Citation Nr: 21067150 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 18-53 196 DATE: November 3, 2021 ORDER Entitlement to service connection for a left ear hearing loss disability is granted. Entitlement to service connection for a right ear hearing loss disability is denied. Entitlement to service connection for an upper back disability is denied. Entitlement to service connection for a lower back disability is denied. Entitlement to service connection for acid reflux is denied. Entitlement to service connection for a respiratory disability, to include bronchitis, is denied. Entitlement to service connection for a disability of the upper extremities, to include degenerative joint disease and rheumatoid arthritis, is denied. Entitlement to service connection for a disability of the lower extremities, to include degenerative joint disease and rheumatoid arthritis, is denied. Entitlement to service connection for hemorrhoids is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for sleep apnea is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include depression, insomnia, and unspecified anxiety disorders, is remanded. Entitlement to service connection for a skin disability, to include athlete's foot, pseudofolliculitis barbae, and tinea pedis, is remanded. Entitlement to service connection for migraine headaches, to include as secondary to lower and upper back disabilities, is remanded. Entitlement to service connection for rhinitis is remanded. FINDINGS OF FACT 1. The Veteran's left ear hearing loss disability began during active service. 2. A right ear hearing loss disability was not manifest in service, an organic disease of the nervous system was not manifest within one year of service, and the current right ear hearing loss disability was not otherwise caused by service. 3. The weight of competent and credible evidence is against finding that an upper back disability began during active service or was otherwise caused by service. 4. The weight of competent and credible evidence is against finding that a lower back disability began during active service or was otherwise caused by service. 5. The weight of competent and credible evidence is against finding that an acid reflux disability began during active service or was otherwise caused by service. 6. The weight of competent and credible evidence is against finding that a respiratory disability began during active service or was otherwise caused by service. 7. The weight of competent and credible evidence is against finding that a disability of the upper extremities, to include degenerative joint disease and rheumatoid arthritis, began during active service or was otherwise caused by service. 8. The weight of competent and credible evidence is against finding that a disability of the lower extremities, to include degenerative joint disease and rheumatoid arthritis, began during active service or was otherwise caused by service. 9. The weight of competent and credible evidence is against finding that a hemorrhoids disability began during active service or was otherwise caused by service. 10. The weight of competent and credible evidence is against finding that a hypertension disability began during active service or was otherwise caused by service. 11. The weight of competent and credible evidence is against finding that a sleep apnea disability began during active service or was otherwise caused by service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left ear hearing loss disability have been met. 38 U.S.C. §§ 1110, 1111, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2021). 2. The criteria for entitlement to service connection for a right ear hearing loss disability have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2021). 3. The criteria for entitlement to service connection for an upper back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 4. The criteria for service connection for a lower back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 5. The criteria for service connection for an acid reflux disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 6. The criteria for service connection for a respiratory disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 7. The criteria for service connection for an upper extremity disability, to include degenerative joint disease and rheumatoid arthritis, are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 8. The criteria for service connection for a lower extremity disability, to include degenerative joint disease and rheumatoid arthritis, are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 9. The criteria for service connection for a hemorrhoid disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). 10. The criteria for service connection for a hypertension disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2021). 11. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Army from August 1990 to November 1991 including service in Germany. Service Connection 1. Entitlement to service connection for a bilateral hearing loss disability 2. Entitlement to service connection for an upper back disability 3. Entitlement to service connection for a lower back disability 4. Entitlement to service connection for acid reflux 5. Entitlement to service connection for a skin disability, to include athlete's foot and tinea pedis. 6. Entitlement to service connection for a respiratory disability, to include bronchitis. 7. Entitlement to service connection for a disability of the upper extremities, to include degenerative joint disease and rheumatoid arthritis 8. Entitlement to service connection for a disability of the lower extremities, to include degenerative joint disease and rheumatoid arthritis 9. Entitlement to service connection for hemorrhoids 10. Entitlement to service connection for hypertension 11. Entitlement to service connection for sleep apnea Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. There is a one-year presumption for cardiovascular disease (including hypertension); arthritis; other organic diseases of the nervous system, and psychoses. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. To establish a right to compensation for a present disability, a Veteran must show: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303(a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran's July 1990 Report of Medical History and Report of Medical Examination at entrance into service both were normal with respect to the claimed issues. In September 1990, the Veteran reported a rash on the legs. In October 1990, the Veteran complained of cold symptoms for the previous 3 days. He had a cough with nausea, vomiting, stomach cramps, yellow sputum, sore throat, fever, chills, and body aches. He also reported feeling off balance and having bilateral temporal headaches. The impression was viral syndrome. In an August 1991 Report of Medical History, the Veteran denied current or past histories of hearing loss, ear trouble, sinusitis, skin diseases, high or low blood pressure, frequent indigestion, stomach or intestinal trouble, arthritis, bone or joint deformity, recurrent back pain, trick or locked knee, asthma, shortness of breath, chronic cough, frequent trouble sleeping, depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort. The Veteran, by contrast, did report a childhood history of low back pain due to trauma. In a contemporaneous Report of Medical Examination, the Veteran had noted postnatal drip and left ear hearing loss in the 4000 to 6000 Hertz range. The Veteran's personnel records document a history of counseling and disciplinary infractions from January 1991 through November 1991 signed by non-commissioned officers and the company commanders. This overlaps with the tour of duty for the Veteran's staff sergeant who provided statements and testimony summarized below. In August 1991 the Veteran was noted to have been involved in two incidents of drunk and disorderly conduct, impersonating a non-commissioned officer (NCO), disrespect toward an NCO, forceful entry, violation of lawful order, and dereliction of duty. For these infringements, the Veteran had his pass privileges pulled for 30 days restricting him to base to ensure that the Veteran did not create a disruption in the surrounding community that would not be positive for the United States Army. The Veteran also had his civilian clothes privilege and the privilege to have female visitors pulled. At that time, the Veteran was counseled on his possible elimination from the service. In September 1991, the Veteran's pass privileges and civilian clothes privileges were pulled for 30 days following the Veteran's failure to notify the chain of command that his wallet had been stolen and lying under oath as to the amount of money in the wallet ($1600). The Veteran ultimately received Article 15s for these infractions. In October 1991, the Veteran received an Article 15 for disobeying a lawful command. In November 1991, the Veteran was convicted in a court martial of larceny of private property of a value of $100 or more for an incident in February 1991. The Veteran received an early general discharge under honorable conditions for misconduct characterized as a serious offense. The Veteran was afforded a VA audio examination in July 2016. Audiogram testing showed a bilateral hearing loss disability for VA compensation purposes. The examiner noted that the Veteran had problems with response consistency, not due to non-organic reasons but due to the severity of his tinnitus and subsequent interference. Following examination, the examiner concluded that it was at least as likely as not that the Veteran's bilateral hearing loss disability was caused by or the result of service. The rationale noted that medical records clearly showed progression in left ear hearing acuity from normal to hearing loss during service. Moreover, although left thresholds were mainly affected, damage to the right ear also was incurred. In September 2016, the Veteran established care with a new VA facility. At that time, he did not report ongoing skin problems, and on examination he had no rashes or suspicious lesions. A September 2016 depression screen was negative, but a PTSD screen was positive. VA treatment records document diagnoses of hearing loss, hypertension, migraine headaches, depression, sleep disorder, arthritis, posttraumatic stress disorder (PTSD), and gastroesophageal reflux disease (GERD). A December 2016 VA examination report included a diagnosis of GERD. The Veteran reported that during