Citation Nr: 18149899 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 14-34 214A DATE: November 14, 2018 ORDER Entitlement to service connection for diabetes mellitus, to include as due to herbicide exposure, is denied. Entitlement to service connection for hearing loss (claimed as left ear condition) is denied. The issue of entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. The issue of entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to diabetes mellitus, is denied. The issue of entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to diabetes mellitus, is denied. The issue of entitlement to service connection for a bilateral eye disability (claimed as diabetic retinopathy and loss of vision), to include as secondary to diabetes mellitus, is denied. The issue of entitlement to service connection for a sleep disorder with fatigue, to include as secondary to diabetes mellitus, is denied. The issue of entitlement to service connection for tinnitus is denied. REMANDED The issue of entitlement to service connection for residuals of a right ankle fracture is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has diabetes mellitus due to a disease or injury in service, to include a specific in-service event, injury, or disease. 2. The preponderance of the evidence is against finding that the Veteran has hearing loss (claimed as left ear condition) due to a disease or injury in service, to include a specific in-service event, injury, or disease. 3. The preponderance of the evidence is against finding that the Veteran has PTSD due to a disease or injury in service, to include a specific in-service event, injury, or disease. 4. The preponderance of the evidence is against finding that the Veteran has peripheral neuropathy of the bilateral upper extremities due to a disease or injury in service, to include a specific in-service event, injury, or disease, or service connected disability. 5. The preponderance of the evidence is against finding that the Veteran has peripheral neuropathy of the bilateral lower extremities due to a disease or injury in service, to include a specific in-service event, injury, or disease, or service connected disability. 6. The preponderance of the evidence is against finding that the Veteran has a bilateral eye disability (claimed as diabetic retinopathy and loss of vision) due to a disease or injury in service, to include a specific in-service event, injury, or disease, or service connected disability. 7. The preponderance of the evidence is against finding that the Veteran has a sleep disorder with fatigue due to a disease or injury in service, to include a specific in-service event, injury, or disease, or service connected disability. 8. The preponderance of the evidence is against finding that the Veteran has tinnitus due to a disease or injury in service, to include a specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus, as due to herbicide exposure, have not been met. 38 U.S.C. §§1101, 1110, 1111, 1112, 1116, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2017). 2. The criteria for service connection for hearing loss (claimed as left ear condition) have not been met. 38 U.S.C. §§1101, 1110, 1111, 1112, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2017). 3. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§1101, 1110, 1111, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017). 4. The criteria for service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§1101, 1110, 1111, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2017). 5. The criteria for service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§1101, 1110, 1111, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2017). 6. The criteria for service connection for bilateral eye disability (claimed as diabetic retinopathy and loss of vision), to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§1101, 1110, 1111, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2017). 7. The criteria for service connection for a sleep disorder with fatigue, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§1101, 1110, 1111, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2017). 8. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§1101, 1110, 1111, 1112, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1970 to November 1971. These matters come before the Board of Veterans’ Appeals (BVA or Board) on appeal from July 2011 and June 2012 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The Veteran originally requested a videoconference hearing before a Veterans Law Judge. The hearing was set for April 2018 and the Veteran was duly notified of this at his address of record. There is no indication in the claims file that the letter was returned or otherwise not received by the Veteran. The Veteran failed to appear at the April 2018 hearing and has not provided any good cause for such failure. Because the Veteran has not submitted good cause for his failure to appear, the request for a hearing is deemed withdrawn. See 38 C.F.R. § 20.704 (d) (2017) (failure to appear for a scheduled hearing treated as withdrawal of request). Rating actions are final and binding based on the evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 U.S.C. § 5108; 38 C.F.R. § 3.104 (a). The claimant has one year from the notification of an RO decision to initiate an appeal by filing a notice of disagreement with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105 (b), (c); 38 C.F.R. § 3.160 (d), 20.200, 20.201, 20.202, 20.302(a) (2017). However, if new and material evidence is presented or secured, VA shall reopen and review the former disposition of the claim. 38 U.S.C. § 5108 (2012). “New and material evidence” is defined as evidence not previously submitted to the agency decision makers which is neither cumulative or redundant, which by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim, and which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The Veteran’s claim for service connection for residuals of a right ankle fracture was denied in a June 1972 rating decision. At the time of the June 1972 rating decision, the evidence of record included partial service treatment records and records related to the medical evaluation board proceedings. Evidence added to the record since the June 1972 decision includes additional service treatment records. The service treatment records that have been associated with the record indicate that there were additional complaints and symptomatology related to the right ankle during service, other than those instances contained in the records at the time of the prior rating decision. Specifically, notations made in April 1971 and June 1971 reflect that the Veteran reported a right ankle strain, as well as pain. At any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of this section. 38 C.F.R. § 3.156 (c)(1). As relevant service treatment records were associated with the claims file that were not considered in the previous rating decision, the claim for service connection for a right ankle disability is not one to reopen but should be addressed on the merits. The claim is remanded below for further development. Service Connection Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. In addition, certain listed chronic diseases, such as diabetes mellitus, sensorineural hearing loss, and tinnitus may be presumed to have been incurred during service if the disease becomes manifest to a compensable degree within one year of separation from qualifying military service. 38 U.S.C. §§ 1101, 1112; Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.307(a)(3), 3.309(a). An alternative method of establishing incurrence or aggravation and a nexus to service is through a demonstration of continuity of symptomatology. 38 C.F.R. § 3.303(b). Continuity of symptomatology may be established if a claimant can demonstrate that a condition was noted during service; (2) there is a post-service continuity of the same symptomatology; and (3) a nexus between the present disability and the post-service symptomatology. The theory of continuity of symptomatology can be used only in cases involving those diseases explicitly recognized as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App 370, 374 (2002). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). However, although the Veteran is competent in certain situations to provide a diagnosis of a simple condition, the Veteran is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for diabetes mellitus, to include as due to herbicide exposure, and PTSD Service connection may be presumed for those exposed to particular herbicide agents. Veterans exposed to Agent Orange or other listed herbicide agents are presumed service-connected for certain conditions, including diabetes mellitus, even if there is no record of such disease during service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). VA regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period from January 9, 1962, to May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116 (2012); 38 C.F.R. § 3.307 (a)(6)(iii) (2017). For purposes of applying the presumption of exposure to herbicide agent under 38 C.F.R. § 3.307 (a)(6)(iii), the service member must have actually been present on the landmass or the inland waters of Vietnam during the Vietnam era. See Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008); cert. denied, 555 U.S. 1149 (2009). Generally, service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the in-service stressor occurred. 38 C.F.R. § 3.304(f). The evidence necessary to establish the occurrence of a recognizable stressor during service to support a diagnosis of PTSD will vary depending upon whether a veteran engaged in “combat with the enemy.” See Gaines v. West, 11 Vet. App. 353, 359 (1998). If VA determines that a veteran engaged in combat with the enemy and his alleged stressor is combat-related, then his lay testimony or statement is accepted as conclusive evidence of the stressor’s occurrence and no further development or corroborative evidence is required, provided that such testimony is found to be “satisfactory,” i.e., credible and “consistent with circumstances, conditions or hardships of service.” See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f)(2); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). Generally, where a determination is made that a veteran did not “engage in combat with the enemy,” or the claimed stressor is not related to combat, a veteran’s lay testimony alone will not be enough to establish the occurrence of the alleged stressor. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996); Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). In such cases, the record must contain service records or other corroborative evidence that substantiates or verifies the veteran’s testimony or statements as to the occurrence of the claimed stressor. See West (Carlton) v. Brown, 7 Vet. App. 70, 76 (1994); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). Regulation 38 C.F.R. § 3.304 (f) was further amended to read that 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 PTSD 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. The Veteran contends that his diabetes mellitus is a result of Agent Orange exposure while serving during the Vietnam era as a loadmaster in the United States Air Force. He does not contend, and the evidence of record does not otherwise suggest that his diabetes mellitus had its onset in service. The Veteran further contends that he has PTSD due to service in Vietnam. The records do not explicitly show that the Veteran set foot in the Republic of Vietnam. However, he has stated that he was in Vietnam to drop off supplies and to transport the bodies of deceased soldiers back to the United States. See Statements dated June 26, 2009 and January 5, 2010. In the June 2009 Statement in Support of Claim, the Veteran reported that he transported medical evacuations from Vietnam (Tan Son Nhut) to Kadena AFB to Hickam AFB and transported deceased combat soldiers from Vietnam (Tan Son Nhut) to Hickam AFB to Travis AFB six or seven times. Additionally, the Veteran’s brother reported that while on a Temporary Duty Assignment to the Canton Islands, he was visited by the Veteran. They “ate lunch and talked for a short time and off he went to Viet Nam to pick up some cargo. [The brother] later found out [the Veteran’s] cargo was bodies of soldiers that had died in battle for their country in Viet Nam.” See Buddy Statement dated September 17, 2010. The Veteran’s wife provided a statement that she later found out that the Veteran was responsible for bringing home soldiers that died in Vietnam. Additionally, the Veteran’s DD Form 214 reflects his military occupational specialty as a loadmaster and his branch as Air Force. The Veteran’s DD Form 214, however, does not show that he was awarded any medals indicative of service in Vietnam or service in other locations in support of military operations in Vietnam such as combat medals, the Vietnam Service Medal, or the Vietnam Campaign Medal. His DD Form 214 also does not reflect foreign service. The Veteran’s statements were forwarded to the Air Force Historical Research Agency (AFHRA) for purposes of verifying his accounts. The response in April 2010 was as follows: I have reviewed the official unit histories of both the 15th Military Airlift Squadron and its parent unit, the 63rd Military Airlift Wing in an effort to find any mention of an aeromedical evacuation mission by these units. I found none. In fact, there is a table in the 63rd Wing's history that breaks down each passenger category, one of which is patients. The number per month, for the months of January, February, and March 1971 is recorded as 'zero.' I have transcribed that table in the attached document. The attached are transcriptions of all references concerning flights conducted to Vietnam. Many flights were conducted to Vietnam and back, as the attached shows, but there is no mention in any of the mission statements for either the 15th or the 63rd as to having an aeromedical evacuation mission. To conduct such a mission, the C-141s that they flew had to be reconfigured from passenger and cargo carrying to patient litters, meal carts, and have an aeromedical evacuation squadron personnel to take care of the patients while en-route. The 63rd had no such equipment or personnel. The flying of human remains back from Vietnam, although not mentioned in the histories, would have been a routine mission. If a C-141 were tasked to fly human remains back to the United States, no passengers were allowed to be flown in that aircraft (unless an escort had been detailed for that duty). No cargo was to be put on the aircraft either. Only the dead, and the aircrew (and maybe an escort) were allowed to be on that flight. The flight was also supposed to fly directly from Tan Son Nhut (where all the deceased U.S. personnel were prepared for shipment) directly back to the United States with no stops. The flight was supposed to go directly to Travis AFB, California. From there, the dead were either flown to other parts of the United States, or picked up by commercial airlines to be shipped to destinations designated by their next of kin. Unfortunately, since the historians of both the 15th and 63rd did not specifically mention the flying home of human remains, I cannot confirm or deny that your veteran referenced below participated or not. However, C-141 aircraft were the aircraft of choice to bring the deceased back home as quickly as possible. Service personnel records show that the Veteran was stationed at Norton AFB. The Veteran was advised of the AFHRA findings in a July 2010 letter in which the RO also requested the following: Currently, we only have verification that you served at Norton Air Force Base and March Air Force Base, California with the 15th Military Alft Squadron as an aircraft loadmaster. In regards to your stressor statement, do you recall transporting deceased combat soldiers from off of planes that were returning from Vietnam while you were stationed at Norton AFB, California? If so, please supply us this information on the enclosed VA Form 21-0781, thank you. Thereafter, no specific response from the Veteran was received. In the July 2011 rating decision, the Veteran was again advised of the AFHRA findings and the July 2010 request for further information. In the November 2011 notice of disagreement, the Veteran did not provide a specific response to the denial of his claim. In the September 2014 statement of the case, the Veteran was again advised of the AFHRA findings and the July 2010 request for further information. In the October 2014 VA Form 9, the Veteran did not provide a specific response to the continued denial of his claim. As noted above, the Veteran failed to appear at the scheduled Board hearing. The Board finds that the lay statements simply do not withstand the substantial service department evidence (service personnel records, the AFHRA findings, and the DD Form 214) that shows no evidence of service in the Republic of Vietnam or service in support of military operations in Vietnam. The preponderance of the evidence is against the claims. Consequently, as the Veteran is not shown to have qualifying service, the presumption of service connection is not available. Additionally, there is insufficient corroborating evidence of the claimed in-service stressors. Accordingly, service connection for diabetes mellitus and PTSD is not warranted. 2. Entitlement to service connection for hearing loss (claimed as left ear condition) and tinnitus. Service connection for hearing loss may be granted where there is credible evidence of acoustic trauma in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service (as opposed to intercurrent causes). Hensley v. Brown, 5 Vet. App. 155, 159 (1993). 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, 4000 Hertz is 40 decibels or greater, or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hertz are 26 decibels or greater, or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Thresholds for normal hearing are between 0 and 20 decibels, and higher thresholds show some degree of hearing loss. Hensley, 5 Vet. App. at 157. The Veteran seeks service connection for hearing loss and tinnitus, which he contends is related to excessive noise exposure during his military service. An audiological examination was performed prior to the Veteran’s enlistment, which did not demonstrate hearing loss for VA purposes. A second evaluation, completed in August 1971, demonstrated an improvement in the Veteran’s hearing since the initial examination in May 1970. Additionally, he affirmatively denied having any audiological symptoms or disabilities during service. Thus, the service treatment records tend to establish that hearing loss and tinnitus were not present during active duty. A VA audiological examination conducted in December 2011 shows auditory thresholds as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 35 50 70 LEFT 20 50 70 65 70 Because there are auditory thresholds greater than 40 decibels in the ears, hearing loss for VA purposes is established. See 38 C.F.R. § 3.385. In light of this evidentiary record, the first requirement to establish service connection, evidence of a current disability, has been met. Next, the evidence of record indicates that the Veteran was exposed to noise during service. At the December 2011 examination, the Veteran stated that he was exposed to jet engine noise while working as a loadmaster in the Air Force. His DD 214 reflects that he did, in fact, serve as a loadmaster, while military personnel records confirm that he loaded and unloaded aircrafts during service. Thus, the Board finds the Veteran’s reports of in-service noise exposure to be credible. The Board finds that the record does not contain evidence indicating that it is at least as likely as not that the currently diagnosed hearing loss and tinnitus are a result of the noise exposure during service. The service treatment records show that on the separation Report of Medical History dated in August 1971, the Veteran did not report any relevant complaints. In the December 2011 VA examination report the Veteran reported constant severe tinnitus (worse in the left ear than the right ear) and that the onset occurred after he was pulled out of a plane with a paratrooper in February/March 1971. In the January 2012 VA opinion, the examiner maintained that since there is no documentation of tinnitus in the Veteran's service treatment records, based on the Veteran's history of inservice and post service noise exposure, it is not possible to determine if the tinnitus is related to inservice noise exposure without resorting to mere speculation. In a February 2014 VA opinion, the examiner determined the Veteran’s hearing loss was less likely as not related to his military noise exposure, based upon the lack of change in his hearing ability during service, as well as the delayed onset of the condition. The examiner cited to medical literature, which concluded that a prolonged delay in the onset of noise-induced hearing loss was unlikely. The study further determined that there was an insufficient scientific basis to conclude that permanent hearing loss directly attributable to noise exposure would develop long after such exposure. The Board finds that the VA examiner’s opinion is adequate and the most probative evidence of record on this matter. The examiner detailed the relevant evidence in the claims file, properly accepted as true the Veteran’s account of in-service noise exposure, and supported her conclusions with a medical study related to military noise exposure. Nevertheless, the examiner concluded that the Veteran’s current hearing loss was not causally or etiologically related to his military service, including noise exposure, based on a thorough review of the claims file and consideration of the Veteran’s service treatment records, which reflected no significant changes in his hearing abilities, and the available medical literature. In VA Form 9 dated in December 2014, the Veteran maintained that he started having ringing in his ears in service, and that the ringing in his ears has persisted all the years after service. The Veteran has contended on his own behalf that his hearing loss is related to his military service. The Board appreciates that the Veteran believes that his current disability is related to service, and that he is competent to report his personal observations. Layno; supra. However, the Board affords the lay opinion low probative value. Although lay persons are competent to provide opinions on some medical issues, see Kahana, supra, as to the specific issue in this case, determining whether a hearing disability from noise exposure that occurred decades earlier in service, falls outside the realm of common knowledge of a lay person. Jandreau; supra. The Board also notes that the Veteran submitted a private treatment record, dated February 10, 2015, which noted the Veteran’s current hearing loss and history of military noise exposure. The Veteran reported that he had ringing in his right ear only. The examiner noted an assessment of sensorineural hearing loss of both ears, and subjective tinnitus of the right ear. However, the private treatment provider did not conclude that the hearing loss and tinnitus were the result of such exposure. Thus, the Board finds the February 2014 VA opinion to be the only probative evidence of record. As for the tinnitus, the evidence contemporaneous to service is negative, including a lack of lay evidence. In regard to the current evidence, the Veteran reported tinnitus in both ears but worse in the left ear in 2011, tinnitus that occurs in both ears in 2014, and tinnitus that occurs in the right ear only in 2015. Unfortunately, due to the overall inconsistencies, the Board cannot render a finding that the lay evidence is reliable and therefore credible to establish the existence of a disability that was present in service and persisted ever since service. Also, the January 2012 VA opinion is inconclusive. The Veteran has not met his burden of proof, and thus the evidence of record is insufficient to substantiate the claim for service connection. See Madden v. Gober, 125 F.3d 1477, 1480-81 (Fed. Cir. 1997) (explicitly rejecting the argument that "the Board must accept a veteran's evidence at face value, and reject or discount it only on the basis of rebuttal evidence proffered by the agency" and holding that the Board must determine "the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence"). Although sensorineural hearing loss and tinnitus are subject to presumptive service connection, service connection would not be warranted unless the hearing loss and tinnitus manifested to a compensable degree within a year of the Veteran’s release from active service, or if he exhibited a continuity of symptomatology since that time. In this case, there is no persuasive evidence of hearing loss and tinnitus manifested to a compensable degree within one year from discharge, nor is there a credible showing of a continuity of symptomatology. In conclusion, the weight of the evidence is against the claims for service connection for hearing loss and tinnitus. Reasonable doubt does not arise and the claims are denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert; supra. 3. Entitlement to service connection for peripheral neuropathy of the upper and lower bilateral extremities, a bilateral eye disability, a sleep disorder with fatigue, and an inactive thyroid condition. Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated (worsened in severity beyond its natural progress) by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448–49 (1995). The Veteran does not contend, and the evidence of record does not otherwise suggest that his claimed disabilities had their onset in service. As discussed above, the Board finds that service connection for diabetes mellitus is not warranted. As the condition precedent of establishing service connection for diabetes mellitus has not been met, the claims of entitlement to secondary service connection cannot be substantiated. Accordingly, the claims are denied. REASONS FOR REMAND 1. The issue of entitlement to service connection for residuals of a right ankle fracture is remanded. Service treatment records reflect that the Veteran reported a history of a broken right leg at the time of enlistment. Additionally, these records reflect a history of a right ankle disability, with symptomatology present during active duty. Records related to the medical evaluation board proceedings indicate that the Veteran had a ligamentous injury to his right ankle, which pre-existed service. These records further noted “service aggravation.” Post-service medical records show that the Veteran injured his ankle again in March 1972. The Board finds that the Veteran should be afforded a VA examination and medical opinion. The matter is REMANDED for the following action: 1. The Veteran should be afforded an appropriate VA examination to determine the nature and etiology of his right ankle disability. The record should be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. The examiner is asked to accomplish the following: a) The examiner should opine as to whether the right ankle disability clearly and unmistakably pre-existed service. b) If so, provide an opinion as to whether the right ankle disability was clearly and unmistakably not aggravated beyond its natural progression during the Veteran’s active duty service. c) Also, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any current right ankle disability is etiologically related to any symptomatology noted in service. The examiner should specifically indicate the reasons and bases for the conclusions expressed. If the examiner is unable to offer the requested opinion, that person should offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Erin J. Trojanowski, Associate Counsel