Citation Nr: 1323177 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 10-12 000 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for bilateral hearing loss disability. 2. Entitlement to service connection for tinnitus. 3. Entitlement to service connection for lumbar degenerative disc disease. 4. Entitlement to service connection for right leg numbness, to include as secondary to lumbar degenerative disc disease. 5. Entitlement to service connection for hemochromatosis. 6. Entitlement to an initial rating in excess of 10 percent for hypertension. 7. Entitlement to a total rating based on unemployability due to service-connected disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and C. C. ATTORNEY FOR THE BOARD Siobhan Brogdon, Counsel INTRODUCTION The Veteran served on active duty from November 1988 to May 1992. He subsequently had periods of active duty for training and inactive duty training in the reserve. This appeal comes before the Department of Veterans Affairs (VA) Board of Veterans Appeals (Board) from rating decisions of the VA Regional Office (RO) in Waco, Texas. The Veteran was afforded a Travel Board hearing in May 2011 before the undersigned Veterans Law Judge sitting at Waco, Texas. The transcript is of record. The issues on appeal were remanded by Board decision in December 2011. The issue of entitlement to service connection for Meniere's disease was raised at the May 2011 hearing. As noted in the December 2011 remand this matter is not properly before the Board for appellate review and is referred to the RO for appropriate consideration. During the pendency of the appeal, service connection was granted for right and left knee chondromalacia patellae by rating action dated in February 2013. This is considered the full benefit of those disorders sought on appeal and they are no longer for appellate consideration. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issue of entitlement to a total disability evaluation on the basis of individual unemployability is addressed in the REMAND portion of the document below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. Noise exposure is consistent with the Veteran's duties in service. 2. A right ear hearing loss developed many years after discharge from active duty, it has been attributed to other causes, and it is not related to service. 3. The Veteran does not have left ear hearing loss as that term is defined by VA regulation. 4. Tinnitus developed many years after discharge from active duty, it has been attributed to other causes, and is not related to service. 5. Degenerative disc disease of the lumbar spine was not shown in service, lumbar arthritis was not manifested to a compensably disabling degree within one year of discharge from active duty, and it is unrelated to service. 6 Right leg numbness was not shown in service, was not manifested to a compensably disabling degree within one year of discharge from active duty, and is unrelated to service. 7. The Veteran's hemochromatosis is hereditary disorder that was not diagnosed in service and was not aggravated therein. 8. Hypertension is manifested by diastolic pressure readings predominantly less than 110 and systolic pressures below 200. CONCLUSIONS OF LAW 1. Bilateral hearing loss disability was not incurred in or aggravated by service, nor may a sensorineural hearing loss be presumed to have been so incurred. 38 C.F.R. §§ 1101, 1110, 1112, 1131, 1137, 1154, 5103, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385 (2012). 2. Tinnitus was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. (2012). 3. Lumbar degenerative disc disease was not incurred in or aggravated by service, and lumbar arthritis may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. Right leg numbness was not incurred in or aggravated by service, a right leg neurological disorder may not be presumed to have been so incurred, and right leg numbness is not caused or aggravated by a service connected disorder. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310 (2012). 5. Hemochromatosis was not incurred in or aggravated by service. 38 U.S.C.A. § 1110, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 6. The criteria for an evaluation in excess of 10 percent for hypertension have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.104, Diagnostic Code 7101 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). The requirements of 38 U.S.C.A. §§ 5103 and 5103A have been met in this instance regarding the Veteran's claims. There is no issue as to providing an appropriate application form or the completeness of the application. VA notified the Veteran in July 2008 and January 2009 and thereafter of the information and evidence needed to substantiate and complete the claims, to include notice of what part of that evidence is to be provided by the claimant, what part VA will attempt to obtain, and how disability ratings and effective dates are determined. VA fulfilled its duty to assist the Veteran in obtaining identified and available evidence needed to substantiate the claims, and affording VA examinations. These examinations were adequate to render determinations as to the issues on appeal. The Board finds that there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. 38 C.F.R. § 3.159(c). As such, the claims are ready to be considered on the merits. Pertinent Law and Regulations - Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may legitimately be questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303. Certain chronic diseases, to include organic disease of the nervous system, including sensorineural hearing loss and arthritis may be service connected if incurred or aggravated by service, or if manifested to a degree of 10 percent disabling or more within one year after separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted for disability that is proximately due to or the result of a service-connected disorder. 