Citation Nr: 18161146 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-54 309 DATE: December 28, 2018 ORDER Entitlement to service connection for left eye disorder is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for hepatitis C is denied. Entitlement to service connection for bilateral hearing loss is denied. FINDINGS OF FACT 1. Currently diagnosed left eye glaucoma did not manifest during active service, and is otherwise shown to be caused by service. 2. The Veteran does not have a disability of tinnitus during the period of the appeal. 3. Currently diagnosed hepatitis C did not manifest during active service, and is otherwise shown to be caused by service. 4. Currently diagnosed hypertension did not manifest during active service or within one year of discharge from service, and is not otherwise shown to be caused by service. 5. The Veteran does not have bilateral hearing loss for VA compensation purposes. CONCLUSIONS OF LAW 1. The criteria for service connection for left eye disorder have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). 2. The criteria for service connection for tinnitus have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). 3. The criteria for service connection for hepatitis C have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). 4. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385 (2018). 5. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service as a seaman in the United States Navy from November 1972 to November 1974. This case comes before the Board of Veterans’ Appeals (Board) on appeal of a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. The Board has recharacterized the issue as left eye disorder to address the Veteran’s symptoms, regardless of how those symptoms are diagnosed or labeled. See Clemons v. Shinseki, 23 Vet App. 1, 5 (2009). Service Connection Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998). If the evidence is competent, the Board must then determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 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); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Some chronic diseases, to include hypertension and sensorineural hearing loss, may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C.§§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303 (b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). All have a presumptive period of one year following separation from service. Hearing loss for the purposes of VA disability compensation is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 hertz are 26 decibels or greater; or when the speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. In addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). Discussion Left Eye Disorder Tinnitus Hepatitis C The Veteran contends that a left eye disorder, tinnitus, and hepatitis C were incurred in active service. A review of the Veteran’s service treatment records (STRs) shows that a November 1974 separation report of medical examination indicates normal clinical evaluation of the eyes; normal ophthalmoscopic evaluation; normal clinical evaluation of the pupils; normal clinical evaluation of ocular motility; and normal clinical evaluation of abdomen and viscera. The Veteran required corrective lenses for visual acuity. The Veteran’s subsequent Reserve STRs include an April 1975 annual report of medical examination, the findings of which mirror those of the November 1974 separation report. An associated April 1975 report of medical history indicates that the Veteran wears glasses or contact lenses as the only reason for his report of “eye trouble.” The Veteran denied hearing loss; stomach, liver, or intestinal trouble; and jaundice or hepatitis; and the examiner noted no related system abnormalities except the need for corrective lenses. VA treatment records from 2014 to 2016 show that the Veteran sought care at an ophthalmology clinic. Clinicians provided extensive notations as to the status of the Veteran’s left eye. Moreover, a VA clinician diagnosed glaucoma of the left eye. These records also show that the Veteran had hepatitis C, which was never treated. In a November 2015 report of general information (VA Form 21-0820), a VA employee noted that the Veteran called and stated that he believed that his exposure to hepatitis C occurred after active service, while he worked at General Motors. See November 23, 2015 VA Form 21-0820. Upon evaluation in February 2016, a VA audiologist opined that the Veteran reported that he did not have recurrent tinnitus, therefore the audiologist provided no indication as to the functional impact of tinnitus. In November 2016, VA received private treatment records from Dr. J. The doctor opined that the Veteran was first seen in August 2016. Dr. J. indicated that the Veteran had a history of glaucoma. The records indicate an onset date of August 22, 2016, when he first sought treatment from the doctor’s facility. While the Veteran has contended that service connection is warranted for left eye disorder, tinnitus, and hepatitis C, he has offered no competent medical evidence to support this contention. While the medical evidence of record includes current diagnoses of left eye disorder and hepatitis C, the record of evidence goes not show in-service incurrences of these disabilities. Whereas the record of evidence provides neither a showing of in-service complaints nor current complaints of tinnitus. Therefore, a nexus cannot be drawn for left eye disorder, tinnitus, or hepatitis C, and the possibility of granting service connection for these three issues is foreclosed. Here, the Board notes that the Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006). The Veteran has not been provided an examination relevant to left eye glaucoma or hepatitis C because there is no evidence of an injury or onset of manifestations of disease in service other than the Veteran’s lay statements that are not consistent with the STRs. VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to” and mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The preponderance of evidence is against the Veteran’s claims and there is no doubt to be resolved. See 38 U.S.C. § 5107(b); Gilbert, supra. Hypertension The Veteran contends that hypertension was incurred in active service. The November 1974 separation report reports a normal clinical evaluation if the Veteran’s vascular system. Blood pressure was recorded as 116/70 mmHg. Likewise, the November 1975 post-service annual examination includes the same normal system finding with blood pressure measured as 117/46 mmHg. Moreover, in the Veteran’s associated April 1975 report of medical history, he denied any history of high or low blood pressure. VA treatment records from 2014 to 2016 include multiple notations concerning essential hypertension. Dr. J. also reported a history of hypertension, without stipulating the date of onset. Further, the doctor opined that the Veteran’s blood pressure has been poorly controlled due to non-compliance. The Veteran has advanced that hypertension was incurred in active service; however, here too he has offered no competent medical evidence to support this proposition. The medical evidence of record includes current diagnoses of essential hypertension; however, the evidence of record does not include either a diagnosis of hypertension (or for that matter elevated blood pressure) in active service or within one year of separation from service. Therefore, a nexus cannot be drawn directly or presumptively. As such, service connection is not warranted. The Veteran has not been provided an examination relevant to hypertension because there is no evidence of an injury or onset of manifestations of disease in service other than the Veteran’s lay statements that are not consistent with the STRs. The preponderance of evidence is against the Veteran’s claim and there is no doubt to be resolved. See 38 U.S.C. § 5107(b); Gilbert, supra. Bilateral Hearing Loss The Veteran contends that he has bilateral hearing loss that was incurred in active service. The November 1974 separation report does not include audiometric measurements. However, STRs do not reflect complaints, consultation, or treatment for either acoustic trauma or bilateral hearing loss. Further, “post-service” Reserve STRs from November 1975 provide the same information as to lack of complaints, consultation, or treatment. In the concurrent medical history questionnaire, the Veteran denied any hearing loss. A review of VA treatment records shows that multiple clinicians indicated that the Veteran’s bilateral hearing acuity was normal. However, in February 2016, a VA clinician reported that the Veteran’s chief complaint was “questionable hearing loss.” This notation was made on the same day that the Veteran was afforded a VA audiological examination. The February 2016 VA audiologist’s audiometric testing revealed pure tone thresholds, in decibels as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 15 25 25 LEFT 0 5 25 25 25 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 100 percent in the left ear. The audiologist provided a diagnosis of normal hearing in both ears. Specifically, there was no permanent threshold shift (worse than reference threshold) greater than normal measurement variability at any frequency between 500 Hz and 600 Hz for either ear. The audiologist provided a negative nexus opinion, based upon a rationale that current audiological findings indicated bilateral hearing within normal limits. Consequently, she opined that there were no functional impacts. See Martinak, supra. The Veteran alleges that he has bilateral hearing loss that was incurred in active service; however, he has offered no competent audiological evidence to support this claim. The Board assigns great probative weight to the February VA audiologist’s findings, which are based upon audiometric testing results, claims file review, and consideration of possible functional impacts. Findings show that the Veteran does not have bilateral hearing loss for VA compensation purposes. Service connection for bilateral hearing loss is not warranted. (Continued on the next page)   The preponderance of evidence is against the Veteran’s claim and there is no doubt to be resolved. See 38 U.S.C. § 5107(b); Gilbert, supra. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. J. Komins, Associate Counsel