his active service he became sick and was vomiting. He went on a sick call visit and was treated for a viral syndrome. The Veteran reported ongoing stomach problems with worsening over the years. Currently, the Veteran had severe burning of the stomach along with cramping at least 3 to 4 times a week. He self-medicated with over-the-counter medication. The pain was worsened by an empty stomach. Following examination, the examiner concluded that it was less likely than not that the Veteran's GERD was incurred in or caused by service. The rationale noted that the service treatment records were silent for GERD. In October 1990, the Veteran was seen for a viral syndrome as a part of an acute condition inclusive of a complaint of acute "stomach cramps with a 3-day history of nausea, one episode vomiting and stomach camps this morning, positive yellow nasal discharge and sputum." The Veteran had acute complaints that were treated and resolved. A December 2016 VA headache examination report is of record. The examiner concluded that the Veteran had not been diagnosed with a headache disability. The Veteran reported that in 1991 he began having headaches that he attributed to his work in service with the field artillery. The Veteran wore sunglasses and light bothered him. The Veteran had headaches 3 to 4 times per week and treated with over-the-counter medication. He could not drive at night due to the lights triggering headaches. The examiner concluded after examination that it was less likely than not that a headache disability was proximately due to or the result of the Veteran's service-connected condition. The rationale noted that the Veteran's service treatment record was silent for a diagnosis meeting the criteria for migraine headaches. The Veteran was seen for headaches related to a viral syndrome in October 1990 as part of an acute condition that was treated and resolved. The examiner concluded, "Currently, there is no current literature supporting the lower back [degenerative disc disease], as a cause of a migraine headache condition. Therefore, it is less likely than not [the V]eteran's currently claimed migraine headache condition is proximately due to or the result of low back condition." In December 2016, the Veteran underwent a VA back examination. The examiner diagnosed degenerative arthritis of the spine, specifically degenerative disc disease. The Veteran denied any known history of childhood back injury. The Veteran stated that around 1991 while in the field and lifting an artillery round he injured his back and was seen and treated with Excedrin for pain relief. His back continued to worsen since leaving service that made lifting and bending difficult, as well as problems with sleep. The Veteran also stated that he was involved in a motor vehicle accident in 2014 where he was hit from behind that caused his back to flare-up. The Veteran was unsure whether the motor vehicle accident worsened his already existing back injury. Following examination, the examiner concluded that the Veteran's back disability clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression by service. The rationale noted that the Veteran's service treatment records were reflective of an isolated acute complaint of back pain during service in October 1990. In August 1991, prior to separation from service, the Veteran denied any back condition. The Veteran's current diagnosis of degenerative disc disease was supported by literature as being caused by injury, aging, and/or obesity. The Veteran acknowledged being treated for a motor vehicle accident with a sustained back injury in 2014. As such, it was less likely than not that the Veteran's current back disability clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression by service. The Veteran had a December 2016 VA audio examination. Valid results could not be obtained because the Veteran was unable or unwilling to provide valid threshold-level responses to pure-tone-air-conduction stimuli. Reinstruction and retesting did not resolve the inconsistencies. The Veteran was afforded a VA skin examination in December 2016. The examiner indicated that the Veteran did not have a diagnosed skin disability. The examiner noted an in-service diagnosis of a skin rash in April 1991 following a petroleum spill on the skin. The Veteran reported worsening symptoms over the years. The rash would flare-up 6 to 7 times per month. At the end of the examination, the examiner indicated that the Veteran had a "Dry rash on anterior and lateral abdomen and anterior thighs," but again reiterated that the Veteran did not have a diagnosed skin condition. The Veteran was afforded a VA back examination in April 2017. The examiner noted diagnoses of lumbosacral strain or retrolisthesis of the lumbar spine. The Veteran reported onset of back problems in 1991 while serving in Germany. The back condition had worsened since that time. Following examination, the examiner concluded that it was clear and unmistakable that the back disability existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by service. The rationale indicated that the attached medical records failed to show an in-service injury that would explain or document "worsening" of the Veteran's back pain while in service. As such, it was less likely than not true that the Veteran's spine condition was "aggravated beyond it's natural progression" by service. In April 2017, the Veteran underwent a VA esophageal examination. The examiner diagnosed GERD. The Veteran reported the onset of symptoms in 1991 while serving in Germany. The condition had worsened and included symptoms of painful burning in the chest, just behind his breastbone, and that his stomach burned all the time so he could not eat anything. Following examination, the examiner concluded that it was less likely than not that the Veteran's GERD was incurred in or caused by service. The rationale discussed the basis for a diagnosis of GERD. The examiner noted that based on the medical records provided there was not evidence of GERD during service. The records failed to show treatment for GERD until several years after service. As such, it was less likely than not that the Veteran's GERD was related to his "vomiting and stomach problems" during service, given that such symptoms could have several etiologies. The Veteran underwent a VA headache examination in April 2017. The examiner diagnosed migraine headaches. The Veteran reported onset of symptoms in 1991 while serving in Germany. The condition had gotten worse. Following examination, the examiner concluded that it was less likely than not that the Veteran's migraines were proximately due to or the result of the Veteran's back disability. The rationale indicated that there was no pathophysiology to explain a relationship between a spine disability and migraine headaches. There was no evidence in the medical records to explain a relationship between the migraines and back disability. A July 2017 statement from one of the Veteran's former supervising staff sergeant noted that the Veteran had served under him from January 1991 to October 1991. The staff sergeant discussed how the Veteran's compliance with orders from the staff sergeant resulted in anger from non-commissioned officers (NCOs) with those individuals promising to retaliate against the Veteran once the staff sergeant left his posting. A July 2017 statement in support of claim for service connection for PTSD indicated that in May 1991 the Veteran's supervising staff sergeant ordered the Veteran not to give anything out of the supply room without the staff sergeant's position. Several NCOs ordered the Veteran to provide them with equipment from the supply room without approval from the Veteran's staff sergeant. The NCOs told the Veteran to get down and do push-ups on the supply room steps and while getting down the Veteran slipped and hurt his back and hit his head. The NCOs threatened the Veteran and he feared for his safety. The Veteran's staff sergeant backed up the Veteran until he transferred duty stations. The NCOs told the Veteran's staff sergeant that after he transferred, they were going to "get" the Veteran. The Veteran reported ongoing problems with depression, anxiety, insomnia, and concentration problems. In December 2017, a "GAD-7 score" was within the range indicating the presence of anxiety symptoms. December 2017 and January 2018 depression screens were negative. In a January 2018 statement, the Veteran stated, "My military career was cut short because of harassment from my superior officers. One officer told me he would make sure my career is destroyed. Living your life under constant pressure and fear brought about my depression. Once my career was destroyed I haven't been able to obtain or maintain gainful employment. Which is very depressing. I'm under constant stress to provide for my family. Daily stress and depression has contributed to me having hypertension, insomnia, and migraines. Also I have erectile dysfunction in which my doctor has attributed to stress. Which is even more stressful and depressing because I am not able to satisfy my wife physically or financially." A February 2019 letter from Veteran's VA treating psychiatrist since January 2018 indicated that the Veteran's psychiatric diagnoses included major depressive disorder and circadian rhythm sleep wake disorder. An August 2019 letter from the Veteran's wife noted that she had known the Veteran since he was 7 years old. She had lived with the Veteran for 22 years and they had been married for 19 years. Since returning from service, the Veteran had not been the same person she knew before service. The Veteran had problems staying focused long enough to finish jobs or tasks. The Veteran also became very frustrated and angry because could not always hear his wife. He also was very loud and embarrassing. He used to be a social person, but no longer. It was difficult to get him out of the house for the movies, dinner, or family events. The Veteran also exhibited paranoia and hypervigilance. The Veteran also had pain in the feet, back, shoulder, hemorrhoids, and a bad skin rash. The Veteran had sleep problems, including nightmares. The Veteran's wife believed these problems were due to the Veteran's active service. A September 2019 letter from the Veteran's friend and fellow servicemember discussed how the Veteran was targeted by certain superior officers so they could recommend him for disciplinary actions. Over time, while still in service the Veteran started drinking heavily and getting into verbal disagreements with his non-commissioned officers. The Veteran, "lost focus and became very irritated with how he was being treated." The Veteran felt embarrassed and humiliated by being singled out in unit formation and his performance deteriorated. After the Veteran separated from service, his friend frequently spoke with the Veteran and his then fiancé who described the Veteran as a different person than she knew prior to his entrance into service. The friend concluded, "I know his situation is a direct result of what he endured while serving in the Army; he has not been the same since. He really wanted to retire from the Army to be an example for his family because no one in his family had ever served in the military. I believe he would have been a great asset to the Army and would have served our country well." A November 2019 letter from the Veteran's treating psychiatrist indicated that the Veteran had diagnoses of major depressive disorder and sleep disorder. The Veteran testified at a hearing before the undersigned in June 2021. The Veteran reported that he believed he had a depressive disorder due to his active service. The Veteran had insomnia beginning in service and for the last 10 years had been walking at night because he could not sleep. He attributed the sleep problems to racism during service. The Veteran's former supervising staff sergeant testified about issues the Veteran faced during service and threats as to what he might face after the staff sergeant left as the Veteran's supervisor. The Veteran's wife testified that she had known the Veteran from childhood and after service. Several years after service the couple were married and thereafter she started noticing symptoms of night screaming and other symptoms. The Veteran stated that he began experiencing headaches during basic training due to loud artillery noises. They had worsened over the years. He believed that his migraines and GERD / acid reflux problems were due to eating MREs during service. When the Veteran told doctors his belief that the MREs had caused the acid reflux problems, "they told me, yeah, that could be the reason why you're regurgitating like you are, having that heartburn and everything because it's sometimes that stuff gets so worse to where oh, my goodness, it'll make your eye cross, and that's too stressful." The Veteran stated that his hemorrhoids started during service due to sitting on hard iron seats. He testified that he had sought treatment for the itching during service. As to his skin problems, the Veteran stated that he had problems with athlete's foot and in the beard area. The Veteran stated that he had been required to dry shave in the field and in basic training, which had caused the skin problems in that area. He believed that he had a rash on his stomach due to the use of diesel fuel to keep the Veteran's tent warm. The Veteran also believed the skin problems on the stomach could have been from poison ivy or other irritants from crawling on the forest floor. As to his bronchitis and rhinitis, the Veteran reported having problems with his sinuses. He had sneezing and nosebleeding episodes while in the field. The Veteran had ongoing problems with sneezing, coughing, and lung problems. The Veteran believed that his sleep problems started due to nighttime guard duty that threw off his sleep pattern. Fellow service members would wake up the Veteran, "asking me am I okay because it's like I ain't breathing." After service, when the symptoms had worsened the Veteran got a CPAP machine. The Veteran remembered that before separating from service he was told his blood pressure was a little high. Over the years, the Veteran had symptoms of dizziness. The Veteran also believed that his ongoing stress affected his blood pressure. As to his upper and lower back problems, the Veteran thought the issues were due to hand to hand combat, wrestling, and other activities during basic training. As to the claimed degenerative arthritis and rheumatoid arthritis, a doctor during a VA examination suggested the problems could be due to being in the cold serving in the field during service. When it would be cold or raining in the field, the Veteran's bones would ache. The Veteran's former staff sergeant believed that nearly all the Veteran's problems were due to the stress endured during service as a result of his mistreatment. In support of his claim, the Veteran submitted a June 2021 Headaches Disability Benefits Questionnaire (DBQ). The examiner noted diagnoses of migraines and headache. The Veteran reported symptom onset in service while stationed in Germany, with frontal facial pain, tension, and tightness in the forehead area, as well as photophobia, vomiting, and nausea. The Veteran was taking medication for the headaches. The examining physician concluded that based on review of the Veteran's medical history and medical records brought by the Veteran that it was the examiner's opinion that the Veteran's migraines were at least as likely as not caused by service. No specific rationale for the opinion was provided. The Veteran also submitted a June 2021 Sinusitis / Rhinitis DBQ. The examiner noted diagnoses of chronic sinusitis, allergic rhinitis, and turbinate hypertrophy. The Veteran reported that he had experienced facial pain, especially around the eyes, pain, pressure, discolored drainage, and rhinitis since service. The examiner concluded that, "After thorough review of the patient[']s medical records and medical history to include physical exam it is my opinion that the patient[']s symptoms of chronic rhinitis[,] sinusitis and turbinate hypertrophy are at least as likely as not caused by his service in the military." No specific rationale for the conclusions were provided. Bilateral Hearing Loss The Veteran contends that he has a bilateral hearing loss disability due to noise exposure while in service. In addition to the above-noted legal authority, the threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Hearing loss disability claims are governed by 38 C.F.R. § 3.385. This regulation provides hearing loss is a disability when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater. 38 C.F.R. § 3.385. Alternatively, a hearing loss disability can be established by auditory thresholds for at least three of those frequencies at 26 decibels or greater or by speech recognition scores under the Maryland CNC Test at less than 94 percent. 38 C.F.R. § 3.385. The question for the Board is whether the Veteran had a current disability that began during service or was at least as likely as not related to an in-service injury, event, or disease. Affording the Veteran the benefit of the doubt, the Board concludes that entitlement to service connection for a left hearing loss disability is warranted. In that regard, the Board recognizes that the Veteran had hearing acuity within normal limits at entrance into service, but that an August 1991 audiogram prior to separation showed a threshold shift of at least 15 decibels in the left ear at 500, 2000, 3000, 4000, and 6000 Hertz, including hearing acuity of 40 decibels at 4000 Hertz. Thus, a left ear hearing loss disability is manifest in service. Moreover, a July 2016 VA examination report concluded that based on the in-service evidence of worsening left ear hearing acuity during service that it was at least as likely as not that the Veteran's left ear hearing loss disability was incurred in service. As such, the Board finds that entitlement to service connection for a left ear hearing loss disability is warranted. As to the Veteran's right ear hearing loss disability, the Board recognizes that the Veteran has a current right ear hearing loss disability. That said, the Board finds that the evidence is against finding that such disability had its onset during service or otherwise was caused by service. In reaching that conclusion, the Board recognizes that the July 2016 VA examination report concluded that the right ear hearing loss disability was due to service. The rationale noted that the decreased hearing acuity primarily was observed in the left ear, but that "damage to the right ear was also incurred." The Board observes, however, that a comparison of the Veteran's audiogram at entrance and separation shows no threshold shift at any frequency in the right ear. Indeed, right ear hearing acuity was the exact same at all frequencies other than 6000 Hertz where hearing acuity improved from 20 decibels to 15 decibels. As such, the Board finds the examiner's conclusion that there was evidence of right ear "damage" during service to not be supported by the evidence. The RO similarly found the rationale inadequate and scheduled the Veteran for another VA examination. At the time of that examination, the Veteran did not cooperate sufficiently to allow the examiner to establish a baseline for testing purposes. The July 2016 examiner attributed the Veteran's problems to his severe tinnitus, but the December 2016 examiner attributed the inconsistencies to other factors. Thus, the medical evidence of record does not adequately link the Veteran's current right ear hearing loss disability to his active service. The Board is aware of the provisions of 38 C.F.R. § 3.303(b), relating to chronicity and continuity of symptomatology in establishing service connection and that such provisions apply to those chronic conditions, such as hearing loss, specifically listed in 3.309(a). See Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013). However, neither right ear hearing loss nor an organic disease of the nervous system was noted during service, including at the time of examination shortly before separation from active service. As noted above, the Veteran's separation examination audiogram included normal right ear hearing acuity for VA purposes. In a contemporaneous Report of Medical History, the Veteran specifically denied a history of hearing loss or ear problems, which clearly demonstrates that the Veteran did not have a lay belief of ongoing right ear hearing loss from service. Thus, the Board finds that there is no credible contention of a continuity of decreased hearing acuity or hearing loss from service. As such, the provisions of 38 C.F.R. § 3.303(b) are not for application. As to the Veteran's general contentions that his right ear hearing loss disability was incurred in or is otherwise caused by his service, the Board finds his opinions to be of limited probative weight. His report of in-service noise exposure is accepted as credible because it is consistent with his activities. Although the Veteran may be competent to report decreased hearing acuity, he has not contended that he experienced decreased hearing acuity in service. As noted above, the Veteran explicitly denied hearing loss or ear problems at separation from service. Given the absence of a continuity of symptomatology from service and the Veteran's lack of education, training, and experience in regards to diagnosing a right ear hearing loss disability and relating such disability to noise exposure years prior to the diagnosis and onset of symptoms, the Board affords his representations as to a relationship between his current right ear hearing loss disability and in-service noise exposure extremely limited probative weight. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). In light of the evidence, the Board concludes that the preponderance of the credible evidence is against the right ear hearing loss claim, and that service connection for a right ear hearing loss disability is not warranted. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). Upper Back, Lower Back, Acid Reflux, Bronchitis, Upper and Lower Extremity Degenerative Joint Disease and Rheumatoid Arthritis, Hemorrhoids, Hypertension, Insomnia, and Sleep Apnea The Veteran alleges that the above disabilities had their onset during his active duty or otherwise were caused by service. As an initial matter, the Board notes that the VA examinations of the back all have evaluated the Veteran based on his back disabilities preexisting his active service. In that regard, every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. In this case, in his August 1991 Report of Medical History the Veteran reported a childhood history of low back pain due to trauma. That said, in the same Report of Medical History the Veteran denied recurrent back pain. In addition, he denied a history of recurrent back pain during his July 1990 Report of Medical History prior to entrance into service. The contemporaneous Report of Medical Examination did not note any abnormal finding as to the spine. As such, the Board does not find that the presumption of sound condition at entrance is overcome. Thus, the Veteran is presumed to have entered service in sound condition as to all of the body systems at issue herein. Even presuming current disabilities as to all of the claimed disabilities, the Board finds that the weight of competent and credible evidence is against finding that these disabilities were incurred in service or otherwise were caused by service. In reaching this conclusion, the Board notes that the primary evidence in support of finding an association between the Veteran's current problems and active service are the general statements of the Veteran linking his current claims to his active service. The Veteran is competent to report physically observed symptoms and, in that regard, the Board notes that in August 1991 shortly before separation the Veteran denied a history of skin diseases, high or low blood pressure, frequent indigestion, stomach or intestinal trouble, arthritis, bone or joint deformity, recurrent back pain, trick or locked knee, asthma, or shortness of breath. He otherwise reported that he was in good health. Thus, the Veteran's current assertions of ongoing problems from service are inconsistent with his contemporaneous statements. As such, the Board finds the current assertions of ongoing problems for the claimed disabilities from service to be of extremely limited probative weight. See Madden v. Brown, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has "the authority to discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence") The Board also acknowledges the statements of the Veteran's former staff sergeant who believed that "99" percent of the Veteran's problems were related to his mistreatment by various NCOs during service. The staff sergeant has offered no rationale as to why any claimed disability (other than the acquired psychiatric disorder claim, remanded herein) was affected by the Veteran's asserted mistreatment. The closest argument made appears to be that the Veteran was made to do pushups or otherwise may have injured himself during punishments levied by the NCOs. As discussed above, however, the Veteran specifically denied a history of recurrent back pain or other problems related to his current claims prior to his separation from service. As such, there is no continuity of symptoms from service and any of the disabilities for which the Veteran had problems during service clearly were acute in nature. Moreover, while the former staff sergeant has a doctorate he is not a medical doctor and there is no evidence that he has the education, training, or experience to link any of the Veteran's disabilities adjudicated herein to any in-service event. The sole competent medical opinions as to any of the claimed disabilities are the VA examination reports of record and in each case the examiner found it less likely than not that the Veteran's claimed disability had its onset in service or otherwise was related to service. The rationale for these opinions generally focused on the absence of any evidence in the service treatment records of the claimed disability. As discussed above, the Board notes that, in fact, as to the majority of the disabilities the Veteran specifically denied ongoing problems shortly before separation from service. As the VA examination reports provided a rationale for the opinions provided and were based on a complete review of the evidence (including the Veteran's lay assertions), the Board finds these opinions the most probative evidence of record. In light of the foregoing, the Board finds that the preponderance of the evidence is against the claims, and the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). The appeals must therefore be denied. REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disorder, to include depression, insomnia, and unspecified anxiety disorders As discussed above, the Veteran contends that he has a current acquired psychiatric disorder due to in-service experiences, including incidents the Veteran and others have interpreted to have been racist. The RO has denied the claim on the premise that the Veteran does not have a current diagnosis of the claimed disability or disabilities. VA treatment records, however, note diagnoses of both depression and PTSD. Moreover, the Veteran has described on multiple occasions how he believes these problems are related to his active service. The Veteran's wife and others also have described the effect of the Veteran's in-service experiences on his current mental health. Given these reports and the absence of a VA examination for this claim, the Board concludes that a remand for a VA examination is necessary. 2. Entitlement to service connection for a skin disability, to include athlete's foot, pseudofolliculitis barbae, and tinea pedis The Veteran contends that he has multiple skin problems that had their onset in service. As noted above, the Veteran sought treatment for skin problems during service in September 1990 and April 1991. The Veteran was afforded a VA examination for the skin in December 2016. At that time, no skin disability was found and no medical opinion as to etiology was provided. The Board finds the foregoing examination report problematic given the examiner's finding that the Veteran had a "dry rash" on the abdomen and thighs, but did not explain why such symptoms did not constitute a skin disability. As such, a new examination is necessary. 3. Entitlement to service connection for migraine headaches, to include as secondary to lower and upper back disabilities The Veteran alleges that he has a headache disability that had its onset during service, was otherwise caused by service, or was caused or aggravated by his upper and/or lower back disabilities. Two VA examination reports have discussed the secondary aspect of the claim, but the reports did not address whether the Veteran had a headache disability that was incurred in service or otherwise was caused by service. The Veteran submitted a June 2021 DBQ wherein the examiner concluded that the Veteran's headaches were the result of service. No rationale for the opinion was provided. Given the foregoing, the Board concludes that a remand for another VA examination is required. 4. Entitlement to service connection for rhinitis The Veteran asserts that he has a rhinitis / sinusitis disability that was incurred in service or otherwise was caused by service. No VA examination is of record, but in support of his claim the Veteran submitted a June 2021 disability benefits questionnaire (DBQ) wherein the examiner concluded that the Veteran's rhinitis and sinusitis were due to service. That said, no rationale for the opinion was provided. As such, a remand for a VA examination is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for the Veteran's claimed acquired psychiatric disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any diagnosed acquired psychiatric disorder, to include depression, at least as likely as not related to service, including the Veteran's reported discrimination by superiors? Attention is called to the written statements by fellow soldiers, hearing testimony, and the file of service personnel records. Provide a rationale to support the opinion(s). 2. Schedule the Veteran for a VA examination for the Veteran's claimed skin disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any diagnosed skin disorder at least as likely as not related to service? Provide a rationale to support the opinion(s). 3. Schedule the Veteran for a VA examination for the Veteran's claimed headache disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any diagnosed headache disorder at least as likely as not related to service? In reaching the above opinion, the examiner is requested to consider, and discuss and reconcile as necessary, the June 2021 Headache DBQ. Provide a rationale to support the opinion(s). 4. Schedule the Veteran for a VA examination for the Veteran's claimed rhinitis / sinusitis disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any diagnosed rhinitis / sinusitis / turbinate hypertrophy / other nasal disorder at least as likely as not related to service? In reaching the above opinion, the examiner is requested to consider, and discuss and reconcile as necessary, the June 2021 Rhinitis / Sinusitis DBQ. Provide a rationale to support the opinion(s). J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.