38 C.F.R. § 3.310 (2012). This includes disability made chronically worse by service-connected disability. See Allen v. Brown, 7 Vet.App. 439 (1995). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing active duty training, or injury incurred while performing inactive duty training. 3 8 U.S.C.A. §§ 101(24), 106, 1110, 1131 (West 2002 & Supp. 2012). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. Reasonable doubt is defined as doubt that exists because of an approximate balance of positive and negative evidence, which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. Factual Background The Veteran's service treatment records reflect that on examination for service entrance in June 1988, an audiogram showed the following puretone thresholds: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 10 10 5 LEFT 10 5 5 5 0 The service treatment records reflect that the appellant was subsequently afforded a number of reference audiograms over the years that did not significantly deviate from the above findings. The Veteran sought treatment in the dispensary in December 1988 for complaints of right knee pain and swelling. Following examination, the assessment was right knee pain, overuse syndrome. He was placed on a physical profile for a week. The appellant was seen in January 1989 with complaints of shin pain on marching, running and walking. There was no history of trauma. Following examination, the assessment was an anterior compartment syndrome. He was placed on physical profile for approximately two weeks for bilateral leg pain with restrictions on running, marching, and prolonged standing. The Veteran completed a Medical History questionnaire dated in July 1991 and denied a history of any back disorder, tingling or numbness in any part of the body, a decrease in his ability to hear, ringing or other unusual sound in the ears, and pain in the ears, etc. The last in-service audiogram of record dated in January 1992 revealed the following: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 5 10 10 LEFT 10 0 5 10 5 It was noted that there had not been a significant threshold shift. Post service, a physical examination for periodic non-fly purposes was conducted in August 1995. An audiogram was obtained that showed the following puretone thresholds: HERTZ 500 1000 2000 3000 4000 RIGHT 20 10 10 20 5 LEFT 10 5 5 15 10 In an August 1995 Report of Medical History, the Veteran denied ear trouble, hearing loss, bone, joint or other deformity, arthritis, recurrent back pain and cramps in legs, etc. The spine and other musculoskeletal system, lower extremities, and ears were evaluated as normal. A letter from J. L. Bull, D.O., dated in September 1995 noted that a recent laboratory evaluation had revealed an increased hemoglobin and hematocrit with increased serum iron due to having too much iron. The appellant was advised to avoid vitamins with iron and to decrease iron in his diet. It was recorded that this was not considered a significant medical problem. A January 1996 Master Workplace Exposure Data Summary indicated that in the Veteran's work location was in structural fabrication. He was found to have had exposure to hazardous noise and would be outfitted with ear plugs/muffs. On a February 2001 Report of Medical History, the Veteran denied hearing loss, ear infection, leg trouble, bone, joint or other deformity, recurrent back pain or any back injury, etc. A clinical evaluation revealed normal findings regarding the ears, lower extremities, and spine. The Veteran completed medical questionnaires for occupational safety purposes in January and February 2002 noting that he worked in aircraft structural repair. He denied difficulty hearing, ear problems, leg weakness, and back pain. He denied having any activity restrictions, including bending from the waist, and squatting. He noted that he wore earplugs and muffs. In February 2002, he reported suffering a back injury. Reference audiograms dated between 2002 and 2004 indicate that the appellant was routinely exposed to steady noise from his job in maintenance and base operations. In a January 2006 clinical record from G. Edelman, M.D., PhD, it was noted that the Veteran presented with a very high ferritin level and that his father had been diagnosed with hemochromatosis. It was reported that a mutation study had come back positive for hereditary hemochromatosis. The overall plan was that he be aggressively phlebotomized with an intention to reduce his ferritin level to below 100. The Veteran completed medical questionnaires for occupational safety purposes in July and August 2005 indicating that he worked in structural maintenance and aircraft structural repair. He denied difficulty hearing, ringing in the ears, and any other ear problem. He also denied leg weakness, back pain, and restriction in activity, including bending from the waist, and squatting. He noted that he wore earplugs and muffs. Private records dating from 2006 from Total Pain Medicine and Anesthesiology indicate that an August 2006 magnetic resonance imaging study revealed a herniated L5 disc for which he was afforded steroid injection the following month. The appellant underwent an initial consultation in September 2006 where it was reported that he worked as an aircraft mechanic, primarily on the airframe, and had had a progressive increase in low back pain for some months. He stated that pain radiated down the right leg, routinely below the buttock, but rarely below the knee. Following examination, the assessments included herniated nucleus pulposus, L5-S1 per MRI, low back pain, and hemochromatosis by history. In March 2007, it was recorded that the appellant reported intermittent right-sided low back pain and leg numbness for the prior 10 months for which therapeutic injections had been administered. Moderately advanced degenerative disc disease at L5-S1 was noted. A Post-Deployment Health Questionnaire completed on May 15th 2007 indicated that the Veteran was deployed with the reserve to Kuwait on May 2, 2007. The appellant denied symptoms to include weakness, painful joints, back pain, numbness or tingling in the hands or feet, and ringing of the ears. He indicated that he did not have any medical problems that developed during the deployment. , The Veteran filed a claim of entitlement to service connection for a low back disorder/degenerative joint disease, right leg numbness, hemochromatosis, a bilateral knee disability, and bilateral hearing loss and tinnitus in June 2008. A September 2008 reserve fitness for duty evaluation notes that the appellant was issued an indefinite excuse from fitness testing, and he was restricted to light duty secondary to lumbar degenerative disc disease. A history of intermittent right-sided low back pain and right lower leg numbness since 2006 was noted. The Veteran alleged that he had treated the pain with oral medication and intermittent steroid injections into July 2007. Reportedly, the pain did not significantly impact his military job performance until April 2007 at which point he had been given a six-month profile based on civilian physicians' recommendations that excused him from the physical fitness test. Current neurological examination disclosed positive right straight leg raising. There was limited back range of motion and some point tenderness in the right buttock. There were some patchy sensory changes in the lateral aspect of the right calf. MRI revealed moderately severe degenerative disc disease at L5-S1 with moderate degenerative disc disease at all other lumbar levels. In October 2008, the Veteran underwent a L5-S1 laminectomy, decompression of the lateral recesses, placement of pedicle screws, posterolateral fusion with bone graft, autograft, allograft and "BMP." The examiner noted a history of intractable low back pain and degenerative disc at L5-S1 and had failed conservative management. A treatment record for Blue Cross/Federal reimbursement dated in November 2008 recorded that the Veteran's was treated the previous day for complaints to include earache, an inability to hear out of the right ear, ringing in the ear, and dizziness. It was noted that he worked around airplanes, and audiogram results disclosed profound hearing loss in the right ear with moderate hearing loss in the left. It was felt that he had an Eustachian tube dysfunction. The appellant was subsequently afforded outpatient consultation in November 2008 and provided history that he had right-side hearing loss had begun seven days before. He reported awakening with a sudden right ear hearing loss, tinnitus and vertigo with associated dizziness and nausea/vomiting. A history of recent back surgery was noted. Following examination, assessments included right sensorineural hearing loss, unilateral (profound and sudden), and hemochromatosis. The Veteran underwent a private follow-up examination in December 2008. He reported dizziness with decreased hearing, tinnitus and a 'swooshing sound' in the right ear that had begun three weeks before. Medical history was positive for musculoskeletal numbness and tingling and back surgery in October 2008. Following examination, assessments of right vestibular neuronitis, right auditory neuritis and hemochromatosis were rendered. The Veteran was afforded a VA audiology examination in December 2008. The examiner indicated that the claims folder was reviewed and pertinent history dating from service was recited, including noise exposure history. Following audiometric study the diagnoses were profound sensorineural hearing loss in the right ear, and for the left ear, hearing within normal limits at 250-2000 Hertz, mild sensorineural hearing loss at 3000 Hertz, and hearing within normal limits from 4000-8000 Hertz. Bilateral tinnitus was also diagnosed. The examiner opined that after a review of the service treatment records, personal interview and audiometric testing, that the Veteran's hearing loss and tinnitus were less likely than not a result of noise exposure during military service. The Veteran underwent a VA examination in March 2009 for hypertension purposes. It was noted that hemochromatosis was diagnosed in 2006 and he regularly had his blood extracted every three to six months. He stated that after the initial diagnosis, he had had blood taken out every week for about nine months until there was noticeable improvement. The appellant related that in October 2008, he had sustained a herniated disc, but had actually had a 'blowout of the disc in 2006' while engaged in a military physical training test. He stated that his back had been better since surgery although some right lower extremity numbness persisted. The Veteran admitted that he suddenly lost the hearing in one ear a few years before but that this was a nonservice-connected event. Following examination, the diagnoses were hypertension, currently controlled by two medications, hemochromatosis, currently controlled with blood extractions, and status post lumbar laminectomy. Subsequently received were clinical records dated between 2007 and 2009 from Arlington Cancer Center showing that the appellant received continuing follow-up and phlebotomy treatment for hereditary hemochromatosis. In May 2009, the Veteran reported having a viral infection that led to his becoming totally deaf in the right ear. In May 2009, a disability retirement was approved by the Office of Personnel Management for the Veteran because it was determined that he was disabled for his position as a sheet metal mechanic due to degenerative disc disease. The Veteran underwent a Physical Evaluation Board by the Air Force Reserves in May 2010 which determined that he was unfit to perform the duties of his office. He was administratively discharged due to degenerative disc disease, and right auditory nerve neuritis/right vestibular nerve neuritis. In September 2010, K. L. Katzen, D.O., opined that the Veteran was permanently disabled due to his medical conditions that included unexplained hearing loss accompanied by vertigo with co-morbid lumbar degenerative disc disease. The physician stated that the appellant had failed back syndrome and was never without pain or discomfort. In May 2011, the Social Security Administration denied the Veteran's claim for benefits and, after discussing his various infirmities, found that neither the objective medical evidence, nor his testimony, nor any other evidence established that his ability to function was so severely impaired as to preclude a reduced range of sedentary work for any period of 12 continuous months. In May 2011 the Veteran testified to the effect that he was totally deaf in the right ear and also had tinnitus. He stated that he did not have hearing loss prior to active duty. The appellant testified that he sustained a back injury while performing annual physical training in the Reserves that led to degenerative disc disease, sciatic pain and numbness radiating into the right leg. The Veteran stated that hemochromatosis went undetected during active duty despite the number of laboratory studies, and this could potentially affect his liver pancreas and heart. He related that hypertension was poorly controlled with medication and that it was on the "high side." The appellant said that he was totally disabled due to back disability compounded by the lack of hearing in his right ear. The Veteran underwent a VA thoracolumbar spine and lower extremity examination in June 2012. He stated that he had the onset of back pain in 2006 or 2007 with paresthesias and pain into the right lateral thigh and leg for which had undergone lumbar fusion. He related that chronic lower lumbar pain and right leg numbness persisted after surgery. A comprehensive physical examination was performed and X-rays were obtained. Following examination, a diagnosis was rendered of lumbar degenerative disc disease with chronic right L5 radiculopathy, status post laminectomy and fusion. The examiner opined that it was at least as likely as not that the lumbar spine disorder was caused by and the result of active military service. The examiner stated that there was no evidence of degenerative lumbar disease between 1988 and 1992. It was reported that the RO's examination request only noted active service from 1988 to 1992, but that the Veteran indicated that he was in active service from 2005 to 2009, and, in fact, had undergone a medical board in 2008 that resulted in his retirement from military service. The examiner stated that the claims folder clearly demonstrated that degenerative disc disease of the lumbar spine developed during this period with corrective surgery in 2008, and that based on this evidence, it was clear that lumbar disease and its associated radiculopathy were caused by or the result of active military service. An opinion was requested from a VA physician as to whether the Veteran's hemochromatosis was related to service. In a report dated in February 2013, the examiner stated that the claims folder, service treatment records, VA electronic records accessed by the Compensation and Pension Records Interchange system, and compensation and pension examinations had been reviewed. A comprehensive clinical history pertaining to the disorder was recited. The examiner provided clinical authority regarding the pathogenesis of hereditary hemochromatosis. Following review of the evidence, the reviewing physician opined that the Veteran's hemochromatosis was less likely than not incurred in or caused by an inservice injury, event or illness. It was further opined that hemochromatosis clearly and unmistakably existed prior to service, and was clearly and unmistakably not aggravated beyond normal progression by an in-service injury, event or illness. It was also indicated that hemochromatosis was not aggravated by service-connected hypertension. The examiner explained in detail that while untreated hemochromatosis could result in organ damage and other complications, this had not happened in the Veteran's case because his diagnosis had been made in adulthood, prior to pathologic manifestations, and had been treated effectively with phlebotomy. Legal Analysis 1. Service connection for bilateral hearing loss disability and tinnitus. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2012). The Veteran worked in structural fabrication during service. Therefore, exposure to noise is consistent with the circumstances of his service. Accordingly, in-service exposure to noise is conceded. 38 U.S.C.A. § 1154. However, this does not by itself provide for grant of service connection. Rather, the evidence must demonstrate that the Veteran has bilateral hearing loss disability that is related to service. After reviewing the evidence in its entirety, the Board concludes that service connection for bilateral hearing loss disability is not warranted. The Veteran's service treatment records do not reflect any complaints or treatment pertaining to hearing impairment, tinnitus or ringing in the ears. In the case of hearing loss, VA has established a medical standard by which this disability may be objectively demonstrated. The reference audiograms afforded the Veteran during service, to include some months prior to separation, indicate that there was negligible threshold shift from the time he entered active duty. As such, he did not meet the threshold criteria to establish hearing loss disability for VA compensation purposes at service discharge. See 38 C.F.R. § 3.385. Although a discharge examination report is not of record, post service records show that he clearly denied hearing loss and ringing of the ears for many years after discharge from active duty. A post service audiogram in 1995 was negative for hearing loss by VA standards. Moreover, the evidence reflects that post service, he became employed as an airplane mechanic and in aircraft structural fabrication where records indicate that he was routinely exposed to noise. The record reflects that substantially diminished right ear hearing was not documented until November 2008. At that time, the appellant was treated for right ear hearing loss of sudden onset. He stated that associated symptoms included ringing in the ears. This is more than 15 years after discharge from active duty. See Maxson v. West, 12 Vet. App. 453 (1999) (service incurrence may be rebutted by the absence of medical treatment of the claimed condition for many years after service). The Veteran's physicians initially diagnosed the profound right ear hearing loss and attendant symptomatology as Eustachian tube dysfunction, right vestibular neuronitis, and right auditory neuritis. At the 2009 VA audiology examination the Veteran himself admitted that he had lost his right ear hearing suddenly a few years before and that this was a nonservice-connected event. He was reported to have told a provider at the Arlington Cancer Center in May 2009 that a viral infection had led to total right ear deafness. There is no showing of a viral infection during service. Thus, the defect in the Veteran's claim is a lack of probative evidence of a nexus to service. The Board has carefully considered the evidence and the assertions that bilateral hearing loss and tinnitus are of service onset. A layman is competent to report what he experiences through the senses. Layno v. Brown, 6 Vet.App. 465 (1994). In this regard, the Board does not dispute the Veteran's account of noise exposure during active duty. In this case, however, the more probative evidence establishes the more remote onset of right ear hearing loss and tinnitus that are unrelated to service. In Hensley v. Brown, 5 Vet.App. 155, 159, the Court held that 38 C.F.R. § 3.385 (2012) does not preclude service connection for a hearing disability where hearing might have been within normal limits at separation from service. The veteran may still be able to establish service connection for hearing impairment by submitting evidence that it is causally related to service. 38 C.F.R. § 3.303(d). The Court found that there is no requirement that there be complaints or treatment in service before service connection for hearing loss can be granted. Ledford v. Derwinski, 3 Vet.App. 87, 89 (1992). Here, however, there is no evidence of either a right hearing loss or tinnitus in proximity to service. Moreover, there is a great deal of evidence indicating that the onset of right ear hearing loss and tinnitus were of acute onset more than 15 years after discharge from active duty. There is no indication that the sudden event occurred during a period of active duty for training or that he sustained any injury to the ear during a period of inactive duty training. The Board also concludes that the Veteran has not been a reliable historian, that his later statements and testimony in this regard are self-serving, inconsistent with prior statements he made, and that he is not credible. Therefore, when considering the entirety of the evidence of record, the Board finds that there is neither inservice chronicity nor continuity of symptomatology of the claimed right hearing loss or tinnitus from service. See 38 C.F.R. § 3.303. Here, the Board attaches greater probative weight to the clinical findings of the VA skilled clinical professional who determined that right ear hearing loss and tinnitus are less likely than not attributable to service. As to the left ear, the most recent VA audiology evaluation in 2008 does not reflect evidence of threshold shifts that comport with hearing loss disability in accordance with 38 C.F.R. § 3.385. Although the Veteran was found to have a mild sensorineural hearing loss at 3000 Hertz, he did not have hearing loss disability by VA standards in the left ear. Service connection requires evidence that establishes that a Veteran currently have a disability for which service connection is sought. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Although the appellant is competent to claim that he has a hearing problem in the left ear, a clinical professional has the greater skill in determining whether he has a hearing loss disability for VA compensation purposes. VA regulations require specific evidence diagnosing the claimed disability, and the appellant's self-assessment is less probative in this instance. See 38 C.F.R. § 3.304. There is no probative evidence in the record showing current left ear hearing loss disability in accordance with 38 C.F.R. § 3.385. Therefore, to the extent that the appellant reports that he has hearing impairment in that ear, his statements, even when accepted as true, do not establish the presence of a disability for VA purposes. Therefore, service connection for left ear hearing loss disability is not warranted, Under the circumstances, the most probative evidence of record demonstrates that current right ear hearing loss disability and tinnitus developed many years after active duty and are unrelated to service. The Veteran does not have a left ear hearing loss under VA regulatory criteria. The Board thus finds that the preponderance of the evidence is against the claims and service connection is denied. 38 U.S.C.A. § 5107(b). 2. Service connection for lumbar degenerative disc disease, and right leg numbness, to include as secondary to lumbar degenerative disc disease The Veteran asserts that he has lumbar degenerative disc disease of service onset for which service connection should be granted. In this regard, however, service treatment records are completely silent for any low back complaints. Although a service discharge examination report is not of record, the evidence reflects that the appellant denied back pain and a lower extremity problem for years after separation from active duty. There is no documentation evidencing treatment for the low back or for right leg numbness immediately after discharge from active duty. The most reliable evidence first documents back and right leg complaints, diagnosed as lumbar degenerative disc disease with right lower extremity radiculopathy in 2006, approximately 14 years after separation from service. Private clinical records reflect that the Veteran presented with complaints of back pain/right lower extremity pain and numbness with no precipitating cause recorded in the extensive clinical data generated at that time. In view of such, the Board finds that lumbar disc disease and right leg numbness did not have onset in service, and that the presumption of entitlement to service connection for lumbar arthritis and right lower extremity radiculopathy does not attach. Neither degenerative disc disease nor right lower extremity radiculopathy were compensably disabling within one year of separation from active duty. In view of such, the Board finds that service connection for lumbosacral degenerative disc disease and right leg numbness is not warranted on either a direct or presumptive basis. See 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. Lay assertions may serve to establish a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F. 3d. 1372 (2007). A layperson is competent to report what he experiences through the senses. Layno, 6 Vet.App. at 470. The Board, however, is obligated to determine whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc. Similarly, the Board can weigh the absence of contemporaneous medical evidence against the lay evidence of record. In considering the lay and clinical history as reported above with respect to the low back and right leg, the Veteran was initially evaluated for back pain in 2006 and thereafter, he did not at any time provide a history of back injury in service or during active duty for training or inactive duty for training. He did not refer to the circumstances of any inservice back problem or injury on the many occasions he was evaluated. The amount of time that elapsed between military service and the first post-service evidence of complaint or treatment may be considered evidence against the claim. Maxson, 230 F.3d at 1333. Additionally, he unequivocally denied having back pain or limitations in various physical examinations and occupational questionnaires completed after service except in February 2002 when he indicated he had had a back injury. The time and place of injury was not reported. However, this was still almost a decade after discharge from service. It is significant to note that he denied back injury and complaints in 2001, thus indicating that any injury occurred between 2001 and 2002. Nevertheless, the circumstances of such are never recorded. At a 2009 VA examination the Veteran presented a vague history of lumbar disc "blowout" while engaged in military training in 2006. However, as indicated previously, there is not a single supporting document to this effect. When examined by VA in June 2012, the examiner did indeed attribute low back disc disease to service. However, it is clearly demonstrated that the attribution of such was based on erroneous evidence obtained or understood by examiner that the Veteran had active service between 2005 and 2009 which was only partially true. While there is evidence in the record that the Veteran did have short periods of active duty for training and inactive duty training, there is no evidence corroborating the assertion that the appellant sustained a back injury during any period of training. Further, the Veteran has not been a reliable historian, and his later statements and testimony in this regard are self-serving and not credible. The examiner correctly observed and noted that there was no evidence of degenerative disc disease between 1988 and 1992, during active service. The inconsistencies and discrepancies in the record undermine the credibility of the Veteran's recent statements and testimony relative to the low back and right leg disorders. In summary, the Board concludes that there is no credible, competent and probative evidence indicating that either lumbar disc disease or right leg numbness are related to service or any incident therein. As service connection for lumbar degenerative disc disease is denied, it is unnecessary to discuss whether right leg numbness or radiculopathy is secondary thereto. See 38 C.F.R. § 3.310. Under the circumstances, the Board concludes that the preponderance of the evidence is against the claims of lumbar spine degenerative joint disease and right lower extremity numbness and service connection is denied. 