Citation Nr: 20032525 Decision Date: 05/08/20 Archive Date: 05/08/20 DOCKET NO. 13-25 399A DATE: May 8, 2020 ORDER Entitlement to an increased rating, over 10 percent, for degenerative arthritis of the spine, prior to August 31, 2018, is denied. Entitlement to an increased rating, over 40 percent, for degenerative arthritis of the spine, since August 31, 2018, is denied. Entitlement to service connection for umbilical hernia is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. Entitlement to service connection for right elbow strain is denied. Entitlement to service connection for chronic obstructive pulmonary disease is denied. Entitlement to service connection for patellofemoral pain syndrome, right knee, is denied. Entitlement to service connection for meniscal tear with patellofemoral pain syndrome, left knee, is denied. Entitlement to service connection for hearing loss is denied. FINDINGS OF FACT 1. Prior to August 31, 2018, degenerative arthritis of the thoracolumbar spine was not manifested by forward thoracolumbar flexion limited to 60 degrees or less, or by a combined range of motion of the thoracolumbar spine limited to 120 degrees or less, or by muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. Degenerative arthritis of the spine is not manifested by either unfavorable ankylosis of the entire thoracolumbar spine, or by an intervertebral disc syndrome with incapacitating episodes having a total duration of at least six weeks during the past twelve months. 3. An umbilical hernia is not related to injury or disease in service and is not caused or permanently worsened by a service-connected disability or disabilities. 4. A chronic gastrointestinal disorder, to include GERD, was not demonstrated while on active duty, and the preponderance of the competent, probative evidence is against finding a relationship between such a disorder and any service-connected disorder. 5. The Veteran’s right elbow strain did not have onset in service, did not manifest to a compensable degree within one year of separation from service, and is not otherwise related to service. 6. A chronic respiratory disorder, to include chronic obstructive pulmonary disease, was not demonstrated in service, and such a disorder is not related to service. 7. The preponderance of the evidence is against finding that a right knee disorder, to include patellofemoral pain syndrome, began during active service, or is otherwise related to an in-service injury or disease, and arthritis of the knees was not compensably disabling within one year of separation from active duty. 8. The preponderance of the evidence is against finding that a left knee disorder, to include residuals of a meniscal tear and patellofemoral pain syndrome, began during active service, or is otherwise related to an in-service injury or disease, and arthritis of the knees was not compensably disabling within one year of separation from active duty. 9. The preponderance of the evidence shows that a hearing loss for VA purposes was not demonstrated during the Veteran’s active duty service, and such a disorder was not compensably disabling within a year of the claimant’s discharge from such service. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent for degenerative arthritis of the thoracolumbar spine prior to August 30, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5242. 2. From August 30, 2018, the criteria for entitlement to a rating in excess of 40 percent for degenerative arthritis of the spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes 5242 and 5243. 3. An umbilical hernia was not incurred or aggravated in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 4.9. 4. A chronic gastrointestinal disorder, to include GERD, was not incurred in or aggravated by service, and it is not caused or aggravated by a service-connected disorder. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 5. The criteria for service-connection for right elbow strain have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 6. A chronic respiratory disorder, to include chronic obstructive pulmonary disease, was not incurred or aggravated inservice. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. Bilateral hearing loss was not incurred or aggravated in service, and a sensorineural hearing loss may not be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107; 38 C.F.R. § § 3.102, 3.303, 3.385, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1982 to April 1990. He ultimately retired from the National Guard in August 2013. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a rating decisions in June 2001 and November 2015 by the Department of Veterans Affairs (VA) Regional Office (RO) located in Chicago Illinois. In July 2017, the Veteran appeared at a hearing before a Veterans Law Judge (VLJ). A transcript of that hearing is associated with the Veteran’s file. A March 2020 letter informed the Veteran that the VLJ who conducted the July 2017 hearing was no longer available and asked him if he wished to attend another hearing before a VLJ who would render a determination in his case. He was further informed that if no response was received that it would be assumed that he did not want another hearing and that a decision on his claim would be made. No response was received from the Veteran. The Veteran has also perfected an appeal to the issues of entitlement to service connection for hypertension, entitlement to increased ratings for an anxiety disorder and a right ankle sprain, and entitlement to a total disability