Citation Nr: 18149956 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 11-00 285 DATE: November 14, 2018 ORDER Service connection for bilateral hearing loss is denied. Service connection for bilateral tinnitus is denied. Service connection for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The Veteran’s hearing loss did not have its onset during service, is not causally related to his active service, and did not manifest within one year after separation from active service. 2. The Veteran’s tinnitus did not have its onset during service, is not causally related to his active service, and did not manifest within one year after separation from active service. 3. The Veteran does not have a current diagnosis of PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 2. The criteria for service connection for bilateral tinnitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Air Force from June 1964 to May 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before a Decision Review Officer (DRO) in June 2010. This case was last before the Board in November 2011, at which time the Board remanded the above issues for additionally development. The case has been returned to the Board for further appellate review at this time following substantial compliance with the November 2011 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). “To establish a right to compensation for a present disability, a Veteran must show: ‘(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’ – the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain chronic diseases, including sensorineural hearing loss and tinnitus (organic diseases of the nervous system), may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Hearing Loss and Tinnitus The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For purposes of VA service connection and compensation, a hearing loss disability is determined through audiologic testing involving puretone frequency thresholds and speech discrimination criteria. 38 C.F.R. § 3.385. Service connection may not be found for disability due to hearing loss or impaired hearing unless the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. Id. The Veteran contends that he is entitled to service connection for hearing loss. He states that his hearing loss was due to sudden decompression in an altitude chamber on a C-130 aircraft while he was in service in 1964. The Veteran said that, as a result of the decompression, he ruptured both eardrums, which caused sudden onset hearing loss and bleeding from the nose and ears. The Veteran said he continued to fly on C-130s, and he ruptured his ear drums several times again after that day in the altitude chamber. He reported recurrent problems with ear pressure equalization, including one incident that required emergency room treatment, and he said his ear problems eventually caused him to be released from duty in the Air Force. The Veteran says his hearing loss has been present since 1964. At the Veteran’s September 2009 VA examination, the examiner diagnosed the Veteran with bilateral sensorineural hearing loss. Specifically, the Veteran had low-normal to moderately severe sensorineural hearing loss in his right ear and mild to moderately severe sensorineural hearing loss for his left ear. The VA examiner noted that the Veteran’s word recognition scores were excellent bilaterally. Speech audiometry showed the Veteran’s right ear with 94 percent speech discrimination and his left ear with 96 percent speech discrimination. The otoscopy revealed clear ear canals and intact tympanic membranes. However, the puretone audiometric examination for the Veteran’s right ear showed frequencies of 2,000, 3,000 and 4,000Hz at 30dB or greater, and the puretone audiometric examination for his left ear showed frequencies of 2,000, 3,000, and 4,000Hz at 40dB or greater. Thus, the Veteran meets the criteria for a current disability in the form of bilateral hearing loss, and he fulfills the first of the three requirements for service connection. 38 C.F.R. § 3.385; Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). To qualify for service connection for hearing loss, the Veteran must next have in-service incurrence or aggravation of his hearing loss disability. Several of the Veteran’s in-service medical examinations note issues with the Veteran’s ears. For example, an October 1964 health record notes aerotitis in the right ear but also notes that the condition had cleared by the time of that examination. A March 1965 examination noted history of an ear block in the right ear from an altitude chamber decent in October 1964, but it also noted that the Veteran had flown since without difficulty. At an annual flying physical examination dated March 1966, the Veteran reported ear blockage during the aforementioned altitude chamber flight and subsequently when flying in C-130 aircraft, though the examination also noted that the ears usually returned to normal within 3 to 4 days with antihistamine treatment. The examiners from April 1966 and May 1967 examinations also noted mild scarring of the left tympanic membrane. The VA examiner from a May 1967 examination noted that the Veteran had a history of ear blockage and three episodes of barotitis. The Veteran was also diagnosed with congenital narrowing of Eustachian tube. A March 1966 examination documented narrowing of Eustachian tube without sufficient passage to permit adequate flow of air into the middle ear, and it stated the Veteran was disqualified for flying class III. The May 1967 examination stated that the Veteran should receive a Medical Board for possible separation from service due to the Veteran’s inability to travel “by means available,” due to chronic difficulty cleaning his ears while flying because of congenital bilateral narrowing of the Eustachian tube. The Veteran’s Medical Board examination from May 1967 noted that his discharge was due to the congenital narrowing of the Eustachian tube that existed prior to service and was not aggravated by service. Congenital or developmental defects are not diseases or injuries within the meaning of applicable legislation and, thus, are not disabilities for which service connection may be granted. 38 C.F.R. §§ 3.303(c), 4.9; Beno v. Principi, 3 Vet. App. 439 (1992). The VA examiner from the September 2009 and July 2010 VA examinations said that the Veteran’s congenital narrowing of the Eustachian tube was less likely than not aggravated by service. The examiner based this opinion on the fact that the condition was congenital and existed prior to military service. Additionally, in July 2011, the Board requested a VHA opinion concerning specific questions about the Veteran’s hearing loss and tinnitus. The opining physician in the VHA opinion agreed that the narrowing of the Eustachian tube was congenital and had originated in childhood. The physician said that the in-service ruptured eardrum and recurrent aerotitis were not related to the narrowing of the Eustachian tube, nor did they constitute aggravation of the pre-existing condition beyond the natural progression of the condition. Importantly, the physician noted that the narrowing of the Eustachian tube is a middle ear problem, but the Veteran’s sensorineural hearing loss disability is related to his inner ear, not to his middle ear. Thus, because the narrowing of Eustachian tubes is a congenital and because the condition was not aggravated beyond its natural progression by the Veteran’s service, it is not subject to service connection under VA law. 38 C.F.R. §§ 3.303(c), 4.9; Beno v. Principi, 3 Vet. App. 439 (1992). While the service treatment records indicate various problems with the Veteran’s ears, the records do not indicate problems, complaints, diagnosis, or treatment of actual hearing loss. In the Veteran’s Report of Medical History at his enlistment in May 1964, the Veteran did not note any problems with his hearing, and he reported that he had never had ear trouble. The Veteran’s hearing was documented to be within normal limits at his enlistment examination in May 1964, as well as at physical examinations in June 1964 and March 1965. See 38 C.F.R. § 3.385; Hensley v. Brown, 5 Vet. App. 155, 157 (1993). At the Veteran’s separation examination in May 1967, the Veteran’s hearing was noted to be within normal limits in both ears with no significant hearing threshold shift since his enlistment audiogram. See Id. Audiology testing standards were set by the American Standards Association (ASA) until November 1, 1967. After that date, audiometric tests were conducted using International Standards Organization (ISO) or American National Standards Institute (ANSI) measurement. However, as it relates to VA examinations and VA records, audiological reports were routinely converted from ISO-ANSI results to ASA units until the end of 1975 because the regulatory standards for evaluating hearing loss were not changed to require ISO-ANSI units until September 9, 1975. Current VA regulations that define hearing loss for VA purposes are based on the dB measurement recorded in the ISO-ANSI units. 38 C.F.R. § 3.385. Accordingly, VA uses a system to convert ASA units to ISO-ANSI units that adds 15 dB to 500 Hz, 10 dB to 1000, 2000, and 3000 Hz, and 5 dB to 4000 Hz. In view of the fact the Veteran’s in-service audiometric examinations were likely conducted under ASA testing standards, the Board has applied the conversion standard to the Veteran’s in-service audiometric results. Even after conversion, the Veteran’s puretone thresholds were well within the range of normal hearing during service. However, the Veteran says he had noise exposure during service in the form of aircraft, engines, and machinery. He did not have hearing protection at the time. The Veteran also reported occupational noise exposure in his few years as an oilfield hand, during which hearing protection was not used. The Veteran is competent to give evidence where he has knowledge of facts or circumstances and where he conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). As such, the Board accepts that the Veteran was exposed to loud noise in service. Therefore, this issue turns on the third element of service connection—the “nexus” requirement—and whether the Veteran’s currently diagnosed hearing loss is causally related to his in-service noise exposure or ear trauma. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In comparing the Veteran’s audiometric findings at his enlistment and separation examinations, there do not appear to be puretone threshold shifts reflective of a worsening in the Veteran’s hearing acuity under VA standards. See 38 C.F.R. § 3.385. This is true even after conversion from ASA to ISO-ANSI audiology testing standards. Id. Indeed, the Veteran’s auditory thresholds in the left ear appear to have improved in the frequency of 4,000 Hz in his left ear. Thus, there is no indication in the Veteran’s service treatment records that the Veteran had a hearing loss disability under VA standards while in service. Id. There is also no evidence of record concerning hearing loss in the years immediately following the Veteran’s service. Thus, service connection may not be presumed here based on manifestation within one year of discharge from active service. The one-year presumption for sensorineural hearing loss under 38 C.F.R. §§ 3.307 and 3.309 is therefore not applicable in this case. See 38 U.S.C. §§ 1101, 1112. At the Veteran’s March 2009 VA examination, the Veteran mentioned he had ear pain, infections, and drainage related to flying in service and in 1981. However, he did not submit medical records from the period surrounding 1981. The Veteran also mentioned visiting a doctor in 1983 around the time he took an airplane to Hawaii with his sister, but the Veteran primarily talks about this doctor visit in reference to his fear of flying. It is unclear from the Veteran’s statement what he was treated for at this doctor visit or whether that doctor diagnosed him with any ear-related condition. Other than the above-mentioned statements by the Veteran, there is no objective evidence of record showing any complaint, diagnosis, or treatment of hearing loss for almost 42 years between the Veteran’s time in service and his claim for entitlement to service connection for hearing loss and tinnitus, which was received in January 2009. Under Maxson v. West, 12 Vet. App. 453 (1999), aff’d, 230 F.3d 1330 (Fed. Cir. 2000), a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim such that it weighs against the claim. The Veteran also says he has had exposure to noise in his post-service activities, including hunting and use of chainsaws, power tools, and lawn equipment without hearing protection. At the time of the Veteran’s September 2009 VA examination, service medical records from the claims file were not available for review, so the VA examiner said the requested opinion as to nexus in service connection could not be rendered without resorting to mere speculation. In a July 2010 VA examination, the September examiner reviewed the records, including the Veteran’s claims file and the September 2009 VA examination. The VA examiner determined that, as there was no significant change noted in hearing thresholds during service, and therefore the Veteran’s current hearing loss was not caused by service. In considering the Veteran’s service treatment records, the VA examiner noted that the tympanic membrane rupture from the altitude chamber incident healed spontaneously and that the Veteran’s documented aerotitis and barotrauma resolved themselves within 3 to 4 days after flying. She further noted that there was no current air/bone gap or conductive overlay to hearing loss that could be attributed to Eustachian tube dysfunction. Similarly, in the July 2011 VHA opinion, looking at the nexus question, the physician responded to the Board’s questions as follows: Is the Veteran’s current hearing loss disability due to narrowing of the Eustachian tubes? The answer to that question is no. This is a sensorineural loss in the inner ear. The Eustachian tubes are involved in the middle ear. Alternatively, is the Veteran’s current hearing loss disability due to the ruptured ear drums or recurrent aerotitis or noise exposure in service? The answer to that is the [Veteran] had normal hearing on discharge from the service; therefore, the current loss is not due to anything that took place in service. The July 2011 VHA examiner noted that there was “[n]o significant air/bone gap or conductive component was measured at either ear.” The examiner said this negates the Veteran’s in-service problems as the cause of the current hearing loss. The examiner agreed that, because there was no significant change noted in the hearing thresholds during military service, the hearing loss was not caused by the Veteran’s service. Thus, the Veteran’s problems in service did not produce any of his hearing loss. The Board has considered the Veteran’s contention that his hearing loss was the result sudden decompression in the C-130 altitude chamber, which occurred in 1964 while he was in service. However, the Veteran, as a layperson, is not competent to give a medical opinion on the etiology or cause of his hearing loss. As such, the Veteran’s assertion as to the origin of his hearing loss is not competent or probative evidence. The Veteran lacks the adequate medical expertise to render a medical opinion as to the etiology or cause of his hearing loss. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Although the Veteran stated that his hearing loss has been present since 1964 during his service, this assertion is not credible due to inconsistency with other evidence of record, including the Veteran’s service treatment records. In weighing credibility, the VA may consider inconsistent statements and consistency with other evidence of record. Caluza v. Brown, 7 Vet. App. 498 (1995). There is no evidence of hearing loss in his enlistment or separation examinations or in any other service treatment records. Thus, the probative value of the Veteran’s statements that his hearing loss had its onset during service is outweighed by the other evidence of record. Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the Veteran). Moreover, the Board finds the opinion of the September 2009 VA examiner in July 2010 and the VHA examiner’s opinion to be the most probative evidence of record concerning whether the Veteran’s current hearing loss disability is causally related to his time in service. Those examiners’ rationale are logical and well-reasoned and based on consideration of the Veteran’s reported history, service treatment records, and post-service history. Thus, the Board is satisfied that those examiners’ opinions are the most competent, credible, persuasive, and probative evidence of record. In short, although the Veteran may have a current disability of bilateral sensorineural hearing loss, a history of various issues with his ears, and exposure to noise and ear-related trauma during his service, the preponderance of the evidence of record in this case does not demonstrate that the Veteran’s current hearing loss was incurred in, aggravated by, or otherwise the result of his service. Therefore, the Veteran’s claim of service connection for bilateral hearing loss must be denied. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Turning to the Veteran’s tinnitus, the Veteran contends that he is entitled to service connection for tinnitus. The Veteran reported a history of “ringing” or noises in both ears. He said the tinnitus began in 1964 when he ruptured his ear drums as a result of sudden decompression in the C-130 altitude chamber. The Veteran reports that his tinnitus is moderately loud with constant high-pitched ringing. He said he hears mild to severe humming and buzzing, as well as constant bones popping sounds with jaw movement. He said the sounds bother him to the point of being intolerable. Additionally, the Veteran was diagnosed with bilateral tinnitus at a VA examination in March 2009. A VA examiner also noted the Veteran’s complaints of tinnitus at his VA examinations from September 2009 and July 2010. Thus, the first element of service connection, which requires a current disability, has been met. See Charles v. Principi, 16 Vet. App. 370, 374 (2002); Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Regarding the second element of service connection – in-service incurrence or aggravation of a disease or injury – as discussed earlier, several of the Veteran’s service treatment records note various issues with the Veteran’s ears, including the incident of sudden decompression in the altitude chamber in October 1964, which ruptured the Veteran’s ear drums and caused bleeding through the ears and nose. Even so, there were no complaints, diagnosis, or treatment of tinnitus in the Veteran’s service treatment records. However, as noted earlier, the Board accepts that the Veteran was exposed to loud noise in service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Thus, this claim turns on the third element of service connection—the “nexus” requirement—which here concerns whether the Veteran’s tinnitus was causally related to his in-service noise exposure or trauma to the ears. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). There is no diagnosis or treatment of tinnitus during the Veteran’s time in service, nor is there any complaint, diagnosis, or treatment of tinnitus in the years immediately following his time in service. Thus, the one-year presumption for tinnitus under 38 C.F.R. §§ 3.307 and 3.309 is not applicable here. See 38 U.S.C. §§ 1101, 1112. There is no objective evidence of record showing any complaint, diagnosis, or treatment of tinnitus for almost 42 years between the Veteran’s time in service and his claim of entitlement to service connection for hearing loss and tinnitus, which was received in January 2009. Under Maxson v. West, 12 Vet. App. 453 (1999), aff’d, 230 F.3d 1330 (Fed. Cir. 2000), a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim such that it weighs against the claim. The VA examiner at the September 2009 and July 2010 VA examination determined that, due to absence of a hearing threshold shift or complaints of tinnitus during service, it is less likely than not that the Veteran’s tinnitus was due to his time in service. As discussed earlier with hearing loss, the Board finds the July 2010 opinion from the September 2009 VA examiner to be the most probative evidence of record concerning whether the Veteran’s tinnitus is causally related to his time in service because the VA examiner’s opinion is well-reasoned and based on the record. The Board acknowledges the Veteran’s statements that his tinnitus is related to his time in service, specifically that the tinnitus started in 1964 after the incident of sudden decompression in the altitude chamber. However, as with hearing loss, the Veteran, as a layperson, is not competent to give a medical opinion on the etiology or cause of his tinnitus. As such, the Veteran’s assertion as to the origin of his tinnitus is not competent or probative evidence. The Veteran lacks the adequate medical expertise in this case to render a medical opinion. See Jandreau, 492 F.3d at 1376-77. Although the Veteran stated that he has had tinnitus since his service, this assertion is not credible due to inconsistency with other evidence of record, including the Veteran’s service treatment records. In weighing credibility, the VA may consider inconsistent statements and consistency with other evidence of record. Caluza v. Brown, 7 Vet. App. 498 (1995). There is no report of tinnitus or ringing in the ears in his enlistment or separation examinations or in any other service treatment records. Thus, the Veteran’s statements that his tinnitus had its onset during service are not entitled to probative weight. As with hearing loss, although the Veteran may have a current tinnitus disability, a history of various issues with his ears, and exposure to noise and ear-related trauma during service, the preponderance of the evidence of record in this case does not demonstrate that the Veteran’s tinnitus was incurred in or otherwise the result of his active service. Therefore, the Veteran’s claim of service connection for tinnitus must be denied. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of service connection for tinnitus, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 PTSD The Veteran contends that he has post-traumatic stress disorder (PTSD) related to his active service. The Veteran filed a claim of service connection for PTSD in April 2009. To establish entitlement to service connection for PTSD, in addition to the three basic elements of service connection discussed earlier, the record must contain the following: (1) medical evidence giving the Veteran a current diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). 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 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 and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, “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; vehicle-imbedded 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. 38 C.F.R. § 3.304(f)(3). If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2). Effective August 4, 2014, the VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to Diagnostic and Statistical Manual, 4th Edition (DSM-IV) and replacing those references with references to the recently updated DSM-V. Here, in November 2011, the Board remanded this case back to the RO for further development, and the case was re-certified to the Board after August 4, 2014. Therefore, the DSM-V applies. See 38 C.F.R. 3.304(f)(2); Molitor v. Shulkin, 28 Vet. App. 397, 410-11 (2017). The Veteran contends that he has PTSD due to his experiences related to his service in the U.S. Air Force. The Veteran said that, in October 1964 while flying in a C-130 aircraft, he experienced sudden decompression and ruptured his eardrums, which caused bleeding from the nose and ears. He was given a temporary order not to fly, and he was told that his ear problems should resolve in a few days. In March 1966, while in another aircraft, the Veteran had trouble equalizing the pressure in his ears; the feeling overwhelmed him, and he had to go to the emergency room. In April 1966, the flight surgeon told him never to get back on an airplane again because of his ear problems. In April 1967, when his Air Force squadron was about to go on a trip overseas, the Veteran went to his superior officer and told him that the flight surgeon had prohibited him from flying. The Veteran’s superior officer told him that he did not want him to come on the trip if he could not fly on airplanes. His superior officer sent him to the flight surgeon and said that if the flight surgeon could not clear him for flying status, then the Veteran could not be in the squadron. The flight surgeon looked at the Veteran’s medical records and called the superior officer. The superior officer told the flight surgeon that he did not want the Veteran in his squadron. The flight surgeon then said he had to put the Veteran out of service. The Veteran was discharged from service soon after. The Veteran first sought treatment for psychiatric problems in March 2009 when his primary care physician suggested he see a psychiatrist. In the March 2009 VA examination, the Veteran reported symptoms including poor interest, insomnia, hopelessness, worthlessness, emotional lability, poor memory, pre-occupation with repetitive thoughts or habits, low energy, and irritability. The VA examiner diagnosed the Veteran with major depressive disorder (MDD). The Veteran filed a claim of service connection for depression in May 2009. In November 2011, the Board granted the Veteran’s claim of service connection for MDD. Thus, the Board will not further discuss the Veteran’s MDD here. The Veteran’s March 2009 VA examination indicates under the old DSM-IV criteria that the Veteran had symptoms of PTSD relative to his discharge from the Air Force, including re-experiencing symptoms of nightmares, flashbacks, physiological or psychological distress; avoidance symptoms of diminished interest and hopelessness; and hyperarousal symptoms of insomnia, irritability or anger, and poor concentration. However, the VA examiner noted that the Veteran had not had an experience where he felt life was threatened, and there were no indications of an in-service stressor as required by VA law. See 38 C.F.R. § 3.304(f). Even though the VA examiner had noted the PTSD-related symptoms, the examiner ultimately diagnosed the Veteran with MDD, not PTSD. Several times throughout the Veteran’s medical history and statements concerning his situation, the Veteran indicated he was depressed because of difficulties related to his ears and hearing loss, the way he was treated when he came home from his time in service, and his frustration with the process of adjudicating his claims with the VA. The Veteran said his difficulty hearing and understanding others upset him and made him irritable. He said he felt ashamed that he was released from the Air Force for medical reasons related to his ears. He feels he was treated wrongly by the Air Force, his family, and his friends because of his ear problems, both during service and after his discharge. He said he has been denied jobs due to his service and discharge. The Veteran said he felt bad when he thought about the wars and the impact they have on the lives of young soldiers. He said he was also depressed by the fact that he has been unable to play his guitar by ear ever since his ear problems started. Furthermore, the Veteran said he was depressed because his VA claims have been repeatedly denied. Several of the VA examiners who have worked with the Veteran have determined that his main reasons for depression are problems with his hearing loss, his discharge from service, and his frustration with the process of adjudicating his VA claims. For example, in a May 31, 2011 Mental Health Evaluation, the examiner determined that the Veteran’s depression was more likely than not caused by or a result of the Veteran’s hearing loss and his medical discharge from the military due to repeated injuries to his ear. The Veteran reported frequent periods of depressed mood related to thoughts about his sense of shame and humiliation regarding his discharge from the military. The Veteran said his depression was also related to his feelings about his mistreatment by the military and to how he thinks his hearing loss has negatively affected his life. However, although the VA examiners acknowledge the Veteran’s symptoms and reasons for depression, the record does not contain any actual diagnosis of PTSD. At a VA examination on July 13, 2013 the Veteran said he had considered suicide through discontinuing the medications necessary for his survival. However, the VA examiner at that examination again diagnosed the Veteran with MDD, not PTSD. Additionally, treatment records show that, on other occasions, the Veteran consistently denied having suicidal thoughts or ideations. The Veteran claims to have seen combat in the Dominican Republic, and he was awarded the Air Force Expeditionary Medal for hostile service there. In a VA examination from May 2011, the Veteran reported traumatic events in his history such as emergency landings in a hailstorm and getting shot at in the Dominican Republic. However, he denied having any re-experiences, avoidance, or hyper-arousal symptoms related to these events. There is no evidence on record of connection between those events and any possible diagnosis of PTSD. At the Veteran’s most recent VA examination concerning his mental disorders in June 2017, the VA examiner, using the DSM-V criteria, diagnosed the Veteran with MDD and noted that the Veteran did not have any diagnosed mental disorder other than MDD. See 38 C.F.R. 3.304(f)(2); Molitor v. Shulkin, 28 Vet. App. 397, 410-11 (2017). The Board finds the June 2017 VA examination the most probative evidence of record regarding whether the Veteran has a current diagnosis of PTSD. In addition to using the current DSM-V criteria for evaluating claims of PTSD, the examiner reviewed the Veteran’s entire file, including the Veteran’s lay statements, VA claims file, and VA e-folder. Thus, the Board is satisfied that the June 2017 VA examiner’s opinion is competent, credible, persuasive, and probative for deciding this appeal. The Board acknowledges the Veteran’s contention that he currently has PTSD and that this is related to his time in service. However, the question of whether the Veteran meets the required diagnostic criteria for PTSD is a complex medical question that is not within the realm of knowledge of a lay person or determinable by observation with one’s senses. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Therefore, the Veteran’s statements are not competent evidence to determine whether the Veteran has PTSD and are therefore not probative for deciding this appeal. Without a current diagnosis of PTSD, the first requirement for establishing service connection for PTSD has not been met. Therefore, the Board finds the preponderance of the evidence is against a grant of service connection for PTSD. As such, the claim of entitlement to service connection for PTSD must be denied. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; McClain v. Nicholson, 21 Vet. App. 319 (2007) (the requirement that a current disability be present is satisfied “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim . . . even though the disability resolves prior to the Secretary's adjudication of the claim.”); Brammer v. Derwinski, 3 Vet. App. 223 (1995) (Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of service connection for PTSD, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Dawn A. Leung, Associate Counsel