Citation Nr: 18150992 Decision Date: 11/20/18 Archive Date: 11/16/18 DOCKET NO. 14-35 220A DATE: November 20, 2018 ORDER Entitlement to service connection for a left shoulder disorder, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for a right shoulder disorder, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for a left thumb disorder, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for a right thumb disorder, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for a neck disorder, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for hypertension, to include as due to exposure to Agent Orange or as secondary to service-connected diabetes mellitus is denied. Entitlement to service connection for a kidney disorder, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for a dental disorder, to include as due to exposure to Agent Orange is denied. REMANDED Entitlement to an initial compensable rating for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The competent, probative evidence of record fails to relate a left shoulder disorder to service. 2. The competent, probative evidence of record fails to relate a right shoulder disorder to service. 3. The competent, probative evidence of record fails to relate a left thumb disorder to service. 4. The competent, probative evidence of record fails to relate a right thumb disorder to service. 5. The competent, probative evidence of record fails to relate a neck disorder to service. 6. The competent, probative evidence of record fails to relate a kidney disorder to service or a service-connected disability. 7. The competent, probative evidence of record fails to relate hypertension to service or a service-connected disability. 8. The record does not reflect the Veteran has a current dental disorder for which VA compensation may be paid; and the preponderance of the competent medical and other evidence of record is against a finding any current dental condition is due to in-service dental trauma. CONCLUSIONS OF LAW 1. The criteria for service connection for a left shoulder disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for a right shoulder disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 3. The criteria for service connection for a left thumb disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 4. The criteria for service connection for a right thumb disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 5. The criteria for service connection for a neck disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 6. The criteria for service connection for a kidney disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2017). 7. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2017). 8. The criteria for service connection for residuals of a dental injury for compensation purposes are not met. 38 U.S.C. §§ 1110, 1131, 1712, 5107; 38 C.F.R. §§ 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1965 to September 1967, with service in the Republic of Vietnam. In May 2018, the Veteran presented testimony before the undersigned Veterans Law Judge at a videoconference hearing. A transcript of the proceedings has been associated with the electronic claims file. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish entitlement to service connection for a 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). As an initial matter, the Board notes that the Veteran has current diagnoses of hypertension, kidney stones, and arthritis of the bilateral shoulders, thumbs, and neck. See April 2016 VA examination, May 2018 statement, and February 2016 VA treatment records. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established for a chronic disease as enumerated for VA compensation purposes, to include hypertension and arthritis, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection for an enumerated “chronic disease” listed under 38 C.F.R. § 3.309(a) can also be also be established on a presumptive basis by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). That is, under 38 C.F.R. § 3.303(b), with an enumerated “chronic disease” such as hypertension or arthritis are shown in service (or within the presumptive period under § 3.307), subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. See also Groves v. Peake, 524 F.3d 1306, 1309 (2008). This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clear cut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity of symptomatology. 38 C.F.R. § 3.303(b). In the present case, the Veteran’s service treatment records do not show in-service diagnoses of arthritis of the shoulders, thumbs, or neck, or a diagnosis of hypertension. Further, there is no medical evidence that these conditions manifested within one year of service, as will be further discussed below. Thus, presumptive service connection for these disorders pursuant to 38 C.F.R. § 3.307 is not established. The law also provides that diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). Section 3.307(d)(6) provides that the term “herbicide agent” or, Agent Orange, means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. 38 C.F.R. § 3.307(d)(6)(i). Section 3.307(d)(6) also provides that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on 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 C.F.R. § 3.307(d)(6)(iii). Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. Id. The diseases presumed to be associated with herbicide exposure include: chloracne or other acneform diseases consistent with chloracne, type 2 diabetes (also known as type II diabetes or adult-onset diabetes), Hodgkin’s disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina), all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia), multiple myeloma, non-Hodgkin’s lymphoma, Parkinson’s disease, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). 38 C.F.R. § 3.309(e). However, for purposes of presumptive service connection due to herbicide exposure, the term “ischemic heart disease” does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. 38 C.F.R. § 3.309(e), Note 2 (codified at 38 C.F.R. pt. 4); 75 Fed. Reg. 53,202-53,205 (August 31, 2010). VA has determined that there is no positive association between exposure to herbicides and any other condition for which he has not specifically determined a presumption of service connection is warranted. See Diseases Not Associated with Exposure to Certain Herbicide Agents, 75 Fed. Reg. 81,332 (Dec. 27, 2010); see also Determinations Concerning Illnesses Discussed in National Academy of Sciences Report: Veterans and Agent Orange, 77 Fed. Reg. 47,924 (Aug. 10, 2012). Here, despite the Veteran’s conceded exposure to Agent Orange as a result of his service in the Republic of Vietnam, none of the Veteran’s claimed disorders—arthritis of the bilateral shoulders, bilateral thumbs, and neck; kidney stones; hypertension; and, and pyorrhea or loss of teeth—are included in the list of diseases associated with presumptive service connection pursuant to 38 C.F.R. § 3.309. Thus, the claims may not be established on this basis. VA must not only determine whether a veteran had a disability recognized by VA as being etiologically related to herbicide exposure, but must also determine whether the disability was otherwise the result of active service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, the fact that the requirements of a presumptive regulation are not met does not in and of itself preclude a claimant from establishing service connection by way of proof of actual direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange). With regard to secondary service connection, a disability can be service-connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(a). Moreover, secondary service connection may also be established by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(b), effective October 10, 2006. See 71 Fed. Reg. 52,744-52,747 (September 7, 2006). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. In short, in order to establish entitlement to service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). 1. Entitlement to service connection for left and right shoulder disorders, left and right thumb disorders, and a neck disorder, to include as due to exposure to Agent Orange As already mentioned, the Veteran has current diagnoses of arthritis of the bilateral shoulders, thumbs, and neck. However, as the record does not show, and the Veteran does not contend, that his arthritis was not diagnosed either during service or within one year of separation, so by 1968, he is not entitled to presumptive service connection pursuant to 38 C.F.R. § 3.307. Further, as arthritis is not included in the list of diseases associated with herbicide exposure, presumptive service connection pursuant to 38 C.F.R. § 3.309 is also not warranted. Thus, the Veteran’s claim turns on whether his diagnosed arthritis may be directly attributable to his military service. The Board concludes that, while the Veteran has current diagnoses of arthritis of the bilateral shoulders, thumbs, and neck, the preponderance of the evidence weighs against finding that the diagnosed arthritis began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA treatment records show the first notation of arthritis was not until August 2013 regarding the neck (cervical spine), and February 2016 for the shoulders and thumbs, which is a minimum of over four decades after his separation from service. However, these VA treatment records do not include an etiological opinion attributing the diagnosed arthritis to the Veteran’s military service. While the Veteran is competent to report having experienced symptoms of pain or stiffness since service, as he testified to during his May 2018 Board hearing, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of arthritis. This issue is also medically complex, as it requires knowledge of the interpretation of complicated diagnostic medical testing, such as x-ray findings, regarding the presence of arthritis. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board acknowledges that the Veteran has not been provided with a VA compensation examination addressing his service connection claims for bilateral shoulder, bilateral thumb, and neck disorders. Regulations provide that VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In service-connection claims, such as is the case here, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). In this case, examinations are not necessary to adjudicate the Veteran’s service-connection claims. As noted in the discussion above, there is no indication of an injury or other incident in service resulting in his current disorders. Therefore, a remand requesting examinations is not required. 38 C.F.R. § 3.159(c)(4); McLendon, supra. In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s currently diagnosed arthritis of the bilateral shoulders, thumbs, and neck, and his active service. In light of the above, the preponderance of the evidence is against the claims, and the benefit-of-the-doubt doctrine is not for application. Accordingly, the claims of entitlement to service connection for service connection for left shoulder, right shoulder, left thumb, right thumb, and neck disorders must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). 2. Entitlement to service connection for a kidney disorder, to include as due to exposure to Agent Orange or as secondary to service-connected diabetes mellitus As already mentioned, the Veteran is not entitled to presumptive service connection for this claimed disorder pursuant to either 38 C.F.R. § 3.307 or § 3.309. As an alternative theory of entitlement, during the May 2018 Board hearing, the Veteran argued that his kidney disorder, manifested by kidney stones, is the result of medications he takes for his service-connected diabetes mellitus. The Board concludes that, while the Veteran has a current diagnosis of kidney stones, the preponderance of the evidence is against finding that the Veteran’s kidney stones, or any other kidney disorder, are proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability, or directly attributable to his military service. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The Veteran has undergone VA examinations in October 2011, August 2012, and September 2014 in connection with his service-connected diabetes mellitus. At no point during these examinations have a kidney disorder, including one manifested by kidney stones, been found to be present that is due to or aggravated by his service-connected diabetes. The Veteran stated he had a kidney stone “years ago” during his hearing, but since taking medications for his diabetes mellitus, they have been more frequent. During the appeal, the Veteran submitted a May 2018 statement from his VA treating physician. The physician stated that he was not aware of any medication that would contribute to kidney stones. The Veteran also included the instruction sheet provided with his diabetes medication, but it does not include kidney stones or kidney disease as a possible side effect. Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s kidney stones is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). In this respect, there is simply no evidence of record, to include VA and private treatment records, that provide an opinion as to whether the Veteran’s kidney stones are due to or aggravated by a service-connected disability, or may be directly attributable to his military service. The Veteran is competent to provide information on when he was diagnosed with kidney stones and the pain associated with suffering from kidney stones. The Board finds his report to be competent, credible, and entitled to probative weight. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, while the Veteran believes his kidney stones are proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability, he is not competent to provide a nexus opinion in this case either on a direct or secondary basis. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the deficit of evidence attributing the Veteran’s kidney stones to his military service or a service-connected disability. The Board acknowledges that the Veteran has not been provided with a VA compensation examination addressing his service connection claim for a kidney disorder. Regulations provide that VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In service-connection claims, such as is the case here, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). In this case, an examination is not necessary to adjudicate the Veteran’s service-connection claim. As noted in the discussion above, there is no indication of an injury or other incident in service resulting in his current disorder, or evidence that this disorder is due to or aggravated by a service-connected disability. Therefore, a remand requesting an examination is not required. 38 C.F.R. § 3.159(c)(4); McLendon, supra. Therefore, while the evidence does show the Veteran suffers from kidney stones, the evidence fails to show that it may be presumptively associated with his military service, was incurred during service, or is proximately due to or the result of, or aggravated beyond the natural progression by a service-connected disability. As such, this claim is denied on all bases. 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, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b) (West 2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 3. Entitlement to service connection for hypertension to include as due to exposure to Agent Orange or secondary to service connected diabetes mellitus As already mentioned, the Veteran is not entitled to presumptive service connection for this claimed disorder pursuant to either 38 C.F.R. § 3.307 or § 3.309. As an alternative theory of entitlement, during the May 2018 Board hearing, the Veteran’s argued that his diagnosed hypertension is due to or aggravated by his service connected diabetes mellitus on a secondary basis. The Board concludes that, while the Veteran has a current diagnosis of hypertension, the preponderance of the evidence is against finding that the Veteran’s hypertension is proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability, or directly attributable to his military service. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The Veteran was scheduled for an in-person VA examination in April 2016. In two opinions offered that same month, the VA examiners both concluded that it was less likely as not that the Veteran’s hypertension was due to or aggravated by his service-connected disabilities because the Veteran has hypertension without kidney disease. Further, the Veteran’s BUN and creatinine levels were normal. Therefore, the Veteran has essential hypertension that is not secondary to his diabetes, which is a finding supported by medical literature. In support of his claim, the Veteran submitted a November 2017 statement from his VA treating physician providing a positive opinion as to the etiology between the Veteran’s hypertension and exposure to Agent Orange. However, as noted above, hypertension is not included in the list of diseases presumptively associated with exposure to Agent Orange. Further, the treating physician provided a generic, conclusory statement as to this purported correlation without any supporting rationale. The Veteran’s treating physician also does not provide any comment as to a relationship between hypertension and the Veteran’s service-connected diabetes mellitus. As such, the Board finds that the April 2016 examination and accompanying opinions are more probative than the November 2017 generic and conclusory statement. See Bloom v. West, 12 Vet. App. 185, 187 (1999); see also Miller v. West, 11 Vet. App. 345, 348 (1998) (medical opinions must be supported by clinical findings in the record and conclusions of medical professionals which are not accompanied by a factual predicate in the record are not probative medical opinions); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996) (holding that a generic statement about the possibility of a link between chest trauma and restrictive lung disease was “too general and inconclusive” to support an award of service connection). The Board finds the April 2016 VA opinion probative as to whether the Veteran’s hypertension is etiologically related to his service-connected diabetes. The examiner reviewed the evidence of record, interviewed the Veteran during the physical examination that same month, considered the relevant medical literature, and provided a medical opinion support by a well-reasoned rationale. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Service connection may also be granted on a direct basis, but the preponderance of the evidence is against finding that the Veteran’s hypertension is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). In this respect, there is simply no evidence of record, to include VA and private treatment records, that provide an opinion as to whether the Veteran’s hypertension is due to or aggravated by a service-connected disability, or may be directly attributable to his military service. The Veteran has also undergone VA examinations in October 2011, August 2012, and September 2014 in connection with his service-connected diabetes mellitus. None of these examinations include a diagnosis of hypertension or any statements indicating the Veteran suffers from hypertension that may be attributable to his diabetes. Finally, the Veteran is not asserting that his hypertension is the result of his military service on a direct incurrence basis. The Veteran is competent to provide information on when he was diagnosed with hypertension and the Board finds his report to be competent, credible, and entitled to probative weight. His report has been internally consistent, and is consistent with other evidence of record, including the VA examination and available VA and private treatment records. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, while the Veteran believes his hypertension is proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability, he is not competent to provide a nexus opinion in this case either on a direct or secondary basis. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the April 2016 VA opinion that fails to link the Veteran’s hypertension to his military service or a service-connected disability. Therefore, while the evidence does show the Veteran has a current diagnosis of hypertension, the evidence fails to show that it may be presumptively associated with his military service, was incurred during service, or is proximately due to or the result of, or aggravated beyond the natural progression by a service-connected disability. As such, this claim is denied on all bases. 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, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b) (West 2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 4. Entitlement to service connection for a dental disorder, to include as due to exposure to Agent Orange The Veteran contends that he is entitled to compensation for the loss of his teeth. Specifically, as he testified to during his May 2018 Board hearing, he states that he had two teeth removed during service, which resulted in bleeding gums and gum disease. Following service, he was diagnosed with pyorrhea. It is his contention that his diagnosed pyorrhea then resulted in the loss of more teeth since service, which is the result of exposure to Agent Orange while in service or, alternatively, due to or aggravated by his service-connected diabetes mellitus. In the VA benefits system, dental disabilities are treated differently from medical disabilities. Generally, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses and periodontal disease will be considered service-connected solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment under the provisions of 38 C.F.R. Chapter 17. 38 C.F.R. § 3.381. Service connection may be awarded for missing teeth due to dental trauma or bone loss in service. The law and regulations also provide that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are considered non-disabling conditions and may be considered service-connected solely for the purpose of determining entitlement to a VA dental examination or outpatient dental treatment. See 38 U.S.C. § 171; 38 C.F.R. §§ 3.381, 17.161; see also Woodson v. Brown, 8 Vet. App. 352, 354 (1995). The Board notes that dental disabilities which may be awarded compensable disability ratings are set forth under 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Given the nature of these disabilities, the Board finds that competent medical evidence is required to diagnose whether such is present, and, if so, the etiology thereof. Here, nothing on file shows that the Veteran has the requisite knowledge, skill, experience, training, or education to render a medical opinion. Consequently, his contentions cannot constitute competent medical evidence. 38 C.F.R. § 3.159 (a)(1). During his military service, the Veteran’s service treatment records do not show that any teeth were removed during service. In fact, his August 1967 separation examination shows all teeth were present. An October 1966 dental examination, conducted in the Republic of Vietnam, reflects that the Veteran was told to have two teeth removed upon return to the continental United States, but there is no indication that was done either while in Vietnam or prior to separation from service. The Veteran’s dental records show several diagnoses of caries of the teeth. There are no other complaints, treatment, or diagnoses during service, to include bleeding gums or gum disease. The Board further finds the record does not reflect the Veteran has a current dental disorder for which VA compensation may be paid. VA treatment records dated through 2018 include complaints of pain associated with the roof of his mouth, cracked teeth, and misaligned jaw. The Veteran was afforded a VA examination in October 2011 regarding his diabetes mellitus, which included discussion of the Veteran’s claimed dental disorder. At that time, the examiner provided a diagnosis of dental caries from August 2011 that have been aggravated by the diabetes. However, the examiner stated that it was unclear whether the Veteran’s diabetes contributed to the dental caries. The Board acknowledges that this examination is inadequate insofar as the substance of the etiological opinion provided. However, dental caries is not a disability for which compensation may be provided pursuant to 38 C.F.R. § 4.150. Neither this examination, nor any other evidence of record shows that the Veteran has ever been diagnosed with chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. No competent medical evidence is otherwise of record which demonstrates a dental disorder for which VA compensation may be paid. Without such a disorder, the claim must be denied. See 38 U.S.C. §§ 1110, 1131; see also Brammer v. Derwinski, 3 Vet. App. 223 (1992); Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). The Board further notes that even if the Veteran did have a dental disorder for which VA compensation may be paid, the claim would still be denied because the preponderance of the competent medical and other evidence of record is against a finding he has any current dental condition due to in-service dental trauma. See Holbrook v. Brown, 8 Vet. App. 91 (1995) (The Board has the fundamental authority to decide a claim in the alternative.). Accordingly, a preponderance of the evidence is against a finding that service connection of dental disability for compensation purposes is warranted, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to an initial compensable rating for bilateral hearing loss The Veteran is seeking entitlement to an initial compensable rating for bilateral hearing loss. During his May 2018 Board hearing, the Veteran testified that it is his belief his hearing has worsened since he was last examined in March 2017. Further, the Veteran indicated that he suffers from a disorder impacting the bone structure in his right ear that he believes is exacerbating his hearing loss disability. Based on the May 2018 testimony, the Veteran must be provided with a new VA examination to specifically address the current level of severity of his bilateral hearing loss as there is an indication the disability has increased in severity since the last examination. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); see also VAOPGCPREC 11-95 (1995), 60 Fed. Reg. 43186(1995). In the examination report, the examiner must address the impact of the Veteran’s hearing loss on his daily functioning. Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007). The matter is REMANDED for the following action: 1. Associate any pertinent, outstanding records with the electronic claims folder. 2. Notify the Veteran that he may submit statements from himself and from other individuals who have first-hand knowledge of the nature, extent and severity of his hearing loss. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for an examination to determine the current severity of his bilateral hearing loss. All indicated tests should be conducted. The examiner must also comment on the Veteran’s statement that the bones in his right ear “do not work.” If an additional disability is found on examination, the VA examiner must provide an etiological opinion as to whether it is due to or aggravated by the Veteran’s hearing loss. In addition to objective test results, the examiner should fully describe the functional effects caused by the hearing disability in his or her final report. The examiner should set forth a complete rationale for all findings and conclusions in a legible report. 4. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE, CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. Yvette R. White Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berry, Counsel