Citation Nr: 1318741 Decision Date: 06/10/13 Archive Date: 06/21/13 DOCKET NO. 09-32 041A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES 1. Entitlement to service connection for a psychiatric disorder to include posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for bilateral hearing loss disability. 3. Entitlement to service connection for tinnitus. 4. Entitlement to service connection for a respiratory disorder, including as secondary to asbestos exposure. 5. Entitlement to service connection for alcohol abuse, including as secondary to PTSD. 6. Entitlement to service connection for hypertension, including as secondary to PTSD. 7. Entitlement to service connection for a heart disorder, including as secondary to PTSD. 8. Entitlement to service connection for an anxiety disorder, including as secondary to PTSD. REPRESENTATION Appellant represented by: Oregon Department of Veterans' Affairs WITNESS AT HEARING ON APPEAL The Veteran (Appellant) ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel INTRODUCTION The Veteran had service from July 1955 to July 1959. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from a July 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. In Clemons v. Shinseki, 23 Vet. App. 1 (2009), the United States Court of Veterans Appeals (Court) held that a claim for service connection for PTSD also encompasses claims for service connection for all psychiatric disabilities afflicting a veteran based on a review of the medical evidence. The Veteran originally filed a claim of entitlement to service connection for PTSD, as well as filed a claim of entitlement to service connection for an anxiety disorder, as secondary to PTSD. As such, the Board characterized the issues on appeal as indicated. A review of the Veteran's Virtual VA claims file reveals that it contains only evidence that is duplicative of that already contained in the paper claims file. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. On March 27, 2013, prior to the promulgation of a decision in the appeal of the Veteran's claim of service connection for a respiratory disorder, the Board received notification from the Veteran's representative that a withdrawal of this appeal is requested. 2. The Veteran did not engage in combat with the enemy during service. 3. The Veteran had a confirmed stressor event in service. 4. The Veteran does not meet the diagnostic criteria for PTSD. 5. Right ear hearing loss disability is related to in-service noise exposure. 6. The Veteran does not have left ear hearing loss disability. 7. Tinnitus is related to in-service noise exposure. 8. Alcohol abuse is not attributable to service. 9. Hypertension is not attributable to service. 10. A heart disorder is not attributable to service. 11. Anxiety disorder is not attributable to service. CONCLUSIONS OF LAW 1. The criteria for withdrawal by the Veteran of a Substantive Appeal of the claim of service connection for a respiratory disorder have been met. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2012). 2. PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.384 (2012). 3. Right ear hearing loss disability was incurred in peacetime service. 38 U.S.C.A. §§ 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.385 (2012). 4. Left ear hearing loss disability was not incurred in or aggravated by service, and an organic disease of the nervous may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385 (2012). 5. Tinnitus was incurred in peacetime service. 38 U.S.C.A. §§ 1131 (West 2002); 38 C.F.R. § 3.303 (2012). 6. Alcohol abuse was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 7. Hypertension was not incurred in or aggravated by service, and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). 8. A heart disorder was not incurred in or aggravated by service, and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). 9. Anxiety disorder and all other acquired pathology was not incurred or aggravated by service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 10. A heart disorder, hypertension, alcohol abuse, and a psychiatric disorder are not proximately due to or a result of a service-connected disease or injury. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Withdrawal of Substantive Appeal Under 38 U.S.C.A. § 7105, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. A Substantive Appeal may be withdrawn at any time before the Board promulgates a decision. 38 C.F.R. § 20.202. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. At the Veteran's hearing before the undersigned, on March 27, 2013, the Veteran's representative indicated that the Veteran wished to withdraw his appeal of his claim of service connection for a respiratory disorder. Hence, there remain no allegations of errors of fact or law for appellate consideration as to that issue. Accordingly, the Board does not have jurisdiction to review the appeal as to that issue and it is dismissed. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The United States Court of Appeals for Veterans Claims (Court) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. In this case, the agency of original jurisdiction (AOJ) issued a notice letter, dated in October 2006, to the Veteran. This letter explained the evidence necessary to substantiate the Veteran's claim for service connection, as well as the legal criteria for entitlement to such benefits. The letter also informed him of his and VA's respective duties for obtaining evidence. The AOJ decision that is the basis of this appeal was decided after the issuance of an initial, appropriate VCAA notice. As such, there was no defect with respect to timing of the VCAA notice. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). VA also has a duty to assist a veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a Federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in Federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). The claims file contains the Veteran's available service treatment records, reports of private and VA post-service treatment and the Veteran's own statements in support of his claims. The Veteran has not been examined by VA in connection with his claim for service connection of alcohol abuse; however, no examination or nexus opinion is required regarding this claim as the weight of the evidence demonstrates no related injury, disease, or event during service; therefore, no examination or nexus opinion is required, and any opinion would be speculative, as there is no injury, disease, or event during service to which such a currently diagnosed disorder could be related. For this reason, a remand to provide the Veteran with a medical examination and/or obtain a medical opinion is not required with respect to the claim for service connection of alcohol abuse. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (where the Board makes a finding that lay evidence regarding an in-service event or injury is not credible, a VA examination is not required). In connection with the current appeal, the Veteran was afforded VA examinations responsive to the claims for service connection of PTSD, bilateral hearing loss, tinnitus, hypertension, a heart disorder, and an anxiety disorder. McClendon v. Nicholson, 20 Vet. App. 79 (2006). The opinions were conducted by medical professionals, following thorough examination of the Veteran, solicitation of history, and review of the claims file. The Board finds that the opinions are adequate. Additionally, the Veteran has not alleged that any examination is inadequate to decide the current claims, so it is presumed to have been adequate. See Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011) (holding that the Board is entitled to presume the competence of a VA examiner and the adequacy of the opinion). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). Finally, during the March 2013 hearing before the undersigned, the Veterans Law Judge clarified the issues on appeal and explained the existence of additional evidence that may have been overlooked. 38 C.F.R. § 3.102. The Board has reviewed the Veteran's statements and medical evidence of record and concludes that there is no outstanding evidence with respect to the Veteran's claims. For these reasons, the Board finds that the VCAA duties to notify and assist have been met. Legal Criteria for Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2012). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) and 38 C.F.R. § 4.125 (2002) (requiring PTSD diagnoses to conform to the DSM-IV). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(1). See also 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d) (pertaining to combat Veterans). A finding that the Veteran engaged in combat with the enemy, however, requires that the Veteran participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality, and does not apply to veterans who served in a general "combat area" or "combat zone" but did not themselves engage in combat with the enemy. See VAOPGCPREC 12-99 (October 18, 1999). Prior to a recent amendment to the regulations, where a determination was made that the Veteran did not "engage in combat with the enemy," or the claimed stressor was not related to combat, the Veteran's lay testimony alone was insufficient to establish the occurrence of the alleged stressor. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996). In such cases, service records or other corroborative evidence were required to substantiate or verify the Veteran's testimony or statements as to the occurrence of the claimed stressor. See West (Carlton) v. Brown, 7 Vet. App. 70, 76 (1994). Effective July 13, 2010, however, 38 C.F.R. § 3.304(f) was amended to reduce the evidentiary burden of establishing a stressor when it is related to a fear of hostile military or terrorist activity. See 75 Fed. Reg. 39843-01 (July 13, 2010), codified at 38 C.F.R. § 3.304(f)(3). That amendment is relevant to the present case. The amendment provides that, if a stressor claimed by a veteran is related to the veteran's fear of hostile military activity, and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, a veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor, as long as the claimed stressor is consistent with the places, types, and circumstances of the veteran's service and there is no clear and convincing evidence to the contrary. Id. "Fear of hostile military activity" is defined to mean that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. The list of examples of such an event or circumstance specifically includes attack upon friendly military aircraft, vehicle-imbedded explosive devices, and incoming artillery, rocket, or mortar fire. In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including cardiovascular-renal disease (including hypertension) and organic diseases of the nervous system (including sensorineural hearing loss) are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. As cardiovascular-renal disease (including hypertension) and organic diseases of the nervous system (including bilateral hearing loss) are considered to be chronic diseases for VA compensation purposes, if chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Service connection is also warranted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Analysis for Service Connection The Board notes initially that, the Veteran did not serve during a period of war. Likewise, the Veteran's DD Form 214 reflects that his military occupational specialty was radio technician; his only award was the Good Conduct Medal. Service personnel records indicate that the Veteran had service in Japan from February 1957 to April 1958. As such, the evidence does not suggest, and the Veteran does not contend, that he engaged in combat with the enemy, or that his claimed PTSD is related to combat. Therefore, neither the combat provisions of 38 U.S.C.A. § 1154 (West 2002) nor the rule relating to combat stressors are applicable. PTSD The Veteran claims that he has delayed onset PTSD due to a plane crash; the Veteran does not assert that he was on the plane, but that he has PTSD because he was scheduled to be on the plane that crashed, and was instead monitoring equipment that may have contributed to the plane crash. Although the RO initially found that the information provided by the Veteran regarding his claimed stressor was insufficient to warrant search by the U.S. Army and Joint Services Records Research Center (JSRRC), in July 2011, pursuant to a Decision Review Officer (DRO) Conference Report, the RO noted that a unit diary entry for Marine Transport Squadron 253, Marine Wing Service Group 17, Marine Corps Air Facility Iwakuni, showed that 6 unit members died as a result of an aircraft accident at the Naval Air Facility at Naha, Okinawa in March 1958. VA treatment records dated at various intervals in 2007 and 2011 indicate that the Veteran was treated for depressive disorder, personality disorder, and rule out PTSD/symptoms of PTSD. A February 2007 VA mental health emergency department note shows an assessment of delayed onset PTSD. The Veteran reported to the emergency department complaining of PTSD symptoms, and reported a history alcohol and drug abuse, family history of drug and alcohol abuse, and emotional abuse as a child, and he was referred for an evaluation. The initial DSM-IV diagnoses, provided after the mental health evaluation, were depressive disorder, personality disorder, and rule out PTSD; a history of bipolar disorder was also noted. A June 2007 psychiatrist note indicates that the Veteran was undergoing psychosocial stress, with divorce and estrangement; diagnoses following evaluation were depressive disorder and personality disorder. The Veteran submitted multiple letters in support of his claim, in which friends and colleagues confirmed that the Veteran had an abrupt decline in psychosocial functioning in 2006. The Board observes that one friend, A-D. S. C., Ph.D., MSW, had work experience as a clinical social worker and therapist. Another friend, M. N. H, M.D., is a former emergency physician and flight surgeon. All of the friends described an abrupt change in the Veteran's behavior in 2006, wherein the Veteran became erratic, impulsive, prone to inappropriate outbursts and periods of severe depression, anger and inappropriate hostility; according to the letters, the Veteran complained of problems at home and at work, with nightmares, rage, and uncontrolled crying. The friends opined that the Veteran may have delayed onset PTSD, but the letters do not indicate that any of them undertook a mental status evaluation of the Veteran in accordance with DSM-IV. The Veteran was afforded a VA examination in July 2011. The VA examiner opined that the Veteran did not have a diagnosis of PTSD in accordance with the criteria of the DSM-IV. The VA examiner instead diagnosed the Veteran with bipolar disorder, anxiety disorder, and alcohol dependence in sustained remission; an Axis II diagnosis of narcissistic personality disorder was also provided. The VA examiner, in reviewing the claims file (including the aforementioned letters of support), noted that the Veteran had a history of witnessing domestic violence in childhood, was diagnosed with bipolar disorder in 2006, had been employed in banking and then as a substance abuse counselor, and underwent a decline in functioning as well as a divorce in 2006. In discussing the Veteran's stressor event, the VA examiner opined that it was insufficient to support the diagnosis of PTSD, as the Veteran did not directly experience the event, and the stressor event was not related to the Veteran's fear of hostile or terrorist activity. The VA examiner noted that the Veteran was initially diagnosed with major depression in 1995, and subsequently diagnosed with bipolar disorder in 2006; symptoms include mood variability, prolonged periods of depression with periods of hypomania, and anxiety with a history of panic attacks. The VA examiner further noted the Veteran claims that he has delayed onset PTSD, with onset following a television commercial involving a cargo plane, which brought back memories of the event; the VA examiner indicated that, during the interview, the Veteran reported minimal acute stress symptoms, and does not endorse symptoms of hyperarousal or avoidance linked to the stressor event. The VA examiner also indicated that there were discrepancies in the Veteran's report of the stressor event and that, at one point, the Veteran alleged that combat exposure and witnessing deaths caused his PTSD. The VA examiner also noted that the Veteran has reported a love of flying. According to the VA examiner, the Veteran has some PTSD symptoms, manifested during episodes of anxiety and depression, but that the most accurate diagnosis is bipolar disorder. As noted above, entitlement to service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), which requires that the diagnosis conform to DSM-IV. The only medical opinion on the question of whether the Veteran has PTSD is that of the July 2011 VA examiner. The examiner reviewed the claims file, addressed each of the Veteran's claimed stressor, and explained why it did not warrant a DSM-IV diagnosis of PTSD, including discussion of whether the stressors met the definition of fear of hostile military or terrorist activity in the new regulation. The examiner's opinion is thus entitled to substantial probative weight. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (stating that factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion). To the extent that the Veteran states he has PTSD due to his claimed in-service stressor, "It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant." Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). To the extent that there are diagnoses of PTSD in the Veteran's letters of support and VA treatment records, the Board is not bound to accept medical opinions that are based on a history that is unsupported by the medical evidence or based upon an inaccurate factual background. Black v. Brown, 5 Vet. App. 177 (1993); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (the Board is not bound to accept a physician's opinion when it is based exclusively on the recitations of a claimant that have been previously rejected). To the extent that the Veteran's testimony is competent, the probative value of his general lay assertions is outweighed by the specific, reasoned conclusions of the July 2011 VA examiner. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, whether the Veteran has PTSD due to service falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer)." As the Veteran does not have a valid diagnosis of PTSD, he has not established the current disability element of the claim for entitlement to service connection for this disability. Moreover, the July 2011 VA examiner noted that the Veteran had bipolar disorder with some symptoms of PTSD related to his depression and anxiety, and opined that, since this disorder did not develop until many years after service, it was not likely related to the Veteran's stressor event during service. There is no evidence of psychiatric disability in service or for many years thereafter, and the Veteran did not assert that his stressor was related to his psychiatric symptomatology until 2006, when he filed his claim for service connection. See Pond v. West, 12 Vet. App. 341 (1999). As the July 2011 VA examiner explained the reasons for his opinion based on an accurate characterization of the evidence of record, this opinion is entitled to substantial probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. To the extent that the Veteran contends that current PTSD symptoms are related to his stressor event or anything else in service, the probative value of his general lay assertions is outweighed by the that of the specific, reasoned opinion of the July 2011 VA examiner. The weight of the evidence therefore reflects that his PTSD is unrelated to service. For the foregoing reasons, the preponderance of the evidence is against the claim for entitlement to service connection for PTSD. The benefit-of-the-doubt doctrine is therefore not for application with regard to the service connection claim decided herein. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). Bilateral Hearing Loss Disability and Tinnitus Service treatment records indicate that the Veteran was treated for a perforation of the right ear drum in July 1959; at that time, the Veteran complained of some right ear hearing loss. Service treatment records indicate that the Veteran did not make any complaints related to his left ear. Audiometric testing was not completed at separation, but whisper voice testing was 15/15 bilaterally. The Veteran is currently service-connected for right otitis media, inactive with history of perforated tympanic membrane. On the February 2008 VA audiological examination, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 25 40 25 30 LEFT 10 10 10 20 35 Maryland CNC speech recognition scores were 94 percent in each ear. After examining the Veteran and reviewing the claims file, the audiology examiner opined that the Veteran experiences asymmetrical hearing loss; the Veteran was diagnosed with mild to moderate flat conductive hearing loss of the right ear and mild to severe high frequency sensorineural hearing loss. The examiner did not provide an opinion as to whether the Veteran's hearing loss disability and tinnitus were likely related to any in-service noise exposure. The VA ear examiner provided an opinion, prior to the audiological evaluation, wherein the VA examiner could not confirm the Veteran's tympanoplasty of the right ear, and opined that, if the audiologist could confirm the perforated right ear drum and the Veteran had conductive hearing loss of the right ear, any right ear hearing loss and tinnitus would be the result of the perforation. The Board acknowledges the Veteran's statements alleging in-service noise exposure, but notes that he did not complain of decreased hearing in service or for many years after service. See 38 C.F.R. § 3.303(a). Regardless, despite the Veteran's complaints of left hearing loss, the post-service medical evidence does not reflect disabling left ear hearing loss for VA disability benefits purposes at any time. He had a Maryland CNC speech recognition score of 94 percent for his left ear at the February 2008 VA examination, and his CNC speech recognition score was 94 percent bilaterally. Similarly, as previously mentioned, his military and VA audiological evaluations show that the Veteran does not have sufficient left ear hearing loss to meet the threshold minimum requirements of 38 C.F.R. § 3.385 to be considered an actual hearing disability by VA. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1998) ("Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. 38 U.S.C. § 1110 (formerly § 310)). The Board has also considered the Veteran's noise exposure and his assertions that he did not have sufficient hearing protection during his service. Nonetheless, the Board notes that, despite the Veteran's complaints, the Veteran did not have auditory thresholds of 26 decibels or greater in at least three frequencies for the left ear, or auditory threshold in excess of 40 decibels in the left ear at any time; likewise, his Maryland CNC speech recognition score was 94 percent in the left ear at the February 2008 VA examination. Moreover, both the VA audiological and ear disease examiners found that the Veteran's left ear hearing was within normal limits bilaterally and that there was no pathology. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000) (a Veteran seeking disability benefits must establish the existence of a disability and a connection between such Veteran's service and the disability). Nevertheless, the results of his February 2008 VA audiological examination confirm that he has sufficient hearing loss in his right ear to meet the threshold minimum requirements of 38 C.F.R. § 3.385 to be considered an actual "disability." The reported audiometric findings at the VA examination revealed the Veteran had auditory thresholds of 40 decibels at 2000 and 30 decibels at 4000 Hertz in the right ear. The Veteran's separation examination was suggestive of normal hearing bilaterally. The Board also acknowledges that the February 2008 VA audiological examiner did not find that the Veteran's right ear hearing loss could be attributed to his perforation of the right ear drum during the Veteran's active military service. However, this is not determinative as to whether his current bilateral hearing loss is etiologically related to his military service and does not preclude service connection in this case. Moreover, the Board points out that the VA ear disease examiner found that, if the Veteran's right ear hearing loss was confirmed to conductive hearing loss, both the right ear hearing loss and tinnitus could be related to the service-connected perforated right ear drum. In this regard, the Board points out that the VA audiological examiner conceded that the Veteran had noise exposure during service and that the Veteran is service-connected for a perforated right ear drum. Hensley v. Brown, 5 Vet. App. 155, 159 (1993) ("[§ 3.385] operates to establish when a measured hearing loss is . . a 'disability' for which compensation may be paid, provided that the requirements for service connection are otherwise met . . ."). Indeed, the opinions rendered in the February 2008 VA examination reports were far from being clear or definitive as to etiology. The VA audiological examiner noted that the Veteran had noise exposure during his period of service, as well as some recreational noise exposure after his service; the VA ear disease examiner could not confirm the right ear perforation or the Veteran's type of hearing loss, but noted that if the Veteran had conductive hearing loss and the right ear perforation was confirmed, service connection was likely warranted. Additionally, the Veteran consistently and credibly contended that the in-service noise exposure and the service-connected perforation of the right ear drum caused his hearing loss; likewise, the Veteran's right ear hearing loss is the type associated with a perforated ear drum. See Layno v. Brown, 6 Vet. App. 465 (1994). The competent and credible evidence of record therefore supports the Veteran's claim. The Board finds that the medical evidence of record supports the Veteran's contention that his tinnitus is related causally to his service. The Board finds that exposure to acoustic trauma in service is consistent with the circumstances of his service. Moreover, although tinnitus was not shown to have been diagnosed during service or within several years thereafter, bilateral tinnitus was diagnosed at the February 2008 VA audiology examination. As previously discussed, the VA examiners found that the Veteran's tinnitus was related to his right ear conductive hearing loss. Therefore, the evidence of record is at least in equipoise, and with resolution of doubt in the Veteran's favor, the Board finds that service connection for tinnitus is also warranted. Alcohol Abuse, Hypertension, Heart Disorder, and Psychiatric Disorder, Including as Secondary to PTSD The Board observes that the Veteran testified before the undersigned that the Veteran only wanted his secondary claims considered upon a grant of service connection for PTSD. As the Board has found that service connection is not warranted for PTSD, there remains no further basis for consideration of the Veteran's claim for alcohol abuse, hypertension, a heart disorder, or an anxiety disorder under 38 C.F.R. § 3.310, as secondary to PTSD. Nevertheless, the Board notes that the Veteran's service treatment records do not show that the Veteran complained of or was treated for alcohol abuse, hypertension, a heart disorder, or an anxiety disorder during his military service, or had symptoms of alcohol abuse, hypertension, a heart disorder, or an anxiety disorder during service. Rather the heart, lungs, chest, chest x-ray, vascular system, and psychiatric evaluation were normal. In this regard, it is important to note that there is simply no indication of any related problems during service. The fact that there has been no demonstration, by competent clinical evidence of record, that the Veteran has PTSD attributable to his military service, unfortunately also, in turn, means that he cannot link his alcohol abuse, hypertension, a heart disorder, or an anxiety disorder, if any, to his service - via his PTSD. See 38 C.F.R. § 3.310(a); Allen, 7 Vet. App. at 448. That is to say, the elimination of one relationship to service, as the supposed precipitant, necessarily also eliminates all associated residual conditions. See Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998) (in "order for service connection for a particular disability to be granted, a claimant must establish he or she has that disability and that there is 'a relationship between the disability and an injury or disease incurred in service or some other manifestation of the disability during service.'") Citing Cuevas v. Principi, 3 Vet. App. 542, 548 (1992)). Therefore, entitlement to service connection for alcohol abuse, hypertension, a heart disorder, or an anxiety disorder must be denied; the benefit-of-the-doubt rule does not apply. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). ORDER Entitlement to service connection for PTSD is denied. Entitlement to service connection for right ear hearing loss disability is granted. Entitlement to service connection for left ear hearing loss is denied. Entitlement to service connection for tinnitus is granted. Entitlement to service connection for alcohol abuse is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a heart disorder is denied. Entitlement to service connection for an anxiety disorder is denied. ____________________________________________ H. N. SCHWARTZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs