Citation Nr: 18155571 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 14-41 523 DATE: December 4, 2018 ORDER 1. Entitlement to service connection for a right shoulder disability is denied. 2. Entitlement to service connection for right knee degenerative joint disease is denied. 3. Entitlement to service connection for a right eye disability, to include glaucoma, is denied. 4. Entitlement to service connection for right ear hearing loss disability is denied. 5. Entitlement to service connection for left ear hearing loss disability is denied. 6. Entitlement to service connection for tinnitus is denied. 7. Entitlement to service connection for chronic headaches is denied. 8. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), mood disorder not otherwise specified, obsessive compulsive disorder, cocaine dependence, alcohol abuse, alcohol dependence, and bipolar disorder, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s right shoulder disability was incurred in or is otherwise related to service. 2. The Veteran’s right knee degenerative joint disease did not have its onset in service, was not manifested to a compensable degree within one year of service discharge, and is not otherwise related to service. 3. The preponderance of the evidence is against finding that the Veteran’s right eye disability, to include glaucoma, was incurred in or is otherwise related to service. 4. The Veteran’s right ear hearing loss disability did not have its onset in service, was not manifested to a compensable degree within one year of service discharge, and is not otherwise related to service. 5. 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 a left ear hearing loss disability. 6. The Veteran’s tinnitus did not have its onset in service, was not manifested to a compensable degree within one year of service discharge, and is not otherwise related to service. The Veteran’s tinnitus is also not proximately due to or aggravated by a service connected disability. 7. The preponderance of the evidence is against finding that the Veteran’s chronic headaches were incurred in or are otherwise related to service. 8. The preponderance of the evidence is against finding that the Veteran’s acquired psychiatric disorder, to include mood disorder, obsessive compulsive disorder, cocaine dependence, alcohol abuse, alcohol dependence, and bipolar disorder, was incurred in or otherwise related to service, or that it is proximately due to or aggravated by a service-connected disability. 9. The preponderance of the evidence is against a finding that there is medical evidence of a causal nexus between the Veteran’s PTSD and a claimed in-service stressor and against a finding of credible supporting evidence that the claimed in-service stressor actually occurred. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for right knee degenerative joint disease are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 3. The criteria for service connection for a right eye disability, to include glaucoma, are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for right ear hearing loss disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a), 3.385. 5. The criteria for service connection for left ear hearing loss disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.385. 6. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a), 3.310, 3.385. 7. The criteria for service connection for chronic headaches are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, mood disorder, obsessive compulsive disorder, cocaine dependence, alcohol abuse, alcohol dependence, and bipolar disorder, are not met. 38 U.S.C. §§ 105, 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.301, 3.303(a), 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1982 to August 1986. In the November 2014 VA Form 9, the Veteran requested a Board hearing by live videoconference. In a February 2015 VA Form 21-0820, it was noted that the Veteran withdrew his request for a hearing. Therefore, the request for a Board hearing is deemed withdrawn. 38 C.F.R. §§ 20.702. In an October 2018 Written Brief Presentation, the Veteran’s representative contended that the Veteran’s service treatment records and other various relevant records were missing, and that VA had not fulfilled its duty to assist in obtaining these records. However, in a November 2012 VA Form 21-3101, it was noted that the Veteran’s complete medical and dental records were both requested and mailed. The Veteran’s available military personnel records and service treatment records have been associated with the Veteran’s file. The service treatment records are dated from 1982 to 1985. On one of the envelopes that contained service treatment records, someone wrote (likely a VA employee) that the service treatment records appeared complete and that there was “no indication of a sep[aration] exam noted.” Accordingly, the Board finds that all available records have been obtained, and the duty to assist has been fulfilled with regard to this contention. The contention related to tinnitus is addressed below in the analysis. In the November 2014 VA Form 9, the Veteran contended that his VA examiners did not adequately review his records and diagnoses. However, the March 2014 VA examiners specifically indicated that they reviewed his claims file and included discussions of the Veteran’s pertinent medical history. Accordingly, the Board finds that the VA examinations were adequate and VA has fulfilled the duty to assist. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection may also be established under 38 C.F.R. § 3.303(b), if a chronic disease is shown in service, and subsequent manifestations of the same chronic disease at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. Service connection may also be established under 38 C.F.R. § 3.303(b), where a disability in service is noted but is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. The continuity of symptomatology provision of 38 C.F.R. § 3.303(b) has been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). The Veteran currently has arthritis, sensorineural hearing loss, and tinnitus, which are chronic diseases under 38 C.F.R. § 3.309(a); thus, 38 C.F.R. § 3.303(b) is applicable. Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. However, where the evidence does not warrant presumptive service connection, a veteran is not precluded from establishing service connection with proof of direct causation. Service connection for PTSD requires the presence of three particular elements: (1) a current medical diagnosis of PTSD; (2) medical evidence of a causal nexus between current symptomatology and a claimed in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. Regarding the in-service stressor element of a claim of service connection for PTSD, the Court of Appeals for Veterans Claims (Court) has held that credible supporting evidence means that the Veteran’s testimony cannot, by itself, as a matter of law, establish the occurrence of a non-combat stressor; nor can credible supporting evidence of the actual occurrence of an in-service stressor consist solely of after-the-fact medical nexus evidence. See 38 C.F.R. § 3.304(f)(3). Instead, the record must contain service records or other independent credible evidence corroborating the Veteran’s testimony as to the alleged stressor. Those service records which are available must support and not contradict the Veteran’s lay testimony concerning stressors. The diagnosis of PTSD must comply with the criteria set forth in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 5th edition, of the American Psychiatric Association (DSM-5). See 38 C.F.R. §§ 4.125(a), 4.130. A veteran’s testimony, by itself, can establish the occurrence of an in-service stressor event if the requirements of 38 C.F.R. § 3.304(f)(3) are met. Currently, 38 C.F.R. § 3.304(f)(3) provides that if a stressor claimed by a veteran is related to the veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3). In substance, under the revised 38 C.F.R. § 3.304(f)(3), service connection can be granted for PTSD if the evidence demonstrates a current diagnosis of PTSD (rendered by an examiner specified by the regulation); an in-service stressor consistent with the places, types, and circumstances of service (satisfactorily established by lay testimony) that has been medically related to the veteran’s fear of hostile military or terrorist activity by a VA psychiatrist or psychologist, or one contracted with by VA; and, PTSD symptoms have been medically related to the in-service stressor by a VA psychiatrist or psychologist, or one contracted with by VA. In this case, the evidence does not show, and the Veteran does not contend, that he engaged in combat, or that he was exposed to hostile military or terrorist activity; therefore, the presumptions afforded to veterans who allege fear of hostile military or terrorist activity are inapplicable in this case. Thus, any alleged in-service stressors must be independently verified, i.e., corroborated by objective, credible supporting evidence. 1. Entitlement to service connection for a right shoulder disability The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for a right shoulder disability. The reasons follow. The Veteran has been diagnosed with a right shoulder disability, and thus there is evidence of a current disability. For example, according to a November 2012 VA treatment record, the Veteran has been diagnosed with a supraspinatous tendinitis, with subacrominal bursitis. VA treatment records from September 2011 and October 2011 show posttraumatic deformity of the right scapula with a bullet fragment. As to a disease or in jury in service, the service treatment records (STRs) show that the Veteran was found to have a clinically normal evaluation of his upper extremities in September 1983. The STRs do not otherwise support evidence of symptoms, complaints, diagnosis or treatment of a right shoulder disease or injury. In this regard, the Board notes that the service treatment records show that the Veteran was seen for multiple medical complaints, such as pharyngitis in August 1982, left ankle injury in April 1983, splinter under a nail in March 1984, strep in April 1984, left thumb pain in September 1984, shaving rash in October 1984 (multiple times) and January 1985, viral gastroenteritis in March 1985, wisdom teeth removal in May 1985, stomach complaints in July 1985, and acute respiratory disease and gastroenteritis in August 1985. This tends to weigh against a finding that he had a right shoulder injury in service, as it would seem likely that the Veteran would have sought treatment for it, as he did for multiple medical complaints. In the September 2014 DRO hearing, the Veteran stated that he injured his right shoulder during a truck accident, when he struck a deer in service, and sustained significant injuries. However, the Veteran’s service records do not support that such an incident occurred. As this is the type of incident that likely would have been recorded, and the record does not support such an accident, the Board affords this allegation no probative value. Again, the STRs show the Veteran was seen for multiple medical complaints. It would seem highly likely that an accident causing significant injuries would have been documented in the STRs. A February 2017 lay statement states that the Veteran hit a deer in service, however the statement does not state that any injuries were sustained as a result of the incident. As such, the statement is of limited probative value and does not assist in a finding of an in-service disease or injury involving the right shoulder. Further supporting this finding that the Veteran did not sustain a right shoulder injury that became chronic thereafter are the VA treatment records. The Veteran began seeking treatment at VA in the early 2000s. When seen in January 2002, the examiner wrote, “He does not admit to any serious medical problems.” The following month, it was noted that the Veteran denied any significant medical problems “except for high blood pressure.” That same month, he was at VA to establish himself as a new patient (he had been a patient for substance abuse prior to February 2002). When asked for his past medical history, the examiner wrote hay fever, headaches, right knee pain, allergic rhinitis, and history of gunshot wound to the back. The Veteran complained of right knee pain at that time, which he reported he had had for approximately 10 years. The Veteran did not complain of right shoulder pain at that time. The Board finds that had the Veteran been experiencing chronic right shoulder pain since service or even 10 years prior to the February 2002 examination, he would have reported it, as he thought to report a 10-year history of right knee pain. The Veteran did not start complaining of right shoulder pain until 2007, which is more than 20 years following service discharge. These facts tend to establish that the Veteran did not have an in-service right shoulder injury that caused chronic right shoulder problems from then and following service. Thus, to the extent that the Veteran has stated that a right shoulder disability had its onset in service, the Board finds that such statement is not credible for all the reasons explained above (no documentation in the STRs, while other STRs document multiple medical complaints, and no report of the in-service injury in the years following service discharge, until 20 years later). The Board finds as fact that there was no in-service disease or injury involving the right shoulder. While the claim cannot be granted without a disease or injury in service, the Board also finds that the preponderance of the evidence is against a nexus between the post-service right shoulder disability and service. Although the Veteran claims that his right shoulder disability is related his service, a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, shoulder disabilities require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s right shoulder disability is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. In sum, the Board concludes that the preponderance of the evidence is against the Veteran’s claim for service connection for a right shoulder disability. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 2. Entitlement to service connection for right knee degenerative joint disease The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for right knee degenerative joint disease on either a direct or presumptive basis. The reasons follow. The Veteran has been diagnosed with right knee degenerative joint disease, and thus there is evidence of a current disability. For example, in a November 2012 VA treatment record, the Veteran was found to have mild degenerative patellofemoral disease. As to a disease or in jury in service, the STRs show that the Veteran was found to have a clinically normal evaluation of his lower extremities in September 1983. The STRs do not otherwise support evidence of symptoms, complaints, diagnosis or treatment related to right knee degenerative joint disease. As noted above, the service treatment records show that the Veteran was seen for multiple medical complaints, which did not include a right knee injury. This evidence tends to weigh against a finding that he had a right knee injury in service, as it would seem likely that he would have sought treatment for it, as he did for multiple medical complaints. There is no competent evidence that degenerative joint disease was diagnosed in service. In the September 2014 DRO hearing, the Veteran stated that he injured his right knee during a truck accident, when he struck a deer in service, and sustained significant injuries. However, the Veteran’s service records do not support that such an incident occurred. As this is the type of incident that likely would have been recorded, and the record does not support any medical report of such an accident, the Board affords this statement no probative value. A February 2017 lay statement states that the Veteran hit a deer in service, however the statement does not state that any injuries were sustained as a result of the incident. As such, the statement is of limited probative value and does not assist in a finding of an in-service disease or injury involving the right knee. Further supporting this finding that the Veteran did not sustain a right knee injury that became chronic thereafter are the VA treatment records. The Veteran began seeking treatment at VA in the early 2000s. When seen in January 2002, the examiner wrote, “He does not admit to any serious medical problems.” The following month, it was noted that the Veteran denied any significant medical problems “except for high blood pressure.” That same month, he was at VA to establish himself as a new patient (he had been a patient for substance abuse prior to February 2002). When asked for his past medical history, the examiner wrote hay fever, headaches, right knee pain, allergic rhinitis, and history of gunshot wound to the back. The Veteran complained of right knee pain at that time, which he reported he had had for approximately 10 years. This would place the onset of the right knee pain as occurring in approximately 1992, which is approximately six years following the Veteran’s discharge from service. These facts tend to establish that the Veteran developed right knee pain after service and did not have a right knee injury that caused chronic right knee problems from then and following service. Thus, to the extent that the Veteran has stated that a right knee disability had its onset in service, the Board finds that such statement is not credible for all the reasons explained above (no documentation in the STRs, while other STRs document multiple medical complaints, and no report of the in-service injury in the years following service discharge, and when he finally reported the knee problems, he attributed it to a period of time well after his service discharge). At the Veteran’s September 2014 DRO Hearing, the Veteran testified that his right knee degenerative joint disease began after a car accident during service. However, in a February 2002 VA treatment record, the Veteran stated that his right knee pain began in relation to wrestling. As these statements contradict one another, the Board assigns them no probative value. The Board finds that the Veteran did not incur an in-service disease or injury involving the right knee. Furthermore, the evidence of record does not demonstrate that the Veteran’s symptoms have been continuous since separation from service in August 1986. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). There were no complaints, diagnosis, or treatment for this disorder for at least six years following service discharge. In a February 2002 VA treatment record, the Veteran stated his knee pain began ten years ago, which is six years following separation. The absence of post-service complaints, findings, diagnosis, or treatment for approximately six years after service is one factor that tends to weigh against a finding of continuous symptoms since separation from service. The Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence. A prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. While the claim cannot be granted without a disease or injury in service, the Board also finds that the preponderance of the evidence is against a nexus between the post-service right knee disability and service. Although the Veteran claims that his right knee degenerative joint disease is related his service, a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, knee disabilities require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s right knee degenerative joint disease is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for right knee degenerative joint disease. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 3. Entitlement to service connection for a right eye disability, to include glaucoma With regard to the right eye disability, the Veteran has restricted his claim to just the right eye, as mentioned in the February 2014 Notice of Disagreement, and restricted his claim to a physical injury related to service, as described in the September 2014 DRO hearing. In June 2018, the Veteran filed a claim for entitlement to service connection for glaucoma. In an appeal for a claim for service connection for a body part, the Board has jurisdiction over all diagnoses associated with that body part, therefore the Board has jurisdiction over the diagnosis of glaucoma in the right eye with regard to this appeal, and it will address that diagnosis. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for a right eye disability, to include glaucoma. The reasons follow. The Veteran has been diagnosed with glaucoma, and thus there is evidence of a current disability. The Board notes, however, that there is no competent evidence that the Veteran has been diagnosed with fragments being embedded in the right eye. The Board finds that there is no competent and credible evidence of an in-service disease or injury involving the right eye. For example, the STRs show that the Veteran was found to have a normal clinical evaluation of his eyes in September 1983. As noted above, the service treatment records show that the Veteran was seen for multiple medical complaints, which did not include a right eye injury. This evidence tends to weigh against a finding that he had a right eye injury with metal fragments in service, as it would seem likely that he would have sought treatment for it, as he did for multiple medical complaints, particularly based on the severity of such described injury. The STRs do not otherwise support evidence of symptoms, complaints, diagnosis or treatment related to a right eye disability, to include glaucoma. This evidence tends to weigh against a finding that the Veteran had a right eye disability, to include glaucoma, during service. As to a nexus to service, the Veteran was first diagnosed with glaucoma in a September 2017 VA treatment record, which is approximately 31 years following service discharge, and tends to establish that a right eye disability did not have its onset in service. Additionally, a February 2011 VA treatment record shows that a review of the Veteran’s medical problems was performed at that time. When asked if the Veteran had or had ever complained of any of the following medical problems, and “Eye problems” was one of them, the examiner wrote, “No.” In November 2011, the Veteran went to the VA eye clinic and told the examiner that he had been noticing a decrease in his visual acuity for a while and his left eye was blurry. When addressing the Veteran’s past ocular history, the examiner wrote, “[N]one” and that the Veteran used over-the-counter reading glasses. This tends to show that the Veteran did not have an in-service injury with metal fragments in his right eye, as it would seem likely that when asked about his ocular history, the Veteran would have reported the incident of having metal fragments in his eye. Based on the lack of in-service findings pertaining to the right eye and the Veteran’s denial of any ocular history when specifically asked about it, the Board finds as fact that there was no disease or injury to the right eye, as described by the Veteran. While the claim cannot be granted without a disease or injury in service, the Board also finds that the preponderance of the evidence is against a nexus between the post-service right eye disability and service. Although the Veteran claims that his right eye disability is related his service, a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, eye disabilities require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s right eye disability is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for a right eye disability, to include glaucoma. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 4. Entitlement to service connection for a right ear hearing loss disability The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for a right ear hearing loss disability. The reasons follow. The Veteran has been diagnosed with a right ear hearing loss disability, and thus there is evidence of a current disability. However, as to an in-service disease or injury, the STRs show that the Veteran was found to have normal results in audiograms conducted in September 1983 and June 1984. The fact that the Veteran was found to have normal findings on audiograms conducted during service is evidence against a finding that the Veteran had a right ear hearing loss disability in service. During the September 2014 DRO hearing, the Veteran stated that he was exposed to noise from training exercises, arms fire, and his regular duties. In light of the foregoing, the Board concedes noise exposure during service. As to a nexus to service, in a February 2002 VA treatment record, the Veteran denied any hearing problems, and in a June 2008 VA treatment record the Veteran was found to have normal hearing. The fact that the Veteran denied hearing loss 16 years after service, and was found to have normal hearing 22 years after service, tends to establish that the Veteran’s right ear hearing loss disability did not have its onset in service. In the March 2013 VA examination, the examiner stated that the hearing loss that the Veteran presented with during the examination was not a ratable loss. Word recognition scores in the right ear, in the opinion of the examiner, were not felt to be indicative of true organic hearing, as the Veteran often would not appropriately respond to the examiner’s prompts. Accordingly, while objective puretone thresholds establish that there is a right ear hearing loss disability, word recognition score testing yielded unreliable results due to the Veteran’s responses. In light of these findings, the Board notes that service connection may not be established on the basis of speculation, and without accurate results of testing, it would be speculation to indicate a nexus between the Veteran’s right ear hearing loss disability to service. Given the above evidence, the Board finds that the preponderance of the evidence is against a nexus between the current right ear hearing loss disability and service. Furthermore, the evidence of record does not demonstrate that the Veteran’s symptoms have been continuous since separation from service in August 1986. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). There were no complaints, diagnosis, or treatment for this disorder for approximately 22 years following service discharge. As mentioned above, a June 2008 VA treatment record established that the Veteran had normal hearing. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 22 years after service is one factor that tends to weigh against a finding of continuous symptoms since separation from service. The Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence. A prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for a right ear hearing loss disability. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 5. Entitlement to service connection for a left ear hearing loss disability The question for the Board in this case 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. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303. In order for service connection to be established, there needs to be competent evidence of a current disability. The Board concludes that the Veteran does not have a current diagnosis of left ear hearing loss disability 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), 38 C.F.R. § 3.303(a), (d). On a VA audiological evaluation in March 2013, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 LEFT 15 20 20 15 20 Speech audiometry revealed speech recognition ability of 94 percent in the left ear. The April 2015 VA examiner evaluated the Veteran and determined that, while he experienced symptoms of hearing loss, the Veteran may have hearing loss at a level that is not considered to be a disability for VA purposes. The examiner wrote that this can occur when there is sensorineural hearing loss in the frequency range of 6000 Hz or higher frequencies. Specific to claims for service connection, impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of these frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. In evaluating claims of service connection for hearing loss disability, it is observed that the threshold for normal hearing is from zero to 20 decibels, with higher threshold levels indicating some degree of hearing loss. Here, at the Veteran’s VA audiological evaluation in March 2013, he did not have an auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz at 40 decibels or greater, or a measurement of auditory thresholds for at least three of these frequencies that was 26 decibels or greater. Furthermore, the VA examiner did not find that he had a current diagnosis of a left ear hearing loss disability. Accordingly, the evidence does not support a left ear hearing loss disability for VA purposes. Service connection is predicated on the existence of a current disability for VA purposes. At present, there is no competent evidence of record that establishes the existence of left ear hearing loss disability under the clear requirement of 38 C.F.R. § 3.385. The United States Court of Appeals for Veterans Claims has specifically upheld the validity of 38 C.F.R. § 3.385 to define hearing loss for VA compensation purposes. Laypersons are sometimes competent to provide opinions regarding etiology and diagnosis. In this case, the Board finds that the specific audiological results shown on examination are more probative evidence as to whether the Veteran manifests a left ear hearing loss disability for VA purposes. While the Veteran believes he has a current left ear hearing loss disability, he is not competent to provide a diagnosis in this case. Whether a claimant has a current hearing loss disability is defined by VA regulation, and the evidence as it now stands does not show that the Veteran has a left ear hearing loss disability as defined by 38 C.F.R. § 3.385. Consequently, the Veteran cannot establish a current left ear hearing loss disability by his own lay statements. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131. Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Because the evidence shows that the Veteran does not have a left ear hearing loss disability during the pendency of the appeal, the Board finds that service connection for a left ear hearing loss disability is not warranted. 6. Entitlement to service connection for tinnitus The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for tinnitus on either a direct, secondary, or presumptive basis. The reasons follow. The Board notes that although the Veteran has not raised the theory of secondary service connection, this theory of entitlement was discussed by the examiner in the March 2013 VA examination. Accordingly, the Board finds that secondary entitlement has reasonably been raised by the record and will provide related analysis, as discussed below. In the October 2018 Written Brief Presentation, the Veteran’s representative expressed confusion regarding the requirement of service connection for hearing loss as the basis for the denial of entitlement to service connection for tinnitus. The Board notes that while the March 2013 VA examination provides a nexus opinion as to secondary service connection, the theory of direct service connection is provided in a March 2013 addendum opinion. The Veteran does not suffer any detriment from the consideration of multiple theories of entitlement, and the Board has fulfilled the duty to assist. The Veteran has been diagnosed with tinnitus, and thus there is evidence of a current disability. As to an in-service disease or injury, the STRs show that the Veteran was found to have normal results in audiograms conducted in September 1983 and June 1984, and do not otherwise support symptoms, complaints, diagnosis or treatment of tinnitus. This evidence tends to weigh against a finding that the Veteran had tinnitus in service. During the September 2014 DRO hearing, the Veteran stated that he was exposed to noise from training exercises, arms fire, and his regular duties. In light of the foregoing, the Board concedes noise exposure during service. As to a nexus to service, in a March 2013 addendum to the March 2013 VA examination, the examiner opinion that the Veteran’s tinnitus was not related to service, because the Veteran’s tinnitus was intermittent and the examiner could not relate the Veteran’s symptoms to an incident in service, which establishes that tinnitus is not related to service. To the extent that the Veteran has stated that tinnitus had its onset in service, his service treatment records do not support such a finding. To the extent that the Veteran has stated that tinnitus is otherwise related to service, his allegation is outweighed by that of the March 2013 examiner, who provided the opinion that tinnitus was not related to service. As to secondary service connection, the Veteran is not service connected for either a right ear hearing loss disability or a left ear hearing loss disability. Accordingly, the Veteran may not be granted secondary service connection on the basis of these disabilities. Furthermore, the evidence of record does not demonstrate that the Veteran’s symptoms have been continuous since separation from service in August 1986. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). As mentioned previously, the Veteran denied any hearing problems in a February 2002 VA treatment record. The first record of tinnitus appears in a computerized problem list from an October 2007 VA treatment record. As such, there were no complaints, diagnosis, or treatment for this disorder for approximately 21 years following service discharge. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 21 years after service is one factor that tends to weigh against a finding of continuous symptoms since separation from service. The Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence. A prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. Given the above evidence, the Board finds that the preponderance of the evidence is against a nexus between the post-service diagnosis and tinnitus and that tinnitus did not manifest during service or within one year of separation from service. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for tinnitus. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 7. Entitlement to service connection for chronic headaches The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for chronic headaches. The reasons follow. The Veteran has been diagnosed with chronic headaches, and thus there is evidence of a current disability. For example, in a June 2008 VA treatment record the Veteran was diagnosed with chronic headaches. As to an in-service disease or injury, the STRs show that the Veteran was found to have a normal clinical evaluation of his head and neurological system in September 1983. As noted above, the service treatment records show that the Veteran was seen for multiple medical complaints, which did not include headaches. This evidence tends to weigh against a finding that he had headaches in service, as it would seem likely that he would have sought treatment for them, as he did for multiple medical complaints. The STRs do not otherwise support complaints, symptoms, diagnosis or treatment for headaches. This tends to weigh against a finding that the Veteran had chronic headaches in service. In the September 2014 DRO hearing, the Veteran stated that he injured his head during a truck accident, when he struck a deer, and sustained significant injuries, resulting in his current chronic headaches. However, the Veteran’s service records do not support that such an incident occurred. Multiple service treatment records show that when the Veteran was seen for multiple medical complaints, the question of whether there was a head injury was asked, and the answer was consistently, “No.” As this is the type of incident that likely would have been recorded, and the record does not support any medical report of such an accident, the Board affords this allegation of an in-service head injury no probative value. The Board notes a February 2017 lay statement that states that the Veteran hit a deer in service, however the statement does not state that any injuries were sustained as a result of the incident. As such, the statement is of limited probative value and does not assist in a finding of an in-service disease or injury involving headaches. Further supporting this finding that the Veteran did not sustain a head injury in service that caused headaches are the VA treatment records. For example, when seen in September 2001, the Veteran reported having headaches, which he stated “ha[d] been going on for nearly 10 years and has not changed.” This shows the onset of headaches in approximately 1991 or later, and is approximately five years following the Veteran’s service discharge. Additionally, a February 2011 VA treatment record shows that a review of the Veteran’s medical problems was performed at that time. When asked if the Veteran had or had ever complained of any of the following medical problems, and “Traumatic brain injury,” and “Other significant trauma” were two of the questions asked, the examiner wrote, “No” for each answer. The Veteran has alleged sustaining significant injuries in this truck accident. These records tend to show that the Veteran did not sustain a head injury in service and that the Veteran’s headaches developed approximately five years following service discharge. Although the Veteran claims that his chronic headaches related his service, a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, headache disabilities require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s chronic headaches is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for chronic headaches. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 8. Entitlement to service connection for an acquired psychiatric disorder The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for an acquired psychiatric disorder, to include PTSD, mood disorder, obsessive compulsive disorder, cocaine dependence, alcohol abuse, alcohol dependence, and bipolar disorder. The reasons follow. The Board notes that although the Veteran has not raised the theory of secondary service connection, this theory of entitlement was discussed by the examiner in the March 2013 VA examination. Accordingly, the Board finds that secondary service connection entitlement has reasonably been raised by the record and will provide related analysis, as discussed below. The Veteran has been diagnosed with an acquired psychiatric disorder, and thus there is evidence of a current disability. For example, the Veteran has been variably diagnosed with PTSD, mood disorder, obsessive compulsive disorder, cocaine dependence, alcohol abuse, alcohol dependence, and bipolar disorder. Due to the distinct legal analysis for PTSD, it will be discussed separately below. Service connection may not be granted for substance abuse on the basis of in-service incurrence or aggravation. However, secondary service connection is available for substance abuse if such abuse is found to be secondary to a service-connected disability. 38 U.S.C. §§ 105, 1110; 38 C.F.R. § 3.301(a); VAOPGCPREC 2-98. The Veteran’s only service-connected disability is pseudofolliculitis barbae. The Veteran does not contend, and the evidence does not show, that the diagnoses of cocaine dependence, depression, alcohol abuse, and alcohol dependence are proximately due to or aggravated by his service-connected pseudofolliculitis barbae. For example, in the March 2014 VA examination, the examiner opined that the Veteran’s acquired psychiatric disorder was not proximately due to or aggravated by his service-connected pseudofolliculitis barbae. Accordingly, the Veteran’s cocaine dependence alcohol abuse, and alcohol dependence are not subject to service connection. However, as to an in-service disease or injury, the STRs show that the Veteran was found to have a clinically normal psychiatric evaluation in September 1983. The STRs do not otherwise support evidence of symptoms, complaints, diagnosis or treatment of an acquired psychiatric disorder. This evidence tends to weigh against a finding that he had an acquired psychiatric disorder in service. To the extent that the Veteran has stated that an acquired psychiatric disorder had its onset in service, the evidence as a whole does not support such a finding. For example, the Veteran started seeking treatment for substance abuse in 2002. There, the Veteran reported that he had “recently experienced serious depression, serious anxiety and tension.” The examiner wrote that the Veteran “does not admit to any previous psychiatric problems.” The Veteran described being homeless and being laid off. The Veteran was seen regularly in 2002, and he was not alleging a long history of psychiatric symptoms or that his psychiatric symptoms had had their onset in service or in close proximity to service. This further supports a finding that a psychiatric disorder did not have its onset in service. As to a nexus to service, in a September 2009 VA treatment record, the Veteran denied any prior history of psychiatric diagnoses or symptoms and stated his current symptoms were the first manifestation of psychiatric issues, which is approximately 23 years following service discharge, and tends to establish that an acquired psychiatric disorder did not have its onset in service. Although the Veteran claims that his acquired psychiatric disorder is related his service, a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, acquired psychiatric disorders require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s acquired psychiatric disorder is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. As to secondary service connection, in the March 2014 VA examination report, the examiner concluded that the Veteran’s acquired psychiatric disorder could not be related to the Veteran’s pseudofolliculitis barbae, because the Veteran’s skin condition was under control, and the examiner attributed the Veteran’s depression and anxiety to his substance abuse problems. This is evidence against a finding that the Veteran’s acquired psychiatric disorder is caused or aggravated by the service-connected pseudofolliculitis barbae. Although the examiner opined that the Veteran’s psychiatric disorder is also not due to the Veteran’s hearing loss disability or tinnitus, the Board notes that the Veteran is not service connected for these disabilities, and accordingly may not be granted service connection on a secondary basis due to these disabilities. With regard to the Veteran’s diagnosis of PTSD, as to direct service connection, the Veteran’s claim fails on both the credible supporting evidence that the claimed in-service stressor actually occurred and medical evidence of a causal nexus between current symptomatology and a claimed in-service stressor. As to the in-service stressor, in a February 2016 VA Form 21-4138 and at the September 2014 DRO hearing, the Veteran stated that his stressor was when his daughter was taken away from him when she was born in December 1985. At the DRO hearing, the Veteran also stated that another stressor was verbal abuse from other service members. However, the record does not support that the Veteran had a child that was taken away from him, or that the Veteran sought psychiatric counseling for either incident during service. This evidence tends to weigh against a finding that the in-service stressor actually occurred. As to medical evidence of a causal nexus between current symptomatology and a claimed in-service stressor, in a November 2011 VA treatment record, an examiner contended that the Veteran’s PTSD was not related to service, and was instead related to the Veteran’s childhood. This finding of PTSD being attributed to the Veteran’s childhood is made throughout the VA treatment records, and the Veteran described extreme anger at his father, who he states physically abused him. This evidence tends to weigh against a finding of a link, established by medical evidence, between the diagnosis of PTSD and the claimed in-service stressors. Additionally, the available VA treatment records from February 2002 until June 2018 do not show that the Veteran referenced either stressor when seeking treatment. As mentioned above, in a September 2009 VA treatment record, the Veteran denied any prior history of psychiatric diagnoses or symptoms, and stated his current symptoms were the first manifestation of psychiatric issues. Regardless, from September 2009 onwards, the record does not support a finding of a PTSD stressor related to the Veteran’s reported stressors as mentioned above. This evidence also tends to weigh against a finding of a link, established by medical evidence, between the diagnosis of PTSD and the claimed in-service stressor. In summary, the record does not support that the claimed stressors actually occurred, and does not support that the circumstances of the Veteran’s claimed in-service stressors are related to his current diagnosis of PTSD. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for an acquired psychiatric disorder. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Husain, Associate Counsel