38 U.S.C.A. § 5107(b). 3. Entitlement to service connection for hereditary hemochromatosis. The Board has carefully reviewed the clinical evidence but finds that service connection for hemochromatosis is not warranted. The evidence discloses that the Veteran underwent laboratory testing in 1995 that revealed an increased hemoglobin and hematocrit with increased serum iron due to having too much iron in the blood. It was felt that this was not considered a significant medical problem. It was subsequently determined that the appellant had hereditary hemochromatosis for which he underwent a courses of aggressive phlebotomy to lower his ferritin levels. The appellant continues to carry this diagnosis. VA regulations provide that congenital or developmental defects are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c) (2012). Significantly, however, VA General Counsel has promulgated an opinion that indicates that a distinction is to be made between congenital/developmental defects and congenital/developmental diseases. VAOPGCPREC 67-90 (July 18, 1990); VAOPGCPREC 82-90 (July 18, 1990); Monroe v. Brown, 4 Vet.App. 513 (1993). The latter may be service connected, primarily because unlike defects, they are subject to improvement or deterioration. Id. VA General Counsel has determined that a congenital or hereditary disease may be service connected if it is shown that the disease was first manifested during active military service. See VAOPGCPREC 67-90 (July 18, 1990). The rationale is that the mere genetic or familial predisposition to develop symptoms, even if the individual is almost certain to develop the condition at sometime in his life, does not constitute having the disease. Only when an active disease process exists can a claimant be said to have developed the disease. Thus, if a claimant has a congenital or hereditary predisposition to develop a certain disease, but no manifestation of such at the time he enters military service, and he later manifests the disease during active military service, service connection may be granted. Id. Therefore, diseases of hereditary origin can be considered to be incurred in service if the disease did not become evident until after entry in military service, and may be found to have been aggravated during service if it progresses during service at a greater rate than normally expected. Id. The record here reflects that hemochromatosis was not diagnosed in service or for several years thereafter. The first evidence of such was in 1995. In February 2013, a VA examiner provided clinical authority and supporting rationale in an opinion which found that hemochromatosis clearly and unmistakably existed prior to service, and was clearly and unmistakably not aggravated beyond normal progression by an in-service injury, event or illness. It was also noted that service-connected hypertension was not implicated as an aggravating factor. There is no competent evidence to the contrary. As such, the preponderance of the evidence weighs against the claim of entitlement to service connection for hemochromatosis both as the result of direct incurrence and on the basis of aggravation, to include as the result of any trauma during active duty or training. In reaching this determination, the Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the Veteran when there is an approximate balance of positive and negative evidence regarding the merits of an issue. However, that doctrine is not applicable in this case because the preponderance of the evidence is against the Veteran's claim. 38 U.S.C.A. § 5107(b). 4. Evaluation in excess of 10 percent for hypertension. Pertinent Law and Regulations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4 (2011). The Board attempts to determine the extent to which the Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life and is based, as far as practicable, on average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.41, 4.10 (2012). The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1 (2012); Schafrath v. Derwinski, 1 Vet.App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is or primary concern. See Francisco v. Brown, 7 Vet.App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the medical evidence since the effective date of the grant of service connection to consider the appropriateness of "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet.App. at 126; see also Hart v. Mansfield, 21 Vet.App. 505 (2007). Hypertension is evaluated pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7101 that provides for 10 percent rating when diastolic pressure is predominantly 100 or more, or systolic pressure is predominantly 160 or more, or, as a minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. To warrant a 20 percent rating, the evidence must show that diastolic pressure is predominantly 110 or more, or that systolic pressure is predominantly 200 or more. Id Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Factual Background and Legal Analysis The Veteran underwent a VA examination in March 2009 for hypertension purposes. On examination, blood pressure readings of 138/91 and 140/88 were obtained. Following examination, a pertinent diagnosis of hypertension, currently controlled by two medications was rendered. Pursuant to the Board's 2011 remand, the Veteran was afforded a VA examination for hypertension in May 2012. A May 2012 addendum was also attached. It was noted that he currently taking only one medication which was Atenolol. On examination, blood pressure readings were 151/93, 136/84, and 130/90. The Veteran related that he took his medication just prior to his appointment but that he felt 'stressed out and anxious' and that this made his blood pressure rise. He denied headaches, blurred vision, chest pain, dizziness or syncope. The examiner reported that the appellant's blood pressure was currently elevated but that in reviewing the medical records, his blood pressure seemed to be under good control with medication. The examiner stated that the appellant did not have a history of diastolic blood pressure elevation of predominantly 100 or more and that hypertension did not impact or inhibit his ability to obtain and maintain gainful employment at that time. Review of the extensive record reflects that the Veteran has necessitated the use of continuous medication for control of hypertension. However, it is not demonstrated that he has had any diastolic readings over 110 at any time during the course of the appeal. Likewise systolic readings predominately in excess of 200 were not shown. Review of the voluminous evidence dating through 2012, including VA examination reports, reflects that the Veteran's diastolic readings have predominantly been in the 60, 70, and 80 ranges over the course of the appeal. Readings of 147/100 and 170/98 were recorded in November 2008 and August 2008, respectively, but these appear to be anomalous. In a private clinical record dated in July 2009, the appellant related that average home blood pressure ranges were in the 120/80 range. As such, the Board finds that the appellant's blood pressure readings are contemplated by the criteria for a 10 percent evaluation and no more. Thus, a rating in excess of 10 percent is not warranted. The Veteran can assert that his hypertension is worse than currently rated. However a higher evaluation for high blood pressure depends on the results of clinical findings. Jandreau. Thus, to the extent that the appellant asserts that his service-connected hypertension is worse, the predominant findings on the private and VA clinical examinations over the years do not establish that he has more severe disability in this respect. The Board concludes that the predominant clinical findings on evaluations over the years are of greater probative value and fail to demonstrate that a higher evaluation is warranted for service-connected hypertension. In view of such, the Board finds that the currently assigned disability evaluation of 10 percent has been appropriate since the date of service connection. Fenderson. The Board considered whether a higher rating for hypertension is warranted on an extraschedular basis. The potential application of 38 C.F.R. § 3.321(b)(1) (2012) has been considered. However, the record does not present such "an exceptional or unusual disability picture as to render impractical the application of the regular rating schedule standards." The objective evidence does not demonstrate that hypertension markedly interferes with employment beyond that contemplated by the rating schedule as indicated on VA examinations noting that the disability had no effects on occupational pursuits. There is no evidence showing that he has been frequently hospitalized due to his symptoms. The evidence shows that the relative manifestations and the effects of the disability have been fully considered and are contemplated by the rating schedule. See Thun v. Peake, 22 Vet.App. 111 (2008). Therefore, the criteria for referral for an extraschedular rating pursuant to 38 C.F.R. § 3.321(b) (1) are not met. See Bagwell v. Brown, 9 Vet.App. 337 (1996); Shipwash v. Brown, 8 Vet.App. 218, 227 (1995). The preponderance of the evidence is against the claim for a rating in excess of 10 percent for hypertension and the claim is denied. 38 U.S.C.A. § 5107(b). ORDER Entitlement to service connection for bilateral hearing loss disability is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for degenerative disc disease of the lumbar spine is denied. Entitlement to service connection for right leg numbness is denied Entitlement to service connection for hemochromatosis is denied. Entitlement to an evaluation in excess of 10 percent for hypertension is denied. REMAND As noted above the appellant has claimed entitlement to service connection for Meniere's disease. This issue is not ripe for appellate consideration, but it is inextricably intertwined with the question of entitlement to a total disability evaluation based on individual unemployability. Hence, this case is REMANDED for the following action: 1. The RO must adjudicate the claim of entitlement to service connection for Meniere's disease. The Veteran is advised that the Board cannot exercise appellate jurisdiction over that matter in the absence of a timely perfected appeal. 2. Thereafter, the RO must readjudicate the issue of entitlement to a total disability evaluation based on individual unemployability. If the claim remains denied the RO must issue a supplemental statement of the case, and offer the appellant a reasonable period of time within which to respond. The case should thereafter be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The Veteran need take no action unless otherwise notified. VA will notify him if further action is required on his part. He has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs