Citation Nr: 1328497 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 11-04 181 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Hartford, Connecticut THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for erectile dysfunction. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Jennifer Hwa, Counsel INTRODUCTION The Veteran served on active duty from October 1968 to October 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Hartford, Connecticut, that denied service connection for bilateral hearing loss, hypertension, and erectile dysfunction. The Veteran filed a Notice of Disagreement for the issue of hearing loss in August 2010, and a Notice of Disagreement for the issues of hypertension and erectile dysfunction in October 2010. The RO furnished the Veteran Statements of the Case in January 2011, and the Veteran filed a Substantive Appeal (VA Form 9) for all issues in February 2011. In August 2011, the Veteran testified before the Board at a video conference hearing. A transcript of this hearing is included in the claims file. The Board notes that, in addition to the paper claims file, there is a paperless, electronic (Virtual VA) claims file associated with the Veteran's claims. A review of the documents in such file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issues on appeal. FINDINGS OF FACT 1. The Veteran's current bilateral hearing loss does not constitute a presently existing disability within the standards established by 38 C.F.R. § 3.385. 2. There is no clear and unmistakable evidence that the Veteran has a preexisting hypertension disability. Hypertension was not shown in service or for many years thereafter, and the most probative evidence fails to link the Veteran's current hypertension to service. 3. Erectile dysfunction was not shown in service, and the most probative evidence fails to link the Veteran's current erectile dysfunction to service. CONCLUSIONS OF LAW 1. Service connection for bilateral hearing loss is precluded by law. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.385 (2012); Sabonis v. Brown, 6 Vet. App. 426 (1994). 2. The criteria for establishing service connection for hypertension have not been met. 38 U.S.C.A. §§ 1110, 1153, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304(b), 3.306, 3.307, 3.309 (2012). 3. The criteria for establishing service connection for erectile dysfunction have not been met. 38 U.S.C.A. §§ 1110, 1153, 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 The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) redefined VA's duty to assist a claimant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). The notice requirements of the VCAA require VA to notify the claimant of any evidence that is necessary to substantiate the claim, as well as the evidence VA will attempt to obtain and which evidence he is responsible for providing. 38 C.F.R. § 3.159(b) (2012). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO). Id.; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, the VCAA notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. See Pelegrini, 18 Vet. App. at 121. In a March 2010 letter issued prior to the decision on appeal, the Veteran was provided notice regarding what information and evidence is needed to substantiate the claims for service connection (including on a secondary basis), as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. The March 2010 letter also advised the Veteran of how disability evaluations and effective dates are assigned, and the type of evidence which impacts those determinations. The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the Veteran. Specifically, the information and evidence that have been associated with the claims file include the Veteran's service treatment records, VA and private medical records, a VA examination report, and hearing testimony. As discussed above, the VCAA provisions have been considered and complied with. The Veteran was notified and aware of the evidence needed to substantiate his claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. The Veteran was an active participant in the claims process by providing evidence and argument, including testimony at a Board hearing. Thus, he was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notice is not shown to have any effect on the case or to cause injury to the Veteran. Therefore, any such error is harmless and does not prohibit consideration of these matters on the merits. See Dingess, supra; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). Analysis Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Moreover, where a veteran served continuously for ninety (90) days or more during a period of war, or during peacetime service after December 31, 1946, and sensorineural hearing loss or hypertension become manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). In order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The Board has reviewed all of 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 the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Bilateral Hearing Loss 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, 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. "[W]hen audiometric test results at a veteran's separation from service do not meet the regulatory requirements for establishing a 'disability' at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service." Hensley v. Brown, 5 Vet. App. 155, 160 (1993). The threshold for normal hearing is from zero to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Id. at 157. The Veteran asserts service connection for bilateral hearing loss on the basis that he developed the condition due to in- service, non-combat-related acoustic trauma. The Veteran's DD-214 indicates that his military occupational specialty was that of an aircraft maintenance specialist and that he was exposed to the noise of jet engines with hearing protection. The Board notes that noise exposure is consistent with the duties and circumstances of working