Citation Nr: 18141996 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 15-14 682A DATE: October 12, 2018 ORDER Entitlement to service connection for a psychiatric disorder to include post traumatic stress disorder (PTSD) is denied. Entitlement to service connection for a left arm disability is denied. Entitlement to service connection for a right arm disability is denied. Entitlement to service connection for a left wrist disability is denied. Entitlement to service connection for a right wrist disability is denied. Entitlement to service connection for a back disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left leg disability is denied. Entitlement to service connection for a right leg disability is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for flatfoot, bilateral is denied. Entitlement to service connection for a left foot disability is denied. Entitlement to service connection for a right foot disability is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for hearing loss is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The Veteran did not engage in combat with the enemy, and has not reported a claimed stressor that is related to the fear of hostile military or terrorist activity; no claimed stressor event has been corroborated, and the Veteran does not currently have a diagnosis of PTSD based upon a verified stressor event. 2. The Veteran did not have psychiatric symptoms in active service, did not have recurrent symptoms since service separation, and the current psychiatric disorder to include adjustment disorder first manifested many years after service separation and is not related to disease or injury or other event in active service. 3. The Veteran does not have a left arm disability. 4. The Veteran does not have a right arm disability. 5. The Veteran does not have a left wrist disability. 6. The Veteran does not have a right wrist disability. 7. A back disability was not manifested in active service, was first manifested many years after service separation, and is not related to disease or injury or other event in active service. 8. The Veteran does not have a left knee disability to include arthritis. 9. The Veteran does not have a right knee disability to include arthritis. 10. The Veteran does not have a left leg disability to include arthritis and shin splints. 11. The Veteran does not have a right leg disability to include arthritis and shin splints. 12. The Veteran does not have a left ankle disability to include arthritis. 13. The Veteran’s right ankle disability, diagnosed as sprain, did not originate in service, and is not otherwise etiologically related to service. 14. The Veteran does not have bilateral flatfoot. 15. The Veteran’s current bilateral foot disabilities to include hallux valgus and calcaneal spurs did not originate in service and are not otherwise etiologically related to active service. 16. The Veteran’s current tinnitus did not originate in service or until many years thereafter, and is not otherwise etiologically related to active service. 17. The Veteran does not have a right and left ear hearing loss disability for VA purposes. 18. Service connection is not in effect for any disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). 2. The criteria for service connection for a psychiatric disorder other than PTSD to include adjustment disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). 3. The criteria for service connection for a left arm disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 4. The criteria for service connection for a right arm disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 5. The criteria for service connection for a left wrist disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 6. The criteria for service connection for a right wrist disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 7. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 8. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 9. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 10. The criteria for service connection for a left leg disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 11. The criteria for service connection for a right leg disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 12. The criteria for service connection for a left ankle disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 13. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 14. The criteria for service connection for flatfeet are not met. 38 U.S.C. §§ 1110, 1132, 1153, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306 (2018) 15. The criteria for service connection for a left foot disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 16. The criteria for service connection for a right foot disability are not met. 38 U.S.C. §§§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 17. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 18. The criteria for service connection for hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385 (2018). 19. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1993 to December 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in June 2014 and December 2014 of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. In August 2018, the Veteran submitted a waiver of agency of original jurisdiction (AOJ) consideration of new evidence pursuant to 38 C.F.R. § 20.1304 (2018). The Board notes that, particularly with respect to psychiatric disorders, a claim of service connection encompasses all pertinent symptomatology, regardless of how that symptomatology is diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In light of Clemons, the Board recharacterized the issue for service connection for a psychiatric disorder and for PTSD on appeal as reflected on the title page. Service Connection Service connection will be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection requires competent evidence showing, (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship 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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, disc disease, or an organic disease of the nervous system become manifest to a degree of 10 percent or more within one year after the date of separation from 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. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). 38 C.F.R. § 3.303 (b) applies to the “chronic diseases” under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. 1. Entitlement to service connection for a psychiatric disorder to include PTSD is denied. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that a veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304 (f) (2018). If a stressor claimed by a veteran is related to his/her fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that his/her symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of his/her service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304 (f)(3) (2018). A grant service connection for PTSD for a non-combat veteran requires credible evidence supporting his/her assertion that the stressful event occurred. A stressor need not be corroborated in every detail. Suozzi v. Brown, 10 Vet. App. 307, 311 (1997). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. Cohen v. Brown, 10 Vet. App. 128, 142 (1997); Moreau v. Brown, 9 Vet. App. 389, 395-396 (1996). 38 C.F.R. § 4.125 requires the mental disorder diagnosis to conform to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). The Board notes VA implemented DSM-5, effective August 4, 2014 and DSM-5 applies to claims certified to the Board on and after August 4, 2014. 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). The DSM-5 applies to the Veteran’s claim since his appeal was certified to the Board in August 2016. The Veteran has made a general assertion that he has PTSD due to his active service. The record shows that the Veteran did not serve in combat and he did not report a stressor event which led to the PTSD. VA made a formal finding in November 2014 that the Veteran did not provide sufficient information to corroborate the stressor associated with PTSD. The Board notes that the Veteran did not identify a stressor event. See the November 2014 VA memo. The service records show that the Veteran served with the U.S. Army from November 1993 to December 1996. His military occupation was chaplain’s assistant. He served in Korea from April 1994 to April 1995. The Veteran was not awarded a Combat Action Ribbon, a Purple Heart Medal, or any other award associated with valor or heroism shown while engaged with an enemy force. The Veteran has not reported coming under enemy fire or fear of hostile military activity during service. Thus, the Board finds that combat service has not been demonstrated based upon this record. The Veteran does not allege fear of hostile military or terrorist activity. The Board finds that the weight of the evidence of record shows that the Veteran does not have a current diagnosis of PTSD based upon a verified stressor event. As noted above, in order to grant service connection for PTSD to a non-combat veteran, there must be credible evidence to support the Veteran’s assertion that the stressful event occurred. Moreover, medical evidence or a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. In the present case, a July 2013 VA treatment record shows a positive PTSD screening, but this assessment alone is not sufficient in and of itself to verify the claimed stressor event. The Board cannot accept the diagnosis of PTSD because this assessment was based upon an unknown and unverified stressor event. Further, this assessment and the remaining evidence of record does not establish a DSM-IV or DSM 5 diagnosis of PTSD based upon a verified stressor event. A January 2018 VA treatment record shows that a PTSD screen was negative. Thus, for the foregoing reasons, the claim for service connection for PTSD must be denied. In reaching this 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. Based upon a review of all the lay and medical evidence, the Board finds the service connection for psychiatric disorder other than PTSD is not warranted. VA treatment records show a diagnosis of adjustment disorder with mixed emotion or with mixed anxiety and depressed mood. See the June 2014 and January 2018 VA treatment records. A September 2016 VA mental health treatment record indicates that the Veteran reported having a stable mood and no symptoms of depression or anxiety or problems with his mood. It was noted that the Veteran is not prescribed medication for depression or anxiety and does not believe that he needs any medication. The Veteran had good coping skills and reports that his sleep has improved. The Veteran had a negative depression screen. Service treatment records do not show any complaints, treatment or diagnosis of a psychiatric disorder. Service examinations in July 1993 (enlistment) and October 1995 (periodic) indicate that psychiatric exam was normal. The Veteran denied psychiatric symptoms. He separated from active service in December 1996. The record shows that the adjustment disorder was first shown in 2014, over 17 years after service separation. This lengthy period of time without complaints or treatment, while not dispositive, is a factor that weighs against the finding that the bilateral hearing loss and tinnitus have existed since service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a lengthy period without medical complaints about a condition can be considered as a factor in resolving a claim). There is no competent evidence to establish a nexus between the claimed psychiatric disorder and any documented event or incident or injury of active service. There is no indication of an association between the claimed psychiatric disorder and any documented event or incident or injury of active service. The Veteran himself generally relates the psychiatric diagnosis to active service. The Board finds that the Veteran, as a layperson, is competent to describe observable symptoms, but as noted above, providing a medical opinion as to the cause and etiology of a psychiatric disorder falls outside the realm of common knowledge of a lay person as it requires knowledge of the various types of mental disorders, medical conditions and psychosocial and environmental problems that contribute to mental disorders. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). There is no evidence showing that the Veteran has medical expertise or training and he is not competent to provide a medical opinion as to the cause of the psychiatric disorders. The Board finds that there is no competent evidence that relates the post-service psychiatric disorder to active service. A VA medical opinion was not provided for the issue of service connection for a psychiatric disorder and PTSD. The record in this case is negative for any indication that the current psychiatric disorder is associated to service. The record in this case is negative for any indication, other than the Veteran’s own general assertion, that this disorder is related to active service. The Veteran did not provide lay or medical evidence of this disorder in active service or symptoms or disease in active service. The Veteran did not identify a stressor event that caused the claimed PTSD. The service treatment records do not document a psychiatric disability. The first evidence of a diagnosis was 17 years after service. The Veteran’s sole assertion that he wants service connection for a psychiatric disorder is insufficient to trigger VA’s duty to provide an examination with an opinion. There is no evidence of the claimed disability in active service or any indication of an association to service. There is sufficient competent evidence on file for the Board to decide the claim. As such, VA’s duty to provide an examination with an opinion is not triggered. For the reasons and bases discussed above, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for PTSD and psychiatric disorder. The Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for left and right knee, left and right leg, left and right ankle, and left and right foot disabilities to include flatfeet is denied. The Veteran asserts that he has ankle, knee, and leg disabilities due to service. He stated that he had pain in both knees after ruck sacking and marching for a long time. The Veteran reported that he thought he saw a doctor for the knees in 2001 or 2002. See the June 2014 VA examination report. Service enlistment exam dated in July 1993 and periodic exam dated in October 1995 indicate that examination of the lower extremity and feet were normal. Pes planus or flatfeet was not detected. There was a diagnosis of patellofemoral pain syndrome in June 1996; the Veteran reported pain in both knees for 2 weeks and he stated that he was running and he felt a sharp pain. In August 1996, the Veteran had a single episode of sore muscles in feet, ankles, back, and wrist due to road march activity. He reported having sore muscles for one day. The diagnosis was muscle strain. A service treatment record dated in August 1996 indicates that the Veteran had pain in the right ankle due to overuse. There was no trauma. The assessment was rule out sprain. There is no separation exam of record. The Veteran separated from active service in December 1996. The Board finds that the weight of the competent and credible evidence establishes that the Veteran does not have current bilateral knee or leg disabilities, flatfeet, or a left ankle disability. The Board finds that the weight of the competent and credible evidence establishes that the right ankle disability and the foot disabilities first manifested many years after service separation and are not related to injury or other event in active service. The Veteran filed his claim for compensation for knee, leg, ankle, and foot disabilities in April 2013, 17 years after service separation. This lengthy period of time without complaints or treatment, while not dispositive, is a factor that weighs against the finding that the bilateral hearing loss and tinnitus have existed since service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a lengthy period without medical complaints about a condition can be considered as a factor in resolving a claim). The Veteran was afforded a VA examination in June 2014. He reported having knee and ankle pain with heavy lifting and prolonged walking. He stated that at times, he has been called off a job because he has pain in knees not ankles. Examination revealed a normal gait. Range of motion of the bilateral knees was limited by 10 degrees on flexion and there was no objective evidence of pain with motion. There were no shin splints on exam or evidence of knee arthritis or patellar subluxation. X-ray exam of the knees revealed no osseous abnormality. The VA examiner noted that there was a diagnosis of patellofemoral pain syndrome in June 1996 that resolved. The VA examiner stated that there were no objective findings related to the knees or legs. Ankle x-ray exam revealed no acute fracture or significant degenerative changes; there was a probable old injury to the right ankle. Foot x-ray exam revealed no acute fracture or significant degenerative changes. There was mild bilateral hallux valgus and a small left posterior calcaneal spur. There was no pes planus. The VA examiner opined that the claimed bilateral leg and knee disabilities were less likely than not incurred in or caused by an in-service illness, event, or injury. The VA examiner noted that in military, the Veteran had a single episode of bilateral patellofemoral syndrome which has totally resolved. The VA examiner stated that the Veteran has no findings suggestive of any patellar condition with no patellar tenderness or other patellar symptoms. The VA examiner noted that in the military, the Veteran had a single episode of sore muscles in feet, ankles, back, and wrist due to road march activity which was diagnosed as muscle strain and which resolved. The VA examiner stressed that this did not involve the knees or lower legs. The VA examiner indicated that the Veteran has no objective findings related to the knees or lower legs; he had normal radiographs of the knees, normal Westergren sedimentation rate, ana, rheumatoid factor, c-reactive protein, and a normal uric acid level, all of this points away from any arthritic or rheumatologic condition. The VA examiner noted that the Veteran does have slight decreased mch, mchc, and mcv with increased red cell distribution width and normal reticulocyte count and normal iron studies, and he may have very minimal but prolonged blood loss, or he may have a thalassemia (most likely). The VA examiner noted that the thalassemia is not related to the joints. The VA examiner indicated that the Veteran has a quantitative serum myoglobin barely increased 79 (28-72) by their lab, high normal in other labs, but which is not indicative of pathology and which is indicative of physical activity. The VA examiner noted that the level is not elevated as in significant muscle trauma, myopathies, acute myocardial infarction, shock, or decreased elimination during renal insufficiency; it is not elevated extremely as occurs in rhabdomyolysis. The VA examiner stated that the Veteran has no findings of objective knee or lower leg pathology or findings of shin splints or stress fractures. The Board notes that an August 2018 x-ray exam of the knees was normal. Regarding the claimed ankle disabilities, the VA examiner opined that the claimed bilateral ankle disability was less likely than not incurred in or caused by an in-service illness, event, or injury. The VA examiner noted that the Veteran had a minimal right ankle sprain in military that was seen by enlisted not physician, physician assistant, or nurse practitioner; from the records, it was temporary and completely resolved. The VA examiner also noted that the Veteran also had bilateral muscle (not joint) pain from a prolonged marching exercise, and the pains were noted in his ankles, feet, back, and wrist. The VA examiner indicated that these were diagnosed as muscle strain, were treated, and resolved, and from the description, it was more myalgia than even muscle strain. The VA examiner noted that there was no residual finding, and no nexus linking these occurrences with the subjective findings of his ankles on examination. The VA examiner indicated that the Veteran does have radiographic findings of right ankle sprain that was severe not mild, and the findings radiographically would not have been consistent with the exam findings in military. The VA examined opined that this was more likely than not a post-military injury. The Board notes that an August 2018 x-ray exam of the ankles was normal. Despite the Veteran’s contentions, bilateral knee and leg disabilities, and a left ankle disability and flatfeet are not currently shown. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The June 2014 VA examination report shows that the Veteran was not found to have bilateral knee or leg disabilities, a left ankle disability, or flatfeet. The June 2014 opinion is considered highly probative, as it is shown to have been based on a review of the Veteran’s claims file and is accompanied by a sufficient explanation. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges that the Veteran is competent to report his symptoms and observations, to include his reports as to pain in the knee or ankle joints, in the legs, and in the feet, during the appeal period, and the Board finds these reports are credible. However, the Board finds that the identification of the specific disabilities and the determination as to a specific diagnosis are essentially medical questions, and as such are beyond the Veteran’s competence to evaluate based upon his own knowledge and expertise. Further, the record does not indicate that the Veteran has medical expertise or training. Thus, his determination that he has a knee, leg, or ankle disability or flatfeet is not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (2007); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Thus, the Veteran’s lay opinions have no probative value. Regarding the claimed foot disabilities, there is no competent evidence to establish a nexus between the claimed foot disabilities to include hallux valgus and calcaneal spurs and any documented event or incident or injury of active service. There is no indication of an association between the bilateral foot disability and any documented event or incident or injury of active service. The Veteran has generally related the claimed foot disabilities to active service. Although lay persons are competent to describe observable symptoms and provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, an opinion as to the etiology and onset of an orthopedic disability falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Some medical issues require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology. There is no evidence that the Veteran has medical expertise or training. Neither the Veteran nor his representative has identified or produced competent evidence that related these disorders to active service. There is no competent evidence that indicates an association between the disorders and any documented event or injury of active service. A VA medical opinion was not provided for the issue of service connection for a foot disability. VA does not have a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, the Secretary’s obligation under 38 U.S.C. § 5103A (d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered unless there is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability. See McLendon, 20 Vet. App.at 81. The record in this case is negative for any indication that the foot disabilities are associated to service. The record in this case is negative for any indication, other than the Veteran’s own general assertion, that these disabilities are related to active service. The Veteran did not provide lay or medical evidence of this disorder in active service or symptoms or disease in active service. The service treatment records do not document a foot disability and only document symptoms on one occasion in August 1996 when muscle strain was diagnosed. The first evidence of hallux valgus and calcaneal spurs was 17 years after service. The Veteran’s sole assertion that he wants service connection for foot disabilities is insufficient to trigger VA’s duty to provide an examination with an opinion. There is no evidence of the claimed disability in active service or any indication of an association to service. There is sufficient competent evidence on file for the Board to make a decision on the claim. As such, VA’s duty to provide an examination with an opinion is not triggered. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for bilateral leg, knee, ankle and foot disabilities. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for left and right arm, right and left wrist, and back disabilities is denied. The Veteran asserts that he has bilateral arm and wrist disabilities and a back disability due to service. Service enlistment exam dated in July 1993 and periodic exam dated in October 1995 indicate that examination of the upper extremities and spine were normal. In August 1996, the Veteran had a single episode of sore muscles in feet, ankles, back, and wrist due to road march activity. He reported having sore muscles for one day. The diagnosis was muscle strain. A service treatment record dated in November 1996 indicates that the Veteran had right wrist pain for one and a half weeks. The Veteran reported that he had been doing push ups and felt pain. The assessment was rule out sprain. There is no separation exam of record. The Veteran separated from active service in December 1996. The Board finds that the weight of the competent and credible evidence establishes that the Veteran does not have current bilateral arm or wrist disabilities and the current back disability is not associated to service. A February 2014 VA treatment record indicates that the Veteran reported having back pain in 2008 when he was slammed onto concrete slab by police. He stated that the pain was is in the thoracic region. He stated that in 2010 and 2012, the Department of Corrections did x-ray exam to the back and stated that it did not show any abnormalities. According to the Veteran, he was placed on Tegretol for pain while in prison. A June 2014 VA treatment record indicates that the Veteran had a diagnosis of lumbago. He reported having back pain with the onset years ago and it progressed over time. It was noted that a 2013 x-ray report indicates that the impression was mild lumbar spasm. The assessment was main problems are pain with muscle tightness in the neck and low back. The physical therapist discussed general back care and body mechanics with the Veteran. An August 2018 x-ray exam of the lumbar spine showed mild degenerative changes. X-ray exam of the thoracic spine in 2013 and 2018 were normal. VA treatment records dated in June 2014 indicate that wrist radiographs are normal. An August 2018 x-ray exam of the hands and fingers were normal. Despite the Veteran’s contentions, bilateral arm and wrist disabilities are not currently shown. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The Board acknowledges that the Veteran is competent to report his symptoms and observations, to include his reports as to pain in the arm and wrists during the appeal period, and the Board finds these reports are credible. However, the Board finds that the identification of the specific disabilities and the determination as to a specific diagnosis are essentially medical questions, and as such are beyond the Veteran’s competence to evaluate based upon his own knowledge and expertise. Further, the record does not indicate that the Veteran has medical expertise or training. Thus, his determination that he has an arm or wrist disability is not competent evidence. See Jandreau; supra; Kahana; supra. Thus, the Veteran’s lay opinions have no probative value. The Board finds that the weight of the competent and credible evidence establishes that the back disability first manifested many years after service separation and is not related to injury or other event in active service. The record shows that the Veteran sustained a back injury in 2008, over 10 years after service separation. The Veteran filed his claim for compensation for a back disability in April 2013, 17 years after service separation. This lengthy period of time without complaints or treatment, while not dispositive, is a factor that weighs against the finding that the bilateral hearing loss and tinnitus have existed since service. See Maxson, supra. There is no competent evidence of record showing a diagnosis of degenerative changes in the back compensable to 10 percent within one year from service separation. Thus, presumptive service connection pursuant to C.F.R. § 3.307 (a) is not warranted. Presumptive service connection under the provisions of 38 C.F.R. § 3.303 (b) is not warranted because there is no competent lay or medical evidence of chronic back symptoms in service and since service separation. There is no competent evidence to establish a nexus between the claimed back disability and any documented event or incident or injury of active service. There is no indication of an association between the back disability and any documented event or incident or injury of active service. The Veteran has generally related the claimed back disability to active service. Although lay persons are competent to describe observable symptoms and provide opinions on some medical issues, see Kahana, 24 Vet. App. at 435, as to the specific issue in this case, an opinion as to the etiology and onset of an orthopedic disability falls outside the realm of common knowledge of a lay person. Jandreau; supra. There is no evidence that the Veteran has medical expertise or training to provide a competent medical opinion as to the etiology of his disability. Neither the Veteran nor his representative has identified or produced competent evidence that related these disorders to active service. There is no competent evidence that indicates an association between the disorders and any documented event or injury of active service. A VA medical opinion was not provided for the issue of service connection for bilateral wrist and arm disabilities or a back disability. VA does not have a duty to provide an examination in every case. The record in this case is negative for any indication, other than the Veteran’s own general assertion, that he has the claimed arm and wrist disabilities or that the back disability is related to active service. The Veteran did not provide lay or medical evidence of the arm or back disorders in active service or symptoms or disease in active service. The service treatment records only document right wrist symptoms on one occasion in November 1996 when the assessment was rule out sprain. The Veteran’s sole assertion that he wants service connection for these disabilities is insufficient to trigger VA’s duty to provide an examination with an opinion. There is no evidence of the claimed disability in active service or any indication of an association to service. There is sufficient competent evidence on file for the Board to make a decision on the claim. As such, VA’s duty to provide an examination with an opinion is not triggered. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for bilateral arm and wrist disabilities and a back disability. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to service connection for tinnitus and hearing loss are denied. In this case, sensorineural hearing loss is listed among the “chronic diseases” under 38 C.F.R. § 3.309 (a), as it is considered an organic disease of the nervous system. In Fountain v. McDonald, 27 Vet. App. 258 (2015), the U.S. Court of Appeals for Veterans Claims declared that tinnitus originating from acoustic trauma is also an organic disease of the nervous system. Therefore, 38 C.F.R. § 3.303 (b) also applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection for impaired hearing shall only be established when hearing status as determined by audiometric testing meets specified pure tone and speech recognition criteria. Audiometric testing measures puretone threshold hearing levels (in decibels) over a range of frequencies (in hertz). Hensley v. Brown, 5 Vet. App. 155, 158 (1993). The determination of whether a veteran has a disability based on hearing loss is governed by 38 C.F.R. § 3.385. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Board finds that the weight of the evidence does not establish current diagnosis or objective findings of current bilateral hearing loss. The VA audiometric tests dated in March 2014 and June 2014 show normal hearing and do not establish a hearing loss disability for VA purposes. The service treatment records document normal hearing. The Veteran has not submitted or identified evidence of a current diagnosis of the claimed disability. The Court has held that Congress specifically limited entitlement to service connected benefits to cases where there is a current disability. “In the absence of proof of a present disability, there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Without competent evidence of a diagnosed disability, service connection for the disorder cannot be awarded. See Brammer; supra; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) (holding that service connection requires a showing of current disability); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding that a grant of service connection requires that there be a showing of disability at the time of the claim, as opposed to sometime in the distant past). Accordingly, on this record, the competent evidence does not establish the presence of a bilateral hearing loss disability for VA purposes. Accordingly, the claim of service connection for bilateral hearing loss is denied. The Board finds that the weight of the competent and credible evidence establishes that the Veteran’s tinnitus first manifested many years after active service and is not medically related to his active service. The service treatment records do not reflect any complaints, diagnoses or treatment for tinnitus. Clinical examination of the ears was normal on entrance exam in July 1993 and on periodic exam in October 1995. A separation exam is not of record. The Veteran separated from active service in December 1996. The Board finds that the more probative evidence establishes that the tinnitus first manifested many years after service separation. There is no lay or medical evidence of tinnitus prior to April 2013 when the Veteran filed his claim for compensation. A February 2014 VA primary care record indicates that the Veteran started that at times, he has ringing in his ears and he has difficulty distinguishing multiple voices and sounds. The Veteran stated that he was around a lot of explosions and a rifle range but he recalled nothing specific that hurt his hearing. The March 2014 VA audiogram results indicate that the Veteran had normal hearing. He was counseled on coping strategies with his tinnitus. This lengthy period of time without complaints or treatment, while not dispositive, is a factor that weighs against the finding that the bilateral hearing loss and tinnitus have existed since service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a lengthy period without medical complaints about a condition can be considered as a factor in resolving a claim). The Board finds that the weight of the competent and credible evidence establishes that the current tinnitus is not due to or related to service. The June 2014 VA audiologist opined that it was less likely than not (less than 50 percent probability) that the tinnitus was caused by or a result of military noise exposure. The VA examiner indicated that review of Veteran’s claims file revealed an absence of complaints of tinnitus or acoustic trauma. Therefore, the VA examiner opined that the Veteran’s current tinnitus was less likely than not secondary to his military service. The Board has considered the Court’s holdings in Hensley v. Brown, 5 Vet. App. 155 (1993) and Dalton v. Peake, 21 Vet. App. 23 (2007). The Board finds that the VA medical opinions are adequate. The VA audiologists considered the Veteran’s report of history and the onset of symptoms. The Board finds that the opinion is based upon sufficient facts and data and that the opinion is probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Veteran has not submitted competent lay or medical evidence that the current tinnitus is causally related to service. The Veteran has not submitted competent lay or medical evidence that the current tinnitus first manifested in active service and has continued since service. In light of the above, the Board finds that the weight of the evidence is against a finding that the Veteran has a bilateral hearing loss disability as defined by VA and is against a finding that tinnitus is related to the Veteran’s active service. Based on a careful review of the entire record, the Board finds that the evidence is not in equipoise as to whether the hearing loss and tinnitus first manifested in or are related to active service, but the weight of the evidence preponderates against the claim. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The claims for service connection for bilateral hearing loss and tinnitus are therefore denied. 5. Entitlement to TDIU is denied. The Veteran contends that he is entitled to a TDIU. VA will grant a total rating for compensation purposes based on individual unemployability when the evidence shows that, by reason of service-connected disability, the veteran is precluded from obtaining or maintaining substantially gainful employment consistent with his or her education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Age, however, will not be considered. Id. at § 4.19. A TDIU rating for compensation purposes may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more; or if there are two or more service-connected disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). The Board notes that service connection is not in effect for any disabilities, and as such, the Board finds that under the law, the Veteran lacks legal grounds to establish entitlement to a TDIU. See Sabonis v. Brown, 6 Vet. App. 426 (1994). In Sabonis, the Court held that in cases in which the law and not the evidence is dispositive, a claim for entitlement to VA benefits should be denied or the appeal to the Board terminated because of the absence of legal merit or the lack of entitlement under the law. Id. Insofar as service connection is not in effect for any disability, entitlement to a TDIU is not applicable under the law. Therefore, the Board finds that entitlement to a TDIU is not warranted and the appeal must be denied. 6. Duties to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. 5103, 5103A (2012); 38 C.F.R. 3.159 (2018). The Veteran filed the claims through VA’s fully developed claim program. The Board finds that the content requirements of a duty-to-assist notice letter have been fully satisfied as the Veteran was provided all of the relevant notice requirements in his April 2013 VA 21-526 EZ Fully Developed Claim forms (EZ Claim). He has had representation throughout the entire appeal period. VA provided the Veteran with 38 U.S.C. 5103 (a)-compliant notice in February 2014 for the TDIU claim. Therefore, additional notice is not required. VA has fulfilled its obligation to assist the Veteran in developing these claims. Neither the Veteran nor his representative has identified any deficiency in VA’s notice or assistance duties. 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2018); Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (“the Board’s obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist). THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel