Citation Nr: 18148028 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-29 790 DATE: November 6, 2018 ORDER An effective date prior to May 15, 2012 for service connection for tinnitus is denied. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and anxiety disorder, including as secondary to the service-connected tinnitus, is denied. Service connection for degenerative disc disease, retrolisthesis, intravertebral disc syndrome, and spondylosis of the lumbar spine (lumbar spine disorder) is denied. Service connection for a bilateral knee disorder is denied. Service connection for chronic obstructive pulmonary disease (COPD) and chronic bronchitis, including as due to asbestos exposure, is denied. Service connection for migraine headaches, including as secondary to the service-connected tinnitus, and including as due to an acquired psychiatric disorder, is denied. Service connection for chronic tendonitis/lateral epicondylitis in the right elbow (claimed as chronic tendonitis in the right arm) (right elbow disorder) is denied. Service connection for chronic right shoulder pain (right shoulder disorder) is denied. Service connection for right ear hearing loss is denied. Service connection for intermittent vertigo is denied. Service connection for intermittent hand tremors is denied. Service connection for intermittent blackouts is denied. A total disability rating based on individual unemployability due to service connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. There were no communications received prior to May 15, 2012 that could be construed as a formal or informal claim for service connection for tinnitus. 2. The Veteran is currently diagnosed with PTSD and anxiety disorder; an in service stressor sufficient to cause PTSD has not been verified; the current PTSD and anxiety disorder are not etiologically related to service; the current PTSD and/or anxiety disorder were not caused by, or worsened beyond its normal progression by, the service-connected tinnitus. 3. The Veteran is currently diagnosed with a lumbar spine disorders of degenerative disc disease, retrolisthesis, intravertebral disc syndrome, and spondylosis; the Veteran sought treatment for back pain during service; symptoms of the current lumbar spine disorder were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of separation; the current lumbar spine disorder is not etiologically related to service, to include the back pain treated during service. 4. The Veteran is currently diagnosed with meniscus tears and arthritis in the knees; symptoms of the current bilateral knee disorder were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of separation; the current bilateral knee disorder is not otherwise etiologically related to an in-service injury, disease, or event. 5. The Veteran is currently diagnosed with COPD and chronic bronchitis; the Veteran was not exposed to asbestos during service; the current COPD and chronic bronchitis are not etiologically related to an in-service injury, disease, or event. 6. The Veteran is currently diagnosed with migraine headaches; the current migraine headaches did not have their onset during service, and are not otherwise etiologically related to an in-service injury, disease, or event; the current migraine headaches were not caused, or worsened beyond its normal progression by, the service-connected tinnitus. 7. The Veteran is currently diagnosed with lateral epicondylitis in the right elbow; the current right elbow disorder is not etiologically related to an in-service injury, disease, or event. 8. The Veteran does not have a current right shoulder disability. 9. The Veteran does not have a current right ear hearing loss disability for VA compensation purposes. 10. The Veteran does not have a current disability manifested by symptoms of intermittent vertigo. 11. The Veteran does not have a current disability manifested by symptoms of intermittent hand tremors. 12. The Veteran does not have a current disability manifested by symptoms of intermittent blackouts. 13. The Veteran is not rendered unable to obtain or maintain substantially gainful employment as a result of the service-connected tinnitus. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to May 15, 2012 for service connection for tinnitus have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400. 2. The criteria for service connection for an acquired psychiatric disorder, to include PTSD and anxiety disorder, including as secondary to the service-connected tinnitus, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 3. The criteria for service connection for a lumbar spine disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 4. The criteria for service connection for a bilateral knee disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 5. The criteria for service connection for COPD and chronic bronchitis, including as due to asbestos exposure, have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 6. The criteria for service connection for migraine headaches, including as secondary to the service-connected tinnitus, have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 7. The criteria for service connection for a right elbow disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 8. The criteria for service connection for a right shoulder disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 9. The criteria for service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326, 3.385. 10. The criteria for service connection for intermittent vertigo have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 11. The criteria for service connection for intermittent hand tremors have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 12. The criteria for service connection for intermittent blackouts have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 13. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.340, 3.341, 4.3, 4.15, 4.16, 4.18, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from February 1987 to February 1990, from February 1991 to March 1991, and from November 1999 to February 2000. 1. An effective date earlier than May 15, 2012 for the grant of service connection for tinnitus The Veteran generally asserts that an earlier effective date for the award of service connection for tinnitus is warranted. See March 2015 Notice of Disagreement. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. After a final disallowance of a claim, the effective is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(q)(2). For claims received prior to March 24, 2015, as pertinent to this case, a “claim” is defined as a formal or informal communication, in writing, requesting a determination of entitlement, or evidencing a belief in entitlement to a benefit and VA is required to identify and act on informal claims for benefits. 38 C.F.R. §§ 3.1(p), 3.155(a); see also Servello v. Derwinski, 3 Vet. App. 196, 198 200 (1992). Pursuant to 38 C.F.R. § 3.155, any communication or action indicating intent to apply for one or more VA benefits, including statements from a veteran’s duly authorized representative, may be considered an informal claim. Such an informal claim must identify the benefit sought. 38 C.F.R. § 3.1(p) defines application as a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. See also Rodriguez v. West, 189 F.3d. 1351 (Fed. Cir. 1999). The date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). Effective March 24, 2015, a change in regulation requires claims be filed on standard forms, eliminating constructive receipt of claims and informal claims. See 38 C.F.R. §§ 3.1(p), 3.150, 3.155, 3.160(a). Instead of informal claims, the new regulation provides that a claimant may request an application for benefits, upon receipt of which, the Secretary shall notify the claimant of the information necessary to complete the application form or form prescribed by the Secretary. 38 C.F.R. § 3.155(a). Non-standard narrative communications/submissions - previously construed as informal claims - will be considered a request for an application for benefits. Standard Claims and Appeals Forms, 79 Fed. Reg. 57660, 57661 (Sept. 25, 2014) (where a claimant submits an informal claim, VA will deem it a request for an application for benefits). In this case, the Board finds that an effective date earlier than May 15, 2012 for service connection for tinnitus is not warranted. The Veteran submitted a formal claim for service connection for right ear hearing loss on May 15, 2012, which the Regional Office (RO) liberally construed to include a claim for service connection for tinnitus. The Board finds that there was no correspondence received by VA prior to May 15, 2012 that can be construed as a claim, either formal or informal, for service connection for tinnitus. Furthermore, the Veteran has not asserted that a formal or informal claim for tinnitus was received by VA earlier than May 15, 2012. On these facts, because the earliest effective date legally possible (May 15, 2012) has been assigned under 38 C.F.R. §§ 3.400(q)(2) and (r), and no effective date for service connection earlier than May 15, 2012 (date of receipt of claim for service connection for tinnitus) is assignable, the appeal for an earlier effective date for service connection for tinnitus is without legal merit, and must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law is dispositive, the claim must be denied due to a lack of legal merit). For these reasons, the Board concludes that an effective date prior to May 15, 2012 for the award of service connection for tinnitus is not warranted as a matter of law. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 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 generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in service disease or injury and the current disability. With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). The Veteran is currently diagnosed with spondylosis in the lumbar spine (as arthritis) and arthritis in the knees. Arthritis is a “chronic disease” under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for “chronic” in-service symptoms and “continuous” post service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. 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. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, 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 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. 2. Service connection for an acquired psychiatric disorder The Veteran asserts that he has PTSD, and that PTSD is the result of two specific stressor incidents that occurred during active service. The Veteran claims that between December 1989 and March 1990 he was stationed in Panama and his unit was engaged in a small arms fire fight while taking over an airfield, during which the Veteran and his unit were captured, taken prisoner for five days, and tortured. Additionally, the Veteran contends that while he was stationed in Kuwait between February 1991 and April 1991, his unit was again involved in small arms fire fights and that he encountered dead women and children on several occasions. The Veteran asserts he was awarded the Liberation of Kuwait Medal in connection with the alleged stressor incident. See May 2012 VA Form 21-0781 Statement in Support of Claim for PTSD. Alternatively, the Veteran contends that anxiety disorder is the result of the service-connected tinnitus. See March 2017 Correspondence. Service connection for PTSD requires the following three elements: (1) a current medical diagnosis of PTSD (presumed to include the adequacy of the PTSD symptomatology and the sufficiency of a claimed in-service stressor in accordance with DSM-V), (2) credible supporting evidence that the claimed in-service stressor(s) actually occurred, and (3) medical evidence of a causal relationship between current symptomatology and the specific claimed in-service stressor(s). See 38 C.F.R. § 3.304 (f). In adjudicating a claim for service connection for PTSD, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran’s military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.304 (f). The evidence necessary to establish the occurrence of an in-service stressor for PTSD will vary depending on whether or not the veteran “engaged in combat with the enemy.” Id. Initially, the Board finds that the Veteran is currently diagnosed with PTSD and anxiety disorder. A December 2012 VA treatment record reflects diagnoses of PTSD and anxiety disorder. After a review of all the lay and medical evidence, the Board finds that the weight of the lay and medical evidence of record demonstrates that an in-service stressor sufficient to cause PTSD has not been verified. The Board finds that the Veteran did not engage in combat with the enemy; accordingly, the Veteran’s lay testimony by itself is not sufficient to establish the occurrence of the alleged stressors and the record does not contain service records or other evidence to corroborate the Veteran’s statements. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f); Moreau v. Brown, 9 Vet. App. 389, 394 (1996). Contrary to the Veteran’s assertions surrounding the claimed service stressors, service personnel records show that the Veteran was stationed in Germany from August 1987 to February 1990, and was not in Panama during that period of time. Additionally, the DD Form 214 covering the period of active service from February 1991 to March 1991 reflects no foreign service; military personnel records do not show that the Veteran had been deployed to Panama or Kuwait at any time during any period of active service, or that he had received the Liberation of Kuwait Medal. Furthermore, the Defense Personnel Records Information Retrieval System (DPRIS) coordinated research with the U.S. Army Center for Military History and was unable to verify that elements from the 16th Engineer Battalion deployed to Panama for Operation Just Cause, or that members from that unit were captured and held prisoner during the Operation. See also April 2013 VA Memorandum (formal finding that claimed in-service stressors could not be corroborated). Because the Board is not bound to accept uncorroborated accounts of stressors, the Board finds that there is no verified in-service PTSD stressor to which the current PTSD may be related. See Wood v. Derwinski, 1 Vet. App. 190 (1991), aff’d on reconsideration, 1 Vet. App. 406 (1991). Next, the Board concludes that, while the Veteran has a current diagnosis of generalized anxiety disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of anxiety disorder began during service or is otherwise related to military service. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303(a), (d). Service treatment records do not reflect any complaints, symptoms, treatment, or diagnoses for any psychiatric disorders. Service examination reports continuously found the Veteran to be psychiatrically normal. See April 1987 service treatment record; April 1995 service treatment record; January 1998 service treatment record; February 2000 service treatment record. Additionally, the Veteran repeatedly denied symptoms and/or treatment for a mental health condition throughout active service on various Reports of Medical History and Applicant Prescreening Forms. See April 1995 service treatment record; January 1997 service treatment record; January 1998 service treatment record. As the evidence of record does not contain any competent medical opinion establishing a medical nexus between the current anxiety disorder and an injury, event, or disease during service, the Board finds that the current anxiety disorder is not etiologically related to active service. The Board further finds that the current anxiety disorder was not caused by, or worsened beyond its normal progression by, the service-connected tinnitus. A January 2016 private examination report indicates a diagnosis for anxiety disorder due to another medical condition. The January 2016 private examination report contains Dr. H.H.’s opinion that the service-connected tinnitus is more likely than not causing the current anxiety disorder. In support of this opinion, Dr. H.H. cites two medical articles that purportedly detail the association between tinnitus and comorbid psychological disorders, including anxiety disorder; Dr. H.H. did not provide an explanation as to how the Veteran’s anxiety disorder was caused or worsened beyond its normal progression by the service-connected tinnitus in the context of the Veteran’s specific medical history. The first medical article titled “Anxiety and depression in tinnitus patients: 5-year follow-up assessment after completion of habituation therapy” pertains to a long-term follow up effect study performed five years after a completed tinnitus habituation therapy program that lasted one year; the record does not indicate that the Veteran ever participated in this specified program, thus, the Board finds this medical article is of no probative value in establishing that the current anxiety disorder is the result of the service-connected tinnitus. The second medical article titled “The Civilian Labor Market Experiences of Vietnam-Era Veterans: The Influence of Psychiatric Disorders,” was cited by Dr. H.H. to support the opinion that some psychiatric diagnoses, including anxiety disorder, leads to occupational dysfunction and poor work-related quality of life; however, this second article does not provide support that the Veteran’s current anxiety disorder was caused or worsened beyond its normal progression by the service-connected tinnitus. Because Dr. H.H.’s January 2016 private medical opinion does not address the Veteran’s specific medical history and how the service-connected tinnitus either caused him to develop anxiety disorder, or worsened the anxiety disorder beyond its normal progression, the Board finds that the January 2016 opinion is of no probative value. As the evidence of record does not contain any competent medical opinion establishing a medical nexus between the current anxiety disorder and an injury, event, or disease during service, or between the current anxiety disorder and the service-connected tinnitus, the Board finds that the criteria for service connection for an acquired psychiatric disorder, to include PTSD and anxiety disorder, including as secondary to the service-connected tinnitus, have not been met. 3. Service connection for a lumbar spine disorder The Veteran generally asserts that service connection for a lumbar spine disorder is warranted. During a May 2013 VA examination, the Veteran reported experiencing back pain starting in 1988 when he was stationed in Germany after hooking up a trailer to a vehicle; the Veteran reported a year later, another service member charged at him while playing football and injured his back. At the outset, the Board finds that the Veteran is currently diagnosed with degenerative disc disease, retrolisthesis, intravertebral disc syndrome, and spondylosis in the lumbar spine. See May 2013 VA examination report. After a review of all the evidence of record, lay and medical, the Board finds that the weight of the evidence demonstrates that the Veteran experienced back pain during service, without evidence of accident, injury, disease, or event in service that may be related to the currently diagnosed lumbar spine disorder. Service treatment records reflect that the Veteran sought treatment for back pain several times in service, from September 1987 to February 1988; in September 1987, the Veteran reported back pain with no direct trauma and X-rays of the dorsal spine revealed normal findings; in October and November 1987, the Veteran reported he was involved in a car accident prior to entering active duty and had experienced back pain since; the Veteran complained of back pain in January and February 1988 after lifting a trailer and helping change a tire. Service treatment records reflect that the service examiners’ assessments of the Veteran’s back pain were muscle spasms and muscle pain. Service treatment records also show that the back pain resolved after February 1988 as there were no further complaints of back pain thereafter, that the Veteran’s spine was repeatedly found to be clinically normal, including at service separation, and that the Veteran continuously denied symptoms of recurrent back pain. See April 1995 service treatment record; January 1997 service treatment record; January 1998 service treatment record; February 2000 service treatment record. The May 2013 VA examination report, discussed below, also supports the finding that the Veteran’s low back pain during service was resolved without prolonged effects or residuals. While the Veteran complained of back pain during service, the evidence does not demonstrate a chronic disease of the lumbar spine manifested in service as defined under 38 C.F.R. § 3.303(b), including chronic symptoms of arthritis during service. The chronicity rule does not mean that any manifestation of joint pain in service will permit service connection of arthritis first shown as a clear cut clinical entity, at some later date. Rather, 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, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” See 38 C.F.R. § 3.303(b). In this case, the complaints and treatment for back pain during service were transient findings relating to muscle spasms and pain. Regardless of the complaints of back pain over the course of six months during service, the evidence does not demonstrate chronic symptoms of arthritis in the lumbar spine during service or continuous symptoms of arthritis in the lumbar spine since service separation. Notably, the Veteran continued to deny symptoms of back pain and back problems during the service examinations that were performed after the complaints of back pain in 1987 and 1988, and subsequent service examination reports shows the Veteran’s spine and other musculoskeletal systems were clinically normal, including the February 2000 service separation examination report. Additionally, X-rays of the spine done in September 1987 revealed negative findings for arthritis. As such, the Board finds that these were isolated instances of back pain and do not establish chronic symptoms of arthritis in the lumbar spine during service. Further, the lay and medical evidence weighs against a finding of continuous symptoms of arthritis in the lumbar spine since service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted based on either “chronic” in-service or “continuous” post-service symptoms. As discussed above, neither the service treatment records nor service examination reports indicated any history or findings or diagnosis of arthritis in the lumbar spine. The May 2013 VA examination report shows the earliest diagnosis for spondylosis in the lumbar spine over 13 years after separation from service and over 12 years outside of the applicable presumptive period. Service connection for a lumbar spine disorder may still be granted on a direct basis; however, in this case, the preponderance of the evidence is against finding that a nexus exists between the Veteran’s lumbar spine disorder and an in-service injury, disease, or event. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). As discussed above, service treatment records do not reflect that the Veteran sustained a back injury during service, and service examination reports show the Veteran’s spine and musculoskeletal systems were repeatedly found to be clinically normal. The May 2013 VA examination report contains the VA examiner’s opinion that it is less likely than not that the current lumbar spine disorder is etiologically related to active service. The VA examiner explained that service treatment records show the Veteran did not experience persistent back pain after 1988, thus, the earlier in service complaints of back pain could not be associated with the degenerative changes noted on the X-rays taken during the May 2013 VA examination. As the evidence of record does not contain a competent medical opinion establishing a medical nexus between the lumbar spine disorder and an injury, disease, or event during service, the Board finds that the weight of the evidence is against service connection for a lumbar spine disorder, and the claim must be denied. 4. Service connection for a bilateral knee disorder The Veteran contends that a current bilateral knee disorder is the result of playing football during active service. See May 2012 Claim. Initially, the Board finds that the Veteran is currently diagnosed with meniscus tears and arthritis in both knees. See September 2011 private treatment records; April 2012 private treatment record. The presumptive service connection questions for the Board are whether the Veteran has a chronic disease (arthritis) that manifested chronic symptoms in service, continuous symptoms since service, or to 10 percent within one year of service. The Board concludes that, while the Veteran has arthritis in the knees, which is a chronic disease under 38 C.F.R. § 3.309(a), the weight of the evidence shows that symptoms of arthritis were not chronic in service, were not continuous since service, and did not manifest to a compensable degree within one year of service. 38 U.S.C. §§ 1101(3), 1112, 1113, 1137; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). A June 2007 private treatment record is the earliest evidence of arthritis in the right knee, over seven years after separation from service and over six years outside of the applicable presumptive period. A September 2011 private treatment record is the earliest evidence of arthritis in the left knee, over 11 years after separation from service and over 10 years outside of the applicable presumptive period. While the Veteran is competent to report experiencing symptoms of knee pain at any time, the Board finds the more recent reports of knee pain/injury during service, chronic symptoms in service, and continuity of symptomatology since service are outweighed by other, more contemporaneous lay and medical evidence of record, so are not credible. The Veteran’s claim that he injured his knees while playing football during service is inconsistent with, and outweighed by, other lay and medical evidence, including in the service treatment records. Service treatment records do not reflect any complaints, symptoms, diagnosis, or treatment for any knee pain or problems, and the Veteran’s lower extremities and musculoskeletal system were continuously found to be clinically normal, including at the February 2000 service separation examination. Furthermore, the Veteran continuously denied symptoms of arthritis, rheumatism, or bursitis, bone, joint, or other deformity, and “trick” or locked knee throughout service. See April 1995 service treatment record; January 1997 service treatment record; January 1998 service treatment record; February 2000 service treatment record. This is highly probative contemporary lay evidence, a report directly from the Veteran, denying the presence of arthritis or arthritis symptoms in the knees during service. As the service treatment records are complete and show complaints and treatment for other disorders, including similar joint or orthopedic disorders that involve painful joints, such as the back pain discussed above, the Veteran similarly would have reported or complained of knee injuries or symptoms, including pain, had such occurred during service. See Fed. R. Evid. 803(7) (indicating that the absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (stating that VA may use silence in the service treatment records as evidence contradictory to a veteran’s assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred) (Lance, J., concurring); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the absence of a notation in a record may only be considered if it is first shown both that the record is complete and also that the fact would have been recorded had it occurred). Service connection for a bilateral knee disorder may still be granted on a direct basis; however, in this case, the preponderance of the evidence is against finding that a nexus exists between the Veteran’s knee disorder and an in-service injury, disease, or event. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). As discussed above, service treatment records do not reflect that the Veteran sustained any knee injury during service, and a February 2000 service separation examination report shows the Veteran’s lower extremities and musculoskeletal systems were found to be clinically normal. Further, the evidence of record does not contain a competent medical opinion establishing a medical nexus between the current bilateral knee disorder and an injury, disease, or event during service. For these reasons, the Board finds that the weight of the evidence is against service connection for a bilateral knee disorder, and the claim must be denied. 5. Service connection for COPD and chronic bronchitis, including as due to asbestos exposure The Veteran asserts that exposure to asbestos and other harmful chemicals such as paint and paint thinners in an enclosed area during service caused him to develop COPD and chronic bronchitis. See May 2012 Claim. The Veteran states that he was ordered to tear down old barracks when he was stationed in Germany in 1988 and painted barracks indoors with the windows closed and without face masks; the Veteran also contends that he was ordered to pain track vehicles in an enclosed area with spray guns and without protective masks on several occasions between 1988 to 1990. See July 2012 Statement. At the outset, the Board finds that the Veteran is currently diagnosed with COPD and chronic bronchitis. See September 2009 private treatment record; August 2012 private treatment record. Next, the Board finds that the Veteran was not exposed to asbestos during service. The DD Form 214 covering the period of the alleged asbestos exposure in 1988 to 1990 shows the Veteran’s military occupational specialty was as a combat engineer, which does not indicate any probable exposure to asbestos. See VA Manual M21-1, Part IV.ii.1.I.3.d. As such, the Board finds that the Veteran’s contentions concerning asbestos exposure in service are not consistent with his occupational specialty and the places, types, and circumstances of his service. 38 U.S.C. § 1154(a). After reviewing all the lay and medical evidence, the Board finds that the weight of the evidence demonstrates that the currently diagnosed COPD and chronic bronchitis are not related to active service. Service examination reports reflect the Veteran’s lungs and chest were found to be clinically normal throughout active service, including at the February 2000 service separation examination, which also shows X-rays of the chest were normal. Furthermore, the Veteran continuously denied respiratory symptoms such as chronic cough, shortness of breath, throat trouble, and pain and pressure in chest throughout service. See April 1995 service treatment record; January 1997 service treatment record; January 1998 service treatment record; February 2000 service treatment record. Post-service private treatment records show the Veteran was not diagnosed with chronic bronchitis and COPD until September 2009 and August 2012, respectively. Although the Veteran also asserts that COPD and chronic bronchitis is the result of hazardous chemical exposures during active service, the etiology of the current COPD and chronic bronchitis is a complex medical etiological question involving internal and mostly unseen system processes unobservable by the Veteran that manifest in some general symptoms of breathing disorder that are common to many respiratory disorders. The question of causation of COPD and chronic bronchitis involves knowledge of multiple other causes of COPD and bronchitis so as to eliminate other etiologies. The Board does not find the Veteran competent to provide evidence of an etiological nexus between any in-service chemical exposure and COPD and chronic bronchitis that developed years after service separation, especially in this case where there is no diagnosis or treatment for symptoms for many years after service. Furthermore, the evidence of record does not contain any competent medical opinion establishing a medical nexus between the current COPD and chronic bronchitis to any injury, disease, or event during service. For the reasons discussed above, the Board finds that the weight of the evidence demonstrates that the current COPD and chronic bronchitis were not incurred in or otherwise caused by active service, to include asbestos exposure. As the preponderance of the evidence is against the claim for service connection for COPD and chronic bronchitis, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Service connection for migraine headaches, including as secondary to the service-connected tinnitus The Veteran asserts that migraine headaches are the result of sustaining two concussions during active service in 1989 and 1990. See May 2012 Claim. Alternatively, the Veteran contends that migraine headaches developed due to the service-connected tinnitus and/or due to an acquired psychiatric disorder. See March 2017 private examination report. Initially, the Board finds that the Veteran is currently diagnosed with migraine headaches. A March 2017 private examination report reflects a diagnosis for migraine headaches. After a review of all the lay and medical evidence, the Board finds that the current migraine headaches did not have its onset during active service, is not otherwise etiologically related to active service, and was not caused by or worsened beyond its normal progression by the service-connected tinnitus. During the March 2017 private examination, the Veteran reported headaches that began during service and that he has been suffering from chronic headaches ever since; however, this is an inaccurate history as service treatment records do not reflect any complaints, symptoms, treatment, or diagnosis for a headache disorder, and service examination reports reflect the Veteran’s head and neurologic system were found to be clinically normal throughout active service, including at the February 2000 service separation examination. Service treatment records also do not show that the Veteran sustained concussions in 1989 and 1990. Furthermore, the Veteran continuously denied symptoms of frequent or severe headaches throughout service. See April 1995 service treatment record; January 1997 service treatment record; January 1998 service treatment record; February 2000 service treatment record. As such, the Board finds the Veteran’s more recent reports of experiencing chronic headaches during active service are outweighed by the contemporaneous medical evidence of record, and are not credible. The March 2017 private examination report also contains the private provider’s opinion that the Veteran’s headache disorder is caused by the service-connected tinnitus and a current acquired psychiatric disorder; however, the March 2017 private examiner did not provide a rationale for this opinion, including in the remarks attached to the private examination report. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (requiring medical examiners to provide a “reasoned medical explanation connecting” observations and conclusions). Although the March 2017 private provider stated the Veteran reported that the service-connected tinnitus can cause or exacerbate a headache, the private examiner did not explain how the service-connected tinnitus either caused the current migraine headache disorder, or worsened it beyond its normal progression. Accordingly, the Board finds the March 2017 private examiner’s opinion is of no probative value in demonstrating that the current migraine headaches are the result of the service-connected tinnitus. The evidence of record does not contain any competent medical opinion establishing a medical nexus between the current migraine headaches to any injury, disease, or event during service. Additionally, as service connection for an acquired psychiatric disorder has been denied in the Board’s instant decision above, service connection for migraine headaches may not be established as secondary to an acquired psychiatric disorder as a matter of law. Based on the foregoing, the Board finds that the criteria for service connection for migraine headaches, including as secondary to the service-connected tinnitus, have not been met. 7. Service connection for chronic tendonitis/lateral epicondylitis in the right elbow The Veteran asserts that a current right elbow disorder is the result of pitching baseball for three years during active service. See May 2012 Claim. Initially, the Board finds the Veteran is currently diagnosed with lateral epicondylitis in the right elbow. See April 2012 private treatment record. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence demonstrates that the current right elbow disorder is not etiologically related to active service. Service treatment records do not reflect any complaints, symptoms, diagnosis, or treatment for any right elbow pain or problems during service, and service examination reports reflect the Veteran’s upper extremities were found to be clinically normal throughout active service, including at the February 2000 service separation examination. Furthermore, the Veteran continuously denied symptoms of a painful or “trick” elbow throughout service. See April 1995 service treatment record; January 1997 service treatment record; January 1998 service treatment record; February 2000 service treatment record. Because the record does not contain any competent opinion establishing a nexus between the current right elbow disorder and active service, the Board finds that the criteria for service connection for a right elbow disorder have not been met. 8. Service connection for chronic right shoulder pain The Veteran generally seeks service connection for chronic right shoulder pain. See May 2012 Claim. After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against a finding of a current right shoulder disability. An April 2008 private treatment record reflects a prescription for physical therapy twice a week for shoulder and knee pain. Private treatment records from a chiropractor show the Veteran complained of pain in the neck, shoulder, and lower back due to multiple knots in the shoulders and along the scapula, which were treated with deep tissue trigger point therapy to relax the muscles, but do not reflect a current diagnosis for a right shoulder disability. See e.g. June 2010 private treatment record; November 2010 private treatment record. The other VA and private treatment records in the claims file also do not reflect a current diagnosis for a right shoulder disability. As discussed above, with any claim for service connection, it is necessary for a current disability to be present. See Moore, 21 Vet. App. at 215; Brammer, 3 Vet. App. at 225; Rabideau, 2 Vet. App. at 143 44; McClain, 21 Vet. App. 319; Romanowsky, 26 Vet. App. 289. Moreover, symptoms such as pain alone, that do not result in functional impairment, do not constitute a disability for VA compensation purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). For the reasons discussed above, the Board finds that the weight of the evidence demonstrates that the Veteran does not have a current right shoulder disability. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 9. Service connection for right ear hearing loss The Veteran seeks service connection for right ear hearing loss due to exposure to loud weapons fire without hearing protection. See May 2012 Claim. For VA purposes, 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 (Hz) is 40 decibels (dB) or greater, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 dB or greater, or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. After a review of all the lay and medical evidence, the Board finds that the Veteran does not have a current right ear hearing loss disability as defined by VA regulatory criteria. November 2013 and December 2013 VA audiometric examination reports reflect the Veteran’s hearing acuity in both ears were measured within normal limits and do not meet the criteria for hearing loss for VA compensation purposes under 38 C.F.R. § 3.385. Accordingly, the Board finds the criteria for service connection for right ear hearing loss have not been met. 10. Service connection for intermittent vertigo 11. Service connection for intermittent hand tremors 12. Service connection for intermittent blackouts The Veteran generally seeks service connection for intermittent vertigo, intermittent hand tremors, and intermittent blackouts. See May 2012 Claim. After a review of all the lay and medical evidence of record, the Board finds that the Veteran does not have, nor has he had at any time proximate to or during the course of this appeal, a diagnosed disability manifested by symptoms of intermittent vertigo, intermittent hand tremors, and/or intermittent blackouts. VA and private treatment records throughout the relevant claims period on appeal do not reflect any complaints, symptoms, treatment, or diagnoses relating to intermittent vertigo, intermittent hand tremors, and/or intermittent blackouts. As discussed above, with any claim for service connection, it is necessary for a current disability to be present. See Moore, 21 Vet. App. at 215; Brammer, 3 Vet. App. at 225; Rabideau, 2 Vet. App. at 143 44; McClain, 21 Vet. App. 319; Romanowsky, 26 Vet. App. 289. As the Veteran is not currently diagnosed with a disability manifested by symptoms of intermittent vertigo, intermittent hand tremors, and/or intermittent blackouts, the Board finds that the criteria for service connection for manifested by symptoms of intermittent vertigo, intermittent hand tremors, and intermittent blackouts have not been met. 13. TDIU A TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a), (b). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In evaluating a veteran’s employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. After a review of all the evidence, lay and medical, the Board finds that entitlement to a TDIU is not warranted. For the relevant period from May 15, 2012 (date of the claim), the Veteran has been awarded service connection for tinnitus (rated as 10 percent disabling). As such, the Veteran’s service connected disability does not meet the rating criteria for a TDIU under 38 C.F.R. § 4.16(a) for any period from May 15, 2012. Further, having considered all the evidence of record, lay and medical, the Board finds that referral under 38 C.F.R. § 4.16(b) to the Director of C&P for consideration is not warranted for any period. The evidence of record does not show that the Veteran is unable to obtain or maintain substantially gainful employment due solely to the service-connected tinnitus. The November 2013 VA examination report shows the Veteran reported experiencing tinnitus three to four times per week for 20 to 30 minutes at a time; the VA examiner assessed the functional impact of the tinnitus is that it affects the Veteran’s work life as it is distracting and makes it hard for him to concentrate. The December 2013 VA examination report shows the functional impact of tinnitus is that it makes it hard for the Veteran to concentrate and to fall asleep. This evidence does not demonstrate unemployability due solely to the service-connected tinnitus. Moreover, in a May 2012 VA Form 21-8940 Application for Increased Compensation Based on Unemployability, the Veteran asserts that the non-service-connected PTSD alone prevents him from securing any substantially gainful employment; the record also contains a January 2016 private examiner’s opinion that the service-connected tinnitus is more likely than not causing anxiety disorder and hindering the Veteran from maintaining substantially gainful employment. A January 2016 private treatment record reflects the Veteran endorsed missing work or leaving work early more than three days per month due to psychiatric symptoms and responding to normal work pressures in an angry manner. However, the Board’s instant decision above denies service connection for an acquired psychiatric disorder, to include PTSD and anxiety disorder, including as secondary to the service-connected tinnitus. As discussed above, a TDIU must be based on solely on service-connected disabilities. Based on the foregoing, the Board finds that the weight of the lay and medical evidence demonstrates that the Veteran’s service connected tinnitus does not prevent obtaining or maintaining substantially gainful employment for any period from May 15, 2012. As the preponderance of the lay and medical evidence is against a finding for a TDIU, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Choi, Associate Counsel