with aircraft. As such, the Board concedes the occurrence of the in-service acoustic trauma. The Veteran's June 1968 pre-enlistment examination reflects that his hearing was within normal limits. Audiometric testing at that time revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 0 0 LEFT 0 0 0 0 15 In a March 1970 service treatment report, the Veteran complained of difficulty hearing out of his left ear. On separation examination in September 1972, the Veteran did not indicate that he experienced any hearing loss on the September 1972 report of medical history. Audiometric testing at that time revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 10 10 10 LEFT 5 5 10 10 10 The relevant post-service medical evidence consists only of a May 2010 VA examination. The Veteran complained that he had experienced a decrease in hearing, which he noticed because he had to ask people to repeat themselves. He reported a history of military noise exposure to jet engines for which hearing protection was used most of the time. He indicated that he had occasional occupational noise exposure while working on the grounds of the Newington VA Medical Center with lawnmowers. Audiometric testing at that time revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 5 15 35 LEFT 5 5 10 20 35 The examiner found that the Veteran had hearing within normal limits at 500 Hz to 3000 Hz, followed by a mild sensorineural hearing loss at 4000 Hz in both ears. She opined that the Veteran's current hearing loss was likely related to his period of service because of the standard hearing threshold shifts that were noted in his file. Although the Veteran's service treatment records demonstrate that his audiometric findings shifted from the time of his enlistment examination to the time of his separation from service, his hearing was still within normal limits on audiometric testing at separation from service. Nevertheless, as noted above, service connection is not precluded where hearing is within normal limits on audiometric testing at separation, provided that the Veteran submits evidence of a current disability that is causally related to service. Hensley, 5 Vet. App. at 160. In this case, the Board acknowledges that the May 2010 VA examiner determined that the Veteran had mild bilateral sensorineural hearing loss at 4000 Hz that was likely related to his period of service. However, despite the VA examiner's positive nexus opinion with regards to the Veteran's hearing loss at 4000 Hz, the evidence shows that the Veteran has bilateral hearing loss at 4000 Hz only, and current audiometric findings do not show a severity of bilateral hearing loss that meets VA requirements for a disability under 38 C.F.R. § 3.385. The Board notes that "[a]lthough [38 C.F.R. § 3.385] speaks in terms of service connection', it operates to establish when a measured hearing loss is (or, more accurately, is not) a 'disability' for which compensation may be paid, provided that the requirements for service connection are otherwise met." Hensley, 5 Vet. App. at 159. Congress specifically limits entitlement for service- connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C.A. §§ 1110; 1131. In the absence of proof of present disabilities there can be no valid claims. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328,1332 (1997) (38 U.S.C.A. § 1131 requires existence of present disability for VA compensation purposes); 38 U.S.C.A. § 1110 (to the same effect); see also Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). Here, although the Veteran has some hearing loss at 4000 Hz, he is not shown to have a bilateral hearing "disability" as defined for VA service connection purposes under 38 C.F.R. § 3.385. Further, the Board notes that the Veteran has not informed VA that his bilateral hearing loss has worsened since his May 2010 VA examination to a degree where the criteria of 38 C.F.R. § 3.385 would be met. Under the standards established by 38 C.F.R. § 3.385, the record evidence does not indicate a hearing "disability" during service or at separation. Moreover, unlike the facts in Hensley, the results of the May 2010 VA audiological examination in the instant case are insufficient to establish that a bilateral hearing "disability" is indicated at present. But see, e.g., Hensley, 5 Vet. App. at 157, 164. Thus, since section 3.385, as relevant here, prohibits a finding of a hearing disability, where the requisite hearing status is not met, Hensley, 5 Vet. App. at 160, it is therefore apparent that the Veteran's bilateral hearing loss (as documented in the May 2010 VA audiological report) does not constitute a "presently existing disability," for which service connection may be granted. See Degmetich v. Brown, supra. As a consequence, in a case such as this one, where the law and not the evidence is dispositive of the issue before the Board, the claim should be denied because of the absence of legal merit or lack of entitlement under the law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Accordingly, the Veteran's claim of service connection for bilateral hearing loss is denied. Hypertension The Veteran contends that he had hypertension that preexisted his period of service. Specifically, he reported at his August 2011 video conference hearing that during his entrance examination, the physicians informed him that they believed he had high blood pressure and would not clear him for enlistment. The Veteran was cleared for enlistment only after he obtained normal blood pressure readings 5 times in the morning and 5 times in the afternoon. A veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable evidence demonstrates that the disability existed prior to service and was not aggravated by service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b). A preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306. Whether a preexisting disorder underwent an increase in severity during service is determined based on evidence of the manifestations of the disorder before, during, and after service. 