Citation Nr: 21000103 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-55 320 DATE: January 4, 2021 ORDER Service connection for bilateral hearing loss is denied. Service connection for hypertension is denied. Service connection for headaches is denied. FINDINGS OF FACT 1. The Veteran has a current bilateral hearing loss disability. 2. The Veteran had noise exposure during active service from machinery equipment. 3. The Veteran’s left ear hearing loss was noted on entry onto active duty, and did not increase in severity beyond its natural progression during active service or as a result of an in-service disease, injury, or event, including noise exposure. 4. The Veteran’s right ear hearing loss did not manifest in active service, and is not linked to a disease or injury incurred or aggravated in active service, including noise exposure. 5. The Veteran’s hypertension did not manifest during active service, and is not linked to disease or injury incurred or aggravated in service. 6. The Veteran has not been diagnosed with a headache disorder, including migraines. 7. The Veteran’s occasional headaches are not linked to disease or injury incurred or aggravated in active service, including complaints of headaches during service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.307, 3.309, 3.385. 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.307, 3.309, 3.385. 3. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1971 to May 1974. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The Board remanded the matters in September 2019. The Veteran and his spouse testified at a hearing before the undersigned Veterans Law Judge in June 2019. A transcript of the hearing is of record. Service Connection Service connection generally will be awarded when a veteran has 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 be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection on a direct basis, the evidence must show: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link between the current disability and the disease or injury incurred or aggravated in service (the “nexus” element). Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). For the chronic diseases listed in 38 C.F.R. § 3.309(a), including sensorineural hearing loss as an organic disease of the nervous system, and cardiovascular-renal disease, including hypertension, service connection may alternatively be established with evidence of chronicity of the disease during service or during a presumptive period following service separation. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015). For conditions noted during service (or in the presumptive period) but not shown to be chronic at the time, a continuity of symptomatology after service is required to support the claim. 38 C.F.R. § 3.303(b). When chronicity or continuity is established, subsequent manifestations of the same chronic disease at any later date, no matter how remote in time from the period of service, will be service connected unless clearly attributable to causes unrelated to service (“intercurrent” causes). Id. In addition, where a veteran served continuously for 90 days or more during a period of war, or after December 31, 1946, there is a presumption of service connection for organic disease of the nervous system and hypertension if the disease manifested to a degree of 10 percent or more within one year from the date of separation from service, even if there is no evidence of the disease during the service period itself. 38 U.S.C. § § 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). This presumption may be rebutted by affirmative evidence to the contrary. 38 C.F.R. § 3.307(d). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) (when the evidence supports the claim or is in relative equipoise, the claim will be granted). Bilateral Hearing Loss The Veteran testified at the June 2019 Board hearing that he was exposed to noise during service from working near a conveyor belt and driving a forklift, which he states was loud and noisy. He testified that he does not remember being given hearing protection during service. He also testified that he felt he did not hear as well out of his right hear compared to before he entered service, and that his pre-existing left ear hearing loss also worsened. See June 2019 Hearing Transcript. For the following reasons, the Board finds that the criteria for service connection for the Veteran’s bilateral hearing loss have not been met. A current bilateral hearing loss disability is established. In this regard, impaired hearing is defined as a disability for VA compensation purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 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. The threshold for normal hearing is from 0 to 20 decibels; higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Here, the October 2015 VA examination report reflects puretone threshold results from audiometric testing of 40 degrees or higher at one or more of the relevant frequencies in both ears. Accordingly, the criteria for a hearing loss disability are satisfied. See 38 C.F.R. § 3.385. Regarding in-service noise exposure, the Veteran’s DD 214 reflects that he had a military occupational specialty (MOS) as a Material Facilities Specialist. According to his service personnel records, he was assigned to the Storage and Issue Unit of Primate Publications Distribution Section. His duties included receiving and warehousing incoming technical material, consolidating and preparing forms and publications for shipment to worldwide installations, and maintaining and consolidating all changes to basic publications. Toward the end of his service period, he was also responsible for the receipt, storage, and issuance of classified technical orders and associated forms, and also for insuring that all mailings complied with security requirements and that the proper postal rates were applied. The places, types, and circumstances of the Veteran’s service do not indicate that he would have had significant noise exposure. However, a June 2019 letter from the Veteran’s private audiologist states, based on the Veteran’s reported history, that the Veteran was exposed to a steady state of noise for up to eight hours working in very close proximity to a conveyor belt in a warehouse setting. He was also exposed to machinery noise such as forklifts and other equipment, and his duty station was near the airfield, where there was repeated aircraft engine noise occurring daily. The audiologist found that the Veteran was routinely exposed to hazardous noise levels. For the following reasons, the Board finds that the preponderance of the evidence weighs against a link between the Veteran’s in-service noise exposure and hearing loss in his left or right ear. With regard to his left ear hearing loss, the Board finds that it pre-existed active service and was not aggravated during or by any incident of active service, for the reasons that follow. Under the presumption of soundness, a veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrated that an injury or disease existed prior to service and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). The Veteran’s left ear hearing loss was noted at entrance into service. Therefore, the presumption of soundness does not apply. See id. Specifically, the March 1971 pre-induction examination contains an audiogram showing puretone thresholds of 30 decibels at 500 Hertz, 15 decibels at 1000 Hertz, 25 decibels at 2000 Hertz, and 60 decibels at 4000 Hertz. The puretone threshold at 3000 Hertz was not recorded. Based on the puretone threshold of 40 degrees or higher at 4000 Hertz, a left ear hearing loss disability was noted on entry. See 38 C.F.R. § 3.385. Moreover, in the PULHES profile, a designation of “2” was entered under “H,” which stands for hearing. This indicates that a defect was noted with respect to the Veteran’s hearing. See McKinney v. McDonald, 28 Vet. App. at 19-20, n. 5; McIntosh v. Brown, 4 Vet. App. 553, 555 (1993). In the March 1971 report of medical history, the Veteran reported a history of ear, nose, or throat trouble. A clinician noted in the summary section of the form that the Veteran had a decrease in hearing, but used the designation for the right ear—a capital R in a circle—rather than the left ear (a capital L in a circle). Based on the audiogram and the April 1974 medical history discussed below, the Board assumes this was a typographical error, and that the clinician meant to designate the left ear. A pre-existing injury or disease will be considered to have been aggravated by active military, naval, or air service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a); Townsend v. Derwinski, 1 Vet. App. 408 (1991). Clear and unmistakable (obvious or manifest) evidence is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. 38 C.F.R. § 3.306(b). This includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the condition. Id. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. Id. If the evidence does not show a worsening during service, then the burden is on the Veteran to show aggravation. Falzone v. Brown, 8 Vet. App. 398, 402 (1995). The evidence does not show that there was an increase in severity of the Veteran’s left ear hearing loss during service. The service treatment records do not show treatment or complaints of hearing loss. The April 1974 separation examination report contains an audiogram showing puretone thresholds for the left ear of 30 decibels at 500 Hertz, 25 decibels at 1000 Hertz, 30 decibels at 2000 Hertz, 60 decibels at 3000 Hertz, and 65 decibels at 4000 Hertz. A designation of “2” was again recorded under “H” in the PULHES profile. In the April 1974 report of medical history, the Veteran endorsed a history of hearing loss. A clinician noted in that form that the Veteran had a history of hearing loss in the left ear since childhood. Over two years after the Veteran’s separation from service, he underwent a periodic U.S. Air Force Reserve examination in September 1976. The examination report contains an audiogram showing puretone thresholds for the left ear of 35 decibels at 500 Hertz, 25 decibels at 1000 Hertz, 35 decibels at 2000 Hertz, 65 decibels at 3000 Hertz, and 65 decibels at 4000 Hertz. In the September 1976 report of medical history, the Veteran endorsed a history of hearing loss. A medical opinion was provided by the examiner who conducted the October 2015 examination. The opinion is based on examination of the Veteran and review of the claims file and pertinent medical history. The examiner opined that the Veteran’s left ear hearing loss was not aggravated beyond normal progression in active service. The examiner explained that when comparing the Veteran’s enlistment audiogram to the April 1974 separation audiogram and September 1976 audiogram, there were no significant puretone threshold shifts. The examiner stated that the audiogram is the objective standard for noise injury, and because there was no significant puretone threshold during active service, there was no evidence that the Veteran’s military noise exposure caused a permanent noise injury affecting hearing sensitivity. The examiner concluded that, therefore, the Veteran’s current left ear hearing loss was less likely than not caused or aggravated by his active service. The October 2015 VA medical opinion is probative, as it was rendered by a medical professional specializing in audiology, is based on a review of the Veteran’s medical history, and is supported by a thorough explanation. In light of the October 2015 VA medical opinion and the service treatment records, the Board finds that the evidence does not show an increase in disability of the Veteran’s left ear hearing loss during service. Consequently, the burden is on the Veteran to show aggravation. See Falzone, 8 Vet. App. at 402. The Board finds that the Veteran has not met his burden of showing service-related aggravation of his left ear hearing loss. He submitted a June 2019 letter by a private treating audiologist which, as discussed above, found that the Veteran was routinely exposed to hazardous noise without hearing protection during service. The audiologist noted that the March 1971 enlistment audiogram showed a mild hearing loss at 500 Hertz and a moderately severe hearing loss at 4000 Hertz. The audiologist stated that the April 1974 separation audiogram showed a mild to severe hearing loss for the left hear from 500 to 6000 Hertz. The audiologist concluded that it is at least as likely as not that the Veteran’s left ear hearing loss is related to in-service noise exposure. The Board finds that the June 2019 private audiologist’s opinion is not probative. The audiologist does not provide a supporting rationale for the conclusion that the Veteran’s pre-existing left ear hearing loss was aggravated beyond normal progression by in-service noise exposure. The audiologist suggests that there was a worsening of the Veteran’s left ear hearing loss during service, stating that the Veteran had moderately severe hearing loss at enlistment, and a severe hearing loss from 500 to 6000 Hertz at separation. The March 1971 pre-induction audiogram does not record the puretone thresholds at 3000 and 6000 Hertz. The April 1974 separation audiogram records a puretone threshold of 70 decibels at 6000 Hertz. Presumably, the private audiologist found that puretone threshold, and perhaps the puretone threshold of 65 decibels at 4000 Hertz, to indicate “severe” rather than “moderately severe” hearing loss. However, that alone does not necessarily show an increase in severity when compared with the enlistment audiogram, as he may have had a puretone threshold of 70 decibels at 6000 Hertz that went unrecorded at the time of that examination. The only difference between the two audiograms in that regard is that the April 1974 audiogram records the puretone thresholds at more frequencies than the March 1971 audiogram. While the Veteran had slightly higher puretone thresholds at the other frequencies compared with the March 1971 audiogram, such as 65 decibels at 4000 Hertz rather than 60 decibels at that frequency in March 1971, the October 2015 VA examiner found that these changes did not constitute significant puretone threshold shifts indicative of a noise injury. As the June 2019 private audiologist’s opinion does not address the fact that the April 1974 audiogram simply provides more information than the March 1971 audiogram, or discuss whether the changes in puretone thresholds where comparison is possible represented significant puretone threshold shifts rather than normal testing variability, it carries less probative weight than the October 2015 VA medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (holding that the probative value of a medical opinion comes from its reasoning). Accordingly, the Board finds that the Veteran’s pre-existing left ear hearing loss was not aggravated beyond normal progression during service or by any incident of service, including in-service noise exposure. Therefore, the criteria for service connection are not satisfied. See Holton, 557 F.3d at 1366. With regard to the right ear, the audiogram in the March 1971 enlistment examination report shows puretone thresholds of 25 decibels at 500 Hertz, 10 decibels at 1000 Hertz, 20 decibels at 2000 Hertz, and 20 decibels at 4000 Hertz. The puretone threshold at 3000 Hertz was not recorded. The audiogram in the April 1974 separation examination report shows puretone thresholds for the right ear of 10 decibels at 500 Hertz, 10 decibels at 1000 Hertz, 15 decibels at 2000 Hertz, 15 decibels at 3000 Hertz, and 20 decibels at 4000 Hertz. Thus, the Veteran’s right ear hearing was normal at separation. See Hensley, 5 Vet. App. at 157. Moreover, his puretone thresholds in the right ear were the same or better compared to those recorded in the March 1971 audiogram. As discussed above, the April 1974 report of medical history reflects that the Veteran endorsed a history of left ear hearing loss. No mention is made of right ear hearing loss. The Board notes that the April 1974 audiogram also records a puretone threshold of 35 decibels at 6000 Hertz for the right ear. A puretone threshold at that frequency is not recorded in the March 1971 enlistment audiogram. Thus, the recording of that puretone threshold in the April 1974 audiogram does not in itself show worsening hearing, since it cannot be compared with the puretone threshold at the same frequency in the March 1971 audiogram. Over two years after the Veteran’s separation from active service, the audiogram in the September 1976 Air Force Reserve examination report shows puretone thresholds for the right ear of 10 decibels at 500 Hertz, 10 decibels at 1000 Hertz, 15 decibels at 2000 Hertz, 15 decibels at 3000 Hertz, and 15 decibels at 4000 Hertz. Thus, his right ear hearing continued to be normal. See Hensley, 5 Vet. App. at 157. He endorsed a history of hearing loss in the September 1976 report of medical history. Given his history of left ear hearing loss, and the fact that his audiograms showed normal right ear hearing, his endorsement of a history of hearing loss does not support a finding that he had right ear hearing loss at that time. The Board has considered the Veteran’s testimony that he believes he experienced worsening hearing in his right ear during service. While he is competent to report such experience, it is contradicted and outweighed by the service audiograms showing normal right ear hearing, and the fact that in the April 1974 report of medical history he endorsed a history of left ear hearing loss but did not mention the right ear, according to the clinician’s notes. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant); Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (holding that when determining whether lay evidence is satisfactory, the Board may properly consider, among other things, its consistency with other evidence submitted on behalf of the Veteran); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (the Board has the "authority to discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence"). In the October 2015 VA examination report, the examiner opined that the Veteran’s right ear hearing loss was less likely than not related to in-service noise exposure. In explanation, the examiner first observed that the Veteran had normal hearing in the right ear at induction, and on separation had normal to mild hearing loss in the right ear. The Board assumes that the examiner’s finding of mild hearing loss at separation is based on the recording of 35 decibels at 6000 Hertz. However, as a puretone threshold was not recorded at that frequency in the March 1971 audiogram, it cannot be determined whether there was in fact a change in frequency or whether the separation audiogram was merely more thorough in terms of recording the puretone thresholds at more frequencies. The Board also notes that the Hensley definition of hearing loss and VA’s criteria for establishing a hearing loss disability are based solely on the frequencies from 500 to 4000 Hertz. The examiner went on to state that the mild hearing loss (i.e. the puretone threshold of 35 degrees at 6000 Hertz) appears to have resolved, as the September 1976 audiogram showed normal hearing in the right ear. In this regard, the Board notes that the September 1976 audiogram records a puretone threshold of 25 decibels at 6000 Hertz. The examiner stated that the audiogram is the objective standard for noise injury, and because the Veteran’s hearing was normal two years after separation, there was no evidence that his military noise exposure caused a permanent noise injury affecting hearing sensitivity. In the June 2019 letter, the private audiologist stated that the March 1971 audiogram showed hearing within normal limits for the right ear, and the April 1974 separation audiogram showed mild hearing impairment in the right ear. The examiner concluded that based on the Veteran’s in-service hazardous noise exposure, it is at least as likely as not that his bilateral hearing loss is related to noise exposure during active service. The Board finds the June 2019 opinion has little probative value. The April 1974 separation audiogram in fact shows normal hearing for the right ear as defined in Hensley, 5 Vet. App. at 157. While the puretone threshold of 35 decibels at 6000 Hertz may indicate some hearing loss, a puretone threshold at that frequency was not recorded in the March 1971 audiogram. Thus, it is not possible to determine whether there was a shift in the puretone threshold at that frequency indicating worsening hearing. Indeed, as already noted, the puretone thresholds at the frequencies recorded at enlistment are the same or higher compared with the separation audiogram. Moreover, the June 2019 opinion does not account for the September 1976 audiogram, which also shows normal hearing at the relevant frequencies (500 to 4000 Hertz) and a puretone threshold of 25 decibels at 6000 Hertz, which the October 2015 VA examiner found to be normal. Thus, as the June 2019 private opinion does not account for that pertinent evidence, it lacks probative value, and is outweighed by the October 2015 VA medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (noting that critical pieces of information from a claimant’s medical history can lend credence to the opinion of a medical expert who considers them, and detract from the medical opinions of experts who do not). The October 2015 VA medical opinion also carries more weight than the Veteran’s lay opinion that his hearing loss was caused or aggravated by in-service noise exposure, as the Veteran is not shown to have relevant medical expertise. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Moreover, whether his pre-existing left ear hearing loss was aggravated by in-service noise exposure, or whether the later onset of his right ear hearing loss may be linked to in-service noise exposure, is a determination that is too complex to be made based on lay observation alone. Accordingly, medical evidence is required. Therefore, as a layperson in the field of medicine, the Veteran’s opinion on this issue is not competent, and therefore is not probative. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 470-71 (1994). The Board notes that in Hensley, the United States Court of Appeals for Veterans Claims (Court) held that section 3.385 of the regulations, which defines the criteria for establishing a hearing loss disability, does not preclude service connection for a current hearing loss disability where hearing was within normal limits on audiometric testing at separation from service. Hensley, 5 Vet. App. at 159. “Therefore, when audiometric test results at a veteran’s separation from service do not meet the regulatory requirements for establishing a ‘disability’ at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service.” Id. at 160. Here, for the reasons discussed above, the Board finds that the October 2015 VA medical opinion is the most probative evidence on the issue. The examiner found that the Veteran’s service audiograms did not show changes in puretone thresholds indicative of a noise injury, and therefore his right ear hearing loss was less likely than not related to in-service noise exposure. The Board bases this decision on that medical opinion with regard to the right ear. The evidence does not show that the Veteran’s right ear hearing loss manifested within a year of service separation or was noted during service or a presumptive period. The September 1976 service examination, which shows normal hearing in the right ear, constitutes probative evidence weighing against such a finding. Accordingly, service connection may not be established based on continuity of symptomatology, or based on hearing loss that manifests to a compensable degree within one year of service separation. 38 C.F.R. §§ 3.303, 3.307. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Hypertension The Veteran seeks service connection for hypertension. For the following reasons, the Board finds that service connection is not established. VA regulation provides, in pertinent part, that hypertension is established when diastolic blood pressure is predominately 90mm or higher. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). The United States Court of Appeals for Veterans Claims (Court) noted that that the medical community has defined hypertension as high arterial blood pressure with a minimum threshold of 140mm for systolic blood pressure and 90mm for diastolic blood pressure. Duenas v. Principi, 18 Vet. App. 512, 519 (2004). The Veteran’s March 1971 enlistment examination report reflects that his systolic blood pressure was initially recorded as 170mm; his diastolic blood pressure was recorded as what appears to be 84mm. However, the report notes that a three-day blood pressure check was within normal limits, and the final reading was 130 over 70. The service treatment records show that in March 1972, the Veteran complained of dizziness, blurred vision, and severe hot and cold flashes. He also reported having severe headaches on and off for the past three months. His peripheral vision was normal. He was assessed with headaches. His blood pressure was recorded as 130 systolic and 90 diastolic. There is no mention of high blood pressure or diagnosis of hypertension in this record. There are no subsequent service treatment record showing similar symptoms or elevated blood pressure readings. The April 1974 separation examination report reflects a systolic blood pressure reading of 116mm, and a diastolic blood pressure reading of 80mm. The Veteran denied a history of high blood pressure in the April 1974 report of medical history. Over two years following the Veteran’s separation from service, the September 1976 U.S. Air Force Reserve examination report reflects a blood pressure reading of 112mm systolic and 72 diastolic. In the September 1976 report of medical history, the Veteran denied a history of high blood pressure. In a May 2016 letter, the Veteran’s private treating physician, R.F., DO, stated that the Veteran had been his patient since 1999. The physician stated that he reviewed the Veteran’s blood pressure readings “from his time in active duty in the 1970’s” and that these readings were consistent with hypertension. The physician further stated that it appeared from the records that the Veteran had hypertension during active service, noting that elevated blood pressure readings are consistent with headaches, which the Veteran also complained of during service. A May 2016 letter from a different treating physician, T.C., MD, states that she reviewed the Veteran’s medical records, and that the Veteran suffered with hypertension while on active duty. A VA examination was performed in August 2016. The examiner noted that the date of diagnosis of hypertension was unknown. The Veteran reported having high blood pressure for forty years. At the June 2019 Board hearing, the Veteran testified that he first received treatment for hypertension in the late 1970’s or early 1980’s. In the January 2020 VA medical opinion, the examiner concluded that it is less likely than not that the Veteran’s hypertension manifested in service or is related to service. The examiner noted the Veteran’s blood pressure reading of 130/90 in the March 1972 service treatment record. However, the examiner stated that this isolated reading was not diagnostic for hypertension. While it was borderline on the diastolic side, there were no subsequent elevated blood pressure readings during service. The examiner stated that the only “true elevation” in blood pressure was in the March 1971 enlistment examination, but that the Veteran underwent a three-day blood pressure check which then showed normal blood pressure. The Board finds that the preponderance of the evidence shows that the Veteran’s hypertension did not manifest during service or within a year of separation. As explained in the January 2020 VA medical opinion, the Veteran’s isolated high blood pressure reading in March 1972 was not diagnostic of hypertension, and there were no subsequent high blood pressure readings. The Board notes that, in keeping with the VA examiner’s explanation, VA’s definition of hypertension requires diastolic blood pressure to be “predominately” 90mm or higher. Clearly, an isolated reading of 90mm, with subsequent normal readings, does not constitute a “predominant” reading. Indeed, both at separation and more than two year after service, the Veteran’s blood pressure readings were normal, as shown in the April 1974 and September 1976 examination reports, and he denied a history of high blood pressure in the corresponding reports of medical history. The Board finds that the May 2016 letters submitted by the Veteran’s private treating physicians are not probative. The letter by R.F. refers to high blood pressure “readings” during the Veteran’s service, indicating by use of the plural that there was more than one, and yet there is only one reading showing a diastolic blood pressure of 90mm in the service treatment records. The opinion by Dr. R.F. does not account for that fact, or the fact that the Veteran’s blood pressure was normal at separation and more than two years after service. While blood pressure medication may have lowered the Veteran’s blood pressure to within a normal range, he denied a history of high blood pressure in the September 1976 report of medical history, which indicates he had not been placed on blood pressure medication at that time. Moreover, at the June 2019 Board hearing, he testified that he was first treated for hypertension in the late 1970’s or early 1980’s, which is a number of years after the September 1976 examination report. The May 2016 letter by Dr. T.C. also lacks probative value, as no explanation was provided, and it does not account for the evidence indicating that the Veteran’s hypertension did not manifest in service, such as the subsequent normal blood pressure readings, as discussed above. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (holding that the probative value of a medical opinion comes from its reasoning, and that critical pieces of information from a claimant’s medical history can lend credence to the opinion of a medical expert who considers them, and detract from the medical opinions of experts who do not). Because the Veteran is a layperson in the field of medicine, he does not have the expertise to render a competent opinion as to whether his symptoms of dizziness, blurred vision, severe hot and cold flashes headaches, and headaches were indicative of high blood pressure at the time, as this is a determination that is too complex to be made based on lay observation alone. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Thus, the Veteran’s statement that such symptoms were indicative of hypertension or high blood pressure at the time is not probative. In sum, the probative evidence weighs against a link between the Veteran’s hypertension and the single reading of diastolic blood pressure of 90mm in March 1972. Because the Veteran’s hypertension was not noted in service or within a year of separation, with his blood pressure being normal more than two years after separation, service connection may not be established based on continuity of symptomatology, or based on hypertension that manifests to a compensable degree within one year of service separation. 38 C.F.R. §§ 3.303, 3.307 As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Headaches The Veteran seeks service connection for a headache condition. For the following reasons, the Board finds that service connection is not established. In the March 1971 pre-induction report of medical history, the Veteran endorsed a history of frequent or severe headaches. In the physician’s summary section of the report, a clinician wrote “headaches – occ.,” which can be interpreted to mean occipital headaches or occasional headaches. The notes do not clarify which meaning was intended. The March 1971 pre-induction examination report reflects that the Veteran’s head, face, and scalp, and neurologic system were clinically evaluated as normal. The service treatment records show that in March 1972, the Veteran complained of dizziness, blurred vision, and severe hot and cold flashes. He also reported having severe headaches on and off for the past three months. His peripheral vision was normal. He was assessed with headaches. The service treatment records do not otherwise show complaints of headaches. In the April 1974 report of medical history at separation, the Veteran denied a history of frequent or severe headaches. The April 1974 separation examination report reflects that the Veteran’s head, face, and scalp, and neurologic system were clinically evaluated as normal. A little over two years after the Veteran’s service separation, in the September 1976 U.S. Air Force Reserve report of medical history, the Veteran endorsed a history of frequent or severe headaches. No further information is provided in this report. The September 1976 U.S. Air Force Reserve examination report reflects that the Veteran’s head, face, and scalp, and neurologic system were clinically evaluated as normal. The VA treatment records reflect that the Veteran was seen as a new patient in April 2016. At that time, he denied headaches. The VA and private treatment records do not otherwise reflect diagnoses or complaints of a headache condition. In a May 2016 letter, the Veteran’s private treating physician, T.C., MD, stated that she reviewed the Veteran’s medical records and it was her opinion that the Veteran suffered headaches while on active duty. A VA examination was performed in August 2016. In the examination report, the examiner indicated that the Veteran had never been diagnosed with a headache condition. The Veteran stated he had a long history of getting frequent headaches. He stated they come and go. He did not take medication for them. At the June 2019 Board hearing, the Veteran testified that his headaches are no longer as frequent. His wife testified that they can be “brought on” by “things . . . he’s involved in.” In the January 2020 VA medical opinion, the examiner opined that it is less likely than not that the Veteran’s headache disorder manifested in active service or is otherwise related to service. The examiner explained that the Veteran reported frequent and severe headaches prior to service (i.e. in the March 1971 report of medical history) and he denied frequent and severe headaches at separation. The examiner observed that the headaches reported by the Veteran in March 1972 was not consistent with aggravation of a pre-existing condition. The Board finds that the preponderance of the evidence weighs against a link between any intermittent headaches the Veteran has experienced during the pendency of this claim and his in-service headaches. He has not been diagnosed with a chronic headache condition, with migraine headaches, or another underlying condition associated with his headaches. The sole fact that he experienced headaches during service does not support a causal relationship between those headaches and his current intermittent headaches, absent evidence of a chronic condition or other causal relationship. See Holton, 557 F.3d at 1366 (holding, in pertinent part, that there must be evidence of a causal relationship between the current disability and the disease or injury incurred or aggravated in active service). It also does not establish that he incurred or aggravated a disease or injury in service, as suggested by the January 2020 VA medical opinion. His endorsement in the March 1971 pre-induction examination of a history of experiencing frequent or severe headaches indicates that he has been prone to headaches since prior to service. The May 2016 letter by the Veteran’s private treating physician does not support a relationship between the Veteran’s current occasional headaches and the headaches he experienced in service; it merely observes that he had headaches in service, without speaking to the issue of whether they are linked to his current headaches. The fact he had headaches in service is already shown by the March 1972 service treatment record. The Board notes that in a May 2016 letter, a different private treating physician, R.F., DO, stated that the Veteran’s “elevated blood pressure readings are consistent with headaches[,] which appear to have been a complaint” during his active service. As discussed above with respect to the claim for hypertension, the Veteran did not have more than one elevated blood pressure reading during service, and service connection for hypertension has not been established. Thus, the May 2016 letter by Dr. R.F. does not support a nexus between the Veteran’s current headaches and the headaches he experienced in service. Because the Veteran is a layperson in the field of medicine, he does not have the expertise to render a competent or probative opinion as to whether his current headaches may be linked to the headaches he experienced in service many years earlier, as this is a determination that is too complex to be made based on lay observation alone. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). The Veteran has not been diagnosed with migraines or a chronic disease associated with his headaches. At the June 2019 hearing, he stated that some time in the past he had gone to a specialist for migraine headaches and was placed on medication. While he may have been diagnosed with migraines in the past, the current treatment records do not show such a diagnosis, and the August 2016 VA examiner indicated he did not have a diagnosis associated with his headaches. The August 2016 VA examination report also reflects that the Veteran denied taking medications for his headaches. Thus, a current migraine or neurological condition is not established. Accordingly, to the extent the Veteran has experienced recurring headaches similar to those he reported in service, as the evidence does not show a chronic disease associated with his headaches, service connection may not be established based on continuity of symptomatology alone. See Walker, 708 F.3d at 1338; 38 C.F.R. § 3.303(b). As explained above, the preponderance of the evidence weighs against a nexus or link between the Veteran’s current occasional headaches and the headaches he experienced during service. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rutkin, 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.