Citation Nr: 1320699 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 07-25 400 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for hearing loss. 2. Entitlement to service connection for tinnitus. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Kristy L. Zadora, Counsel INTRODUCTION The Veteran had active duty service from May 1966 to May 1968, to include service in the Republic of Vietnam. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri which, in pertinent part, denied the Veteran's claims for service connection for bilateral hearing loss and tinnitus. A review of the Virtual VA claims processing system does not reveal any documents pertinent to the instant appeals. In June 2010, the Board denied the instant claims. The Veteran subsequently appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In an April 2012 Memorandum Decision, the Court vacated the Board's June 2010 decision and remanded the claims to the Board for additional development and adjudication. In October 2012, the Veteran completed an Appointment of Veterans Service Organization as Claimant's Representative (VA Form 21-22) identifying private attorneys Marcia Moellring and Kate Ambler as his representatives. The Board again remanded the instant claims in December 2012. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran currently suffers from bilateral hearing loss as a result of a disease or injury incurred in active duty service or that such hearing loss manifested within one year of service discharge. 2. The preponderance of the evidence is against a finding that the Veteran currently suffers from tinnitus as a result of a disease or injury incurred in active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2012). 2. The criteria for service connection for tinnitus have not been met. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist With respect to the Veteran's claims decided herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2012). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II), the United States Court of Appeals for Veterans Claims (Court) held that VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Prior to initial adjudication of the Veteran's claims decided herein, a letter dated in December 2004 fully satisfied the duty to notify provisions as to claims for service connection on a secondary basis. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio, at 187. Since the Board has concluded that the preponderance of the evidence is against the claims for service connection for bilateral hearing loss and tinnitus, any questions as to the appropriate disability rating or effective date to be assigned are rendered moot, and no further notice is needed. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). All the law requires is that the duty to notify is satisfied and that claimants are given the opportunity to submit information and evidence in support of their claims. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996); see also 38 C.F.R. § 20.1102 (harmless error). In view of the foregoing, the Board finds that the Veteran was notified and aware of the evidence needed to substantiate his claims, as well as the avenues through which he might obtain such evidence, and of the allocation of responsibilities between himself and VA in obtaining such evidence. Accordingly, there is no further duty to notify. The Board also concludes VA's duty to assist has been satisfied. The evidence of record includes the service treatment records, VA outpatient treatment records, various private treatment records and the VA examination reports. Additionally, the Veteran was afforded VA examinations in order to adjudicate his claims for service connection. In this regard, the Board notes that the March 2013 VA examiner offered etiological opinions as to each claimed disorder and based his conclusions on interviews with the Veteran, a review of the record, and full examinations. Moreover, such opinions offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). As such, the Board finds that the opinions proffered by the VA examiners are sufficient to assist VA in deciding the instant claims for service connection. Additionally, the Board finds there has been substantial compliance with its December 2012 remand directives. The Board notes that the Court has recently noted that "only substantial compliance with the terms of the Board's engagement letter would be required, not strict compliance." See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268) violation when the examiner made the ultimate determination required by the Board's remand.) The record indicates that the Appeals Management Center (AMC) scheduled the Veteran for a VA audiology examination, which he attended. The Board notes that although the Veteran did not specifically refer evidence in the record outside of the March 2010 VA examination, he addressed the substance of the evidence, including the content of the private audiology opinion. Based on the foregoing, the Board finds that the AMC substantially complied with the mandates of its remand. See Stegall, supra, (finding that a remand by the Board confers on the appellant the right to compliance with its remand orders). Therefore, in light of the foregoing, the Board will proceed to review and decide the claims. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007). The Veteran has submitted argument and evidence in support of the appeals. Based on the foregoing, the Board finds that the Veteran has had a meaningful opportunity to participate in the adjudication of his claims such that the essential fairness of the adjudication is not affected. III. Service Connection Applicable Laws and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical 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 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 v. Gober, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). In a recent decision, the United States Court of Appeals for the Federal Circuit (the Federal Circuit) determined that such an alternative method can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In relevant part, 38 U.S.C.A. § 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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 profession." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence.") Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno v. Brown, 6 Vet. App. 465 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). Certain chronic disabilities such as organic diseases of the nervous system, which has been interpreted to include hearing loss, are presumed to have been incurred in service if such manifested to a compensable degree within one year of separation from service. This presumption applies to veterans who have served 90 days or more of active service during a war period or after December 31, 1946. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a), 3.309(a). With hearing loss claims, VA may only find hearing loss to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz 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 are less than 94 percent. See 38 C.F.R. § 3.385. Prior to November 1, 1967, audiometric testing for hearing by a service department were reported by a standard set by the American Standards Association (ASA). Since November 1, 1967, the standard for audiometric testing for hearing has been set by the International Standards Organization (ISO)-American National Standards Institute (ANSI). The ISO standard is the current method for measuring hearing loss and used by VA to determine a hearing loss disability under 38 C.F.R. § 3.385. Tinnitus has been variously defined. It is "a sensation of noise (as a ringing or roaring) that is caused by a bodily condition (as wax in the ear or a perforated tympanic membrane"). See Butts v. Brown, 5 Vet. App. 532, 540 (1993). It is a noise in the ears, such as ringing, buzzing, roaring, or clicking. See YT v Brown, 9 Vet. App. 195, 196 (1996). It is a ringing, buzzing noise in the ears. See Kelly v. Brown, 7 Vet. App. 471, 472 (1995). "Tinnitus can be caused by a number of conditions, including injuries, acute diseases, and drug reactions [but] disablement from tinnitus does not depend on its origin." See 59 Fed. Reg. 17,297 (April 12, 1994). The requirements for service connection for hearing loss as defined in 38 C.F.R. § 3.385 need not be shown by the results of audiometric testing during a claimant's period of active military service in order for service connection to be granted. The Court has held that 38 C.F.R. § 3.385 does not prevent a claimant from establishing service connection on the basis of post-service evidence of hearing loss related to service when there were no audiometric scores reported at separation from service. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Facts and Analysis The Veteran asserts that his exposure to loud noise during service has caused the claimed bilateral hearing loss and tinnitus. Specifically, he asserts that in-service noise exposure occurred while serving in the light weapons artillery and in combat. The Veteran's service treatment records do not document the occurrence of, or treatment for, any specific incident of acoustic trauma. However, the Veteran is competent to assert the occurrence of an in-service injury, to include in-service noise exposure. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1991). The Board notes that his Form DD-214 shows that his military occupational specialty was light weapons infantryman and that he had earned the Marksman Badge (Rifle). Additional service personnel records show that he participated in the Vietnam Counteroffensive, Phase II. Given the circumstances of the Veteran's duties in service, the Board finds that he was likely exposed to some noise in service. Thus, although there is no objective evidence to support a specific incident of acoustic trauma in service, the Board accepts the Veteran's assertions of in-service noise exposure as credible and consistent with the circumstances of his service. See 38 U.S.C.A. § 1154. That fact notwithstanding, the Board also finds that the record presents no basis for the grant of service connection for bilateral hearing loss or tinnitus. A January 1966 service entrance audiological evaluation revealed the following results, measured in decibels and converted to ISO units: Hertz 500 1,000 2,000 4,000 Right 15 10 10 10 Left 15 10 10 5 A March 1968 service discharge audiological evaluation revealed the following results, measured in decibels: Hertz 500 1,000 2,000 4,000 Right 10 10 10 10 Left 10 10 10 15 The Veteran denied hearing loss or ear trouble in an accompanying Report of Medical History. In a May 1968 Statement of Medical Condition, the Veteran indicated that there had been no change in his medical condition since his last separation examination. The remaining service treatment records were negative for complaints, treatments or diagnoses related to hearing loss or tinnitus. Service treatment records reflect no complaints of diminished hearing of the ears, and reveal that hearing during service and at separation was within normal limits (audiogram results were within normal limits). Thus, bilateral hearing loss and tinnitus disabilities were not shown during service. The Board notes, however, that the absence of in-service evidence of hearing loss is not fatal to the claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of section 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). A March 2005 VA audiology consultation noted that the Veteran had been exposed to constant noise while in the artillery during service. Following service, he worked as an electrician for 37 years and was "not really" exposed to noise in that capacity. He reported that he had experienced tinnitus three to four times per week, with each episode lasting between 30 and 60 minutes, for "probably" 30 years. Audiological examination revealed the following results, measured in decibels: Hertz 500 1,000 2,000 3,000 4,000 Right 10 15 15 80 85 Left 10 5 10 60 60 Word recognition testing was 96 percent in the right ear and a score in the left ear was not recorded. The examiner noted that it was possible that this (hearing) loss was related to military service. A June 2005 VA audiology examination reflected the Veteran's reports of in-service noise exposure while in the light weapons artillery and in combat. Post-service, he worked as an electrician for 37 years and reported that it was "moderately noisy at times." Recreational noise exposure, ototoxic medication, ear surgery, head trauma and a family history of hearing loss were denied. Audiological examination revealed the following results, measured in decibels: Hertz 500 1,000 2,000 3,000 4,000 Right 15 15 15 80 80 Left 15 15 10 60 60 Word recognition testing was 96 percent bilaterally. Following this examination and a review of the Veteran's claims file, the examiner opined that it was less likely as not (less than a 50/50 probability) that the Veteran's hearing loss and tinnitus were caused by or a result of military-related acoustic trauma as auditory data indicated that there was normal hearing across the frequency range 500 to 4000 Hertz bilaterally. In June 2006, a private audiology consultation noted possible noise trauma during service. Audiological examination revealed the following results, measured in decibels: Hertz 500 1,000 2,000 3,000 4,000 Right 10 10 10 85 85 Left 5 10 10 50 55 A March 2010 VA audiology examination reflected the Veteran's reports of in-service noise exposure from engine noise due to armored personnel carriers and weaponry. Post-service noise exposure was reported to be "minimal" as the Veteran worked as an electrician for 40 years and denied recreational noise exposure. In addition, he reported that this tinnitus began 30 to 40 years ago and was worse on the right side. He also reported sustaining a head injury after falling while attempting to ride a horse. Audiology examination revealed the following results, measured in decibels: Hertz 500 1,000 2,000 3,000 4,000 Right 15 10 20 90 85 Left 15 10 15 65 65 Word recognition score in the right ear was 86 percent and 92 percent in the left ear. Following this examination and a review of the Veteran's claims file, the examiner opined that the Veteran's bilateral hearing loss and tinnitus were not at least as likely as not (50 percent probability or greater) caused by or a result of an event in service as the Veteran's service entrance and discharge examinations revealed normal hearing at all test frequencies bilaterally and the Veteran denied ear, nose or throat trouble at service separation. The examiner noted that this data reflected functionally normal hearing after leaving service and after possible exposure to service related noise. The examiner further opined that the status of the Veteran's hearing seen on the present audiogram was the result of non-military activities involving high risk noise, genetic factors and aging. Moreover, the examiner noted that there was insufficient evidence from longitudinal studies to determine whether permanent noise-induced hearing loss (NIHL) can develop much later in life, long after cessation of noise exposure, and that that available anatomical and physiologic evidence suggested that delayed post-exposure noise induced hearing loss was not likely. In addition, the examiner opined that it was less likely than not (less than a 50/50 probability) that the Veteran's tinnitus was caused by or a result of acoustic trauma during service as he did not time lock the onset of his