Citation Nr: 1329486 Decision Date: 09/13/13 Archive Date: 09/20/13 DOCKET NO. 08-07 943 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Honolulu, Hawaii THE ISSUES 1. Entitlement to service connection for a right ankle disorder. 2. Entitlement to service connection for migraine headaches. 3. Entitlement to service connection for hypertension. 4. Entitlement to service connection for bilateral hearing loss. ATTORNEY FOR THE BOARD K.S. Hughes, Counsel INTRODUCTION The appellant is a Veteran who served on active duty from April 1975 to August 1977. These matters are before the Board of Veterans' Appeals (Board) on appeal from a February 2007 rating decision by the Honolulu, Hawaii, Department of Veterans Affairs (VA) Regional Office (RO). In July 2010, the Veteran failed to appear for a Travel Board hearing scheduled at his request. The case was previously before the Board in August 2010, January 2012 and April 2013, when it was remanded for additional development. [This appeal is processed using VA's paperless claims processing system. Any future consideration of the case should take into consideration the existence of the electronic record.] FINDINGS OF FACT 1. The Veteran's right ankle sprain in service was acute and transitory, and resolved; a chronic right ankle disability was not manifested in service; and a current right ankle disability is not shown. 2. A chronic headache disorder was not manifested in service, and a current such disability is not shown. 3. The Veteran was on medical hold for blood pressure check on service enlistment; essential hypertension was not manifested in service or in the first year following the Veteran's discharge from active duty, and the preponderance of the evidence is against a finding that his current hypertension is related to an event, injury, or disease in service. 4. A hearing loss disability of either ear was not manifested in service; sensorineural hearing loss (SNHL) was not manifested in the first postservice year; and there is no competent (medical) evidence that the Veteran's current hearing loss disability is related to an event, injury, or disease in service. CONCLUSIONS OF LAW 1. Service connection for a right ankle disability is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.326, 3.655 (2012). 2. Service connection for a chronic headache disorder is not warranted. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.326, 3.655 (2012). 3. Service connection for hypertension is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.326, 3.655 (2012). 4. Service connection for bilateral hearing loss disability is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.326, 3.385, 3.655 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative of any information, and any 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 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice requirements apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484-86 (2006), aff'd, 483 F.3d 1311 (Fed. Cir. 2007). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Veteran was advised of VA's duties to notify and assist in the development of his claim prior to its initial adjudication. Letters in June 2006 (for the claims of service connection for a right ankle disability, migraine headaches, and bilateral hearing loss) and September 2006 (as to service connection for hypertension) explained the evidence necessary to substantiate the claims, the evidence VA was responsible for providing, and the evidence he was responsible for providing, and informed him of disability rating and effective date criteria. A September 2010 letter also advised the Veteran of the consequences of a failure to report for a scheduled VA medical examination without good cause. See 38 C.F.R. § 3.655. The claims were thereafter readjudicated (See November 2011, October 2012, and June 2013 supplemental statements of the case (SSOC)). It is not alleged that notice in these matters was less than adequate. The Veteran's pertinent service treatment records (STRs) and postservice treatment records have been secured. Pursuant to the August 2010 Board remand, the Veteran was scheduled for VA examinations to secure nexus opinions in connection with his claims. The Veteran acknowledged notice of the scheduled examinations, but then failed (without giving cause) to report; in a November 2012 response to the October 2012 SSOC, he reiterated that his military records support his claim). Obviously, without his cooperation the further development necessary to secure the opinions is not possible. VA's duty to assist the Veteran is met. Legal Criteria, Factual Background and Analysis Initially, the Board notes that it has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claims. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection also may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disorder, there must be (1) evidence of a current disability; (2) evidence of incurrence or aggravation of a disease or injury in service; and (3) evidence of a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). In the absence of proof of a current disability, there is no valid claim of service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Certain chronic disabilities (to include hypertension and organic diseases of the nervous system - such as sensorineural hearing loss (SNHL)) may be service-connected on a presumptive basis if manifested in a specified period of time following a veteran's discharge from active duty (one year for organic diseases of the nervous system and hypertension). 38 U.S.C.A. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). However, lay evidence may be competent evidence to establish incurrence. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (e.g., a broken leg), (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 (Fed. Cir. 2007). Competent medical evidence is needed where the determinative question is one requiring medical knowledge. Id. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. It may also mean statements conveying sound medical principles found in medical treatises, and may include statements in authoritative writings, such as medical and scientific articles and research reports. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means 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 layperson. 38 C.F.R. § 3.159(a)(2). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, 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 fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Right Ankle and Migraine Headaches In his March 2007 notice of disagreement, the Veteran stated that migraine headaches and a right ankle disability were manifest while he was on active duty and have continued to bother him. In his March 2008 substantive appeal, he recalled experiencing headaches from "smelling gas from the planes" while serving aboard the USS Enterprise. The Veteran's STRs show that during service he was seen for a right ankle sprain in June 1976 and for a headache in November 1976. His lower extremities and neurological system were normal on clinical evaluation on July 1977 service separation examination. The earliest postservice medical evidence of record is in VA and private treatment reports dated in 2006. The Veteran has not authorized VA to obtain private treatment records, or indicated that he received VA treatment, prior to 2006. [In February 2012, in response to VA request for treatment records in connection with his claims, the Veteran stated that he had "decided to give [VA] most of [his] LBJ medical records from 2006 to the present time."] Treatment records from LBJ Tropical Medical Center (LBJ), dated from February 2006 to January 2012, note a history of gouty arthritis, right ankle X-ray report showing "no pathology" (November 2006), a notation of right foot swelling and pain (November 2008), and headache complaints. A March 2007 letter from I. Saleapaga, M.D., the Veteran's physician at LBJ, states that the Veteran has "service connected" migraine headaches and stutus post right ankle injury. Dr. Saleapaga noted that the Veteran had "intermittent attacks of headaches," received treatment for headaches and has right ankle pain with full range of motion. Dr. Saleapaga also noted that a right ankle X-ray and a computed tomography (CT) scan of the brain were negative. The impression was history of migraine headaches and history status post injury right ankle; a diagnosis of a current right ankle or migraine headache disability was not given. In a March 2013 statement, in pertinent part, Dr. Saleapaga noted that the Veteran had gout. November 2007 VA treatment records note the Veteran's complaint of headaches (which often throb) over the top of his head, and that he has a history of gout and hyperuricemia. A May 2012 VA treatment report notes that the Veteran was last seen in November 2007. The Veteran was scheduled for a January 2011 VA examination, for which he failed (without explanation) to report. The threshold requirement that must be met in order to establish a claim for service connection is that there must be competent evidence (a medical diagnosis) of a current disability (or one that existed on or after the date of application for service connection). See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board acknowledges the Veteran's complaints of headache and right ankle pain; recognizes that he is competent to testify as to observable symptoms, like pain; and finds no reason to question the credibility of his lay accounts of pain. 38 C.F.R. § 3.159(a)(2); see also Layno v. Brown, 6 Vet. App. 465, 471 (1994). However, pain alone, without a diagnosed or underlying malady or condition is not a disability for which service connection may be granted. Sanchez-Benitez v. West, 13 Vet. App. 282 (1999), aff'd in part, vacated and remanded in part on other grounds, 259 F.3d 1356 (Fed. Cir. 2001). The Veteran has not provided any competent (medical) evidence that a chronic right ankle or headache disability was diagnosed at any time during the pendency of this claim/appeal. Records from a private provider he has submitted note only a history of such disabilities, and do not show current findings or diagnosis of such disabilities. Significantly, whether there is underlying pathology to account for symptoms of right ankle pain and whether complaints of headaches represent a current chronic headache disability are not question that can be resolved by mere lay observation alone; they require medical expertise (and may require diagnostic studies). The Veteran is a layperson with no medical training; he does not cite to any medical texts or treatises to support a self-diagnosis. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans' Court); see also Davidson, 581 F.3d at 1316. The Board sought (by August 2010 remand for a VA examination) to assist the Veteran in establishing he has current chronic right ankle and headache disabilities. However, he failed (without giving cause) to report for such examination on the scheduled date. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (VA's duty to assist a Veteran in developing the facts and evidence pertinent to his claim is not a one-way street). A governing regulation (38 C.F.R. § 3.655) provides that when a claimant fails [without good cause] to report for an examination scheduled in conjunction with a claim for entitlement or continued entitlement to a benefit, and such benefit cannot be established or confirmed without a current VA examination or reexamination, the claim shall be rated based on the evidence of record. A claimant failing to report for a scheduled examination must show good cause for not doing so. See 38 C.F.R. § 3.655; see also Engelke v. Gober, 10 Vet. App. 396, 399 (1997). In the absence of any competent evidence showing that the Veteran has a chronic right ankle disability or migraine headaches, he has not presented a valid claim of service connection for such disabilities. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the appeal as to the claims of service connection for a right ankle disability and migraine headaches must be denied. Hypertension For VA purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 mm. (millimeters of mercury) or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm. or greater with a diastolic blood pressure of less than 90 mm. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). The Veteran's STRs show that he did not report a history of high or low blood pressure on his January 1975 enlistment examination; his heart and vascular system were normal on clinical evaluation. Although he was on medical hold for blood pressure check, on April 1975 physical inspection, his blood pressure average was 130/80, ncd (not considered disabling) and he was found "fit" for military service. Elevated blood pressure readings and/or hypertension were not noted during service. On July 1977 separation examination, the Veteran's heart and vascular system were normal on clinical evaluation and his blood pressure was 114/72. The earliest postservice medical evidence of record consists of VA and private treatment reports dated from 2006. The Veteran has not authorized VA to obtain records of private treatment prior to 2006 or identified any VA treatment prior to. 2006 [In February 2012, in response to VA's request for treatment records in connection with his claims, the Veteran stated that he had "decided to give [VA] most of [his] LBJ medical records from 2006 to the present time."] VA and LBJ treatment records, dated from February 2006 to January 2012, show diagnoses of hypertension and hypertensive cardiovascular disease, not controlled. A November 2007 VA treatment report notes that the Veteran had "been diagnosed with hypertension for several years." A March 2007 letter from Dr. Saleapaga states that the Veteran has "service connected" hypertension" and was seen in the Internal Medicine Clinic for hypertension. In a March 2013 statement, in pertinent part, Dr. Saleapaga noted that the Veteran had a "history of service connected hypertension since April 14, 1975. (See outpatient visit record while in active duty.)" The Veteran was scheduled for a January 2011 VA examination, for which he failed to report (without explanation). It is not in dispute that the Veteran receives treatment for, and has a diagnosis of, hypertension. His STRs show that at service entrance he was placed on medical hold for blood pressure check (suggesting he may have had some elevated blood pressure readings); however, he was found fit for military service (and hypertension was not diagnosed). Furthermore, on service separation examination, his heart and vascular system were normal on clinical evaluation. There is no evidence that hypertension was manifested in service or during the first postservice year. The earliest clinical record showing that the Veteran had hypertension is dated in 2006, (some 29 years after his retirement from service), although hypertension may have been diagnosed prior to 2006 (he has not authorized release of pre-2006 private treatment records to VA). Consequently, service connection for hypertension on the basis that it was became manifest in service and persisted, or on a chronic disease presumptive basis (under 38 U.S.C.A. § 1112) is not warranted. What remains for consideration is whether or not in the absence of a diagnosis in service and/or postservice continuity of symptoms, the Veteran's hypertension may nonetheless somehow otherwise be related to his service. Although Dr. Saleapaga has opined that the Veteran has had hypertension since April 14, 1975, citing to the April 1975 medical hold on enlistment; he provides no further explanation of rationale for this opinion. Although the opinion is by a medical professional competent to provide it, the Board finds it to be of less than persuasive probative value because, by itself, it is conclusory and does not include any explanation of rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Further, as the April 1975 STR does not show a finding of hypertension, Dr. Saleapaga's opinion appears to be based on an inaccurate factual premise and lacks probative value. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding a medical opinion based on incorrect factual premise is not probative). As is noted above, the Board sought (by August 2010 remand for a VA examination) to assist the Veteran in establishing the etiology of his current hypertension. However, he failed (without giving cause) to report for such examination on the scheduled date. A governing regulation provides that when (as here) a veteran fails to report for an examination scheduled in connection with an original compensation claim, the claim will be decided based on the evidence of record. 38 C.F.R. § 3.655. As such evidence does not show that there is a nexus between any current hypertension and the Veteran's service, the evidence is inadequate to substantiate his claim. Significantly, the matter of a nexus between current hypertension and remote service is a medical question. Hypertension is not a disability capable of lay observation; its presence is established by diagnostic measurements. The Veteran's own statements relating his current hypertension to service are not competent evidence in the matter. He is a layperson with no medical training; does not cite to any medical texts or treatises that support his theory of causation; has not submitted any supporting medical opinion; and does not offer any explanation of rationale (other than to note that he was placed on medical hold for blood pressure check [on entry] in service (a fact not in dispute)). See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007. In light of the foregoing, the preponderance of the evidence is against this claim, therefore the benefit of the doubt doctrine does not apply. The claim must be denied. Bilateral Hearing Loss Hearing loss disability is defined by regulation. For the purpose of applying the laws administered by VA, impaired hearing is considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Court has also held that the regulation does not necessarily preclude service connection for hearing loss that first met the regulation's requirements after service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Thus, a claimant who seeks to establish service connection for a hearing disability must show, as is required in any claim of service connection, that a current hearing disability is the result of an injury or disease incurred in service. The Veteran served on board the USS Enterprise, and has reported exposure to noise trauma working on aircraft on the flight deck. His DD Form 214 shows he served aboard the USS Enterprise and his military occupational specialty (MOS) was "air transportations occupations." The Board finds his account of noise exposure in service to be credible. The Veteran's STRs show that the audiometry on enlistment found that puretone thresholds, in decibels, were: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 10 10 10 LEFT 10 10 10 10 5 The Veteran's ears were normal on clinical evaluation on July 1977 service separation examination. Whispered voice testing found 15/15 (normal) hearing acuity; audiometry was not available; an audiogram was recommended. Postservice medical evidence of record consists of VA and private treatment reports dated from 2006. The Veteran has not authorized VA to obtain prior private treatment records (or indicated that he received VA treatment prior to 2006). [In February 2012, in response to a VA request for treatment records in connection with his claims, the Veteran stated that he had "decided to give [VA] most of [his] LBJ medical records from 2006 to the present time."] The initial postservice finding of hearing loss was on March 2007 audiometry at LBJ (presented in chart form, not converted to numerical values) and shows a diagnosis of sensorineural hearing loss bilaterally. Subsequent VA and LBJ treatment records also show findings of bilateral hearing loss. In a March 2007 letter, Dr. Saleapaga stated that "audiogram showed bilateral sensory-neural loss," hearing loss is "service connected," and described it as "significant." On July 2009 VA examination, it was noted that the Veteran's claims file was reviewed. Puretone thresholds, in decibels, were: HERTZ 500 1000 2000 3000 4000 RIGHT 75 90 95 105 100 LEFT 85 85 95 100 95 Speech audiometry revealed speech recognition ability of 48 percent in the right ear and 56 percent in the left ear. The examiner indicated that the reliability of audiometric testing was poor, even following repeated reinstruction; noted that audiometry results were inappropriate for rating purposes; and stated that in light of these factors an opinion regarding the etiology of the Veteran's hearing loss could not be given. Pursuant to the Board's August 2010 remand (which noted that the July 2009 VA examination report did not provide adequate explanation as to whether the inability to obtain accurate audiometry findings was due solely to lack of co-operation or malingering or to inadequacy of the process and Board found that follow-up was necessary), the Veteran was scheduled for another VA audiological evaluation (with audiometry) in January 2011. He failed (without giving cause) to report. It is not in dispute that the Veteran has a bilateral hearing loss disability as defined in 38 C.F.R. § 3.385, as such was shown on July 2009 VA audiometry. As was noted above, based on his duties in service, it may also reasonably be conceded that the Veteran was exposed to hazardous levels of noise in service. What remains necessary to establish service connection for his bilateral hearing loss is competent evidence of a nexus between the current hearing loss and his service/noise trauma therein. A hearing loss disability was not manifested in service. The Veteran's STRs are silent for such disability and, although audiometry was recommended on service separation examination, whispered voice test results showed normal hearing. Furthermore, SNHL was not manifested in the first postservice year. Consequently, service connection for the bilateral hearing loss disability on the basis that such disability became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C.A. § 1112. 1137) is not warranted. What remains for consideration is whether in the absence of manifestation in service, and continuity since, the Veteran's bilateral hearing loss disability may nonetheless be related to his remote service/noise trauma therein. The evidence that tends to support the Veteran's claim consists of the March 2007 letter from Dr. Saleapaga, who opined that the Veteran had "service-connected" hearling loss. The opinion is by a medical professional competent to provide it and is probative evidence in the matter. However, the Board finds it to be of less than persuasive probative value in that, by itself, it is conclusory and does not include any explanation of rationale as to why the Veteran's hearing loss is service-connected. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). As is noted above, because the July 2009 VA examiner indicated that an opinion regarding the etiology of the Veteran's hearing loss could not be given (the examination was inappropriate for rating purposes due to the poor reliability of audiometric testing), the Board (in its August 2010 remand) sought to assist the Veteran to establish a likely etiology of his current bilateral hearing loss by arranging for a VA examination for that purpose. However, he failed (without giving cause) to report for such examination on the scheduled date. Regulation provides that when (as here) a veteran fails to report for an examination scheduled in connection with an original compensation claim, the claim will be decided based on the evidence of record. 38 C.F.R. § 3.655. As such evidence does not show a nexus between a current hearing loss and the Veteran's service/ exposure to noise trauma therein, the requirements for establishing service connection for the hearing loss are not met. The Board has considered the Veteran's lay statements concerning the etiology of his bilateral hearing loss. While he may be competent to testify as to the symptoms he experiences, he is not competent to, by his own opinion, relate the loss of hearing acuity he has observed to his exposure to noise trauma in service. He is a layperson, and lacks the training/expertise to opine competently on a medical question such as that presented in the instant case, i.e., whether hearing loss first documented many years after exposure to noise trauma may be related to such trauma rather than to intervening etiological factors. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In light of the foregoing, the Board finds that the preponderance of the evidence is against this claim. Therefore the benefit of the doubt doctrine does not apply. The claim must be denied. ORDER Service connection for a right ankle disorder is denied. Service connection for migraine headaches is denied. Service connection for hypertension is denied. Service connection for bilateral hearing loss is denied. ____________________________________________ GEORGE R. SENYK Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs