Citation Nr: 18150689 Decision Date: 11/16/18 Archive Date: 11/15/18 DOCKET NO. 16-41 350 DATE: November 16, 2018 ORDER 1. The claim of entitlement to service connection for a low back disability is not reopened, and the appeal is denied. 2. The claim of entitlement to service connection for a bilateral foot disability is not reopened, and the appeal is denied. 3. Entitlement to service connection for a lung disability is denied. 4. Entitlement to service connection for a headache disability is denied. 5. Entitlement to service connection for lacrima-auriculo-dento-digital disease (LADD) is denied. 6. Entitlement to service connection for erectile dysfunction is denied. 7. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities is denied. 8. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is denied. 9. Entitlement to service connection for diabetes mellitus is denied. 10. Entitlement to service connection for an enlarged prostate condition is denied. 11. Entitlement to service connection for an acquired psychiatric disorder, to include depression and anxiety, is denied. 12. Entitlement to service connection for obstructive sleep apnea is denied. 13. Entitlement to service connection for hypertension is denied. 14. Entitlement to a compensable rating for bilateral hearing loss is denied. 15. Entitlement to an increased rating in excess of 10 percent for tinnitus is denied. FINDINGS OF FACT 1. Final April 2014 and August 2014 rating decisions denied the Veteran’s claims for service connection for a low back disability and a bilateral foot disability, respectively; although notified of the decision, the Veteran did not express an intent to appeal the decisions, and new and material evidence was not added within one year of those decisions. 2. Additional evidence associated with the claims file since the April 2014 rating decision is cumulative and redundant of the evidence of record at the time of the prior denial, it does not relate to unestablished facts necessary to substantiate his claim for service connection for a low back disability, and it does not raise a reasonable possibility of substantiating the claim. 3. Additional evidence associated with the claims file since the August 2014 rating decision is cumulative and redundant of the evidence of record at the time of the prior denial, it does not relate to unestablished facts necessary to substantiate his claim for service connection for a bilateral foot disability, and it does not raise a reasonable possibility of substantiating the claim. 4. The Veteran has not been diagnosed with a lung disability during the pendency of his claim. 5. The Veteran has not been diagnosed with a headache disability during the pendency of his claim. 6. The Veteran has not been diagnosed with LADD during the pendency of his claim. 7. The Veteran has not been diagnosed with erectile dysfunction during the pendency of his claim. 8. The preponderance of the evidence shows that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities is not related to service and did not manifest itself to a compensable degree within one year of service. 9. The preponderance of the evidence shows that the Veteran’s diabetes mellitus is not related to service and did not manifest itself to a compensable degree within one year of service. 10. The preponderance of the evidence shows that the Veteran’s enlarged prostate condition did not have its onset in service and is not etiologically related to service. 11. The preponderance of the evidence shows that the Veteran’s acquired psychiatric disorder did not have its onset in service and is not etiologically related to service. 12. The preponderance of the evidence shows that the Veteran’s sleep apnea did not have its onset in service and is not etiologically related to service. 13. The preponderance of the evidence shows that the Veteran’s hypertension is not related to service and did not manifest itself to a compensable degree within one year of service. 14. During the appeal period, the Veteran’s bilateral hearing loss has been manifested, at its worst, by Level I hearing loss. 15. The Veteran’s service-connected bilateral tinnitus is assigned a 10 percent rating, the maximum rating authorized under Diagnostic Code (DC) 6260. CONCLUSIONS OF LAW 1. The April 2014 and August 2014 rating decisions that denied service connection for a low back disability and bilateral foot disability are final. 38 U.S.C. § 7105 (c) (2012); 38 C.F.R. § 3.104, 20.302, 20.1103 (2017). 2. As evidence received since the April 2014 rating decision is not new and material, the criteria for reopening the Veteran’s claim for service connection for a low back disability are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 3. As evidence received since the August 2014 rating decision is not new and material, the criteria for reopening the Veteran’s claim for service connection for a bilateral foot disability are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2017). 4. The criteria for entitlement to service connection for a lung disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 5. The criteria for entitlement to service connection for a headache disability have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 6. The criteria for entitlement to service connection for LADD have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 7. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 8. The criteria for entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5103(a), 5103A; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2017). 9. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5103(a), 5103A; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2017). 10. The criteria for entitlement to service connection for an enlarged prostate condition have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 11. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 12. The criteria for entitlement to service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 13. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5103(a), 5103A; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2017). 14. The criteria for a compensable disability rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.85, 4.86, DC 6100 (2017). 15. There is no legal basis for the assignment of a schedular evaluation in excess of 10 percent for bilateral tinnitus. 38 U.S.C. §1155 (2012); 38 C.F.R. § 4.87, DC 6260 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1973 to September 1975. The Board notes that the Veteran reported service in Vietnam to a treatment provider in February 2014. However, military personnel records do not indicate that he had service in Vietnam while on active duty. These matters come before the Board of Veterans’ Appeals (BVA or Board) on appeal from a January 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. In September 2017, the Veteran’s representative submitted correspondence indicating that he was withdrawing as the appointed representative. Thus, the Veteran is currently unrepresented in this appeal. The Board notes that the United States Court of Appeals for Veterans Claims (Court) has held that the Board must broadly construe claims. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran has alleged multiple psychiatric symptoms, and has been diagnosed with depression and anxiety. Accordingly, the issue on the title page reflects the expanded issue. The issue of entitlement to an earlier effective date for tinnitus was raised in the March 2016 Notice of Disagreement, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over this issue, and it is referred to the AOJ for appropriate action. 38 C.F.R. § 19.9 (b) (2017). New and Material Evidence 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 Court has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what evidence is new and material, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court further held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). 1. The claim of entitlement to service connection for a low back disability is not reopened, and the appeal is denied. The Veteran’s claim for service connection for a low back disability was denied in an April 2014 rating decision. The RO determined that the evidence of record failed to demonstrate that the Veteran had a current diagnosis of a low back disability. At the time of the April 2014 rating decision, the evidence of record included service treatment records. The Veteran was notified of the decision and his appellate rights in April 2014. However, he did not file a notice of disagreement in response to the rating decision. No further communication regarding his claim was received until November 2015, when VA received his petition to reopen. Therefore, the April 2014 rating decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. § 3.104, 20.302, 20.1103. Evidence added to the record since the April 2014 rating decision includes post-service VA treatment records and the Veteran’s lay statements. The new evidence of record does not contain any indication that the Veteran has a current diagnosis of a back disability. Although he has reported that he broke his tailbone during service, the additional evidence of record does not further suggest that a current back condition exists. Thus, the new evidence of record does not suggest that the Veteran has a diagnosed back disability and cannot be considered new and material evidence. In sum, as the evidence submitted since the April 2014 rating decision is not new and material, the claim for service connection for a low back disability is not reopened and the appeal is denied. 2. The claim of entitlement to service connection for a bilateral foot disability is not reopened, and the appeal is denied. The Veteran’s claim for service connection for a bilateral foot disability was denied in an August 2014 rating decision. The RO determined that the evidence of record failed to demonstrate that any foot disability was related to his military service. At the time of the August 2014 rating decision, the evidence of record included service treatment records, private treatment records, and post-service VA treatment records. The Veteran was notified of the decision and his appellate rights in August 2014. However, he did not file a notice of disagreement in response to the rating decision. No further communication regarding his claim was received until November 2015, when VA received his petition to reopen. Therefore, the August 2014 rating decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. § 3.104, 20.302, 20.1103. Evidence added to the record since the August 2014 rating decision includes additional VA treatment records and the Veteran’s lay statements. The new evidence of record does not contain any indication that any foot disability is related to the Veteran’s military service. The Board notes that he has reported that an in-service incident occurred, in which he burned his feet during basic training. However, there is no evidence that he has a current diagnosis of a bilateral foot disability for which service connection can be granted. Thus, his assertions cannot be considered new and material evidence, as they do not raise a reasonable possibility of substantiating the claim. Furthermore, the additional medical evidence of record is not considered new, as it demonstrates an absence of a current diagnosis of a bilateral foot disability. Thus, the new evidence of record does not suggest that there is a diagnosis that can be linked to his military service and cannot be considered new and material evidence. In sum, as the evidence submitted since the August 2014 rating decision is not new and material, the claim for service connection for a bilateral foot disability is not reopened and the appeal is denied. 