Citation Nr: 21070382 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 11-00 624 DATE: November 23, 2021 ORDER New and material evidence has not been received, and reopening of the claim for service connection for nicotine dependence is denied. New and material evidence has not been received, and reopening of the claim for service connection for coronary artery disease is denied. New and material evidence has not been received, and reopening of the claim for service connection for neuropathy of the legs is denied. New and material evidence has not been received, and reopening of the claim for service connection for loss of vision in the left eye is denied. Entitlement to service connection for cataracts is denied. Entitlement to service connection for atrial fibrillation is denied. Entitlement to service connection for obesity is denied. Entitlement to service connection for a cerebrovascular accident is denied. Entitlement to service connection for diabetes mellitus, type II, is denied. Entitlement to service connection for porokeratosis is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for hyperlipidemia is denied. Entitlement to service connection for bilateral sensorineural hearing loss is granted. Entitlement to degenerative joint and disc disease of the lower back is granted. FINDINGS OF FACT 1. Service connection for nicotine dependency acquired in service was denied in an August 2005 Board decision that was not appealed and became final as it pertains to this issue. 2. The evidence related to nicotine dependency received since the August 2005 Board decision is new but fails to show that his nicotine dependence can be related to service or service-connected disability. 3. Service connection for coronary artery disease was denied in an August 2005 Board decision that was not appealed and became final. 4. The evidence related to coronary artery disease received since the August 2005 Board decision is new but fails to show that the Veteran has coronary artery disease that may be related to service. 5. Service connection for neuropathy of the legs was denied in an August 2005 Board decision that was not appealed and became final. 6. The evidence related to neuropathy of the legs received since the August 2005 Board decision is new but fails to show that the Veteran has neuropathy of the legs that may be related to service. 7. Service connection for loss of vision in the left eye was denied in a November 2007 Board decision that was not appealed and became final. 8. The evidence related to loss of vision in the left eye received since the November 2007 Board decision is new but fails to show that the Veteran has loss of vision in the left eye that may be related to service. 9. The Veteran's cataracts did not have their onset in service and are not otherwise the result of a disease or injury incurred in service. 10. The Veteran's atrial fibrillation did not have its onset in service, is not otherwise the result of a disease or injury incurred in service, and was not incurred within a year of service. 11. The Veteran's obesity did not have its onset in service and is not otherwise the result of a disease or injury incurred in service; the increase in weight gain since service has also not been shown to be productive of functional impairment. 12. The Veteran's cerebrovascular accident did not have its onset in service, is not otherwise the result of a disease or injury incurred in service, and was not incurred within a year of service. 13. The Veteran's diabetes mellitus, type II, did not have its onset in service, is not otherwise the result of a disease or injury incurred in service, and was not incurred within a year of service. 14. The Veteran's porokeratosis did not have its onset in service and is not otherwise the result of a disease or injury incurred in service. 15. The Veteran's hypertension, did not have its onset in service, is not otherwise the result of a disease or injury incurred in service, and was not incurred within a year of service. 16. The Veteran's hyperlipidemia did not have its onset in service, is not otherwise the result of a disease or injury incurred in service, and was not incurred within a year of service; hyperlipidemia is also a laboratory finding that could result in disability that could be service connected, but is not itself a disability for VA benefits purposes. 17. Giving every reasonable doubt to the Veteran, his bilateral sensorineural hearing loss is related to service. 18. Giving every reasonable doubt to the Veteran, his degenerative joint and disc disease of the lower back is related to service. CONCLUSIONS OF LAW 1. The criteria for reopening the claim for service connection for nicotine dependency acquired in service have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. The criteria for reopening the claim for service connection for coronary artery disease have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for reopening the claim for service connection for neuropathy of the legs have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. The criteria for reopening of the claim for service connection for loss of vision in the left eye have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 5. The criteria for service connection for cataracts have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 6. The criteria for service connection for atrial fibrillation have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 7. The criteria for service connection for obesity have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 8. The criteria for service connection for a cerebrovascular accident have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 9. The criteria for service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 10. The criteria for service connection for porokeratosis have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 11. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 12. The criteria for service connection for hyperlipidemia have not been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 13. The criteria for service connection for bilateral sensorineural hearing loss have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385. 14. The criteria for service connection for degenerative joint and disc disease of the lower back have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1950 to May 1954. He was in combat in Korea. This claim was previously before the Board in October 2017 and January 2020, at which time the Board remanded it for additional development. The requested development has been completed, and the claim is properly before the Board for appellate consideration. Service Connection A previously denied claim may be reopened by the submission of new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence is defined as evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In Shade v. Shinseki, 24 Vet. App. 110, 118 (2010), the United States Court of Appeals for Veterans Claims (Court) stated that when determining whether the submitted evidence meets the definition of new and material evidence, VA must consider whether the new evidence could, if the claim were reopened, reasonably result in substantiation of the claim. Id. at 118. Thus, pursuant to Shade, evidence is new if it has not been previously submitted to agency decisionmakers and is material if, when considered with the evidence of record, it would at least trigger VA's duty to assist by providing a medical opinion, which might raise a reasonable possibility of substantiating the claim. Id. To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent." However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Service connection will also be presumed for certain chronic diseases, including type II diabetes mellitus, cardiovascular disease, and other organic diseases of the nervous system such as sensorineural hearing loss, if manifest to a compensable degree within one year after discharge from service. 38 C.F.R. §§ 3.307, 3.309. Such a chronic disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). In order for the presumption to apply, the claimant must be a veteran with 90 days of active, continuous service. 38 C.F.R. § 3.307(a)(1). In addition to the elements of direct service connection and presumptive service connection, service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Reopening of the claim for service connection for nicotine dependence is denied herein. Therefore, service connection cannot be granted for any disability secondary nicotine dependence or the use of tobacco products. A Veteran, or former reservist or member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service. 38 C.F.R. § 3.307(a)(7). If a Veteran served on Camp Lejeune during the time frame specified, kidney cancer, liver cancer, Non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer shall be service connected, even though there is no record of such disease during service. 38 C.F.R. § 3.309(f). The Veteran's service personnel records show that he served at Camp Lejeune from September 1950 to December 1951 and from November 1953 to May 1954. Therefore, the Veteran is presumed to have been exposed to contaminated water at Camp Lejeune since he served for at least 30 days there during the presumptive period. See 38 C.F.R. § 3.307(a)(7). In cases where a Veteran asserts service connection for injuries or disease incurred or aggravated in combat, 38 U.S.C. § 1154(b) and its implementing regulation, 38 C.F.R. § 3.304(d), are applicable. This statute and regulation ease the evidentiary burden of a combat Veteran by permitting the use, under certain circumstances, of lay evidence. If the Veteran was engaged in combat with the enemy, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that in the case of a combat Veteran, not only is the combat injury presumed, but so is the disability due to the in-service combat injury. Reeves v. Shinseki, 682 F.3d 988, 998-99 (Fed. Cir. 2012). To establish service connection, however, there must be evidence of a current disability and a causal relationship between the current disability and the combat injury. Id. (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The Veteran was not afforded a VA examination for cataracts, atrial fibrillation, obesity, a cerebrovascular accident, type II diabetes mellitus, porokeratosis, hypertension, a low back disability, and hyperlipidemia on the basis that there is already sufficient medical evidence to decide the claim, and the Board agrees. In McClendon v. Nicholson, 20 Vet. App. 79 (2006), the Court reviewed the criteria for determining when an examination is required by applicable regulation and how the Board applies 38 C.F.R. § 3.159(c). The three salient benchmarks are: competent evidence of a current disability or recurrent symptoms; establishment of an in-service event, injury, or disease; and indication that the current disability may be associated with an in-service event. While the Veteran had been diagnosed with cataracts, atrial fibrillation, obesity, a cerebrovascular accident, type II diabetes mellitus, porokeratosis, hypertension, a low back disability, and hyperlipidemia, there is no indication that they are related to the active service. Therefore, the Board finds that the evidence of record does not trigger the necessity of an examination in order to decide the claim on the merits. See 38 C.F.R. § 3.159(c). 