Citation Nr: 1340722 Decision Date: 12/11/13 Archive Date: 12/20/13 DOCKET NO. 10-11 020 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Whether there is new and material evidence to reopen a claim of entitlement to service connection for a dental condition for treatment purposes. 2. Entitlement to service connection for bilateral hearing loss. 3. Entitlement to service connection for tinnitus. 4. Entitlement to service connection for vertigo. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The Appellant-Veteran ATTORNEY FOR THE BOARD A. Dean, Associate Counsel INTRODUCTION The Veteran served on active duty from February to August 1966. This appeal to the Board of Veterans' Appeals (Board/BVA) is from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). As support of his claims, the Veteran testified at a videoconference hearing in May 2013 before the undersigned Veterans Law Judge (VLJ) of the Board. FINDINGS OF FACT 1. A January 1967 rating decision denied service connection for a dental condition for treatment purposes. 2. The Veteran has not alleged that he did not receive notice of that January 1967 decision, and he did not appeal it. 3. The additional evidence received since that January 1967 decision, when considered along with the evidence already of record, is cumulative or redundant or does not raise a reasonable possibility of substantiating this claim of entitlement to service connection for a dental condition for treatment purposes. 4. Although the Veteran has bilateral hearing loss and tinnitus, the most probative (meaning competent and credible) medical and other evidence of record indicates these conditions are unrelated to his military service, including specifically to exposure to loud noise during his service and consequent injury (acoustic trauma). 5. There is no probative evidence that he has a current disability of vertigo or that he has had any such disability at any point since filing this claim. CONCLUSIONS OF LAW 1. The January 1967 rating decision denying service connection for a dental condition for treatment purposes is a final and binding determination. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 3.104(a), 3.160(d), 20.200, 20.1103 (2013). 2. There is not new and material evidence since that decision to reopen this claim of entitlement to service connection for a dental condition for treatment purposes. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2013). 3. The Veteran's bilateral hearing loss and tinnitus were not incurred in or aggravated by his military service and may not be presumed to have been. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (2013). 4. It is not shown he has a diagnosis of vertigo, much less due to or as a consequence of his active military service. 38 U.S.C.A. §§ 1110, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Standard of Review In deciding these claims, the Board has reviewed all of the evidence in the claims file, both the physical claims file and electronic ("Virtual VA") portion of it, and has an obligation to provide an adequate statement of reasons or bases supporting this decision. See 38 U.S.C.A. § 7104(d)(1) (West 2002); Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). But while the Board must review the entire record, it need not discuss each and every piece of evidence, certainly not in exhaustive detail. See id. The analysis below therefore focuses only on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board addresses its reasons for rejecting evidence favorable to the claimant). The Board must assess the credibility and weight of all relevant evidence, so both the medical and lay evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive and providing reasons for rejecting any evidence favorable to the claimant. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. When the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must weigh against a claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). II. The Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), sets forth VA's duties to notify and assist a claimant in substantiating a claim for VA benefits. The VCAA was codified as amended at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, and the implementing regulations were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative of any information and medical or lay evidence not of record that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In order to satisfy its duty to notify the claimant under the VCAA, the United States Court of Appeals for Veterans Claims (Court/CAVC) held that VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will obtain; and (3) that the claimant is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Ideally, VCAA notice should be provided prior to an initial decision on a claim by the RO as the Agency of Original Jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, if notice was not provided prior to initially adjudicating a claim, or if provided and it was inadequate or incomplete, the issuance of a fully compliant VCAA notification followed by readjudication of the claim, including in a statement of the case (SOC) or supplemental SOC (SSOC), is sufficient to "cure" the timing defect because the intended purpose of the notice is preserved, not frustrated, since the Veteran is still given meaningful opportunity to participate effectively in the adjudication of his claim. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370 (2006). A claim of entitlement to service connection consists of five elements: (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. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484 (2006). The Court has held that notification of what evidence is necessary to substantiate the claim under 38 U.S.C.A. § 5103(a) thus requires notice of all five of these elements, so including concerning the "downstream" disability rating and effective date that are assigned once service connection is granted. See id. at 486; Quartuccio, 16 Vet. App. at 187. Consider also that, in Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court clarified VA's duty to notify in the context of claims to reopen. With respect to such claims, VA must both notify a claimant of the evidence and information that is necessary to reopen the claim and of the evidence and information necessary to establish entitlement to the underlying benefit being sought. To satisfy this requirement, VA is required to look at the bases for the denial in the prior decision and provide the claimant a notice letter describing what evidence would be necessary to substantiate the elements required to establish entitlement to service connection that were found insufficient in the previous denial. In Shinseki v. Sanders, 129 S. Ct. 1696 (2009), however, the U.S. Supreme Court clarified that VCAA notice errors, even when shown to have occurred, are not presumptively prejudicial, rather, must be judged on a case-by-case basis. And as the pleading party attacking the agency's decision, the Veteran, not VA, bears this burden of proof of not only establishing error but also, above and beyond that, showing how it is unduly prejudicial, meaning outcome determinative of his claim. Here, in an April 2008 letter, the RO duly advised the Veteran that his claim of entitlement to service connection for a dental condition for treatment purposes had been previously considered and denied in a prior rating decision, which since had become a final and binding determination since not appealed. The letter further advised him of the bases of the previous denial (no evidence of treatment in service for a dental condition and no evidence that the dental condition being claimed was caused by an injury, event, and/or disease in service), and informed him that new and material evidence tending to show otherwise was needed to reopen the claim. See VA Gen. Couns. Mem., para. 2, 3 (June 14, 2006) (wherein VA's Office of General Counsel issued informal guidance interpreting Kent as requiring the notice to specifically identify the kind of evidence that would overcome the prior deficiency rather than simply stating the evidence must relate to the stated basis of the prior denial). Regarding his remaining claims for service connection for bilateral hearing loss, tinnitus, and vertigo, prior to initially deciding these claims in September 2011, a September 2010 letter informed him of all five elements of these claims, so including of the "downstream" disability rating and effective date elements, also gave examples of the types of evidence he could submit in support of these claims and informed him of his and VA's respective responsibilities in obtaining relevant records and other evidence on his behalf that would tend to support these claims. He therefore received all required notice concerning these claims and in the preferred sequence. VA's duty to assist under the VCAA includes helping the claimant obtain relevant records, including service treatment records (STRs) and other pertinent records, such as regarding his evaluation and treatment since service, whether from VA or private healthcare providers, as well as providing an examination or obtaining a medical opinion when needed to make a decision on the claim. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). To this end, the Veteran's STRs and post-service treatment records have been obtained and associated with the claims file for consideration. He has not identified any outstanding records that he wants VA to obtain or that he believes are relevant to his claims. Therefore, the duty to assist him in obtaining pertinent records has been satisfied. See 38 C.F.R. § 3.159(c). The duty to assist also, as mentioned, includes providing a medical examination or obtaining a medical opinion when necessary to make a decision on a claim. 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. §§ 3.159(c)(4), 3.326(a). See also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, in March 2011, the Veteran was provided the appropriate VA examination for the necessary medical nexus opinion for his bilateral hearing loss and tinnitus. The VA examination report provides the information needed to make an informed decision on these claims. It is evident from the report that the examiner reviewed the claims file for the pertinent history, including of the Veteran's claimed acoustic trauma in service and of the complaints, evaluation and treatment in the aftermath and during the many years since. The examiner also performed a personal evaluation of the Veteran and, most importantly, provided explanatory rationale for the consequent opinion that is grounded in fact and based on information in pertinent medical literature. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (holding that an examination is adequate when it is based on consideration of the claimant's medical history and describes the disability in sufficient detail so the Board's evaluation of the disability will be a fully informed one). Unless the claimant challenges the adequacy of the examination or opinion, the Board may assume that the examination report and opinion are adequate and need not affirmatively establish the adequacy of the examination report or the competence of the examiner. See Sickels v. Shinseki, 643 F.3d, 1362, 1365-66 (Fed. Cir. 2011) (holding that, although the Board is required to consider issues independently raised by the evidence of record, the Board is still "entitled to assume" the competency of a VA examiner and the adequacy of a VA opinion without "demonstrating why the medical examiners' reports were competent and sufficiently informed"); see also Rizzo v. Shinseki, 580 F.3d 1288, 1290-1291 (Fed. Cir. 2009) (similarly holding that the Board is entitled to assume the competency of a VA examiner unless the competence is challenged). Indeed, even when this is challenged, the Board may assume the competency of any VA medical examiner, including even nurse practitioners, as long as, under 38 C.F.R. § 3.159(a)(1), the examiner is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. See Cox v. Nicholson, 20 Vet. App. 563 (2007). The Board realizes the Veteran has not been provided a VA compensation examination in response to his claim for vertigo, nor has a medical nexus opinion been obtained. VA is obliged to provide a VA compensation examination or medical opinion when (1) there is competent evidence the Veteran has a current disability or persistent or recurrent symptoms of disability; (2) there is evidence establishing that he suffered an event, injury or a disease in service or has a disease or symptoms of a disease within a specified presumptive period; (3) the evidence indicates the current disability or symptoms may be associated with service or a service-connected disability; but (4) there is insufficient medical evidence on file to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). See also 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4). In both McLendon and Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010), the U.S. Court of Appeals for Veterans Claims (Veterans Court/CAVC) and the U.S. Court of Appeals for the Federal Circuit (Federal Circuit Court) clarified that, when determining whether a VA examination and opinion are required under 38 U.S.C. § 5103A(d)(2), the law requires competent evidence of a disability or persistent or recurrent symptoms of a disability, but does not require competent evidence of a nexus, only that the evidence indicates an association between the disability and service or a service-connected disability. The third prong, which requires that the evidence of record "indicate" that the claimed disability or persistent or recurrent symptoms "may be" associated with the established event, injury, or disease in service is a "low threshold". McLendon, at 83. See also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (Medically competent evidence is not required in every case to "indicate" that the claimant's disability "may be associated" with the claimant's service.). This is not however to say or suggest that VA is obligated to provide an examination for a medical nexus opinion merely as a matter of course. See Duenas v. Principi, 18 Vet. App. 512, 519 (2004). If such were the case, this would circumvent the craftily tailored language of the statute and regulation governing when examinations and opinions should be obtained and require provision of an examination and opinion in virtually every instance, so virtually without exception. And here, as will be explained below, there is no evidence of a current disability of vertigo, therefore a VA examination and a medical opinion are not needed to fairly decide this claim inasmuch as the Veteran has not first established he has this alleged condition or even persistent or recurrent symptoms of it. See McLendon, 20 Vet. App. 79, citing 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c)(4). Accordingly, VA's duty to obtain a VA examination and opinion is satisfied. See 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. §§ 3.159(c)(4); 3.326(a); McLendon, 20 Vet. App. at 83; Barr, 21 Vet. App. at 312. The Veteran has received all essential notice and assistance, has had a meaningful opportunity to participate effectively in the development of his claims, and is not prejudiced by any technical notice or assistance deficiency along the way. Under the circumstances presented, it is difficult to discern what additional guidance VA could have provided him regarding what further evidence he should submit to substantiate his claims. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). Accordingly, the Board may proceed with appellate review of his claims. III. Legal Criteria for New and Material Evidence Claim Generally, a claim that has been denied in an unappealed RO decision or an unappealed Board decision may not thereafter be reopened and allowed. 38 U.S.C.A. §§ 7104(b), 7105(c) (West 2002). The exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. Although the RO reopened the Veteran's claim, the Board must determine independently whether new and material evidence has been presented to reopen the claim as a jurisdictional matter, irrespective of the decision of the RO. See Jackson v. Principi, 265 F. 3d 1366 (Fed. Cir. 2001). If the Board determines there is not the required new and material evidence to reopen the claim, what the RO determined concerning this is irrelevant since the Board is precluded from further consideration of the claim; this further consideration is neither required nor permitted. Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). See also McGinnis v. Brown, 4 Vet. App. 239 (1993) (Board reopening is unlawful when new and material evidence has not been submitted); Butler v. Brown, 9 Vet. App. 167, 171 (1996); and VAOPGCPREC 05-92 (March 4, 1992). New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final and binding denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The credibility of the evidence in question must be presumed, albeit just for the limited purpose of determining whether it is new and material. Justus v. Principi, 3 Vet. App. 510, 513 (1992). This presumption no longer applies when making a determination as to the ultimate credibility and weight of the evidence as it relates to the merits of the claim. Essentially, the presumption of credibility "dissolves" once the claim is reopened and decided on the merits. See also Duran v. Brown, 7 Vet. App. 216 (1994) (indicating "Justus does not require the Secretary [of VA] to consider the patently incredible to be credible" or blindly accept as credible assertions that are beyond the competence of the person making them). Also, evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented. Anglin v. West, 203 F.3d 1343 (2000). But in Shade v. Shinseki, 24 Vet. App. 110 (2010), the Court explained that when determining whether the submitted evidence meets the definition of new and material evidence, VA must consider whether the new evidence could, if the claim were reopened, reasonably result in substantiation of the claim. Id., at 118. Thus, pursuant to Shade, evidence is new if it has not been previously submitted to agency decision makers and is material if, when considered with the evidence of record, it would at least trigger VA's duty to assist by providing a medical opinion, which might raise a reasonable possibility of substantiating the claim. In other words, the Court indicated there are two, not three, requirements for reopening a claim, those being that the evidence is new and material, not instead that it is new, material, and raises a reasonable possibility of substantiating the claim. The Court pointed out that the post-VCAA version of § 3.156(a) establishes a "low threshold" for reopening a claim, one that does not require that a claimant submit a medical opinion to reopen a claim. Rather, if there is newly submitted evidence of a current disability that in connection with the prior evidence raises a reasonable possibility of substantiating the claim, and the element of a nexus could be established by providing a VA examination, the claim may be reopened. This then triggers VA's duty to assist in providing the claimant with a VA examination. In determining whether new and material evidence is required, the focus of the Board's analysis must be on whether the evidence presented truly amounts to a new claim based upon distinctly diagnosed diseases or injuries or whether the evidence substantiates an element of a previously adjudicated matter. See Velez v. Shinseki, 23 Vet. App. 199 (2009). New arguments based on the same evidence of record at the time of the previous final denial do not constitute the presentation of new and material evidence. See Untalan v. Nicholson, 20 Vet. App. 467 (2006). IV. Analysis of New and Material Evidence Claim The Veteran originally filed his claim of entitlement to service connection for a dental condition for treatment purposes in January 1967. In a rating decision later in January 1967, the RO denied service connection on the basis that the evidence then of record did not show his dental condition was due to combat wounds, trauma, or based on prisoner of war (POW) status of less than 90 days. Although there is no evidence of record that he received notification of that decision, such as in the way of a copy of the notification letter in the claims file, he was also informed of the denial in a May 1993 rating decision for separate claims. He never claimed not to have received notification of the January 1967 rating decision, and he did not appeal it. Consider also that VA's protocol at the time did not require maintaining a hard copy of the notification letter in the file. As well, effective February 1, 1990, Title 38 U.S.C. § 5104(b) requires ROs to specify, in each rating decision, the evidence considered and the reasons for the disposition; before then, rating decisions generally lacked this level of specificity. See 38 U.S.C.A. § 5104(b) (West 2002); see also Crippen v. Brown, 9 Vet. App. 412, 420 (1996). Thus, "[s]ilence in a final RO Decision made before February 1990 cannot be taken as showing a failure to consider evidence of record." Crippen v. Brown, 9 Vet. App. at 421. At the time of that January 1967 denial, the record before the RO, which was the adjudicating Agency of Original Jurisdiction (AOJ), appears to have consisted solely of the Veteran's STRs, which showed evidence of dental treatment during his active duty service. That alone, however, is not necessarily grounds for entitling him to VA outpatient dental treatment once out of service. Disability compensation and VA outpatient dental treatment may be provided for certain specified types of service-connected dental disorders. For other types of service-connected dental disorders, the claimant may receive treatment only and not compensation. 38 U.S.C.A. § 1712; 38 C.F.R. §§ 3.381, 4.150, 17.161. The Veterans Court (CAVC) has held that a claim for service connection for a dental disorder is also a claim for VA outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302 (1993). In dental claims, the RO adjudicates the claim for service connection and the VA Medical Center (VAMC) adjudicates the claim for outpatient treatment. Effective February 29, 2012, VA amended its adjudication regulations regarding service connection of dental conditions for treatment purposes under 38 C.F.R. § 3.381. See 77 Fed. Reg. 4470 (Jan. 30, 2012) (codified at 38 C.F.R. § 3.381(a) (2013)). This section identifies some of the circumstances under which dental conditions that may not qualify as disabilities for purposes of VA disability compensation nevertheless may be service connected for purposes of VA dental treatment under 38 U.S.C. § 1712 and 38 C.F.R. § 17.161. The amendments clarify existing regulatory provisions and reflect the respective responsibilities of the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA) in making determinations concerning eligibility for dental treatment. Dental disabilities that may be awarded compensable disability ratings are set forth in 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, loss of the maxilla, nonunion or malunion of the maxilla, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. The pertinent evidence that has been received in the several years since the January 1967 rating decision includes a letter from the Veteran stating that his dental records from Dr. Grant from August 1966 to 1967 are unavailable; private dental treatment records from October 1995 to October 1998 and from October 1999 to October 2000; an August 2008 lay statement from the Veteran claiming he fell and hit his teeth in service (i.e., sustained dental trauma); a May 2009 lay statement from him discussing his April 1966 dental treatment; hearing testimony from May 2013 during which he conversely denied sustaining any trauma to his mouth or jaw; and two buddy statements from the same friend who stated the Veteran had described his teeth problem and that he was aware the Veteran had received dental treatment in service. In consideration of the additional evidence received since that final and binding January 1967 RO decision, the Board finds that the additional evidence is cumulative or redundant of evidence already considered in that earlier decision, does not relate to an unestablished fact necessary to substantiate this claim, and does not raise a reasonable possibility of substantiating this claim. The evidence therefore is not new and material to the claim. See 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). And as new and material evidence to reopen this finally disallowed claim has not been received, the benefit-of-the-doubt doctrine is inapplicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). V. Legal Criteria for Service Connection Claims Service connection is granted for current disability resulting from a disease contracted or an injury sustained in the line of duty during active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for a disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain diseases are considered chronic, per se, and therefore will be presumed to have been incurred in service if manifested to a compensable degree of at least 10-percent disabling within one year after service. Bilateral hearing loss (assuming it is sensorineural) is one such condition, as it is considered to be an organic disease of the nervous system. The VBA's M21-1MR has a section titled "Determining Impaired Hearing as a Disability," which includes the following note: "Sensorineural hearing loss is considered an organic disease of the nervous system and is subject to presumptive service connection under 38 CFR 3.309(a)." M21-1MR III.iv.4.B.12.a. See, too, Memorandum, Characterization of High Frequency Sensorineural Hearing Loss, Under Secretary for Health, October 4, 1995 (reaffirming that sensorineural hearing loss is an organic disease of the nervous system). This presumption of incurrence in service, however, is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). So service connection may be established either by showing direct service incurrence or aggravation or by using applicable presumptions, if available. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection on a direct-incurrence basis requires competent and credible evidence showing: (1) the Veteran has the alleged disability or, at the very least, indicating he has at some point since the filing of his claim; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002). Also of application to claims for direct service connection is the principle that where a chronic disease is shown during service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. On the other hand, continuity of symptomatology is required where the condition noted during service is not shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned. In this circumstance, a showing of continuity of symptomatology since service is required to establish chronicity of disease or injury in service and in turn link current disability to service. 38 C.F.R. § 3.303(b). However, the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court) since has clarified in Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013), that this notion of continuity of symptomatology is limited to where involving those specific diseases denoted as "chronic" (and for which presumptive service connection is otherwise available) under 38 C.F.R. § 3.309(a). Thus, if the claimant does not have one of the chronic diseases enumerated in section 3.309(a), then the more relaxed continuity-of-symptomatology standard does not apply, and "medical nexus of a relationship [sic] between the condition in service and the present condition is required." Id. at 1338; see also id. at 1336, 1340 (holding that the claimant's allegation of a continuity of hearing loss ever since active service was insufficient to support the claim under subsection 3.303(b), as hearing loss was not among the chronic diseases listed in section 3.309(a)). Because however the Veteran has been diagnosed with a particular type of hearing loss, namely, sensorineural hearing loss, and since sensorineural hearing loss as mentioned is an organic disease of the nervous system for purposes of section 3.309(a), the provisions of subsection 3.303(b) for chronic disabilities apply, and the claim may be supported by evidence of a continuity of symptomatology since service. The determination as to whether the requirements for service connection are met is based on an analysis of all the relevant evidence of record, medical and lay, and the evaluation of its competency and credibility to determine its ultimate probative value in relation to other evidence. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Generally, lay statement evidence may have direct relevance to establishing underlying components of a claim for service connection. In Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the Federal Circuit Court commented that competence to establish a diagnosis of a condition can exist 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. Lay testimony where found credible is also competent to establish the presence of continuity of symptomatology for a claimed disability during and since separation from military service (again, subject to the limitation that a "chronic" disease is involved as defined under 38 C.F.R. § 3.309(a)). See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The Federal Circuit Court has further held in Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010) and in Waters v. Shinseki, 601 F.3d 1274, 1278 (2010), that it is error to suggest that lay evidence can never be sufficient to satisfy the requirement of 38 U.S.C.A. § 5103A(d)(2)(B) that there be a nexus between military service and a claimed condition. But as also observed by the Federal Circuit Court, lay evidence must "demonstrate some competence." See King v. Shinseki, (Fed. Cir. 2012) (citing 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 3.307(b)) (internal quotation marks omitted). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is "credible," or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 (2007). Only if evidence is both competent and credible does it ultimately have probative value. See Layno v. Brown, 6 Vet. App. 465 (1994); Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). 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 lay person. 38 C.F.R. § 3.159(a)(2). In ascertaining the competency of lay evidence, lay evidence has been found competent with regards to a disease with "unique and readily identifiable features" that is "capable of lay observation." See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). Laypersons equally have been found not competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). See also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (concluding that a Veteran's lay belief that his schizophrenia had aggravated his diabetes and hypertension was not of sufficient weight to trigger VA's duty to seek a medical opinion on the issue). Competent medical evidence, as opposed to lay evidence, is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza at 511-512 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see also Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997). As fact finder, when considering whether lay evidence is satisfactory, the Board may not only consider internal inconsistency of statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, but also the Veteran's demeanor when testifying at a hearing when he has testified. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). See, too, Macarubbo v. Gober, 10 Vet. App. 388 (1997). In ultimately rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons or bases for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). To this end, the Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the Federal Circuit Court, citing its decision in Madden, recognized that the Board had inherent fact-finding ability. Id., at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002). Moreover, the Court similarly has declared that, in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). VI. Analysis of Service Connection Claims A. Bilateral Hearing Loss and Tinnitus The Veteran claims he has bilateral hearing loss and tinnitus from when he was in service and "a bunch of guns went off" close to his head. He also has acknowledged not knowing why or when these conditions began. In cases involving claims for hearing loss, the Veteran must have a certain level of hearing loss before VA considers it to be an actual ratable disability. So there may be occasions when a Veteran has hearing loss, just insufficient hearing loss to consider it an actual disability by VA standards. For the purposes of applying the laws administered by VA, impaired hearing only will be considered to be a ratable 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 these frequencies 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. Since November 1, 1967, audiometric results have been reported in standards set forth by the International Standards Organization (ISO)-American National Standards Institute (ANSI). Service department audiometric charts dated after November 1, 1967 are presumed to be in ISO-ANSI units unless otherwise specified, while charts in VA medical records dated after June 30, 1966, are similarly presumed to be in ISO-ANSI units. Service department records from October 31, 1967, or earlier used American Standards Association (ASA) units, so in turn have to be converted to the current ISO-ANSI units. Here, the Veteran's military pre-induction and separation examinations are dated April 1965 and August 1966, respectively, so the Board has converted the results of those examinations. On the Veteran's pre-induction exam in April 1965, audiological testing revealed that puretone thresholds, in decibels, were as follows: HERTZ 500 1,000 2,000 3,000 4,000 RIGHT 15 (30) 15 (25) 10 (20) 15 (25) 15 (20) LEFT 30 (45) 20 (30) 15 (25) 15 (25) 15 (20) [The figures in parentheses represent conversions of audiometry reported in ASA values to ISO (ANSI) units, and are provided for data comparison purposes.] Thus, when entering active service, the Veteran had some pre-existing hearing loss in both ears; however, bilateral hearing loss was not actually "noted" during his entrance examination. A Veteran is considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious and manifest) evidence demonstrates that an injury or a disease existed before acceptance and enrollment into service and was not aggravated by such service. 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b). A pre-existing injury or disease will be considered to have been aggravated by service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progression of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306. The threshold for normal hearing is from 0 to 20 decibels; higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155 (1993) (citing Current Medical Diagnosis & Treatment, Stephen A. Schroeder, et. al. eds., at 110-11 (1988)). When his hearing acuity was retested in August 1966 for separation from service, his puretone thresholds, in decibels, were as follows: HERTZ 500 1,000 2,000 3,000 4,000 RIGHT 5 (20) 5 (15) 10 (20) 15 (25) 15 (20) LEFT 15 (30) 5 (15) 5 (15) 10 (20) 15 (20) Thus, his hearing actually improved in several frequencies, and did not decrease any. However, the lack of hearing loss at time of discharge is not an absolute bar or preclusion to granting service connection for any later diagnosed hearing loss. The Court has held that, even though disabling hearing loss may not have been demonstrated at time of separation from service, that is, according to the threshold minimum requirements of 38 C.F.R. § 3.385 to have a ratable hearing loss disability, a Veteran may nevertheless establish his entitlement to service connection for a current hearing loss disability by having evidence that the current disability is related to his military service and not the result of intercurrent or other unrelated factors or causes. See Hensley, supra; Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Nevertheless, here, the Board also sees that on his Report of Medical History completed in conjunction with his discharge examination, the Veteran specifically denied having hearing loss, running ears, or any other trouble with his ears. Conversely, he now maintains that he was exposed to loud noises during his six months of service from February to August 1966 and that he had hearing loss and tinnitus (i.e., ringing in his ears) for 20 years. He has also alternately stated that he does not remember when or how his hearing loss and tinnitus began. The Veteran is competent to make statements regarding his hearing acuity and to having ringing in his ears since lay evidence may establish the presence of observable symptomatology such as this. See Barr, 21 Vet. App. at 310. However, even if lay testimony is competent, should VA find it to be mistaken or lacking credibility, the Board may reject it as unpersuasive and, thus, not ultimately probative. Buchanan, 451 F.3d at 1337; see also Rucker, 10 Vet. App. at 74; Layno, 6 Vet. App. 465. The Board may find a lack of credibility in, for example, conflicting medical statements or witness biases. Buchanan, 451 F.3d at 1337. And, here, the Veteran's more recent assertions are not supported by the evidence far more contemporaneous to his service and, indeed, is in direct contradiction to the statements he made at separation when he specifically denied having any then current hearing loss or any other problems with his ears. See Macarubbo, 10 Vet. App. 388 (holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor). See also Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (upholding a Board decision assigning more probative value to a contemporaneous medical record report of cause of a fall than subsequent lay statements asserting different etiology); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (upholding Board decision giving higher probative value to a contemporaneous letter the Veteran wrote during treatment than to his subsequent assertion years later). Thus, while the Board accepts that the Veteran may have sustained acoustic trauma during his military service from repeated exposure to excessively loud noises, as probably nearly every soldier does at some point during the course of his service, the Board does not find credible his statements that he was experiencing hearing loss and tinnitus at the time he exited service since, to the contrary, he made a point of denying having these very specific problems in his Report of Medical History during his military discharge examination. And this is otherwise supported by the complete lack of any complaints, findings, treatment, or diagnosis of hearing loss or tinnitus at any point during his service, including during that separation examination. Further, while post-service evidence establishes current hearing loss and tinnitus, the most probative evidence shows these diagnoses are unrelated to his service. In March 2011, the Veteran had a VA audiological examination for compensation purposes. The claims file was reviewed for the pertinent history of his hearing loss and tinnitus. The Veteran reported serving for six months during the Vietnam War but not to having engaged in combat against any enemy force. He said his duties nonetheless were in the infantry, that he did not use hearing protection, but that after his military service he had worked as a brick mason for 40 years, also without hearing protection. Still, he reported no exposure to loud noise outside of his military service. He stated he had a diagnosis of hearing loss, which is confirmed by his VA treatment records, and that the condition had existed for just 20 years, so, if true, since only 1991 or thereabouts. He described balance issues, roaring, ear fullness, and hearing loss, for which he had received VA-issued hearing aids. He also reported experiencing recurrent/intermittent tinnitus that began years earlier, although he said he could not be certain as to how or when it began. As part of the examination, he had an audiogram, the results of which were: HERTZ 500 1,000 2,000 3,000 4,000 RIGHT 45 50 55 70 75 LEFT 45 45 50 65 70 Additionally, he had Maryland CNC speech recognition scores of 68 percent in the right ear and 72 percent in the left ear. He has hearing loss exceeding 40 decibels in both ears, so he has a ratable bilateral hearing loss disability for VA compensation purposes - meaning according to the threshold minimum requirements of 38 C.F.R. § 3.385. Indeed, the VA examiner stated in his report that the Veteran has moderately-severe sensorineural hearing loss in both the right and left ears. But as concerning the etiology of the hearing loss and tinnitus, the examiner opined that it is less likely than not these conditions were the result of noise exposure in the military. The examiner explained that the Veteran's complaints of aural fullness, balance issues, dizziness, roaring/ringing, and hearing loss are more consistent with a possible underlying medical issue such as Meniere's Disease or endolymphatic hydrops. In addition, the examiner noted that the bilateral hearing loss did not present as due to noise exposure. Further, the examiner stated that the medical records indicated normal hearing on the Veteran's pre-induction examination with a low frequency asymmetry that is more consistent with Meniere's Disease or endolymphatic hydrops. In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. 295; see also Stefl, 21 Vet. App. at 124 ( "[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Board attaches significant probative value to the VA opinion as the Nieves criteria are met in this opinion, as it is well reasoned, detailed, consistent with other evidence of record, and included an access to the accurate background of the Veteran. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). There is no disputing there was an explicit denial by the Veteran of hearing loss and tinnitus when examined for separation from service. And, post-service, there is an absence of ear-related symptoms or pathology for many years following the claimed acoustic trauma in service. The lack of hearing loss and tinnitus on examination for discharge and the express denial by the Veteran of hearing loss and tinnitus at that time of discharge combined with the lack of any relevant complaints, findings, treatment, or diagnosis post-service for decades tend to refute any notion he has experienced continuity of symptomatology since service. 38 C.F.R. § 3.303(b). The Board may consider the absence of any indication of a relevant medical complaint until relatively long after service as one factor, though not the only or sole factor, in determining whether a disease or an injury in service resulted in chronic or persistent residual disability. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). See, too, Mense v. Derwinski, 1 Vet. App. 354 (1991) (holding that VA did not err in denying service connection when the Veteran had failed to provide evidence demonstrating continuity of symptomatology and had failed to account for the lengthy time period following service during which there was no clinical documentation of the claimed disorder). The concept of continuity of symptomatology under 38 C.F.R. § 3.303(b) only applies when a condition was observed ("noted") in service, which, as mentioned previously, did not occur in this particular instance. Ultimately, the Board must consider all the evidence relevant to the claim, including the availability of medical records, the nature and course of the disease or disability, the amount of time that has elapsed since military service, and any other pertinent facts. Cf. Dambach v. Gober, 223 F.3d 1376, 1380-81 (Fed. Cir. 2000). Thus, when appropriate, the Board may consider the absence of evidence when engaging in a fact-finding role. See Jordan v. Principi, 17 Vet. App. 261 (2003) (Steinberg, J., writing separately) (noting that the absence of evidence may be considered as one factor in rebutting the aggravation part of the section 1111 presumption of soundness). Here, one must also consider that there is no other competent and credible evidence otherwise linking the Veteran's post-service diagnosis of hearing loss and tinnitus to his service. Thus, the only evidence of this claimed linkage between these current diagnoses and his service comes in the way of his own unsubstantiated lay statements coming many years after his service. Since, however, the Board finds that his more recent assertions of having had both bilateral hearing loss and tinnitus for a long time or since service are not credible based on the contradictory information he provided at discharge, this lack of credibility on his part with regard to these statements also in turn weighs against their probative value. Further, and in contrast, a VA examiner has provided an unfavorable medical nexus opinion regarding these current diagnoses and their potential correlation with his military service, indicating they are not etiologically related to his service and providing good rationale for his opinion. So, ultimately, the Board finds this opinion to be more persuasive and, in fact, the most probative evidence of record on this point, outweighing the Veteran's statements to the contrary. Accordingly, service connection for bilateral hearing loss and tinnitus is not warranted. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by statute and VA regulation. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Instead, for the reasons and bases discussed, the preponderance of the evidence is against the Veteran's claims, so they must be denied. B. Vertigo The Veteran has asserted he has vertigo as a result of his military service. A review of the Veteran's STRs are unremarkable for any complaints of or treatment for vertigo or similar symptomatology. During his separation examination from active service, he specifically denied experiencing dizziness or fainting spells in service. A review of his post-service VA treatment records reflect a complaint of vertigo in March 2011. At that time, he reported that he may have vertigo as he had lost his balance several months prior and almost fell. He also reported that two weeks prior he had lost his balance and fell. He denied any associated dizziness, lightheadedness, vertigo, or change in consciousness. The examiner made a notation of gait instability but stated there was no evidence of vertigo. As explained, the first and indeed perhaps most fundamental requirement for any service-connection claim is there must be competent and credible evidence confirming the Veteran has the claimed disability - or that he at least has since filing the claim. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Braymer v. Derwinski, 3 Vet. App. 223, 225 (1992) (service connection presupposes a current diagnosis of the condition claimed, to at least confirm the Veteran has it, irrespective of whether it is attributable to his military service; without this minimum level of proof, there can be no valid claim because, without this required proof of current disability, there necessarily is no current disability to relate or attribute to his military service). A review of the evidence of record shows there is no medical evidence of a current diagnosis of vertigo. As explained, VA compensation only may be awarded to an applicant who has disability existing on the date of application, not for past disability, and service connection is not warranted for this claimed disability as there is no current disability, including indication of this since the filing of this claim. It is worth repeating that Congress has specifically limited entitlement for service-connected disease or injury to cases where such incidents have resulted in disability. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998). And a current disability means a disability shown by competent and credible evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997). The most fundamental requirement for any claim for service connection is that the Veteran must have proof he has the condition claimed. See Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328 (1997) (indicating VA compensation only may be awarded to an applicant who has disability existing on the date of application, not for past disability); but see, too, McClain v. Nicholson, 21 Vet. App. 319 (2007) (further clarifying that this requirement of current disability is satisfied when the claimant has the disability at the time the claim for VA disability compensation is filed or during the pendency of the claim and that a claimant may be granted service connection even though the disability resolves prior to VA's adjudication of the claim). The VA compensation examiner concluded the Veteran does not have vertigo, therefore in effect ruled out this condition's presence. That examiner did, however, seemingly concede the Veteran's complaints of aural fullness, balance issues, dizziness, roaring/ringing, and hearing loss are more consistent with a possible underlying medical issue such as Meniere's Disease or endolymphatic hydrops. The Board therefore must also consider the viability of this other possible diagnosis since, when a Veteran files a claim, he is seeking compensation regardless of how his symptoms are diagnosed or labeled. The Veterans Court (CAVC) has held that the scope of a claim for service connection includes any disability that reasonably may be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009); see also Brokowski v. Shinseki, 23 Vet. App. 79, 85 (2009) (A claimant's identification of the benefit sought does not require any technical precision), citing Ingram v. Nicholson, 21 Vet. App. 232, 256-57 (2007) (It is the pro se claimant who knows what symptoms he is experiencing and that are causing him disability); see, too, Robinson v. Nicholson, 21 Vet. App. 545, 552 (2008) (The Board is required to consider all issues raised either by the claimant or the evidence of record). But even accepting there may be this other underlying diagnosis to account for his symptoms, there still was not the required attribution of this diagnosis to his military service. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."). Thus, even in this alternative scenario the claim must be denied. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for vertigo. This being the case, there is no reasonable doubt to resolve in the Veteran's favor, requiring denial of his claim. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER New and material evidence not having been received, the petition to reopen the claim for service connection for a dental condition for treatment purposes is denied. The claim of entitlement to service connection for bilateral hearing loss is denied. The claim of entitlement to service connection for tinnitus is denied. The claim of entitlement to service connection for vertigo is denied. ____________________________________________ KEITH W. ALLEN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs