Citation Nr: 21001531 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 15-38 528 DATE: January 8, 2021 ORDER Entitlement to service connection for type 2 diabetes mellitus is denied. Entitlement to service connection for a bilateral leg disability, claimed as peripheral neuropathy of the lower extremities, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for a bilateral foot disability is denied. Entitlement to service connection for a bilateral shoulder disability is denied. Entitlement to service connection for a bilateral knee disability is denied. Entitlement to service connection a bilateral elbow disability is denied. Entitlement to service connection for a bilateral wrist disability is denied. Entitlement to service connection for a bilateral hand/finger disability, to include the fingers, is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The Veteran served on active duty in Korea and is not presumed to have been exposed to herbicide agents. 2. The Veteran’s currently diagnosed type 2 diabetes mellitus was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his service. 3. The Veteran’s currently diagnosed bilateral leg disability was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his service or any service-connected disability. 4. The Veteran’s currently diagnosed bilateral foot disability was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his service. 5. The Veteran’s currently diagnosed bilateral shoulder disability was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his service. 6. The Veteran’s currently diagnosed bilateral knee disability was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish etiological relationship between this disability and his service. 7. The preponderance of the evidence weighs against a finding that the Veteran has a bilateral elbow disability at this time. 8. The preponderance of the evidence weighs against a finding that the Veteran has a bilateral wrist disability at this time. 9. The preponderance of the evidence weighs against a finding that the Veteran has a bilateral hand/finger disability at this time. CONCLUSIONS OF LAW 1. Type 2 diabetes mellitus was not incurred in or aggravated by service and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2019). 2. A bilateral leg disability was not incurred in or aggravated by service and may not be presumed related to service or any service-connected disability. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2019). 3. A bilateral shoulder disability was not incurred in or aggravated by service and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2019). 4. A bilateral knee disability was not incurred in or aggravated by service and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2019). 5. Criteria for entitlement to service connection for a bilateral elbow disability, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2019). 6. Criteria for entitlement to service connection for a bilateral wrist disability, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2019). 7. Criteria for entitlement to service connection for a bilateral hand/finger disability, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1965 to October 1967. He served in the Republic of Korea from February 1966 to March 1967. These matters are on appeal from an April 2012 rating decision. In August 2018, these matters were remanded by the Board for further development. The claims of entitlement to service connection for diabetes mellitus and disabilities of the Veteran’s shoulders, elbows, knees, feet, lower extremities, and hands are ready for adjudication. In correspondence dated in November 2020, the Veteran’s representative stated that it had waived the right to provide an informal hearing presentation (IHP). Regarding the claim of entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include a bilateral foot disability, this issue has been recharacterized as stated on the title page, to more accurately reflect the Veteran’s contentions. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In addition, certain diseases, such as arthritis, organic diseases of the nervous system, and diabetes mellitus, are presumed to have been incurred in service if manifested to a compensable degree within one year after service. The presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2019). When chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim for such diseases. 38 C.F.R. § 3.303 (b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (2019). Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to the adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, when the record contains a recent diagnosis of disability prior to the Veteran’s filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time of the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 49 (1990); Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018); Wait v. Wilkie, No. 18-4349, U.S. Court of Appeals for Veterans Claims (August 26, 2020). Herbicide Agent Exposure The Veteran contends that he has type 2 diabetes mellitus and peripheral neuropathy related to herbicide agent exposure during security patrols along the demilitarized zone (DMZ) in Korea. See, September 2010 statement. If a Veteran was exposed to an “herbicide agent,” such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, then, absent affirmative evidence to the contrary, certain diseases will be service-connected even if there is no in-service record of the disease in service. 38 C.F.R. §§ 3.307 (a)(6), (d), 3.309(e). Notwithstanding the foregoing presumptions, a Veteran is not precluded from establishing service connection due to exposure to herbicide agents with proof of direct causation. Combee v. Brown, 38 F.3d 1039, 1042 (Fed. Cir. 1994). VA has extended the presumption of service connection for diseases listed under 3.309(e) to Veterans who served in Korea in or near the demilitarized zone (DMZ) between April 1, 1968, and August 31, 1971, or in Thailand at certain designated bases and whose duties placed him on or near the perimeter of the base, where Agent Orange was sprayed. 38 C.F.R. § 3.307 (a)(6)(iv); see also Compensation and Pension Bulletin, New Procedures for Claims Based on Herbicide Exposure in Thailand and Korea, 3 (May 2010). However, the Veteran’s arguments about exposure in Korea are insufficient to establish exposure to herbicide agents. The Veteran contends, and the service personnel records show, that he served in Korea from February 28, 1966 to March 28, 1967. As the service personnel records show that the Veteran was in Korea, his service in Korea is not in dispute. In a September 2010 statement, the Veteran stated that while in Korea he was assigned to the 1st Battalion 38th Infantry, 2nd Div. Charlie Co. In February 1966, his duties upon arriving in Korea were to perform guard duty out post by the North Korean fence. He stated that he became a LT driver and patrolled the DMZ to check out spots to set up ambush patrols. They saw Korean soldiers with backpack sprayers spraying along the road to the outpost and was told if they did not it would look like a jungle. In this regard, in September 2010, the VA Personnel Information Exchange System (PIES) indicated that there were no records of the Veteran’s exposure to herbicide agents during service. In a July 2011 Formal Finding the RO determined that the information required to corroborate the Veteran’s claimed herbicide agent exposure was insufficient to send the Joint Services Records Research Center (JSSRC), noting the Veteran’s service in Korea from February 28, 1966 to March 28, 1967, which is prior to the presumed period for herbicide agent exposure. The Veteran submitted several statements from his friends in support of his claimed herbicide agent exposure during service in Korea. While the Veteran and his friends are competent to report their experiences (i.e. exposure to herbicide agents in or near the DMZ), they conflict with the official service records and the JSSRC lack of findings. Although the Veteran and his friends theorize that he was exposed to herbicide agents during service in Korea, there is no corroborating evidence in the Veteran’s service personnel records to support that theory of contact with any herbicide agent, the DOD has not identified this as a credible source of exposure to herbicides, and neither the Veteran nor his friends have demonstrated any experience with herbicide agents or chemicals that would have allowed either to recognize it in service or distinguish the herbicide agents listed in 38 C.F.R. § 3.307 (a)(6)(i). See Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (a layperson’s assertions indicating exposure to gases or chemicals during service were not sufficient evidence alone to establish that such an event actually occurred during service). Therefore, the Board finds that the Veteran’s statements and those of his friends provided more than 44 years after the alleged exposure are insufficient to establish exposure to herbicide agents (i.e. Agent Orange) during his service while stationed in Korea, especially prior to the presumed period for herbicide agent exposure. As such, the Veteran does not meet the criteria for the presumption of herbicide exposure. The Veteran also submitted excerpts of prior rating decisions in which service connection was granted for disabilities, including diabetes mellitus, based on herbicide exposure during service in Korea, including in 1967. However, the Board notes that prior rating decisions related to other Veterans’ cases are not precedential and are not binding on either RO or Board decisions in other cases. 38 C.F.R. § 20.1303 (2019); McDowell v. Shinseki, 23 Vet. App. 207, 228 (2009). “Each case presented to the Board will be decided on the basis of the individual facts of the case.” 38 C.F.R. § 20.1303. Accordingly, based on a detailed review of the record, the Board must find that the evidence, overall, provides evidence against the evidence against the Veteran’s claim of herbicide agent exposure while stationed in Korea. Next, where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has determined that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). 1. Type 2 diabetes mellitus As previously stated, the Veteran contends that he has type 2 diabetes mellitus that is related to his service. Turning to the evidence of record, the Veteran’s service treatment records (STRs) are void of findings, complaints, symptoms, or diagnosis of diabetes mellitus. Post-service, VA treatment records include an April 2007 report which indicates a diagnosis of diabetes mellitus. A July 2010 report indicates a diagnosis of type 2 diabetes mellitus with peripheral neuropathy. The Board acknowledges that some of the VA treatment records, including an August 2010 report, indicate a history of herbicide agent exposure. However, to the extent that the Veteran’s herbicide agent exposure came from the Veteran’s report, those facts are unsupported by the objective evidence of record. Accordingly, any treatment records indicating a history of herbicide agent exposure carry little probative weight. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). The Board finds that the claim must be denied. There is no competent medical evidence to show that the Veteran has had any diagnosed type 2 diabetes mellitus that is related to his service. Moreover, post-service, the record does not reflect or reference any history of type 2 diabetes mellitus until decades after discharge from active service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Horn v. Shinseki, 25 Vet. App. 231, 240 n.7 (2012). The Board finds in this case that the lack of evidence of type 2 diabetes mellitus during service coupled with the fact that a diagnosis of type 2 diabetes mellitus was not made until over four decades post-service, is sufficient to rebut a finding of service incurrence. In this case, the earliest post-service medical evidence of the Veteran’s type 2 diabetes mellitus was in April 2007 which is over 40 years after service. This long period without problems weighs against the claim. Moreover, the Board finds that the Veteran’s statements relating his type 2 diabetes mellitus to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over four decades after service. Finally, there is no competent medical evidence that the Veteran has type 2 diabetes mellitus that is related to his service. 2. Bilateral leg disability The Veteran contends that he has a bilateral leg disability, claimed as peripheral neuropathy, that is related to herbicide agent exposure during service. He also contends that he was exposed to cold weather during guard duty in Korea which caused him to lose feeling in his legs. See, January 2011 VA mental health report. The STRs are void findings, complaints, symptoms, or any diagnosis of a bilateral leg disability, to include peripheral neuropathy or any other neurological disability. Post service, VA treatment records include a July 2010 report which indicates a diagnosis of type 2 diabetes mellitus with peripheral neuropathy. The Board finds that the claim must be denied. In this case, there is no competent medical evidence that supports the conclusion that the Veteran has any bilateral leg disability that was incurred in or aggravated by his service. In this case, the earliest post-service medical evidence of the Veteran’s peripheral neuropathy of the lower extremities was in July 2010 which is over 42 years after service. This long period without problems weighs against the claim. See, Buchanan supra; see also, Maxson, supra; see also, Horn, supra. In addition, continuity of symptomatology has also not been established, either through the competent evidence of record or through the Veteran’s statements. Moreover, the Board finds that the Veteran’s statements relating his bilateral leg disability to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over four decades after service. Finally, there is no competent medical evidence that the Veteran has any bilateral leg disability that is related to his service. To the extent that the evidence suggests that the Veteran’s peripheral neuropathy is secondary to his type 2 diabetes mellitus, service connection has not been granted for type 2 diabetes mellitus. Therefore, neither disability may serve as a predicate service-connected disability upon which to base this claim, and a claim for peripheral neuropathy based on “secondary” service connection fails as a matter of law. See 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426 (1994). There is no evidence to show that a service-connected disability caused or aggravated the Veteran’s peripheral neuropathy of the lower extremities. 3. Bilateral foot disability The Veteran contends that he has a bilateral foot disability that is related to his service. Specifically, he contends that he went on a 12-mile force march with full gear weighing 90 pounds which caused his feet to hurt. See, September 2010 statement. The STRs include a September 1965 pre-induction examination report which indicates a diagnosis of pes planus, NCD (not currently disabling). These records are otherwise void of any findings, complaints, symptoms, or any diagnosis related to a bilateral foot disability. Post-service VA treatment records dated in June 2010 indicate a complaint of burning feet at night. In July 2010, he complained that his feet were frozen during service. An August 2010 report indicates a diagnosis of type 2 diabetes mellitus and early neuropathy to the feet. A January 2011 mental health report reflects the Veteran’s complaint of a recurrence of blisters on his feet every summer since service in Korea which were treated by a family physician whose records are unavailable. The Board finds that the claim must be denied. In this case, there is no competent medical evidence that supports the conclusion that the Veteran has any bilateral foot disability that was incurred in or aggravated by his service. In this case, the earliest post-service medical evidence of the Veteran’s bilateral foot disability was in June 2010 which is over 42 years after service. This long period without problems weighs against the claim. See, Buchanan supra; see also, Maxson, supra; see also, Horn, supra. In addition, continuity of symptomatology has also not been established, either through the competent evidence of record or through the Veteran’s statements. Moreover, the Board finds that the Veteran’s statements relating his bilateral foot disability to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over four decades after service. Finally, there is no competent medical evidence that the Veteran has a bilateral foot disability that is related to his service. To the extent that the evidence suggests that the Veteran’s neuropathy of the feet is secondary to his type 2 diabetes mellitus, service connection has not been granted for type 2 diabetes mellitus. Therefore, neither disability may serve as a predicate service-connected disability upon which to base this claim, and a claim for headaches based on “secondary” service connection fails as a matter of law. See 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426 (1994). There is no evidence to show that a service-connected disability caused or aggravated the Veteran’s bilateral foot disability. 4. Bilateral shoulder disability The Veteran contends that he has a bilateral shoulder disability that is related his service. Specifically, he was on a 12-mile force march with full gear which caused shoulder pain. See, September 2010 statement. The STRs are void of findings, complaints, symptoms, or any diagnosis related to a bilateral shoulder disability. Post service VA treatment records dated in March 2007 indicate a 3-day complaint of left shoulder pain. It was noted that the Veteran hauled heavy equipment and thought that he may have injured his shoulder lifting or swinging heavy equipment. The assessment was left shoulder pain. An April 2007 report indicates a diagnosis of osteoarthritis. In February 2010 degenerative joint disease of the shoulder was diagnosed. The Board finds that the claim must be denied. In this case, there is no competent medical evidence that supports the conclusion that the Veteran has any bilateral shoulder disability that was incurred in or aggravated by his service. In this case, the earliest post-service medical evidence of the Veteran’s bilateral shoulder disability was in April 2007 which is over 41 years after service. This long period without problems weighs against the claim. See, Buchanan supra; see also, Maxson, supra; see also, Horn, supra. In addition, continuity of symptomatology has also not been established, either through the competent evidence of record or through the Veteran’s statements. Moreover, the Board finds that the Veteran’s statements relating his bilateral shoulder disability to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over four decades after service. Finally, there is no competent medical evidence that the Veteran has a bilateral shoulder disability that is related to his service. 5. Bilateral knee disability The Veteran contends that he has a bilateral knee disability that is related to his service. However, the STRs are void of findings, complaints, symptoms, or any diagnosis related to a bilateral knee disability. Post service VA treatment records include an August 2010 report which indicates a diagnosis of knee pain secondary to osteoarthritis. In this case, the earliest post-service medical evidence of the Veteran’s bilateral knee disability was in August 2010 which is over 42 years after service. This long period without problems weighs against the claim. See, Buchanan supra; see also, Maxson, supra; see also, Horn, supra. In addition, continuity of symptomatology has also not been established, either through the competent evidence of record or through the Veteran’s statements. Moreover, the Board finds that the Veteran’s statements relating his bilateral knee disability to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over four decades after service. Finally, there is no competent medical evidence that the Veteran has a bilateral knee disability that is related to his service. 6. Bilateral elbow disability The Veteran contends that he has bilateral elbow disability that is related to his service. However, the STRs are void of findings, complaints, symptoms, or any diagnosis related to a bilateral elbow disability. Post-service, the record does not contain any medical records or evidence of any diagnosed bilateral elbow disability. The Board finds that the claim must be denied. There is no competent medical evidence to show that the Veteran has had any diagnosed bilateral elbow disability since the Veteran’s service. As the competent medical evidence does not show diagnosis of any bilateral elbow disability, service connection is denied. See Brammer, supra; see also McClain, supra; Romanowsky, supra; Saunders, supra. To the extent that the Veteran complaints of bilateral elbow pain, there is no indication that any subjective complaints result in functional impairment of earning capacity. See Hunt, supra; Saunders, supra. Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current diagnosis of any bilateral elbow disability and the record does not contain a recent diagnosis of disability prior to the Veteran’s filing of a claim. Therefore, service connection for a bilateral elbow disability is not warranted. 7. Bilateral wrist disability The Veteran contends that he has bilateral wrist disability that is related to his service. However, the STRs are void of findings, complaints, symptoms, or any diagnosis related to a bilateral wrist disability. Post-service, the record does not contain any medical records or evidence of any diagnosed bilateral wrist disability. The Board finds that the claim must be denied. There is no competent medical evidence to show that the Veteran has had any diagnosed bilateral wrist disability since the Veteran’s service. As the competent medical evidence does not show diagnosis of any bilateral wrist disability, service connection is denied. See Brammer, supra; see also McClain, supra; Romanowsky, supra; Saunders, supra. To the extent that the Veteran complaints of bilateral wrist pain, there is no indication that any subjective complaints result in functional impairment of earning capacity. See Hunt, supra; Saunders, supra. Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current diagnosis of any bilateral wrist disability and the record does not contain a recent diagnosis of disability prior to the Veteran’s filing of a claim. Therefore, service connection for a bilateral wrist disability is not warranted. 8. Bilateral hand/finger disability The Veteran contends that he has bilateral hand/finger disability that is related to his service. However, the STRs are void of findings, complaints, symptoms, or any diagnosis related to a bilateral hand or finger disability. Post-service, the record does not contain any medical records or evidence of any diagnosed bilateral hand or finger disability. The Board finds that the claim must be denied. There is no competent medical evidence to show that the Veteran has had any diagnosed bilateral hand or finger disability since the Veteran’s service. As the competent medical evidence does not show diagnosis of any bilateral hand or finger disability, service connection is denied. See Brammer, supra; see also McClain, supra; Romanowsky, supra; Saunders, supra. To the extent that the Veteran complaints of bilateral hand or finger pain, there is no indication that any subjective complaints result in functional impairment of earning capacity. See Hunt, supra; Saunders, supra. Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current diagnosis of any bilateral hand/finger disability and the record does not contain a recent diagnosis of disability prior to the Veteran’s filing of a claim. Therefore, service connection for a bilateral hand/finger disability is not warranted. Additional considerations The Board has taken the contention that the Veteran has bilateral elbow, wrist, and hand/finger disabilities and that his type 2 diabetes mellitus and bilateral leg, foot, shoulder, and knee disabilities were caused by service, seriously. Although the Veteran might believe that he has bilateral elbow, wrist, and hand/finger disabilities and that his type 2 diabetes mellitus and bilateral leg, foot, shoulder, and knee disabilities are related to etiologically related to his service, the Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that he has currently diagnosed bilateral elbow, wrist, and hand/finger disabilities or any evidence that may serve as a medical nexus between the Veteran’s service and his type 2 diabetes mellitus and bilateral leg, foot, shoulder, and knee disabilities. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issues in this case, the existence of currently diagnosed bilateral elbow, wrist, and hand/finger disabilities and the etiology of type 2 diabetes mellitus and bilateral leg, foot, shoulder, and knee disabilities, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In light of the above, the Board finds that the weight of the probative evidence is against a finding that the Veteran has bilateral elbow, wrist, and hand/finger disabilities or type 2 diabetes mellitus and bilateral leg, foot, shoulder, and knee disabilities, that are related to his service. REASONS FOR REMAND Bilateral hearing loss The Veteran contends that he has bilateral hearing loss related to acoustic trauma during service. The STRs include a September 1965 pre-induction examination and September 1967 ETS examination which show non-disabling bilateral hearing loss. On December 2011 VA hearing loss and tinnitus DBQ examination, the Veteran presented with a history of reported military noise exposure from tanks and mortars. After a thorough examination of the Veteran, the examining audiologist opined that the Veteran’s bilateral sensorineural hearing loss was not caused by, or a result of, military noise exposure. In pertinent part, the rationale was that the Veteran’s hearing was normal at induction and separation. On review of the medical opinion, to the extent that the VA audiologist’s opinion is based on the lack of hearing loss during service, including at separation from service, the Board finds that it is flawed because normal hearing upon separation is not necessarily fatal to a claim for service connection for hearing loss or tinnitus. Ledford v. Derwinski, 3 Vet. App. 87 (1992); see also Hensley v. Brown, 5 Vet. App. 155, 159 (1993). In addition, the examination report states that the Veteran’s hearing loss did not pre-exist service. However, the pre-induction report reflects non-disabling hearing loss. Due to the deficiencies in the December 2011medical opinion, an addendum opinion is necessary. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: Provide the claims file to a VA audiologist, other than the December 2011 VA examining audiologist, who should determine whether a new VA examination is warranted in order to provide an opinion. The claims file, including a copy of this remand, must be made available to the examiner for review who should indicate that the claims file was reviewed. The examiner should provide the following opinions: (a) Please opine as to whether there is clear and unmistakable (undebatable) evidence to show that any bilateral hearing loss disability, pre-existed service. (b) If the examiner determines that there is clear and unmistakable evidence that a bilateral hearing loss disability pre-existed service, is there clear and unmistakable evidence that the Veteran’s pre-existing bilateral hearing loss did NOT undergo a worsening in service to a permanent degree beyond that which would be due to the natural progression of the disability? (c) If there is not clear and unmistakable evidence that a pre-existing bilateral hearing loss disability was not worsened beyond its natural progression by service, is it at least as likely as not (i.e., a 50 percent probability or greater) that any bilateral hearing loss disability, diagnosed at any time during the course of the appeal, had its onset in or is etiologically-related to the Veteran’s active duty service, to include acoustic trauma during service? The examiner is asked to consider and discuss as necessary the pertinent evidence of record to include the Veteran’s lay statements and complaints concerning the onset of his hearing loss. The examiner is also advised that the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file. The report of examination should include the complete rationale for all opinions expressed. The phrase “at least as likely as not” does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. If an opinion cannot be rendered without resorting to speculation, the examiner should explain why it would be speculative to respond. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Adams, 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.