Citation Nr: 1322676 Decision Date: 07/16/13 Archive Date: 07/24/13 DOCKET NO. 06-30 494 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for left ear hearing loss. 2. Entitlement to service connection for tinnitus. 3. Entitlement to service connection for hemorrhoids. 4. Entitlement to service connection for a left shoulder disorder. REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD C. Kedem, Counsel INTRODUCTION The Veteran had active service in the Army from December 1980 to April 1985 with subsequent service in the National Guard, with periods of active duty and/or active duty training, to include in June 1986, January 1987, and June 1987, and from September 1987 to January 1988, November 1990 to April 1991, and April 1992 to July 1992. This matter came before the Board of Veterans' Appeals (Board) on appeal from a January 2005 rating decision by which the RO denied entitlement to the benefits sought herein. The Board must note that in reviewing this case the Board has not only reviewed the Veteran's physical claims file, but also his file on the "Virtual VA" system to insure a total review of the evidence. The Board remanded the issues on appeal to the RO in February 2012 and in December 2012; as will be discussed below, the requested development has been accomplished; and because the Board's order was fully complied with, there is no prejudice for the Board to proceed. See Stegall v. West, 11 Vet. App. 268 (1998). In May 2013, the Veteran submitted additional evidence to the Board along with a waiver of initial RO consideration of that evidence. 38 C.F.R. § 20.1304 (c) (2012). FINDINGS OF FACT 1. The Veteran has left ear hearing loss in his left ear as defined by VA regulations. 2. Noise exposure in service is shown. 3. The weight of the evidence does not establish that the Veteran's hearing loss in his left ear either began during or was otherwise caused by his military service. 4. The evidence does not establish that the Veteran's hearing loss in his left ear was diagnosed in service, within a year of service or was continuous since service. 5. Tinnitus has been associated with the Veteran's left ear hearing loss; but was not shown to have begun during service or to have been otherwise caused by military noise exposure. 6. A chronic hemorrhoid disorder is not shown to have either began during or been otherwise caused by the Veteran's military service. 7. A chronic left shoulder disability is not shown to have either began during or been otherwise caused by the Veteran's military service. CONCLUSIONS OF LAW 1. Criteria for service connection for hearing loss in the left ear have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3.385 (2012). 2. Criteria for service connection for tinnitus have not been met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). 3. The criteria for service connection for hemorrhoids have not been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 4. The criteria for service connection for a left shoulder disability have not been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) Under applicable criteria, VA has certain notice and assistance obligations to claimants. See 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits and must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). With respect to service connection claims, a section 5103(a) notice should also advise a claimant of the criteria for establishing a disability rating and effective date of award. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 486 (2006). In a timely April 2004 letter, the RO provided notice to the Veteran regarding what information and evidence is needed to substantiate claims for service connection as well as what information and evidence must be submitted by him and what evidence VA would obtain. The notice did not include provisions for disability ratings and for the effective date of the claim. However, this information was conveyed to the Veteran in a March 2006 letter, and the Veteran has not alleged any prejudice caused by the timing of such letter; and the Board concludes that any defect concerning the timing of the notice requirement was harmless error. Although the March 2006 letter was not given prior to the first adjudication of the claim, the Veteran has been provided with every opportunity to submit evidence and argument in support of his claim and ample time to respond to VA notices. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). Additionally, the Veteran's claim was readjudicated following completion of the notice requirements. Under these circumstances, the Board finds that the notification requirements of the VCAA have been satisfied. As to VA's duty to assist, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The Board is also satisfied VA has made reasonable efforts to obtain relevant records and evidence. The record contains the service treatment records and private medical records as well as the Veteran's statements. The Board also remanded the Veteran's claim in August 2010 to ensure that all of his service treatment records had been obtained. Following the remand, the RO contacted the Alabama National Guard and additional service treatment records and service personnel records were obtained; thereby complying with the Board's remand instructions. Additionally, the Veteran was offered the opportunity to testify at a hearing before the Board, but he declined. The Veteran was afforded several VA medical examinations in connection with the claims. To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board acknowledges that the 2004 VA medical examinations are inadequate for rating purposes to the extent that they failed to provide any opinions as to the etiology of the claimed disabilities. However, no corrective action is necessary because Veteran has not attempted to schedule new examinations. When the Veteran indicated that the date of the VA examinations scheduled in his behalf conflicted with work obligations, the RO asked him to call and schedule the examinations at a convenient date. He did not. The Board notes that "[t]he duty to assist in the development and adjudication of a claim is not a one way street." Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). VA could have done no more regarding the scheduling of VA medical examinations without the Veteran's cooperation. VA fulfilled its duty to assist by giving the Veteran an opportunity to set his own examination times. He failed to do so. It is noted that the Veteran wrote a letter in May 2013 in which he stated that he had been unable to reschedule his VA examinations because he did not have the phone number. However, the fact remains that the letter that was sent to the Veteran asking him to reschedule his examinations contained a phone number for him to call. Moreover, the Veteran is represented in this case, and his representative acknowledged in a June 2013 record that the RO had requested that the Veteran contact them to reschedule his examinations, and had even attempted to contact him by phone, but "the Veteran ha[d] yet to respond to [VA's] request to reschedule." It is noted that the Veteran has a duty to keep VA apprised of his current address and contact information, yet it is clear that he has failed to do this, as reflected by a mail 2013 email in which it was noted that VA had attempted to contact the Veteran at all three contact numbers but had not been able to reach the Veteran. See Hyson v. Brown, 5 Vet. App. 262, 265 (1993) (in the normal course of events, it is the burden of a claimant to keep the VA apprised of his or her whereabouts, and there is no burden on the part of the VA to turn up heaven and earth to find him or her if he or she does not do so). The Board wishes to express sincere frustration in this case, having remanded the Veteran's claim on three separate occasions in an effort to assist him in proving his claim. In the most recent remand, the Board specifically explained that it had been concluded that the evidence of record was insufficient to support a grant of service connection for any of the Veteran's claimed conditions; and that it was therefore imperative for him to attend the scheduled examinations. However, he once again failed to do this. The Board is aware of the Veteran's repeated assertions throughout the claims file that his is "willing" to report to an examination, but he has repeatedly cancelled the examinations or failed to report. VA even wrote him asking when it would be possible for him to attend an examination, but he failed to comply with this request as well. Accordingly, the Board finds that VA's duty to assist with respect to arranging a medical examination has been met to the extent possible. 38 C.F.R. § 3.159(c)(4). The Board is also satisfied VA has made reasonable efforts to obtain relevant records and evidence. Specifically, the information and evidence that has been associated with the claims file includes the Veteran's service treatment records, private medical records, and the Veteran's statements. For these reasons, the Board finds that VA has fulfilled the duties to notify and assist the Veteran. Law and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 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). The Board notes that 38 C.F.R. § 3.303(b) is applicable to the Veteran's left ear hearing loss claim, as he suffers from left ear sensorineural hearing loss, which is a chronic disease under 38 C.F.R. § 3.309(a). See generally Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The term "active military, naval, or air service" includes active duty, any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty, and any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C.A. §§ 101(22) 101(24) (West 2002 & Supp. 2011); 38 C.F.R. § 3.6 (2012). Service connection for INACDUTRA is permitted only for injuries, not diseases, incurred or aggravated in line of duty. See Brooks v. Brown, 5 Vet. App. 484, 485 (1993). VA's General Counsel has interpreted that it was the intention of Congress when it defined "active service" in 38 U.S.C.A. § 101(24) to exclude inactive duty training during which a member was disabled or died due to nontraumatic incurrence or aggravation of a disease process. VAOPGCPREC 86-90. 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). The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as sensorineural hearing loss, to a degree of 10 percent or more within one year from separation from service, such diseases may 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. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Specific to claims for service connection, impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; the thresholds for at least three of these frequencies are 26 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 may also be granted for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). When a claimant fails to report, without good cause, for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit that was previously disallowed, or a claim for increase, the claim shall be denied. Id. Examples of "good cause" include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. Id. Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997); Layno v. Brown, 6 Vet. App. 465 (1994); Cartwright v. Derwinski, 2 Vet. App. 24 (1991) (although interest may affect the credibility of testimony, it does not affect competency to testify). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465. The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In weighing 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 witness. Caluza v. Brown, 7 Vet. App. 498 (1995). 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 F.3d 1331 (Fed. Cir. 2006). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the veteran's claims file. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Medical evidence that is speculative, general or inconclusive in nature cannot support a claim. Obert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). A physician's statement framed in terms such as "may" or "could" is not probative. See Warren v. Brown, 6 Vet. App. 4, 6 (1993). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a veteran or obtained on a veteran's behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Left ear hearing loss and tinnitus The Veteran has tinnitus and hearing loss in his left ear which he believes are the result of military noise exposure during his time on active duty. During active duty, the Veteran was an aircraft mechanic. He is the recipient of the Aircraft Crewman Badge. Other personnel records indicate that he had periods of active duty or active duty for training during which he commanded an armor tank platoon; duties in that position included maintenance of platoon equipment and heading the platoon in both training and battle situations. In his February 2004 claim for benefits, the Veteran indicated that he began to experience left ear hearing loss in 1981. However, service treatment records pertaining to the Veteran's periods of active duty to include active duty for training do not reflect hearing loss as defined for VA purposes. See generally 38 C.F.R. § 3.385. Specifically, none of the three audiometric tests that are of record from the Veteran's time on active duty show hearing loss in his left ear. Moreover, the hearing tests actually show some improvement in the hearing acuity of the Veteran's left ear. An October 1980 audiogram reflected the following: HERTZ 500 1000 2000 3000 4000 LEFT 20 20 15 15 20 A February 1983 audiogram revealed the following: HERTZ 500 1000 2000 3000 4000 LEFT 15 10 5 5 15 In August 1985, left ear hearing was as follows: HERTZ 500 1000 2000 3000 4000 LEFT 10 10 5 5 10 In March 2001, approximately 16 years after active duty and nearly a decade after his final period of active duty for training, audiometric testing showed hearing loss in the Veteran's left ear for the first time: HERTZ 500 1000 2000 3000 4000 LEFT 70 60 25 45 40 However, there is no indication that this hearing loss had either begun during or been otherwise caused by the Veteran's active duty for training. Moreover, the testing did not show hearing loss in the Veteran's right ear for VA purposes at that time. The Veteran submitted a September 2006 letter from JMM, M.D. an otolaryngologist who had been treating him "for some time." Dr. JMM indicated that the Veteran was experiencing asymmetrical sensorineural hearing loss and opined that this hearing loss was as likely as not due to a history of noise exposure in service and that tinnitus was the result of the sensorineural hearing loss. However, the doctor did not provided any rationale for such a conclusion and he failed to address the fact the audiologic testing in service had repeatedly shown normal hearing in the Veteran's left ear, and even appeared to show some improvement in his hearing acuity. He also failed to address the relevance, if any, of the sloping of the Veteran's hearing loss in his left ear. In January 2009, the Veteran was afforded a VA audiologic examination conducted by an audiologist. On examination, the Veteran complained of loss of hearing and ringing in his ears over the previous 20 years; and he reported a history of military noise exposure that included noise associated with small arms fire, grenades, helicopters, and tanks as well as an occupational history of noise exposure in the field of aircraft maintenance. The Veteran also reported a history occasional recreational noise exposure from the use of lawnmowers and weed trimmers as well as noise exposure from such activities as hunting and recreational motorcycle use. Audiometric testing of the left ear was as follows: HERTZ 500 1000 2000 3000 4000 LEFT 65 55 25 25 40 The examiner diagnosed left ear sensorineural hearing loss. The examiner noted that audiometric testing in 1984 and 1994 indicated that hearing was within not limits and that testing in 2001 indicated significant left ear hearing loss. The examiner opined that given the fact that the Veteran's hearing was normal in 1985 and 1994, the Veteran's current left ear hearing loss was not likely due to noise exposure on active duty. In May 2013, the Veteran submitted further records from Dr. JMM dated from December 2001 to September 2006. On initial evaluation by Dr. JMM, the Veteran reported a long history of working around tanks and aircraft. He complained of hearing loss as well as ringing in the ears. The Veteran indicated that he had been experiencing the hearing loss and tinnitus symptoms "for a while." Due to the Veteran's in-service duties in the vicinity of aircraft, tanks, and small arms fire, the Board concedes noise exposure in service. Additionally left ear hearing loss within the meaning of VA regulations is shown by the evidence of record. 