38 C.F.R. § 3.306. For a disorder to be considered aggravated in service, there must be worsening of the underlying condition, not just temporary or intermittent flare-ups of the symptoms of the condition. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). At the Veteran's June 1968 enlistment examination, the Veteran's blood pressure reading was noted to be 132/76. He had an additional 3 day blood pressure reading check in which his blood pressure was noted to be 130/74, 132/76, 132/70, 134/70, 134/72, and 132/72. On separation examination in September 1972, the Veteran reported that he had high blood pressure. However, he was not found to have hypertension. His blood pressure reading was 130/72. Private medical records dated from March 2005 to January 2010 show that the Veteran received intermittent treatment for hypertension. A February 2010 letter from a private physician indicates that the Veteran had been diagnosed with hypertension since March 2005. The physician noted that the Veteran was taking medication for his hypertension. The Veteran also submitted a log of elevated blood pressure readings that were dated from November 2004 to February 2006. In an October 2010 letter, a private physician noted the Veteran's report that as a young man, he had received a questionable diagnosis of hypertension. The Veteran indicated that his blood pressure had always vacillated between high and normal. He stated that he had only recently begun therapy for his hypertension, although he maintained that this abnormality had been detected prior to his period of service. The Veteran testified before the Board at a video conference hearing in August 2011. Testimony revealed, in pertinent part, that the Veteran did not remember having elevated blood pressure in service. The Veteran testified that he had first started receiving treatment for hypertension 3 or 4 years previously. The initial determination is whether the Veteran's hypertension was present prior to service. In Crowe v. Brown, 7 Vet. App. 238 (1994), the Court indicated that the presumption of soundness attaches only where there has been an induction medical examination, and where a disability for which service connection is sought was not detected at the time of such examination. The Court added that the regulation provides expressly that the term "noted" denotes only such conditions as are recorded in examination reports, and that history of pre-service existence of conditions recorded at the time of examination does not constitute a notation of such conditions. 38 C.F.R. § 3.304(b)(1) (2012). In cases where the disease or injury at issue is not noted on the entrance examination, a two-pronged test is for consideration in determining whether the presumption of soundness has been rebutted. First, VA must show by clear and unmistakable evidence that the disease or injury existed prior to service. Second, VA must show by clear and unmistakable evidence that the preexisting disease or injury was not aggravated by service. VAOPGCPREC 3-2003 (July 16, 2003). See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). The Veteran is not required to show that the disease or injury increased in severity during service before VA's duty under the second prong of this rebuttal standard attaches. See id. The Board must follow the precedent opinions of the General Counsel. See 38 U.S.C.A. § 7104(c). In this case, the evidence of record does not show that the Veteran had a diagnosis of hypertension (140 systolic and 90 diastolic) upon entry into service. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1) (2012). Therefore, the Board finds that the presumption of soundness attaches with respect to this portion of the claim. See 38 U.S.C.A. § 1111; see also Doran v. Brown, 6 Vet. App. 283, 286 (1994). Thus, the burden is on VA to rebut the presumption by clear and unmistakable evidence that hypertension was both preexisting and not aggravated by service. Based on the medical evidence set forth above, and based on the Veteran's statements, the Board does not find that there is clear and unmistakable evidence that the Veteran had a hypertensive condition that preexisted service. The Veteran testified at his August 2011 hearing and reported to his October 2010 private physician that he had suffered from high blood pressure prior to service. The Veteran alleges that his pre-service hypertension almost prevented him from being able to enlist in service. The Board notes that hypertension falls outside the realm of common knowledge of a lay person, and therefore, the Veteran is not competent to provide a diagnosis of pre-service hypertension. See Kahana v. Shinseki, 24 Vet. App. 428; Jandreau v. Nicholson, 492 F.3d 1372. Additionally, the Veteran's June 1968 enlistment examination did not note that the Veteran had any pre- service history of high blood pressure. The Veteran's blood pressure reading was found to be 132/76 on examination, and an additional 3 day blood pressure reading check revealed blood pressure readings of 130/74, 132/76, 132/70, 134/70, 134/72, and 132/72. Given that there is conflicting evidence as to whether the Veteran had a preexisting hypertensive disability, the Board finds that the medical record does not show clearly and unmistakably that hypertension existed prior to service. As the Board has not found that there is clear and unmistakable evidence that the Veteran had hypertension that existed prior to service, the presumption of soundness has not been rebutted, and the Veteran's claim essentially becomes one for service connection based on service incurrence. See 38 U.S.C.A. § 1111; Wagner, 370 F.3d at 1094-96 (holding that where the presumption of soundness is not rebutted, a claim for service connection based on aggravation is converted into a claim for service connection based on service incurrence). With regard to service connection for hypertension on a direct basis, the Board reiterates that the Veteran's service treatment records are negative for any complaints, diagnosis, or treatment of hypertension. In addition, hypertension was not shown to a compensable degree within one year following his discharge from service. Indeed, at his August 2011 hearing, the Veteran acknowledged that he did not have high blood pressure when he was in service and that he only began receiving treatment for hypertension 3 or 4 years previously. Additionally, at no time did any treating provider relate the Veteran's hypertension to his period of service. The Board also notes that the Veteran does not contend, and the evidence does not show, that he was diagnosed with hypertension in service, or that blood pressure readings consistent with a diagnosis of hypertension (140 systolic and 90 diastolic) were noted in service. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Additionally, there is no evidence suggesting the disorder arose during the year following discharge from service. Indeed, the first objective post-service evidence of a diagnosis of hypertension is in March 2005, which is approximately 33 years after the Veteran's period of service. As hypertension was not shown for many years after the Veteran's period of service, this weighs against a claim that it was related to service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim). See also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). The Board notes that the Veteran has been diagnosed with hypertension, which is a condition explicitly recognized as chronic under 38 C.F.R. § 3.309(a) (2012). Service connection based on a continuity of symptomatology can be warranted under 38 C.F.R. § 3.303(b) (2012) for chronic diseases. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, in this case, the Veteran has not asserted having hypertension in service, nor has he asserted a continuity of symptomatology after discharge. Indeed the Veteran reported at his August 2011 hearing that that he had only began receiving treatment for hypertension 3 or 4 years previously. Moreover, the objective evidence of record does not show that the Veteran has continuously had hypertension since discharge from service. Therefore, the Board finds that service connection for hypertension based on a theory of continuity of symptomatology is not warranted. The Board notes that lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, hypertension falls outside the realm of common knowledge of a lay person. Thus, while the Veteran can competently report symptoms of dizziness, an actual diagnosis of hypertension requires objective testing to diagnose, and can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Moreover, whether symptoms the Veteran experienced in service or following service are in any way related to his current hypertension requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("Although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). To the extent that the Veteran himself believes that his current hypertension is due to service, as a lay person, he is not shown to possess any specialized training in the medical field. The Veteran's opinion as to the etiology of his current hypertension is not competent medical evidence, as such question requires medical expertise to determine. Id. In any event, the Board concludes that the medical evidence is of greater probative value than the lay contentions of the Veteran. The Board notes that the RO did not seek a VA medical opinion for the claim for service connection. However, as explained above, there is no competent evidence that the Veteran's hypertension is related to his period of service. Accordingly, a VA examination is not required. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet App. 79, 81 (2006); see also Duenas v. Principi, 18 Vet. App. 512 (2004). In sum, the Board finds that the most competent and probative evidence indicates that hypertension was not shown in service or for many years thereafter, and the most probative evidence fails to link the Veteran's current hypertension to service. Accordingly, service connection for hypertension is not warranted on any basis. In reaching the conclusion above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Erectile Dysfunction The Veteran contends that his erectile dysfunction is due to his period of service, specifically to treatment for gonorrhea. Alternatively, he alleges that his erectile dysfunction is secondary to his hypertension. Service connection may also be established for disability which is proximately due to or the result of a service- connected disability. 38 C.F.R. § 3.310(a) (2012). Further, a disability which is aggravated by a service- connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310 (2012); Allen v. Brown, 7 Vet. App. 439 (1995). Service treatment records are negative for any complaints, diagnosis, or treatment for erectile dysfunction. The service treatment records do confirm that the Veteran received treatment for gonorrhea in December 1970, January 1971, and February 1971. On separation examination in September 1972, the Veteran made no genitourinary complaints, and his genitourinary system was found to be normal. Private medical records dated from March 2005 to January 2010 show that the Veteran received intermittent treatment for erectile dysfunction. In an October 2010 letter, the Veteran's private urologist stated that the Veteran had previously been treated by two other urologists, one over 30 years ago, who had since retired. The urologist noted that the Veteran had contracted gonorrhea in service and found that this had been treated with penicillin without any lasting ill effects. Sometime after returning from service, the Veteran began noticing that his erections were less firm and somewhat transient. The problem was initially felt to be largely psychological, and the Veteran was referred to a psychologist. However, the Veteran witnessed no improvement after 12 weeks of counseling. The Veteran admitted that he had been drinking beer at the time. The urologist reported that more recently in June 1996, a duplex sonogram indicated that the etiology of the Veteran's erectile dysfunction was hypogonadism, and the Veteran was treated with testosterone replacement and antidepressant. Currently, the Veteran was being treated with Cialis, which had been highly effective. The urologist determined that the Veteran had had longstanding erectile dysfunction, which had been responding well to oral therapy. He explained that erectile dysfunction was often multifactorial and included hypogonadism and hypertension. He reported that alcoholism could also contribute to erectile dysfunction and that there was also often a huge psychological component to erectile dysfunction. The Veteran testified before the Board at an August 2011 video conference hearing. Testimony revealed, in pertinent part, that the Veteran's erectile dysfunction began in 1972 or 1973 shortly after he was discharged from service. The Veteran testified that he began seeing an urologist in 1974 or 1975. He reported that he was only achieving a partial erection at that time. He stated that he did not have erectile dysfunction in service. He maintained that he contracted gonorrhea twice during his period of service and received penicillin to treat it. He indicated that no doctor had ever told him that his erectile dysfunction was a result of sexually transmitted diseases, and that no doctor had been able to give him a definite answer as to why he was having the problem. He reported that throughout the years, he had received testosterone injections, referred to a psychologist, received penile injections with an ultrasound, and been prescribed Cialis. The Board reiterates that the Veteran's service treatment records are negative for any complaints, diagnosis, or treatment of erectile dysfunction. In addition, the Veteran does not contend that he had erectile dysfunction during service. Indeed, at his August 2011 hearing, the Veteran acknowledged that he did not have erectile dysfunction when he was in service. Additionally, at no time did any treating provider relate the Veteran's erectile dysfunction to his period of service, to include his treatment for gonorrhea. Instead, the October 2010 private urologist found that the Veteran's in- service gonorrhea had been treated with penicillin without any lasting ill effects. He explained that hypertension was often multifactorial and included hypogonadism and hypertension. He also indicated that alcoholism could contribute to erectile dysfunction and that erectile dysfunction had a huge psychological component. The Board notes that the Veteran has reported that he continuously received treatment for erectile dysfunction since his discharge from service. Indeed, the Veteran submitted several statements explaining that he had been unable to obtain many of his private treatment records relating to erectile dysfunction because the physicians were retired or deceased, and the medical records were therefore no longer available. However, erectile dysfunction is not a condition explicitly recognized as chronic under 38 C.F.R. § 3.309(a) (2012). Service connection based on a continuity of symptomatology can be warranted under 38 C.F.R. § 3.303(b) (2012) only for the chronic diseases listed under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Therefore, the Board finds that service connection for erectile dysfunction based on a theory of continuity of symptomatology is not warranted. The Board acknowledges the Veteran's argument that his erectile dysfunction is due to or aggravated by his hypertension. However, in the Board's decision herein, service connection for hypertension has been denied. Therefore, consideration of a claim for service connection for erectile dysfunction that is secondary to service-connected hypertension is not warranted because the Veteran's hypertension is not a service-connected disability. The Board notes that lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, erectile dysfunction falls outside the realm of common knowledge of a lay person. Thus, while the Veteran can competently report symptoms of less firmness, an actual confirmed and chronic diagnosis of erectile dysfunction requires objective testing to diagnose, and can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Moreover, whether symptoms the Veteran experienced in service or following service are in any way related to his current erectile dysfunction requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("Although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). To the extent that the Veteran himself believes that his current erectile dysfunction is due to service, as a lay person, he is not shown to possess any specialized training in the medical field. The Veteran's opinion as to the etiology of his current erectile dysfunction is not competent medical evidence, as such question requires medical expertise to determine. Id. In any event, the Board concludes that the medical evidence is of greater probative value than the lay contentions of the Veteran. The Board notes that the RO did not seek a VA medical opinion for the claim for service connection. However, as explained above, there is no competent evidence that the Veteran's erectile dysfunction is related to his period of service. Accordingly, a VA examination is not required. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet App. 79, 81 (2006); see also Duenas v. Principi, 18 Vet. App. 512 (2004). In sum, the Board finds that the most competent and probative evidence indicates that erectile dysfunction was not shown in service, and the most probative evidence fails to link the Veteran's current erectile dysfunction to service. Accordingly, service connection for erectile dysfunction is not warranted on any basis. In reaching the conclusion above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for erectile dysfunction is denied. ____________________________________________ DEBORAH W. SINGLETON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs