Citation Nr: 1323987 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 09-32 102 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Entitlement to service connection for residuals of bilateral heel fractures. 2. Entitlement to service connection for back condition, to include as secondary to bilateral heel fractures. 3. Entitlement to service connection for bilateral leg condition. 4. Entitlement to service connection for numbness of right lower extremity from knee to hip. 5. Entitlement to service connection for bilateral hearing loss. 6. Entitlement to service connection for tinnitus. REPRESENTATION Appellant represented by: Colorado Division of Veterans Affairs WITNESSES AT HEARING ON APPEAL Appellant and Appellant's Wife ATTORNEY FOR THE BOARD Amanda Christensen, Associate Counsel INTRODUCTION The Veteran had active military service from October 1965 to October 1967. This appeal comes to the Board of Veterans' Appeals (Board) from August 2008 and December 2008 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided sworn testimony in support of his appeal during a hearing before the undersigned Veterans Law Judge in May 2013; the hearing transcript has been associated with the file and has been reviewed. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence. FINDINGS OF FACT 1. The Veteran was diagnosed with bilateral heel fractures in service, and giving the Veteran the benefit of the doubt, the evidence shows he currently experiences residuals of that injury that are related to service. 2. The Veteran has been diagnosed with multilevel degenerative thoracolumbar spondylosis; however, the evidence does not show complaints of back problems in service or for many years thereafter, and the competent medical opinion of record weighs against the Veteran's claim for service connection as secondary to his bilateral heel fractures. 3. The only current leg disabilities the Veteran has been diagnosed with are venous insufficiency and sciatica-like symptoms, but no leg problems were noted in service or for many years thereafter, and the evidence does not support a connection between the Veteran's service and any current leg disability. 4. Although the Veteran has been diagnosed with sciatica-like symptoms, no leg numbness was noted in service or for many years thereafter, and the evidence does not support a connection between the Veteran's service and any current leg numbness. 5. The evidence does not show that the Veteran's current bilateral hearing loss had its onset in active service, was manifested within the first year after service, or otherwise is related to active service. 6. The evidence does not show that the Veteran's current tinnitus had its onset in active service or otherwise is related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of bilateral heel fractures have been met. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). 2. The criteria for service connection for back condition have not been met. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). 3. The criteria for service connection for bilateral leg disability have not been met. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). 4. The criteria for service connection for numbness of right lower extremity have not been met. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). 5. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1110, 1112 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 6. The criteria for service connection for tinnitus have not been met. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection for certain chronic diseases, including an organic disease of the nervous system, may be granted if such disease is manifested in service, or manifested to a compensable degree within one year following separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310. To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Service connection for certain chronic diseases, including an organic disease of the nervous system, may be granted, even if not otherwise established as incurred in or aggravated by service, if such disease is manifested in service, or manifested to a compensable degree within one year following separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For chronic diseases shown in service or within the presumptive period of 38 C.F.R. § 3.307, service connection may also be granted if there was a showing of the chronic disease in service and continuity of symptomatology since service. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Competent medical evidence is 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 include statements conveying sound medical principles found in medical treatises. It also includes 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 is 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 lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau, 492 F.3d 1372. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. A. Bilateral Heel Fractures The Veteran's feet were found normal at his entrance examination in September 1965. The Veteran testified at his May 2013 Board hearing that during basic training he dropped about three feet off of monkey bars while wearing a full field pack. He said he landed wrong and the next morning his feet and legs were so swollen he couldn't get his socks and shoes on. He crawled three blocks to get medical treatment. He then was told to rest in an empty barracks for a week to a week and a half and then sent home for a week or two before having to start basic training over again. The Veteran testified that he returned to medical multiple times but was told the fracture was healing. Service treatment records reflect that in November 1965 the Veteran complained of right ankle soreness when walking and painful heels. He was given foam rubber padding to put in the heels of his boots. Several days later he reported continued pain and swelling in both heels. After being referred to the podiatry clinic x-rays showed stress fractures of both heels. He was given pads for his feet and put on limited duty. X-rays taken near the end of the month showed good healing of his bilateral heel stress fractures. The Veteran testified he completed basic training the second time wearing arches in his shoes. He then went to helicopter school but was pulled from going to Vietnam. He said his back and feet continued to hurt, but he didn't complain. The Veteran reported no history of medical problems, including foot trouble, on his discharge report of medical history, and his feet were found normal at his discharge examination in August 1967. The Veteran testified that after service he worked on an assembly line for the next seven to eight years sitting in a chair. He then worked for the next 27 years at another company that let him sit down when he wanted. He also sold cars for several years, then worked at Sam's Club, but quit because the job involved too much lifting, and for the past ten years has worked in building maintenance. He said none of his jobs since service have involved carrying the equivalent of a combat load. He said his current job involves some heavy lifting, but he either gets someone to help him or uses a hand truck. He testified his feet continue to hurt and that if he wears new shoes for a day he is unable to walk for a couple days afterward. He said doctors have told him he has nerve damage in his feet and up his legs. The Veteran said that as a result of the injury he has an altered gait in which his left foot flops. He also said his right leg is numb down to his foot. He testified he sometimes takes Aleve for the pain, but mostly deals with it. The Veteran's wife testified that she met him in 1972 and at that time he would often complain that his feet and ankles hurt. He also had broken blood vessels around his ankles. The Veteran's ex-wife, who reported that she was married to the Veteran for nearly 25 years starting in 1966, wrote in a statement that the Veteran had no problems with his feet, legs, or back prior to service but has had pain since he was injured in basic training. She stated that the Veteran's problems with his feet have become worse over the years. On a November 1971 pre-employment health history form, the Veteran reported himself to be in good health, denying "swelling of feet, ankle or legs" and "prolonged foot trouble." He again denied both on a December 1977 employment health history form. In October 1987, on an employment health questionnaire, he denied having any condition that would limit prolonged standing or walking. In August 2007 the Veteran complained to his private physician, Dr. T, that he was having increasing pain in his heels, the left greater than the right, radiating up both legs. He reported he had had pain in his heels since an injury in service but that it had worsened since that time. Dr. T noted the Veteran had tenderness to palpation of the plantar surface of his left heel and assessed him with likely degenerative bone and joint disease, possibly related to old fractures. He referred him to an orthopedic doctor. The Veteran first saw the private orthopedic doctor in September 2007, who recommended physical therapy after hearing the Veteran's complaint of worsening heel pain and finding the Veteran had some underlying gastrocnemius-driven equinus and some sciatica-type symptoms. The doctor noted the Veteran had tenderness to palpation along the medial band of the plantar fascia at about the midfoot and then extending along the posterior aspect of the calcaneus. In October 2007 the Veteran was noted to have well-resolving periostitis and plantar fasciitis of his left heel. The Veteran was afforded a VA examination in July 2008. He told the examiner that his feet hurt all the time, his left worse than his right. He uses shoe inserts and walking boots. He said he avoids walking as that exacerbates the pain. The examiner found the Veteran had no painful motion, edema, weakness, or instability on examination. He was tender to deep palpation at his left heel. The examiner found no signs of abnormal weight bearing, posture, or gait. She further found that the Veteran's feet were normally aligned. The Veteran's vibratory sensation was negative at the fifth metatarsal joints bilaterally and protective sensation was present in 10 of 10 sites on his right foot but only 4 of 10 sites on his left foot. X-rays showed bilateral calcaneal spurs and bilateral degenerative osteoarthropathy most conspicuously involving the first metatarsophalangeal joints bilaterally as well as multiple interphalangeal joints. The examiner diagnosed venous insufficiency in the bilateral lower legs and feet, peripheral neuropathy in the bilateral feet, and bilateral calcaneal spurs. The Veteran underwent another VA examination in October 2010. The Veteran reported bilateral foot pain and that his feet swell after eight hours of work with decreased endurance after four to five hours on his feet. The examiner found no evidence of muscle atrophy in the lower calf or foot, but that the Veteran's calf, Achilles, and foot muscles were tight. The examiner noted the Veteran had an antalgic gait