Citation Nr: 21001592 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 16-39 091 DATE: January 11, 2021 ORDER Service connection for a low back condition is denied. Service connection for a right ankle condition is denied. Service connection for a left ankle condition is denied. Service connection for bilateral hearing loss is denied. Service connection for hypertension is denied. Service connection for obstructive sleep apnea (OSA), as secondary to the Veteran’s service-connected rhinitis, is denied. FINDINGS OF FACT 1. The weight of the evidence is against finding that the Veteran’s lumbar spine condition had its onset during his active duty service; or was otherwise caused by his active duty service. 2. The weight of the evidence is against finding that the Veteran’s bilateral ankle condition had its onset during his active duty service; or was otherwise caused by his active duty service. 3. The Veteran has not been shown to have hearing loss for VA purposes in either ear. 4. The weight of the evidence is against finding that the Veteran’s hypertension had its onset during his active duty service or within one-year of his separation from the military, and it has not otherwise been related to his service or to a service connected disability by the weight of the evidence. 5. The weight of the evidence is against finding that the Veteran’s OSA had its onset during his active duty service or within one-year of the Veteran’s separation from the military; or that is secondary to his service-connected rhinitis. CONCLUSIONS OF LAW 1. The criteria for service connection for a low back condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right ankle condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a left ankle condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for OSA, as secondary to the Veteran’s service-connected rhinitis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1972 to January 1996. In March 2019, the Veteran testified at a Board hearing held before the undersigned Veterans Law Judge (VLJ). A complete transcript is of record. This appeal was previously before the Board in September 2019. The issues currently on appeal were remanded for further development. The specific remand instructions regarding the respective issues will be addressed in the appropriate section. Service Connection 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). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310 (b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). Service connection may also be granted for chronic disabilities if shown to have been manifested to a compensable degree within one year after the Veteran was separated from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. As an alternative to the nexus requirement, service connection for a chronic disability may be established through a showing of continuity of symptomatology since service. 38 C.F.R. § 3.303 (b). The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Service connection for a low back condition is denied. The Veteran asserts that his active duty service caused his current low back condition. Specifically, he asserts that his MOS as a system organization maintenance technician caused chronic back pain due to heavy lifting and high tempo operations. See Medical Treatment Record received September 1, 2020. This issue was previously before the Board in September 2019. The service connection claim for a back condition was remanded to obtain outstanding VA treatment records from January 1996 to March 2013 and for a VA examination to address the etiology of the Veteran’s back condition. The regional office (RO) requested the treatment records and the Veteran’s outstanding treatment records have been associated with the Veteran’s claims file. The Veteran was also afforded a VA examination in December 2019 and the examiner provided a medical nexus opinion regarding the etiology of the Veteran’s low back condition. As such, the Board finds that there has been substantial compliance with the September 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran’s service treatment records (STRs) show that he complained of back pain. The medical officer indicated that there was no history of trauma, but noted that the Veteran performed some heavy lifting at work. See STR dated November 20, 1975. There were no further complaints of back pain. His 1985 separation examination showed a normal clinical evaluation. See Separation Examination dated September 19, 1995. The Veteran denied having had recurrent back pain on his medical questionnaire and the physician’s summary did not include any remarks about back pain. Id. The Veteran provided testimony regarding his service connection claim for a back condition, stating that he performed heavy lifting as part of an aviation unit. He asserted that it was his belief that his back issues were the result of the type of work that he performed during his active duty service. He testified that he did not have a specific back injury, just that he had back pain that came and went. When asked if the back pain he experienced ever went away, he stated that the pain would come and go, but was more prevalent now. He also testified that he sought treatment for his back, soon after he separated from the military, in April 1996. The Board has reviewed the Veteran’s April 1996 VA treatment record, which he referenced in his testimony, which shows complaints of back pain about three months following his separation from the military. However, the Board does not agree with the Veteran’s characterization of the treatment record. The treatment note states that the Veteran came as a walk-in patient complaining of severe neck pain and numbness or weakness of his legs. There is also a note that states he should follow the exercise hand out, and to use exercises to strengthen his neck. There is no mention of back pain. The Veteran was afforded a VA examination in December 2019. The examiner reported that a 2019 MRI confirmed that the Veteran had spinal stenosis of the lumbar spine. As such, the Board concedes that the Veteran has a current diagnosis for a low back condition. However, after an in-person examination, a review of the Veteran’s claims file, and a review of the September 2019 Board remand directives, the examiner provided a negative nexus opinion. The examiner noted the Veteran’s 1995 separation examination, which showed a normal clinical evaluation and the Veteran’s 1975 report of back pain. The examiner explained that the Veteran had a chronic condition, spinal stenosis of the lumbar spine, but that there were no medical entry notes during his military service that documented any evaluations for low back pain issues or back-related conditions. The examiner reported without any objective medical evidence, they could not state that the Veteran’s current lumbar spine condition was incurred in or was caused by his active duty service training or duties. The Board notes that during the September 2019 Board hearing, the Veteran’s representative stated that they would try and get a medical nexus opinion from the Veteran’s treating physical therapist because he had an upcoming appointment. However, after a careful review of the Veteran’s claims file, there does not appear to be any medical nexus opinions provided by any of the Veteran’s treating medical professionals. To the extent that the Veteran believes that his low back condition is the result of his active duty service, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the Veteran testified that he sought medical treatment for his low back pain within a year of his January 1996 separation from service, a VA examination was ordered to address the medical evidence of record and to provide an etiology opinion. Unfortunately, the December 2019 VA examiner provided a negative nexus opinion. The Board notes that the Veteran has not offered any medical evidence that would undermine the VA examiner’s medical opinion in regard to service connection for a low back condition. Here, there is only one competent medical opinion of record, the December 2019 VA examiner’s opinion that the Veteran’s low back condition is not related to his active duty service. The only opinion of record that the Veteran’s low back condition is due to his active duty service, are lay assertions made by the Veteran. The Board affords the December 2019 VA examiner’s opinion great probative weight because the examiner thoroughly examined the Veteran’s claims file and provided an explanation for their negative nexus opinion. On the other hand, the Board affords no probative weight to the Veteran’s opinion because he is not medically qualified to provide such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To rebut the December 2019 VA examiner, the Veteran must provide a medical opinion from a competent medical professional. The Board acknowledges the Veteran’s sincere belief that his low back condition is a result of his active duty service, to include heavy lifting as part of an aviation unit. The Board recognizes his testimony that he sought medical treatment for his back pain, soon after he separated from the military. The Veteran also provided a collection of medical records that purported to show that service connection for a low back condition is warranted. See Medical Treatment Record received September 1, 2020. The correspondence contained the April 1996 medical treatment record, which he asserted included reports of neck and back pain, his 1975 STR that showed a complaint of back pain, and a written summary of pertinent facts. Id. However, the contemporaneous medical evidence of record does not support his assertion. The April 1996 medical treatment record showed that he only complained of severe neck pain and numbness or weakness in his legs. There was no mention of any back pain. The Board also acknowledges that the Veteran’s updated treatment records from 1996 to 2013 were limited; however, there is no medical evidence showing treatment or complaints of back pain within a year of his separation from the military. Further, the first instance of reported low back pain in his post-service medical records was in 2013, about 17 years after his separation from the military. See VA Treatment Record dated July 22, 2013. The Board also acknowledges the Veteran’s representative has asserted that there has been a showing of a continuity of symptomatology in regard to his low back pain. See Appellate Brief dated November 2, 2020. The Board notes that the Veteran testified at the September 2019 Board hearing that the onset of his back pain was during his active duty service and that his back pain came and went, but was now more prevalent. The Board has considered whether service connection on a presumptive basis is warranted because the Veteran testified that he experienced back pain since his active duty service. 38 C.F.R. § 3.303 (b). However, the Board finds that any continuity was essentially severed based on the Veteran’s 1995 separation examination, where he did not report any recurrent back pain, and his testimony that his back pain came and went over the years, but was more prevalent now. Here, the Veteran has not described a continuity of symptomatology that would warrant service connection on a presumptive basis. The Board is sympathetic to the Veteran’s claim and does not wish to minimize his assertions or beliefs. However, the criteria for service connection have not been met; until a competent positive nexus opinion is associated with the Veteran’s claims file, the Board cannot resolve reasonable doubt in his favor because the weight of the evidence is not in relative equipoise. Accordingly, service connection for a low back condition is denied. 2. Service connection for a bilateral ankle condition is denied. The Veteran asserts that his right and left ankle conditions are due to his active duty service. Specifically, that his ankles sprain easily and that he was fitted for higher boots during his active duty service. The issue of service connection for a bilateral ankle condition was previously before the Board in September 2019. The issues were remanded based on the Veteran’s STRs showing a left ankle sprain and that he was required to wear high-top boots. The VA examiner was asked to diagnose any ankle conditions, and if any were diagnosed, to provide an etiology opinion. The Veteran was afforded a VA examination in December 2019. The Veteran was diagnosed with a bilateral ankle condition and the examiner provided nexus opinions for both ankles. As such, the Board finds that there has been substantial compliance with the September 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran’s STRs show that he suffered from a left ankle sprain while playing basketball. See STR dated May 1981. A follow-up showed that he had tenderness of the left ankle, but had full range of motion. He was advised to wear high topped shoes. His 1985 separation examination showed a normal clinical evaluation. See Separation Examination dated September 19, 1995. The Veteran did not indicate swollen or painful joints or foot trouble on his medical questionnaire and the physician’s summary did not include any remarks about ankle problems. Id. The Veteran provided testimony regarding his service connection claim for a bilateral ankle condition. He testified that he sprained his ankles easily during active duty service and was fitted for higher boots that provided stability for his ankles. The Veteran provided a written summary of his bilateral ankle medical history and included the pertinent STRs. See Medical Treatment Record received September 1, 2020. The Veteran stated that a March 1973 STR stated that he had bilateral ankle sprains and was prescribed high-top boots; two May 1981 entries reporting a left ankle sprain; and an October 1984 entry reporting a right calf injury, affecting his right ankle. The Board agrees that the March 1973 STR entry shows that the Veteran was advised to wear high-top boots due to a history of an ankle sprain. However, it does not state that he had a history of ankle sprains in both of his ankles, as the Veteran asserts. The Board notes that the entry is not entirely legible, but notes that the medical officer wrote “sprained ankle.” There is no “s” at the end of ankle, and there is no indication of which ankle, so it cannot be concluded that the medical officer meant both of his ankles. The Board also concedes that the Veteran sprained his left ankle in 1981. Regarding the 1984 right calf injury, the STR entry did note a right calf injury, and although not entirely legible, appears to state that it caused ankle laxity difficulty. The Veteran was afforded a VA examination for his ankles in December 2019. He was diagnosed with bilateral lateral collateral ligament sprain. As such, the Board concedes that the Veteran has a current diagnosis for a bilateral ankle condition. However, after an in-person examination and a review of the Veteran’s claims file, the VA examiner provided a negative nexus opinion for both ankles. Regarding the left ankle, the