Citation Nr: 18159723 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 16-52 170 DATE: December 19, 2018 ORDER Entitlement to service connection for throat condition is denied. Entitlement to service connection for an acquired psychiatric condition, to include adjustment disorder, depression, anxiety, and anger condition, is denied. Entitlement to service connection for vertigo is denied. Entitlement to service connection for right ear hearing loss is denied. Entitlement to service connection for left ear hearing loss is denied Entitlement to service connection for tinnitus is denied. REMANDED Entitlement to service connection for allergic rhinitis, claimed as nose condition, is remanded. FINDINGS OF FACT 1. 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 throat condition. 2. The preponderance of the evidence of record is against finding that an acquired psychiatric condition, to include adjustment disorder, depression, anxiety, and anger condition began during active service, or is otherwise related to an in-service injury, event, or disease. 3. 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 vertigo. 4. 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 right ear hearing loss. 5. The preponderance of the evidence of record is against finding that the Veteran has left ear hearing loss due to a disease or injury in service, to include specific in-service event, injury, or disease. 6. The preponderance of the evidence of record is against finding that the Veteran has tinnitus due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a throat condition are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for an acquired psychiatric condition, to include adjustment disorder, depression, anxiety, and anger condition are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a vertigo condition are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.385. 5. The criteria for service connection for left ear hearing loss are not met. 38 U.S.C. §§ 1110, 1111, 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. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from October 1994 until his honorable discharge in November 1997. The Veteran also served in the United States Army National Guard from May 2000 until his discharge in March 2001. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2017). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2017). As for his service with the National Guard, active military service includes any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of inactive duty training during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C. § 101 (21) and (24) (2012); 38 C.F.R. § 3.6 (a) and (d) (2017). It follows that service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty for training (ACDUTRA), or from injury incurred or aggravated while performing inactive duty for training (INACDUTRA). 38 U.S.C. §§ 101 (24), 106, 1131. ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). INACDUTRA is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). Active service also includes authorized travel to or from such duty or service. 38 U.S.C. § 106 (d); 38 C.F.R. § 3.6 (e). In summary, when a claim for service connection is based only on a period of ACDUTRA or INACDUTRA, there must be evidence that the Veteran became disabled as a result of a disease or injury incurred or aggravated in the line of duty during that period of ACDUTRA or INACDUTRA. See 38 U.S.C. §§ 101 (2), (22), (24); 38 C.F.R. § 3.6 (a). In the absence of such evidence, the period of ACDUTRA or INACDUTRA would not qualify as “active military, naval, or air service,” and the Veteran would not qualify as a “Veteran” for that period of ACDUTRA or INACDUTRA service alone. 38 U.S.C. § 101 (2), (24); see Acciola v. Peake, 22 Vet. App. 320, 324 (2008). Generally, no presumptions (including the presumptions of soundness, aggravation, or for presumptive diseases) attach to periods of ACDUTRA and INACDUTRA unless “Veteran” status is attained during those periods. Paulson v. Brown, 7 Vet. App. 466, 470 (1995).   1. Entitlement to service connection for throat condition. The Veteran alleges that his throat condition is related to an in-service dental extraction and restoration. See December 2014 Fully Developed Claim; January 2015 Fully Developed Claim. The Board finds that there is not a current disability during the pendency of the claim. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran has not provided any evidence, including medical evidence or lay statements, of a current diagnosis of a throat condition. In the absence of a disability during the pendency of the claim, service connection cannot be established. See Holton, 557 F.3d at 1366 (holding that entitlement to service requires, among other things, evidence of a current disability); see also Degmetich v. Brown, 104 F.3d 1328, 1332 (1997). Based on the foregoing, the preponderance of the evidence is against the claim for service connection for a throat condition. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. §5107(b); 38 C.F.R. §3.102. 2. Entitlement to service connection for an acquired psychiatric condition, to include adjustment disorder, depression, anxiety, and anger condition. The Veteran alleges that his acquired psychiatric disorder is related to his motor vehicle accident in April 2001. See December 2014 Fully Developed Claim, January 2015 Fully Developed Claim, and July 2015 VA PTSD Examination. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran was diagnosed with other specified trauma and stressor related disorder. See July 2015 VA PTSD Examination, p. 1. Second, the Board finds that there was not an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran reported no traumatic events in the military, no mental health treatments or complaints during his military service. Additionally, the only traumatic incident and mental health treatment reported by the Veteran was due to a motor vehicle accident that occurred in 2001 while the Veteran was not on active duty. See July 2015 VA Psychiatric Examination, pp. 3-4. Thus, without an in-service event, injury or disease during the requisite service period, direct service connection is not warranted. Third, even if the Board found that there was an in-service event, injury or disease, there would still need to be a nexus between the in-service event, injury or disease and the acquired psychiatric disability. The Board finds that the evidence of record does not support a finding that an acquired psychiatric disability is related to the Veteran’s active service. The Veteran was afforded a VA examination in July 2015. See July 2015 Psychiatric VA Examination. As noted above, the July 2015 examiner diagnosed the Veteran with other specified trauma and stressor related disorder and noted a history of seizures and headaches since the 2001 motor vehicle accident. See July 2015 VA Psychiatric Examination, p. 1. The Veteran did not report a history of mental health treatment and reported that he did not have any traumatic events during his military service. See July 2015 VA Psychiatric Examination, p. 3. The Veteran also reported the sole traumatic event that he experienced was when, as a passenger of a privately-owned vehicle, he was involved in a motor vehicle accident in 2001. See July 2015 VA Psychiatric Examination, pp. 3-4. The Veteran reported that when a friend of his lost control of his vehicle, the friend was killed in the accident and the Veteran was severely injured with head trauma. Id. The Veteran reported that he suffered head trauma from the accident that resulted in a 7-week coma and a 2 ½ month hospitalization followed by therapy and anti-depressant medication for headaches. Id. The examiner concluded that the Veteran’s diagnosis of other specified trauma and stressor related disorder is more likely than not related to the motor vehicle accident while the Veteran was on inactive duty for the National Guard. See 38 U.S.C. §§ 101 (2), (22), (24); 38 C.F.R. § 3.6 (a); see also Acciola v. Peake, 22 Vet. App. 320, 324 (2008). Accordingly, service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for vertigo. The Veteran alleges that his ear condition began during service and has existed since that time and/or it is related to an in-service dental extractions and restoration. See December 2014 Fully Developed Claim; January 2015 Fully Developed Claim. The Board has recharacterized the Veteran’s claim for service connection for ear condition into four separate and distinct claims. There have been four claims developed under the claim for entitlement to service connection for an ear condition. The first claim is entitlement to service connection for vertigo, which will be addressed here. The second claim is for entitlement to service connection for hearing loss in the Veteran’s right ear, the third claim is for entitlement to service connection for hearing loss in the Veteran’s left ear, and the fourth claim is for entitlement to service connection for tinnitus. The hearing and tinnitus claims will be addressed later in this decision. First, the Board finds that there is not a current disability for the claim of vertigo. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran was afforded a VA examination in July 2015. See July 2015 VA Examination. The July 2015 VA examiner provided that the Veteran did not have, nor has ever been diagnosed with an ear or peripheral vestibular condition. See July 2015 VA Examination, p. 1. The examination summarizes the Veteran’s history including the fact that the Veteran alleges that he bumped his head into the wing of an aircraft being towed during service and that in April 2001, the Veteran was also involved in a serious motor vehicle accident that required neurosurgical intervention and caused a traumatic brain injury. See July 2015 VA examination, p. 1. Additionally, the Veteran underwent an additional enlistment examination in June 2006 where he denied dizziness and fainting spells. See Service Treatment Records, p. 16. The examiner found that the Veteran did not have vertigo or nystagmus symptoms during the testing. See July 2015 VA Examination, p. 3. Furthermore, the examiner found that there were no other pertinent physical findings, complications, conditions, signs, or symptoms related to vertigo or nystagmus. See July 2015 VA Examination, pp. 3-4. In the absence of a disability during the pendency of the claim, service connection cannot be established. See Holton, 557 F.3d at 1366 (holding that entitlement to service requires, among other things, evidence of a current disability); see also Degmetich v. Brown, 104 F.3d 1328, 1332 (1997). Based on the foregoing, the preponderance of the evidence is against the claim for service connection for a vertigo condition. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. §5107(b); 38 C.F.R. §3.102. 4. Entitlement to service connection for right ear hearing loss. The Veteran alleges that his ear condition began during service and has existed since that time and/or it is related to an in-service dental extractions and restoration. See December 2014 Fully Developed Claim; January 2015 Fully Developed Claim. As noted above, the Board has recharacterized the Veteran’s claim for service connection for ear condition into four separate and distinct claims. Having denied the first claim for service connection for vertigo, the Board will now address the claim of entitlement to service connection for hearing loss in the Veteran’s right ear. Sensorineural hearing loss is a condition that is considered chronic, and therefore, will be presumed to have been incurred in service if it manifested to a compensable degree (meaning to at least 10 percent disabling) within one year after discharge from service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 264, 271 (2015) (specifying that sensorineural hearing loss and tinnitus are considered organic diseases of the nervous system subject to § 3.309(a)). This presumption, however, is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as sensorineural hearing loss is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater, or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hertz are 26 decibels or greater, or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Also, the threshold for normal hearing is between 0 and 20 decibels, and higher threshold shows some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The absence of evidence of a hearing disability during service (i.e., one meeting the requirements of 38 C.F.R. § 3.385 above) is not always fatal to a service connection claim. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Service connection for hearing loss may be granted where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service (as opposed to intercurrent causes). Hensley, 5 Vet. App. 155, 159. The Board finds that there is not a current right ear hearing disability for VA purposes during the pendency of the claim. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran was afforded a VA hearing examination in June 2015. See June 2015 VA Hearing Examination. On the authorized audiological evaluation in June 2015, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 5 0 5 Speech audiometry revealed speech recognition ability of 100 percent in the right ear. The examiner found that the Veteran had normal hearing in the right ear. See June 2015 VA Hearing Examination, p. 2. In the absence of a disability during the pendency of the claim, service connection cannot be established. See Holton, 557 F.3d at 1366 (holding that entitlement to service requires, among other things, evidence of a current disability); see also Degmetich v. Brown, 104 F.3d 1328, 1332 (1997). Based on the foregoing, the preponderance of the evidence is against the claim for service connection for a throat condition. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. §5107(b); 38 C.F.R. §3.102. 5. Entitlement to service connection for left ear hearing loss. The Veteran alleges that his ear condition began during service and has existed since that time and/or it is related to an in-service dental extractions and restoration. See December 2014 Fully Developed Claim; January 2015 Fully Developed Claim. Furthermore, the Veteran asserts that his left ear hearing has decreased since the motor vehicle accident in 2001. See June 2015 VA Hearing Loss Examination, p. 4. As noted above, the Board has recharacterized the Veteran’s claim for service connection for ear condition into four separate and distinct claims. Having dined the claims of entitlement to service connection for vertigo and hearing loss in the right ear, the Board will now consider the claim of entitlement to service connection for hearing loss in the Veteran’s left ear. Sensorineural hearing loss is a condition that is considered chronic, and therefore, will be presumed to have been incurred in service if it manifested to a compensable degree (meaning to at least 10 percent disabling) within one year after discharge from service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 264, 271 (2015) (specifying that sensorineural hearing loss and tinnitus are considered organic diseases of the nervous system subject to § 3.309(a)). This presumption, however, is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as sensorineural hearing loss is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater, or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hertz are 26 decibels or greater, or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Also, the threshold for normal hearing is between 0 and 20 decibels, and higher threshold shows some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The absence of evidence of a hearing disability during service (i.e., one meeting the requirements of 38 C.F.R. § 3.385 above) is not always fatal to a service connection claim. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Service connection for hearing loss may be granted where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service (as opposed to intercurrent causes). Hensley, 5 Vet. App. 155, 159. First, the Board finds that there is a current disability for hearing loss in the left ear for VA purposes. See Holton, 557 F.3d at 1366; 38 C.F.R. §§ 3.303(d), 3.385. See June 2015 VA Hearing Examination. Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). With a Tactical Aircraft Maintenance Military Occupational Specialty (MOS), the Veteran’s in-service noise exposure is conceded. See November 1997 DD-214. Third, the Board finds that the evidence of record does not support a finding that the Veteran’s hearing loss is related to active service. On the authorized audiological evaluation in October 1993, the Veteran was provided an enlistment examination which showed that the Veteran’s pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 LEFT 0 0 0 5 5 See Service Treatment Records, p. 37, 39. During his active service, the Veteran was provided an audiological examination in November 1995. On the authorized audiological evaluation in November 1995, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 LEFT 10 0 5 0 5 See Service Treatment Records, p. 33. In June 2006, the Veteran was provided an additional audiological examination in conjunction with an application for re-enlistment into the Army National Guard. On the authorized audiological evaluation in June 2006, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 LEFT 20 10 5 0 5 As noted above, in conjunction with this claim, the Veteran was afforded a VA audiological examination in June 2015. On the authorized audiological evaluation in June 2015, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 LEFT 25 30 40 30 35 Speech audiometry revealed speech recognition ability of 100 percent in the left ear. The VA examiner opined that, after being discharged for nearly a decade, the Veteran had excellent hearing for all frequencies on the June 2006 audiological examination and concluded that the Veteran’s active duty noise exposure did not cause the Veteran’s left ear hearing loss. The Board notes that the Veteran had been separated for nearly a decade when he underwent the June 2006 audiological examination and that the preponderance of the evidence is against finding that the Veteran has left ear hearing loss due to a disease or injury in service, to include specific in-service event, injury, or disease. Therefore, the Board finds the Veteran’s left ear hearing loss did not manifest during or within the year after his separation from service, and the evidence of record does not establish that he has had continuous difficulty hearing since he separated from service. He is therefore not entitled to service connection on a presumptive basis, including on the basis of continuity of symptomatology. The failure to establish a presumptive basis of service connection, with regard to the Veteran’s disability, does not preclude the Veteran from establishing service connection on another basis. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); 38 U.S.C. § 1113 (b). Instead, the Veteran may establish direct service connection to the current disability. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993), which held that the Veteran may submit evidence that the disability is causally related to service. Here, however, the Board concludes that the evidence weighs against the service connection claim on a direct incurrence basis. The June 2015 VA examination found the Veteran’s left ear hearing loss is not related to service. This examiner conducted a comprehensive clinical examination and evidentiary review, and indicated familiarity with the Veteran’s pertinent medical and lay history. The examiner provided an adverse opinion regarding the relationship between the Veteran’s active duty service and the results of the examination. There are no conflicting opinions. In sum, there is no competent medical evidence of record reflecting that the Veteran demonstrated left ear hearing loss to a compensable degree within one year of discharge from active duty, and the VA examiner’s opinion also weighs against this finding as there is no indication the Veteran sought treatment for hearing loss until approximately a decade after his separation from service. Otherwise, there is no medical evidence of record indicating that the Veteran’s left ear hearing loss was caused or aggravated by his active duty service. Accordingly, entitlement to direct service connection under 38 C.F.R. § 3.304 or to presumptive service connection for left ear hearing loss under 38 C.F.R. § 3.309(a) is not shown. The Veteran has asserted his personal belief that he has hearing loss due to noise exposure in service. The Veteran is competent to report noise exposure in service, and he is competent to report difficulty hearing since, but he is not competent as a layperson to opine regarding the etiology of hearing disability that demonstrably became manifest years after service. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to service connection for tinnitus. The Veteran alleges that his ear conditions began during service and has existed since that time and/or it is related to an in-service dental extractions and restoration. See December 2014 Fully Developed Claim; January 2015 Fully Developed Claim. Furthermore, the Veteran asserts that his tinnitus began approximately one month after the motor vehicle accident in 2001. See June 2015 VA Tinnitus Examination, p. 4. As noted above, the Board has recharacterized the Veteran’s claim for service connection for ear condition into four separate and distinct claims. The fourth claim is for entitlement to service connection for tinnitus, is addressed here. Tinnitus is defined as “a noise in the ear, such as ringing, buzzing, roaring, or clicking. It is usually subjective in type.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY (DORLAND’S) 1956 (31st ed. 2007). And, indeed, because of the inherently subjective nature of it, it is readily capable of even lay diagnosis. Charles v. Principi, 16 Vet. App. 370 (2002). First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). See June 2015 VA Tinnitus Examination. Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran was assigned a Tactical Aircraft Maintenance MOS, the Veteran’s in-service noise exposure is conceded. See November 1997 DD-214. Third, the Board finds that the evidence of record does not support a finding that the Veteran’s tinnitus is related to active service. As noted above, the Veteran asserts that his tinnitus began approximately one-month after his motor vehicle accident in 2001. Because the Veteran’s tinnitus began nearly 5 years after his discharge from the military and the Veteran reported no traumatic events in the military, no treatments or complaints for tinnitus during his military service, the VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran’s tinnitus was caused by or a result of military noise exposure because there was no link to the Veteran’s military service. Accordingly, service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990).   REASONS FOR REMAND Entitlement to service connection for allergic rhinitis, claimed as nose condition. The Veteran alleges that his nose condition is related to an in-service dental extraction and restoration. See December 2014 Fully Developed Claim; January 2015 Fully Developed Claim. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In the present case, the Veteran was afforded a VA examination concerning his nose condition. See July 2015 VA Examination. The examiner diagnosed the Veteran with allergic rhinitis and opined that the Veteran’s condition had not been aggravated beyond normal progression for this condition because of his military service. See July 2015 VA Examination, p. 3. Despite providing the opinion with a clear conclusion, the examiner failed to provide a reasoned medical explanation or rationale to support the opinion. Because the VA examiner failed to provide any rationale to support the opinion, the VA examination is inadequate and the claim must be remanded. The 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 currently diagnosed allergic rhinitis, claimed as nose condition. The examiner must opine whether the Veteran’s current allergic rhinitis, claimed as nose condition, is at least as likely as not (50 percent probability or greater) related to an in-service injury, event, or disease. The examiner is advised that they must provide a detailed rationale to support the opinion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. T. BERRY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. DEEMER, ASSOCIATE COUNSEL