Citation Nr: 1322227 Decision Date: 07/11/13 Archive Date: 07/18/13 DOCKET NO. 07-38 954 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a right ankle disability. 2. Entitlement to service connection for bilateral hearing loss. REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD M. M. Celli, Associate Counsel INTRODUCTION The Veteran served on active duty from October 1977 to October 1980, with additional service in the Army Reserve from October 1980 to December 1997. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2006 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Veteran's claim of entitlement to service connection for tinnitus was remanded by the Board in March 2012 for additional development. Subsequently, in an October 2012 rating decision, the VA Appeals Management Center granted the Veteran's claim of entitlement to service connection for tinnitus. As this represents a total grant of that benefit sought on appeal, this issue is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). FINDINGS OF FACT 1. The competent medical evidence of record does not demonstrate that the Veteran has a right ankle disability causally related to active service. 2. The competent medical evidence of record does not demonstrate that the Veteran's bilateral hearing loss is causally related to active service. CONCLUSIONS OF LAW 1. A right ankle disability was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303. 2. Bilateral hearing loss disabilitywas not incurred in or aggravated by active service, nor may it be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1101, 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify and Assist VA has a duty to notify and assist veterans in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Proper notice from VA must inform the veteran of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the veteran is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183 (2002). The notice requirements apply to all five elements of a service connection claim, including: (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. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 486 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Dingess/Hartman, 19 Vet. App. at 486. This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). By letters dated in December 2005 and March 2006, the RO provided notice to the Veteran regarding what information and evidence were needed to substantiate a claim for service connection, as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. These letters also advised the Veteran of how VA assigns a disability rating and an effective date and the type of evidence which impacts such. Because VCAA notice in this case was completed prior to the initial RO adjudication denying the claims, the timing of the notice complies with the express requirements of the law as found by the Court in Pelegrini. The Veteran has been provided with every opportunity to submit evidence and argument in support of his claims and to respond to VA notices. VA has also satisfied its duty to assist the Veteran at every stage of this case. The claims file contains a portion of the Veteran's service treatment records, his VA examination records, private and VA post service clinical treatment records, and his lay statements. In this respect, the Veteran was notified in February 2006 that the original service treatment records for his active duty service from October 1977 to October 1980 were unavailable for review. When records in government custody are lost or destroyed, VA has a heightened duty to consider the benefit of the doubt doctrine, to assist the claimant in developing the claim, and to explain its decision. See Russo v. Brown, 9 Vet. App. 46, 51 (1996). However, the threshold for allowance of a claim is not lowered and the need for probative medical nexus evidence causally relating a current disability to service is not eliminated. In February 2010, the Board remanded the Veteran's claims, in part, to obtain any records pertaining to treatment for his right ankle and/or bilateral hearing loss. However, the evidence does not demonstrate that the Veteran responded to the request with a completed VA Form 21-4142, Authorization and Consent to Release Information, and a January 2012 informal hearing presentation from the Veteran's representative did not indicate that additional records were available. In addition, the Board directed that the RO attempt to obtain any police or other pertinent records regarding the Veteran's motorcycle accident, which he avers occurred in Portageville, Missouri in June 1978. Finally, the Board instructed the RO to afford the Veteran a medical examination for the issue of entitlement to service connection for a right ankle disability and to obtain a supplemental medical opinion with respect to the issue of entitlement to service connection for bilateral hearing loss. In March 2012, the Board again remanded the Veteran's claims for additional development. Specifically, the Board instructed the RO to obtain the Veteran's service personnel records documenting the exact dates of his active duty for training and inactive duty for training as well as his Army Reserve personnel records. Accordingly, the claims file includes the Veteran's service personnel records, to include documentation of his periods of active duty for training and inactive duty training. In addition, the Board directed the RO to request that the Veteran complete and return a VA Form 21-4142 for any medical treatment from facilities or employers from whom he received treatment for his right ankle and/or bilateral hearing loss. Again, the evidence does not demonstrate that the Veteran responded to the request with a completed VA Form 21-4142, and a June 2013 informal hearing presentation from the Veteran's representative did not indicate that additional records were available. The RO was also directed to resend to the Veteran, at his most recent address listed in the claims file, the VA letter dated in June 2010 informing him that VA had contacted the Portageville, Missouri Police Department for police records of the 1978 motorcycle accident and that such records had not been obtained. The record demonstrates such notice was provided to the Veteran in a March 2012 correspondence. Finally, because the record shows the Veteran refused to attend the VA examinations scheduled pursuant to the February 2010 remand, the Board directed the RO to reschedule the Veteran for additional VA examinations with respect to his service connection claims for a right ankle disability and bilateral hearing loss. In April 2012, the Veteran underwent VA examination in connection with his claim of entitlement to service connection for a right ankle disability. The April 2012 VA examiner also provided an addendum opinion in July 2012 after a review of the Veteran's claims file. 38 C.F.R. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Upon review, the Board finds the April 2012 VA examination and the July 2012 addendum opinion, taken together, are adequate for the purpose of determining service connection. The VA examiner reviewed the Veteran's relevant medical history and lay testimony, completed a physical examination and other appropriate testing, and provided an opinion as to the clinical findings. In addition, the VA examiner provided an adequate rationale for the opinions stated, relying on and citing to the records reviewed. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). The Veteran was also afforded VA examinations in April 2006 and May 2012 in conjunction with his claim of entitlement to service connection for bilateral hearing loss. The record shows the April 2006 VA examiner reviewed the Veteran's claims file and provided an opinion with respect to a causal relationship between the Veteran's bilateral hearing loss and his active duty service from October 1977 to October 1980. However, because the VA examiner did not provide an opinion as to whether the Veteran's bilateral hearing loss was causally related to his Reserve service, the Board remanded the claim in March 2010 for an additional medical opinion. Accordingly, the Veteran underwent VA examination in May 2012. As described in greater detail below, the Board finds that the subsequent May 2012 VA examination and opinion, in conjunction with the April 2006 VA examination and opinion, are adequate for the purpose of determining service connection. The record shows the VA examiners reviewed the Veteran's relevant medical history and lay testimony, completed physical examinations and other appropriate testing, and provided opinions as to the clinical findings. In addition, the VA examiners provided adequate rationales for the opinions stated, relying on and citing to the records reviewed. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met with respect to both issues on appeal. 38 C.F.R. § 3.159(c)(4). In addition, the Board finds the RO substantially complied with the February 2010 and March 2012 remand directives. See 38 U.S.C.A. § 5103A(b); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). As all relevant facts have been properly and sufficiently developed in this appeal, no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to his claims. Essentially, all available evidence that could substantiate the claims has been obtained. Legal Criteria Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also 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). In addition, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and sensorineural hearing loss becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). The term "active military, naval, or air service" includes active duty, any period of active duty for training during which the individual concerned was disabled or died from disease or injury incurred or aggravated in the line of duty, and any period of inactive duty training during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C.A. § 101(24) (West 2002). Presumptive periods do not apply to active duty for training or inactive duty training. Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). In relevant part, 38 U.S.C. § 1154(a) (West 2002) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability benefits. In order to establish direct service connection for a disorder, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of a disease contracted, an injury suffered, or an event witnessed or experienced in active service; and (3) competent evidence of a nexus or connection between the disease, injury, or event in service and the current disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent." However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. at 309. Competent medical evidence means 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 mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). 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 layperson. 38 C.F.R. § 3.159(a)(2). Analysis The Board has reviewed all the evidence in the Veteran's claims file. Although there is an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Right Ankle Disability The Veteran asserts that he has a right ankle disability due to a motorcycle accident that occurred while he was on active duty in 1978. He reports that he was a home recruiter in Missouri and that after visiting a recruit one day, he was hit by a truck while riding his motorcycle. The Veteran states that after his injury he was treated at an Air Force Base, where he stayed two nights. He reports that he has had trouble with his right ankle since the in-service injury. The available service treatment records do not demonstrate complaints of, treatment for, or a diagnosis of a right ankle disability. A September 1984 report of medical history indicates the Veteran reported breaking his hand in a motor vehicle accident. A July 1992 report of medical history shows the Veteran again reported a history of breaking his right hand in a 1978 motor vehicle accident. The reports of medical history do not demonstrate any complaints regarding a right ankle injury. A December 2007 private treatment record reflects that the Veteran complained of back pain, knee pain, and hand pain due to a motor vehicle accident that occurred while he was on active duty. On VA examination in April 2012, the Veteran reported flare-ups that lasted about one to two hours, during which he had to sit down and prop his foot up to relieve the pain. The Veteran also reported regularly taking Advil for the pain. He stated that his ankle problems made it more difficult for him to perform his job. He stated that going up and down ladders and stairs was a problem for him and that over the years he had learned to deal with the pain. He also stated that he had to grab onto things around him whenever his ankle became really painful. X-ray examination did not reflect any abnormal findings. The VA examiner diagnosed ankle pain and remarked that the examination was suboptimal with minimal effort from the Veteran. The VA examiner reported that the Veteran ambulated without difficulty but demonstrated an inability to dorsoflex and had minimal strength with strength testing. The VA examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury. The VA examiner stated that the claims file was not available and that without evidence to support the incurrence of an in-service injury, the current disability was less likely than not incurred in or caused by a claimed in-service injury. In the July 2012 addendum opinion, the VA examiner found there was no evidence to substantiate direct service connection for the right ankle. The VA examiner stated that there was no documentation in the Veteran's claims file of an in-service injury to the right ankle while serving on active duty or during his Reserve service. Without evidence demonstrating the Veteran sustained an injury during service, it was less likely than not that the claimed right ankle disability was incurred in or caused by an in-service injury. After review, the Board finds that the medical evidence of record does not support a current diagnosis of a disability for which service connection may be granted. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. §§ 1110, 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the veteran has the disability for which benefits are being claimed. See also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the absence of proof of a present disability, there can be no valid claim. Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Here, the Board finds it probative that the April 2012 VA examiner did not provide a clear diagnosis for a right ankle disability. Rather, the April 2012 VA examiner diagnosed ankle pain. The April 2012 VA examiner performed a full evaluation of the Veteran, noted his reported medical history, and considered his statements concerning his symptomatology. Pain alone, without a diagnosed or identifiable underlying malady or condition does not in and of itself constitute a disability for which service connection may be granted. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). The Board is also cognizant of the holding of the U.S. Court of Appeals for Veterans Claims (Court) in Romanowsky v. Shinseki, No. 11-3272 (Vet. App. May 9, 2013). In Romanowsky, the Court held that when the record contains a recent diagnosis of disability prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. In a footnote, the Court noted that a determination that a diagnosis is "sufficiently proximate to the filing of a claim so as to constitute evidence of a 'current diagnosis' is a factual finding to be made by the Board in the first instance." The Veteran filed his service connection claim for a right ankle disability in November 2005. The Veteran's available service treatment records dated through December 1997 do not demonstrate complaints of, treatment for, or a diagnosis of a right ankle disability. Additionally, a review of the medical evidence dated since December 1997 does not demonstrate a diagnosis of a right ankle disability at any point prior to the filing of the November 2005 claim. As such, the Board finds the evidence does not demonstrate a diagnosis of a current right ankle disability for the purpose of service connection. The Board acknowledges the Veteran's assertions that he suffers from a right ankle disability and recognizes that he is competent to provide evidence about the symptoms he experiences. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Charles v. Principi, 16 Vet. App. 370 (2002) (finding the veteran competent to testify to symptomatology capable of lay observation); Layno v. Brown, 6 Vet. App. 465, 469 (1994) (noting competent lay evidence requires facts perceived through the use of the five senses). The Board further notes that lay 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 professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (lay witness capable of diagnosing dislocated shoulder). However, a right ankle disability is not the type of disability that is subject to lay diagnosis. Hence, while the Veteran is competent to report the symptoms he experiences, he is not competent to diagnose a right ankle disability, as he has not been shown to have the medical training necessary to do so. In this case, the Veteran reported his symptoms to the April 2012 VA examiner; however, after considering the Veteran's statements and performing a physical evaluation, the VA examiner diagnosed right ankle pain. In addition, the clinical evidence of record does not demonstrate a diagnosis of a right ankle disability at any time prior to or during the pendency of the appeal. The Board concludes, therefore, that the medical findings are of greater probative value than the Veteran's allegations regarding the existence of a right ankle disability. Without evidence of a diagnosis of a current right ankle disability, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a right ankle disability. No further discussion of the remaining nexus element for service connection is necessary. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The benefit of the doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Bilateral Hearing Loss The Veteran asserts that he has bilateral hearing loss as the result of exposure to aircraft noises during active duty and/or Reserve service. He reports that his military occupation specialty was an aircraft weapons systems repairman. In addition, he reports that he repaired loud generators during his service in the Army Reserve. VA has specifically defined the term "disability" for service connection claims involving impaired hearing. 38 C.F.R. § 3.385. "[I]mpaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz 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. The threshold for normal hearing is from zero to 20 decibels, and higher threshold levels indicate some degree of hearing loss. See 38 C.F.R. § 3.385; see also Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Additionally, the absence of documented hearing loss while in service is not fatal to a claim for service connection. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). When a Veteran does not meet the regulatory requirements for a disability at separation, he can still establish service connection by submitting evidence that a current disability is causally related to service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); Hensley v. Brown, 5 Vet. App. 155, 159-160 (1993). The Veteran's DD-214 shows his military occupation specialty during active duty was aircraft weapons system repairer. His service personnel records from his Reserve service reflect that he worked with smoke generators. The Board again recognizes that the Veteran's original service treatment records from the period of active duty service from October 1977 to October 1980 are unavailable for review. The results of pure tone thresholds, in decibels, on a September 1984 medical examination were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 10 20 20 30 LEFT 15 20 20 25 20 The examination record shows the Veteran had mild hearing loss, both ears, non-progressive. A September 1984 report of medical history reflects that the Veteran denied a history of and current symptoms of hearing loss. A February 1989 report of medical history indicates the Veteran denied a history of and current symptoms of hearing loss. In February 1989, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 5 20 15 15 LEFT 15 20 20 20 15 The Veteran denied a history of and current symptoms of hearing loss on a July 1992 report of medical history. On a July 1992 medical examination, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 15 - 15 LEFT 15 20 20 - 10 On VA examination in April 2006, the Veteran reported that his bilateral hearing loss had its onset approximately 26 years ago and had occurred gradually and progressively. He stated that from 1977 through 1980 he had been a weapons specialist, working with weapons on the Cobra Assault Chopper. He also stated that he had done flight line work the entire time and that he had been exposed to a variety of different types of aircraft noise. The Veteran denied wearing hearing protection. From 1980 through 1997, the Veteran stated that he had worked on and with smoke generators and had a significant amount of noise exposure without the use of hearing protection. He also reported that his Reserve service required yearly qualifications on the firing range and that he had worn hearing protectors for those examinations. The Veteran reported that, following service, he worked for one year at Tyson's Foods performing maintenance work on ammonia systems and boilers. The Veteran stated that he had a significant amount of noise exposure but that hearing protection was required. He denied recreational noise exposure. Audiometric findings demonstrated bilateral hearing loss disability for VA purposes pursuant to 38 C.F.R. § 3.385. The VA examiner diagnosed bilateral symmetric sensorineural hearing loss. The VA examiner reviewed the Veteran's service treatment records, specifically noting the examination findings described above. The VA examiner noted that the Veteran's hearing in the left ear had been within normal limits in 1984, 1989, and 1992. In the right ear, although the September 1984 audiogram showed a mild hearing loss at 4000 Hz, the Veteran's right ear hearing at 4000 Hz was normal in February 1989 and July 1992. Although no service treatment records were available for the period of active duty from 1977 to 1980, the VA examiner opined that since the Veteran's hearing in the left ear had been normal in 1984, 1989, and 1992, and since the Veteran's hearing in the right ear had been within normal limits in 1989, it was not at least as likely