examiner reported that the Veteran had one medical entry note documenting a left ankle injury in 1981, but had no other ankle evaluations and no mention of a left ankle condition at his separation examination. The examiner reported that they could not state that one incident in 1981 is the culprit of his current left ankle condition. Regarding the right ankle, the examiner pointed out that there were no medical records documenting any injury or evaluation for a right ankle injury or condition. Without any objective medical evidence showing an in-service right ankle injury, it was less likely than not due to his military service. To the extent that the Veteran believes that his bilateral ankle condition is the result of his active duty service, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the Veteran’s STRs showed an in-service left ankle sprain and that he was prescribed high-top boots, a VA examination was ordered to diagnose any ankle conditions and if any were diagnosed, an etiology opinion. Unfortunately, the December 2019 VA examiner provided a negative nexus opinion for the Veteran’s right and left ankles. The Board notes that the Veteran has not offered any medical evidence that would undermine the VA examiner’s medical opinion in regard to service connection for a bilateral ankle condition. Here, there the only competent medical opinions of record have been provided by the December 2019 VA examiner. The examiner provided a negative nexus opinion that the Veteran’s bilateral ankle condition is not related to his active duty service. The only opinion of record that the Veteran’s bilateral ankle condition is due to his active duty service, are lay assertions made by the Veteran. The Board affords the December 2019 VA examiner’s opinion great probative weight because the examiner thoroughly examined the Veteran’s claims file and provided an explanation for their negative nexus opinion. On the other hand, the Board affords no probative weight to the Veteran’s opinion because he is not medically qualified (by training or experience) to provide an etiology opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To rebut the December 2019 VA examiner, the Veteran must provide a medical opinion from a competent medical professional. The Board acknowledges the Veteran’s sincere belief that his bilateral ankle condition is a result of his active duty service because they sprained easily and was prescribed high-top boots to stabilize his ankles. The Board recognizes that the Veteran provided a collection of STRs that purported to show that service connection for a bilateral ankle condition is warranted. See Medical Treatment Record received September 1, 2020. The correspondence contained the March 1973, May 1981, and October 1984 STR entries regarding his ankles. However, the STRs only show that he had a left ankle injury. Although the October 1984 STR entry shows that a right calf injury caused difficulty with ankle laxity, the medical records nonetheless show that his right ankle was never injured. Further, after the October 1984 note of difficulty with ankle laxity, there was no mention of right ankle problems. For example, at the 1995 separation examination, the Veteran did not report any problems with his ankles. The Board also notes that the Veteran’s updated treatment records from 1996 to 2013 did not include any information regarding complaints of pain or treatment of either ankle. The first instance of reputed ankle pain was in 2013. See VA Treatment Record dated July 26, 2013. Here, the Board recognizes that the Veteran has testified that his ankles were easily sprained during his active duty service and that he was prescribed high-top boots for his ankle stability. The Board notes that the contemporaneous evidence of record supports his assertion that he was prescribed high-top boots, as his STRs show that high-top boots were recommended. See STR dated March 2, 1973. However, the Veteran’s STRs only contained one entry noting an ankle sprain, to his left ankle in 1981. There were no further reports of left ankle sprains and there were no reports of any right ankle sprains. There was a 1984 note that reported that right calf trauma caused difficulty with ankle laxity; however, there was no further indication that his right ankle had any laxity problems after the 1984 report of a right calf injury. Here, the Veteran’s testimony that his ankles were easily sprained are not supported by the contemporaneous evidence of record because there was only one report of any ankle sprains during the Veteran’s active duty service, which lasted 24 years. The December 2019 VA examiner was able to review the medical evidence of record and the examiner noted the Veteran’s report of needing high-top boots in the evidence review section of the medical opinion report. However, even after reviewing the remand directives and the medical evidence of record, the examiner nonetheless provided a negative nexus opinion. The Board also notes that neither the Veteran nor his representative has asserted that the December 2019 medical opinion was inadequate or insufficient in any way. See Appellate Brief dated November 2, 2020. The Board also acknowledges the Veteran’s representative has asserted that there has been a showing of a continuity of symptomatology in regard to his bilateral ankle pain. Id. The Board notes that the Veteran testified at the September 2019 Board hearing that he sprained his ankles easily and that after he separated from the military, he used hot/cold compresses and elevation to self-treat his ankle pain. The Board has considered whether service connection on a presumptive basis is warranted. 38 C.F.R. § 3.303 (b). However, the Veteran’s diagnosed condition of lateral collateral ligament sprain is not considered a chronic disease. Id. Further, the Veteran has not described a continuity of symptomatology. As such, the Board finds that service connection on a presumptive basis is not warranted. The Board is sympathetic to the Veteran’s claim and does not wish to minimize his assertions or beliefs. However, the criteria for service connection have not been met; until a competent positive nexus opinion is associated with the Veteran’s claims file, the Board cannot resolve reasonable doubt in his favor because the weight of the evidence is not in relative equipoise. Accordingly, service connection for a bilateral ankle condition is denied. 3. Service connection for bilateral hearing loss is denied. The Veteran asserts that he was exposed to hazardous acoustic trauma as a maintenance craft technician. The Board notes that the Veteran’s MOS was system organization maintenance technician and he testified that he worked around jets. As such, the Board concedes that the Veteran was exposed to military acoustic trauma. This issue was previously before the Board in September 2019. The Board found that a private medical treatment record from April 2019 showed decreased hearing acuity. The service connection claim for bilateral hearing loss was remanded for a VA examination to assess whether the Veteran’s bilateral hearing loss was the result of his military noise exposure. The Veteran was afforded a VA examination in December 2019, which addressed whether he had hearing loss for VA purposes and the etiology of his hearing loss. As such, the Board finds that there has been substantial compliance with the September 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). For the purposes of applying the laws administered by VA, impaired hearing will be considered a disability 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 provisions of 38 C.F.R. § 3.385 do not require that hearing loss be shown as defined in that regulation at the time of separation from service, if there is sufficient evidence to demonstrate a relationship between a veteran’s service and his current disability. Hensley v. Brown, 5 Vet. App. 155 (1993). VA regulations do not require hearing loss for VA purposes to be present during service. Rather, hearing loss, if sensorineural in nature, is a “chronic disease” listed under 38 C.F.R. § 3.309 (a); therefore, 38 C.F.R. § 3.303 (b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease shown in service or within the presumptive period, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. The Veteran’s STRs show that he had normal hearing sensitivity at his May 1972 entrance examination and at the September 1995 separation examinations. The Veteran also had numerous other audiometric examinations throughout his military service, and all showed results within normal limits. The Veteran’s September 1995 puretone thresholds in decibels are as follows: Hertz 500 1000 2000 3000 4000 R. Ear 25 25 25 25 10 L. Ear 20 20 5 10 10 The Veteran was afforded a VA examination in March 2013. The Veteran’s puretone thresholds in decibels are as follows: Hertz 500 1000 2000 3000 4000 R. Ear 25 25 25 25 20 L. Ear 25 20 25 20 15 The Veteran’s speech discrimination test (Maryland CNC), showed 94 percent in both ears. The Veteran was seen for an audiological re-evaluation in April 2018. Results in puretone thresholds were not provided, but both of his hears showed normal hearing in the 250-6000 Hz, dipping to a mild sensorineural hearing loss at 8000 Hz. His word discrimination was 94 percent in both ears. The Veteran provided a private audiometric examination from April 2019. The Board notes that the audiogram was represented in graphical form; however, the Board, as the finder of fact, may interpret a graphical audiogram. See Kelly v. Brown, 7 Vet. App. 471 (1995). The Veteran’s puretone thresholds in decibels are as follows: Hertz 500 1000 2000 3000 4000 R. Ear 25 35 40 40 45 L. Ear 30 40 45 45 50 The Veteran’s speech discrimination test (Maryland CNC), showed 92 percent in both ears. The Veteran was afforded a VA examination in December 2019. The Veteran’s puretone thresholds in decibels are as follows: Hertz 500 1000 2000 3000 4000 R. Ear 20 25 20 25 25 L. Ear 25 25 20 15 20 The Veteran’s speech discrimination test (Maryland CNC), showed 96 percent in both ears. The examiner indicated that there was no permanent positive threshold shift greater than normal measurement variability at any frequency between 500 and 6000 Hz in either ear. The examiner explained that the Veteran’s entrance examination showed mild hearing loss at 500 Hz for both ears, but normal hearing sensitivity at 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz bilaterally. The examiner also reported that hearing examinations in 1985, 1987, 1988, 1990, 1991, 1994, 1995, and 2013 showed normal hearing sensitivity at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz bilaterally. The examiner did note a 15 dB decrease noted at 6000 Hz at the 1995 examination, when compared to the 1972 audiogram. The examiner also noted an April 2018 VA audiometric examination which showed normal hearing in the 250-6000 Hz, with mild hearing loss at 8000 Hz. The examiner reported that the 2019 hearing examination agrees with the results of the March 2013 VA examination and the VA audiological examination in 2018 and concluded that the Veteran did not have hearing loss for VA purposes. Although the examiner did not address the April 2019 private audiometric examination, which showed hearing loss for VA purposes, the examiner explained that given the hearing tests on file with stable thresholds and today’s testing with borderline normal hearing, similar to the test from the 2013 VA examination, his hearing loss is less likely caused by military noise exposure. A private audiological examination from April 2019 showed hearing loss for VA purposes. However, the Board finds these results represent an anomaly in an otherwise consistent record. The Board has the responsibility to interpret medical examinations in light of the entirety of the record, and to reconcile various examinations into a consistent disability picture. 38 C.F.R. § 4.2. As such, in light of the fact that every other examination of record has not shown hearing loss for VA purposes, the Board finds that the entirety of the record supports finding that the Veteran does not have hearing loss for VA purposes. Further, the December 2019 VA examiner explained that the 2019 hearing examination agrees with the results of the March 2013 VA examination and the VA audiological examination in 2018. Here, the Board is satisfied that the December 2019 VA audiometric results are accurate and consistent with the previous audiometric examinations of record. Here, the Board finds that service connection for bilateral hearing loss is not warranted. Based on the VA audiology tests of record, the Veteran does not have hearing loss for VA purposes because his puretone thresholds are all less than 40 decibels, he does not have at least three of the frequencies at 26 decibels or greater, and his speech recognition scores was 96 percent in both ears at the most recent examination. Further, even if the Board were to accept the findings of the private April 2019 audiological examination and find that the Veteran has hearing loss for VA purposes, there has been no competent medical evidence suggesting the Veteran’s hearing loss is a result of his active duty service. The Board acknowledges the Veteran’s complaints of hearing loss and his exposure to hazardous military noise in service. The Board also acknowledges the assertion that the Veteran’s wife noticed the Veteran’s decreased hearing during his active duty service. He and his wife are considered competent to describe their perception of diminished hearing acuity because lay testimony is competent to establish the presence of observable symptomatology and may provide sufficient support for a claim of service connection. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, even to the extent the Veteran and his wife would be competent to report diminished hearing acuity, they would not be competent to diagnose hearing loss for VA purposes, as such a determination would require both objective audiometric and speech recognition testing, which the Veteran could not perform on himself. Thus, the Board must rely on the objective clinical testing and medical opinion of record, which shows that the Veteran does not have hearing loss for VA purposes and that any hearing loss he does have was less likely than not caused by military noise exposure. Here, the competent evidence does not show hearing loss for VA purposes and service connection is not warranted. Accordingly, service connection for bilateral hearing loss is denied. 4. Service connection for hypertension is denied. The Veteran asserts that he had high blood pressure during his active duty service and was prescribed medication soon after separating from the military. This issue was previously before the Board in September 2019. The service connection claim for hypertension was remanded to obtain outstanding VA treatment records from January 1996 to March 2013 and for a VA examination to address the etiology of the Veteran’s hypertension. The RO requested the treatment records and the Veteran’s outstanding treatment records have been associated with the Veteran’s claims file. The Veteran was also afforded a VA examination in December 2019 and the examiner provided a medical nexus opinion regarding the etiology of the Veteran’s hypertension. As such, the Board finds that there has been substantial compliance with the September 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran’s STRs show the following blood pressure readings: 130/79 in October 1991, 114/78 in January 1992, 108/68 in February 1993, 140/87 in March 1992, and 120/86 in September 1995, at his separation examination. The Veteran testified that he applied for and was denied service connection for hypertension in 1996, soon after he separated from the military. He testified that he was informed of elevated blood pressure readings in-service and informed he had hypertension prior to separation from service. He also testified that he was first prescribed medication for blood pressure, at some point in 1996 and has been on it ever since. The Veteran was afforded a VA examination in December 2019. The examiner noted that the Veteran was currently diagnosed with hypertension and had been prescribed continuous medication for hypertension. The Veteran’s blood pressure was not taken during this examination, but the examiner noted that the Veteran did not have a history of diastolic blood pressure, predominantly 100 or more. After an in-person examination and a review of the Veteran’s claims file, the examiner provided a negative nexus opinion. The examiner acknowledged that the Veteran had an elevated blood pressure reading (135/95) at a May 1996 VA examination; however, one elevated blood pressure reading does not qualify for a diagnosis of hypertension. The examiner explained that there were no medical record entries noted during his active duty service for evaluation of elevated blood pressure issues, nor symptoms that would suggest blood pressure issues. For those reasons, the examiner could not conclude that the currently diagnosed hypertension began during service or was related to military service. The Board has reviewed the updated VA treatment records, which includes treatment records from 1996. His blood pressure was noted to be 132/74 in April 1996, 118/72 in May 1996, and 126/88 in August 1996. His medications were listed in the April and August 1996 treatment notes, however, neither appear to show medication for high blood pressure. It appears he was taking INH and pyridoxine (Vitamin B6) in August 1996. The Veteran has asserted that he had hypertension prior to his separation from service and was taking medication for hypertension within a year of his separation. However, the medical evidence of record does not support his assertion. His STRs show that he had normal blood pressure readings throughout his active duty service. The medical evidence, to include the updated treatment records from 1996, show that he also had normal readings and do not appear to show that he was taking medication for hypertension. To the extent that he does believe that his hypertension is the result of his military service, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here, VA provided the Veteran with an examination, but the examiner unfortunately provided a negative nexus opinion. The Board notes that the Veteran has not offered any medical evidence to refute the VA examiner’s medical opinion. Here, there is only one competent medical opinion of record, the December 2019 VA examiner’s opinion that the onset of the Veteran’s hypertension was not within a year of separation from service and was not otherwise related to his active duty service. The only opinion of record that the onset of the Veteran’s hypertension was during his active duty service, are lay assertions made by the Veteran. The Board affords the December 2019 VA examiner’s opinion great probative weight because the examiner thoroughly examined the Veteran’s claims file and provided an explanation for their negative nexus opinion. On the other hand, the Board affords no probative weight to the Veteran’s opinion because he is not medically qualified to provide such an opinion; he cannot determine when he was diagnosed with hypertension. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To rebut the December 2019 VA examiner, the Veteran must provide a medical opinion from a competent medical professional. The Board acknowledges that hypertension is a disease subject to presumptive service connection. 38 C.F.R. § 3.303 (b). The Veteran’s representative has asserted that the Veteran’s hypertension manifested itself within a year of service and is currently diagnosed with the same condition. See Appellate Brief dated November 2, 2020. The Board notes that the Veteran testified at the September 2019 Board hearing that he was informed of elevated blood pressure readings in-service and informed he had hypertension prior to separation from service. However, as explained, the contemporaneous medical evidence of record does not support his testimony. Here, the Veteran has not established the criteria for service connection on a presumptive basis. The Board also acknowledges the Veteran’s written correspondence, with pertinent STRs regarding his hypertension. The Veteran listed his blood pressure readings from 1984-1995, yet all showed normal hypertension results. The Veteran also listed his prescribed medications for hypertension, but the medical records do not show that he was prescribed the medications during his active duty service, or within a year of his separation from the military. The Board is sympathetic to the Veteran’s claim and does not wish to minimize his assertions or beliefs. However, the criteria for service connection have not been met; until a competent positive nexus opinion is associated with the Veteran’s claims file, or he can show medical evidence of a diagnosis for hypertension or the prescription of continuous for control of hypertension within a year of separation from the military; the Board cannot resolve reasonable doubt in his favor because the weight of the evidence is not in relative equipoise. Accordingly, service connection for hypertension is denied. 5. Service connection for OSA, as secondary to the Veteran’s service-connected rhinitis, is denied. The Veteran asserts that his sleep apnea is secondary to perennial rhinitis, for which he is service connected for. The Veteran’s STRs shows no evidence that he complained of sleep issues or was diagnosed with any sleep disorders. For example, he specifically denied frequent trouble sleeping in his medical questionnaire that was in conjunction with his 1995 separation examination. Further, the medical officer who conducted his separation examination only noted cramps in his calves and sea sickness as active problems at the time of separation. The Board notes that the Veteran was diagnosed with moderate OSA after completing a sleep study. See VA Treatment Record Dated May 14, 2019. As such, the Board concedes that here is a current diagnosis. The Veteran was afforded a VA examination in December 2019 to address the etiology of his OSA. Regarding direct service connection, the examiner provided a negative nexus opinion. After reviewing the Veteran’s in-service and post-service medical records, there was no evidence to support that his currently diagnosed OSA was incurred in or caused by issues during his active duty service. Regarding secondary service connection, the examiner provided a negative nexus opinion. After reviewing the Veteran’s in-service and post-service medical records, the examiner acknowledged that the Veteran has upper respiratory infections (URIs), but reported that this is not enough evidence to suggest that the URI symptoms aggravated the Veteran’s service-connected rhinitis. The Veteran’s representative has asserted that OSA is a disability subject to presumptive service connection. 38 C.F.R. § 3.303 (b). However, the Board notes that OSA is not considered to be a chronic disability under 38 C.F.R. § 3.303 (b). As such, service connection of a presumptive basis for OSA is not warranted. To the extent that the Veteran believes that his OSA is secondary to his service-connected rhinitis, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the Veteran’s 2019 sleep study showed a diagnosis for OSA, a VA examination was ordered to address the medical evidence of record and to provide an etiology opinion. Unfortunately, the December 2019 VA examiner provided a negative nexus opinion. The Board notes that the Veteran has not offered any medical evidence that would undermine the VA examiner’s medical opinion in regard to service connection for OSA. Here, there is only one competent medical opinion of record, the December 2019 VA examiner’s opinion that the Veteran’s OSA is not related to his service-connected rhinitis. The only opinion of record that the Veteran’s OSA is secondary to his service-connected rhinitis, are lay assertions made by the Veteran. The Board affords the December 2019 VA examiner’s opinion great probative weight because the examiner thoroughly examined the Veteran’s claims file and provided an explanation for their negative nexus opinion. On the other hand, the Board affords no probative weight to the Veteran’s opinion because he is not medically qualified to provide such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To rebut the December 2019 VA examiner, the Veteran must provide a medical opinion from a competent medical professional. The Board is sympathetic to the Veteran’s claim and does not wish to minimize his assertions or beliefs. However, the criteria for service connection have not been met; until a competent positive nexus opinion is associated with the Veteran’s claims file, the Board cannot resolve reasonable doubt in his favor because the weight of the evidence is not in relative equipoise. Accordingly, service connection for OSA, as secondary to the Veteran’s service-connected rhinitis, is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, 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.