Citation Nr: 1304884 Decision Date: 02/11/13 Archive Date: 02/21/13 DOCKET NO. 10-13 220 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for bilateral hearing loss. 3. Entitlement to service connection for tinnitus. REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD A. Nigam, Counsel INTRODUCTION The Veteran served on active duty from January 1969 to December 1971; from May 1974 to February 1979; and from October 1979 to December 1988, including various periods of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA) with the National Guard of Michigan. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2009 rating decision and an April 2011 rating decision by the Department of Veterans Affairs (VA) Regional Offices (ROs) in Togus, Maine and Detroit, Michigan. Both decisions were issued from the Detroit RO. The March 2009 rating decision reopened, and confirmed and continued a previous denial for service connection for bilateral hearing loss. The April 2011 rating decision denied service connection for tinnitus. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ) in January 2012. A transcript of this proceeding is of record. A review of the Virtual VA paperless claims processing system does not reveal any additional documents pertinent to the present appeal. FINDINGS OF FACT 1. The Veteran's request to reopen the claim for service connection for bilateral hearing loss was denied by an unappealed rating decision in June 2006, of which the Veteran was advised in June 2006. 2. The evidence received since the June 2006 rating decision relates to an unestablished fact necessary to substantiate the claim for bilateral hearing loss and raises a reasonable possibility of substantiating the claim. 3. The preponderance of the evidence of record shows that the Veteran's recently diagnosed VA compensable bilateral hearing loss is not presumed to be related to a qualifying period of his military service, nor is it otherwise etiologically related to a qualifying period of the his military service. 4. The preponderance of the evidence of record shows that the Veteran's currently diagnosed tinnitus is not etiologically related to a qualifying period of his military service. CONCLUSIONS OF LAW 1. The unappealed June 2006 rating decision, which denied the request to reopen the claim for service connection for bilateral hearing loss, is final. 38 U.S.C.A. § 7105(b), (c) (West 2002); 38 C.F.R. §§ 3.158, 3.160(d), 20.201, 20.302, 20.1103 (2012). 2. New and material evidence has been received, and the claim for service connection for bilateral hearing loss is reopened. 38 U.S.C.A. §§ 5108, 7105 (West 2002); 38 C.F.R. § 3.156(a) (2012). 3. Bilateral hearing loss was not incurred in or aggravated by a qualifying period of military service, nor may it be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385 (2012). 4. Tinnitus was not incurred in or aggravated by a qualifying period of military service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In this decision, the Board will discuss the relevant law which it is required to apply. This includes statutes enacted by Congress and published in Title 38, United States Code ("38 U.S.C.A."); regulations promulgated by VA under the law and published in the Title 38 of the Code of Federal Regulations ("38 C.F.R.") and the precedential rulings of the Court of Appeals for the Federal Circuit (the Federal Circuit) (as noted by citations to "Fed. Cir.") and the Court of Appeals for Veterans Claims (the Court) (as noted by citations to "Vet. App."). The Board is bound by statute to set forth specifically the issue under appellate consideration and its decision must also include separately stated findings of fact and conclusions of law on all material issues of fact and law presented on the record, and the reasons or bases for those findings and conclusions. See 38 U.S.C.A. § 7104(d); see also 38 C.F.R. § 19.7 (implementing the cited statute); see also Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999); Gilbert v. Derwinski, 1 Vet. App. 49, 56-57 (1990) (the Board's statement of reasons and bases for its findings and conclusions on all material facts and law presented on the record must be sufficient to enable the claimant to understand the precise basis for the Board's decision, as well as to facilitate review of the decision by courts of competent appellate jurisdiction). The Board must also consider and discuss all applicable statutory and regulatory law, as well as the controlling decisions of the appellate courts. The Board must determine the value of all evidence submitted, including lay and medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. See Barr v. Nicholson, 21 Vet. App. 303 at 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a). Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson 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 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (where widow seeking service connection for cause of death of her husband, the Veteran, the Court holding that medical opinion not required to prove nexus between service connected mental disorder and drowning which caused Veteran's death). In ascertaining the competency of lay evidence, the Courts have generally held that a layperson is not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183 (1997). In certain instances, however, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). Laypersons have also been found to not be competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. See Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"); Caluza v. Brown, 7 Vet. App. 498, 511-512 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C.A. § 5107 (West 2002). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Duties to Assist and Notify 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 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the Veteran and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim, and to indicate which information and evidence VA will obtain and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice requirements apply to all five elements of a service connection claim: (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. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 486 (2006). The notice must be provided to the Veteran prior to the initial adjudication of his claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). VA has satisfied its duty to notify by issuing February 2006, March 2006, August 2008 and June 2010 pre-adjudication notice letters for the Veteran's claims for service connection. These letters advised the Veteran of what evidence was required to substantiate his claims, and of his and VA's respective duties for obtaining evidence. They also provided notice regarding the disability evaluation and effective date elements of a service connection claim. Dingess, 19 Vet. App. at 473. His claims were then readjudicated in a March 2010 and a May 2011 statement of the case (SOC). See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as an SOC or supplemental SOC (SSOC), is sufficient to cure a timing defect). Accordingly, prejudicial error in the timing or content of VCAA notice has not been established and any error is not outcome determinative. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency). Further, if any notice deficiency is present in this case, the Board finds that any prejudice due to such error has been overcome by the following: (1) based on the communications sent to the Veteran over the course of this appeal, the Veteran clearly has actual knowledge of the evidence the Veteran is required to submit in this case; and (2) based on the Veteran's contentions as well as the communications provided to the Veteran by VA, it is reasonable to expect that the Veteran understands what was needed to prevail. See Shinseki v. Sanders/Simmons, 129 S. Ct. 1696 (2009); Fenstermacher v. Phila. Nat'l Bank, 493 F.2d 333, 337 (3d Cir. 1974) ("[N]o error can be predicated on insufficiency of notice since its purpose had been served."). In order for the Court to be persuaded that no prejudice resulted from a notice error, "the record must demonstrate that, despite the error, the adjudication was nevertheless essentially fair." Dunlap v. Nicholson, 21 Vet. App. 112, 118 (2007). Specific to requests to reopen, the claimant must be notified of both the reopening criteria and the criteria for establishing the underlying claim for service connection. See Kent v. Nicholson, 20 Vet. App. 1 (2006). In this case, the February 2006 and August 2008 letters included the criteria for reopening a previously denied claim, the criteria for establishing service connection, and information concerning why the claim was previously denied. Further, the Board has reopened the Veteran's claim for service connection for bilateral hearing loss. Therefore, any notice deficiency regarding the criteria for reopening the Veteran's claim was not prejudicial. Bernard v. Brown, 4 Vet. App. 384 (1993). The duty to assist provisions of the VCAA have been met. The claims file contains service treatment records; service personnel records; post-service medical records; VA examination reports; and the Veteran's lay statements and hearing testimony submitted in support of his claims. With respect to the VA examinations, the Board notes that 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 VA examination reports reflect review of the claims file and Veteran's lay assertions, examination of the Veteran, and description and evaluation of the Veteran's hearing loss and tinnitus. These examination findings are sufficient for proper application of the relevant rating criteria and adequate for the purpose of adjudication. During his January 2012 hearing, the Veteran testified that he was tested "5 times" for hearing loss and that one of those times was a "civilian" test. He reported that he believed the test took place in 2004, and insisted that he submitted a copy of this test for association with the claims file at some point during the appeal. The Board notes that the only private audiogram of record is dated in December 2007. The Board further notes that throughout his hearing testimony the Veteran appears to have misstated dates of specific occurrences, and in this case, he likely misstated the date of the "civilian" test as taking place in 2004, when he instead was referring to the December 2007 report. Also, he provided a VA Form 21-4142, Authorization and Consent to Release of Information to the Department of Veterans Affairs, in June 2010, requesting that treatment records be obtained from "Spectrum Health." However, he failed to provide another VA Form 21-4142 for a 2004 "civilian" audiology report, and did not identify any outstanding evidence with respect to the claims on appeal. Thus, the Board finds that the duty to assist has been satisfied in this regard. The Veteran has not made the RO or the Board aware of any additional evidence that must be obtained in order to fairly decide the appeal. He has been given ample opportunity to present evidence and argument in support of his claims. Pursuant to 38 C.F.R. § 3.655, all relevant evidence necessary for an equitable disposition of the Veteran's appeal of this issue has been obtained and the case is ready for appellate review. General due process considerations have been complied with by VA. See 38 C.F.R. § 3.103 (2012). There is no indication in the claims file that there are additional available relevant records that have not yet been obtained. The notification and assistance requirements of the VCAA have been satisfied and the Veteran has been provided a meaningful opportunity to participate in development of his claims. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005). In Bryant v. Shinseki, 23 Vet App 488, 496-97 (2010), the Court held that the VLJ who chairs a Board hearing fulfill two duties to comply with 38 C.F.R. § 3.103(c)(2). These duties consist of (1) fully explaining the issues pertinent to the claim(s) on appeal and (2) suggesting the submission of evidence that may have been overlooked. See also 38 C.F.R. § 3.103(c)(2). At the January 2012 hearing, the undersigned VLJ, the Veteran and the Veteran's representative outlined the issues on appeal and engaged in a colloquy as to substantiation of the claims. Overall, the hearing was legally sufficient and the duty to assist has been met. 38 U.S.C.A. § 5103A (West 2002 & Supp. 2011). The Merits of the Claim-New and Material Evidence The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). Service connection may be granted for any disease 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) (2012). The Veteran is seeking to reopen his claim for service connection for bilateral hearing loss. The Board presently reopens this claim. The Veteran initially filed his claim for service connection for bilateral hearing loss in December 1988, which was denied in an unappealed rating decision dated in August 1989, and issued in September 1989. The RO based this determination on a post-service audiometric examination, which indicated the Veteran exhibited a very mild high frequency sensorineural hearing loss in both ears, and that for VA purposes, hearing was within normal limits. The Veteran was notified of this decision and of his appellate rights; however, although he submitted a notice of disagreement (NOD) and was issued an SOC, he did not submit a VA Form 9, Appeal to Board of Veterans' Appeals. In general, rating decisions that are not timely appealed are final. See 38 U.S.C.A. § 7105; 38 C.F.R. § 20.1103. The Veteran requested to reopen his claim in January 2006, which was denied in an unappealed rating decision in June 2006. The RO based this determination on a finding that, though the Veteran submitted new evidence of military and occupational noise exposure, it was not material because it did not relate to an unestablished fact necessary to substantiate the claim and did not raise a reasonable possibility of substantiating the claim. Specifically, it did not contain an opinion linking the Veteran's hearing loss to his military service. The June 2006 rating decision is final but may be reopened upon receipt of new and material evidence. See 38 U.S.C.A. §§ 7104, 7105 (West 2002); 38 C.F.R. §§ 20.1100, 20.1103 (2012). At the time of this denial, the pertinent evidence of record included VA treatment records showing diagnosis of bilateral sensorineural hearing loss; a VA examination report showing findings of very mild high frequency sensorineural hearing loss in both ears that, for VA purposes, was within normal limits; statements from the Veteran; and service treatment records that were negative for findings of or treatment for any bilateral hearing loss, although they did reflect shifts in hearing on audiometric testing. Evidence submitted since the June 2006 rating decision, includes statements from the Veteran; his hearing testimony; VA and private treatment records; and VA examination reports. The Veteran recently sought to reopen his claim in July 2008. The March 2009 decision currently on appeal subsequently reopened the claim for service connection for bilateral hearing loss and adjudicated the claim on a de novo basis. As will be explained below, the Board believes that the RO's adjudication regarding reopening the Veteran's claim for service connection is ultimately correct. However, regardless of what the RO has done in cases such as this, "the Board does not have jurisdiction to consider a claim which it previously adjudicated unless new and material evidence is presented, and before the Board may reopen such a claim, it must so find." Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996); 38 U.S.C.A. §§ 5108, 7104(b). Although this claim does not involve a prior final denial by the Board but rather by the RO, the Court has held that the same statutory reopening requirements apply to prior final RO decisions. Suttmann v. Brown, 5 Vet. App. 127, 135 (1993). Therefore, the Board is required by statute to review whether new and material evidence has been received to reopen the claim. Despite the finality of a prior adverse decision, a claim will be reopened and the former disposition reviewed if new and material evidence is furnished with respect to the claim which has been disallowed. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The definition of new and material evidence was revised in August 2001. The change in the law, however, pertains only to claims filed on or after August 29, 2001. Because the Veteran's request to reopen was initiated after August 2001, his case will be adjudicated by applying the law currently in effect. For purposes of the present appeal, new evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). See also Evans v. Brown, 9 Vet. App. 273, 283 (1996). Section 3.156(a) "must be read as creating a low threshold," and "suggests a standard that would require reopening if newly submitted evidence, combined with VA assistance and considering the other evidence of record, raises a reasonable possibility of substantiating the claim." Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). "[T]he phrase 'raise a reasonable possibility of substantiating the claim' does not create a third element for new and material evidence." Id. at 10. Instead, it is intended to guide VA adjudicators in "determining whether submitted evidence meets the new and material requirements." Id. However, "[f]or reopening, 38 U.S.C. § 5103A(a) does not require VA to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim." Id. at n.7. The Board has thoroughly reviewed the evidence associated with the claims file subsequent to the June 2006 rating decision and finds that this evidence constitutes new and material evidence which is sufficient to reopen the previously denied claims for service connection. The majority of this evidence is new, in that it was not previously of record. In this regard, the medical evidence associated with the claims after the June 2006 decision includes VA examination reports which show evidence of current VA compensable hearing loss. This evidence further documents the Veteran's complaints associated with his bilateral hearing loss. Also, the Veteran's testimony during his January 2012 hearing generally provides more information concerning the circumstances surrounding the onset and etiology of his claimed hearing loss disorder, see Hodge v. West, 115 F.3d 1356, 1363 (Fed. Cir. 1998), and thus is material in that it relates to previously unestablished facts that tend to substantiate the Veteran's claim. In particular, the testimony provides further description of the type and onset of hearing loss he experienced in service. The Board must presume the credibility of this evidence for the purpose of determining whether it constitutes new and material evidence needed to reopen the claims and may not assess its probative weight in relation or comparison to other evidence for reopening purposes. See Justus v. Principi, 3 Vet. App. 510, 513 (1992) (in determining whether evidence is new and material, "credibility" of newly presented evidence is to be presumed unless evidence is inherently incredible or beyond competence of witness). The Veteran is competent to describe observable symptoms. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (noting competent lay evidence requires facts perceived through the use of the five senses). Therefore, the newly submitted evidence pertains to elements of the claim that were previously found to be lacking. For these reasons, the Board finds that the additional evidence received since the June 2006 rating decision warrants a reopening of the Veteran's claim of service connection for bilateral hearing loss, as it is new and material evidence within the meaning of 38 C.F.R. § 3.156(a). The Merits of the Claim-Service Connection As noted, 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, 1131; 38 C.F.R. § 3.303(a). A "veteran" is defined as "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable." 38 U.S.C.A. § 101(2); 38 C.F.R. § 3.1(d). Active service includes (1) active duty, (2) any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty, and (3) any period of inactive duty training (INACDUTRA) during which an individual was disabled or died from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 C.F.R. § 3.6(a). In other words, service connection is available for injuries and/or diseases incurred during active duty or ACDUTRA, but (except for the exceptions listed) only for injuries, and not diseases, sustained on INACDUTRA. Brooks v. Brown, 5 Vet. App. 484 (1994). ACDUTRA is defined, as full-time duty in the Armed Forces performed by Reserves for training purposes or full-time duty performed for training purposes by members of the National Guard of any State. 38 U.S.C.A. § 101(22); 38 C.F.R. § 3.6(c). INACDUTRA is generally duty (other than full-time duty) prescribed for the Reserves, or duty performed by a member of the National Guard of any state (other than full-time duty). 38 U.S.C.A. § 101(23); 38 C.F.R. § 3.6(d). Annual training is an example of ACDUTRA, while weekend drills are INACDUTRA. Presumptive periods do not apply to ACDUTRA or INACDUTRA. Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). VA's Adjudication Procedure Manual, M21-1R, Part III, subpart ii, 6.3.c., notes that full-time National Guard service is considered ACDUTRA under 38 U.S.C.A. § 101(22)(C) if performed under 32 U.S.C. §§ 316, 502, 503, 504, or 505. This is so whether the individual is performing operational duty or undergoing training. The section notes that operational duty includes active guard/reserve and active duty support, which apply to Guard personnel as well as to Reservists serving in these capacities. An additional note reflects that, since 1964, National Guard members have been assigned to full-time operational duty under 32 U.S.C. § 502(f) to provide full-time support to Guard components even though they are not activated. It appears from the record that the Veteran's service from October 1979 to December 1988 was performed in accordance with 32 U.S.C. § 502(f) and has been identified as active guard/reserve service. Establishing service connection generally requires (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96; see Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and VA regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 C.F.R. § 3.303(d). If sensorineural hearing loss becomes manifest to a degree of 10 percent within one year of separation from active service, then it is presumed to have been incurred or aggravated during active service, even though there is no evidence of hearing loss during service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In this case, despite the Veteran's report that he experienced bilateral hearing loss since service, neither the clinical nor lay record show that the Veteran experienced sensorineural hearing loss manifested to a degree of 10 percent within one year of his separation from a qualifying period of active service. In fact, a January 1989 VA audiology examination shows audiometry results indicating that the Veteran did not have VA compensable hearing loss within one year of his discharge from service. However, disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz, in International Organization for Standardization (ISO) units, is 40 decibels or greater; or when the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2012). Once the requirements of 38 C.F.R. § 3.385 have been met and present hearing "disability" under applicable VA laws and regulations is found, a determination must be made as to whether the current hearing disorder is related to service. In particular, the Court has held that 38 C.F.R. § 3.385 operates to establish when a measured hearing loss is, or is not, a "disability" for which compensation may be paid, provided that the requirements for service connection are otherwise met. See Hensley v. Brown, 5 Vet. App. 155 (1993). Even if a Veteran does not have a hearing loss disability for VA compensation purposes recorded during service, service connection may still be established if post-service evidence satisfies the criteria of 38 C.F.R. § 3.385 and the evidence links the present hearing loss to active service. Id. at 158. The threshold for normal hearing is 0 to 20 decibels. Id. at 157. The absence of in-service evidence of hearing loss is not fatal to a claim for service connection. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The Veteran's DD Forms 214, Certificates of Release or Discharge from Active Duty, indicate that he served as a military policeman for the entirety of his extensive military career, and a March 1988 reference audiogram indicates that he was routinely exposed to hazardous noise. Therefore, his account of in-service noise exposure appears credible and consistent with the circumstances of his service. See VBA Fast Letter 10-35 (September 2010). The Veteran is competent to assert the occurrence of in-service injury, to include in-service acoustic trauma. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1991). Thus, the Board concedes the Veteran's exposure to noise in service. The Board also concedes that the Veteran currently experiences VA compensable bilateral hearing loss (see December 2007 private audiological evaluation report; June 2008 VA audiological evaluation report; and January 2009 and June 2010 VA audiology examination reports). See 38 C.F.R. § 3.385. Moreover, he is competent to report symptoms of hearing loss and tinnitus as a disability because symptoms of hearing loss and tinnitus are capable of lay observation. See Charles v. Principi, 16 Vet. App. 370 (2002); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Therefore, the Veteran meets the threshold criterion for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Veteran's in-service audiometric test results reflect an upward shift in thresholds throughout his service, but no in-service test results meet the requirements for a hearing "disability" under 38 C.F.R. § 3.385. Specifically, audiometric testing in June 1968 showed puretone thresholds in the right ear of 15, -5, -5, and 0 decibels, respectively, at 500, 1000, 2000 and 4000 Hz. The thresholds in the left ear at the same frequencies were 5, -5, 5 and 5 decibels, respectively. Audiometric testing in September 1971 showed puretone thresholds in the right ear of 10, 10, 10 and 5 decibels, respectively, at 500, 1000, 2000 and 4000 Hz. The thresholds in the left ear at the same frequencies were 15, 5, 10 and 0 decibels, respectively. Audiometric testing in July 1979 showed puretone thresholds in the right ear of 10, 5, 0, 5 and 5 decibels, respectively, at 500, 1000, 2000, 3000 and 4000 Hz. The thresholds in the left ear at the same frequencies were 15, 10, 10, 10 and 15 decibels, respectively. Audiometric testing in May 1985 showed puretone thresholds in the right ear of 15, 10, 5, 5 and 25 decibels, respectively, at 500, 1000, 2000, 3000 and 4000 Hz. The thresholds in the left ear at the same frequencies were 10, 5, 10, 10 and 20 decibels, respectively. Finally audiometric testing in August 1988 for the purpose of Medical Board review showed puretone thresholds in the right ear of 10, 10, 5, 5 and 20 decibels, respectively, at 500, 1000, 2000, 3000 and 4000 Hz. The thresholds in the left ear at the same frequencies were 10, 20, 15, 20 and 20 decibels, respectively. On all of these reports, he was assigned a score of H-1 for his hearing on his Physical Profile Serials [or as it is more commonly known, PULHES]. See Odiorne v. Principi, 3 Vet. App. 456, 457 (1992) [Observing that the "PULHES" profile reflects the overall physical and psychiatric condition of the veteran on a scale of 1 (high level of fitness) to 4 (a medical condition or physical defect which is below the level of fitness for retention in the military service]. He also denied experiencing any hearing loss, or ear, nose or throat trouble on the Reports of Medical History that were completed in conjunction with these examinations, including on the August 1988 Report of Medical History for the Medical Board review. However, pursuant to Ledford, 3 Vet. App. at 89, a lack of such results is not a bar to a subsequent grant of entitlement to service connection when post-service audiometric testing produces findings meeting the requirements of 38 C.F.R. § 3.385. A February 1989 VA examination report reflects a diagnosis of very mild high frequency sensorineural hearing loss in both ears. Examination of the ears was described as "negative." Audiometric testing showed puretone thresholds in the right ear were 0, 0, 5 and 25 decibels, respectively, at 1000, 2000, 3000 and 4000 Hz. The thresholds in the left ear at the same frequencies were 0, 5, 5 and 20 decibels, respectively. The audiologist noted speech audiometry results of 98 percent right ear discrimination, and 98 percent left ear discrimination. The report does not indicate what kind of speech discrimination testing was employed. The Veteran also indicated that he experienced light-headedness on examination, and reported that he was employed as a hotel security guard since January 1989, after a brief period of unemployment post-service. On a September 1989 NOD, the Veteran reported that he experienced hearing loss at the time he left service, and argued that "after 20 years in the service any such hearing loss should be presumed as service-connected without specific hearing trauma." He failed to identify any significant noise exposure at that time. A November 2005 VA clinic note reveals the Veteran reported that he was employed as a mail handler. He complained of progressive hearing loss in crowds and with respect to female voices. He also complained of mild right ear tinnitus. He indicated that he was exposed to loud noise in the military, including while serving as a military policemen on the gun range two times a year, and for 6 months as a fire direction control specialist in the artillery. He noted that his post-service employment duties included using mail sorting equipment periodically over the past 17 years. He denied experiencing headaches or dizziness. The Veteran was assessed with an impression of hearing loss and was referred to audiology. In December 2005, the Veteran underwent a VA hearing evaluation performed by an audiologist. The Veteran complained of gradual, right worse than left, hearing loss, more noticeable over the past year, and of difficulty hearing speech, primarily in noise. He exhibited intolerance to loudness, worse on the right year. He also reported experiencing mild tinnitus in the right ear, mainly when it was very quiet, over the past few years. He denied experiencing otalgia, otorrhea and vertigo, and reported military noise exposure without using hearing protection. The Veteran described civilian occupational noise exposure, including working for 17 years in the postal service, while working intermittently around running machinery without the use of hearing protection. The Veteran noted high pitched noise from equipment being dragged across the floor into elevators. He was assessed with mild to moderate sensorineural hearing loss in his right ear, and mild sensorineural hearing loss in the left ear. The audiologist indicated word recognition scores of 68 percent in the right ear, and 80 percent in the left ear, using recorded NU6 word-list 2A. The Veteran was prescribed a hearing aid for the right ear at that time, and was encouraged to use hearing protection in loud environments. An accompanying audiological evaluation revealed audiometric testing results, for bone conduction, of pure tone thresholds in the right ear of 20, 20, 25, 30 and 45 decibels, respectively, at 500, 1,000, 2,000, 3000 and 4,000 Hz. The thresholds in the left ear at the same frequencies were 20, 25, 30, 20 and 25 decibels, respectively. Audiometric testing results, for air conduction, of puretone thresholds in the right ear were 25, 25, 30, 35 and 45 decibels, respectively, at 500, 1,000, 2,000, 3000 and 4,000 Hz. The thresholds in the left ear at the same frequencies were 25, 25, 30, 25 and 25 decibels, respectively. In December 2007, the Veteran underwent a private binaural audiogram, in which the test results showed puretone thresholds in the right ear were 30, 30, 25 and 40 decibels, respectively, at 500, 1,000, 2000 and 4,000 Hz. The thresholds in the left ear at the same frequencies were 30, 35, 30 and 25 decibels, respectively. A June 2008 VA audiological evaluation and accompanying consultation report revealed audiometric testing results, for bone conduction, of puretone thresholds in the right ear of 30, 20, 25, 30 and 45 decibels, respectively, at 500, 1,000, 2,000, 3000 and 4,000 Hz. The thresholds in the left ear at the same frequencies were 25, 25, 25, 25 and 25 decibels, respectively. Audiometric testing results, for air conduction, of puretone thresholds in the right ear were 30, 25, 30, 35 and 45 decibels, respectively, at 500, 1,000, 2,000, 3000 and 4,000 Hz. The thresholds in the left ear at the same frequencies were 25, 25, 25, 25 and 25 decibels, respectively. The audiologist indicated word recognition scores of 84 percent in the right ear, and 92 percent in the left ear, using recorded NU6 word-list 2A. The audiologist noted the Veteran reported stable hearing in both ears and stable tinnitus, in the right ear only. Dizziness, otalgia and otorrhea were observed to be negative. On VA audiology examination in January 2009, the audiologist reviewed the Veteran's claims file and service medical record. The audiologist observed the June 2008 VA audiogram showed a bilateral, borderline normal-to-mild sensorineural hearing loss; the May 2008 private audiogram (misdated, otherwise known as the December 2007 private audiogram) showed a bilateral, borderline normal-to-mild sensorineural hearing loss; and the December 2005 VA audiogram showed a bilateral, borderline normal-to-mild sensorineural hearing loss. The audiologist also noted the January 1989 VA audiology examination, which showed normal bilateral hearing sensitivity according to puretone, air conduction thresholds. The audiologist further listed the test results of in-service air conduction audiograms. The Veteran reported a history of bilateral hearing loss with reported onset 3 to 4 years prior to the date of the examination. He primarily experienced problems with hearing his wife, watching television, talking on the telephone, and communicating in group conversation, as well as when competing background noise was present. The audiologist noted an in-service history of military noise exposure, including small arms fire and exposure to 108 Howitzers as a military policeman; and a post-service history of occupational noise exposure while working at the United States Postal Service as a machine operator from 1989 to 2009, without using hearing protection. The Veteran also reported recreational noise exposure limited to routine use of a lawn mower and snow blower with use of hearing protection since approximately 4 years prior to the examination. He denied a history of ear pathology or trauma prior to entering service. He reported experiencing a brief loss of consciousness during service when he was hit over the head with a bottle during a bar fight, but denied experiencing any residual effects. The Veteran denied any current complaint of tinnitus. The audiologist indicated CNC word recognition scores of 80 percent in the right ear, and 80 percent in the left ear. Audiometric testing results of puretone thresholds in the right ear were 30, 25, 35, 35 and 45 decibels, respectively, at 500, 1,000, 2,000, 3000 and 4,000 Hz. The thresholds in the left ear at the same frequencies were 30, 25, 25, 25 and 25 decibels, respectively. Otoscopic examination revealed findings of clear external auditory canals with intact and normal appearing tympanic membranes bilaterally. The audiologist noted that all findings were consistent and felt to be a reliable reflection of organic threshold of hearing. The Veteran was diagnosed with mild to moderate sensorineural hearing loss in the right ear, and hearing loss not disabling in the left ear. The audiologist indicated that combat noise exposure had been conceded for the Veteran based on his MOS. The audiologist noted there were significant effects of the Veteran's hearing loss on his occupation. The audiologist observed that the Veteran's service medical record showed that he entered and exited military service with normal, bilateral hearing sensitivity according to his puretone, air conduction audiograms. Further, "the service medical record was void of any documented complaint, evaluation, or treatment of ear or hearing problems." The audiologist noted that following military separation, on VA examination in 1989, audiometric test results again showed "clinically normal, bilateral hearing sensitivity." The audiologist indicated that the first documented evidence of a borderline normal-to-mild hearing loss was the 2005 VA audiogram, which took place 17 years post-military service. The audiologist cited to a "2005 Landmark Study on Military Noise Exposure," which found that there was no scientific basis for delayed or late onset noise-induced hearing loss causally attributable to military noise exposure 20 to 30 years later. The audiologist concluded that, based on this evidence, the Veteran's current hearing loss was not due to military acoustic trauma, but was acquired post-military service. A June 2009 private treatment record from "Spectrum Health" reflects that the Veteran was treated for dizziness described as vertigo sensation; however, he denied experiencing ringing sensation in his ears or recent ear infection. He was given a provisional diagnosis of benign positional vertigo. A June 2010 VA audiological examination report reflects that the same audiologist who performed the January 2009 examination conducted the examination. The Veteran's claims file and service medical record were reviewed, and the audiologist noted that the December 2005 VA audiogram report indicated that the Veteran complained of mild tinnitus in the right ear "over the past few years;" and the June 2008 VA audiogram report indicated findings of "stable tinnitus [right ear] only." The Veteran complained of constant, bilateral tinnitus likened to the sound of a motor running and/or a telephone ringing for the past 1 to 2 years. The Veteran reported that he experienced a recurrent, bilateral tinnitus for approximately 20 years prior to the tinnitus becoming constant, and noted that the tinnitus interfered with his hearing abilities. The Veteran provided a history of in-service noise exposure due to small arms fire as a military policeman, as well as to 108 Howitzers and helicopters. He reported post-service civilian noise exposure from 1989 to 2009 while working for the United States Postal Service as a machine operator, and from 2009 to 2010, as an electric Hi-Lo driver. He denied using any hearing protection at any point in service or during his post-service employment. Recreational noise exposure included the limited-to-routine use of a lawn mower and snow blower with the use of hearing protection for approximately 5 years previously. Also the Veteran described a history of very occasional ear infections successfully treated with antibiotic eardrops and no known residual effects. He indicated that he experienced a brief loss of consciousness during his military service after being hit over the head with a bottle in a bar fight, but there were no known residual effects. Audiometric testing results, for air conduction, of puretone thresholds in the right ear were 25, 25, 20, 30 and 45 decibels, respectively, at 500, 1,000, 2,000, 3000 and 4,000 Hz. The thresholds in the left ear at the same frequencies were 25, 25, 25, 25 and 30 decibels, respectively. The audiologist noted Maryland CNC word recognition scores of 84 percent in the right ear, and 88 percent in the left ear. The Veteran initially demonstrated difficulty responding at or near threshold for both speech and pure tone stimuli, and he was repeatedly instructed with responses becoming more consistent. The audiologist noted those findings were deemed to be of good reliability. Otoscopic examination revealed clear canals with intact tympanic membranes. The Veteran was diagnosed with mild-to-moderate sensorineural hearing loss in the right ear, and mild sensorineural hearing loss in the left ear. The audiologist noted that the Veteran's hearing loss had a significant effect on his occupation. The audiologist opined that tinnitus was as likely as not a symptom associated with hearing loss. The audiologist also opined that the Veteran's tinnitus was less likely as not caused by or a result of military service noise exposure. The audiologist explained that the Veteran's service medical record showed that he entered and exited military service with normal, bilateral hearing sensitivity according to his puretone, air conduction audiograms. The audiologist noted that the service medical record was void of any documented complaint, evaluation, or treatment of hearing loss or tinnitus. The 1989 VA examination performed following separation from service documented a mild, high frequency sensorineural hearing loss, but there was no complaint of tinnitus at that time. The audiologist observed that the first documented evidence of a borderline normal-to-mild hearing loss was the 2005 VA audiogram, 17 years post-military service. The audiologist again referenced the "2005 Landmark Study on Military Noise Exposure," which determined that there was no scientific basis for delayed or late onset noise-induced hearing loss causally attributable to military noise exposure 20 to 30 years later. The audiologist noted that, while the Veteran reported a constant, bilateral tinnitus for the past 1 to 2 years, with a preceding periodic, bilateral tinnitus for at least 20 years or more, the December 2005 report from the "Grand Rapids Community Based Outpatient Clinic," only showed complaint of right ear tinnitus "for the past few years." The audiologist noted the June 2008 report also indicated complaint of right ear tinnitus. Citing the book "Tinnitus: Theory and Management," the audiologist indicated that hearing loss was the most common cause of tinnitus, and the greater the hearing loss, the greater the possibility of one experiencing tinnitus. The audiologist reasoned that the Veteran's hearing loss was acquired post-military service, and concluded that the onset of the Veteran's tinnitus was reported post-military service, regardless of contradictory timelines of onset, therefore the tinnitus was less likely as not caused by or a result of military noise exposure. A VA Form 21-4138, Statement in Support of Claim, received in June 2010, indicates the Veteran described a ringing noise in his ears that sounded like a motor running. He indicated that occasionally he experienced severe vertigo, and argued that when he was given his separation physical for the purpose of retirement, he was diagnosed with tinnitus. The Veteran indicated that the "Grand Rapids Clinic" audiologist "placed a diagnosis of tinnitus in [his] records," but he was never asked about having tinnitus while being treated in "Battle Creek." He stated that "only now when [he] went [to Battle Creek] for the last hearing test (June 2010)" did he report experiencing tinnitus. The Board notes that review of the service treatment records show no evidence of complaint of, diagnosis of or treatment for tinnitus. In a VA Form 646, Statement of Accredited Representative in Appealed Case, dated in May 2011, the Veteran's representative argued that the service treatment records clearly indicate there was a shift in the Veteran's hearing thresholds, and that the holding in Hensley was ignored when the RO denied the claim for hearing loss. The representative called into question the "Landmark" study cited in both VA examinations, and referenced an Occupation Health & Safety Administration (OSHA) study on the development of hearing loss after exposure to acoustic trauma. The representative indicated that although noise-induced hearing loss was one of the most common occupational illnesses, it was often ignored because there were no visible effects, it usually developed over a long period of time, and, except in very rare cases, there was no pain. The representative then cited to information from the National Institute on Deafness and other Communication Disorder's (NIDCD) website, and quoted an excerpt from the Mayo Clinic's website, both of which defined noise-induced hearing loss and explained how it occurred. In a VA Form 646, Statement of Accredited Representative in Appealed Case, dated in October 2011, the Veteran's representative argued that, although VA reports indicate the onset of tinnitus took place many years post-service, the Veteran contended that it existed prior to that, and to a compensable degree. In his hearing testimony in January 2012, the Veteran reported that he experienced excessive noise exposure while serving in the artillery and infantry as a military policeman and a fire direction control specialist, and noted that he was issued hearing protection and was fitted for ear plugs towards the end of his military career. He acknowledged that in 2005 he reported only experiencing tinnitus for 1 or 2 years prior to the evaluation, but noted that he experienced it on and off for 20 years prior to that. He described his tinnitus as sounding like "motors running" and being so loud that it gave him headaches. He also described experiencing hearing loss in service. The Veteran testified that his post-service employment history did not cause him to experience hazardous noise levels. He initially reported that he was first issued a set of hearing aids in 1993 or 1994, but then changed that time frame to 2000 or 2004. He described being barely able to hear, and relying heavily upon the use of his hearing aids to function. He also testified that he first experienced noticeable hearing loss in service. The Board has reviewed the information cited to by the Veteran's representative from OSHA, the NIDCD and the Mayo Clinic, and finds that although these reports establish that hearing loss and tinnitus can occur gradually from exposure to loud noise over a long period of time, they also indicate that this hearing loss is usually evidenced by a progressive loss of communication, socialization, and responsiveness to the environment. Although the Veteran described progressive hearing loss in crowds and with respect to female voices in 2005, there is no evidence to show that he experienced this progression continuously since his separation from service. There is no dispute that Veteran is competent to report when he first noticed difficulty hearing difficulty and tinnitus because this requires only personal knowledge as it comes to him through his senses. Layno, supra. Further, although the Veteran clearly filed a claim for service connection for hearing loss right after his discharge from service, and was afforded a VA examination in close proximity thereto which showed some mild high frequency sensorineural hearing loss, there was no hearing loss manifest to a compensable degree shown within one year of service discharge, and there is no competent and credible medical evidence linking any current hearing loss to the Veteran's service or to findings shown in close proximity thereto. In fact, the VA examiner in January 2009 and in June 2010 specifically viewed the audiological findings shown in service and in 1989 and despite the showing of one 25 decibel loss the right ear at 4000 Hz in 1985 and in 1989, found overall the findings shown on the latter examination evidenced "clinically, normal, bilateral hearing sensitivity" (see January 2009 VA examination). The Board notes further, that the Veteran's testimony regarding continuous hearing loss since service is not entirely credible due to the conflicting statements made at the time of his separation from service; the absence of any complaints or treatment for any compensable or progressive hearing loss or tinnitus for more than 16 years after he separated from service; the report on VA treatment in December 2005 that his tinnitus had an onset "over the past few years;" the report on January 2009 examination that his bilateral hearing loss had a reported onset 3 to 4 years prior and that he did not have any current tinnitus; and his testimony that he experienced tinnitus and hearing loss since service. As noted, the record shows that after 1989, the Veteran did not again seek treatment for his hearing loss until 2005, and did not report tinnitus until 2005, with an onset of a few years prior to 2005. In fact, the Board finds the Veteran's reports during treatment and examination in 2005, 2009 and 2010, of his in-service and post-service noise exposure, along with his reports of the dates of onset of his tinnitus and hearing loss symptomatology, are highly probative, both as to his 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). Additionally, this evidence weighs heavily against the Veteran's contention that a continuity of symptomatology since service has been demonstrated. Although he filed a claim for hearing loss in 1989, and reported experiencing hearing loss while in service, his first documented diagnosis of VA compensable hearing loss and tinnitus was made more than 16 years after he separated from military service, and followed "hazardous" post-service noise exposure. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). More significantly, the record contains no competent and probative medical evidence linking any current hearing loss and/or tinnitus to any symptomatology that has purportedly been continuous since service. Further, to the extent that the Veteran contends that a medical relationship exists between his hearing loss and service, any such statements offered in support of his claim do not constitute competent evidence and are not probative. Although the Veteran is competent to testify as to symptoms he observes and experiences, where the determinative issue involves a question of medical diagnosis or causation, only individuals possessing specialized medical training and knowledge are competent to render such an opinion. See Espiritu, supra. The evidence does not reflect that the Veteran currently possesses a recognized degree of medical knowledge that would render his opinion on medical causation competent. Most critically, the Veteran's essential contention of a nexus between the in-service noise exposure and his current diagnoses has been fully investigated as mandated by the Court's decision in Jandreau, and there is no medical opinion of record that supports the Veteran's contentions. The most competent and credible opinions of record, those of the VA audiologist in January 2009 and June 2010, found that the first treatment for any significant bilateral hearing loss or tinnitus did not occur until 17 years post-military service, and that his current hearing loss and tinnitus were not due to military acoustic trauma. The Board finds the evidence against the claim to be more probative than the evidence in favor of the claim. Therefore, the Veteran's claims for service connection for hearing loss and tinnitus must be denied. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine in not applicable where, as here, the preponderance of the evidence is against the claims. See 38 U.S.C.A. § 5107(b); see Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). ORDER New and material evidence has been received to reopen a claim for entitlement to service connection for bilateral hearing loss and, to that extent only, the claim to reopen is granted. Service connection for bilateral hearing loss is denied. Service connection for tinnitus is denied. ____________________________________________ S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs