Citation Nr: 21061351 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 16-12 408A DATE: October 1, 2021 ORDER Entitlement to a compensable rating for dermatitis is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety and depression is denied. FINDINGS OF FACT 1. During the appellate period, the Veteran's service-connected dermatitis was not manifested by at least 5 percent, but less than 20 percent, of the entire body, or; at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period; or characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period; or disfigurement of the head, face, or neck, or scars. 2. Bilateral hearing loss was not present in service, did not manifest to a compensable disabling degree within the first year after discharge from service, and is not otherwise shown to be causally related to his service 3. A psychiatric disability did not originate in service or within a year of discharge; and the preponderance of the evidence does not establish that a present psychiatric disability is etiologically related to service or a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for service-connected dermatitis have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.400, 4.3, 4.7, 4.21, 4.118, DC 7806. 2. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.385. 3. The criteria for service connection for an acquired psychiatric disorder, to include anxiety and depression have not been met. 38 U.S.C. §§ 1111, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1974 to February 1981. These matters are before the Board of Veterans' Appeals (Board) following November 2018 and April 2021 Board remands. This matter was originally on appeal from a May 2014 rating decision. A February 2016 rating decision proposed to sever service connection for dermatitis. The Veteran has disagreed with the proposal. To date, a severance has not been implemented to date, and therefore, consideration of the propriety of any severance now would be premature. That matter is not before the Board; the matter of the initial rating for dermatitis remains before the Board. Initial Rating Disability ratings are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a reasonable doubt as to the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. 38 C.F.R. § 4.21. Where the appeal concerns the initial rating assigned a service-connected disability, as is the case for the Veteran's service-connected hypertension, VA assesses the level of disability from the effective date of service connection. See Fenderson v. West, 12 Vet. App. 119, 125 (1999); 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Where the appeal concerns the rating already in place, as is the case for the Veteran's service-connected bilateral loss, status-post fracture, left little finger, and eczema, the relevant temporal focus is from the time period one year before the claim was filed; in this case, August 13, 2014, one year prior to the Veteran's August 13, 2015, claim, until VA makes a final decision on the claim. See Hart v. Mansfield, 21 Vet. App. 505 (2007); 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2). Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. Hart, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. 119, 126 (1999). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). The Appellant bears the burden of presenting and supporting a claim for benefits. 38 U.S.C. § 5107 (a). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board has considered the Veteran's claims and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record. 1. Entitlement to a compensable rating for dermatitis Prior to August 13, 2018, under DC 7806, a noncompensable rating is assigned for less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and no more than topical therapy required during the past 12 months. A 10 percent rating is assigned for at least 5 percent, but less than 20 percent, of the entire body, or; at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is assigned for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past 12-month period. A 60 percent rating is assigned for more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, DC 7806. For claims filed prior to August 13, 2018, the United States Court of Appeals for Veterans Claims (Court) held that a systematic therapy is one that that affects the entire body in its treatment of the condition at issue, and that the Board must determine: (1) whether a topical treatment affects the body as a whole in treating a Veteran's skin condition; and (2) whether the given treatment is "like" a corticosteroid or other immunosuppressive drug." Burton v. Wilkie, 30 Vet. App. 286 (2018). Only the second question need be addressed if the treatment is clearly systemic. Id. Effective August 31, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118 (a). Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to DCs 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7803, 7804, or 7805). 38 C.F.R. § 4.118, General Rating for the Skin for DCs 7806, 7809, 7813-7816, 7820-7822, and 7824. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g); VAOPGCPREC 3-2000. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003. If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's claim under both the old and new rating criteria, and the criteria that is more favorable to the Veteran will be applied. The Veteran's service treatment records (STRs) show a September 1977 report of heat rash on wrists and a May 1979 report of lesions on testes, thigh, and leg, in addition to papular, non-erythematous lesions. In April 2014, the Veteran was afforded a VA examination for his skin condition. The examination notes the Veteran was diagnosed with dermatitis in 1980. The examiner noted the Veteran reported that his skin allergy began after service. He also reported that he has been under multiple treatment but has never been told the cause and that the same itching continues. Reported contaminants were degreaser, diesel, motor oil, and gasoline. The examiner noted the Veteran has used antihistamines for less than six weeks in the past 12 months and has not had any treatments or procedures other than systemic or topical medications in the past 12 months. The examiner noted the Veteran's dermatitis was not visible on any area of the body. A September 2014 VA examiner noted the evidence found on Veteran's STRs are from April and May 1979 where he was evaluated at sick call due to old bug bites in his right leg, and then another visit from September 26, 1977, where he was diagnosed with a "heat rash" in his waistline. Noting that both episodes are not permanent conditions and in his January 1978 re-enlistment exam there is no skin complaints, or any skin lesions found on examination. A March 2018 VA treatment note indicates examination of the Veteran's skin was negative. However, the Veteran reported a history of tinea unguium consulted to dermatology clinic for evaluation of "intermittent and diffuse plaque like dark lesions over arms and legs since last 5-10 years." The examiner noted on examination the Veteran complained of rash on groin and right large toenail fungus and stated he was not aware of plaques on arms and legs. The examiner noted the Veteran was recently prescribed 60-day course of oral Terbinafine 250 mg daily which he continues to take and has clotrimazole solution he applies to toenails. The Veteran stated the groin rash itches to the point that it causes burning at times. The examiner noted the Veteran's skin was dry in general, the Veteran had some scattered warty brown and black papules on his face, oval hyperpigmented patch on left ventral forearm, demarcated hyperpigmented patch bilateral inguinal area on his groin, few excoriations on lower extremities, right foot first and fourth toenail discolored and thickened. The examiner noted "tinea unguium, tinea cruris, xerosis, seb keratosis." The Veteran was afforded a new examination in May 2021 following the April 2021 Board remand. The examiner noted diagnoses of dermatitis and tinea unguium. In regard to the Veteran's dermatitis, the examiner noted the Veteran referred to having dermatitis problems since the 1980s approximately. It was evaluated multiple times with treatment without improvement. The identified areas are feet, genitals, scalp, hands, and other areas of the body. The Veteran described having an allergic rash mostly in the area of the feet and genitalia, sometimes his toenails have become dark almost black during episodes of rash on his feet. The examiner noted treatment was antihistamines, steroid creams, and moisturizers. Further noting the skin lesions may occur at any time without prior exposure, not related to temperature, humidity, or seasons, it currently refers to having a mild to moderate rash on the feet and genital area. The examiner noted the medical record is consistent with history of tinea unguium, tinea cruris, xerosis, seb keratosis; treated with clotrimazole, cetirizine, min oil/petro cream and terbinafine. Additionally, medical reports are consistent with a mild, recurrent condition that partially responds to treatment. The examiner indicated the Veteran's course of condition since onset has stayed the same. The examiner noted the Veteran has not had any treatments or procedures other than systemic or topical medications in the past 12 months for any skin condition. The examiner did not note the Veteran's visible characteristic lesions due to dermatitis. However, the examiner noted visible characteristics of less than five percent of his total body for a diagnosis of tinea cruris and tinea unguium. The examiner also noted there was no current diagnosis of seborrheic keratosis warranted, no signs observable on tele-C&P exam. The examiner stated the Veteran described recurrent episodes with rash on genital area, feet, and scalp, stating that it does not have a pattern that can be described, it is not related to temperatures, times of year or activities. According to the Veteran's description the condition has affected his groin area, large toe, and a small area of the scalp sometimes, a total maximum area less than five percent is estimated. The examiner noted the combined skin conditions only affected four percent of the total body. The examiner also noted there is no objective clinical evidence to support a relationship between tinea and dermatitis. Tinea unguium is produced by a fungus that affects the nails. Also noting, as the dermatitis is presently asymptomatic, there is no mechanism by which tinea could be due to or otherwise be related to asymptomatic dermatitis. Although VA treatment records indicate the Veteran has either been prescribed or uses over-the-counter topical medications, which may be a corticosteroid, there is no medical evidence that treatment with such amounts to systemic therapy. The VA examiner declined to describe the Veteran's treatment as systemic corticosteroids or other immunosuppressive medications, there were no systemic manifestations, and the May 2021 VA examiner noted the Veteran has not been treated with medication in the past 12 months for any skin condition as opposed to noting corticosteroids or other immunosuppressive medications. The April 2014 examiner noted the Veteran had used antihistamines for less than six weeks in the past 12 months. There is no indication or assertion from the Veteran in the record of side effects or symptoms affecting a large area of the body as a result of the Veteran's medications; and there is no persuasive indication that these medications are like or similar to systemic corticosteroids or other immunosuppressive drugs. See Warren v. McDonald, 28 Vet. App. 194, 197 (2016). Based on the forgoing, the Board concludes that there is no evidence that the Veteran's service-connected dermatitis or any other skin condition has been manifested by at least 5 percent, but less than 20 percent, of the entire body, or; at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period; or characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period; or disfigurement of the head, face, or neck, or scars, as is required for a compensable rating. 38 C.F.R. § 4.118, DC 7806. The Board finds that a compensable rating for the Veteran's dermatitis is not warranted under both previous Diagnostic Code 7806 criteria, and the new General Rating Formula for Skin. In both VA examinations, the Veteran's dermatitis covered less than 5 percent of either the total or exposed body area. Further, there is no evidence of record to indicate the Veteran's skin condition covered at least five percent of either the total or exposed body area. Therefore, a compensable rating for dermatitis is not warranted under either rating formula. In sum, the Board has considered whether a higher rating might be warranted for any period of time during the pendency of this appeal. However, the Board finds that the evidence of record demonstrates that during the entire appellate period, the Veteran's service-connected dermatitis does not warrant an initial compensable rating. The Board also finds a compensable rating for the Veteran's skin condition is not warranted under other diagnostic codes as the Veteran has not alleged that he has scarring and physical examination has revealed no scarring. 38 C.F.R. § 4.118, DCs 7800-7805. The Veteran's dermatitis does not cause burn or disfigurement to the head, face, or neck to warrant a rating under Diagnostic Code 7800. Therefore, a higher rating is not warranted under DCs 7800 through 7805. Further the evidence of record is silent to presence of erythroderma. As such, the Veteran is not entitled to a higher rating under Diagnostic Code 7817. Thus, the Board finds that the Veteran's symptoms most closely approximate a noncompensable rating throughout the appeal period under the pertinent diagnostic criteria. As the preponderance of the evidence is against the Veteran's claim, the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. 49 (1990). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) incurrence or aggravation of a disease or injury in service; 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). Certain chronic diseases may be presumed to be service connected if they become manifested to a compensable degree of 10 percent within a specified period of time following separation from service (one year for arthritis). Such disease shall be presumed to have been incurred in service, even though there 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. For the chronic diseases listed in 38 C.F.R. § 3.309(a) service connection may be established by showing continuity. See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). For VA purposes, hearing impairment is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. 2. Entitlement to service connection for bilateral hearing loss The Veteran contends that service connection is warranted for bilateral hearing loss, incurred as a result of his service. The Veteran's service records show his military occupational specialty (MOS) was an electronic equipment repairman and include a certificate for completing a course as an anti-tank assault man from infantry training school. Therefore, in-service noise exposure is conceded. The Veteran's STRs include a July 1974 Report of Medical Examination audiometric test revealing the Veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 20 15 X 5 LEFT 20 20 15 X 5 A January 1978 Report of Medical Examination audiometric test revealing the Veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 5 5 0 LEFT 25 15 5 5 0 A January 1981 Report of Medical Examination indicate the examiner found the Veteran's ears to be normal. The Veteran's STRs do not indicate the Veteran complained of hearing loss in service. A February 2014 treatment note indicated the Veteran's ear exam was negative. In April 2014 the Veteran was afforded a VA examination. The audiometric testing revealed that the Veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 25 30 25 30 LEFT 15 20 25 45 40 The examiner opined that the Veteran's hearing loss was less likely than not caused by or a result of an event in military service. The examiner stated at separation the hearing test performed was a whispered voice test. A normal whisper test excludes the presence of significant hearing deficit affecting communication. Service records show no evidence of complaints of hearing loss while in active service, or after release of active service. VA medical files are silent as to evidence of any audiological treatment/care for hearing loss while inactive service nor after release of active service. Additionally noting, current test results show mild right ear hearing loss, and mild to moderate for the left ear. It is well established in the medical literature that exposure to high levels of noise causes either immediate hearing loss, such as in cases of noise/acoustic trauma, or progressive hearing deficits during prolonged periods of exposure during military service, but retroactive hearing effect is not expected 33 years after being exposed to military noise. Therefore, it is my opinion that the claimed hearing loss condition is less likely as not caused by noise exposure or acoustic trauma during military service. The April 2021 Board remand directed the AOJ to afford the Veteran a new VA examination because the April 2014 VA examiner's opinion was found to be inadequate. In June 2021 the Veteran was afforded a new VA examination. The audiometric testing revealed that the Veteran's pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 30 35 35 35 LEFT 20 20 35 50 55 The examiner opined that the claimed hearing loss condition is less likely as not caused by noise exposure or acoustic trauma during military service. The Veteran served in the Marine Corps with an MOS as Electronic Equipment Repair from 1974 to 1981. He reported hazardous noise exposure from weapons and machinery related to electronic equipment repair. Service treatment records document normal hearing sensitivity upon enlistment/separation and are negative for significant shifts in thresholds during service. Although noise exposure is conceded and the relationship between noise, auditory damage and hearing loss is well documented; auditory damage and hearing loss are not conceded based on noise alone; therefore, a nexus is not established. In addition to the aforementioned, his allegations were contradictory and unclear. His hearing loss is more related to presbycusis and post service occupation. The examiner noted the Veteran's post-service military noise exposure was work as an electronic equipment repair technician until 2008. The examiner stated the Veteran reported in-service hazardous noise exposure from weapons and machinery related to electronic equipment repair. Service treatment records document normal hearing sensitivity upon enlistment/separation and are negative for significant shifts in thresholds during service. Although noise exposure is conceded and the relationship between noise, auditory damage and hearing loss is well documented; auditory damage and hearing loss are not conceded based on noise alone; therefore, a nexus is not established. Further stating, in addition to that, his allegations were contradictory and unclear. Additionally, the examiner stated the Veteran's hearing loss is more related to presbycusis and post service occupation. The examiner stated presbycusis is well known to be the most common cause of hearing loss in adults more than 65 years old (he is 67 years). He also has a positive history noise exposure related to post service which is concomitant, and both are considered to have 50 percent or more probability to be the cause of his hearing loss. Further noting, his lay evidence was contradictory and unclear about the existence of hearing loss (consistent with declined amplification) and laterality of tinnitus. Here, the June 2021 medical opinion of record constitutes probative evidence weighing against a link between the Veteran's bilateral hearing loss and his military service, as the opinion represents the conclusion of a medical professional with sufficient expertise, is based on the Veteran's medical history, and is support by a clear explanation sufficient for the Board to make an informed decision. Notably, the Veteran has not provided any competent medical evidence or opinion to the contrary or identified evidence that diminishes the probative value of the VA opinions against the claim. Wray v. Brown, 7 Vet. App. 488, 492-93 (1995). The Board finds that although the Veteran asserted that his hearing loss is due to service, he is not competent to make that conclusion. Although lay persons are competent to attest to symptoms experienced first-hand, the issue of whether bilateral hearing loss diagnosed nearly 33 years after separation is related to service, falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board accords significantly more weight to the medical evidence than to lay assertions. Even considering the lay statements with regard to the matters they are competent to address, the most probative evidence weighs against the claim of entitlement to service connection for hearing loss. Therefore, the Board finds that the medical evidence of record is more persuasive because of the training, experience, and rationales provided by the examiner. The Board has also considered presumptive service connection under 38 C.F.R. § 3.309(a) for bilateral hearing loss and service connection based on a continuity of symptomatology under 38 C.F.R. § 3.303(b). However, the probative evidence does not indicate that the disability manifested within a year of separation of service or that it occurred continuously since discharge from service. The Veteran's service treatment records are silent for any diagnoses of, complaints of, or treatment for hearing loss. The June 2021 VA examiner noted the Veteran's treatment records are negative for significant shifts in thresholds during service. Based on the record, there is no indication that the Veteran had hearing loss during service or within a year of his separation from service in 1981. Given that it was over 30 years after service before the Veteran presented with hearing complaints, presumptive service connection and service connection based on continuity of symptomatology are not warranted. 3. Entitlement to service connection for an acquired psychiatric disability, to include anxiety and depression The Veteran contends that he has a current acquired psychiatric disability, to include anxiety and depression that is related to service. The Veteran's STRs do not show treatment for a psychiatric disability during service. The Veteran's January 1978 Report of Medical Examination indicates the examiner found the Veteran's psychiatric evaluation to be normal, and a January 1981 Report of Medical Examination indicates the examiner found the Veteran's psychiatric evaluation to be normal. A diagnosis of major depression is noted in an October 2008 treatment note. A February 2014 treatment record notes depression as a problem and that clonazepam is prescribed for anxiety and sertraline is prescribed for depression. In addition, an assessment of schizoaffective disorder is noted. In May 2021, the Veteran was afforded a VA examination for PTSD. The examiner noted the Veteran's symptoms did not meet the diagnostic criteria for PTSD under DSM-5 and noted a diagnosis of schizoaffective disorder, bipolar type. The examiner noted the Veteran stated that when he went through court-martial in 1979, he felt traumatized from the experience, however, he did not seek treatment at that time. Additionally, the examiner stated the Veteran began seeking treatment after he fractured his arm while working for American Airlines in 2005. The Veteran has not worked since then, he stated that symptoms of depression and anxiety began after his accident. The veteran underwent two psychiatric hospitalization in 2008 due to experiencing hallucinations and having difficulties managing a domestic issue with neighbors in which he felt homicidal. The Veteran has a history of schizoaffective disorder but did not reveal this in the evaluation. The examiner noted the Veteran's records indicate his psychiatric history to include anxiety NOS and a history of schizoaffective disorder. The examiner also noted the Veteran's mother was diagnosed with schizophrenia. The examiner opined the Veteran's claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated the Veteran meets the criteria for schizoaffective disorder, bipolar type. Research indicated that the Veteran's family history of schizophrenia (his mother) made him genetically more predisposed for this disorder. He was diagnosed after his service in approximately 2006 and his symptoms, which include intermittent hallucinations, major mood episodes, sleep difficulties, anhedonia, and lack of motivation do not appear to be related in any way to his time in service or a trauma-related experience. The examiner also stated it should be noted that his symptoms of depression and anxiety are subsumed under this diagnosis. Therefore, it is less likely than not that his schizoaffective disorder was caused by his service. The examiner also opined the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected conditions. The examiner stated dermatitis and tinnitus are not related in any way to schizoaffective disorder, there is no clinical link. There is no clinical link, therefore the diagnosed disorder was less likely than not aggravated beyond its natural progression by the service-connected dermatitis and/or tinnitus. Furthermore, the examiner stated the Veteran's mother was diagnosed with schizophrenia and research indicates a strong genetic predisposition for the disorder. Therefore, it is safe to assume the Veteran was born with a genetic predisposition. He was later formally diagnosed in 2006 per the records. Stress is another factor that contributes to schizoaffective disorder. The records plus the Veteran's account of having discord and domestic issues with neighbors coupled with two psychiatric admissions in 2008 for hallucinations, anxiety, and depression support this factor in his diagnosis. The Veteran has not provided a private opinion relating a psychiatric disability to service. The Veteran stated that symptoms of depression and anxiety began after his accident while working for American Airlines in 2005. The examiner noted his symptoms of depression and anxiety are subsumed under the diagnosis of schizoaffective disorder. Further stating, it is safe to assume the Veteran was born with a genetic predisposition due to his mother's diagnosis of schizophrenia as research indicates a strong genetic predisposition for the disorder. Thus, there is no competent evidence to establish a nexus between the Veteran's service and his current psychiatric diagnosis. Consideration has been given to the Veteran's belief his psychiatric disability is related to his military service. The Board notes the Veteran is competent to provide testimony concerning factual matters of which he has firsthand knowledge and experiences through his senses. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Further, under certain circumstances, lay statements may support a claim for service connection by supporting the occurrence of lay observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay persons are also competent to provide opinions on some medical issues, such as when the Veteran began experiencing readily observable symptoms such as pain. Kahana v. Shinseki, 24 Vet. App. 428 (2011). The issue of causation of a psychiatric disability, however, is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As noted above, the examiner stated the Veteran was diagnosed after his service in approximately 2006 and his symptoms do not appear to be related in any way to his time in service or a trauma-related experience. Thus, although the Board has carefully considered the lay contentions of record suggesting that the Veteran's psychiatric disability is related to his service, the Board affords the objective medical evidence of record, which weighs against finding such a connection, with greater probative weight than the lay opinions, because such evidence was provided by a medical professional and concerned the Veteran's mental health, which requires specialized training and expertise to diagnose and treat. In sum, the Board finds that service connection for an acquired psychiatric disorder is not warranted. Regarding secondary service connection, whether a service-connected disability caused or aggravated a psychiatric disability is a medical question that requires medical expertise. See Jandreau v. Nicholson, 492 F.3d, 1372, 1377 (Fed. Circuit 2007). There is no medical evidence in the record supporting a secondary theory of entitlement based on the Veteran's service-connected tinnitus or dermatitis. In fact, in opining the Veteran's schizoaffective disorder is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected conditions, the examiner stated the Veteran's mother was diagnosed with schizophrenia and research indicates a strong genetic predisposition for the disorder. Therefore, it is safe to assume the Veteran was born with a genetic predisposition. Further stating, dermatitis and tinnitus are not related in any way to schizoaffective disorder, there is no clinical link. The Veteran's treatment records do not indicate any connection between the Veteran's tinnitus or dermatitis, causing or aggravating his schizoaffective disorder. As the preponderance of the evidence weighs against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim of service connection for an acquired psychiatric disability, to include anxiety and depression and to also include secondary to the service-connected disabilities, the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. At 55. Yvette R. White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Daley, 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.