Citation Nr: 18123765 Decision Date: 08/03/18 Archive Date: 08/02/18 DOCKET NO. 12-15 695 DATE: August 3, 2018 ORDER Entitlement to service connection for left foot degenerative joint disease (claimed as arthritis throughout the body) is denied. Entitlement to service connection for right foot degenerative joint disease (claimed as arthritis throughout the body) is denied. Entitlement to service connection for left hip degenerative joint disease (claimed as arthritis throughout the body) is denied. Entitlement to service connection for degenerative disc disease and degenerative joint disease of the lumbar spine is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for bipolar disorder with depression is denied. Entitlement to nonservice-connected pension is denied. FINDINGS OF FACT 1. The appellant did not become disabled due to left foot degenerative joint disease during ACDUTRA; the record contains no indication that the current left foot degenerative joint disease is related to disease or injury during her active service. 2. The appellant did not become disabled due to right foot degenerative joint disease during ACDUTRA; the record contains no indication that the current right foot degenerative joint disease is related to disease or injury during her active service. 3. The appellant did not become disabled due to left hip degenerative joint disease during ACDUTRA; the record contains no indication that the current left hip degenerative joint disease is related to disease or injury during her active service. 4. The appellant did not become disabled due to a lumbar spine disease or injury during ACDUTRA; the record contains no indication that the current degenerative disc disease and degenerative joint disease of the lumbar spine is related to disease or injury during her active service. 5. The appellant does not have a current bilateral hearing loss disability for VA purposes. 6. The appellant did not become disabled due to tinnitus during ACDUTRA and the most probative evidence of record indicates that her current tinnitus is not related to disease or injury during any period of active service. 7. The appellant did not become disabled due to hypertension during ACDUTRA and the record contains no indication that the current hypertension is related to disease or injury during her active service. 8. Schizophrenia preexisted the appellant’s ACDUTRA and was not aggravated therein. 9. The appellant did not become disabled due to bipolar disorder with depression during ACDUTRA; the record contains no indication that the current bipolar disorder with depression is related to an injury or disease during active service. 10. The appellant did not serve during a period of war. CONCLUSIONS OF LAW 1. The criteria for service connection for left foot degenerative joint disease have not been met. 38 U.S.C. §§ 101, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for right foot degenerative joint disease have not been met. 38 U.S.C. §§ 101, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 3. The criteria for service connection for left hip degenerative joint disease have not been met. 38 U.S.C. §§ 101, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 4. The criteria for service connection for degenerative disc disease and degenerative joint disease of the lumbar spine have not been met. 38 U.S.C. §§ 101, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 5. The criteria for service connection for bilateral hearing loss and tinnitus have not been met. 38 U.S.C. §§ 101, 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 6. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 101, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 7. The criteria for service connection for bipolar disorder with depression have not been met. 38 U.S.C. §§ 101, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 8. The criteria for nonservice-connected pension benefits are not met. 38 U.S.C. § 1521; 38 C.F.R. §§ 3.3, 3.6. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant was a member of the Army Reserve from April 1979 to January 1986. She had an initial period of active duty for training from May 1979 to January 1980. See Request for Information dated June 18, 2010, characterizing this period of service as active duty for training (ACDUTRA); see also Record of Assignment, characterizing this period of service as “ADT.” The appellant thereafter had a subsequent two week period of ACDUTRA from June 12, 1983, to June 25, 1983, and a third period of ACDUTRA in April 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) located in Denver, Colorado. In the appellant’s June 2012 substantive appeal (VA Form 9), she requested a Board hearing, which was subsequently scheduled in April 2018. The record shows that the RO sent several notices regarding the hearing to multiple addresses provided for the appellant. However, the notices were returned as undeliverable and the appellant failed to report for the scheduled hearing. The Board notes that neither the appellant nor her representative has advised the Board of a new address for her. See Hyson v. Brown, 5 Vet. App. 262, 265 (1993) (noting that the Veteran bears the burden of keeping VA apprised of his whereabouts and that, where he does not, “there is no burden on the part of the VA to turn up heaven and earth to find him”). 38 C.F.R. § 20.704(d) (2017). Pursuant to 38 C.F.R. § 20.702(d) (2017), when a Veteran fails to appear for a scheduled hearing and has not requested a postponement, the case will be processed as though the request for a hearing had been withdrawn. Thus, the Board will proceed with consideration of the appeal based on the evidence of record. Service Connection Congress has authorized the United States to pay a “veteran” compensation for any disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a pre-existing injury or disease in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.306 (2017). The term “veteran” means a person who has served in “active military, naval, or air service” and was discharged or released therefrom under conditions other than dishonorable. 38 U.S.C. § 101(2). The term “active military, naval, or air service” means active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(24) (2012); Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has noted that VA regulations require that a “veteran must establish entitlement to disability compensation under title 38 in one of two ways: (1) by “affirmatively showing inception or aggravation during service”; or (2) “through the application of statutory presumptions.” Jackson v. Shinseki, 526 Fed. Appx. 947, 950 (2013). Generally, however, no presumptions (including the presumptions of soundness, aggravation, or for presumptive diseases) apply to periods of ACDUTRA and INACDUTRA unless “veteran” status is attained during those periods. Paulson v. Brown, 7 Vet. App. 466, 470 (1995). In this case, the appellant has not established veteran status for any period of ACDUTRA or INACDUTRA and she did not serve on active duty. In Smith v. Shinseki, the Court held that claims based on periods of ACDUTRA or INACDUTRA “can never be entitled to the presumption of service connection.” 24 Vet. App. 40, 47 (2010) (emphasis in original). The Court reasoned that [b]y definition, the presumption of service connection applies where there is no evidence that a condition began in or was aggravated during the relevant period of service. By contrast for a claimant whose claim is based on a period of [ACDUTRA or INACDUTRA] to establish entitlement to benefits, there must be some evidence that his or her condition was “incurred or aggravated” during the relevant period of service. 38 U.S.C. § 101(24)(B). These circumstances are necessarily mutually exclusive.” Id. (emphasis in original). In addition to the criteria set forth above, service connection for impaired hearing is subject to the additional requirement of 38 C.F.R. § 3.385, which provides that impaired hearing will be considered to be a disability only if at least one of the thresholds for the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; the thresholds for at least three of the frequencies are greater than 25 decibels; or speech recognition scores using the Maryland CNC Test are less than 94 percent. See also Hensley v. Brown, 5 Vet. App. 155 (1993). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b) (2012); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for degenerative joint disease of the left hip, left foot, and right foot (claimed as arthritis throughout the body) The appellant asserts that service connection for degenerative joint disease of left hip, left foot, and right foot is warranted. Service treatment records, however, are negative for any indication of disease or injury pertaining to the feet or left hip. At the time of her April 1979 military enlistment examination, clinical evaluation of the appellant’s feet, lower extremities and musculoskeletal system was normal. Similarly, at a January 1983 quadrennial report of medical examination for the appellant’s Reserve service, clinical evaluation of the feet, lower extremities, and musculoskeletal system was normal. In the accompanying report of medical history, the appellant denied having or ever having had arthritis, rheumatism, bursitis, or foot trouble. Similar findings were made in a July 1984 report of medical examination and accompanying report of medical history. As set forth above, the term “active military, naval, or air service” means active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(24) (2012); Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). In this case, the record contains no indication that the appellant became disabled from arthritis of the feet or left hip or an injury to the feet or left hip during ACDUTRA. Although arthritis is a chronic disease, as set forth above, in Smith v. Shinseki, the Court held that claims based on periods of ACDUTRA or INACDUTRA “can never be entitled to the presumption of service connection.” 24 Vet. App. 40, 47 (2010) (emphasis in original). In this case, the most probative evidence shows that the appellant did not develop a chronic left hip or bilateral foot disability, including arthritis, during any period of ACDUTRA or that there was continuity of symptoms thereafter. As set forth above, service treatment records are negative for treatment for, complaints of, or a diagnosis of a disability of the feet or left hip. Regardless, the most probative evidence indicates that symptoms associated with the claimed conditions have not persisted on a continuous basis since service. In this regard, in reports of medical history dated in January 1983 and July 1984 for the appellant’s reserve service, the appellant specifically denied arthritis and foot trouble. On clinical evaluation, the appellant’s feet and lower extremities were found to be normal. More importantly, the appellant has not argued that the claimed conditions have persisted since service. The contemporaneous record suggests that the appellant’s left hip and bilateral foot disabilities started more than 20 years after military service. The record otherwise contains no evidence which links the appellant’s claimed disabilities to service. The post-service clinical records on appeal reveal a diagnosis of osteoarthritis of the joints and degenerative joint disease of the bilateral feet. Specifically, private x-ray reports dated in September 2003 show osteoarthritis of the feet and degenerative changes to the left hip. A May 2015 VA x-ray report showed degenerative joint disease of both great toes. These records, however, contain no indication that these disabilities had their inception during ACDUTRA or are otherwise related to ACDUTRA. The Board acknowledges the appellant’s general assertion that her left hip, left foot, and right foot disabilities are related to military service. Although in some cases a layperson is competent to offer an opinion addressing the etiology of a disorder, the Board finds that, in this case, the determination of the origin of the degenerative arthritis is a medical question not subject to lay expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The conditions involve pathological processes that are not readily observable to a layperson. The Board finds that in light of the non-observable nature of the pathology, the issue of the origin of the diagnosed disabilities is a medical question requiring medical training, expertise and experience. In summary, the Board finds that the most probative evidence shows that a chronic left hip disability and bilateral foot disability were not present during active service and did not manifest to a compensable degree within one year of separation from active duty service. The Board also concludes that the most probative evidence shows that the current left hip and bilateral foot disabilities are not related to the appellant’s active service. For these reasons, the preponderance of the evidence is against the claims and service connection must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for degenerative disc disease and degenerative joint disease of the lumbar spine The appellant asserts that service connection for a lumbar spine disability is warranted. She recalls straining her back in service while lifting a patient. Service treatment records corresponding to the appellant’s first period of ACDUTRA are negative for any indication of disease or injury pertaining to the lumbar spine. At her April 1979 enlistment examination report, clinical evaluation of the appellant’s spine was normal. In the accompanying report of medical history, she denied recurrent back pain and the remaining records corresponding to that period of ACDUTRA are negative for complaints or findings of a low back disease or injury. In January 1983, between her first and second periods of ACDUTRA, the appellant underwent a medical examination during which she reported a history of recurrent back pain. Her spine was normal on clinical evaluation. Clinical records corresponding to the appellant’s second and third periods of ACDUTRA are negative for complaints or findings of a low back injury or disease. As set forth in more detail below, the appellant was hospitalized during this period of ACDUTRA. Records of that period of hospitalization, however, indicate that physical examination was normal in all pertinent respects. In July 1984, the appellant again underwent a medical examination in connection with her Reserve service. At that time, she again reported a history of recurrent back pain due to an L-4 fracture. Clinical evaluation of the appellant’s spine was normal. Post-service medical records note complaints of back pain. Notably, in private treatment records dated in December 2009, the appellant sought treatment for back pain after she was involved in an incident in which the van in which she was riding hit a bump causing her to land hard and compress her back. She stated that her back pain started after the accident. Following examination, the appellant was assessed with back strain of the lumbar spine. In February 2010, the appellant again sought treatment for back pain. Back strain of the lumbar spine, status post motor vehicle accident, was assessed. The appellant was referred for physical therapy. The appellant was provided a VA examination in June 2010. At that time, the appellant reported that she first developed back pain during military service in 1980 or 1981. She stated that she had been a patient care assistant working at a hospital in Denver, Colorado, and helped to lift a 500-pound patient, which caused her to hurt her back. She stated that an x-ray showed scoliosis but she was unsure of other findings. She reported that the miliary offered to discharge her due to back pain but she declined. She indicated that she wore a back brace but her back never completely healed. The appellant reported that since 1980, she had had intermittent low back pain. She denied other injuries or accidents and indicated that she had had no evaluation or treatment for her back until recently. She explained that during the past 6 months, she had been involved 3 motor vehicle accidents. In December 2009, she had had a whiplash injury in an access van. In February 2010, the van in which she was riding hit a pothole and she hurt her lower back. Most recently, two and a half weeks prior to the examination, the appellant reported that she was in a motor vehicle accident in which her car was rear-ended. She reported that she did not go to the doctor or the emergency room. She reported that since the accidents, she has had a flare-up of back pain. Following evaluation, the examiner assessed lumbar spine degenerative disc disease and degenerative joint disease with recent flare causing continuous pain due to motor vehicle-type incidents. She opined that the appellant’s current lumbar spine condition is less likely as not due to or caused by the appellant’s reported L-4 fracture and back pain during military service. In this regard, the examiner noted that there was no evidence of an old L-4 fracture on x-ray and that the current lumbar spine disability which developed after discharge from service was due to the appellant’s genetic tendency for osteoarthritis and obesity. Analysis After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for a lumbar spine disability. As delineated above, service treatment records corresponding to the appellant’s periods of ACDUTRA are negative for complaints or findings of a low back injury or disease. Although in between her first and second periods of ACDUTRA she reported recurrent back pain at a January 1983 quadrennial examination, the examiner expressly indicated that it was not disabling and that the appellant’s spine was normal. Additionally, although the appellant reported a history of an L4 fracture at a July 1984 examination, her spine was again normal and there is no indication that she sustained this during a period of ACDUTRA or INACDUTRA. Moreover, as set forth above, VA examination has demonstrated that the appellant does not currently have any evidence of an old L4 fracture. As set forth above, the term “active military, naval, or air service” means active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(24) (2012); Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). In this case, the record contains no probative evidence in the contemporaneous record that the appellant became disabled from a low back disability or sustained an injury to the low back during a period of ACDUTRA or INACDUTRA. Although arthritis is a chronic disease, in Smith v. Shinseki, the Court held that claims based on periods of ACDUTRA or INACDUTRA “can never be entitled to the presumption of service connection.” 24 Vet. App. 40, 47 (2010) (emphasis in original). In this case, the most probative evidence shows that the appellant did not develop a chronic low back disability, including arthritis, during any period of ACDUTRA or that there were continuity of symptoms thereafter. Regardless, the most probative evidence indicates that symptoms associated with the appellant’s low back have not persisted on a continuous basis since service. The appellant herself described her post-service symptoms as intermittent and post-service clinical records show that in December 2009, she dated the onset of her back pain to a recent accident. As noted, the legal presumptions do not apply to periods of ACDUTRA unless “veteran” status is attained during those periods which has not been shown here. Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Regardless, the most probative evidence shows that the appellant did not develop a chronic low back disability, including arthritis, during any period of ACDUTRA or that there was continuity of symptoms thereafter. As set forth above, service treatment records corresponding to her periods of ACDUTRA are negative for treatment for, complaints of, or a diagnosis of a disability of the low back and there is no indication that she was on ACDUTRA or INACDUTRA at the time she reports sustaining a low back injury while lifting a patient. Regardless, the record contains no probative evidence which links the appellant’s current low back disability to service. As set forth above, after examining the appellant and reviewing the record, the June 2010 VA examiner concluded that the available record did not support direct service connection for the lumbar spine disability. The Board finds that the examiner’s opinion is persuasive and assigns it significant probative weight. In this regard, the examiner explained that the appellant’s current lumbar spine disability developed after discharge from service due to genetic tendency for osteoarthritis and obesity. The examiner acknowledged the appellant’s report of a L-4 fracture but explained that there was no evidence of an old L-4 fracture on current x-ray. There is no medical opinion to contradict the examiner’s findings or otherwise indicate that service connection on a direct basis could be established. Neither the appellant nor her representative has identified any such evidence. In light of the foregoing, service connection on a direct basis is not warranted. The Board acknowledges the appellant’s assertion that her lumbar spine disability is related to military service. Although in some cases a layperson is competent to offer an opinion addressing the etiology of a disorder, the Board finds that, in this case, the determination of the origin of the arthritis is a medical question not subject to lay expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The condition involves pathological processes that are not readily observable to a layperson. The Board finds that in light of the non-observable nature of the pathology, the issue of the origin of the diagnosed disability is a medical question requiring medical training, expertise and experience. For these reasons, the preponderance of the evidence is against the claim and service connection must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 3. Entitlement to service connection for bilateral hearing loss The appellant asserts that service connection for bilateral hearing loss is warranted. Available service treatment records are negative for treatment for or complaints of hearing loss during military service. Post-service treatment records demonstrate complaints of hearing loss. In an October 2004 private treatment record, the appellant presented with complaints of hearing difficulty. Following evaluation, the physician reported that the appellant had normal hearing levels. In a November 2009 private treatment record, the appellant complained of hearing loss, which she first noticed several years ago. Following examination, the physician assessed normal right ear hearing acuity and left ear normal to very mild sensorineural hearing loss. Audiometric test results were not provided. The appellant was afforded a VA medical examination in June 2010. Audiometric testing conducted in connection with that examination did not show a hearing loss disability for VA purposes. Specific audiogram findings indicated pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 5 5 5 LEFT 15 10 10 5 10 Speech recognition was 94 percent bilaterally. Analysis After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for bilateral hearing loss. The Board acknowledges the appellant’s post-service complaints of difficulty hearing. These facts alone, however, do not provide a sufficient basis upon which to grant the claim. As discussed above, service connection for impaired hearing is subject to the requirements of 38 C.F.R. § 3.385, a provision which specifically defines the level of impaired hearing which constitutes a disability for VA compensation purposes. In this case, the Board has carefully reviewed the record on appeal, but finds no probative evidence showing that the appellant currently has bilateral hearing loss to the extent necessary to constitute a disability for service connection purposes under 38 C.F.R. 3.385. Nor has the appellant pointed to any such evidence. The Board acknowledges that in a November 2009 private treatment record, left ear sensorineural hearing loss was assessed. However, audiometric findings were not provided, thus there is no basis to support a conclusion that such sensorineural hearing loss met the criteria set forth in section 3.385. Further, such assessment was made prior to the appellant’s claim of service connection for bilateral hearing loss. Notably, the evidence received since the appellant’s February 2010 service connection claim does not show a diagnosis of bilateral hearing loss for VA compensation purposes. As delineated above, audiometric testing conducted at the June 2010 VA examination affirmatively showed that the appellant did not exhibit hearing loss of 40 decibels or greater in at least one of the thresholds for the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz, nor did she exhibit thresholds of greater than 25 decibels for at least three of the frequencies. In addition, her speech discrimination was 94 percent. Thus, the appellant does not exhibit a bilateral hearing loss disability for VA purposes at this time. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. §§ 1110, 1131; Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding VA’s interpretation of the provisions of 38 U.S.C.A § 1110 to require evidence of a present disability to be consistent with congressional intent); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (the law limits entitlement for service-related diseases and injuries to cases where the underlying in-service incident has resulted in a disability). In other words, the law limits entitlement to compensation to cases where the underlying in-service incident has resulted in a current disability. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). In this case, the numeric designations shown on audiometric testing and speech recognition tests indicate that the appellant’s hearing acuity is not severe enough to constitute a disability for VA compensation purposes. As the preponderance of the evidence is against the claim of service connection for bilateral hearing loss, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for tinnitus. The appellant asserts that service connection for tinnitus is warranted because she has had intermittent ringing of the ears since service. Service treatment records corresponding to the appellant’s periods of ACDUTRA are entirely negative for any indication of tinnitus. On reports of medical history in January 1983 and July 1984, and during her June 1983 period of hospitalization, she denied having or ever having had ear trouble and hearing loss and her ears and neurological system were normal on clinical evaluation. The appellant was provided a VA audiological examination in June 2010. The examiner concluded that based on electronic hearing testing conducted during service and the appellant’s current audiological test results, the appellant did not have hearing damage while in service and her current reported tinnitus is less likely as not caused by or a result of noise exposure while in service. After reviewing the record in its entirety, the Board finds that the preponderance of the evidence is against the claim. As delineated above, service treatment records corresponding to the appellant’s periods of ACDUTRA are negative for complaints or findings of ringing in the ears. In fact, service treatment records spanning her entire membership in the Reserve contain no indication of tinnitus. As set forth above, the term “active military, naval, or air service” means active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(24) (2012); Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). In this case, the record contains no probative evidence in the contemporaneous record that the appellant became disabled from tinnitus or sustained an acoustic trauma injury resulting in tinnitus during a period of ACDUTRA or INACDUTRA. The Board has considered the appellant’s recent statements to the effect that she has experienced tinnitus on an intermittent basis since service, but finds such statements to be lacking in credibility as they are contradicted by the contemporaneous evidence. As set forth above, service treatment records show that the appellant repeatedly denied having or ever having had trouble with her ears. Although tinnitus is a chronic disease, in Smith v. Shinseki, the Court held that claims based on periods of ACDUTRA or INACDUTRA “can never be entitled to the presumption of service connection.” 24 Vet. App. 40, 47 (2010) (emphasis in original). In this case, the most probative evidence shows that the appellant did not develop a tinnitus during any period of ACDUTRA or that there were continuity of symptoms thereafter. Again, the most probative evidence indicates that the appellant’s tinnitus did not persist on a continuous basis since service. The appellant herself described her post-service symptoms as intermittent. As noted, the legal presumptions do not apply to periods of ACDUTRA unless “veteran” status is attained during those periods which has not been shown here. Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Regardless, the most probative evidence shows that the appellant did not develop tinnitus during any period of ACDUTRA or that there was continuity of symptoms thereafter. As set forth above, service treatment records corresponding to her periods of ACDUTRA are negative for treatment for, complaints of, or a diagnosis of tinnitus and there is no indication in the service treatment records that she sustained acoustic trauma during any period of ACDUTRA or INACDUTRA. Regardless, the record contains no probative evidence which links the appellant’s current tinnitus to service. As set forth above, after examining the appellant and reviewing the record, the VA examiner concluded that the appellant’s tinnitus was not causally related to in-service noise exposure, given the findings on in-service audiograms. The Board finds that the examiner’s opinion is persuasive and assigns it significant probative weight. There is no medical opinion to contradict the examiner’s findings or otherwise indicate that service connection on a direct basis could be established. Neither the appellant nor her representative has identified any such evidence. In light of the foregoing, service connection on a direct basis is not warranted. For these reasons, the preponderance of the evidence is against the claim and service connection must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 5. Entitlement to service connection for hypertension The appellant asserts that service connection for hypertension is warranted. Service treatment records corresponding to the appellant’s periods of ACDUTRA are entirely negative for any indication of hypertension. Similarly, in reports of medical examinations in January 1983 and June 1984 for reserve service, the appellant’s blood pressure readings were within normal limits. In the accompanying reports of medical history, the appellant denied a history of high or low blood pressure. Post-service treatment records demonstrate a diagnosis of and treatment for hypertension, but the records do not suggest that the condition is related to the appellant’s active service. The first documentation of hypertension was in 2006. Analysis After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for hypertension. Service treatment records are negative for treatment for or a diagnosis of hypertension during active service. In examinations in April 1979, January 1983, and June 1984, as well as during the appellant’s period of hospitalization in June 1983, the appellant’s blood pressure was within normal limits, there was no finding of hypertension, and in the accompanying reports of medical history, the appellant consistently denied a history of high blood pressure. The first notation of hypertension in the medical records is in 2006, more than 30 years after active duty. Notwithstanding the confirmed diagnosis of the condition, however, the record contains no indication that the appellant’s current hypertension is related to active service. No medical professional has related the appellant’s current hypertension to her active service. The Board acknowledges the appellant’s assertion that her hypertension is related to military service. Although in some cases a layperson is competent to offer an opinion addressing the etiology of a disorder, the Board finds that, in this case, the determination of the origin of hypertension is a medical question not subject to lay expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The condition involves a pathological process that is not readily observable to a layperson. The Board finds that in light of the non-observable nature of the pathology, the issue of the origin of the appellant’s hypertension is a medical question requiring medical training, expertise and experience. For these reasons, the preponderance of the evidence is against the service connection claim. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 6. Entitlement to service connection for bipolar disorder with depression The appellant assert that service connection for bipolar disorder is warranted. Service treatment records corresponding to the appellant’s period of ACDUTRA from May 1979 to January 1980 are negative for findings of a psychiatric disability. At her April 1979 enlistment examination, the appellant reported infrequent sleeplessness associated with worrying and a history of headaches associated with tension, but psychiatric evaluation was normal at that time. The remaining service treatment records corresponding to the appellant’s period of ACDUTRA are negative for findings of a psychiatric disability. In January 1983, the appellant underwent a quadrennial examination for purposes of her Reserve service. She was not on ACDUTRA at the time. She reported a history of depression, frequent trouble sleeping, and nervous trouble. She further reported that she had been treated for depression in 1980 and had been prescribed Lithium. The examiner noted that the appellant had been under psychiatric care since 1980 and had been on Lithium for one year and was now Navane as needed. The examiner assigned a “3” in the psychiatric PULSES category but ultimately concluded that the appellant was qualified for retention. On June 12, 1983, the appellant was ordered to ACDUTRA for a period of 14 days. The record shows that this was the appellant’s first period of active service since her initial period of service from May 1979 to January 1980 because a pregnancy and “other conditions” had prevented her from attending active service previously. See e.g. June 1983 hospitalization summary. On June 17, 1983, during her period of ACDUTRA, the appellant was hospitalized with rambling and tangential speech with intermittent blocking. Her mood was confused and perplexed and her affect was inappropriate. Her judgment was significantly impaired. She reported hearing voices. On admission, it was noted that this was the appellant’s fourth psychiatric hospitalization since October 1980, shortly after the birth of her daughter. In June 1981, she had a second and third hospitalization after a favorite aunt was terminally ill with cancer. She indicated that she had been prescribed Thorazine during her first admission which was later changed to Lithium. She took this medication until September 1982 until it was discontinued and she was prescribed Navane to be taken as needed. According to the hospitalization summary, although moderately psychotic at the time of admission, the appellant responded extremely well to medication, her reality testing promptly improved, and her condition quickly entered remission. The diagnosis on discharge was schizophrenia, chronic undifferentiated type, treated, improved, near full remission. It was determined that the condition had existed prior to service and had not been incurred in the line of duty. In a June 1983 Statement of Medial Examination and Duty Status, it was determined that the appellant was not mentally sound due to schizophrenia which had not been incurred in the line of duty and that the condition had not been service-aggravated. A January 1984 Line of Duty determination similarly found that the appellant’s psychiatric disability had existed prior to her entry as she had been treated for psychiatric problems three times prior to her entry into active service, to include two periods of hospitalizations, and that her condition had not been aggravated during service. Thus, it was determined that the appellant’s psychiatric disability had not been incurred in the line of duty. The appellant was ordered to another period of ACDUTRA from May 26 to June 9, 1984, but it appears that she did not report. The appellant was provided an additional examination in connection with her Reserve service in July 1984. At that time, psychiatric examination was normal. In the accompanying report of medical history, the appellant reported frequent trouble sleeping and depression or excessive worry. She indicated that she had had three periods of hospitalization for depression between 1980 and 1983 and that her current physician felt that the condition was “near full remission.” In September 1984, the appellant was charged with unexcused absence and it was noted that she had accrued four unexcused absences in the past year. According to a June 1985 service treatment record, in April 1985, the appellant was attending a third period of ACDUTRA and was again hospitalized for psychiatric treatment. It was noted that this was the appellant’s fifth psychiatric hospitalization and that her prognosis was guarded. It was determined that the appellant’s condition and personality features were so seriously pathological that it would be a hinderance for her to continue her duties with the unit. In July 1985, a physical profile board proceeding was conducted. The documented defect was schizophrenia, chronic, undifferentiated. It was determined that the appellant’s condition rendered her unfit for service. It was recommended that the unit complete medical separation board proceedings. Post-service medical records note treatment for psychiatric disabilities, to include schizophrenia and bipolar disorder. Analysis After carefully considering the record on appeal, the Board finds that the preponderance of the evidence is against the claim of service connection for bipolar disorder with depression. In this regard, the Board finds that the most probative evidence establishes that the appellant’s bipolar disorder with depression did not manifest during ACDUTRA nor is there any indication that it is otherwise related to such service. As set forth above, the appellant’s service treatment records do not reveal treatment for bipolar disorder with depression. While post-service medical records demonstrate treatment for the claimed condition, the records contain no indication that any medical professional has related the appellant’s current bipolar disorder with depression to her active service. The Board acknowledges that service treatment records demonstrate that the appellant was hospitalized for treatment of schizophrenia during a period of ACDUTRA. As noted, however, the service department determined that the disability was not incurred in the line of duty, as it had existed prior to service and had not been aggravated during service. The Board has considered the presumptions of soundness and aggravation but, as discussed above, such presumptions are not applicable to claimants whose claims are based on a period of ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40 (2010). As none of the presumptions apply, the issue becomes whether the pre-existing psychiatric disability underwent an increase in severity during a period of ACDUTRA. The appellant has the burden to establish both that the preexisting disability worsened in service and that such worsening was beyond the natural progression of the disease. Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010). However, the record in this case contains no indication that the condition was aggravated by military service. Rather, as delineated above, in a June 1983 Statement of Medial Examination and Duty Status, it was expressly determined that the condition had not been aggravated by service. The appellant has not provided any evidence to suggest otherwise. Moreover, neither the appellant nor the evidence of record contains any indication that that the current bipolar disorder is related to the schizophrenia treated during military service. The Board acknowledges the appellant’s assertion that her bipolar disorder with depression is related to military service. Although in some cases a layperson is competent to offer an opinion addressing the etiology of a disorder, the Board finds that, in this case, the determination of the origin of the degenerative arthritis is a medical question not subject to lay expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The condition involves pathological process that is not readily observable to a layperson. The Board finds that in light of the non-observable nature of the pathology, the issue of the origin of the diagnosed disability is a medical question requiring medical training, expertise and experience. 7. Entitlement to nonservice-connected pension is denied. VA nonservice-connected pension benefits are payable to a veteran who is permanently and totally disabled from nonservice-connected disability or disabilities, which is not the result of willful misconduct, but only where the veteran has the requisite active wartime service. 38 U.S.C. § 1521(a); 38 C.F.R. §§ 3.3, 3.314(b). A veteran meets the service requirements of that section if he served in active military, naval, or air service: (1) for 90 days or more during a period of war; (2) during a period of war and was discharged or released from service for a service-connected disability; (3) for a period of 90 consecutive days or more and such period began or ended during a period of war; or (4) for an aggregate of 90 days or more in two or more separate periods of service during more than one period of war. 38 U.S.C. § 1521(j); 38 C.F.R. § 3.3(a)(3). In the present case, the appellant’s service personnel records show that she was a member of the Army Reserve from April 1979 to January 1986, during which she had periods of ACDUTRA. This service does not coincide with a period of war, as defined by VA regulation. See 38 C.F.R. § 3.2. The Vietnam era ended May 5, 1975. The next period of war proclaimed was the Persian Gulf War, which started on August 2, 1990 and continues to the present. Because the appellant did not have active service during a period of war as set forth in § 3.2, the criteria for entitlement to pension benefits are not satisfied. 38 U.S.C. § 1521 (a) and (j); 38 C.F.R. § 3.3. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Jones, Counsel