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, certain listed chronic diseases, such as peripheral neuropathy, diabetes, and hypertension, 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). In this case, there is no probative evidence of peripheral neuropathy, diabetes, or hypertension manifested to a compensable degree within one year from discharge, nor is there probative evidence demonstrating continuity of symptomatology. Thus, service connection under 38 C.F.R. § 3.309(a) is not warranted for these disabilities. Additionally, 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 a lung disability, a headache disability, LADD, and erectile dysfunction is denied. The Veteran contends that he has a lung disability, headaches, LADD, and erectile dysfunction that are related to his service. Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); see Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a Veteran has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability 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. Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1. See Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995). In the instant case, the Board notes that the service treatment records reflect complaints of headaches in December 1973 and June 1974. However, the probative evidence of record fails to demonstrate a current diagnosis of a lung disability, a chronic headache disorder, LADD, or erectile dysfunction. While the Board has also considered the Court’s holding in Romanowsky, supra, there is also no probative evidence of a recent diagnosis of these disabilities prior to the Veteran’s claims. The Board has considered the Veteran’s general allegations that he experienced these disabilities as a result of service. In this regard, while he is competent to report having pain or discomfort, the evidentiary record does not reflect that this pain or discomfort has been attributed to any specific disability. The Board notes that the Veteran is competent to report his own symptoms or matters within his personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (the Board’s categorical statement that ‘a valid medical opinion’ was required to establish nexus, and that a layperson was ‘not competent’ to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). However, the matters of a medical diagnosis for a disability not capable of lay observation, such as those at issue here, are matters within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Specifically, the diagnosis of a lung disability, a chronic headache disability, LADD, and erectile dysfunction involves medical subjects concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of specialized testing. In the instant case, there is no suggestion that the Veteran has had any medical training. Therefore, as the Veteran does not have the appropriate medical training and expertise to competently self-diagnose a lung disability, a chronic headache disability, LADD, or erectile dysfunction, the lay assertions in this regard have no probative value. Jandreau, supra at 1377 n.4 (“[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer”); see also Woehlaert, supra. There is also no persuasive evidence that he has symptoms that result in any functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that a “disability” under 38 U.S.C. § 1110 refers to functional impairment of earning capacity). The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Thus, where, as here, the probative evidence indicates that the Veteran does not have a current diagnosis of a lung disability, a headache disability, LADD, or erectile dysfunction for the entire appeal period; there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer, supra. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection for a lung disability, a headache disability, LADD, or erectile dysfunction. As such, that doctrine is not applicable in the instant appeals, and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 2. Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities is denied. Post-service VA treatment records indicate that the Veteran has been diagnosed with neuropathy. See February 14, 2014 VA Treatment Record. The Board finds that service connection is not warranted for peripheral neuropathy. Initially, the Board finds a preponderance of the evidence shows that neuropathy was not present during active duty. The Veteran’s service treatment records do not show any complaints, treatment or diagnoses related to peripheral neuropathy. Although he reported seeking treatment from neurologists in the 1990’s, the earliest post-service evidence of neuropathy, in which a private treatment provider noted peripheral neuropathy, is dated in February 2010, approximately 35 years after separation from service. In this regard, evidence of a prolonged period without medical complaint, and the amount of time that elapsed since military service, can be considered as evidence against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Here, there is no competent evidence of record indicating that the diagnosed neuropathy is due to any disease or injury from military service. Although the Veteran contends that his neuropathy is related to wearing boots that were too small during his military service, the record does not include probative evidence linking his peripheral neuropathy to service. Furthermore, his lay opinion concerning this matter requiring medical expertise is not competent evidence of the alleged nexus. See Jandreau, supra. The Board notes that the record contains no probative evidence in support of a relationship between the diagnosed peripheral neuropathy and the Veteran’s active duty service. As such, the preponderance of the evidence is against entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As there is no indication in the evidence that the neuropathy is related to service, there is no duty to provide the Veteran with a VA examination. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i); see also Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (distinguishing cases where only a conclusory generalized statement is provided by the veteran and rejecting the theory that medical examinations are to be routinely and virtually automatically provided to all veterans in disability cases involving nexus issues). 3. Entitlement to service connection for diabetes mellitus is denied. Post-service VA treatment records indicate that the Veteran has been diagnosed with diabetes mellitus. See September 15, 2014 VA Treatment Record. The Board finds that service connection is not warranted for diabetes. Initially, the Board finds a preponderance of the evidence shows that diabetes mellitus was not present during active duty. The Veteran’s service treatment records do not show any complaints, treatment or diagnoses related to diabetes. Additionally, he has not alleged a specific in-service event to which this disability is related. Applicable clinical evaluation was normal throughout service, and the earliest post-service evidence of diabetes mellitus, in which a VA treatment provider noted the diagnosis, is dated in February 2014, approximately 39 years after service separation. Maxson, supra. Here, there is no competent evidence of record indicating that the diagnosed diabetes mellitus is due to any disease or injury from military service. Although the Veteran contends that his diabetes is related to his military service, the record does not include probative evidence linking his diabetes to service. Furthermore, his lay opinion concerning this matter requiring medical expertise is not competent evidence of the alleged nexus. See Jandreau, supra. The Board also notes that the record contains no evidence in support of a relationship between the diagnosed diabetes mellitus and the Veteran’s active duty service. As such, the preponderance of the evidence is against entitlement to service connection for diabetes mellitus. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As there is no indication in the evidence that the diabetes is related to service, there is no duty to provide the Veteran with a VA examination. McLendon, supra. 4. Entitlement to service connection for an enlarged prostate condition is denied. Post-service VA treatment records indicate that the Veteran has been diagnosed with benign prostatic hypertrophy. See September 15, 2014 VA Treatment Record. The Board finds that service connection is not warranted for an enlarged prostate condition. Initially, the Board finds a preponderance of the evidence shows that this condition was not present during active duty. The Veteran’s service treatment records do not show any complaints, treatment or diagnoses related to an enlarged prostate. Additionally, he has not alleged a specific in-service event to which this disability is related. Applicable clinical evaluation was normal throughout service, and the earliest post-service evidence of this condition, in which a private treatment provider noted prostate firmness, is dated in May 2010, approximately 35 years after service separation. Maxson, supra. Here, there is no competent evidence of record indicating that the diagnosed prostate condition is due to any disease or injury from military service. Although the Veteran contends that his enlarged prostate is related to his military service, the record does not include probative evidence linking this condition to service. Furthermore, his lay opinion concerning this matter requiring medical expertise is not competent evidence of the alleged nexus. See Jandreau, supra. The Board also notes that the record contains no evidence in support of a relationship between the diagnosed prostatic hypertrophy and the Veteran’s active duty service. As such, the preponderance of the evidence is against entitlement to service connection for an enlarged prostate condition. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As there is no indication in the evidence that this condition is related to service, there is no duty to provide the Veteran with a VA examination. McLendon, supra. 5. Entitlement to service connection for an acquired psychiatric disorder, to include depression and anxiety, is denied. Post-service VA treatment records indicate that the Veteran has been diagnosed with depression and anxiety. See April 14, 2014 and September 15, 2014 VA Treatment Records. The Board finds that service connection is not warranted for an acquired psychiatric disorder. Initially, the Board finds a preponderance of the evidence shows that psychiatric symptoms were not present during active duty. The Veteran’s service treatment records do not show any complaints, treatment or diagnoses related to depression or anxiety. Although the Veteran contends that his anxiety resulted from poor treatment during basic training, the earliest post-service evidence of depression, in which a private treatment provider noted the diagnosis, is dated in May 2010, approximately 35 years after separation from service. Maxson, supra. Here, there is no competent evidence of record indicating that the diagnosed psychiatric disorder is due to any disease or injury from military service. The only evidence of record that the Veteran's depression and anxiety are in any way related to his military service are the lay assertions of record. The issue of whether a lay person is competent to diagnose depression and anxiety and opine as to its cause is not unique to veterans law. See generally Restatement (Third) of Torts: Phys. & Emot. Harm, § 4 (2010) (reviewing evidentiary rulings on proving the existence of emotional harm and its likely causes from several jurisdictions). To the extent that other courts have addressed the weight to be given to lay evidence on this issue, the Board finds the logic and reasoning of these cases useful. Generally, courts have required objective indicia or "some guarantee of genuineness" sufficient to verify the existence of a mental injury or emotional harm. Johnson v. State, 334 N.E.2d 590, 592 (N.Y. 1975). The rationale given for this rule is that mental disturbance is easily simulated. The requirement of objective indicia may be met by clear medical proof of the existence of the claimed injury. The Board concludes that this rule is compatible with the veterans benefits system. VA regulations already require medical proof that psychoses and posttraumatic stress disorder are diagnosed in conformity with the medical standards contained in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorder, Fifth Ed. See 38 C.F.R. §§ 3.304 (f), 3.384, 4.125(a) (2017). Although the Board recognizes that a lay person may competently report subjective feelings, the Board looks to the medical evidence of record to determine whether a current psychiatric disability exists, and whether it is etiologically related to service. Here, there is no medical opinion evidence linking the Veteran's psychiatric disorder to service. While psychoses are diseases subject to the chronic disease presumption, depression and anxiety are not enumerated psychoses under 38 C.F.R. § 3.384, which lists what psychiatric disorders fall under this definition. Therefore, service connection based on presumptive service connection or continuity of symptomatology is not warranted for either disability. As such, the preponderance of the evidence is against entitlement to service connection for an acquired psychiatric disorder. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As there is no indication in the evidence that the psychiatric disabilities are related to service, there is no duty to provide the Veteran with a VA examination. McLendon, supra. 6. Entitlement to service connection for obstructive sleep apnea is denied. Post-service VA treatment records indicate that the Veteran has been diagnosed with obstructive sleep apnea. See October 14, 2015 VA Treatment Record. The Board finds that service connection is not warranted for sleep apnea. Initially, the Board finds a preponderance of the evidence shows that this condition was not present during active duty. The Veteran’s service treatment records do not show any complaints, treatment or diagnoses related to sleep apnea. Additionally, he has not alleged a specific in-service event to which this disability is related. Applicable clinical evaluation was normal throughout service, and the earliest post-service evidence of sleep apnea, in which a private treatment provider noted the diagnosis, is dated in October 2014, approximately 39 years after service separation. Maxson, supra. Here, there is no competent evidence of record indicating that the diagnosed sleep apnea is due to any disease or injury from military service. Although the Veteran contends that his sleep apnea is related to his military service, the record does not include probative evidence linking this condition to service. Furthermore, his lay opinion concerning this matter requiring medical expertise is not competent evidence of the alleged nexus. See Jandreau, supra. The Board also notes that the record contains no evidence in support of a relationship between the diagnosed obstructive sleep apnea and the Veteran’s active duty service. As such, the preponderance of the evidence is against entitlement to service connection for sleep apnea. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As there is no indication in the evidence that the sleep apnea is related to service, there is no duty to provide the Veteran with a VA examination. McLendon, supra. 7. Entitlement to service connection for hypertension is denied. For VA purposes, the term hypertension means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104 (Note (1) to DC 7101). DC 7101 provides that hypertensive vascular disease with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control, is to be rated as 10 percent disabling. 38 C.F.R. § 4.104, DC 7101. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. In this case, the preponderance of the evidence is against a finding that the Veteran’s hypertension had its onset in or is related to an injury or disease incurred in service, or manifested to a compensable degree within one year of his separation from active military service. There is no dispute that the Veteran has a current diagnosis of hypertension. See November 5, 2010 Private Treatment Record. His service treatment records show that he was not diagnosed or treated for hypertension or high blood pressure, nor is there evidence that he demonstrated high blood pressure in service. Additionally, he has not alleged a specific in-service event to which this disability is related. Likewise, there is no evidence in the record showing that he was diagnosed with or treated for hypertension or high blood pressure within one year of his separation from active duty service, or that his hypertension manifested to a compensable degree during that time. The first notation in the record referencing high blood pressure is in February 2010. His blood pressure at that time was 144/96. Thus, the Board finds that the Veteran’s hypertension did not manifest within one year of separation from active duty. 38 C.F.R. §§ 3.307, 3.309. Although the Veteran contends that the hypertension is related to his military service, the record does not include probative evidence linking his hypertension to service. The Board notes that although the Veteran linked his hypertension to his military service, his lay opinion concerning this matter requiring medical expertise is not competent evidence of the alleged nexus. See Jandreau, supra. As such, the preponderance of the evidence is against service connection for a hypertension. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As there is no indication in the evidence that the hypertension is related to service, there is no duty to provide the Veteran with a VA examination. McLendon, supra. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Where a claimant appeals the denial of a claim of an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). Staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 50 (2007). 1. Entitlement to a compensable rating for bilateral hearing loss is denied. The Rating Schedule provides a table for ratings purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, established by a state-licensed audiologist including a controlled speech discrimination test (Maryland CNC), and based upon a combination of the percent of speech discrimination and the puretone threshold average which is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four. See 38 C.F.R. § 4.85. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal row represents the ear having the poorer hearing and the vertical column represents the ear having the better hearing. Id. Table VIA is used when the examiner certifies that the use of speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of 38 C.F.R. § 4.86. 38 C.F.R. § 4.85 (c). When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86 (a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86 (b). To evaluate the degree of disability from defective hearing, the rating schedule establishes eleven auditory acuity levels designated from I for essentially normal acuity, through XI for profound deafness. 38 C.F.R. § 4.85, Tables VI, VII. A 10 percent evaluation is provided where hearing in the better ear is I and hearing in the poorer ear is X and XI; where hearing in the better ear is II and hearing in the poorer ear is V to XI; where hearing in the better ear is III and hearing in the poorer ear is IV to VI; or where hearing in the better ear is IV and hearing in the poorer ear IV to V. 38 C.F.R. § 4.85, Table VII, DC 6100. The next higher evaluation of 20 percent is provided where hearing in the better ear is III and hearing in the poorer ear is VII to XI; where hearing in the better ear is IV and hearing in the poorer ear is VI to VII; or where hearing in the better ear is V and hearing in the poorer ear V and VI. 38 C.F.R. § 4.85, Table VII, DC 6100. Pertinent case law provides that the assignment of disability ratings for hearing impairment are to be derived by the mechanical application of the Ratings Schedule to the numeric designations assigned after audiometry evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). In Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the Court held that relevant to VA audiological examinations, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Id. At a December 2015 VA audiological examination, the Veteran described difficulty hearing background noise and the television. An audiogram revealed the following puretone thresholds, in decibels: HERTZ 500 1000 2000 3000 4000 LEFT 25 30 30 35 35 RIGHT 20 25 20 25 15 The puretone threshold average was 21 in the right ear and 33 in the left ear. Speech recognition testing using the Maryland CNC Word List revealed speech recognition ability of 94 percent in both ears. Using Table VI, these audiometry test results equated to Level I in both ears. 38 C.F.R. § 4.85. Applying these levels to Table VII, the Veteran’s hearing acuity equated to a 0 percent disability rating. 38 C.F.R. § 4.85. The examiner noted that the Veteran had sensorineural hearing loss in both ears. Subsequent VA and private treatment records do not indicate the Veteran’s hearing acuity has altered since the time of the VA examination. The Board has considered the Veteran’s lay statements and acknowledges that he is competent to give evidence about what he has experienced or observed. However, these assertions are outweighed by the VA examination report, which evaluated both ears. Additionally, the VA examination report was based upon an interview with the Veteran, an examination, review of the Veteran’s VA treatment records, and the VA examiner’s medical expertise. Based on the foregoing, the Veteran’s bilateral hearing loss warrants a noncompensable rating under 38 C.F.R. 4.85, DC 6100. 2. Entitlement to an increased rating in excess of 10 percent for tinnitus is denied. The Veteran was awarded service connection for tinnitus with an evaluation of 10 percent by way of a December 2013 rating decision. In November 2015, the Veteran filed a claim for an increased rating for the service-connected tinnitus. Under 38 C.F.R. § 4.87, DC 6260, there is no provision for assignment of a rating in excess of 10 percent for tinnitus, including no rating allowing separate 10 percent rating for tinnitus of each ear. In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the United States Court of Appeals for the Federal Circuit concluded that 38 C.F.R. § 4.25 (b) and 38 C.F.R. § 4.87, DC 6260, limit a Veteran to a single disability rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. The Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available for tinnitus. 38 C.F.R. §4.87, DC 6260. As there is no legal basis upon which to award an increase, to include separate schedular ratings for tinnitus in each ear, the Veteran’s appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Erin J. Trojanowski, Associate Counsel