Citation Nr: 20006433 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 19-13 219 DATE: January 27, 2020 ORDER Entitlement to service connection for gout is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a low back disability is denied. Entitlement to service connection for left lower extremity radiculopathy is denied. Entitlement to service connection for right lower extremity radiculopathy is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for prostate cancer is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a heart disability is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for kidney stones is denied. Entitlement to a compensable initial evaluation for bilateral hearing loss is denied. Entitlement to an initial evaluation higher than 10 percent for tinnitus is denied. REMANDED The issue of entitlement to service connection for a left knee disability is remanded. The issue of entitlement to an evaluation higher than 10 percent for right knee torn medial meniscus, status post removal of semi-lunar cartilage, is remanded. FINDINGS OF FACT 1. Gout was not manifest in service and is unrelated to service. 2. A cervical spine disability was not manifest in service and arthritis of the cervical spine was not manifest within one year following separation; the Veteran’s cervical spine disability is not otherwise related to service. 3. A low back disability was not manifest in service and arthritis of the lumbar spine was not manifest within one year following separation; the Veteran’s low back disability is not otherwise related to service. 4. Left lower extremity radiculopathy was not manifest in service or within one year following separation from service; radiculopathy of the left lower extremity is not otherwise related to service or to a service-connected disability. 5. Right lower extremity radiculopathy was not manifest in service or within one year following separation from service; radiculopathy of the right lower extremity is not otherwise related to service or to a service-connected disability. 6. Sleep apnea was not manifest in service and is unrelated to service. 7. Prostate cancer was not manifest in service and is unrelated to service. 8. Hypertension was not manifest in service or within one year following separation from service; hypertension is not otherwise related to service. 9. A heart disability was not manifest in service or within one year following separation from service; a heart disability is not otherwise related to service. 10. Diabetes mellitus was not manifest in service or within one year following separation from service; diabetes mellitus is not otherwise related to service. 11. Kidney stones were not manifest in service or within one year following separation from service; kidney stones are not otherwise related to service. 12. Bilateral hearing loss is manifested by Level I hearing loss in the right ear and Level I hearing loss in the left ear. 13. Tinnitus is assigned a 10 percent rating, the maximum rating authorized under Diagnostic Code 6260. CONCLUSIONS OF LAW 1. The criteria to establish service connection for gout are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. § 3.303(a) (2019). 2. The criteria to establish service connection for a cervical spine disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 3. The criteria to establish service connection for a low back disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 4. The criteria to establish service connection for left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 5. The criteria to establish service connection for right lower extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 6. The criteria to establish service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. § 3.303(a) (2019). 7. The criteria to establish service connection for prostate cancer are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b) (2012); 38 C.F.R. § 3.303(a) (2019). 8. The criteria to establish service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 9. The criteria to establish service connection for a heart disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 10. The criteria to establish service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 11. The criteria to establish service connection for kidney stones are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 12. The criteria for a compensable initial evaluation for bilateral hearing loss are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.85, Tables VI, VIA, VII; 4.86; Diagnostic Code 6100 (2019). 13. Tinnitus is assigned the maximum schedular initial rating of 10 percent. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.321, 4.25, 4.87, Diagnostic Code 6260 (2003), Diagnostic Code 6260 (2019); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994); Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1972 to June 1976. He served as an aircraft power plants mechanic. Service Connection Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110 (wartime service), 1131 (peacetime service); 38 C.F.R. § 3.303. 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service incurrence or aggravation of arthritis, calculi of the kidney, cardiovascular renal disease (including hypertension), diabetes mellitus, and organic diseases of the nervous system may be presumed to have been incurred or aggravated if the disability is manifested to a compensable degree within one year of the Veteran’s discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted for any disease 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). However, “[a] determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service.” Watson v. Brown, 4 Vet. App. 309, 314 (1993). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. A decision of the U. S. Court of Appeals for the Federal Circuit (Federal Circuit), however, clarified that this notion of continuity of symptomatology since service under 38 C.F.R. § 3.303(b), which as mentioned is an alternative means of establishing the required nexus or linkage between current disability and service, only applies to conditions identified as chronic under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Service connection for gout Service treatment records are negative for any diagnosis, complaint, or abnormal finding suggestive of gout. On report of medical history in October 1974, the Veteran denied arthritis, rheumatism, or bursitis; bone, joint, or other deformity; and lameness. He indicated that his present health was good and that he was on no medication. Examination at that time revealed normal extremities, feet, spine, and other musculoskeletal. On separation examination in June 1976, the examiner noted that the Veteran had undergone surgical repair of his right medial meniscus. His extremities, feet, spine, and other musculoskeletal were otherwise normal. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. The list of health issues includes gout, which was diagnosed in September 2010. The Board concludes that, while the record demonstrates current gout, it did not manifest to a compensable degree in service, and continuity of symptomatology is not established. In that regard, the first indication of gout dates to 2010, many years following the Veteran’s separation from service. The record does not otherwise establish a relationship between gout and service. To the extent that the Veteran asserts that his gout is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record demonstrates a diagnosis of gout, it does not contain reliable evidence which relates this claimed disability to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for gout must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for a cervical spine disability 3. Service connection for a low back disability 4. Service connection for left lower extremity radiculopathy 5. Service connection for right lower extremity radiculopathy Service treatment records are negative for any diagnosis, complaint, or abnormal finding indicating any spine or neurological disability. In May 1974, the Veteran complained of a pulled muscle in his upper back. The impression was slight muscle strain in the upper back. Aspirin and heat were recommended. On report of medical history in October 1974, the Veteran denied recurrent back pain; arthritis, rheumatism, or bursitis; bone, joint, or other deformity; and lameness. He indicated that his present health was good and that he was on no medication. Examination at that time revealed normal extremities, spine, and other musculoskeletal, and neurological systems. On separation examination in June 1976, the examiner noted that the Veteran had undergone surgical repair of his right medial meniscus. His extremities, spine, and other musculoskeletal were otherwise normal. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. The list of health issues includes low back pain (diagnosed in November 2008), spondylosis of the lumbar region (diagnosed in June 2015), cervical disc degeneration (diagnosed in May 2015), radiculopathy of the cervical region (diagnosed in May 2015) and of the lumbar region (diagnosed in May 2009). In May 2018, the Veteran submitted a February 2017 report from Arlington Orthopedic Associates, P.A. At that time, he complained of low back pain radiating into the hip and down the legs. He stated that these symptoms began approximately seven years previously, with insidious onset. The assessment was lumbago, lumbar spondylosis, degenerative disc disease of the lumbar spine, lumbar facet arthropathy, and lumbar facet joint syndrome. The Board concludes that, while the record demonstrates current diagnoses referable to the Veteran’s spine and lower extremities, none of these disabilities manifested to a compensable degree in service or within an applicable presumptive period. In that regard, as discussed, none of these disabilities were diagnosed until many years following the Veteran’s separation from service. The record does not otherwise establish a relationship between these disabilities and service. With respect to the single impression of upper back muscle strain in May 1974, the Board observes that on subsequent examination in October 1974, the Veteran specifically denied recurrent back pain, and that his spine was noted to be normal at that time. It was also normal on separation examination in June 1976. The first post-service diagnoses referable to the Veteran’s spine date to November 2008 and May 2015, many years following his separation. Moreover, in 2017, the Veteran reported that his low back and lower extremity symptoms began in approximately 2010, and the record indicates diagnoses referable to the cervical spine dating to 2015. Thus, it cannot be stated that continuity of symptomatology has been demonstrated. To the extent that the Veteran asserts that these disabilities are related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnoses because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record demonstrates diagnoses referable to the Veteran’s cervical and lumbar spine, as well as neurological manifestations in the lower extremities, it does not contain reliable evidence which relates these claimed disabilities to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for a cervical spine disability, a low back disability, and radiculopathy of the lower extremities must be denied, as the preponderance of the evidence is against the claims. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Entitlement to service connection for sleep apnea Service treatment records are negative for any diagnosis, complaint, or abnormal finding suggestive of sleep apnea. On report of medical history in October 1974, the Veteran denied respiratory symptoms and frequent trouble sleeping. He indicated that his present health was good and that he was on no medication. Examination at that time revealed normal mouth and throat as well as lungs. On separation examination in June 1976, the Veteran’s mouth, throat, and lungs were normal. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. The list of health issues includes obstructive sleep apnea, diagnosed in April 2012. The Board concludes that, while the record demonstrates a diagnosis of sleep apnea, it did not manifest to a compensable degree in service, and continuity of symptomatology is not established. In that regard, the first indication of sleep apnea dates to 2012, many years following the Veteran’s separation from service. The record does not otherwise establish a relationship between sleep apnea and service. To the extent that the Veteran asserts that his sleep apnea is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record demonstrates a diagnosis of sleep apnea, it does not contain reliable evidence which relates this claimed disability to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for sleep apnea must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Service connection for prostate cancer Service treatment records are negative for any diagnosis, complaint, or abnormal finding suggestive of any prostate problem. On report of medical history in October 1974, the Veteran denied urinary symptoms. He indicated that his present health was good and that he was on no medication. Examination at that time revealed a normal genitourinary system. On separation examination in June 1976, the Veteran’s genitourinary system was normal. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. The list of health issues includes malignant neoplasm of the prostate. There is no date listed for this diagnosis. In May 2018, the Veteran submitted copies of articles including one suggesting environmental contamination at El Toro Marine Corps Base, to include that caused by Agent Orange. This article also suggested that nuclear materials were present at El Toro. In April 2019, the Veteran submitted a copy of a report by the Deputy Assistant Secretary of Defense for Environment, Safety and Occupational Health. This report addressed perfluoro octane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) and their potential presence in groundwater at various military installations, including El Toro. An additional article addressed cleanup activities at Andrews Air Force Base. The Veteran’s April 2019 submission also included copies of various Board decisions, one granting service connection for prostate cancer based on a finding that the Veteran’s service exposed him to trichloroethylene (TCE), and a reasoned opinion by that appellant’s treating oncologist. The Board observes that generic information from a medical journal, treatise, or website is too “general and inconclusive” to establish a medical nexus to a disease or injury. See Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). Without application to the specific facts of a particular Veteran’s case, such generic information does little to support the Veteran’s contentions. See Sacks, 11 Vet. App. at 316-17 (holding that a medical article or treatise can provide support for a claim, but must be combined with an opinion of a medical professional and be reflective of the specific facts of a case as opposed to a discussion of generic relationships); Libertine v. Brown, 9 Vet. App. 521, 523 (1996) (finding that generic medical literature, which does not apply medical principles to the facts of an individual case, does not provide competent evidence). In this case, the Veteran has submitted no information regarding the specific facts and circumstances or nature of any alleged exposure, and no medical evidence linking his claimed prostate cancer to service, to include any exposure therein. Thus, the material submitted constitutes only generic information, and is of little probative value in support of the Veteran’s claim. The Board concludes that, while the record demonstrates a diagnosis of prostate cancer, it did not manifest to a compensable degree in service, and continuity of symptomatology is not established. The record does not otherwise establish a relationship between prostate cancer and service. To the extent that the Veteran asserts that his prostate cancer is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record demonstrates a diagnosis of prostate cancer, it does not contain reliable evidence which relates this claimed disability to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for prostate cancer must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 8. Service connection for hypertension Service treatment records are negative for any diagnosis, complaint, or abnormal finding suggestive of hypertension. On report of medical history in October 1974, the Veteran denied high or low blood pressure. He indicated that his present health was good and that he was on no medication. Examination at that time revealed normal heart and vascular system. The Veteran’s blood pressure was 130/80. On separation examination in June 1976, the Veteran’s heart and vascular system were normal. His blood pressure was 126/82. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. The list of health issues includes essential hypertension. The Board concludes that, while the record demonstrates current hypertension, it did not manifest to a compensable degree in service or within an applicable presumptive period, and continuity of symptomatology is not established. The record does not otherwise establish a relationship between hypertension and service. To the extent that the Veteran asserts that his hypertension is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. Moreover, to the extent that the Veteran might argue that hypertension is related to any exposure during service, the Board again notes that he has submitted no information regarding the specific facts and circumstances or nature of any alleged exposure, and no medical evidence linking his claimed hypertension to service, to include any exposure therein. Thus, the material he has submitted constitutes only generic information, and is of little probative value in support of his claim. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record demonstrates a diagnosis of hypertension, it does not contain reliable evidence which relates this claimed disability to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for hypertension must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 9. Service connection for a heart disability Service treatment records are negative for any diagnosis, complaint, or abnormal finding suggestive of a heart disability. On report of medical history in October 1974, the Veteran denied shortness of breath, pain or pressure in his chest, and palpitation or pounding heart, as well as heart trouble. He indicated that his present health was good and that he was on no medication. Examination at that time revealed normal heart and vascular system. On separation examination in June 1976, the Veteran’s heart and vascular system were normal. A September 1976 VA chest X-ray report indicates that the heart was within normal limits of size and shape, and that the supracardiac structures were normal. There was no evidence of acute pulmonary disease. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. The list of health issues includes palpitations, noted in August 2009. The Board concludes that, while the record demonstrates palpitations, a heart disability did not manifest to a compensable degree in service, cardiovascular renal disease did not manifest within an applicable presumptive period, and continuity of symptomatology is not established. In that regard, the record shows palpitations in 2009, many years following the Veteran’s separation from service. The record does not otherwise establish a relationship between a heart condition and service. To the extent that the Veteran asserts that he has a heart disability that is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. Moreover, to the extent that the Veteran might argue that a heart disability is related to any exposure during service, the Board again notes that he has submitted no information regarding the specific facts and circumstances or nature of any alleged exposure, and no medical evidence linking his claimed heart disability to service, to include any exposure therein. Thus, the material he has submitted constitutes only generic information, and is of little probative value in support of his claim. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record indicates palpitations, it does not contain reliable evidence which relates a heart disability to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for a heart disability must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 10. Service connection for diabetes mellitus Service treatment records are negative for any diagnosis, complaint, or abnormal finding suggestive of diabetes. On report of medical history in October 1974, the Veteran denied sugar in his urine. He indicated that his present health was good and that he was on no medication. Examination at that time revealed a normal endocrine system, and urinalysis was negative for sugar. On separation examination in June 1976, the Veteran’s genitourinary system was normal. Urinalysis was negative for sugar. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. The list of health issues includes diabetes mellitus, diagnosed in May 2009. The Board concludes that, while the record demonstrates a diagnosis of diabetes mellitus, it did not manifest to a compensable degree in service or within an applicable presumptive period, and continuity of symptomatology is not established. In that regard, the record shows diabetes mellitus diagnosed in 2009, many years following the Veteran’s separation from service. The record does not otherwise establish a relationship between diabetes mellitus and service. To the extent that the Veteran asserts that he has diabetes mellitus that is related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. Moreover, to the extent that the Veteran might argue that diabetes mellitus is related to any exposure during service, the Board again notes that he has submitted no information regarding the specific facts and circumstances or nature of any alleged exposure, and no medical evidence linking his claimed diabetes mellitus to service, to include any exposure therein. Thus, the material he has submitted constitutes only generic information, and is of little probative value in support of his claim. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record indicates diabetes mellitus, it does not contain reliable evidence which relates this diagnosis to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for diabetes mellitus must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 11. Service connection for kidney stones Service treatment records are negative for any diagnosis, complaint, or abnormal finding indicating kidney stones. On report of medical history in October 1974, the Veteran denied urinary symptoms, kidney stones, and blood in his urine. He indicated that his present health was good and that he was on no medication. Examination at that time revealed a normal genitourinary system. On separation examination in June 1976, the Veteran’s genitourinary system was normal. In conjunction with his December 2017 claim, the Veteran submitted records from Baylor Scott & White Health. These records include the Veteran’s report of a history of surgery for kidney stones. The Board concludes that, while the record demonstrates a diagnosis of kidney stones, they did not manifest to a compensable degree in service or within an applicable presumptive period, and continuity of symptomatology is not established. The record does not otherwise establish a relationship between kidney stones and service. To the extent that the Veteran asserts that kidney stones are related to service, the Board observes that he may attest to factual matters of which he has first-hand knowledge, such as subjective complaints, and that his assertions in that regard are entitled to some probative weight. He is competent to report incidents and symptoms in service and symptoms since then. He is not, however, competent to render an opinion as to the cause or etiology of the current diagnosis because he does not have the requisite medical knowledge or training, and because this matter is beyond the ability of a lay person to observe. Moreover, to the extent that the Veteran might argue that kidney stones related to any exposure during service, the Board again notes that he has submitted no information regarding the specific facts and circumstances or nature of any alleged exposure, and no medical evidence linking his claimed kidney stones to service, to include any exposure therein. Thus, the material he has submitted constitutes only generic information, and is of little probative value in support of his claim. The grant of service connection requires competent evidence to establish a diagnosis and, as in this case, relate the diagnosis to the Veteran’s service. While the record indicates a history of kidney stones, it does not contain reliable evidence which relates this claimed disability to any incident of service. For these reasons, the Board concludes that the claim of entitlement to service connection for kidney stones must be denied, as the preponderance of the evidence is against the claim. The doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings based on average impairment in earning capacity. 38 U.S.C. § 1155 (2012). Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2019). The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2019). VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. If there is a question as to which evaluation to apply to the Veteran’s disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2019). 12. Compensable evaluation for service-connected bilateral hearing loss Evaluations of hearing loss range from noncompensable to 100 percent, based upon organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests (Maryland CNC), together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. 38 C.F.R. § 4.85 (2019). To evaluate the degree of disability for service-connected bilateral hearing loss, the rating schedule establishes eleven (11) auditory acuity levels, designated from level I, for essentially normal acuity, through level XI, for profound deafness. 38 C.F.R. § 4.85, Diagnostic Code 6100 (2019). The assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). When the pure tone thresholds at each of the four specified frequencies (1000, 2000, 3000, and 4000 hertz) are 55 decibels or more, or when the pure tone thresholds are 30 decibels or less at 1000 Hz and 70 decibels or more at 2000 Hz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next highest Roman numeral. 38 C.F.R. § 4.86. The record does not demonstrate one of these exceptional patterns of hearing impairment. As such, § 4.86 does not apply in this case. In this matter, the Veteran was granted service connection for bilateral hearing loss in a January 2018 rating decision; he was assigned a noncompensable (zero percent) rating from December 7, 2017. He disagreed with the assigned initial rating and this appeal follows. The Veteran asserts entitlement to a compensable rating for service-connected bilateral hearing loss. For the reasons set forth below, the Board finds that a compensable rating is not warranted under the pertinent diagnostic criteria. On VA examination in January 2018, the Veteran reported difficulty hearing and understanding speech, especially in the presence of background noise. Audiometric testing revealed the following puretone thresholds: HERTZ 1000 2000 3000 4000 Average RIGHT 35 15 35 65 37 LEFT 40 30 20 65 39 Speech discrimination scores were 96 percent on the right and 94 percent on the left. The Board observes that application of the regulation to the findings of the January 2018 VA examination results in a numeric designation of I for each ear. A noncompensable evaluation is warranted when those values are applied to Table VII. 38 C.F.R. § 4.85, Diagnostic Code 6100 (2019). As such, the currently assigned noncompensable evaluation is correct. The Board does not doubt the sincerity of the Veteran’s assertions regarding the severity of his hearing loss, or its functional impact. However, the Board must apply the regulation as it is currently written, which requires objective audiometric testing at certain levels to qualify for the various levels of compensation. The more probative evidence consists of that prepared by skilled audiologists, and such evidence demonstrates that the currently assigned evaluations for the Veteran’s hearing loss disability are appropriate. The evidence preponderates against a finding that a compensable initial evaluation is warranted. 13. Evaluation in excess of 10 percent for service-connected tinnitus In this matter, the Veteran was granted service connection for tinnitus in a January 2018 rating decision; he was assigned a 10 percent rating from December 7, 2017. He disagreed with the assigned initial rating and this appeal follows. The Veteran asserts entitlement to a compensable rating for service-connected tinnitus. For the reasons set forth below, the Board finds that a compensable rating is not warranted under the pertinent diagnostic criteria. In Smith v. Nicholson, 19 Vet. App. 63, 78 (2005) the U.S. Court of Appeals for Veterans Claims (Court) held that the pre-1999 and pre-June 13, 2003 versions of diagnostic code 6260 required the assignment of dual ratings for bilateral tinnitus. VA appealed this decision to the U.S. Court of Appeals for the Federal Circuit (Federal Circuit). In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the Federal Circuit concluded that the Court erred in not deferring to the VA’s interpretation of its own regulations, 38 C.F.R. § 4.25(b) and Diagnostic Code 6260, which limits a Veteran to a single disability evaluation for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. The Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available for tinnitus. 38 C.F.R. § 4.87, Diagnostic Code 6260. As there is no legal basis upon which to award a higher schedular evaluation for tinnitus or separate schedular evaluations for tinnitus in each ear, the Veteran’s appeal must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). REASONS FOR REMAND 1. Service connection for a left knee disability In his December 2017 claim, the Veteran indicated that he sought service connection for a left knee disability as secondary to his right knee disability. On VA examination in January 2018, range of motion of the left knee was normal. No pain or crepitus was noted on examination. There was no functional loss with repeated use. Muscle strength was 5/5. There was no joint instability. However, the examiner indicated that the Veteran had a history of bilateral recurrent patellar dislocation, or shin splints. He concluded that there was no objective evidence of a left knee condition on examination. This appears to conflict with his identification of shin splints. An additional examination is necessary to determine whether there is any left knee disability, and if so, its etiology. 2. Evaluation in excess of 10 percent for service-connected right knee torn medial meniscus, status post removal of semi-lunar cartilage The Veteran’s right knee disability is evaluated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5259-5260, for symptomatic removal of semilunar cartilage with limitation of flexion. On VA examination in January 2018, the Veteran reported flare-ups that caused increased pain and popping. He also endorsed functional limitation, noting that he had difficulty with long distance ambulation or prolonged standing. The examiner indicated that pain, weakness, fatigability, or incoordination would significantly limit functional ability with flare-ups, but indicated the could not describe this in terms of additional limited motion, as she was not witness to a flare-up. The Court has held that, with respect to flare-ups, VA examiners must do all that reasonably should be done to become informed before concluding that a requested opinion cannot be provided without resorting to speculation, including by soliciting information regarding frequency, duration, characteristics, severity, or functional loss. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). Considering the Veteran’s competent reports of functional limitation caused by flare-ups, and the VA examiner’s failure to adequately address the reported limitation, the Board concludes that an additional examination is necessary to obtain an estimate of the Veteran’s functional loss due to his flare-ups. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of his claimed left knee disability, and the severity of his right knee disability. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. Left knee: After the record review and examination of the Veteran, the examiner should identify all relevant diagnoses referable to the Veteran’s left knee. The examiner should provide an opinion regarding whether it is at least as likely as not that any such diagnosis was caused or aggravated by the Veteran’s right knee disability. In rendering this opinion, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. Right knee All pertinent symptomatology and findings referable to the Veteran’s right knee disability should be reported in detail, including range of motion (ROM) testing. The examiner should set forth the Veteran’s range of motion findings and note any pain, pain on use, weakness, incoordination, or excess fatigability. If feasible, the examiner should portray any additional functional limitation of the knees due to these factors in terms of degrees of additional loss of motion. If not feasible, this should be stated and discussed in the examination report. If the Veteran does not have pain or any of the other factors, that fact should also be noted. The examiner should also test the range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner must also address at what point in the arc of motion pain limits function both regularly and during flare-ups, even if a flare-up is not observed on that day. In addressing the nature of any disability during a flare-up the examiner must address the severity of the flare-up, the frequency and duration of the flare-up, and all precipitating and alleviating factors. All examination findings/testing results, along with complete, clearly-stated rationale for the conclusions reached, must be provided. 2. Then, readjudicate the Veteran’s claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Barone, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.