evaluation based on individual unemployability due to service-connected disorders. In June 2017, however, the appellant requested to testify at a video conference Board hearing. To date that hearing has not been held or scheduled. As such, those issues will be the subject of a separate Board hearing and a separate decision at a later date. Increased rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule). The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Under 38 C.F.R. § 4.40, consideration must be given to functional loss due to pain and weakness causing additional disability beyond that reflected by range of motion measurements. Under 38 C.F.R. § 4.45, consideration must be given to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. Painful, unstable, or misaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Where entitlement to compensation has already been established and an increase in the disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, in a claim for an increased rating, “staged” ratings may be warranted where the factual findings show distinct time periods when the disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). The Veteran contends that his degenerative arthritis of the spine is more severely disabling than represented by the ratings assigned. The Veteran was granted entitlement to service connection for degenerative arthritis of the spine in a June 2, 2011 rating decision and assigned a 10 percent rating from November 18, 2010, to August 30, 2018, and a 40 percent rating effective from August 31, 2018. The Veteran appealed those ratings. The Veteran’s degenerative joint disease of the spine is rated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Code 5242. The General Rating Formula provides a 10 percent rating where there is forward thoracolumbar flexion greater than 60 degrees but not greater than 85 degrees; or, a combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. Id. A 20 percent rating is assigned when forward thoracolumbar flexion is greater than 30 degrees, but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or, there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted when forward thoracolumbar flexion is 30 degrees or less; or when there is favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. Id. These ratings apply with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. VA regulations set forth at 38 C.F.R. §§ 4.40, 4.45, and 4.59 provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. However, as previously noted, the general formula for disabilities of the spine expressly states that the criteria and ratings apply “with or without symptoms such as pain.” See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. In other words, the presence of pain is already considered in the formula. 68 Fed. Reg. 51454 -5 (Aug. 27, 2003) (“Pain is often the primary factor limiting motion, for example, and is almost always present when there is muscle spasm. Therefore, the evaluation criteria provided are meant to encompass and consider the presence of pain, stiffness or aching, which are generally present when there is a disability of the spine.”) There are alternative rating criteria for an intervertebral disc syndrome under Diagnostic Code 5243. Under that Code a rating is assigned based on the frequency and extent of incapacitating episodes. 38 C.F.R. § 4.71a. An incapacitating episode is defined as “a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.” Id. at Note (1). A 40 percent rating is warranted where incapacitating episodes have a total duration of four weeks but less than six weeks during the past twelve months. Id. A 60 percent rating is warranted where incapacitating episodes have a total duration of six weeks during the past twelve months. Id. After a complete review of the record, the Board finds that prior to August 31, 2018 degenerative arthritis of the thoracolumbar spine was not manifested by forward thoracolumbar flexion limited to 60 degrees or less, or by a combined range of motion of the thoracolumbar spine limited to 120 degrees or less, or by muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. There is no evidence of unfavorable ankylosis of the entire thoracolumbar spine during the entire period. The Veteran was provided a VA examination in February 2011. The VA examination recorded a normal flexion range of motion, with extension limited to 25 degrees, and lateral bending right and left limited to 30 degrees. Pain on motion was noted from 60 to 90 degrees in flexion, 20-25 degrees in extension, 25-30 degrees bending laterally to the right, 25-30 degrees bending laterally to the left, and 25-30 degrees rotating both right and left. The Veteran demonstrated guarding but could walk two to three miles. The Veteran described pain after standing for five to ten minutes. The Veteran was provided another VA examination in May 2014. The Veteran reported no significant change to his low back since the last exam. He reported a constant aching, throbbing discomfort in the law back. The pain was rated as between four and nine out of ten, with aggravation on physical use. The Veteran limited standing to 10 to15 minutes, walked up to a quarter of a mile, and limited lifting to 20-30 lbs. The Veteran’s range of motion was normal with objective evidence of painful motion starting at 30 degrees for flexion, and 20 degrees for extension. The examiner described the Veteran’s pain as anticipatory and guarded but he was able to perform full range of motion with prompting. Repeated use