38 C.F.R. § 3.385. However, military noise exposure alone is not considered to be a disability; rather, the noise exposure must cause hearing loss for VA purposes. The record herein contains two opinions regarding the etiology of the Veteran's left ear sensorineural hearing loss. The January 2009 VA opinion is against the claim, while Dr. JMM's opinion weighs in favor of it. Yet, as was explained by the Board in the December 2012 remand, these opinions on their own are considered insufficient to establish service connection. That is the private medical opinion failed to include any rationale for the opinion expressed; and a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Moreover, a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty to warrant service connection. Bloom v. West, 12 Vet. App. 185, 187 (1999). 38 C.F.R. § 3.385 does not preclude service connection for a current hearing disability where hearing was within normal limits on audiometric testing at separation from service if there is sufficient evidence to demonstrate a relationship between the Veteran's service and his current disability. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The January 2009 VA examiner in effect opined that the current left ear hearing loss was not likely related to service because hearing was essentially normal throughout service. However, to the extent that this opinion is found not to take into account the Court's holding in Hensley the fact is that the private medical opinion must also be treated as non evidence. That is, the September 2006 opinion of Dr. JMM appears to lack a sufficient rationale for the conclusion that the Veteran's left ear hearing loss and tinnitus were related to noise exposure in service. It is acknowledged that additional records from Dr. JMM were submitted in May 2013 showing treatment by Dr. JMM since approximately 2001. However, there is no indication that the doctor knew that the audiometric testing in service had repeatedly failed to show any hearing loss in the Veteran's left ear. It is acknowledged that as a lay person, the Veteran may be considered competent to report what comes to him through his senses, and as such he could opine as to his perceptions of his hearing acuity. See Layno v. Brown, 6 Vet. App. 465 (1994). However, determining whether hearing loss exists for VA purposes and the etiology of hearing loss are considered to be complex medical determinations; and the Veteran lacks the medical training and expertise to provide a complex medical opinion as to the etiology of a particular cancer. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). The record, as it stands, contains two medical opinions regarding the etiology of the Veteran's left ear hearing loss; but each opinion is lacking somewhat, and it was stressed to the Veteran previously that this evidence alone was not considered to be sufficient to support a grant of service connection. It was further emphasized to him that it was imperative that he attend a VA examination, and he was warned that failure to appear at a scheduled VA examination could result in the denial of his claim. Unfortunately, he failed to report to his scheduled VA examination. As such, since the remand explaining that the evidence of record was insufficient to support a grant of service connection, the only additional evidence that has been submitted with regard to the Veteran's hearing is records from 2001 which essentially confirm what has already been acknowledged. That is, that the Veteran currently has hearing loss in his left ear for VA purposes. Unfortunately, without further explanation as to why the Veteran's hearing loss in his left ear is related to service, the criteria for service connection have not been met on a direct basis. Service connection for hearing loss in his left ear has also not been met on a presumptive basis as the in-service hearing tests did not show hearing loss in his left ear during active duty or within a year of separation from active duty. Moreover, the evidence did not show hearing loss in his left ear that was continuous since service, as the first record of hearing loss in his left ear for VA purposes appeared a number of years after separation. The evidence also does not show that the Veteran's hearing loss in his left ear either began during or was otherwise caused by a period of active duty for training. As such, the criteria for service connection have not been met, and the Veteran's claim for service connection for hearing loss in his left ear is denied. With regard to the Veteran's claim for tinnitus, the service treatment records are silent for either complaints of ringing or any diagnoses of tinnitus. Moreover, the Veteran consistently denied any ear problems on medical history surveys. The Court has specifically held that tinnitus is a type of disorder associated with symptoms capable of lay observation. See Charles v. Principi, 16 Vet. App. 370 (2002). In his claim, the Veteran noted that his tinnitus had begun in 1981 and been treated from 1981-84, and he referred VA to his service treatment records. However, as noted the service treatment records do not show any diagnosis of or treatment for tinnitus while the Veteran was in service. Moreover, at his VA examination in 2009, the Veteran reported ringing in his ears over the previous 20 years. However, this would place the onset in approximately 