Citation Nr: 18143374 Decision Date: 10/19/18 Archive Date: 10/18/18 DOCKET NO. 15-12 063A DATE: October 19, 2018 ORDER The entitlement to service connection for tinnitus is granted. The entitlement to service connection for an acquired psychiatric condition (including post-traumatic stress disorder [PTSD]) is granted. The entitlement to service connection for a left shoulder disability is denied. The entitlement to service connection for a right shoulder disability is denied. The entitlement to service connection for a left knee disability is denied. The entitlement to service connection for a right knee cap disability is denied. The entitlement to service connection for bilateral pes planus is denied. The entitlement to service connection for bilateral hearing loss is denied. The entitlement to service connection for a left groin disability is denied. The entitlement to service connection for a right groin disability is denied. The entitlement to service connection for a headache disability is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his tinnitus is at least as likely as not related to noise exposure during service. 2. Resolving reasonable doubt in the Veteran’s favor, his acquired psychiatric condition (including PTSD) is at least as likely as not related to witnessing victims of a crane accident during service. 3. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a left shoulder disability. 4. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a right shoulder disability. 5. The preponderance of the evidence is against finding that the Veteran has a left knee disability due to a disease or injury in service, to include specific in-service event, injury, or disease. 6. The preponderance of the evidence is against finding that the Veteran has a right knee cap disability due to a disease or injury in service, to include specific in-service event, injury, or disease. 7. The preponderance of the evidence is against finding that the Veteran has Bilateral pes planus due to a disease or injury in service, to include specific in-service event, injury, or disease. 8. The preponderance of the evidence is against finding that the Veteran has Bilateral hearing loss due to a disease or injury in service, to include specific in-service event, injury, or disease. 9. The preponderance of the evidence is against finding that the Veteran has a left groin disability due to a disease or injury in service, to include specific in-service event, injury, or disease. 10. The preponderance of the evidence is against finding that the Veteran has a right groin disability due to a disease or injury in service, to include specific in-service event, injury, or disease. 11. The preponderance of the evidence is against finding that the Veteran has a headache disability due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for an acquired psychiatric condition (including PTSD) have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for service connection for a right knee cap disability have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 7. The criteria for service connection for Bilateral pes planus have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for Bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for service connection for a left groin disability have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for service connection for a right groin condition have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 11. The criteria for service connection for a headache disability have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1986 to May 1989. The Veteran appeals an October 2013 and December 2015 rating decisions from the Department of Veteran Affairs (VA) Regional Office (RO) in Los Angeles, California. The Board notes that for the sake of judicial economy, we merged the Veteran’s appeal from a December 2015 rating decision for an acquired psychiatric disability (including PTSD) into his appeal on issues stemming from the October 2013 rating decision. The Veteran had a Board hearing in May 2018. Service Connection The Veteran asserts that his headaches, left shoulder, right shoulder, left groin, right groin, left knee, right knee cap disabilities, tinnitus, bilateral hearing loss, bilateral pes planus, and an acquired psychiatric disability (including PTSD) are related to service. Service connection is warranted where the evidence of record establishes that a particular injury or disease results in a present disability that incurred in the line of duty during active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). I. Tinnitus The Veteran assets that his hearing loss is due to noise exposure while working on board the U.S.S. Sacramento. The Veteran asserts that he has had periodic ringing in both ears for over 20 years. A Veteran is competent to observe he has ringing in his ears, and generally objective evidence of this condition is not possible. See Charles v. Principi, 16 Vet. App. 370 (2002). According to the Veteran’s DD-214, the Veteran served as a seaman with his last duty assignment aboard the U.S.S. Sacramento. The Veteran stated that he was a cook during his time aboard the U.S.S. Sacramento. The Veteran’s service treatment records report him being exposed to noise while working on the decks of the U.S.S. Sacramento and U.S.S. Fort McHenry. The Board finds that the Veteran’s circumstances of service are consistent with exposure to loud noise. See 38 U.S.C. § 1154(a). Thus, the claim turns on whether the Veteran’s tinnitus is related to his in-service noise exposure. Regarding a nexus between the in-service event and the disability, the Board acknowledges the negative September 2014 VA examination. The Board also notes the Veteran’s competent and credible statements. For example, the Veteran asserts that he has had periodic ringing in both ears for over two decades, and that the ringing makes it difficult to hear at work. Further, the VA medical records note the Veteran’s complaints of ringing in his ears. Finally, as noted above, the Veteran’s service treatment records reflect that the Veteran was exposed to noise while in service. The Board thus finds that the record evidence is at least in relative equipoise as to whether the Veteran’s tinnitus is related to military service. The Board notes that when the evidence is in relative equipoise, by law; the Board must resolve all reasonable doubt in favor of the claimant. See U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinksi, 1 Vet. App. 49, 53-56 (1990). Therefore, the Board finds that service connection for tinnitus is warranted. II. Acquired Psychiatric Disorder (Including PTSD) The Veteran asserts that his acquired psychiatric disorder (including PTSD) is related to witnessing the victims, including dead bodies, of a crane accident in the San Diego shipyard. Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. The Veteran was diagnosed with PTSD in December 2015. The Veteran stated that after a July 1987 crane accident aboard the U.S.S. Sacramento, he witnessed the injured victims of the accident, including those that died. The Veteran submitted two newspaper accounts, from July 1987, of the crane accident at the San Diego shipyard. Therefore, the Veteran’s claim rest on a nexus between the crane accident and the Veteran’s PTSD. A February 1989 service treatment note reported the Veteran as having anxiety. The Veteran was afforded a VA examination in December 2015. During the exam, the Veteran reported experiencing anxiety, flashbacks, and nightmares in the military. The VA examiner opined that the Veteran had anxiety, chronic sleep impairment, difficulty in establishing and maintaining effective work relationships, and an inability to establish and maintain effective relationships. Further, the VA examiner opined that the Veteran’s PTSD was connected to the in-service stressor stating, “as a result of [the crane accident], [the Veteran] subsequently developed symptoms of PTSD, which meet full diagnostic criteria for PTSD according to the DSM-5.” The Board notes that there is a discrepancy of exactly where the Veteran was during the accident. Nonetheless, the Veteran’s personnel records do place him in San Diego at the time of the crane accident. It is plausible that the Veteran could have witnessed the accident aboard the U.S.S. Ft. McHenry rather than the U.S.S. Sacramento, or that he may have witnessed the bodies elsewhere on base. Additionally, the Veteran’s service treatment records reported the Veteran being treated for anxiety. The Board thus finds that the record evidence is at least in relative equipoise as to whether the Veteran’s problem is related to military service. The Board notes that when the evidence is in relative equipoise, by law; the Board must resolve all reasonable doubt in favor of the claimant. See U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinksi, 1 Vet. App. 49, 53-56 (1990). Therefore, the Board finds that service connection for an acquired psychiatric disorder (including PTSD) is warranted. III. Bilateral Hearing Loss The Veteran assets that his hearing loss is due to noise exposure working on board the U.S.S. Sacramento. The Veteran was afforded a VA examination in December 2014. The VA examiner found the following pure tone thresholds: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 20 20 20 LEFT 0 20 20 20 25 The right ear had a speech discrimination score of 96 percent, while the left ear had a score of 98 percent. The first element of service connection requires evidence of a present disability. For the purposes of applying the laws administered by VA, impaired hearing will result in 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. Accordingly, the Board finds service connection for bilateral hearing loss is not warranted. Simply stated, very generally speaking, the Veteran’s hearing (while maybe not what it once was), is within a range of “normal” for VA purposes. To be considered for service connection, a claimant must first have a disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, without a current disability, service connection for bilateral hearing loss is not warranted. IV. Right and Left Shoulder Disabilities The Veteran asserts that he has a right and left shoulder disability resulting from daily work in the shipyard. Although the VA medical records reflect complaints of shoulder pain, the Veteran does not have a current diagnosis for either a right or left shoulder condition. To be considered for service connection, a claimant must first have a disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, without a current disability, service connection for either a right or left shoulder disability is not warranted. V. Remaining Conditions The Veteran asserts that his headaches, left groin, right groin, left knee, right knee cap disabilities, and bilateral pes planus are related to his time in service. The Board acknowledges that the Veteran was not provided a VA examination for the above conditions. A VA examination is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) 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, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). See also 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. Here, we find that a VA examination is not warranted. The evidence of record does not indicate that the Veteran’s headaches, left groin, right groin, left knee, right knee cap disabilities, and bilateral pes planus may be associated with the Veteran’s time in service more than 30 years ago. The Veteran’s service treatment records reflect treatments for facial acne, anxiety, stomach illness, and dental treatments. The evidence of record does not reflect treatment, or a diagnosis, for the any of the above conditions until 2011, nearly three decades after separation. Neither does the Veteran claim that the conditions are secondary to a service connected disability, or a result of a continued symptomatology. In this case, unlike the issues above, the only evidence of record relating the Veteran’s remaining conditions (listed above) in any way to his military service is the Veteran’s own general conclusory statements, which does not meet the low threshold of an indication that the claimed disability is due to service. See Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (distinguishing cases where only a conclusory generalized statement is provided by the veteran and rejecting the theory that medical examinations are to be routinely and virtually automatically provided to all veterans in disability cases involving nexus issues). Therefore, the Board finds that a remand to obtain a VA examination for these claims is not necessary. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, determining the etiology of headaches, left groin, right groin, left knee, right knee cap disabilities, and bilateral pes planus, fall outside the realm of common knowledge of a lay person because it involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, while Veteran can competently report the onset of symptoms, any opinion regarding the nature and etiology of his condition requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Board cannot assign any probative weight to the Veteran's assertions that his stated conditions are in any way related to his military service. See Waters v. Shinseki, 601 F.3d at 1278-79. The Board finds that the service and post-service medical evidence provides highly probative evidence against this claim that it cannot ignore, indicating problems that began decades after service with no connection to service more than 30 years ago. (Continued on the next page)   Consequently, the Board finds that the weight of the evidence is against a finding of service connection for headaches, left groin, right groin, left knee, right knee cap disabilities, and bilateral pes planus. 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 claim, that doctrine is not applicable. 38 C.F.R. § 3.102, Gilbert v. Derwinski, 1 Vet. App. 49, 54-56. JOHN J. CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Timothy A. Campbell, Associate Counsel