tinnitus to service and tinnitus was not reported in the medical records. An October 2012 opinion from D. J., a private audiologist, indicated that a standard threshold shift is defined as a hearing level change, relative to the baseline audiogram, of an average of 10 decibels or more at 2000, 3000 or 4000 Hertz in either ear. The provider noted that the Veteran's left ear changed from zero decibels to 10 decibels at 2000 Hertz and from zero decibels to 15 decibels at 4000 Hertz from his entrance and exit examinations, and therefore exhibited a 12.5 decibel standard threshold shift when averaging the 2000 and 4000 Hertz. Such would be considered a significant change in hearing from entrance to exit, although the exit thresholds were still within the normal range of hearing. The provider noted that there was no evidence that follow-up testing to determine if this was a permanent threshold shift was either ordered by the examiner or conducted. The provider opined that, when considering the Veteran's reports of noise exposure during service, the decreased hearing sensitivity from entrance to exit was at least as likely as not related to his military service. The provider opined that the degrees of hearing loss observed today were significantly depressed compared to thresholds observed at the exit examination and that the additional hearing loss was likely not related to noise exposure in the military as research indicates noise induced hearing loss does not progress once an individual was removed from the noise. A March 2013 VA audiology opinion indicated that a case history and comprehensive hearing test had been obtained and the Veteran's claims file had been reviewed. While referencing the March 2010 VA opinion, the examiner noted that with regard to the change in hearing status from the Veteran's enlistment as compared to his discharge hearing thresholds, threshold testing is plus or minus 10 decibels when generated by degree audiologists. The examiner noted that these examinations were obtained two years apart by medical technicians at different locations and environmental noise conditions and calibration efforts alone were considered critical additional variables. On examination today, the examiner indicated that the Veteran's threshold variability was greater than 20 decibels on re-test, indicative of behavioral variability (the greatest factor affecting valid threshold measurements). However, of even greater importance to the claim of hearing loss attributable to noise exposure, was the configuration of the audiograms as changes from low to mid frequency range was not related to hearing loss from noise exposure. Cochlear damage from high risk noise was found in the high frequency range, not 250 through 1000 Hertz, and the second audiogram (i.e., the discharge audiogram) was not a valid indicator of a decline in hearing from military related noise exposure. Comments regarding his post-military noise risks being minimal are not sufficient regarding his current hearing status as other medical factors may also interact with this claim. The examiner opined that the single greatest factor involving the opinion provided is related to his hearing status as discharge and the configuration of that data and it was noted, and agreed, that hearing loss from noise exposure was static once the noise agent ceased. The March 2013 VA examiner continued that the previous March 2010 VA opinion had been supported by the absence of any evidence of high frequency hearing loss at discharge along with the absence of any complaints at service discharge. The examiner noted that the Veteran's complaints of tinnitus unfortunately varied from one audiological examination to another and from one clinician to another clinician. The greatest factor is the absence of high frequency cochlear damage, which correlated with tinnitus being attributable to high risk noise exposure, in the examiner's opinion. The March 2013 examiner's opinion is consistent with the evidence of record. Notwithstanding the Veteran's credible assertions of in-service noise exposure, the Veteran's service discharge examination reflects hearing that was within normal limits and was negative for tinnitus. With respect to post-service medical records, the first evidence of hearing loss or tinnitus was in a March 2005 VA consultation. As noted above, there is nothing in the Veteran's service records to indicate hearing loss or tinnitus had its onset during service or shortly after service. Rather, the first medical evidence of such hearing loss and tinnitus was in 2005, approximately 37 years after the Veteran separated from service. The Board points out that the passage of many years between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). Furthermore, there is no competent evidence or opinion even suggesting that there exists a medical nexus between the bilateral hearing loss and tinnitus diagnosed so many years after the Veteran's discharge and any incident of service. While the March 2005 VA examiner indicated that it was "possible" that the Veteran's hearing loss was related to military service, no rationale for this opinion was provided. A medical opinion which only contains data and conclusions, and is not supported by reasons or rationale is accorded no probative weight. Nieves-Rodriguez, supra; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two-" a medical opinion . . . must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). In addition, this opinion was speculative and not stated to the degree of certainty required to substantiate a claim for service connection. See Obert v. Brown, 5 Vet. App. 30, 33 (1993) (medical opinions that are speculative, general, or inconclusive in nature cannot support a claim). The March 2005 VA audiology opinion is therefore being afforded little, if any, probative weight. Moreover, the October 2012 private audiology opinion indicated that the decreased hearing sensitivity from entrance to exit was at least as likely as not related to the Veteran's military history as the 12.5 threshold shift was a significant change. In addition, the provider opined the additional hearing loss was likely not related to noise exposure during service as research indicated that noise induced hearing loss did not progress once an individual was removed from the noise. However, it does not appear that this provider converted the January 1966 service entrance audiology results from ASA units to ISO units, as the threshold shift stated in the opinion was based on a zero decibels at 2000 Hertz, and is thus based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 460, 461(1993) (an opinion based on an inaccurate factual premise has no probative value). This October 2012 private audiology opinion is therefore being afforded little, if any, probative weight. Moreover, this provider's opinion as to hearing loss in excess of that which was demonstrated at service discharge is consistent with the March 2013 VA examiner's opinion in that both audiologists agree that research indicates that noise-induced hearing loss does not progress once an individual is removed from the noise. The Board notes that the Veteran has, on occasion, alleged a continuity of symptomology with regards to his tinnitus, which he is competent to assert. However, he has not been consistent in his assertions regarding the onset and presence of such tinnitus. Hearing loss as well as ear trouble of any sort was denied by the Veteran in a March 1968 Report of Medical History. The Veteran reported in a March 2005 VA treatment note that he had experienced tinnitus for "probably" 30 years (i.e. since 1975) and reported its onset to have occurred 30 years ago (i.e., since 1975) in a June 2005 VA examination. In addition, he reported its onset to have been 30 to 40 years ago (i.e., 1970 to 1980) in a March 2010 VA examination. In contrast, he asserted that he suffered from tinnitus continuously since service in a June 2006 statement. The Board, therefore, accords the Veteran's statements regarding the onset of his tinnitus during his VA examinations more probative weight than any report of tinnitus made in connection with, or, presumed by the filing of, the Veteran's December 2004 claim for service connection, to include the June 2006 statement. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (a pecuniary interest may affect the credibility of a claimant's testimony). In addition, the Veteran reported that his post-service employment was "moderately noisy at times" in June 2005 but reported only minimal post-service occupational noise exposure in March 2010. In light of these contradictory statements, the Board finds that any current assertions as to experiencing tinnitus continuously since service or his post-service occupational noise exposure, advanced in furtherance of the appeal, are deemed not credible. Furthermore, as for any direct assertions by the Veteran and/or his representative that there exists a medical relationship between the Veteran's bilateral hearing loss or tinnitus and service, the Board finds that no such assertions provide persuasive evidence in support of the claims. The matter of the etiology of the disability here at issue is one within the province of trained professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As none of the identified individual is shown to be other than a layperson without the appropriate training and expertise, neither is competent to render a probative (i.e., persuasive) opinion the medical matter upon which this claim turns. See, e.g., Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ('a layperson is generally not capable of opining on matters requiring medical knowledge'). Hence, the lay assertions of medical nexus have no probative value. Finally, neither sensorineural hearing loss or tinnitus may be presumed to have been incurred during service here because they did not manifest to a compensable degree within one year of separation from active duty. For all the foregoing reasons, the claims for service connection for bilateral hearing loss and tinnitus must be denied. In reaching the conclusion to deny the claims, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Service connection for hearing loss is denied. Service connection for tinnitus is denied. ____________________________________________ MARJORIE A. AUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs