Citation Nr: 18154991 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 16-24 256 DATE: December 4, 2018 ORDER The claim of entitlement to service connection for gout is denied. The claim of entitlement to service connection for an ear condition (described as constant pressure) is denied. The claim of entitlement to service connection for hypertension (also claimed as high blood pressure) is denied. The claim of entitlement to service connection for diabetes is denied. The claim of entitlement to service connection for headaches is denied. The claim of entitlement to service connection for peripheral neuropathy, left upper extremity, is denied. The claim of entitlement to service connection for peripheral neuropathy, right upper extremity, is denied. The claim of entitlement to service connection for peripheral neuropathy, left lower extremity, is denied. The claim of entitlement to service connection for peripheral neuropathy, right lower extremity, is denied. REMANDED The claim of entitlement to service connection for right ear hearing loss is remanded. The claim of entitlement to service connection for tinnitus is remanded. FINDINGS OF FACT 1. The most probative evidence of record indicates that the Veteran’s gout did not manifest during service and is not causally related to service. 2. The most probative evidence of record indicates that the Veteran’s ear condition (described as constant pressure) did not manifest during service and is not causally related to service. 3. The most probative evidence of record indicates that the Veteran’s hypertension did not manifest in service, within one year of separation, and is not otherwise related to any in-service disease, injury or event. 4. The most probative evidence of record indicates that the Veteran’s diabetes mellitus did not manifest in service, within one year of separation, and is not otherwise related to any in-service disease, injury or event. 5. The most probative evidence of record indicates that the Veteran’s headaches did not manifest during service and is not otherwise causally related to service. 6. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of peripheral neuropathy, left upper extremity. 7. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of peripheral neuropathy, right upper extremity. 8. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of peripheral neuropathy, left lower extremity. 9. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of peripheral neuropathy, right lower extremity. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for gout have not been met. 38 U.S.C. §§ 1110, 5107 (West 2014); 38 C.F.R. § 3.303 (2018). 2. The criteria for establishing entitlement to service connection for an ear condition (described as constant pressure) have not been met. 38 U.S.C. §§ 1110, 5107 (West 2014); 38 C.F.R. § 3.303 (2018). 3. The criteria for establishing entitlement to service connection for hypertension (also claimed as high blood pressure) have not been met. 38 U.S.C. §§ 1110, 1154(b), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. (2018). 4. The criteria for establishing entitlement to service connection for diabetes have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107 (West 2014); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). 5. The criteria for establishing entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5107 (West 2014); 38 C.F.R. § 3.303 (2018). 6. The criteria for establishing entitlement to service connection for peripheral neuropathy, left upper extremity, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2018). 7. The criteria for establishing entitlement to service connection for peripheral neuropathy, right upper extremity, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2018). 8. The criteria for establishing entitlement to service connection for peripheral neuropathy, left lower extremity, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2018). 9. The criteria for establishing entitlement to service connection for peripheral neuropathy, right lower extremity, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Marine Corps from August 1990 to March 1991. While the Veteran was previously scheduled for a hearing, he notified VA in September 2018 that he desired to cancel his requested hearing. Service Connection Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. § 1110, 1131 (West 2014); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical ‘nexus’ requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2018). In determining whether service connection is warranted for a disorder, 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 (West 2014); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for gout The Veteran contends that he suffers from gout or chronic joint pain as causally related to active service. On review of the record, the Board concludes that, while the Veteran has a current diagnosis of gout, the preponderance of the evidence is against finding that it began during active 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) (2018). Service treatment records are silent for complaints of general joint pain or a diagnosis of gout. A report of medical examination in November 1989, revealed normal physical findings at induction. One year later, the Veteran was granted a medical discharge do to chronic back and bilateral foot pain. Specifically, the Veteran was diagnosed with pes planus. A January 1991 treatment note recorded a 5-month history of low back pain, and a diagnosis of mechanical back pain was assigned at this time. The Veteran is already service-connected for both pes planus and a low back disability. No other complaints of joint pain were reported or indicated in November 1991. Post service treatment records show that the Veteran was treated for gout. A treatment record from his primary care physician noted a history of joint pain described as gout in December 2011. In January 2012, the Veteran was provided a list of foods to avoid in order to prevent symptom aggravation. In February 2013, complaints of redness, swelling, and tenderness around the ankle deemed consistent with gout were noted in a physical evaluation. Oral medications were prescribed to treat pain. One month later, the Veteran’s wife contacted his primary care physician to report that the prescribed medications were unable to resolve his symptoms. The Board recognizes that a VA examination has not been scheduled. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran’s service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and the veteran’s service. In this case, there is no evidence that the Veteran was treated for gout or chronic joint pain in service, in addition to those conditions for which service connection has already been established. Post service treatment records fail to show treatment or complaints of symptoms within one year of separation. Under the circumstances, a medical examination would serve no useful purpose in this case, since the requirement of evidence of an in-service disease or injury to establish a service connection claim cannot be met upon additional examination. Therefore, the Veteran was not prejudiced by the lack of VA examination. While the Board recognizes the Veteran’s competence to report on his current symptoms and their onset, the evidence of the record does not support his contention. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for gout must be denied. 2. Entitlement to service connection for an ear condition (described as constant pressure) The Veteran contends that he suffers from constant ear pressure, which is worse in the right ear, and that his condition was causally related to active service. However, on review of the record, the Board concludes that, while the Veteran has been treated for chronic ear pressure, the evidence is against finding that it began during active 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) (2018). Service treatment records are silent for complaints of ear trouble. A report of medical examination in November 1989, revealed normal hearing at induction. One year later, the Veteran was granted a medical discharge due to chronic back and bilateral foot pain. No complaints of ear pain or pressure was reported or indicated in November 1991. Post service treatment records show that the Veteran complained of ear trouble. A treatment record from his primary care physician noted complaints of both ears feeling “clogged” in June 2002. Worsening symptoms were reported on the right ear in May 2005. In August 2008, the Veteran complained that his right ear continued to feel “stopped up” and use of allergy medications such as Claritin and Flonase had not resolved his symptoms. Worsening right ear pressure was noted in an audiological examination in September 2012. A tympanometry evaluation revealed a normal ear canal, volume, pressure, and compliance, bilaterally. A primary care treatment note, dated August 2013, noted right ear fullness, mild pressure over the Veteran’s sinuses. Probable seasonal allergic rhinitis and eustachian tube dysfunction with sinus headaches was listed as the current diagnoses. Complaints of ear pressure were again reported during an audiological evaluation in April 2017. Right-sided aural fullness was noted. An otoscopy examination revealed clear canals with the tympanic membranes visualized, bilaterally. A tympanometry evaluation revealed normal pressure in the left and right ear. None of these records suggested a potential relationship between this condition and military service. The Board recognizes that the Veteran has not been afforded a VA examination. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran’s service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon, 20 Vet. App. at 79; 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and the veteran’s service. In this case, there is no evidence that the Veteran was treated for ear pressure in service. Post service treatment records fail to show treatment or complaints of symptoms within one year of separation. Under the circumstances, a medical examination would serve no useful purpose in this case, since the requirement of evidence of an in-service disease or injury to establish a service connection claim cannot be met upon additional examination. Therefore, the Veteran was not prejudiced by the lack of VA examination. While the Board recognizes the Veteran’s competence to report on his current symptoms and their onset, the evidence of the record does not support his contention. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for ear pressure must be denied. 3. Entitlement to service connection for hypertension (also claimed as high blood pressure) The Veteran also asserts that his hypertension is causally related to active service. For certain chronic diseases, including hypertension, see 38 C.F.R. § 3.309 (a), the law presumes the disease was incurred in or aggravated by service if the disease becomes manifest to a compensable degree within one year from the date of separation from service. See 38 C.F.R. § 3.307 (a)(3) (2018). On review of the record, the Board concludes that, while the Veteran has a diagnosis of hypertension, the preponderance of the evidence is against finding that the condition began during active service, had its onset within one year of separation, 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) (2018). Service treatment records are silent for high blood pressure readings or a diagnosis of hypertension. A report of medical examination in November 1989, revealed normal physical findings at induction. Blood pressure readings in January 1991, were noted as 118/90 and 136/84. A report of medical history in November 1991 listed the Veteran’s blood pressure as 120/80. Hypertension, at least for rating purposes, is defined as diastolic blood pressure that is predominantly 90 millimeters (mm) or greater, or systolic blood pressure that is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104, Diagnostic Code 7101 (Note 1). To support a diagnosis of hypertension, the blood pressure readings must be taken two or more times on at least three different days. Id. One year later, the Veteran was granted a medical discharge due to chronic back and bilateral foot pain. No complaints of high blood pressure were reported or indicated in November 1991. Post service treatment records show that the Veteran was diagnosed with hypertension in November 2009. An emergency department note referenced treatment for high blood pressure. The Veteran was advised to schedule an appointment with his primary care physician for a formal diagnosis. A diagnostic evaluation the same month shows that the Veteran was diagnosed with Stage I hypertension. Oral prescription medication was prescribed to treat his symptoms. The Board recognizes that the Veteran has not been afforded a VA examination. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran’s service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon, 20 Vet. App. at 79; 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and the veteran’s service. In this case, there is no evidence that the Veteran was treated for hypertension in service. In fact, multiple blood pressure readings showed readings within normal ranges. Post-service treatment records fail to show treatment or complaints of symptoms within one year of separation. The Veteran was first diagnosed with hypertension in 2009, more than a decade after separation. Under the circumstances, a medical examination would serve no useful purpose in this case, since the requirement of evidence of an in-service disease or injury to establish a service connection claim cannot be met upon additional examination. Therefore, the Veteran was not prejudiced by the lack of VA examination. While the Board recognizes the Veteran’s competence to report on his current symptoms and their onset, the evidence of the record does not support his contention. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for hypertension must be denied. 4. Entitlement to service connection for diabetes mellitus, type II. The Veteran also asserts that he suffers from diabetes mellitus, type II as due to active service. For certain chronic diseases, including diabetes mellitus, type II, see 38 C.F.R. § 3.309 (a), the law presumes the disease was incurred in or aggravated by service if the disease becomes manifest to a compensable degree within one year from the date of separation from service. 38 C.F.R. § 3.307 (a)(3) (2018). On review of the record, the Board concludes that, while the Veteran has a diagnosis of diabetes, the preponderance of the evidence is against finding that it began during active service, had its onset within one year of separation, 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), 3.307 (a)(3), 3.309 (a) (2018). Service treatment records are silent for complaints of any condition of the endocrine system or a diagnosis of diabetes mellitus, type II. A report of medical examination at induction in November 1989, revealed normal physical findings. One year later, the Veteran was granted a medical discharge due to chronic back and bilateral foot pain. No diagnosis of diabetes or symptoms related thereto were reported or indicated in November 1991. Post service treatment records show that the Veteran was diagnosed with diabetes mellitus, type II, in August 2012. In the same month, he was advised to consider dietary changes; participation in a diabetic education program was recommended. In a primary care treatment note, dated June 2002, the Veteran denied any family history of diabetes or hypertension. No signs or symptoms of an endocrine system disease were noted in April 2006. In October 2012, the Veteran joined a diabetes management program. None of these records suggest any relationship between the currently diagnosed diabetes mellitus and military service. The Board recognizes that the Veteran has not been afforded a VA examination. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran’s service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon, 20 Vet. App. at 79; 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and the veteran’s service. In this case, there is no evidence that the Veteran was treated for any condition of the endocrine system or received a diagnosis of diabetes in service. Post-service treatment records fail to show treatment or abnormal findings involving the endocrine system within one year of separation. In fact, the record shows that the Veteran was first diagnosed with diabetes mellitus, in August 2012, more than two decades after separation. Under the circumstances, a medical examination would serve no useful purpose in this case, since the requirement of an in-service disease or injury to establish a service connection claim cannot be met upon additional examination. Therefore, the Veteran was not prejudiced by the lack of VA examination. While the Board recognizes the Veteran’s competence to report on his current symptoms and their onset, the evidence of the record does not support his contention. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Furthermore, there is no evidence of record to suggest that the Veteran has the requisite training or expertise to offer a medical opinion as complex as linking diabetes mellitus to events that occurred many years earlier. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for diabetes mellitus, type II must be denied. 5. Entitlement to service connection for headaches The Veteran also contends that he suffers from headaches that are causally related to active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of headaches, the preponderance of the evidence is against finding that they began during active service, or are 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). Service treatment records are silent for complaints of headaches or related treatment in service. Post-service treatment records show sporadic complaints of headaches. In November 2009, the Veteran reported sharp headache pain described as a 10 on a 10-point scale. He complains of symptoms that were reported as causally related to sleep deprivation, and later performing his duties as a truck driver. A subsequent reference to headaches was noted in December 2009, as a possible side effect of oral medications and/or exposure to sunlight. Headaches were also reported in May 2015 following the Veteran’s international travel. In July 2017, severe headaches were noted in relation to suspicion of diabetic retinopathy. The Board recognizes that the Veteran has not been afforded a VA examination. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran’s service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon, 20 Vet. App. at 79; 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and the veteran’s service. In this case, there is no evidence that the Veteran complained of headaches or received related treatment in service. Post-service treatment records are silent for treatment or complaints of symptoms within one year of separation. In fact, the record shows that the Veteran reported symptoms in connection with other conditions. Under the circumstances, a medical examination would serve no useful purpose in this case, since the requirement of an in-service disease or injury to establish a service connection claim cannot be met upon additional examination. Therefore, the Veteran was not prejudiced by the lack of VA examination. While the Veteran is competent to report on his experience of headaches and their onset, the medical evidence fails to show any complaints of symptoms prior to 2009. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). At no time has the record revealed or suggested any causal connection between the Veteran’s symptoms and active service, to include any in-service event, injury, or condition. While the Board recognizes the Veteran’s subjective belief that his headaches were caused by or otherwise related to active service, the evidence of record does not support his contention. Furthermore, the evidence of record fails to reflect that the Veteran has the requisite training or expertise to offer a medical opinion as complex as linking a current headache disability to events that happened years earlier. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for headaches must be denied. 6. Entitlement to service connection for peripheral neuropathy, left upper extremity; peripheral neuropathy, right upper extremity; peripheral neuropathy, left lower extremity; and peripheral neuropathy, right lower extremity The Veteran contends that he suffers from peripheral neuropathy in the upper and lower extremities and that his condition is causally related to active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of peripheral neuropathy of the upper or lower extremities and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Board notes that service connection is already in effect for radiculopathy of the lower extremities associated with a lumbar spine disability, bilaterally. Service treatment records are silent for any complaints of peripheral neuropathy of the upper or lower extremities. No symptoms were reported at induction or separation. Post service treatment records fail to show a diagnosis of peripheral neuropathy. A compensation and pension note, dated April 2006, described slightly more diminished peripheral pulses than normal in both the upper and lower extremities. No peripheral edema or evidence of venous stasis pigmentation was indicated. There was no evidence of muscle atrophy and the Veteran’s range of motion and muscle strength was normal. In June 2009, a primary care treatment record noted possible neuropathy in the right leg. Complaints of neuropathy in the thighs was again reported in December 2009. In November 2010, a neurology consultation suggested possible meralgia paresthetica. The absence of lower extremity reflexes was noted, with possible polyneuropathy. A subsequent neurology consultation was conducted in March 2011. No lower extremity radicular pain was noted. A physical examination, revealed normal motor strength in the bilateral lower extremities. The Veteran’s gait was also described as normal. Possible polyneuropathy was noted based a finding on absent lower extremity reflexes. During a rheumatology consultation in January 2012, the Veteran denied any symptoms of peripheral arthritis. He also reported involvement in a motor vehicle accident in 1996 and stated that a screw was placed in his left knee following the accident. On examination in April 2017, normal peripheral pulses were indicated. On review of the record, the Board acknowledges periodic complaints of symptoms and suggestions of a possible diagnosis; however, no confirmed diagnosis of peripheral neuropathy has ever been rendered. Further, even if the Board were to assume that the references to a “possible diagnosis” had been confirmed, there is no medical evidence that complaints of similar symptoms were reported in service or within one year of separation. Furthermore, as previously noted, service connection is already in effect for lower extremity radiculopathy, bilaterally. While the Board recognizes the Veteran’s subjective belief that he has a current diagnosis of peripheral neuropathy in the upper and lower extremities, he is not competent to provide a diagnosis in this case. Assigning such a diagnosis is medically complex and requires specialized medical expertise, training, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). There is no evidence that the Veteran possesses the required skill-set. Consequently, the Board gives more probative weight to the competent medical evidence. As the record fails to show any current diagnosis, no further analysis is required. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for peripheral neuropathy in the upper and lower extremities must be denied. REASONS FOR REMAND Regrettably, a remand is necessary in this case to ensure that due process is followed and that there is a complete record upon which to decide the appellant’s claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A (West 2014); 38 C.F.R. § 3.159 (2018). The Veteran contends that he suffers from right ear hearing loss and tinnitus and his conditions are causally related to active service. Service treatment records are silent for complaints of hearing loss or tinnitus in service. No complaints of bilateral hearing loss were noted in a report of medical history at enlistment in November 1989. A report of medical history at separation, in November 1991, showed normal audiological findings. Post-service treatment records show that the Veteran complained of bilateral hearing loss and tinnitus. A September 2012 audiological consultation referenced an onset of hearing loss and tinnitus in 1991. He also described an occasional “clogged” sensation and worsening tinnitus in the right ear. On examination, normal hearing was noted in the right ear from 250-3000 Hertz (Hz), with severe sensory neural hearing loss at 4000 Hz and mild hearing loss at 6000-8000 Hz. In the left ear, normal hearing was noted from 250-2000 Hz, with mild to moderately severe sensory neural hearing loss from 3000-6000 Hz. Speech discrimination scores were listed a 92 percent in the right ear and 88 percent in the left ear. There was no evidence of external, middle or retrocochlear ear disease. The results were described consistent with aging and noise-induced cochlear pathology. In August 2013, a primary care note referenced intermittent nasal stuffiness, congestion, right ear fullness, and mild pressure over sinuses. Occasional clear rhinorrhea was also noted. In March 2014, the Veteran was afforded a VA examination. No diagnostic findings were reported. The examiner did not render any diagnosis as to right ear hearing loss or tinnitus. The opinion suggested that a pathology could not be established due to inconsistencies in the Veteran’s responses. In an otolaryngology consultation note, dated April 2017, the Veteran’s complaints of hearing loss, tinnitus, described as worse in the right ear, and pressure in the right her were noted. His symptoms were previously evaluated in August 2016. Bilateral hearing loss was described as beginning at 4000 Hz and it was deemed consistent with noise induced hearing loss. Reports of longstanding tinnitus and intermittent right-sided aural fulness was also endorsed. A reference to noise exposure at the firing range without use of hearing protection was reported. On examination, diagnostic findings revealed normal right-sided hearing was noted at 250-2000 Hz, mild sensory neural hearing loss at 3000 Hz, moderately severe hearing loss at 4000 Hz, with moderate to mild hearing loss between 6000 Hz and 8000 Hz. Left-sided hearing was noted at 250-2000 Hz, mild sensory neural hearing loss at 3000 Hz, moderately severe hearing loss at 4000 Hz, with moderate to mild hearing loss between 6000 Hz and 8000 Hz. Speech discrimination scores noted as 96 percent in the right ear and 88 percent in the left ear. No meaningful change in diagnostic findings was noted since the Veteran’s prior examination. On review of the record, the Board finds that the March 2014 VA examination inadequate. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See 38 U.S.C. § 5103(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, this matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral hearing loss and tinnitus. The entire claims file, to include a complete copy of this REMAND and all evidence relevant to the examiner’s review, must be made available to the physician designated to examine the Veteran, and the report of examination should include discussion of the Veteran’s documented history and all lay assertions. The examiner must opine whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s bilateral hearing loss was caused by or otherwise related to hazardous noise exposure in service. The examiner is specifically invited to comment on post-service treatment records which suggest that the Veteran has a current diagnosis of bilateral hearing loss and reported the onset of his symptoms during or soon after separation. The examiner must opine whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s tinnitus was caused by or otherwise related to hazardous noise exposure in service. The examiner is specifically invited to comment on post-service treatment records which suggest that the Veteran has a current diagnosis of tinnitus and reported the onset of his symptoms during or soon after separation. The examiner must fully review and evaluate the claims file and attest to its review. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail along with supportive rationale. If the examiner cannot provide the requested opinions without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. 2. Thereafter, re-adjudicate the Veteran’s claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC) and an adequate opportunity to respond before returning the matters to the Board for further adjudication, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (West 2014). B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Whitaker, Associate Counsel