as not that the Veteran's current sensorineural hearing loss was related to military service. The VA examiner clarified that the opinion was specifically in relation to the Veteran's active duty service from October 1977 through October 1980 and not his service in the Army Reserve. An April 2006 VA follow-up record notes the audiogram showed a mild-to-moderate sensorineural hearing loss through 4000 Hz and a moderately severe-to-severe sensorineural hearing loss above 4000 Hz bilaterally. A December 2007 private treatment record indicates the Veteran had decreased hearing in his left ear and right ear. In May 2012, the VA examiner diagnosed sensorineural hearing loss in the frequency range of 500 to 4000 Hz in both ears. After a review of the claims file, the VA examiner opined that the Veteran's hearing loss was not at least as likely as not caused by or a result of an event in military service. The VA examiner noted the Veteran's lay statements regarding his in-service exposure and cited the available service treatment records. In particular, the VA examiner noted that the Veteran had normal hearing sensitivity in both ears in 1984 and 1989. The July 1992 examination reflected normal hearing sensitivity in the left ear and a mild hearing loss at 6000 Hz in the right ear, which is considered non-disabling for VA purposes. In addition, the VA examiner found that the mild, 30 decibels, hearing loss in the right ear at 4000 Hz shown on the 1984 examination was most likely an error or a temporary shift in hearing. The VA examiner explained that both the February 1989 and July 1992 medical examinations revealed normal sensitivity in the 4000 Hz in the right ear. Given the Veteran's essentially normal hearing sensitivity in both ears for 12 years following his active duty service, the VA examiner determined it was unlikely that military noise exposure contributed to the decrease in the Veteran's hearing. The VA examiner noted that the Veteran had a history of civilian noise exposure in industrial maintenance and as a deputy sheriff, which could have contributed to the decline of his hearing. First, the April 2006 VA examiner diagnosed bilateral symmetric sensorineural hearing loss, and the May 2012 VA examiner diagnosed sensorineural hearing loss in the frequency range of 500 to 4000 Hz in both ears. As the examination findings meet VA's criteria for consideration as a disability, the Board finds the Veteran has demonstrated a current disability for the purpose of service connection. With respect to an in-service injury or event, the September 1984 medical examination reflects a diagnosis of mild hearing loss in both ears non-progressive. In addition, the Board concedes exposure to acoustic trauma as the Veteran's descriptions of his noise exposure are consistent with his circumstances of service and are competent and credible. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006) (noting that the Board must determine whether lay evidence is credible due to possible bias, conflicting statements, and the lack of contemporaneous medical evidence, although that alone may not bar a claim for service connection); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (holding that a lay witness is competent to testify to that which the witness has actually observed and is within the realm of his personal knowledge). In this respect, the Veteran's DD-214 demonstrates his military occupation specialty was aircraft weapons system repairer and service personnel records corroborate his statements regarding his in-service duties. Further, the RO has already conceded such exposure when granting tinnitus in the October 2012 rating decision. Accordingly, the Board finds the Veteran has established an in-service event for the purpose of service connection. With evidence of a current disability and an in-service event, the remaining element required to establish service connection is a nexus between the current disability and the in-service event. Here, the Board finds the competent and probative evidence of record does not support the finding that the Veteran's current bilateral hearing loss is causally related to active service. First, the Board notes that the evidence indicates sensorineural hearing loss was not diagnosed until April 2006, approximately 16 years after the Veteran's separation from active duty service. As such, service connection for bilateral hearing loss cannot be granted on a presumptive basis. See 38 C.F.R. §§ 3.307, 3.309; see Biggins, 1 Vet. App. 477-78. Further, this prolonged period without complaints or treatment is evidence for consideration in determining continuity of symptomatology and weighs against the claim herein. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (holding that VA did not err in denying service connection when the veteran failed to provide evidence which demonstrated continuity of symptomatology and failed to account for the lengthy time period for which there is no clinical documentation of his low back condition). Nevertheless, during the pendency of this appeal, the Veteran asserted that he experienced bilateral hearing loss during and since active duty. "Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Savage v. Gober, 10 Vet. App. 488, 496 (1997), citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991); see also 38 C.F.R. § 3.303. Accordingly, the Board will consider the lay evidence submitted by the Veteran regarding his audiological symptoms during and since active duty as well as the medical opinions of record. The Veteran's assertions that he continuously experienced bilateral hearing loss since active duty are considered competent evidence as to the presence of observable symptoms such as decreased hearing acuity. Layno, 6 Vet. App. at 469-70. While the Veteran's statements have been deemed competent evidence as to the presence of observable symptoms, however, the Board must also determine whether such evidence is credible. Id. In weighing the credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the veteran. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Further, the Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 Vet. App. 1331 (Fed. Cir. 2006). In contrast to the Veteran's current assertions, the service treatment records from the his Reserve service reflect normal hearing for VA purposes. Curry v. Brown, 7 Vet. App. 59, 68 (1994) (holding that contemporaneous evidence has greater probative value than history as reported by a veteran). There was some question as to whether the mild, 30 decibels hearing loss in the right ear at 4000 Hz shown on the 1984 examination indicated decreased hearing acuity. However, the May 2012 VA examiner explained that this was most likely an error or a temporary shift in hearing as both the February 1989 and July 1992 examinations revealed normal sensitivity at 4000 Hz. In addition, the September 1984, February 1989, and July 1992 reports of medical history demonstrate that the Veteran denied a history of and current symptoms of hearing loss during his Reserve service. Therefore, the Board finds that the Veteran's statements are not credible evidence as to experiencing bilateral hearing loss during and since his active service. Caluza, 7 Vet. App. at 506; Buchanan v. Nicholson, 451 Vet. App. 1331 (Fed. Cir. 2006); Rhodes, 4 Vet. App. at 126-127. As such, the Board finds that service connection for bilateral hearing loss is not warranted on the basis of continuity of symptomatology since active service. 38 C.F.R. § 3.303(b). Here, the Board affords the April 2006 and May 2012 VA medical opinions significant probative value with respect to a nexus between the Veteran's current bilateral hearing loss and the in-service noise exposure. The evidence demonstrates the VA examiners reviewed the Veteran's pertinent medical history, to include the available service treatment records and his lay testimony concerning his in-service injury and symptomatology. The VA examiners also completed physical examinations and other appropriate testing, provided opinions as to the clinical findings, and supported the opinions with adequate rationale. Nieves-Rodriguez, 22 Vet. App. 295 (2008). With respect to the Veteran's active duty service from October 1977 to October 1980, the April 2006 VA examiner opined that since the Veteran's hearing in the left ear had been normal in 1984, 1989, and 1992, and since the Veteran's hearing in the right ear had been within normal limits in 1989, it was not at least as likely as not that the Veteran's current sensorineural hearing loss was related to military service. Similarly, the May 2012 VA examiner determined that the Veteran's hearing loss was not at least as likely as not caused by or a result of an event in military service. The VA examiner noted the Veteran's lay statements regarding his in-service exposure and noted that the Veteran had normal hearing sensitivity in both ears in 1984 and 1989. Given the Veteran's essentially normal hearing sensitivity in both ears for 12 years following his active duty service, the VA examiner determined it was unlikely that military noise exposure contributed to the decrease in the Veteran's hearing. The VA examiner found the Veteran's history of civilian noise exposure in industrial maintenance and as a deputy sheriff could have contributed to the decline of his hearing. Although the Veteran asserts that his current bilateral hearing loss is due to in-service exposure to acoustic trauma, it is well established that a layperson without medical training is not qualified to render medical opinions regarding the etiology of disorders and disabilities. See 38 C.F.R. § 3.159(a)(1). In certain unique instances, lay testimony may be competent to establish medical etiology or nexus. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). However, the evidence does not show that the Veteran possesses the requisite training or credentials needed to render a competent opinion as to medical causation. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Here, the Board finds that the relationship between bilateral hearing loss and in-service acoustic trauma is not something for which a layman is competent to provide an opinion. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) (noting that lay testimony is competent to establish observable symptomatology but not competent to establish medical etiology or render medical opinions). As such, the Veteran's lay opinion does not constitute competent medical evidence and lacks probative value. Additionally, the Board may not base a decision on its own unsubstantiated medical conclusions. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). There is no post-service evidence of record that relates the Veteran's bilateral hearing loss to his active duty or Reserve service beyond his own assertions. The only competent etiological opinions of record are those of the April 2006 and May 2012 VA examiners, which are negative to the Veteran's claim. Based on the foregoing, the Board finds that the preponderance of the evidence is against a grant of service connection for bilateral hearing loss. In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 55-56 (1990). ORDER Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for bilateral hearing loss is denied. ____________________________________________ U. R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs