Citation Nr: 18145226 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 11-06 721 DATE: October 26, 2018 ORDER Entitlement to service connection for post-traumatic stress disorder (PTSD) is denied. Entitlement to service connection for bilateral hearing loss is denied. REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. Entitlement to service connection for asbestosis is remanded. FINDINGS OF FACT 1. The evidence of record contains nothing to corroborate, verify or credibly support the claimed PTSD stressors. 2. The Veteran’s lay testimony alone does not establish an in-service stressor based on combat experiences. 3. The Veteran’s lay testimony alone does not establish an in-service stressor based on fear of hostile military or terrorist activity. 4. The Veteran’s lay testimony alone does not otherwise establish any claimed in-service stressor. 5. The objective medical evidence does not show that the Veteran’s bilateral hearing loss is caused by an event, injury or disease during active service, nor did sensorineural hearing loss manifest to a compensable degree within one year of separation from active service. CONCLUSIONS OF LAW 1. The criteria to establish service connection for PTSD have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017). 2. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Navy from April 1972 to January 1974. In October 2014, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. Service Connection Generally, service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) The existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). See also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Certain chronic diseases may be service connected on a presumptive basis if manifested to a compensable degree in a specified period after service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309 (2016). That period is usually one year. 38 C.F.R. § 3.307 (a)(3). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). Under 38 C.F.R. § 3.303(b), an alternative method of establishing and in-service disease or injury and a nexus for chronic diseases is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was “noted” during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96; see Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303 (b). 1. Entitlement to service connection for PTSD. Evidence Service connection for PTSD requires medical evidence establishing a diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. Cohen v. Brown, 10 Vet. App. 128 (1997). The diagnostic criteria, including those related to stressors for mental disorders, set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (5th ed. 2013) (DSM-V) have been adopted by VA. 38 C.F.R. § 4.125. A diagnosis of PTSD requires exposure to a traumatic event and a response involving intense fear, helplessness, or horror. A stressor involves exposure to a traumatic event in which the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and the person’s response involved intense fear, helplessness or horror. See Cohen, 10 Vet. App. 128. The sufficiency of a stressor is a medical determination and is presumed by a medical diagnosis of PTSD. Id. The evidence necessary to establish the occurrence of a stressor during service to support a diagnosis of PTSD will vary depending upon whether the Veteran engaged in “combat with the enemy,” as established by official records. See 38 U.S.C. § 1154 (b); 38 C.F.R. § 3.304 (f); DiZoglio v. Brown, 9 Vet. App. 163, 164 (1996); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). For stressors unrelated to combat, credible supporting evidence is necessary in order to grant service connection. “Credible supporting evidence” of a non-combat stressor may be obtained from service records or other sources. Moreau v. Brown, 9 Vet. App. 389 (1996). The Court has held that the regulatory requirement for “credible supporting evidence” means that “the appellant’s testimony, by itself, cannot, as a matter of law, establish the occurrence of a noncombat stressor.” DiZoglio, 9 Vet. App. 163. Therefore, the Veteran’s lay testimony is insufficient, standing alone, to establish service connection. Cohen, 10 Vet. App. at 147 (citing Moreau, 9 Vet. App. at 395). It is the Board’s responsibility to assess the credibility and therefore the probative value of proffered evidence of record in its entirety. Owens v. Brown, 7 Vet. App. 429, 433 (1995). In determining whether documents submitted by a veteran are credible, the Board may consider internal consistency, plausibility and consistency with other evidence submitted on behalf of the Veteran. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The law provides, however, that the Board is not required to accept a veteran’s uncorroborated account of his or her active service experiences. See Wood v. Derwinski, 1 Vet. App. 190, 192 (1991). It is also clear that the Board is not required to accept a veteran’s statement regarding his alleged symptoms, including nightmares, flashbacks and other difficulties associated with active service, if the Board does not find the statements of symptoms credible. The Veteran’s service treatment records (STRs) show that, in his November 1971 enlistment examination, the category of “psychiatric” was checked off as normal. He denied past or current “depression or excessive worry” or “nervous trouble of any sort.” In May 1972, the Veteran presented at the hospital dispensary with complaints of “nerves.” In a May 1973 “congressional interest” examination, the category of “psychiatric” was checked off as normal. A consultation report describes the Veteran as follows: Presents a chronically mildly tense young man with a somewhat low threshold to frustration, who is reacting to the uncertainty of Complaints of [a] release. He is concerned about getting home to be married. Tends to be a manipulator and quite immature in his thinking. Presents a very questionable prognosis for completion of [boot camp]. In May 1973, the Veteran requested an appointment with a psychiatrist. The consultation report which followed his appointment stated: In talking with patient it becomes apparent that patient’s problem is centered around his frustration at his inability to get the rate he deserves. He manifests the normal reaction to the frustration of military life. Imp[ression] – No psychiatric abnormality. [Neuropsychiatric] consult would not be of help. In July 1973, the Veteran presented at sick call with a request for a neuropsychiatric consult for “nerves.” The in-service examiner stated: This 20-year old [seaman] with 18 months active duty has been seen by me on several occasions desiring to see a psychiatrist. Never have I been able to find evidence that [neuropsychiatric] consult would be beneficial to the patient. Presently the patient expresses again repeatedly that he desires to see a psychiatrist “because I think I’m going crazy; I can’t keep my mind on anything; I’m in two different worlds.” …. Patient is quite suggestible in responding affirmatively to most review of systems-type questions. Judgment and insight are limited. Imp[ression] – Immature personality [assessed with] situational anxiety. Comment: Though I believe this patient has some personality problems, I do not feel that [neuropsychiatry] can offer him anything more than the chaplain or anybody also who is interested and will develop as relationship with him. I believe also that his low frustration level combined with his inadequate methods of coping with routine stresses of military life will lead to continued poor performance. Therefore, I believe that administrative separation is advisable. In October 1973, a consultation sheet shows that the Veteran again requested an appointment with a psychiatrist, stating: “He is constantly in trouble aboard ship and I believe his problem is immaturity. He has been seen by other Drs. about the same problem but continues to present himself with the same complaint. Please evaluate and advise.” Late in October 1973, the Veteran’s evaluation stated the following: This 20-year-old male enters with the chief complaint of “I cannot take the Navy anymore.” Very briefly this sailor has had numerous disciplinary charges brought against aim. He is almost constantly in trouble with his superiors, and from his own perspective he is being unfairly treated. He complains that his job is dangerous, and that he is constantly in fear for his life. He unconvincingly relates two recent dreams about death. During the interview he also made some empty statements about maybe hurting someone “if he is not let off the ship.” From a mental status viewpoint, this man was both well oriented and extremely cogent during our forty-minute interview. He very rationally described not liking being told what to do, and not liking his life being ordered by other people. It was obvious during the interview that the man’s disciplinary problems heightened this aspect of his complaint. The patient was an extremely manipulative person, but with certainly no signs of overt neurosis or psychosis. He appeared to be harboring a great deal of pent-up anger, without giving the impression that anxiety was his major problem. In talking with both the patient and his command it is obvious that this man is an immature individual who rejects authority, and has not yet learned to accept responsibility for his own actions. Verbal consultation with the psychiatry department at the Naval Hospital reinforced this impression. The department also refused to see him in consultation. The command having once before not accepted recommendations for administrative discharge and since I feel that this man is neither psychiatrically ill, nor a true personality disorder, he is referred back to his command for disposition. In a November 1973 evaluation, the Veteran’s treatment notes states “extreme explosive disorder, severe personality disorder.” In the Veteran’s December 1973 discharge examination, the category of “psychiatric” was checked off as normal. The Veteran’s Arguments The Veteran has reported three stressors to support his claim for PTSD. The first concerns a near-accident, during which, while stationed on deck, he steadied the rope line which spanned the space of open sea between the Veteran’s ship and another ship and which carried and guided the hose for refueling the neighboring ship from the storage tanks on the Veteran’s ship. The rope caught on the propeller of the Veteran’s ship, quickly coiled and suddenly and violently drew the Veteran to the edge of the deck. He was able to grab a nearby chain line and prevent being dragged over board. The Veteran reports he was put in fear for his life, suffered mental distress and continues to have symptoms of distress, such as nightmares and intrusive thoughts. As a second stressor, the Veteran reports, while on a street in Naples, Italy, he witnessed a dispute between a shipmate and a resident of the city, during which his shipmate drew a knife. The Veteran intervened and he wrestled the knife from his shipmate, putting the Veteran in fear for his life. His third stressor is based on the Veteran’s report, as recorded by the March 2018 VA examiner, that “the SEALS had to go and do something and they needed someone to decoy...I was the gig captain and I volunteered to take them to the beach and they had to do something and I had to stand up on top to see if anyone was standing behind…I had to elevate the grenade launcher and it was set to explode 5 feet of the ground...I’ve seen bodies fly.” He reported his life was constantly in danger. He stated, “we were called in general quarters [sic].” In his June 2018 Appellate Brief, the Veteran’s representative contends that the Veteran is entitled to service connection for PTSD because the Veteran has current symptoms and a current diagnosis of PTSD; two of the Veteran’s claimed stressors support a diagnosis of PTSD; his symptoms are related to the stressors; one of the stressors is based on fear of hostile military or terrorist activity; there is credible supporting evidence that the claimed in-service stressors occurred; and the claimed stressors are consistent with the places, types and circumstances of the Veteran’s service. The Veteran’s representative further contends that therefore, the Veteran’s lay testimony alone establishes the occurrence of the claimed in-service stressors, consistent with 38 C.F.R. § 3.304 (f)(3). Specifically, the Veteran’s representative asserts the following: Veteran has a current PTSD diagnosis by a psychologist that conforms to DSM – V criteria. See C&P Exam (“DBQ PSYCH...”) (04/13/2018) at 2. Further, two stressors were noted as meeting the criteria to support the diagnosis of PTSD, and it was noted Veteran was a Vietnam era combat veteran. See id. at 4, 7-8. The first stressor involved a ship accident in service where Veteran’s safety harness was not hooked and he felt he could have died. See id. at 7. The other stressor was noted as related to Veteran’s fear of hostile military or terrorist activity, and involved setting a grenade launcher and seeing bodies fly. See id. at 8. Further, the psychologist found that Veteran’s PTSD was at least as likely as not incurred or caused by service, and stated in her rationale that veteran indicated his symptoms began during service where he began to exhibit markers such as disciplinary problems on the job, aggressive behaviors, and poor impulse control. See C&P (“DBQ Medical Opinion”) (2nd from top of efolder) (04/13/2018) at 3. The examiner further stated that a review of Veteran’s records noted they were consistent with Veteran’s report and supported the current rationale, including a letter from [the] Navy showing offenses committed in service and a mental health examination showing extreme explosive disorder/severe personality disorder. See id. A review of Veteran’s service treatment records further corroborate[s] his stressors. An October 1973 record noted that Veteran complained his job in the Navy was dangerous and he was constantly in fear for his life, as well as that he wanted to be let off his ship. See STR – Medical (08/25/2008) at 14. This corresponds with the first noted stressor above where Veteran reported he thought he could have died after the safety harness incident. Veteran argues the evidence demonstrates that he has been diagnosed with PTSD, his stressors are consistent with the places, types, and circumstances of his service as a combat veteran, his stressors have been found sufficient to support a diagnosis of PTSD, and a positive medical nexus has found a link between his current symptoms and his claimed in-service stressors. Further, there is credible supporting evidence in the record in regards to Veteran’s first stressor and Veteran’s other stressor has been found to be related to fear of hostile military or terrorist activity. Therefore, all of the elements have been met and service connection must be granted in accordance with Cohen [v. Brown, 10 Vet. App. 128, 150 (1997)]. At the outset, the Board notes that the evidence of record shows a September 2009 VA memorandum, containing a “Formal Finding of lack of information required to verify stressors with a claim for service connection for PTSD.” The finding further states “[r]eview of the file and service treatment records [does] not show evidence of a combat related incident that contributed to [the Veteran’s] claim for PTSD.” The Board is well aware that the Veteran has not asserted that the claimed stressors are combat-related. However, the representative’s statement states that the Veteran was noted by the March 2018 VA examiner to be a combat veteran. It appears that the March 2018 VA examiner noted an earlier treatment note from January 2012, which described the Veteran as a combat veteran. Nonetheless, as a starting point in its analysis of the arguments set forth above, the Board’s review of the record has revealed no indication that the Veteran was a combat veteran. The Veteran’s military service records show no indication of combat service, the record does not reflect that his ship, U.S.S. CANISTEO, was deployed in combat operations and the Board is otherwise unaware of the CANISTEO ever being deployed in a combat theater of operations during the period in which the Veteran served as a member of its company. Moreover, although a February 2012 VA treatment note says the Veteran is a combat veteran and the January 2012 VA mental health initial evaluation note states under its Axis IV diagnosis: “[Psychiatric status schedule] 4 due to past combat experiences,” nothing in the record supports this and these descriptions can only have been based solely on the Veteran’s reports, which would have no verification value regarding the claimed stressors. The Veteran’s representative, however, has further asserted that the third stressor, pertaining to assisting Navy SEALS, engendered in the Veteran fear of hostile military or terrorist activity. It is one of the two stressors which the March 2018 VA examiner found supported her diagnosis of PTSD. 38 C.F.R. § 3.304 (f)(3) states: If a stressor claimed by a veteran is related to the veteran’s 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 post-traumatic stress disorder and that the veteran’s 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 the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. Yet, § 3.304 (f)(3) further states: For purposes of this section, “fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the Veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror (emphasis added). Put plainly, from the Veteran’s report of his third stressor event of assisting Navy SEALS, the Board is not able to conclude that the event was one during which the Veteran was confronted with an event or circumstance that involved actual or threatened death or serious injury to himself or others. From the Veteran’s report, it is not clear exactly what happened or might imminently have happened. The Veteran’s own report to the March 2018 VA examiner provides no specificity beyond “the SEALS had to go and do something.” As the record cannot establish that the Veteran or his ship were in combat situations or in an operational theater involving combat operations, there is no basis on which to conclude that the SEALS were engaged in other than a training exercise. Moreover, if the Veteran’s assertion implies that there might have been terrorist activity involved, the basis for that implication presently eludes the Board. Once again, based on the Veteran’s own account, nothing points to that possibility and the Board will not intrude its own conjectural scenarios in order to knit together fragments of information appearing in the Veteran’s report. Without more, the claimed stressor event cannot merely be assumed to be an instance of “actual or threatened death or serious injury” and, therefore, it could not have related to fear of hostile military or terrorist activity. Additionally, returning to the long first sentence of § 3.304 (f)(3), the claimed stressor is in fact not at all “consistent with the places, types and circumstances of the [V]eteran’s service.” As already repeatedly stated, there is no combat duty ascribed to the Veteran in his military service records; no relevant circumstances have been established showing confrontation with an event that involved actual or threatened death or serious injury to the Veteran or others; therefore, there is nothing which establishes fear of hostile military or terrorist activity. In the same passage, § 3.304 (f)(3) also requires that such a claimed stressor will have been confirmed by a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted. In his June 2018 brief, the Veteran’s representative in turn has emphasized that the March 2018 VA examiner found Veteran’s PTSD was at least as likely as not incurred or caused by service, and stated in her rationale that [V]eteran indicated his symptoms began during service where he began to exhibit markers such as disciplinary problems on the job, aggressive behaviors, and poor impulse control…. The examiner further stated that a review of Veteran’s records noted they were consistent with Veteran’s report and supported the current rationale, including a letter from that Navy showing offenses committed in service and a mental health examination showing extreme explosive disorder/severe personality disorder. As the record does not provide corroborating or credible supporting evidence for the claimed stressors, the Board at this point will emphasize that, whatever the March 2018 VA examiner’s findings were, the United States Court of Appeals for Veterans Claims (Court) has held that “credible supporting evidence of the actual occurrence of an in-service stressor cannot consist solely of after-the-fact medical nexus evidence.” Moreau v. Brown, 9 Vet. App. 389, 396 (1996). The Court arrived at this holding based on the recognition that “credible supporting evidence,” as a concept, would otherwise become pointless and worthless. The Board, too, notes that, if the ultimate point of reference were the nexus evidence, the in-service stressor in fact would never be established. Its validity would simply be implied by way of a circuitous and self-confirming forward glance at the newly-found service connection, as being in and of itself determinative in establishing the stressor; yet, service connection in turn would only have been achieved based on that uncorroborated and unsupported stressor. In looking to the first stressor of the shipboard near-accident during refueling operations, it remains that the Veteran’s statement alone is not enough to establish the occurrence of this stressor. As now repeatedly stated, the record contains nothing to corroborate the claimed stressor event. As the Veteran did not serve in combat and the stressor is not related to fear of hostile military or terrorist activity, as a matter of law, the Veteran’s testimony alone is insufficient to establish the occurrence of the claimed stressor. See Cohen v. Brown, 10 Vet. App. 128 (1997); Moreau v. Brown, 9 Vet. App. 389 (1996); DiZoglio v. Brown, 9 Vet. App. 163 (1996). For the rest, the Veteran’s representative has asserted: “A review of Veteran’s service treatment records further corroborate his stressors. An October 1973 record noted that Veteran complained his job in the Navy was dangerous and he was constantly in fear for his life, as well as that he wanted to be let off his ship. See STR – Medical (08/25/2008) at 14. This corresponds with the first noted stressor above where Veteran reported he thought he could have died after the safety harness incident.” The Board does not find this persuasive. This is not corroboration of anything. As set forth above, the Veteran’s October 1973 in-service evaluation noted what the representative asserts, but also notes that the Veteran’s motivations revolved around his insistence that he was being treated unfairly. The evaluator concluded that, in speaking with the Veteran and his command, “it is obvious” that the Veteran is immature, rejects authority and has not yet learned to accept responsibility for his own actions. The evaluator further observed that the Veteran is an “extremely manipulative person, but with certainly no signs of overt neurosis or psychosis.” For these reasons and based on the evidence of record, the Board finds the record contains nothing to corroborate, verify or credibly support the claimed stressors. The Board finds the Veteran’s lay testimony alone does not establish an in-service stressor based on combat experiences. The Board also finds the Veteran’s lay testimony alone does not establish the in-service stressor which the March 2018 VA examiner found supported her diagnosis of PTSD, as being based on fear of hostile military or terrorist activity. The Board further finds the Veteran’s lay testimony alone does not otherwise establish any claimed in-service stressor. Consequently, service connection for PTSD has not been established. 2. Entitlement to service connection for bilateral hearing loss. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz 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 Consonant-Vowel Nucleus-Consonant (CNC) Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran’s service treatment records (STRs) show that, in his November 1971 enlistment examination, the categories of “Ears -general” and “Drums” were checked off as normal. The Veteran denied past or current hearing loss. Audiometric findings for VA purposes were as follows: 500 Hz 1000 2000 3000 4000 Right 10 dB 5 5 5 10 Left 10 10 10 5 5 April 1972 audiometric findings for VA purposes were the following. 500 Hz 1000 2000 3000 4000 Right 10 dB 5 0 - 0 Left 35 20 10 - 10 In the May 1973 “congressional interest” examination, the categories of “Ears -general” and “Drums” were checked off as normal. Audiometric findings for VA purposes were as follows: 500 Hz 1000 2000 3000 4000 Right 15 dB 15 10 5 5 Left 25 20 20 20 5 The December 1973 discharge examination checked off as normal the categories of “Ears -general” and “Drums.” A June 2009 VA ambulatory care initial visit note states in its Review of Systems, as reported by the Veteran, “[n]o hearing deficits.” However, after testing, an October 2009 VA examiner for hearing loss found right-ear results were consistent with an essentially mild sensorineural hearing loss at 250 Hz - 8 000 Hz. She further found left-ear results were consistent with borderline normal hearing at 250 Hz - 1 500 Hz, sloping to a mild/moderate sensorineural hearing loss through 4000 Hz, with recovery to within normal limits thereafter. She added that speech recognition thresholds corroborated the three-frequency pure tone average for the right ear and the two-frequency pure tone average for the left ear. Speech recognition scores using the CNC-50-word lists were 80 percent for the right ear and 96 percent for the left. The audiometric findings were not set forth. The October 2009 VA examiner diagnosed the Veteran with “right-ear essentially mild sensorineural hearing loss at 250 Hz - 8 000 Hz and left-ear borderline normal hearing at 250 Hz - 1 500 Hz, sloping to a mild/moderate sensorineural hearing loss through 4000 Hz, with recovery to within normal limits thereafter.” She opined that it is less likely as not (less than 50/50 probability) that the Veteran’s hearing loss is the result of the identified in-service injury, event or illness. She explained: 1. [The Veteran’s] pure tone findings at discharge on 12/19/73 were within normal limits bilaterally at 500 Hz - 6000 Hz. Hearing loss appears to have been documented after discharge from the Navy. 2. The [V]eteran reported occupational noise exposure since leaving the military working as a master plumber in heavy construction until his reported fall at a construction site in January 2007. 3. The [V]eteran reported recreational noise exposure. Specifically, he hunted and participated in target shooting until at least 5 years ago. June 2012 VA audiometric readings for VA purposes for hearing aids later issued to the Veteran were as follows:   500 Hz 1000 2000 3000 4000 Right 15 dB 20 35 40 50 Left 30 35 40 40 60 Word recognition scores were 76 percent in the right ear and 100 percent in the left ear. The VA audiologist stated the above thresholds indicated mild-to-moderate-to-mild sensorineural hearing loss beginning at.5k in the right ear and a mild-to-moderately-severe-to-mild sensorineural hearing loss beginning at 1.5-6k in the left ear. He noted the Veteran’s report of in-service weapons fire noise exposure and his feeling of decreased hearing since about 1974, but also noted occupational construction noise exposure, recreational noise exposure and a family history of hearing loss at an early age. In April 2018, the Veteran underwent a VA examination for hearing loss, in which the audiometric findings for VA purposes were the following. 500 Hz 1000 2000 3000 4000 Average Right 60 dB 60 75 90 100 81.25 Left 85 80 95 100 105 95 The April 2018 VA examiner further found the Maryland CNC Word List Speech Discrimination score for the right ear was 70 percent. She stated no score is available for the left ear. For each ear, she diagnosed sensorineural hearing loss. The April 2018 VA examiner rendered an opinion for each ear, stating hearing loss is not at least as likely as not (50 percent probability or greater) caused by or a result of an event in military service. She explained: It is less likely than not that the claimant’s hearing loss is a result of military service. Rationale: His hearing on his separation exam of 12-19-73 was well within normal limits with no threshold shifts as compared to his enlistment exam of 11-9-71. The Institute of Medicine Study (2005) “Noise and Military Service: Implications for Hearing Loss and Tinnitus” states: “There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after the cessation of that noise exposure. Although the definitive studies to address this issue have not been performed, based on the anatomical and physiological data available on the recovery process following noise exposure, it is unlikely that such delayed effects occur.” Therefore, based on the objective audiometric data, there is no evidence on which to conclude that the [V]eteran’s current hearing loss was caused by or a result of the [V]eteran’s military service including noise exposure. The foregoing summary of the treatment record indicates that both the October 2009 and the April 2018 VA examiners appear to have mistaken the Veteran’s in-service May 1973 “congressional interest” examination audiometric results as belonging with his December 1973 discharge examination results. However, this misapprehension of the date is immaterial, as it not only concerns a difference of only approximately six to seven months, but is of no consequence regarding their conclusions. Both VA examiners note that there are no threshold shifts differences between those found in the November 1971 enlistment examination and the latest in-service audiometric findings found in the STRs. Moreover, the later examination’s audiometric findings were described by both VA examiners as well within normal limits. Therefore, this indicates decreases in hearing occurred after service. In his June 2018 Appellate Brief, the Veteran’s representative asserts that “[r]esearch has shown that noise-induced hearing loss may come on gradually and eventually lead to severe hearing loss, as the record shows happened in Veteran’s case” and cites to a National Institutes of Health web page on Deafness and Other Communication Disorders. The page addressing noise-induced hearing loss in fact states “[noise-induced hearing loss] can be immediate or it can take a long time to be noticeable.” The Board is uncertain what “a long time to be noticeable” means, but also notes that the above statement did not speak specifically to gradual onset. However, as set forth above, the April 2018 VA examiner stated her explanation on this point that, as yet, audiological studies provide no conclusive findings to show that permanent noise-induced hearing loss can develop much later, long after the cessation of noise exposure. According to the 2005 Institute of Medicine study she cites, clinical evidence to support this so far is insufficient. The Veteran’s representative further contends that the March 2018 VA examination is inadequate, as the March 2018 VA examiner did not address the Veteran’s statements on the onset of hearing loss in service. A review of the second part of the examination, shows that the March 2018 VA examiner also examined the Veteran for tinnitus and opined positively for service connection. This is not at all relevant for this appeal, as the Veteran is already service connected for tinnitus at the highest disability rating allowed under the relevant regulation and there is no appeal for tinnitus before the Board. Nonetheless, in reviewing the entire record, as the Board is required to do, a cursory glance at that portion of the examination shows that the March 2018 was very familiar indeed with the Veteran’s statements on in-service exposure to noise. She set forth their details and considered them in determining the etiology of the disorder. Moreover, the March 2018 VA examiner stated at the beginning of the examination that she had reviewed the claims file and it is reasonable to conclude that her familiarity with the Veteran’s statements for the tinnitus part of the examination also informed her findings, conclusions and opinion for bilateral hearing loss. As stated at the beginning of this decision, certain chronic diseases may be service connected on a presumptive basis if manifested to a compensable degree, usually within one year. “Other organic diseases of the nervous system” are included among chronic diseases. VA considers sensorineural hearing loss to be an organic disease of the nervous system. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309 (e). However, the record gives no indication of the manifestation of sensorineural hearing loss in complaints, treatment or diagnoses within a year of separation from active service. Consequently, the presumption of service connection for bilateral hearing loss as a chronic disease is not available to the Veteran. Additionally, because sensorineural hearing loss was never identified in service, it would be impossible to establish continuity of symptomatology following upon service and, as just stated, the subsequent record does not reflect this. Based on the objective medical evidence, the Board finds that the Veteran’s bilateral hearing loss is not caused by an event, injury or disease during active service, nor did sensorineural hearing loss manifest to a compensable degree within one year of separation from active service. Conclusion The Board has reviewed and carefully considered the Veteran’s testimony and that of his wife at the October 2014 Board hearing; the Veteran’s September 2009 Statements in Support of Claim; his September 2009 correspondence statement; his May 2011 Statement in Support of Claim; his wife’s December 2012 lay statement; the several statements sent in 2017 and 2018 to the Veteran’s congressional representatives; and the Veteran’s May 2017 statement sent to the President of the United States, as well as his reports to treatment providers, as they appear throughout the record. All these have helped the Board in understanding better the nature and development of the Veteran’s disorders and how they have affected him. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran and his wife are competent to provide statements of symptoms which are observable to their senses and there is no reason to doubt their credibility. However, the Board must emphasize that they are not competent to diagnose psychiatric and audiological disorders or interpret accurately clinical findings pertaining to them, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Based on the evidence of record, for each claim the Board has made it findings as stated above. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claims, the doctrine is not applicable and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. REASONS FOR REMAND 1. Entitlement to service connection for COPD. 2. Entitlement to service connection for asbestosis. Upon the Board’s denial in its October 2017 decision of the Veteran’s claims for service connection for COPD and asbestosis, the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court), which vacated the Board’s decision on these issues and remanded them to the Board for action consistent with the Joint Motion for Partial Remand (JMPR), submitted by the parties. The JMPR states the Board erred in finding the June 2011 VA opinion was adequate and fulfilled VA’s duty to assist, as that opinion failed to provide an adequate rationale, specifically, in not explaining how the finding of a nonspecific inflammatory process of uncertain etiology informed the June 2011 VA examiner’s ultimate conclusion that the Veteran’s condition “was not secondary to asbestos exposure or service.” Consistent with the JMPR, the Board remands both claims “for a new opinion.” The Board at this point notes that the record documents sufficiently that the ship on which the Veteran served during active service contained asbestos. The matters are REMANDED for the following action: 1. Contact the Veteran and/or his representative for information pertaining to any current treatment for COPD and asbestosis at any VA facility and by any private treatment provider. Obtain any records of the above treatments not yet associated with the claims file and associate them with the claims file. The assistance of the Veteran and/or his representative should be requested in obtaining any records of recent treatment as indicated. All attempts to obtain records should be documented in the claims file. 2. After all additional records have been obtained and associated with the claims file, but whether or not records are obtained, arrange for the production of an addendum opinion by a VA examiner with appropriate specialties for producing findings for COPD and asbestosis. The complete electronic claims file must be made available to the examiner. The examiner should detail all findings. The examiner is requested to render opinions, addressing the following: (a) Whether it is more likely than not (more than a 50 percent probability) or less likely than not (less than a 50 percent probability) that the Veteran’s COPD is caused by or otherwise related to exposure to asbestos during active service. (b) Whether it is more likely than not (more than a 50 percent probability) or less likely than not (less than a 50 percent probability) that the Veteran’s asbestosis is caused by or otherwise related to exposure to asbestos during active service. The opinions must be explained by adequate rationales, by which conclusions of the examiner are supported by direct references to clinical findings made on examination and medical literature. The examiner is specifically requested to address, consider and discuss the etiology of the Veteran’s COPD and asbestosis. The examiner is further requested to address, consider and discuss the August 2011 x-ray findings and accompanying statements found in the Medical Treatment Record, associated with the claims file both on February 8, 2013 and July 13, 2016. The examiner should comment on the findings and opinions of other examiners, which appear in the record. In addition, the examiner should acknowledge, address, consider, and discuss all lay evidence in the record pertaining to the Veteran’s COPD and asbestosis, including the Veteran’s October 2014 Board hearing testimony, his lay statements, any lay statements of his wife, other family members, friends, co-workers, or others, as well as the Veteran’s reports to treatment providers, as they appear throughout the record. Findings should be reconciled with other records on file to the extent possible. If the examiner determines a new examination is necessary in order to produce the requested opinions, arrange for the examination, in which the examiner should provide findings and diagnoses as to the nature, extent and current severity of the disorders. 3. After completing the above development and any other indicated development, review the record to ascertain that all development has been accomplished. If not, please undertake corrective action. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Franke, Associate Counsel