did not affect range of motion. Another VA examination was performed in March 2018. During this examination the Veteran noted that his low back pain has grown progressively worse. He now rated it as interfering with standing and other activities to a greater extent. He reported daily persistent throbbing and aching discomfort. All of his range of motion tests were normal, with pain noted on the exam that did not result in any additional functional loss. The Veteran then submitted a private examination from September 2018. This examination represented a drastic departure from previous exams. The Veteran’s flexion and extension were not tested due to back pain and pain was noted on all range of motion tests. The examiner noted inability to sit or stand for any length of time. The examiner then noted that the Veteran’s range of motion was limited to 20 degrees in all directions due to pain. No ankylosis was noted during the exam. The examiner also noted that intervertebral disc syndrome was not present. The Board acknowledges the Veteran’s reports of back pain as well as the report of the August 2013 examiner that the appellant experienced flare-ups of pain. However, again, the Board observes that the pertinent criteria and ratings apply “with or without symptoms such as pain.” See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Additionally, the record does not include evidence of any specific degree of additional limitation of motion due to pain or flare-ups. Accordingly, the medical evidence pertinent to this period preponderates against finding that prior to August 31, 2018, the Veteran’s low back symptoms, to include on flare-up, more nearly approximated forward thoracolumbar flexion of 60 degrees or less, a combined range of motion of the thoracolumbar spine of 120 degrees or less, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Further, the entire record of evidence preponderates against finding such symptoms that equate to unfavorable ankylosis of the entire thoracolumbar spine to warrant a rating higher than 40 percent from August 31, 2018. There is no evidence of record indicating that separate ratings for neurological impairment associated with the Veteran’s lumbar spine disability, beyond those already assigned, are warranted in this case. In sum, the Board finds that the preponderance of the evidence is against finding that a rating higher than 10 percent for thoracolumbar degenerative joint disease is warranted prior to August 31, 2018, and the claim is denied. The preponderance of the evidence is also against finding that a rating in excess of 40 percent since August 31, 2018. As the preponderance of the evidence is against the appeal, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be established by showing evidence of a chronic disease in service, which requires 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. Id. The provisions of 38 C.F.R. § 3.303(b) pertaining to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). An umbilical hernia is not a disorder listed under 38 C.F.R. § 3.309. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disorder on a direct basis, there must be competent evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The term “active military service” includes active duty, any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, and any period of inactive duty training 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); 38 C.F.R. § 3.6(a). The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for umbilical hernia The Veteran contends that his umbilical hernia residuals are due to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of umbilical hernia residuals, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The Veteran had a February 2013 general VA examination which mentioned his umbilical hernia. The examiner noted that the Veteran developed an umbilical hernia while straining to lift a large tire in the fall of 2010 while on active duty training. The Veteran does not have a line of duty determination for this reported incident. He underwent hernia repair in May 2011. During the same examination the Veteran noted twisting his left knee in 2007, when he slipped off an Army truck. The Veteran noted that he was not on active duty at the time. The Veteran was provided another VA examination in October 2015. During this examination the Veteran stated that he developed his umbilical hernia and injured his left knee in 2010 while trying to load a spare tire on a trailer during National Guard training and it fell off on top of him. The VA examiner opined that the Veteran’s umbilical hernia is not at least as likely as not related to an in-service injury, event, or disease. While the Veteran is competent to report that he thinks his hernia was due to an injury during National Guard service, his reports are largely not credible due to internal inconsistency and inconsistency with other evidence in the record. There is no evidence of a line of duty report or any other medical documentation noting an injury during that time period. There is also no medical opinion that links his eventually June 2011 umbilical hernia surgery to this type of injury or time period. The Veteran’s story has also changed (e.g. whether he also injured his left knee at the time of the claimed hernia injury), resulting in decreased credibility about the claimed in-service incident. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). While the Veteran believes his umbilical hernia is related to an incident during National Guard training in 2010, the Board reiterates that the preponderance of the evidence weighs against findings that, the incident lead to his umbilical hernia, and that the Veteran was performing qualifying active service when the injury occurred. Accordingly, the preponderance of the most probative evidence is against finding that an umbilical hernia is related to the Veteran’s period of service, to include as secondary to any service-connected condition. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for GERD. The Veteran contends that he has GERD and it was caused by his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of GERD, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The Veteran was provided VA examination in February 2013. The examiner noted that the Veteran described his GERD symptoms as chronic diarrhea and heartburn, starting in 1987. The Veteran was on active duty at the time in Korea. The Veteran was eventually diagnosed with hiatal hernia, duodenitis and gastritis. An October 2015 VA examiner, who examined the Veteran and reviewed the claims file, opined that the Veteran’s GERD was not at least as likely as not related to an in-service injury, event, or disease. The examiner noted that the Veteran stated he has had problems with chronic heartburn and acid reflux since active duty. The Veteran did not remember any treatment for this condition. The examiner noted that there was no evidence in the Veteran’s service treatment records (STR’s) of any diagnosis of or treatment for GERD. The first mention of the condition was in 2004, more than 14 years after discharge. The examiner explained that GERD is a chronic condition brought on mainly by poor diet, excess weight, alcohol and smoking, of which, the Veteran demonstrated all these risk factors. The examiner also noted that the condition was not related to his National Guard training. The Veterans STR’s include his Medical Evaluation Board brief which determined that the Veteran had GERD but that it was not related to duty. While the Veteran is competent to report that he experienced heartburn, his reports are largely not credible due to internal inconsistency and inconsistency with other evidence in the record. There is a lack of any evidence in his STR’s for treatment related to this type of condition. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). While the Veteran believes his GERD is related to his active service, the Board reiterates that the preponderance of the evidence weighs against findings that the Veteran was diagnosed or treated for GERD while on active duty or within a year of discharge. There is no competent medical evidence that relates the Veteran’s disorder to his military service. The only medical opinion of record that addresses the relationship between his GERD and his military service weighs against the claim. The Veteran has not provided any evidence to diminish the weight of this probative opinion. Accordingly, the preponderance of the most probative evidence is against finding that GERD is related to the Veteran’s period of service, to include as secondary to any service-connected condition. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for right elbow strain. The Veteran contends that he has right elbow strain due to his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of right elbow strain, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The Veteran was provided VA examination for his right elbow in February 2013. The examiner noted that the Veteran related nontraumatic right elbow arthritic type pain and crepitus in late 2010. The Veteran was evaluated by his primary care provider and diagnosed with strain. The Veterans symptoms improved with treatment, but the pain has not entirely resolved. The October 2015 VA examiner opined that the Veteran’s right elbow pain is not at least as likely as not related to an in-service injury, event, or disease. The examiner referred to the examination from February 2013 for comparison. The Veteran again denied any traumatic event or injury but felt that it was caused by his National Guard training, although he never reported it. The Veteran was provided a range of motion and functional limitation test which did not find any abnormalities. The Veteran’s range of motion testing were all normal. The Veteran did not remember any specific injury or event to link his service to his right elbow pain. He also did not present with any symptoms during his examination. While the Veteran subjectively believes his right elbow pain is related to his National Guard service, the Board reiterates that the preponderance of the evidence weighs against findings that any in service injury to the right elbow occurred. There is no competent medical evidence that relates the Veteran’s disorder to his active duty or National Guard service. The Veteran has not provided any competent and credible medical evidence of such a relationship or otherwise identified evidence to rebut the probative VA opinion against the claim. Accordingly, the preponderance of the most probative evidence is against finding that a right elbow injury is related to the Veteran’s period of service, to include as secondary to any service-connected condition. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to service connection for chronic obstructive pulmonary disease The Veteran contends that he has chronic obstructive pulmonary disease and it was caused by his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of chronic obstructive pulmonary disease, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The Veteran was provided VA examination in February 2013. The examiner noted that the Veteran was provided a pulmonary evaluation for his unrelated sleep apnea in July 2011. This evaluation diagnosed moderate obstructive lung disease with a PEV1 of 64 percent. A chest radiograph also positively reported chronic obstructive pulmonary disease. The examiner noted that the Veteran is an active smoker since the age of 17. The diagnosis was also not listed in his VA findings. The Veteran was asymptomatic for breathing problems, but his physical examination did reveal wheezing on the lung exam. The Veteran was again provided VA examination in October 2015. The VA examiner noted that during this examination the Veteran claimed that he started developing chronic obstructive pulmonary disease when he had pneumonia on active duty in 1987. The Veteran stated that his breathing was never the same with frequent episodes of shortness of breath. The Veteran denied any environmental exposures while on active duty. The examiner reiterated that the Veteran has been a smoker since his late teens and continues to smoke a pack of cigarettes every three to four days. The examiner opined that the Veteran’s chronic obstructive pulmonary disease is not at least as likely as not related to an in-service injury, event, or disease. He explained that isolated episodes of pneumonia are not considered a risk factor for developing chronic obstructive pulmonary disease. The examiner continued to say that the main risk factor for developing chronic obstructive pulmonary disease is smoking. While the Veteran is competent to recently report that he has experiences shortness of breath since service, his reports are largely not credible due to internal inconsistency and inconsistency with other evidence in the record. There were no reports of shortness of breath in the Veteran’s STR’s and the Veteran did not complain of shortness of breath until the symptom was reported during his February 2013 exam. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). While the Veteran believes his chronic obstructive pulmonary disease is related to his isolated instance of pneumonia, the Board reiterates that the preponderance of the evidence weighs against any connection between the Veteran’s pneumonia during service and his current chronic obstructive pulmonary disease. The Veteran has not provided any competent and credible medical evidence of an etiological relationship between his disability and his military service or otherwise identify evidence to rebut the probative VA opinion against the claim. Accordingly, the preponderance of the most probative evidence is against finding that chronic obstructive pulmonary disease is related to the Veteran’s period of service. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 5. Entitlement to service connection for a right knee disability. The Veteran contends that he has patellofemoral pain of the right knee that is connected to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of right knee patellofemoral pain syndrome, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The February 2013 VA examiner opined that the Veteran’s right knee pain was not at least as likely as not related to an in-service injury, event, or disease. The Veteran noted pain and crepitus for about three years prior to the examination. The Veteran denied seeking any type of medical attention and did not describe any functional loss or flares of pain. The Veteran was provided another VA examination in October 2015. This examination found no loss of range of motion or functional limitation in the right knee. The Veteran claimed that he injured both knees when he fell off a truck during National Guard training. He has continued to have pain daily in both knees since the accident. While the Veteran is competent to report that he has experienced bilateral knee pain since 2007, his reports are largely not credible due to internal inconsistency and inconsistency with other evidence in the record. The Veteran’s story regarding his 2007 injury being during National Guard service has varied depending on the date of his examination. His date of the start of his right knee pain has also been internally inconsistent. Such inconsistencies diminish the overall credibility of his statements regarding the origin and onset of his symptomatology. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). While the Veteran believes his right knee pain is related to a 2007 fall while on National Guard duty, the Board reiterates that the preponderance of the evidence weighs against findings that any in-service injury occurred. There is no competent medical evidence that relates the Veteran’s disorder to his military service. The only medical opinion of record that addresses the relationship between his right knee and his military service weighs against the claim. The Veteran has not provided any evidence to diminish the weight of this probative opinion. Accordingly, the preponderance of the most probative evidence is against finding that the Veterans right knee pain is related to the Veteran’s period of service, to include as secondary to any service-connected condition. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Entitlement to service connection for a left knee disability. The Veteran contends that his left knee pain is related to his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of patellofemoral pain in his left knee and evidence of a prior meniscal tear, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The 2013 VA examiner noted that the Veteran reported twisting his left knee when he slipped off of an Army truck in October 2007. The Veteran himself related that he was not on active duty at the time, but he was in his regular line of work picking up trailers at Camp Lincoln. The Veteran worked as a civilian mechanic tech for the National Guard. The Veteran underwent an arthroscopy which resulted in a medial meniscectomy and chondroplasty in November 2007. The Veteran was provided a 2015 examination of the left knee and the examiner noted limited loss of range of motion in the left knee. The Veteran claimed that he injured both knees when he fell off a truck during National Guard training. He has continued to have pain daily in both knees since the accident. The Veterans STR’s include his Medical Evaluation Board brief which determined that the Veteran had osteoarthritis generally and left knee pain, neither of which was related to duty. While the Veteran is competent to report left knee pain and a prior medial meniscotomy, his reports are largely not credible due to internal inconsistency and inconsistency, as noted above. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). The Veteran has also stated that there was no line of duty determination made and that he was not on active duty during this injury. While the Veteran believes his left knee pain is related to service, the Board reiterates that the preponderance of the evidence weighs against findings that his injury occurred while in an active duty, active duty for training, or an inactive duty for training status. Accordingly, the preponderance of the most probative evidence is against finding that a left knee pain is related to the Veteran’s period of service, to include as secondary to any service-connected condition. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 7. Entitlement to service connection for hearing loss. The Veteran contends that he has hearing loss due to his military service. The Veteran filed his first claim for hearing loss in March 1999 and has filed multiple claims since. Ordinarily, once a VA decision becomes final, the Veteran must submit new and material evidence to reopen the claim. See 38 C.F.R. § 3.156(a). However, new and material evidence is not required to reopen a claim when, after a final decision, VA receives relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim. 38 C.F.R. § 3.156(c). The Veteran’s complete STR’s were added to the file in March 2014. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Service connection may be presumed for sensorineural hearing loss that develops to a compensable degree within one year after discharge from active duty, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. § § 3.307(a)(3), 3.309(a). The presumption that a chronic disease is service connected is rebuttable by probative evidence to the contrary. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Even though disabling hearing loss is not demonstrated at separation, a veteran may, nevertheless, establish service connection for a current hearing disability by submitting evidence that a current disability is related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). When symptoms are capable of lay observation, a layman can be competent to testify about a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and his medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). When considering whether lay evidence is competent, the Board must determine in each case whether the disability in concern is one concerning which lay statements may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). The Board concludes that, while the Veteran has a diagnosis of bilateral hearing loss, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. As noted above, the Veteran left active duty in April 1990 and left National Guard service in August 2013. The Veterans active duty STR’s contain multiple hearing examinations, none of which demonstrate hearing loss for VA purposes. 38 C.F.R. § 3.385 The Veteran’s VA records note denial of any hearing loss in July 2012, July 2013, and December 2014. The Veteran was provided VA examination in March 2018. This March 2018 examination reveals that the Veteran does have hearing loss for VA purposes. The examination also details hearing tests from the Veteran’s STR’s, none of which demonstrate hearing loss, as defined by 38 C.F.R. § 3.385. The March 2018 VA examiner opined that the Veteran’s hearing loss was not at least as likely as not related to in service noise exposure. The rationale was that the Veteran’s STR’s demonstrated no permanent positive shift in hearing thresholds, and the passage of time between the Veteran’s discharge and diagnosis of hearing loss, make it more likely than not that the Veteran did not experience hearing loss during or due to service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Although the Veteran believes his hearing loss is related to an in-service injury, event, or disease, he Veteran, in this case, is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the March 2018 VA examination. Accordingly, the preponderance of the most probative evidence is against finding that bilateral hearing loss is related to the Veteran’s period of service, to include as secondary to any service-connected condition. As such, reasonable doubt does not arise, and the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph Montanye, Associate 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.