1989, multiple years after the Veteran separated from active duty. Given the discrepancy in the dates of onset as reported by the Veteran, the Board does not find his statements on their own to be sufficiently credible to establish that the onset of his tinnitus was in service, particularly in light of the fact that no mention was made of tinnitus in the service treatment records. Nevertheless, given the Veteran's assertions, a VA examination was provided. However, the examiner opined in January 2009 that it while military noise exposure could not be ruled out as a possible contributing factor, given its date of reported onset it can be stated that the Veteran's tinnitus is less likely as not due to noise exposure in the active duty military. The only other medical opinion of record that addresses the etiology Veteran's tinnitus was provided by his private doctor who related the tinnitus to the Veteran's hearing loss in his left ear. However, as noted above, service connection has been denied for hearing loss in the Veteran's left ear and therefore service connection cannot be granted for a condition as secondary to the hearing loss. Additionally, tinnitus is not a "chronic disease" listed under 38 C.F.R. § 3.309(a), therefore 38 C.F.R. § 3.303(b) does not apply. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As such, the criteria for service connection for tinnitus have not been met, and the Veteran's claim is denied. Hemorrhoids In his claim for benefits, the Veteran indicated that his claimed hemorrhoid disability had its onset in 1981. On entry into service, the Veteran's anus and rectum were found to be normal. In May 1981, the Veteran was treated for a thrombosed hemorrhoid. A subsequent medical examination report, dated in March 1983, revealed that the Veteran's anus and rectum were normal. In a report of medical history completed in August 1985 prior to service separation, the Veteran denied piles or rectal disease. In the corresponding medical examination report, the Veteran's rectum and anus were found to be normal. The service treatment records contain no other information regarding hemorrhoids. Following active duty service, a November 1992 private treatment record reflecting a diagnosis of a thrombosed external hemorrhoid. In a report of medical history dated in March 2001, the Veteran denied piles or rectal disease. Similarly, on March 2001 medical examination, the Veteran's anus and rectum were again assessed as normal. A December 2002 private medical treatment record indicated that the Veteran received treatment for a thrombosed external hemorrhoid that had resolved. On July 2004 VA rectum and anus examination, the Veteran gave a history of hemorrhoid flare-ups from once a month to once or twice a year. He reported that on a few occasions, surgical treatment was necessary. On examination, the examiner observed non-thrombosed hemorrhoids. She did not offer an opinion regarding the etiology of the Veteran's hemorrhoids. In June 2012, the Veteran sought treatment for rectal bleeding that began two weeks earlier. A history of hemorrhoids was noted. The diagnosis was of rectal bleeding. The Board notes that the Veteran was scheduled for a VA examination in April 2013. The Veteran contacted the RO that month and indicated he could not be absent from work. The RO sent him a letter asking that he reschedule the examination. The RO also made unfruitful efforts to contact the Veteran by telephone. The Veteran did not respond and made no attempt to reschedule the examination. The Board is aware of the Veteran's contentions regarding hemorrhoids since 1981. The Board notes that the Veteran is competent to provide evidence regarding hemorrhoids, as they are given to lay observation. See, e.g., Charles v. Principi, 16 Vet. App. 370, 374 (2002) (lay evidence may establish tinnitus, which is capable of lay observation); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flat feet are given to lay observation); Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service symptoms and post-service symptoms of dizziness, loss of balance, hearing trouble, stumble and fall, and tinnitus that later formed the basis of diagnosis of Meniere's disease); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology). The Board recognizes the one instance of hemorrhoids in service in 1981. The Board, however, does not find the Veteran's assertions of unrelenting symptoms credible, as he did not seek treatment for hemorrhoids at any other time in service and explicitly denied a history of hemorrhoidal problems on reports of medical history in 1983 and 1985. See Washington v. Nicholson, 19 Vet. App. 362, 367-68 (2005) (stating that it is the Board's duty, as fact finder, to determine the credibility and weight to be given to the evidence); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) (noting that the Board must account for the evidence which it finds to be persuasive or unpersuasive, analyze the credibility and probative value of all material evidence, and provide the reasons for its rejection of any such evidence); see also Rucker, 10 Vet. App. at 74 (stating that competency must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence). Indeed, there was a gap of over a decade after 1981, where the Veteran does not appear to have suffered from hemorrhoids. The Board, therefore, finds that the incident of hemorrhoids in 1981 was acute and transitory and not an indication of the onset of disease in service. As explained above, the Veteran is competent to provide evidence regarding the presence of hemorrhoids. Lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, namely the etiology of hemorrhoids, 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)." Thus, the Board finds that the Veteran's assertions regarding the etiology of hemorrhoids are not competent and lack probative weight. As such, the Board cannot accept the Veteran's assertions of an etiological nexus between any current hemorrhoidal disability and service. There is no competent evidence of record reflecting a link between hemorrhoids and service. Because a hemorrhoidal disability was not incurred in service and because competent evidence does not show that a hemorrhoid disability is otherwise related to service, service connection for hemorrhoids is denied. 38 C.F.R. § 3.303(a), (d). Additionally, hemorrhoids are not a "chronic disease" listed under 38 C.F.R. § 3.309(a), therefore 38 C.F.R. § 3.303(b) does not apply. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). This is not a case where the evidence is in relative equipoise. As outlined above, there is no competent evidence in favor of the claim. Consequently, the preponderance of the evidence is against the claim, and the benefit of the doubt rule is not for application. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Alemany, supra. Left shoulder The Veteran contends that he has a left shoulder disability that had its onset in 1981. In an October 1980 report of medical history, the Veteran denied a painful or "trick" shoulder. The corresponding medical examination report reflects that the upper extremities, spine, and other portions of the musculoskeletal system were normal. In January 1981, the Veteran presented with complaints of left shoulder pain. In a March 1983 report of medical history, the Veteran expressly denied a painful or "trick" shoulder. The corresponding medical examination report indicated that the upper extremities, spine, and other portions of the musculoskeletal system were normal. In March 1984, the Veteran reported left shoulder pain after an injury playing basketball the day before. The diagnosis was of ligamentous strain, and the Veteran was barred from performing pushups for three days. In an August 1985 report of medical history, the Veteran denied a painful or "trick" shoulder. In the corresponding medical examination report, the upper extremities, spine, and other portions of the musculoskeletal system were found to be normal. In July 2004, the Veteran was afforded a VA medical examination. At that time, the Veteran gave a history of first injuring his left shoulder in service. The Veteran indicated that he currently experienced left shoulder weakness after heavy lifting or raising his arm repeatedly. An X-ray study of the left shoulder was normal. The examiner diagnosed left shoulder strain with mild to moderate limitation due to pain. The July 2004 VA examiner offered no opinion regarding the etiology of the currently diagnosed left shoulder disability. As such, the July 2004 VA examination report is of little probative value. The Board finds that a left shoulder disability was not incurred in service because despite left shoulder treatment in service, the Veteran expressly denied the presence of a left shoulder disability just a few short months after separation from his period of active duty. The Veteran asserts that a left shoulder disability is related to service. While the Board concedes that the Veteran has a current left shoulder disability consisting of left shoulder strain, a current disability is a necessary but insufficient condition for the granting of service connection. See, e.g., Shedden, supra. As well, the Board does not find the Veteran's assertions of a nexus between the current left shoulder disability and service competent for although lay persons are competent to provide opinions on some medical issues, see Kahana, 24 Vet. App. at 435, the specific issue in this case, namely the etiology of orthopedic disabilities, falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377 n.4 (lay persons not competent to diagnose cancer)." Thus, the Board finds that the Veteran's assertions regarding the etiology of left shoulder strain are not competent and lack probative weight. As such, the Board cannot accept the Veteran's assertions of an etiological nexus between any current left shoulder strain and service. There is no competent evidence of record reflecting a link between hemorrhoids and service. Because left shoulder strain was not incurred in service and because competent evidence does not show that left shoulder strain is otherwise related to service, service connection for a left shoulder disability is denied. 38 C.F.R. § 3.303(a), (d). Additionally, a shoulder strain is not a "chronic disease" listed under 38 C.F.R. § 3.309(a), therefore 38 C.F.R. § 3.303(b) does not apply. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). This is not a case where the evidence is in relative equipoise. As outlined above, there is no competent evidence in favor of the claim. Consequently, the preponderance of the evidence is against the claim, and the benefit of the doubt rule is not for application. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Alemany, supra. ORDER Service connection for left ear hearing loss is denied. Service connection for tinnitus is denied. Service connection for hemorrhoids is denied. Service connection for a left shoulder disability is denied. ______________________________________________ MATTHEW W. BLACKWELDER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs