statute requires the existence of a current disability for VA compensation purposes); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The preponderance of the evidence indicates that the Veteran has not met the current disability requirement with regard to a disability involving the left lower extremity for which he is claiming service connection. As he has failed to carry his burden with regard to an essential element of his claim for entitlement to service connection for a disability of the left lower extremity, the claim must be denied. 38 U.S.C.A. § 5107 (a) (West 2002); Skoczen v. Shinseki, 564 F.3d 1319, 1323 (Fed. Cir. 2009). (The "support" requirement of 38 U.S.C.A. § 5107 (a) requires the claimant to provide some evidentiary basis for his or her benefits claim). As a preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C.A. § 5107 (b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). Liver Disability and Disability Manifested by Nodules of the Throat As the Veteran served in Vietnam, he is presumed to have been exposed to Agent Orange. The law provides that certain listed diseases, including cancer of the larynx, are presumed service connected in such Veterans. 38 U.S.C.A. § 1116; 38 C.F.R. §§ 3.307, 3.309. The record shows that the Veteran has had elevated bilirubin for many years. However, as the Veteran was informed by a private physician in May 1977, recent studies showing elevated bilirubin were consistent with an abnormality which is most likely hereditary in nature, that being Gilbert's disease, and this is an innocent type of abnormality which "has no clinical problems associated with it." The physician at that time said there were otherwise normal liver function studies and the Veteran had the feeling of general well being. The physician did not therefore direct a liver biopsy at that time. He recommended periodic monitoring of the Veteran's bilirubin. Subsequent testing over the years has continued to show elevated bilirubin, but no documentation of a chronic liver disease process. Elevated bilirubin is a laboratory test result and not, in and of itself a disability. See 61 Fed. Reg. at 20,445 (May 7, 1996). The applicable laws and regulations do not permit a grant of service connection for a laboratory finding absent a showing of related disability. See Brammer v. Derwinski, 3 Vet. App. 223, 25 (1992). The pertinent medical evidence includes an evaluation of the Veteran by VA on one occasion in August 2011. At that time he continued to have elevated liver function testing results and Gilbert's disease was described as likely. However, no other work-up was needed and no chronic acquired liver disorder was identified. As noted above, there is no basis for the grant of service connection for elevated bilirubin as it is not in and of itself a disability. With regard to the claim for a disability manifested by nodules in the throat, at the time of the March 2011 hearing, the Veteran's wife referred to treatment records from the Cleveland Clinic in the mid 1970's for granuloma of the larynx. Medical records from the Cleveland Clinic reflect in March 1977 the Veteran had granuloma removed from the vocal cord. The records at that time make no reference to the presence of cancer. When the Board remanded the case for further development in June 2011, it noted that the Veteran had not presented evidence of a current diagnosis of a disease (nodules). The Veteran has not submitted any evidence with regard to a diagnosis of cancer of the larynx or any other part of the body. Post service medical notes, both private and VA, do not reflect a diagnosis of cancer of the larynx or other disability involving the throat. The Veteran does not claim, and the evidence of record does not reflect or raise any issue as to whether the Veteran is entitled to service connection for disability manifested by throat nodules under any other theory than his exposure to herbicides in Vietnam. Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) (although in direct appeals all theories must be considered, when "a fully developed record is presented to the Board with no evidentiary support, or particular theory of recovery, there is no reason for the Board to address or consider such a theory"). The service treatment records do not contain complaints, symptoms or diagnoses relating to throat nodules. None of the private treatment records referring to the vocal cord granuloma in 1977, a time years following service discharge, contains an opinion indicating that it is or may be associated with service. There is no showing that there is any disability manifested by throat nodules that is in any way related to the Veteran's active service. Accordingly, the preponderance of the evidence is against the claim for entitlement to service connection for a disability manifested by throat nodules. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. See 38 U.S.C.A. § 5107 (b); 38 C.F.R. § 3.102; see also Fagan v. Shinseki, 573 F.3d, 1282, 1287 (Fed. Cir. 2009). ORDER Service connection for tinnitus is granted. Service connection for a skin disability, classified as tinea pedis of the left foot, is granted. Service connection for claimed residuals of a left leg disability is denied. Service connection for a chronic liver disorder, claimed as due to herbicide exposure, is denied. Service connection for a disability manifested by throat nodules, claimed as due to herbicide exposure, is denied. Service connection for hearing loss disability is denied. ______________________________________________ Vito A. Clementi Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs