Citation Nr: 1304645 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 10-38 023 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to an increased disability rating for bilateral hearing loss disability, currently evaluated as 10 percent disabling. 2. Entitlement to service connection for diabetes mellitus. 3. Entitlement to service connection for an eye disorder. REPRESENTATION Appellant represented by: Tennessee Department of Veterans' Affairs ATTORNEY FOR THE BOARD Anthony M. Flamini, Counsel INTRODUCTION The Veteran had active military service from October 1959 to October 1963. These matters come before the Board of Veterans' Appeals (Board) from September 2009 and January 2010 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The Board notes that the Veteran was scheduled for a videoconference hearing in September 2011. In September 2011, the Veteran withdrew his request for a hearing. Therefore, the Board will proceed to adjudicate the case based on the evidence of record. See 38 C.F.R. § 20.704 (9d), (e) (2012). FINDINGS OF FACT 1. Throughout the rating period on appeal, the Veteran's bilateral hearing loss disability has been manifested by complaints of difficulty understanding conversations in a noisy environment. 2. The Veteran's bilateral hearing loss disability has been clinically shown to be manifested by no worse than Level III hearing in the right ear and Level III in the left ear throughout the rating period on appeal. 3. There has been no demonstration by competent medical, nor competent and credible lay, evidence of record, that diabetes mellitus, which was initially treated years after service, is causally related to the Veteran's military service. 4. There has been no demonstration by competent medical, nor competent and credible lay, evidence of record, that any diagnosed eye disability for VA purposes is causally related to the Veteran's military service; defective vision was noted upon the Veteran's induction into active service and not shown to have been permanently aggravated by that service. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for the Veteran's bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.321, 4.85, Diagnostic Code 6100 (2011). 2. Diabetes mellitus was not incurred in, or aggravated by, active service, nor may it be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1101, 1110, 1131, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309 (2012). 3. An eye disorder was not incurred in, or aggravated by, active service. 38 U.S.C.A. §§ 1101, 1110, 1131, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Duty to Notify Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012); 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 unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). In March 2006, the United States Court of Appeals for Veterans Claims (Court) issued its decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Court in Dingess/Hartman held that the VCAA notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim. As previously defined by the courts, those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Upon receipt of an application for "service connection," therefore, VA is required to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. This includes notice that a disability rating and/or an effective date will be assigned if service connection is awarded. Because the Court's decision is premised on the five elements of a service connection claim, it is the consensus opinion within the VA that the analysis employed can be analogously applied to any matter that involves any one of the five elements of a "service connection " claim, to include an increased rating claim. In VA correspondence to the Veteran dated in August 2009 and November 2009, the Veteran was informed of what evidence was required to substantiate the claims, of his and VA's respective duties for obtaining evidence, and of the criteria necessary for assignment of a disability rating. In Pelegrini, supra, the Court held that compliance with 38 U.S.C.A. § 5103 required that VCAA notice be provided prior to an initial unfavorable AOJ decision. Because VCAA notice in this case was completed prior to the initial AOJ adjudications denying the claims, the timing of the notice does comply with the express requirements of the law as found by the Court in Pelegrini. All the VCAA requires is that the duty to notify is satisfied, and that claimants are given the opportunity to submit information and evidence in support of their claims. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996). The Board finds the VCAA notice requirements have been met in this case. Duty to Assist With regard to the duty to assist, the claims file contains a VA examination and treatment records as well as service treatment records. The Board has perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claims. The Veteran has not identified any possible records which may be pertinent to his appeals and which are not already currently of record. Based on the foregoing, the Board finds that VA does not have any further duty to attempt to obtain records. A VA examination with respect to the claim for an increased rating for hearing loss was obtained in November 2009. 38 C.F.R. § 3.159(c) (4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the examination is adequate, as it includes a full audiometric examination of the Veteran. The report of the examination contains findings necessary to evaluate the hearing loss disability under the applicable diagnostic code rating criteria. The report also reflects that the effect of the Veteran's disabilities on his usual occupation and daily activity. See Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Board has considered whether the Veteran is entitled to a VA opinion on the issues of entitlement to service connection for diabetes mellitus and an eye disorder, but finds that he is not. The Secretary's obligation under 38 U.S.C. § 5103A(d) to provide the Veteran with a medical examination or to obtain a medical opinion occurs when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App.79, 81 (2006). The claims file is negative for any competent credible indication that the Veteran had an injury or disease incurred in service, or that he may have a diabetes mellitus or an eye disorder associated with his service. He has not alleged continuity of symptomatology since service. In addition, the clinical evidence of record, as noted below, is against a finding of continuity of symptomatology since service. The Board finds that there is sufficient competent evidence on file to make a decision on the claims; therefore, a VA opinion is not warranted. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to his claims. Essentially, all available evidence that could substantiate the claims has been obtained. Rating Hearing Loss Disability evaluations are determined by comparing a Veteran's present symptomatology with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Further, a disability rating may require reevaluation in accordance with changes in a Veteran's condition. It is thus essential in determining the level of current impairment that the disability is considered in the context of the entire recorded history. 38 C.F.R. § 4.1. Nevertheless, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board notes that staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability ratings for hearing loss are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by pure tone audiometric tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. The rating schedule establishes 11 auditory acuity levels designated from Level I for essentially normal hearing acuity, through Level XI for profound deafness. VA audiometric examinations are conducted using a controlled speech discrimination test together with the results of a pure tone audiometric test. The horizontal lines in Table VI (in 38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The vertical columns in Table VI represent nine categories of decibel loss based on the pure tone audiometric test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the horizontal row appropriate for the percentage of discrimination and the vertical column appropriate to the pure tone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85) by intersecting the horizontal row appropriate for the numeric designation for the ear having the better hearing acuity and the appropriate vertical column to the numeric designation level for the ear having the poorer hearing acuity. See 38 C.F.R. § 4.85(e) (2012). The provisions of 38 C.F.R. § 4.86(a) provide that when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately. The provisions of 38 C.F.R. § 4.86(b) provide that when the pure tone threshold is 30 decibels or less at 1,000 hertz, and 70 decibels or more at 2,000 hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever result provides the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. Here, in a statement received on November 2, 2009, the Veteran sought an increased evaluation for his service-connected bilateral hearing loss disability, which is rated as 10 percent disabling. As the Veteran's claim was received by VA on November 2, 2009, the rating period on appeal would normally be from November 1, 2008, one year prior to the date of receipt of the increased rating claim provided that the disability increased during that one year period. 38 C.F.R. § 3.400(o)(2) (2012), see also Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). However, an unappealed rating decision in March 2009 adjudicated the initial rating assigned for the same disability at issue. As that decision is final as to the rating assigned as of the date of that decision, the rating period on appeal is from March 12, 2009, the day following the March 11, 2009 rating decision. (In this regard, the Board notes that the Veteran's November 2009 statement may not be reasonably construed as a timely notice of disagreement with the March 2009 rating decision as it did not reference, or express disagreement with, the initial rating assigned for bilateral hearing loss in that determination. Rather, it was asserted that his hearing loss had worsened, and that an increased rating was sought.) Nevertheless, in accordance with 38 C.F.R. §§ 4.1 and 4.2 (2012) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the history of the disability is for consideration in rating a disability. The pertinent competent clinical evidence of record includes a November 2009 VA audiology examination report. The report revealed the relevant pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 RIGHT 20 35 55 75 LEFT 20 40 55 70 On the basis of the numbers shown above, the Veteran's pure tone threshold average for the right ear was recorded as 46.25 decibels. His pure tone threshold average for the left ear was also recorded as 46.25 decibels. His speech recognition ability was 76 percent for the right ear and 76 percent for the left ear using the Maryland CNC speech recognition test. Applying 38 C.F.R. § 4.85, Table VI, to the November 2009 VA audiological examination, the Veteran's right ear hearing loss is a Level III impairment based on a pure tone threshold average of 46.25 decibels and a 76 percent speech recognition score. The Veteran's left ear hearing loss is a Level III impairment based on a pure tone threshold average of 46.25 decibels and a 76 percent speech recognition score. Applying the criteria from Table VI to Table VII, based on the results of the November 2009 audiological examination findings, a noncompensable evaluation is derived from Table VII of 38 C.F.R. § 4.85 by intersecting row III with column III. The Board has considered the provisions of 38 C.F.R. § 4.86, but these provisions do not apply here. The Board acknowledges the Veteran's statements to the November 2009 examiner that he has difficulty understanding conversations in a noisy environment. The Board finds that in determining the actual degree of disability, the objective examinations are more probative of the degree of the Veteran's impairment. Furthermore, the opinions and observations of the Veteran alone cannot meet the burden imposed by the rating criteria under 38 C.F.R. § 4.85, Diagnostic Code 6100, with respect to determining the severity of his service-connected bilateral hearing loss disability. See Moray v. Brown, 2 Vet. App. 211, 214 (1993); see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992); 38 C.F.R. § 3.159(a)(1) and (2) (2011). In conclusion, the evidence of record does not reflect that a rating in excess of 10 percent is warranted for any of the time period on appeal for the Veteran's bilateral hearing loss. Service Connection Claims The Veteran also seeks entitlement to service connection for diabetes mellitus and an eye disorder. Service connection is warranted if it is shown that a Veteran has a disability resulting from an injury incurred or a disease contracted in active service or for aggravation of a pre-existing injury or disease in active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). "Generally, to prove service connection, a claimant must submit (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, 346 (1999). Where the determinative issue involves a medical diagnosis, competent medical evidence is required. This burden typically cannot be met by lay testimony because lay persons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). In Robinson v. Shinseki, 312 Fed. Appx. 336 (2009), the Court held that, in some cases, lay evidence will be competent and credible evidence of etiology. Whether lay evidence is competent in a particular case is a question of fact to be decided by the Board in the first instance. The Court set forth a two-step analysis to evaluate the competency of lay evidence. First, Board must first determine whether the disability is the type of injury for which lay evidence is competent evidence. If so, the Board must weigh that evidence against the other evidence of record-including, if the Board so chooses, the fact that the Veteran has not provided any in-service record documenting his claimed injury - to determine whether to grant service connection. The Board observes that this Federal Circuit decision is nonprecedential. But see Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (a non-precedential Court decision may be cited "for any persuasiveness or reasoning it contains"). The Board believes that if Bethea applies to the utility of Court decisions, it surely applies to the utility of a decision of a superior tribunal, the Federal Circuit. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). Diabetes Mellitus The Veteran seeks entitlement to service connection for diabetes mellitus. For certain disabilities, such as diabetes mellitus, where a Veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and the disability becomes manifest to a degree of 10 percent or more within one year from the 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, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309 (2012). VA regulations further provide that certain diseases associated with exposure to herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e) (2012). A Veteran who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a). If a Veteran was exposed to an herbicide agent during active service, Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes) is listed among the diseases that shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 75 Fed. Reg. 53202 (August 31, 2010), 38 C.F.R. § 3.309(e). Here, however, there is no evidence or allegation that the Veteran served in the Republic of Vietnam or was exposed to herbicide agents. However, where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has determined that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). VA medical records reflect that the Veteran has a diagnosis of diabetes mellitus and has been prescribed glyburide and metformin; thus, the Board finds that the first element for service connection has been met. The first mention of diabetes in the claims file is found in a June 1990 private treatment record. As the Veteran separated from service in 1963, the earliest evidence of record of diabetes is more than 26 years later. The Board notes that, in assessing whether the current disability is etiologically related to service, the absence of demonstration of the disability at issue until years after service is for consideration in adjudicating the Veteran's claim, but is not solely dispositive. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006), Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) and Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Service connection may be established by competent medical evidence, or competent and credible lay evidence, of a relationship to service or of continuity of symptomatology since service. There is no clinical evidence of record which causally relates the Veteran's diabetes mellitus to active service. The Board also finds that there has been no showing of continuity of symptomatology since service. The Veteran's service treatment records do not reveal any symptomatology related to diabetes mellitus. Specifically, on his September 1963 Report of Medical History at separation, the Veteran reported that he was in good health and did not report any diabetes. Similarly, his September 1963 Report of Medical Examination at separation indicated that his endocrine system was within normal limits, and that his urinalysis was negative for sugar and albumin. Moreover, as the Veteran has not been shown to have the necessary medical training, he is not competent to relate any symptoms he experienced in or after service to a current diagnosis of diabetes mellitus, as such diagnosis does not lend itself to lay diagnosis. Based on the foregoing, the Board finds that service connection is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Eye Disorder The Veteran also seeks entitlement to service connection for an eye disorder. Treatment records reveal that the Veteran has been diagnosed as having acute posterior vitreous detachment associated with mild vitreous hemorrhage status post cataract surgery, vitreous syneresis, pseudophakia, arcus, pinguecula, and refractive status. The Veteran's service treatment records reveal that he was diagnosed with poor vision upon entry into the service. Although the Veteran denied ever having worn glasses on his October 1959 Report of Medical History upon entrance, his Report of Medical Examination upon entrance indicated that his distant vision was 20/20 in the right eye and 20/30, corrected to 20/20, in the left eye. The examination report further noted that the Veteran had "poor vision - pinhole corrected." In the Veteran's September 1963 Report of Medical History upon separation, he reported having worn glasses during the last 6 months for reading. His corresponding Report of Medical Examination at separation indicated that his eyes were within normal limits, and that his distant vision and near vision were 20/20, bilaterally. His field of vision was described as "normal." Therefore, there is no evidence to suggest that the Veteran suffered from an eye disorder incurred in service or underwent worsening of a preexisting eyesight deficit during service. At the outset, the Board emphasizes that congenital or developmental defects, e.g., refractive error of the eyes, as such, are not diseases or injuries within the meaning of applicable legislation and, thus, are not disabilities for which service connection may be granted. 38 C.F.R. § 3.303(c) (2012); see also 38 C.F.R. § 4.9 (2012); Beno v. Principi, 3 Vet. App. 439 (1992). Refractive errors are defined to include astigmatism, myopia, hyperopia, and presbyopia. See M21-1MR, Part III, Subpart iv, 4.B.10.d. In addition, a preexisting injury or disease will be considered to have been aggravated by active service, where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. A Veteran is considered to be in sound health when examined, accepted, and enrolled for service - except as to defects, infirmities, or disorders noted at the time of his entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior to service, and was not aggravated by such service. 38 U.S.C.A. §§ 1111, 1132. Although defective left eye vision was noted on examination for entrance to service, the first evidence of defective vision following service is a private optometrist's report dated in December 1985 showing naked vision of 20/25 in the right eye and 20/30 in the left eye. In correspondence dated in March 2007, the Veteran's private physician indicated that the Veteran's past ocular history was significant for cataract surgery, bilaterally, and that the Veteran was diagnosed as having an acute posterior vitreous detachment with associated very mild vitreous hemorrhage in the right eye. An August 2009 VA treatment note diagnosed the Veteran as having vitreous syneresis, pseudophakia, arcus, pinguecula, and refractive status in both eyes. The Board reiterates that congenital or developmental defects such as refractive error of the eyes are not disabilities for which service connection may be granted. Moreover, as noted above, in order to rebut the presumption of soundness, there must be clear and unmistakable evidence which demonstrates that an injury or disease existed prior to service and was not aggravated by such service. Based on the October 1959 induction examination which revealed poor vision in general and distant vision of 20/30 in the left eye, the Board finds that the Veteran's left vision deficit preexisted service. As no right eye disability was demonstrated on examination for entrance to service, the presumption of soundness attaches as to the right eye. There is no clear and unmistakable evidence which demonstrates that a right eye disability existed prior to service and was not aggravated by such service so as to rebut the presumption of soundness. The Board notes that the Veteran's distant vision actually improved to 20/20, bilaterally, on his September 1963 Report of Medical Examination for separation from service. In addition, there were no service treatment records suggesting complaints of, treatment for, or diagnoses of ocular symptomatology. As such, the Board finds that that there was no demonstration of a right or left eye disability during service, and that the Veteran's pre-existing left eye defective vision was not aggravated by such service. With respect to non-congenital disorders of the eye which were diagnosed subsequent to the Veteran's service, the first mention of post-service treatment for eye symptomatology in the claims file is found in a December 1985 private treatment record. As the Veteran separated from service in 1963, the earliest evidence of additional eye symptomatology is more than 20 years later. The Board notes that, in assessing whether the current disability is etiologically related to service, the absence of demonstration of the disability at issue until years after service is for consideration in adjudicating the Veteran's claim, but is not solely dispositive. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006), Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) and Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Service connection may be established by competent medical evidence, or competent and credible lay evidence, of a relationship to service or of continuity of symptomatology since service. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006), Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) and Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). There is no clinical evidence of record which causally relates the Veteran's current left or right eye disability to service. The Board also finds that there has been no showing of continuity of symptomatology since service. The Veteran's service treatment records do not reveal any ocular abnormality. Indeed, on his September 1963 Report of Medical Examination at separation, it was indicated that his vision was 20/20, bilaterally. Moreover, as the Veteran has not been shown to have the necessary medical training, he is not competent to relate any symptoms he experienced in or after service to any current eye diagnosis, as such diagnosis does not lend itself to lay diagnosis. Based on the foregoing, the Board finds that service connection is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER Entitlement to an increased disability rating for bilateral hearing loss disability, currently evaluated as 10 percent, is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for an eye disorder is denied. ____________________________________________ U. R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs