Citation Nr: 21069628 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 18-14 699 DATE: November 19, 2021 ORDER Service connection for a left knee disability, diagnosed as degenerative joint disease, is granted. Service connection for a cervical spine disability, diagnosed as degenerative arthritis, is granted. Service connection for bilateral hearing loss is granted. REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. FINDINGS OF FACT 1. The Veteran's left knee disability, diagnosed as degenerative joint disease, had its onset in service. 2. The Veteran's cervical spine disability, diagnosed as degenerative joint disease, had its onset in service. 3. The Veteran's bilateral hearing loss had its onset in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability, diagnosed as degenerative joint disease, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for a cervical spine disability, diagnosed as degenerative arthritis, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from June 1967 to December 1979. This matter is before the Board of Veterans' Appeals (Board) on appeal of March 2015 and May 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The March 2015 RO decision denied service connection for bilateral hearing loss. The May 2015 RO decision denied service connection for a low back disability (listed as a back condition); a cervical spine disability (listed as a neck condition); a right hip disability (listed as a right hip condition); a left hip disability (listed as a left hip condition); a right knee disability (listed as a right knee condition); and for a left knee disability (listed as a left knee condition). A December 2015 RO decision continued the denials of service connection for a low back disability (listed as a back condition); a cervical spine disability (listed as a neck condition); a right hip disability (listed as a right hip condition); a left hip disability (listed as a left hip condition); a right knee disability (listed as a right knee condition); and for a left knee disability (listed as a left knee condition). In June 2021, the Veteran appeared at a Board hearing before the undersigned Veterans Law Judge. 1. Left Knee Disability Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. 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). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Veteran is service-connected for an unspecified insomnia disorder; status post an appendectomy; a surgical scar associated with status post an appendectomy; and for tinnitus. The Veteran contends that he has a left knee disability that is related to service. He specifically maintains that he injured his left knee playing soccer in 1969, while at the Naval Academy, during his period of service. He reports that he had swelling and popping of the left knee in 1969, that he was placed on a profile and light duty, and that he received a waiver so that he did not have to run. The Veteran also indicates that he injured his left knee in swim class in 1970, and that he was underwent an orthopedic consultation. He states that, prior to his left knee injury, he went to jump school during his first year at the Naval Academy, and that after he injured his knee, he was never able to perform parachute jumps again. The Veteran essentially asserts that he suffered from left knee problems during service and ongoing left knee problems since that time. The Veteran served on active duty in the Marine Corps from June 1967 to December 1979. A DD Form 214, for his period of active duty in the Marine Corps from June 1971 to December 1979, lists his occupational specialties as an F4B pilot for five years and two months, a ground safety specialist for four years, and as an embark officer for four years. The Veteran's service personnel records indicate that he was awarded the Parachutist Badge in August 1968. The Veteran's service treatment records indicate that he was treated for left knee problems on multiple occasions during service. A September 1969 treatment entry notes that the Veteran was seen for a left knee injury. He reported that he hit his left knee while playing soccer the previous day. The examiner stated that there appeared to be fluid in the joint, and that the Veteran had a vague history of twisting, with no locking. The impression was a contusion. An October 1969 entry notes that the Veteran complained of a bruise on the left knee. The examiner reported that the Veteran still had effusion of the left knee, with pain in the posterior area of the muscle, with exercise. The examiner stated that there was no laxity of the ligament. A diagnosis was not provided at that time. A January 1970 treatment entry refers to the October 1969 entry, above, and indicates that the Veteran was provided with a waiver for a mile run. A March 1970 entry indicates that the Veteran reported that he injured his left knee during swim team the previous night. The Veteran reported that he had suffered recurrent pain, with effusion, following minimal injuries. The examiner stated that there was full range of motion, with moderate effusion, and pain over the medial joint line, of the medial meniscus. The impression was a medial meniscus injury. It was noted that the Veteran would be sent for an orthopedic appointment. A March 1970 consultation sheet notes that the Veteran was referred for recurrent knee injuries, with effusions, and for an evaluation for possible surgery. The provisional diagnosis was a medial meniscus injury. The examiner reported that the Veteran had definite signs and symptoms of a chronic subluxing patella, clinically. The examiner stated that the Veteran had a high riding patella, with out-turning, crepitation, and typical tenderness. The examiner maintained that there were no symptoms of a cartilage injury. It was noted that the Veteran was started on straight leg raising exercises. On a September 1970 medical history form at the time of a September 1970 examination, the Veteran checked that he did not have swollen or painful joints, and a trick or locked knee. The examiner reported that the Veteran had a history of intermittent pain and effusion of the left knee secondary to a soccer injury. The reviewing examiner stated that an orthopedic impression in March 1970 refers to a chronic subluxing left patella, mild. It was noted that the Veteran had undergone physical therapy. The reviewing examiner stated that the Veteran would receive a consultation for an opinion concerning a possible chronic injury. A September 1970 objective examination report includes a notation that the Veteran's lower extremities were normal. The examiner, in an April 1971 addendum notation, indicated that the Veteran had a history of mild laxity of the left patella. The examiner maintained that an October 1970 orthopedic consultation indicates that the Veteran was fully qualified for aviation. An October 1970 consultation sheet notes a provisional diagnoses of rule out organic knee disease and a chronic disability. The examiner stated that the Veteran had mild laxity of the patella, with some tenderness on palpation on the left, which would be come fairly asymptomatic with exercise. The examiner indicated that he did not feel that the Veteran had a disability preventing aviation. On a medical history form at the time of an October 1971 examination, the Veteran checked that he had swollen or painful joints. The reviewing examiner reported that that the Veteran had "right" peripatellar swelling early in 1970. It was noted that an orthopedic consultation in "April 1970" indicates that the Veteran was fully qualified for aviation. The reviewing examiner stated that the Veteran had no sequelae, that he had presently had full duties, and that his knee condition was not considered disabling. An October 1971 objective examination report includes a notation that the Veteran's lower extremities were normal. Post-service private and VA treatment records, including a VA examination report, show treatment for left knee disabilities, including grade 4 chondrosis, with full-thickness chondral defects of the medial compartment of the left knee, complex tearing of the posterior horn and body of the medial meniscus of the left knee, irregular full-thickness and chondral fissuring/tearing and superficial tearing of the left knee, and a large, complex, ruptured Baker's cyst of the left knee; left knee pain; arthritis of the (left) knee; (left) knee pain secondary to an old anterior ligament disruption; arthritis, pain, and degenerative joint disease of the left knee; and for degenerative joint disease of the left knee. A July 2021 lay statement from the Veteran's wife indicates that she married the Veteran in 1979, and that she had known him well during the last part of his military service. She reported that since she had known the Veteran, he had complained of a left knee injury from playing soccer. The Veteran's wife stated that the Veteran had suffered pain with walking since she had known him, and that the pain increased significantly over the years. She maintained that the Veteran's left knee would buckle. The Veteran's wife indicated that the Veteran had been told for decades that he would knee to have both knees replaced. She related that the Veteran had bone on bone for decades in his left knee, and that the injury led to significant arthritis. The Board notes that the evidence of record includes opinions, as to the etiology of the Veteran's claimed left knee disability, pursuant to a July 2014 statement from J. S., M.D.; an August 2014 VA knee and lower leg conditions examination report, with an April 2015 addendum opinion; a November 2015 VA physician statement; an August 2016 statement from L. H., M.D.; and a July 2021 statement from J. L., M.D. An August 2016 statement from L. H., M.D., indicates that there were records, which are dated from September 1969, March 1970, September 1970, and October 1970, that show that the Veteran had a left knee injury when he was in the service. Dr. L. H., reported that the Veteran also indicated that he did not play sports after his separation from the military, which was erroneously stated in a VA denial letter, and that he only played the listed sports while at the Naval Academy. Dr. L. H., reported that after the Veteran's left knee injury, he did not play soccer, lacrosse, or run cross country again. It was noted that the Veteran played the minimal amounts of sports required, which most likely exacerbated his left knee injury. Dr. L. H., stated that prior to the left knee injury, the Veteran engaged in parachute jumping, but that he was never able to participate in that activity again. Dr. L. H., indicated that the denial of the Veteran's claim should be reconsidered based on the information that it was more likely than not that the Veteran's left knee injury, while attending the Naval Academy, caused his current condition. Dr. L. H., also reported that there were military records that clearly show that the Veteran had a neck injury from a sudden 8.5G pull-up while riding in the backseat of a T-A4 aircraft in June 1977. Dr. L. H., stated that records dated on June 24, 1977, and June 28, 1977, should be reviewed. Dr. L. H., maintained that such initial injury more likely than not caused the progressive chronic neck pain from the Veteran had been suffering. The Board observes that the Veteran's service treatment records show that he was treated for left knee problems on multiple occasions, and that diagnoses, and/or notations, included a contusion; a medial meniscus injury; definite signs and symptoms of a chronic subluxing patella; and a history of mild laxity of the patella. The Board notes that post-service treatment records show treatment for left knee disabilities, including grade 4 chondrosis, with full-thickness chondral defects of the medial compartment of the left knee, complex tearing of the posterior horn and body of the medial meniscus of the left knee, irregular full-thickness and chondral fissuring/tearing and superficial tearing of the left knee, and a large, complex, ruptured Baker's cyst of the left knee; left knee pain; arthritis of the (left) knee; (left) knee pain secondary to an old anterior ligament disruption; arthritis, pain, and degenerative joint disease of the left knee; and for degenerative joint disease of the left knee. Additionally, the Veteran has stated that he suffered from left knee problems during service and since that time. The Board further notes that in a July 2021 lay statement, the Veteran's wife reported that she knew the Veteran well during the last part of his military service, and that he had suffered pain with walking since she knew him, and that the pain had increased significantly over the years. The Board observes that in an August 2016 statement, Dr. L. H., specifically found that that it was more likely than not that the Veteran's left knee injury, while attending the Naval Academy, caused his current condition. In light of the above, the Board finds that the August 2016 statement from L. H., as to the etiology of the Veteran's claimed left knee disability, is the most probative of record. The Board observes that the Veteran is currently diagnosed with a left knee disability, diagnosed as degenerative joint disease. The opinion provided by L. H., supports the Veteran's claim for service connection for a left knee disability, diagnosed as degenerative joint disease, on a direct basis. As such, service connection for a left knee disability, diagnosed as degenerative joint disease, is warranted. As the Board has granted service connection for a left knee disability, diagnosed as degenerative joint disease, on a direct basis, it need not address any other theories of service connection, such as secondary service connection. 2. Cervical Spine Disability The Veteran is service-connected for an unspecified insomnia disorder; status post an appendectomy; a surgical scar associated with status post an appendectomy; and for tinnitus. As discussed above, the Veteran is also now service-connected for a left knee disability, diagnosed as degenerative joint disease. The Veteran contends that he has a cervical spine disability that is related to service. He specifically maintains that he served as a pilot, and that he suffered a neck and/or cervical spine injury from a sudden 8.5G pull-up, while riding in the backseat of a T-A4 aircraft, during his period of service in June 1977. The Veteran asserts that he from suffered cervical spine problems during service, and recurrent cervical spine problems since service. The Veteran served on active duty in the Marine Corps from June 1967 to December 1979. A DD Form 214, for his period of active duty in the Marine Corps from June 1971 to December 1979, lists his occupational specialties as an F4B pilot for five years and two months, a ground safety specialist for four years, and as an embark officer for four years. The Veteran's service personnel records indicate that he was awarded the Parachutist Badge in August 1968. The Veteran's service treatment records show that the was treated for neck and/or cervical spine problems on occasions during service. A June 1977 treatment entry notes that the Veteran complained of back and neck pain since he was caught in an 8.5G pull-up. The assessment was a mild strain. A subsequent June 1977 entry notes that the Veteran complained of some pain and stiffness in the neck and upper back muscles. The assessment was a strain. A December 1979 entry notes that the Veteran complained of chronic low back pain. The Veteran stated that he had an ache/spasm in the back under the right scapula, which would come and go. The assessment was somewhat illegible, but apparently, was muscle strain. Post-service private and VA treatment records, including a VA examination report, show treatment for variously diagnosed cervical spine problems, including chronic, recurrent neck pain; a cervical disc disorder, unspecified, mid cervical region; and for degenerative arthritis of the cervical spine. At a June 2021 Board hearing, the Veteran's wife stated that while the Veteran was on active duty, he would complain that his neck was sore and that he had a stiff neck. She maintained that the Veteran had been bothered with neck pain since service for forty years. A July 2021 lay statement from the Veteran's wife indicates that she married the Veteran in 1979, and that she had known him well during the last part of his military service. She stated that she witnessed the Veteran complaining of severe neck pain that was caused during his military service by an unexpected 8.5G pullup in a jet that occurred when he was leaning down, while riding in a TA-4 aircraft. The Veteran's wife maintained that the Veteran's neck pain had continued throughout their life together. The Board notes that the evidence of record includes opinions, as to the etiology of the Veteran's claimed left knee disability, pursuant to a July 2014 statement from J. S., M.D.; an August 2014 VA knee and lower leg conditions examination report, with an April 2015 addendum opinion; a November 2015 VA physician statement; and an August 2016 statement from L. H., M.D. An August 2016 statement from L. H., M.D., indicates that there were records, which are dated from September 1969, March 1970, September 1970, and October 1970, that show that the Veteran had a left knee injury when he was in the service. Dr. L. H., reported that the Veteran also stated that he did not play sports after his separation from the military, which was erroneously indicated in a VA denial letter, and that he only played the listed sports while at the Naval Academy. Dr. L. H., related that after the Veteran's left knee injury, he did not play soccer, lacrosse, or run cross country again. It was noted that the Veteran played the minimal amounts of sports required, which most likely exacerbated his left knee injury. Dr. L. H., reported that prior to the left knee injury, the Veteran engaged in parachute jumping, but that he was never able to participate in that activity again. Dr. L. H., indicated that the denial of the Veteran's claim should be reconsidered based on the information that it was more likely than not that the Veteran's left knee injury, while attending the Naval Academy, caused his current condition. Dr. L. H., also reported that there were military records that clearly show that the Veteran had a neck injury from a sudden 8.5G pull-up while riding in the backseat of a T-A4 aircraft in June 1977. Dr. L. H., stated that records dated on June 24, 1977, and June 28, 1977, should be reviewed. Dr. L. H., maintained that such initial injury more likely than not caused the progressive chronic neck pain from the Veteran had been suffering. The Board observes that the Veteran's service treatment records show that he was treated for cervical spine complaints on occasions during service, and that he was diagnosed with a strain. The Board notes that post-service private and VA treatment records show treatment for variously diagnosed cervical spine problems, including chronic, recurrent neck pain; a cervical disc disorder, unspecified, mid cervical region; and for degenerative arthritis of the cervical spine. Additionally, the Board notes that the Veteran has reported that he suffered from neck and/or cervical spine problems during and since service. The Board further observes that the Veteran's wife has reported that she knew the Veteran well during the last part of his military service, that he complained of neck pain during service, and that his neck pain had continued throughout their life together. The Board observes that in an August 2016 statement, Dr. L. H., specifically found that the Veteran's initial neck injury in June 1977, from a sudden 8.5G pull-up while riding in the backseat of a T-A4 aircraft, caused the progressive neck pain from which he had been suffering. The Board finds that the August 2016 statement from L. H., as to the etiology of the Veteran's claimed cervical spine disability, is the most probative of record. The Board observes that the Veteran is currently diagnosed with a cervical spine disability diagnosed as degenerative arthritis. The opinion provided by L. H. supports the Veteran's claim for service connection for a cervical spine disability, diagnosed as degenerative arthritis, on a direct basis. As such, service connection for a cervical spine disability, diagnosed as degenerative arthritis, is warranted. As the Board has granted service connection for a cervical spine disability, diagnosed as degenerative arthritis, on a direct basis, it need not address any other theories of service connection, such as secondary service connection. 3. Bilateral Hearing Loss Impaired hearing will be considered to be a disability for VA purposes when the thresholds for any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz are 40 decibels or more; the thresholds for at least three of these frequencies are 26 decibels; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2016). One requirement for service connection is the current existence of the claimed disability. With regard to hearing loss, 38 C.F.R. § 3.385 defines what constitutes the current existence of a hearing loss disability. For service connection, it is not required that a hearing loss disability by the standards of 38 C.F.R. § 3.385 be demonstrated during service, although a hearing loss disability by the standards of 38 C.F.R. § 3.385 must be currently present, and service connection is possible if such current hearing loss disability can be adequately linked to service. Ledford v. Derwinski, 3 Vet. App. 87 (1992). The Veteran is service-connected for tinnitus. He is also service-connected for an unspecified insomnia disorder; status post an appendectomy; and a surgical scar associated with status post an appendectomy. As discussed above, the Veteran is now also service-connected for a left knee disability, diagnosed as degenerative joint disease, and for a cervical spine disability, diagnosed as degenerative arthritis. The Veteran contends that he has bilateral hearing loss that is related to service. He specifically maintains that he has bilateral hearing loss as a result of acoustic trauma while serving as a pilot. He reports that he was exposed to jet engine noise, and aircraft noise on the flight line. He also reports that he was exposed to noise from shooting guns, artillery, and helicopters at Quantico. The Veteran indicates that he first noticed a decline in his hearing during his period of service. The Veteran essentially asserts that his bilateral hearing loss was first experienced during service and has continued since that time. The Veteran served on active duty in the Marine Corps from June 1967 to December 1979. A DD Form 214, for his period of active duty in the Marine Corps from June 1971 to December 1979, lists his occupational specialties as an F4B pilot for five years and two months, a ground safety specialist for four years, and as an embark officer for four years. The Veteran's service personnel records indicate that he was awarded the Parachutist Badge in August 1968. The Veteran's service treatment records do not show a hearing loss disability in either ear as defined by 38 C.F.R. § 3.385. There is no specific evidence of hearing loss within the year after service as required for the presumption of service connection. Post-service private and VA treatment reports, including a VA examination report, show treatment for bilateral hearing loss under the provisions of 38 C.F.R. § 3.385. The evidence of record does show that the Veteran was exposed to in-service acoustic trauma and that he has been currently diagnosed with bilateral hearing loss, under the provisions of 38 C.F.R. § 3.385. The Board notes that there are opinions of record, as to the etiology of the Veteran's bilateral hearing loss, pursuant to a July 2014 statement from J. S., D.O., and a March 2015 VA audiological examination report. A July 2014 statement from Dr. J. S., indicates that due to the Veteran's fighter pilot status between 1971 to 1979, he was subject to extreme G force maneuvers and that his current neck pain, bilateral hearing loss, and tinnitus (from barotrauma) were likely related to his military service. A March 2015 VA audiological examination report includes a notation that the Veteran's claims file was reviewed. The Veteran reported that he was a pilot and a Naval flight officer during service. He stated that he was not in combat, but, as a pilot, he was exposed to jet engines on the flight line, as well as to aircraft noise in general. The Veteran indicated that he had occupational noise exposure as a pilot, for an airline organization, for thirty-four years after separating from the military. He denied that he had any recreational noise exposure. The examiner reported results that were indicative of bilateral hearing loss as defined by 38 C.F.R. § 3.385. The diagnoses were sensorineural hearing loss in the frequency range of 500 to 4000 Hertz in the right ear, and sensorineural hearing loss in the frequency range of 500 to 4000 Hertz in the left ear. The examiner indicated that the Veteran's right ear hearing loss and left ear hearing loss were not at least as likely as not (50 percent probability or greater) caused by, or a result of, an event during military service. The examiner stated that multiple audiograms were located while reviewing the Veteran's service treatment records, including two that were close to his enlistment, with one dated in September 1970 (one year prior to his enlistment), and the other dated in October 1971 (almost five months after his enlistment). The examiner reported that there was only one audiogram five months before the Veteran's separation in July 1979. The examiner maintained that all the audiograms reviewed, show a pattern of stable thresholds, and no significant shifts were seen during the Veteran's period of active service. The Board observes that Dr. J. S., indicated that due to the Veteran's fighter pilot status between 1971 to 1979, he was subject to extreme G force maneuvers and that his current bilateral hearing loss (from barotrauma) was likely related to his military service. The Board notes that there is no indication that Dr. J. S., reviewed the Veteran's claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, Dr. J. S., provided little in the way of a rationale for her opinion that the Veteran's bilateral hearing loss was likely related to his G force maneuvers during his military service. Therefore, the Board finds that the opinion from Dr. J. S., is not probative in this matter. The Board observes that the examiner, pursuant to the March 2015 audiological examination, following a review of the Veteran's claims file, indicated that the Veteran's bilateral hearing loss was not at least as likely as not caused by, or a result of, an event during military service. The examiner specifically indicated that all the Veteran's reviewed audiograms, during his period of service, show a pattern of stable thresholds, and no significant shifts were seen during the Veteran's period of active service. The Board notes that the examiner essentially found that the Veteran's bilateral hearing loss was not related to his period of service because he had normal audiograms during service. The Board observes, however, that in regard to the Veteran's bilateral hearing loss, the absence of documented hearing loss, as defined by VA, while in service is not fatal to a claim for service connection. See Ledford, 3 Vet. App. at 87. Additionally, when a Veteran does not meet the regulatory requirements for a disability at separation, he can still establish service connection by submitting evidence that a current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 159-160 (1993). The Board also notes that the examiner did not address the Veteran's reports of hearing problems during service and since service. The Veteran is competent to report in-service hearing problems, continuous hearing loss symptomatology since service, and current symptoms that form the basis for diagnosis of disability. See Davidson, 581 F.3d at 1313. Therefore, the Board finds that the VA examiner's opinions, pursuant to the March 2015 VA audiological examination report, are not probative in this matter. The Veteran is competent to report bilateral hearing problems during service and since that time. Moreover, the Board finds that his reports of noise exposure during service and bilateral hearing problems during and since service are credible. See also Jandreau v. Nicholson, 492 F.3d 1372 (2007). Resolving any doubt in the Veteran's favor, the Board finds that the Veteran has bilateral hearing loss that had its onset during his period of service. Service connection for bilateral hearing loss is warranted. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for a low back disability; a right hip disability; a left hip disability; and for a right knee disability. As discussed above, the Board has granted service-connection for a left knee disability, diagnosed as degenerative joint disease, and for a cervical spine disability, diagnosed degenerative arthritis. Given this change in circumstances, and to accord the Veteran due process, the RO should readjudicate the issues of entitlement to service connection for a low back disability; a right hip disability; a left hip disability; and for a right knee disability. The Veteran is service-connected for an unspecified insomnia disorder; status post an appendectomy; a surgical scar associated with status post an appendectomy; a left knee disability, diagnosed as degenerative joint disease; a cervical spine disability, diagnosed as degenerative arthritis, and for tinnitus. The Veteran contends that he has a low back disability; a right hip disability; a left hip disability; and a right knee disability, that are related to service, or, more specifically, are related to his now service-connected left knee disability, diagnosed as degenerative joint disease. The Veteran served on active duty in the Marine Corps from June 1967 to December 1979. A DD Form 214, for his period of active duty in the Marine Corps from June 1971 to December 1979, lists his occupational specialties as an F4B pilot for five years and two months, a ground safety specialist for four years, and as an embark officer for four years. The Veteran's service personnel records indicate that he was awarded the Parachutist Badge in August 1968. The Veteran's service treatment records show treatment for low back problems on occasions during service. Such records do not specifically show treatment for right and left hip problems, or for right knee problems. Post-service private and VA treatment records, including VA examination reports, show treatment for low back disabilities; right and left hip disabilities, and for right knee disabilities. The Board notes that the evidence of record includes opinions, as to the etiology of the Veteran's claimed disabilities, pursuant to a July 2014 statement from J. S., M.D.; an August 2014 VA back conditions examination report, an August 2014 VA knee and lower leg conditions examination report, and an August 2014 VA hip and thigh conditions examination report, all with April 2015 addendum opinions; and a July 2021 statement from J. L., M.D. The Board finds that all of the etiological opinions are inadequate. For example, there is no indication that Dr. J. S., and Dr. J. L., reviewed the Veteran's claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board notes VA examiner and VA physician opinions of record, respectively, were provided before service-connection was granted for a left knee disability, diagnosed as degenerative joint disease, and for a cervical spine disability, diagnosed degenerative arthritis. The Board notes that the examiner and physician were not able to address whether the Veteran's claimed disabilities were caused or aggravated by his now service-connected left knee disability, diagnosed as degenerative joint disease, and/or cervical spine disability, diagnosed degenerative arthritis. In El-Amin v. Shinseki, 26 Vet. App. 136 (2013), a decision issued by the United States Court of Appeals for Veterans Claims (Court), the Court vacated a decision of the Board where a VA examiner did not specifically opine as to whether a disability was aggravated by a service-connected disability. In light of the above, the Board finds that the Veteran should be afforded a VA examination with the opportunity to obtain responsive etiological opinions, following a thorough review of the record, as to his claims for service connection for a low back disability; a right hip disability; a left hip disability; and for a right knee disability. Such an examination must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for low back problems; right hip problems; left hip problems; and right knee problems, since December 2015. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed low back disability; right hip disability; left hip disability; and right knee disability. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed low back disability; right hip disability; left hip disability; and right knee disability. The claims file must be reviewed by the examiner. The examiner must diagnose all current low back disabilities; right hip disabilities; left hip disabilities; and right knee disabilities. The examiner must provide a medical opinion as to whether it is at least as likely as not that any currently diagnosed low back disabilities; right hip disabilities; left hip disabilities; and right knee disabilities, are related to, and/or had their onset during, the Veteran's period of service. The examiner must specifically acknowledge and discuss the Veteran's treatment for low back problems during service, and any reports of the Veteran of low back problems; right and left hip problems, and right knee problems, during and since his periods of service. The examiner must further opine as to whether the Veteran's service-connected disabilities, to specifically include his service-connected left knee disability, diagnosed as degenerative joint disease, and cervical spine disability, diagnosed as degenerative arthritis, caused or aggravated any currently diagnosed low back disabilities; right hip disabilities; left hip disabilities; and right knee disabilities. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, 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.