1. Whether new and material evidence has been received to reopen the claim for service connection for nicotine dependency acquired in service Service connection for nicotine dependence was denied in an August 2005 Board decision. The Veteran did not appeal the August 2005 Board decision, and new and material evidence was not received during the appeals period. Therefore, the August 2005 Board decision became final. 38 C.F.R. § 20.1100. At the time of a June 1998 rating decision, the record contained an October 1997 statement from a private physician that the Veteran had been a chronic smoker for many years. The claim was denied because the record did not show that nicotine dependence was acquired in service. In March 1998 the Veteran wrote that he smoked for many years, and he noted the cost of cigarettes during his military service. Regarding the claim to reopen the previously denied claim, at a February 2002 VA examination the Veteran said that he started smoking in 1949 while in the Naval reserves and smoked two to three packs a day before quitting in the mid-1960s. He then smoked cigars until the 1970s. In October 2004 a VA examiner opined that the diagnosis of nicotine dependence cannot be confirmed as having developed during military service under the DSM-IV criteria for substance abuse disorder. In January 2005 E.S.F. wrote that he stayed at the Veteran's home from 1956 to 1958 while attending university, and they could not study together because the Veteran smoked two to three packs a day. The Veteran told him how difficult it was for him to quit smoking. Mr. F. "grew up with the Veteran" and did not recall him smoking prior to military service. An August 2005 Board decision considered the issue of entitlement to service connection for nicotine dependence in addition to whether secondary service connection was warranted for additional disability that arose from such dependence, and determined that entitlement to service connection for nicotine dependence was not warranted. A VA examiner opined in May 2006 that the Veteran did not develop a dependence on nicotine during service. It was noted that the Veteran had reported increasing his smoking level while in college after service. H.M.T.C. wrote in March 2009 that he had known the Veteran for more than 60 years and never saw him smoking prior to military service. The Veteran thereafter filed his application to reopen this claim in February 2009. In September 2011 Dr. O, a private treating physician, noted the Veteran's history of smoking during service. The law provides that, for claims filed after June 9, 1998, as in the instant case, service connection may not be granted on the basis that it resulted from disease or injury attributable to the use of tobacco products during active service. See 38 U.S.C. § 1103(a); 38 C.F.R. § 3.300. Furthermore, there is no basis on which to award service connection for tobacco use itself. While there has been new evidence since the August 2005 Board decision, it is not material because the claim must be denied as a matter of law since it is attributable to tobacco use, including during service. See 38 U.S.C. § 1103(a); 38 C.F.R. § 3.300. Therefore, the evidence does not and cannot possibly relate to an unestablished fact necessary to substantiate the claim since the claim cannot be granted under law. The claim is therefore not reopened. 38 C.F.R. § 3.156(b). 2. Whether new and material evidence has been received to reopen the claim of service connection for coronary artery disease Service connection for coronary artery disease was denied in an August 2005 Board decision. The Veteran did not appeal the August 2005 Board decision, and it became final. 38 C.F.R. § 20.1100. At the time of the August 2005 Board decision, the evidence of record included the service treatment records (STRs), which do not show any complaints, treatment, or diagnoses related to coronary artery disease. March 1998 VA treatment records noted a history of coronary artery disease that had progressed. No opinion was provided regarding etiology. The Veteran had a VA heart examination in February 2002 at which it was noted that he underwent a coronary artery bypass in July 1997 and a stent implant in October 1997. No opinion was provided on etiology. Regarding the claim to reopen the previously denied claim, VA treatment records show ongoing treatment for coronary artery disease without an opinion on etiology. While the VA treatment records are new evidence, they are not material because they do not tend to show that coronary artery disease is related to service or was incurred within a year of service. Therefore, the evidence does not relate to an unestablished fact necessary to substantiate the claim. The claim is therefore not reopened. 38 C.F.R. § 3.156(b). 3. Whether new and material evidence has been received to reopen the claim of service connection for neuropathy of the legs Service connection for neuropathy of the legs was denied in an August 2005 Board decision. The Veteran did not appeal the August 2005 Board decision, and it became final. See 38 C.F.R. § 20.1100. At the time of the August 2005 Board decision, the evidence of record included the STRs, which do not show any complaints, treatment, or diagnoses related to coronary artery disease. A February 1996 VA examination report states that the Veteran had had diabetic neuropathy since 1990. There were cramps in the legs and loss of balance. The Veteran had a VA examination in May 2004 at which it was noted that Social Security records shows decreased sensation in the lower extremities due to peripheral autonomic neuropathy in 1992. He reported pain and numbness in the lower extremities at the time of the May 2004 VA examination. The diagnosis was peripheral sensory motor neuropathy in the lower extremities and intermittent claudication due to peripheral vascular disease. Both conditions were due to diabetes mellitus. The examiner noted that there was no evidence in the STRs of peripheral neuropathy, and that the post-service records do not show peripheral neuropathy until 1990. Regarding the claim to reopen the previously denied claim, VA treatment records show ongoing neuropathy of the lower extremities. Service connection for lower extremity neuropathy cannot be granted as due to diabetes mellitus as a matter of law because the claim for service connection for diabetes mellitus, type II, is denied herein. While the VA treatment records are new evidence, they are not material because they do not tend to show that neuropathy of the legs is related to service or was incurred within a year of service. Therefore, the evidence does not relate to an unestablished fact necessary to substantiate the claim. The claim is therefore not reopened. 38 C.F.R. § 3.156(b). 4. Whether new and material evidence has been submitted to reopen the claim for service connection for loss of vision in the left eye Service connection for loss of vision in the left eye was denied in an August 2005 Board decision. The Veteran did not appeal the August 2005 Board decision, and it became final. See 38 C.F.R. § 20.1100. At the time of the August 2005 Board decision, the evidence of record included the STRs, which do not show any complaints, treatment, or diagnoses related to coronary artery disease. A February 1996 VA general medicine examination reports says that diabetic retinopathy was suspected since 1982 and that there was a refraction error. The Veteran also had a VA diabetes examination in February 1996, at which he was diagnosed with diabetic retinopathy. In February 2000 a private treating ophthalmologist wrote that the Veteran had a left eye condition that decreased depth perception, and vision with the best correction was 20/500. The Veteran had a VA eye examination in November 2006 at which he was diagnosed with a profound visual impairment of the left eye most probably due to ischemic optic neuropathy. Regarding the claim to reopen the previously denied claim, the Veteran had a VA examination in September 2008 at which it was noted that he had poor left eye vision after a cerebrovascular accident. The Veteran was diagnosed with left eye profound visual impairment and left eye possible sectoral ischemic optic neuropathy. The record shows continued left eye vision impairment. While the VA treatment records are new evidence, they are not material because they do not tend to show that left eye vision loss is related to service or was incurred within a year of service. Therefore, the evidence does not relate to an unestablished fact necessary to substantiate the claim. The claim is therefore not reopened. 38 C.F.R. § 3.156(b). 5. Entitlement to service connection for cataracts The STRs do not show any complaints, treatment, or diagnoses related to cataracts. The Veteran was diagnosed with bilateral senile cataracts at the November 2006 VA eye examination. Subsequent VA treatment records show a diagnosis of bilateral senile cataracts. June 2019 VA treatment records indicate that the Veteran had bilateral age related nuclear cataracts. While the Veteran has made statements to the effect that he feels that his cataracts are related to service, he is not competent to make such a determination, because the question of whether they are related to service is a medical question. His statements on etiology are therefore afforded little, if any, probative value. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2009). There are no competent opinions that the Veteran's cataracts are related to service. Because the evidence preponderates against the claim of service connection for cataracts, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 6. Entitlement to service connection for atrial fibrillation The STRs do not show any complaints, treatment, or diagnoses related to atrial fibrillation. At November 2004 VA treatment the Veteran was noted to have de novo atrial fibrillation. Subsequent VA treatment records show a diagnosis of chronic atrial fibrillation, without an opinion on etiology. While the Veteran has made statements to the effect that he feels that his cataracts are related to service, he is not competent to make such a determination, because the question of whether they are related to service is a medical question. His statements on etiology are therefore afforded little, if any, probative value. See Jandreau, 492 F.3d at 1376-77. There are no competent opinions that the Veteran's atrial fibrillation is related to service. Furthermore, the record does not show that atrial fibrillation was incurred within a year of service. Because the evidence preponderates against the claim of service connection for atrial fibrillation, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-57. 7. Entitlement to service connection for obesity The May 1954 discharge examination report notes that the Veteran was 69 inches tall and weighed 170 pounds. The Veteran weighed 190 pounds at the February 1996 VA general medicine examination, which was noted to be overweight, but this was 42 years after service and there is no indication in the record that such an increase in his weight was related to service or service-connected disability, or that any functional impairment resulted from such weight gain. He weighed 205 pounds at the February 2002 VA heart examination. Subsequent VA treatment records include obesity in the problem list. Although obesity is not ratable under the rating schedule, it can be a disability under 38 U.S.C. §§ 1110, 1131. Larson v. McDonough, 10 F.4th, 1325, 1328-29 (Fed. Cir. 2021); see also Saunders v. Wilkie, 886 F.3d 1356, 1358 (Fed. Cir. 2018). While the Veteran has made statements to the effect that he feels that his obesity is related to service, he is not competent to make such a determination, because the question of whether it is related to service is a medical question. His statements on etiology are therefore afforded little, if any, probative value. See Jandreau, 492 F.3d at 1376-77. There are no competent opinions that the Veteran's obesity is related to service or to the service-connected tinnitus, tonsillectomy, or bladder carcinoma. Because the evidence preponderates against the claim of service connection for obesity, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-57. 8. Entitlement to service connection for a cerebrovascular accident 9. Entitlement to service connection for diabetes mellitus, type II 10. Entitlement to service connection for porokeratosis 11. Entitlement to service connection for hypertension 12. Entitlement to service connection for hyperlipidemia The STRs do not show any complaints, treatment, or diagnoses related to a cerebrovascular accident, diabetes mellitus, porokeratosis, hypertension, and hyperlipidemia. At the discharge examination, blood pressure was 120/56. The Veteran was noted to have borderline blood pressure at the February 1996 VA examination. Subsequent VA treatment records show a diagnosis of hypertension. In January 2019 the Veteran suffered a hypertensive crisis, and it was noted that he was not compliant with his medication. At a February 1996 VA general medicine examination, it was noted that the Veteran had a history of non-insulin dependent diabetes going back 15 years. The Veteran also had a diabetes VA examination in February 1996 at which he was diagnosed with diabetes mellitus, type II, diabetic retinopathy, and diabetic nephropathy. The Veteran said he had had diabetes for many years. Subsequent VA treatment records show a diagnosis of and treatment for diabetes without an opinion on etiology. In March 2019 the Veteran was treated for hyperglycemia. VA treatment records show that the Veteran had an acute cerebrovascular accident in November 2004. In January 2007 the Veteran presented to VA treatment with dizziness. A head CT scan was unremarkable, but it was noted that an early cerebrovascular accident could not be ruled out. A follow up CT scan showed no acute changes. The Veteran had a right thalamic infarction in February 2017 and an interventricular hemorrhage in June 2017 after falling and hitting his head. VA treatment records from January 2006 show a diagnosis of hyperlipidemia and that the Veteran was to continue on a statin. Problem lists from VA treatment since February 2009 include a diagnosis of porokeratosis. There is no opinion on etiology in the treatment records for hyperlipidemia or porokeratosis. While the Veteran has made statements to the effect that he feels that his cerebrovascular accidents, diabetes mellitus, porokeratosis, hypertension, and hyperlipidemia are related to service, he is not competent to make such a determination, because the question of whether they are related to service is a medical question. His statements on etiology are therefore afforded little, if any, probative value. See Jandreau, 492 F.3d at 1376-77. There are no competent opinions that the Veteran has had a cerebrovascular accident, or diabetes mellitus, porokeratosis, hypertension, and hyperlipidemia, that is related to service. Furthermore, the record does not show that a cerebrovascular accident, diabetes mellitus, type II, hypertension, or hyperlipidemia was incurred within a year of service. Finally, the Board finds that hyperlipidemia is a laboratory finding that could result in disability that could be service connected, but is not itself a disability for VA benefits purposes. Because the evidence preponderates against the claims for service connection for cerebrovascular accident, diabetes mellitus, porokeratosis, hypertension, and hyperlipidemia, the benefit of the doubt doctrine is inapplicable, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-57. 13. Entitlement to service connection for bilateral sensorineural hearing loss For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, or 4000 Hz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Even if disabling loss is not demonstrated at separation, a veteran may establish service connection for a current hearing disability by submitting evidence that a current disability is causally related to service. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993). The Board initially acknowledges that the lack of any evidence showing the Veteran had hearing loss during service is not fatal to his claim for service connection. The laws and regulations do not strictly require in-service complaint of, or treatment for, hearing loss in order to establish service connection. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Instead, the Court of Appeals for Veterans Claims has held where there is no evidence of the veteran's claimed hearing disability until many years after separation from service, "[i]f evidence should sufficiently demonstrate a medical relationship between the veteran's in-service exposure to loud noise and his current disability, it would follow that the veteran incurred an injury in service..." Hensley, supra, (quoting Godfrey v. Derwinski, 2 Vet. App. 352, 356 (1992)). Therefore, the critical question is whether the veteran has current hearing loss disability which is causally related to service. The Veteran's STRs show that at the May 1954 discharge examination, right and left whispered voice tests were 15/15. At May 2002 VA treatment the Veteran reported bilateral hearing loss for some time. On the audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 25 35 45 55 LEFT 15 25 35 30 45 The Veteran was diagnosed with mild to severe sensorineural hearing loss at higher frequencies with slightly reduced word recognition scores. In September 2011 Dr. O wrote that the Veteran watched television and listened to the radio at higher than normal volumes. He needed people to repeat things, and being in a crowded place made it difficult for him to understand conversations. It was noted that the Veteran was exposed to high frequency firearm noise during service. Dr. O opined that this was more probably than not the cause of the Veteran's hearing loss and wrote that prolonged exposure to high intensity noises causes permanent damage in the inner structures of the ears. The Veteran had an examination arranged through VA in April 2019. On the audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 40 55 70 70 75 LEFT 40 45 60 70 75 Speech audiometry revealed speech recognition ability of 76 percent in the right ear and 84 percent in the left ear. The Veteran was diagnosed with bilateral sensorineural hearing loss, and the examiner opined that it was less likely than not related to service. The examiner wrote that the normal whispered voice test from discharge excludes the presence of a significant hearing deficit at that time. It was noted that hearing loss was first identified in May 2002, which was 48 years after separation from service. Hearing deficits appear immediately after a noise trauma, or gradually during the exposure period. There would not be a retroactive effect with hearing loss developing so many years after military noise exposure. Probative value cannot be given to the April 2019 examiner's opinion because the May 2002 treatment records show that the Veteran reported having had hearing loss for years, and the Veteran is competent to report that. 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); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("[M]ost of the probative value of a medical opinion comes from its reasoning" and the Board "must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion."). Furthermore, the Veteran's reports at the May 2002 treatment of having had hearing loss for many years is credible. The Veteran's reports of noise exposure during service are consistent with the circumstances of his being in combat in Korea. See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). Probative value is given to Dr. O's opinion since it is based on a review of the record and consideration of military noise exposure. See Hensley, 5 Vet. App. at 160. When there is an approximate balance of positive and negative evidence regarding a material issue, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. § 3.102. As the evidence is at least in equipoise, service connection for bilateral hearing loss is granted. 14. Entitlement to service connection for a low back disability The STRs do not show any complaints, treatment, or diagnoses related to a low back disability. At the February 1996 VA general medicine examination, the Veteran was noted to have degenerative joint disease, arthritis, and low back pain. A November 2006 MRI of the lumbar spine showed a small disc protrusion at L4-L5 and L5-S1. Dr. O opined in her September 2011 letter that the Veteran's back problem that include degenerative changes and small disc protrusion at L4-L5 and L5-S1, is more probably than not service connected due to the duties performed during service. It was noted that the Veteran injured his back during service as a result of training and performing duties with heavy equipment. The STRs do not show complaints related to a back injury during service, and other than Dr. O's letter, the record does not show a report of a back injury during service. However, the Veteran has credibly reported the onset of his symptoms and there is no evidence that directly contradicts his assertion. The Board further notes that as arthritis and diseases of the nervous system are chronic diseases, the Veteran's statements of continuing symptoms since service constitute further evidence of a link between his current disabilities and service. Therefore, the Board will give the Veteran every benefit of the doubt, and find that service connection for degenerative disc and joint disease of the lower back is also warranted. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Scott Shoreman, 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.