and an excessive wear pattern on the heel of his left shoe. He also had mild swelling over his left ankle and dorsal side of the foot anterior to the lateral malleoli. The examiner also noted tenderness with deep palpation along both sides of the Achilles tendon and calcaneal bursa bilaterally and bilateral heel pads. The Veteran's vibratory sense was faint to absent at the lateral malleoli bilaterally and his first through fifth metatarsal joints. Protective sensation was also absent in 10 of 10 sites bilaterally. The examiner diagnosed calcaneal heel spurs and a history of calcaneal heel stress fractures with no evidence of residuals on x-ray. The examiner opined that the Veteran's current heel spurs are not caused by or a result of his bilateral calcaneal heel fractures that occurred in service. She explained that calcaneal heel spurs are typically asymptomatic and are more commonly caused by alterations in foot structure, tendon, ligament, and muscle tightness or prolonged running or standing. In February 2009 the Veteran's private family doctor, Dr. T, wrote a letter in which he opined that the Veteran's bilateral stress fractures incurred in service in 1965 are a contributing factor to his ongoing foot pain. Dr. T stated that he had reviewed the Veteran's service treatment records of his 1965 foot injury. He stated that the Veteran had reported he had suffered from chronic pain on the plantar surfaces of his feet since that time. When he evaluated him in February 2009, Dr. T said that the Veteran had moderate tenderness to palpation of the plantar surface of the arch of both feet and heels not associated with edema or erythema. Dr. T stated that as a result the Veteran had some difficulty with ambulation. While pain alone without a diagnosed or underlying malady or condition is not a disability for which service connection may be granted, here the pain is associated with functional impairment. Specifically, Dr. T stated that the Veteran has some difficulty with ambulation, the October 2010 VA examiner noted that the Veteran had an antalgic gait, and the Veteran testified that he has an altered gait as a result of his bilateral foot condition. The Board finds the Veteran's testimony as to his ongoing bilateral heel problems since his 1976 in-service injury is credible and has considered the opinions of both the October 2010 VA examiner and the Veteran's private doctor, Dr. T. While the VA examiner has opined that the Veteran's calcaneal heel spurs are not a result of his in-service bilateral heel fractures, Dr. T has opined that the Veteran continues to experience residuals from the heel fractures he incurred in service, including pain and difficulty with ambulation. Considering all of the evidence, including the opinions of the October 2010 VA examiner and Dr. T, the Board finds the evidence is in equipoise as to whether the Veteran's current bilateral foot condition is related to his service, and the Veteran should be given the benefit of the doubt. Therefore, the Board finds that service connection should be granted for residuals of bilateral heel fractures. B. Back The Veteran testified his cervical spine and neck began hurting during his second time in basic training. He said he would feel the pain on the monkey bars and other activities, but he didn't report it. He said today if he climbs a ladder he will have pain from his feet up to the top of his neck. The Veteran testified that in summer 1967 while in service he was riding in the back of a jeep when the driver reversed into a cement block and nearly threw him forward out of the front of the jeep. He said his legs and back hurt for awhile afterward. The Veteran's spine was found to be normal both at his September 1965 entrance examination and August 1967 discharge examination. His service treatment records do not contain any reference to complaints related to his back. The Veteran's post-service employment health records reflect the Veteran denied chronic back pain in 1971 and 1977 and having a disc condition in his back in 1987. Also, on a 1971 medical history report, the Veteran reported he had seen a private doctor in 1970 for his back. In July 1993 the Veteran sought medical treatment, complaining of lumbar spine pain that began as a result of a twisting injury. An MRI showed diminished signal intensity on T2 weighted imaging at the 4-5 disc space level and a broad based bulge causing a mild to moderate degree of spinal stenosis. The Veteran began seeking chiropractic treatment in 2000 for his back. At his July 2008 VA examination the Veteran reported he has experienced intermittent back problems since 1966. He described the pain as starting in his heels and progressing along his lower legs to his low back. The examiner diagnosed multilevel degenerative thoracolumbar spondylosis; remote-appearing mild 5-10% anterior compression deformities involving the L1, L2, and L3 vertebra; and osteopenia. The examiner opined that the Veteran's upper and lower back problems are not caused by or a result of the Veteran's bilateral foot injury in service. She stated his back problems were instead caused by spondylosis, compression fractures, and osteopenia not related to his feet condition. Although the Board has found the Veteran's bilateral foot disability is service-connected, the evidence does not support that the Veteran has a back condition secondary to his foot disability. Although the Veteran has opined that is the case, the Board finds his opinion has little probative weight. While lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet.App. 428, 435 (2011), the etiology of multilevel degenerative thoracolumbar spondylosis 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). The only competent medical opinion of evidence, that of the VA examiner, is that the Veteran's back disability is not related to his bilateral foot disability. Further, the evidence does not support that the Veteran's back disability is directly related to his service. The Veteran's first treatment for his back is more than 20 years after service and was precipitated by a workplace injury. The Veteran previously denied back problems on employment health forms. No competent medical opinion evidence suggests a nexus between the Veteran's current back disability and his service. Overall, the preponderance of the evidence is against the Veteran's claim for service connection for multilevel degenerative thoracolumbar spondylosis. 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 outstanding issue. That doctrine, however, is not applicable in this case because the preponderance of the evidence is against the Veteran's claim. See Gilbert, 1 Vet. App. at 55; 38 U.S.C.A. § 5107(b); 38 C.F.R. § 4.3. C. Bilateral Leg Disability The Veteran's service treatment records contain no complaints of or treatment for any leg conditions. His lower extremities were found normal at his August 1967 discharge examination. On November 1971 and December 1977 employment health history forms the Veteran denied swelling in his legs; pain in his leg muscles when walking; and numbness, tingling, or "pins & needles" of his legs. In an October 1987 employment health history form, the Veteran reported he has experienced weakness in his arms or legs in the past six years and difficulty walking or keeping his balance in the past 12 months. A July 1993 private treatment record reflects that as part of an evaluation of lumbar spine pain as a result of a recent twisting injury the Veteran reported radiation of pain down his right lower extremity and numbness over the lateral aspect of the thigh radiating into the anterior knee region. A July 2004 private treatment record reflects that the Veteran raised a new complaint of moderate pain in the anterior lower legs. In September 2007 the Veteran reported pain radiating from his legs to his back and was noted to have sciatica-type symptoms. The Veteran testified he has been told he has nerve damage in his feet going up to his legs. The July 2008 VA examiner diagnosed the Veteran with venous insufficiency in his bilateral lower legs and feet. The examiner noted the Veteran had numerous superficial dilated veins on his bilateral legs and feet, his left worse than his right. The Veteran's treatment records after service reflect only a few complaints of leg pain many years after he left service with no diagnosis of a leg disability. Service treatment records show no leg injury or complaints of leg problems. No medical professional has opined that the Veteran has a leg condition that is related to the Veteran's service, including his 1965 heel injury. Although the Veteran has opined as such, the Board finds his opinion is not probative as the etiology of any leg disability is a complex medical question not capable of lay observation. As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply, and the Veteran's claim for service connection for a bilateral leg disability must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. D. Right Lower Extremity Numbness In a September 2008 statement the Veteran said he has experienced numbness from his right knee up to his hip since his problems with his feet started in service. At his May 2013 Board hearing the Veteran testified that his right leg has been numb since he dropped from the monkey bars in service injuring his heels. However, the Veteran's service treatment records contain no complaints of or treatment for right lower extremity numbness, weighing against his claim. A July 1993 private treatment record reflects that as part of an evaluation of lumbar spine pain due to a recent twisting injury the Veteran reported radiation of pain down his right lower extremity and numbness over the lateral aspect of the thigh radiating into the anterior knee region. The record makes no mention of right lower extremity numbness existing since the Veteran left service more than 20 years prior, rather suggesting the symptom was related to his 1993 back injury. In November 1971 and December 1977 employment health history forms the Veteran denied numbness, tingling, or "pins & needles" of his legs. The evidence does not show the Veteran was diagnosed with a condition involving right lower extremity numbness within a year of service. Although in September 2007 the Veteran was diagnosed with sciatica-like symptoms, the medical evidence does not support that any right lower extremity numbness experienced by the Veteran is connected to service. Although the Veteran has opined as such, the Board finds his opinion is not probative as the etiology of any leg disability is a complex medical question not capable of lay observation. As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply, and the Veteran's claim for service connection for right lower extremity numbness. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. E. Bilateral Hearing Loss Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 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. The Veteran's hearing was tested in September 1965, prior to his October induction into service, and then tested again at his October 1965 induction. In September 1965 the Veteran's audiological examination showed pure tone thresholds, in decibels, as follows. (Note: Prior to November 1, 1967, service department audiometric test results were reported in standards set forth by the American Standards Association (ASA). Since November 1, 1967, those standards have been set by the International Standards Organization (ISO)-American National Standards Institute (ANSI). In order to facilitate data comparison in this decision, for service department audiometric test results through October 31, 1967, the ASA standards have been converted to ISO-ANSI standards.): HERTZ 500 1000 2000 3000 4000 RIGHT 30 25 25 N/A 20 LEFT 30 25 25 N/A 20 His October 1965 audiological examination showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 10 10 10 5 LEFT 15 10 10 10 5 At his discharge examination in August 1967, the Veteran's audiological examination showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 10 20 N/A 10 LEFT 15 15 25 N/A 15 While the Veteran's pre-induction audiological test results show less hearing acuity than his induction examination a month later, neither examination, nor the Veteran's August 1967 discharge examination, demonstrate impaired hearing for VA purposes under 38 CFR § 3.385. The Veteran testified that during training as a crew chief and door gunner he fired a .50 caliber gun. After he was pulled from going to Vietnam he testified that he mostly worked on an airfield runway. He said he used cigarette butts as makeshift ear plugs while mowing along the runway on a riding lawn mower. In post-service employment medical examinations, the Veteran was diagnosed with high frequency hearing loss as early as November 1971. An audiological examination done at that time showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 0 0 10 25 LEFT 10 5 5 10 40 Examinations done in 1972, 1973, 1974, and 1977 also all show hearing loss for VA purposes in the left ear but not the right. In October 1985 the Veteran reported being exposed to gunfire four to five times per month and only starting to wear ear plugs two years prior. In July 2008 the Veteran was afforded a VA audiological examination. He reported military noise exposure from helicopters and the M14. After service he reported 28 years of occupational exposure to machines and recreational noise exposure involving hunting and power tools. The Veteran's examination showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 20 65 75 LEFT 10 5 20 85 95 His speech recognition score was 96 percent in his right ear and 100 percent in his left ear. The examiner diagnosed moderately severe to severe sensorineural hearing loss at 3k-8k bilaterally. The examiner opined that it is less likely than not that the Veteran's hearing loss is related to his military noise exposure given his normal hearing test done at separation. Sensorineural hearing loss is considered by VA to be an organic disease of the nervous system and is thus subject to presumptive service connection under 38 CFR § 3.309(a). M21-1MR III.iv.4.B.12.a. However, no audiological examination done within one year of when the Veteran left service in 1967 is in evidence; the earliest is from four years later. Therefore, the evidence does not show the Veteran's hearing loss manifest to a compensable degree within one year of service. The evidence also does not show chronic hearing loss during service or continuity of symptomatology since service so as to entitle the Veteran to service connection under 38 C.F.R. § 3.303(b). There are no records of complaint of, treatment for, or diagnosis of hearing loss in either ear for four years after the Veteran left service. Although in 1971 he was diagnosed with high frequency hearing loss in his left ear, his post-service employment audiograms from the 1970s consistently show an improvement in hearing acuity over the Veteran's discharge examination for both ears in all frequencies except for 4000 Hz. Further, hearing loss for VA purposes is not shown in his right ear until 2008. Finally, a preponderance of the evidence is against finding that the Veteran's hearing loss is related to his service. The only opinion as to etiology by a medical professional is that of the VA examiner, who opined that the Veteran's hearing loss is less likely than not related to his service considering his normal hearing examination at separation. Although the Veteran himself has opined that there is a nexus, the Board finds his opinion is not probative. A lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau, 492 F.3d 1372). However, in this case, the question of an association between noise exposure in service and the Veteran's current bilateral sensorineural hearing loss disability, which is not a simple medical condition, cannot be determined by the Veteran's own personal observation without having specialized education, training, or experience. 38 C.F.R. § 3.159. Therefore, the Veteran's statements are not competent evidence favorable to his claim. As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply, and the claim for service connection for bilateral hearing loss must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. F. Tinnitus At his Board hearing, the Veteran testified the ringing in his ears started when he was working on the airfield runway in service. However, the Veteran's service treatment records contain no complaints of tinnitus. On November 1971 and December 1977 health history forms the Veteran denied ringing or buzzing in his ears. On an October 1987 health history form the Veteran denied having ringing or buzzing in his ears once a week or more. At his July 2008 VA examination the Veteran reported he did not recall having tinnitus in the military and onset was 20 years ago. He stated that his tinnitus is intermittent, occurring twice a month for an hour at a time. The examiner opined that it is less likely than not that the Veteran's tinnitus is related to his military noise exposure given the date of onset. The Board finds a preponderance of the evidence is against the Veteran's claim for service connection for tinnitus. Although the Veteran testified at his Board hearing he began having ringing in his ears in service, at his VA examination he estimated the condition began approximately 20 years later. Further, he denied having ringing or buzzing in his ears multiple times between 1971 and 1987 on post-service employment health history forms. Therefore, although the Veteran is competent to report the onset of his tinnitus, in this case the Board notes he has not been consistent in his reporting, and therefore the Board finds his testimony that his tinnitus began in service not to be credible. Also, to the extent that the Veteran has opined as to the etiology of his tinnitus, the Board finds he is not competent to do so as he does not possess any medical training or expertise to competently opine as to the etiology of the condition. See Jandreau, 492 F.3d 1372. As a result, the Board finds that the Veteran's statements are not sufficient to establish a nexus between his tinnitus and service. Finally, the only competent medical opinion of evidence, that of the July 2008 VA examiner, is that the Veteran's tinnitus is not related to his service. As the preponderance of the competent, probative evidence is against this claim, the benefit of the doubt doctrine does not apply, and the claim for service connection for tinnitus must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Duties to Notify and Assist As provided for by the 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, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). Such notice should also address VA's practices in assigning disability evaluations and effective dates for those evaluations. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). While the required notice should be furnished prior to the issuance of the appealed rating decision, any initial errors of notice will not be prejudicial if: 1) corrective actions (e.g., issuance of a post-adjudication notice letter containing the required information) are taken, and 2) the appeal is readjudicated (e.g., in a Supplemental Statement of the Case). See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Here, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in May 2008 and October 2008. In the letters, the RO informed the Veteran of what evidence was required to substantiate the claims for service connection and of the Veteran's and VA's respective duties for obtaining evidence. In the letters the RO also provided notice with regard to how VA assigns disability ratings and effective dates in the event that service connection is established. VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). The Board finds that all necessary development has been accomplished. The RO has obtained the Veteran's service treatment records, VA treatment records, and private treatment records identified by the Veteran. The Veteran also submitted lay statements. Neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. The Veteran was afforded VA medical examinations in July 2008 and October 2010. The examiners, medical professionals, obtained an accurate history, listened to the Veteran's assertions, and performed the necessary tests. Therefore, the Board finds that the examinations are adequate and contain sufficient information to decide the issues on appeal. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio, 16 Vet. App. 183. Also, in Bryant v. Shinseki, the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. 3.103(c)(2) requires that the VLJ who conducts a hearing fulfill two duties to comply with the regulation. They consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. In this case, during the May 2013 Board personal hearing, the VLJ fully explained the issue on appeal. The Veteran was assisted at the hearing by an accredited representative from the Colorado Division of Veterans Affairs, and the VLJ and the representative asked questions regarding the nature and etiology of the Veteran's claimed disabilities. The Veteran's representative sought to ensure all of the Veteran's post-service employment treatment records were in the record, and no pertinent evidence that might have been overlooked and that might substantiate the claim was identified by the Veteran or his representative. Neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2) or identified any prejudice in the conduct of the Board hearing. As such, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. § 3.103(c)(2), and that any error in notice provided during the Veteran's hearing constitutes harmless error. ORDER Service connection for residuals of bilateral heel fractures is granted. Service connection for multilevel degenerative thoracolumbar spondylosis, to include as secondary to bilateral heel fractures, is denied. Service connection for bilateral leg condition is denied. Service connection for numbness of right lower extremity from knee to hip is denied. Service connection for bilateral hearing loss is denied. Service connection for tinnitus is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs