Citation Nr: 1329267 Decision Date: 09/12/13 Archive Date: 09/20/13 DOCKET NO. 07-37 293 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for a left knee disorder. 3. Entitlement to service connection for a left shoulder disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. Peters, Associate Counsel INTRODUCTION The Veteran had active duty service from December 1998 to June 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2006 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, denied service connection for bilateral hearing loss, left shoulder and left knee disorders. The Veteran timely appealed those issues. This case was last before the Board in November 2011, at which time it was remanded for further development to include obtaining VA treatment records from the Tuscaloosa and Birmingham VA Medical Centers. That development having been completed, the case has been returned to the Board for further appellate review at this time. FINDINGS OF FACT 1. The Veteran does not have hearing loss that had its clinical onset in service and is not otherwise related to active duty. 2. The Veteran has residuals of a left knee strain that had its onset in service. 3. Chronic left shoulder disability did not have its clinical onset in service and is not otherwise related to active duty. CONCLUSIONS OF LAW 1. Bilateral hearing loss was not incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 5103, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.385 (2013). 2. Chronic residuals of a left knee strain were incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.102, 3.303 (2013). 3. Chronic left shoulder disability was not incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 5103, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.303 (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act of 2000 (VCAA) 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. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2013). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In addition, the notice requirements of the VCAA apply to all elements of a service- connection claim, including the degree of disability and the effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. VCAA notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). Where complete notice is not timely accomplished, such error may be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). With respect to the claim of service connection for a left knee disorder, as this allows service connection for residuals of a left knee strain, the Board finds that further discussion with regards to VCAA compliance is not necessary at this time. This decision is fully favorable with respect to the benefit sought as to that issue. Turning to the claims of service connection for bilateral hearing loss and left shoulder disability, the Veteran was sent a letter in June 2005 that provided information as to what evidence was required to substantiate that claim and of the division of responsibilities between VA and a claimant in developing an appeal. A March 2006 letter also explained what type of information and evidence was needed to establish a disability rating and effective date. Accordingly, no further development is required with respect to the duty to notify. Next, VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting him in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The claims file contains the Veteran's service treatment records, as well as post-service reports of VA treatment and examination. Moreover, his statements in support of the claim are of record. The Board has carefully reviewed such statements and concludes that no available outstanding evidence has been identified. The Board has also perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claims herein decided. Additionally, the Board recognizes that this case was previously remanded by the Board in November 2011, such that additional VA treatment records from the Tuscaloosa and Birmingham VA Medical Centers could be obtained. Those records have been obtained and associated with the Veteran's Virtual VA efolder. Therefore, the Board finds that its remand order has been substantially complied with, and it may proceed to adjudicate upon the merits of this case. See Stegall v. West, 11 Vet. App. 268 (1998) (A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order). For the above reasons, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant 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 v. Principi, 16 Vet. App. 183 (2002). Analysis 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 claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post- service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96; see Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b). In relevant part, 38 U.S.C.A. 1154(a) (West 2002) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). "[L]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). "Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Savage, 10 Vet. App. at 496 (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")). 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 opposed to merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service (or during any applicable presumptive period) is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). However, 38 C.F.R. § 3.303(b) only applies to the list of chronic diseases/disabilities recognized by VA as being chronic and those chronic diseases/disabilities are listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (holding that 38 C.F.R. § 3.303(b) only applies to the listed chronic disabilities in 38 C.F.R. § 3.309(a)). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2013). 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 arthritis or sensorineural hearing loss become manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2013). 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 (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2013). Additionally, the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). 38 C.F.R § 3.385 does not preclude service connection for a current hearing loss disability where hearing was within normal limits on audiometric testing at separation from service. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Rather, when audiometric test results at a veteran's separation from service do not meet the requirements of 38 C.F.R. § 3.385, a veteran may nevertheless establish service connection for current hearing disability by submitting medical evidence that the current disability is causally related to service. Hensley, supra. On appeal, the Veteran has averred that he should be service connected for bilateral hearing loss. He has not made any other specific allegations with respect to his bilateral hearing loss. Turning to the evidence of record, the Veteran's service treatment records reveal the following audiometric data on enlistment into service in October 1998: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 5 10 0 LEFT 5 5 10 10 10 In the report of medical history at that time, the Veteran did not report any hearing loss or other ear problems. The Veteran was additionally audiometrically tested in December 1998, February 1999, and July 2001; all of those results are substantially similar to the October 1998 audiometric examination, though there are some differences in decibel loss shown. On separation from service in February 2005, the Veteran's audiometric data demonstrated the following results: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 10 15 10 LEFT 10 10 10 20 15 Again, the Veteran did not report any hearing loss or other ear problems on his report of medical history obtained at that time. The intercurrent treatment records do not demonstrate any complaints of, treatment for, or diagnosis of any hearing loss or other ear problems. The Board has additionally reviewed the Veteran's VA treatment records through March 2011, which are of record and associated with the Veteran's Virtual VA efolder. Those records do not demonstrate any treatment for, complaints of, or diagnosis of any hearing loss or other ear problems; those records also do not contain any audiometric data. Following discharge from service, the Veteran underwent a VA audiologic examination in June 2006. The Veteran reported during that examination that he was a heavy equipment operator in the military and that he did not always have hearing protection. He reported that his hearing was better some days than others, but that it began giving him problems approximate 5 years prior to the examination, when he was three years into his military service. He felt that his hearing loss was due to operating heavy equipment without hearing protection. His current occupation involved operation of heavy equipment with hearing protection. The following audiometric data was obtained on examination at that time: 500 Hz 1000 Hz 2000 Hz 3000 Hz 4000 Hz Speech Discriminat ion RIGHT 10 10 15 10 5 100% LEFT 15 15 15 20 15 96% The examiner noted that the Veteran's examination indicated "normal middle ear function at the time of the test . . . [i]nner test reliability was considered good. . . . Test results indicate hearing within normal limits bilaterally. No medical follow-up is indicated at this time." Based on the foregoing evidence, the Board must deny the Veteran's claim of service connection for bilateral hearing loss. The Board has specifically reviewed all of the audiometric data both during and after military service. Based on this review, the Board finds that none of the audiometric data of record demonstrates a hearing loss disability for VA compensation purposes. See 38 C.F.R. § 3.385. While Veteran has stated that he feels he has defective hearing, he is not competent to diagnose hearing loss as a disability. 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); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Even audiologists who are trained in the diagnoses and treatment of hearing impairment rely on audiometric test results to determine if defective hearing is pathologic. The Board additionally notes that subjective reports of hearing loss in this case cannot be a substitute for a hearing loss disability, which has a specific definition in the VA regulations. The Veteran's claimed hearing loss does not meet those specific requirements to amount to a disability at this time. As the Veteran does not have a current disability under the relevant VA regulations, the Board finds it unnecessary to address any further aspect of the Veteran's service connection claim at this time, including the other elements necessary for service connection. In short, the Veteran does not have a current hearing loss disability as defined by VA regulations. Accordingly, the Board must deny service connection for bilateral hearing loss at this time. See 38 C.F.R. §§ 3.102, 3.303, 3.385; Brammer v. Derwinski, 3 Vet. App. 223 (1995) (Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability). In reaching the above conclusion, 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) (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Left Knee Disorder The Veteran has averred on appeal that he should be service connected for left knee disability as a result of an October 2002 dirt bike injury. He has stated that he has had chronic pain in his left knee since that time. A review of the Veteran's service treatment records documents that he injured his left knee in a dirt bike accident when it struck a dirt wall in October 2002. He was treated at a private hospital at that time for an acute left knee contusion and abrasions. He followed up with service medical personnel a few days later, at which time he was diagnosed with a "left knee contusion/MCL strain"; x-rays at that time showed no abnormal findings. In November 2002, a Magnetic Resonating Imaging (MRI) scan of his left knee showed preliminary findings of large "bone bruises vs. subostial fracture of the lateral tibia and medial lateral femoral condyles"; increased signal in the ACL consistent with a "strain or partial tear"; an MCL "strain vs. partial tear"; and, "PHMM-increased signal but low probability of tear." An email accompanying the MRI noted that the subostial part was hard to read and that the reader "was guessing" as to that part. Apparently, the Veteran received physical therapy for his knee until January 2003. In July 2003, the Veteran reaggravated his left knee when he "twisted" it playing basketball; he was again diagnosed with a left knee strain the next day. No further treatment records demonstrate any further treatment for his left knee. During his February 2005 separation examination, the Veteran's left knee was reportedly normal. However, in the Veteran's report of medical history filled out at that examination, he reported having knee trouble. The examiner noted the Veteran's motorcycle wreck in 2002 and partially torn ACL. The Veteran reported knee pain whenever he was "stressed." It was noted that he had physical therapy until 2003 post-injury and that it does not impact his ability to run or perform physical training. It was not considered disabling at that time, though the Veteran additionally reported that he had to wear a knee brace whenever he performed something physical. Post-service VA treatment records contained in his Virtual VA efolder demonstrate repeated reports of and diagnosis of chronic left knee pain; however, no further evidence of a more particular diagnosis is contained in those records. The Veteran underwent a VA general medical examination, which included his left knee, in June 2006. During that examination, the Veteran reported he was in a dirt bike accident in February 2003 and that ever since that time his left knee has had swelling in it. He noted that an MRI taken at that time revealed a partially torn ACL, MCL and meniscus. He reported that he underwent physical therapy, which helped reduce his swelling and pain, but that he has worn a Neoprene brace on his left knee most of the time, particularly when he goes to work, since that accident. X- rays of the Veteran's left knee showed no significant bony abnormalities at that time. The Veteran was diagnosed with "left knee arthralgia" at that time by the examiner. The examiner further stated that The Veteran's examination is suggestive of anterior cruciate ligament [ACL], medial collateral ligament [MCL], and medial meniscus injury. MRI's are not done at the time of this examination. The major functional impairment is secondary to pain. He has fallen ten times in the last two years, because his left knee could not support him unexpectedly. Outside of this impairment due to pain-there is no additional impairment due to fatigue, weakness, or lack of endurance following repetitive use. The pain and partial injuries to the ACL, MCL and medial meniscus, can cause some lack of coordination during flare-ups. Based on the foregoing evidence, the Board finds that residuals of a left knee strain are warranted. The Board does find that a current disability exists on the basis of the Veteran's June 2006 VA general medical examination and his previous diagnosis in service of a left knee strain. The Veteran's service treatment records fully document that he had an MCL strain in October and November 2002 following his dirt bike accident in service; later he was diagnosed with a left knee strain. The Board notes that such are current disabilities in this case, particularly in light of the June 2006 examiner's statements that the Veteran's examination at that time was "suggestive of anterior cruciate ligament [ACL], medial collateral ligament [MCL], and medial meniscus injury." Moreover, the Veteran's "left knee arthralgia" (i.e., his left knee pain) is later associated by the examiner to his "partial tears" injury. Thus, the June 2006 examiner additionally provides a nexus to the Veteran's dirt bike injury in service as well. In short, the Veteran's June 2006 VA examination demonstrates that he has symptomatology at that time consistent with residuals of a left knee strain, which is well-documented in service. That VA examiner additionally links the Veteran's left knee symptomatology demonstrated on that examination to the partial tears and left knee strain shown in the Veteran's service treatment records. Accordingly, all three elements of service connection have been met in this case, and therefore, service connection for residuals of a left knee strain is warranted in this case. See 38 C.F.R. §§ 3.102, 3.303. In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Left Shoulder Disorder On his October 1998 enlistment examination it was noted that the Veteran had fractured his left clavicle prior to entrance into military service. The Veteran's left shoulder was noted as normal at that time. In December 1998, service treatment records demonstrate that the Veteran's left clavicle fracture occurred approximately 2 years prior to entrance into service-in 1996-and that in December 1998, the Veteran suffered a sprained left shoulder which was treated at that time with a sling. In a December 1998 treatment record, the Veteran's left shoulder sprain is noted as being resolved and was not considered disabling. No further treatment for a left shoulder disorder was sought during military service; the Veteran's left shoulder was noted as normal on discharge from service in his February 2005 separation examination. The Board has also reviewed the Veteran's VA treatment records from post-discharge; there is no record of treatment for any left shoulder problems. In a VA general medical examination in June 2006, the Veteran was diagnosed with "left shoulder arthralgia." The examiner noted that the Veteran had a pre-existing broken clavicle he suffered in a motor vehicle accident at the age of 15 or 16. It was noted that there was no decreased motion, no impairment due to weakness, fatigue, or lack of endurance following repetitive use, though there was "ache with use." The Veteran's notice of disagreement indicates that he feels that he should be service connected for his left shoulder disorder, and in his November 2007 substantive appeal, VA Form 9, he concedes that "[s]ome conditions did happen prior to service but was aggravated by service and service medical records shows treatment while in service. [He felt] that aggravation did happen while in service and medical treatment has been submitted." The Board finds that service connection for a left shoulder disorder must be denied. Initially, the Board notes that the Veteran does not have a current left shoulder disorder diagnosed. As noted above, arthralgia is defined as "pain in a joint." Dorland's Illustrated Medical Dictionary, 31st Ed., p. 152 (2007). Thus, such a "diagnosis" cannot be service connected as such is not a disability for which service connection can be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), dismissed in part, vacated in part on other grounds sub. nom. Sanchez-Benitez v. Principi, 259 F.3d 1356, 1362 (Fed. Cir. 2001) (pain, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection can be granted). The Veteran's left shoulder examination in June 2006 does not disclose any underlying disorder or disability of the left shoulder to which the Veteran's "ache" or pain/arthralgia can be attributed. There is no decreased motion of the joint, nor does there appear to be any other injury or dysfunction of the left shoulder present either on that examination or in any of the VA treatment records in the record. The Board is therefore forced to conclude at this time that the Veteran does not have a current left shoulder disability. Additionally, the Board notes that the Veteran's left shoulder clavicle was broken prior to service, and such was noted on his enlistment examination. Insofar as the Veteran's sprained left shoulder in service is claimed to demonstrate an "aggravation" of any left clavicle fracture residuals, the Board notes that such a sprain resolved during military service and did not result in any permanent increase in symptomatology. The Board relies on the notation in the service treatment records that such resolved and that such was not considered disabling. The Veteran's left shoulder was additionally normal on separation from military service, and he did not seek any treatment for a left shoulder disorder following the resolution of his left shoulder sprain in December 1998. Also, the Board notes the lack of any treatment for his left shoulder disorder in his VA treatment records. Moreover, the June 2006 VA examination results confirm this finding of non-aggravation, as there was no diagnosed disability at that time. The Veteran's only symptom noted was "ache with use," without any functional impairment at all, including no decreased motion or other impairment due to weakness, fatigue, or lack of endurance after repetitive use. While the Board acknowledges that the Veteran has averred that he has a left shoulder disability, and acknowledges that he is competent to state that he has symptomatology, the Veteran is not competent to diagnose any left shoulder disability. 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); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Insofar as the Veteran is competent and credible to relate his symptomatology, the Board notes that such statements were made to the June 2006 VA examiner, who considered those statements in conjunction with examination of the Veteran. The results of that examination and consideration of the Veteran's statements of symptomatology did not result in a diagnosis of a current left shoulder disability for which service connection can be granted. Accordingly, the Board finds that service connection for a left shoulder disorder must be denied at this time. See 38 C.F.R. §§ 3.102, 3.303, 3.306; Brammer v. Derwinski, 3 Vet. App. 223 (1995) (Congress specifically limited entitlement for service- connected disease or injury to cases where such incidents had resulted in a disability). In reaching the above conclusion, 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) (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER Service connection for bilateral hearing loss is denied. Service connection for residuals of a left knee strain is granted. Service connection for a left shoulder disorder is denied. ____________________________________________ THOMAS J. DANNAHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs