Citation Nr: 21070657 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-65 109 DATE: November 24, 2021 ORDER Entitlement to service connection for bilateral hearing loss disability is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. Bilateral hearing loss manifested more than one year after separation, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. Tinnitus manifested more than one year after separation, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 3. Hypertension manifested more than one year after separation, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. A bilateral hearing loss disability was not incurred in or aggravated by service, and such incurrence may not be presumed. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2021). 2. A tinnitus disability was not incurred in or aggravated by service, and such incurrence may not be presumed. 38 U.S.C. §§ 1101, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2021). 3. A hypertension disability was not incurred in or aggravated by service, and such incurrence may not be presumed. 38 U.S.C. §§ 1101, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1975 to January 1977. This case comes before the Board of Veterans' Appeals (Board) on appeal from September 2015 and December 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO), in Oakland, California. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in a virtual conference hearing in August 2021. A transcript of the hearing is of record. Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2021). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Service Connection General Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Depending on the evidence and the contentions of record in a particular case, lay evidence can be competent and sufficient to establish a diagnosis and medical etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The United States Court of Appeals for Veterans Claims held that "when audiometric test results at a veteran's separation from service do not meet the regulatory requirements for establishing a 'disability' at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service." In evaluating claims of service connection for hearing loss, it is observed that the threshold for normal hearing is from zero to 20 decibels, with higher threshold levels indicating some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 160 (1993). To make this determination, the Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include organic diseases of the nervous system such as sensorineural hearing loss and tinnitus, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For organic diseases of the nervous system, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). Service connection for hearing loss can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service-connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303(b). For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. Id. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. Proof of a current disability is a threshold to establishing service-connection for any claimed disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). To be a present as a current disability, there must be evidence of the condition at some time during the appeals period. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a 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. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Evidence Bilateral Hearing Loss and Tinnitus The Veteran, who served on active duty to include as a medical corpsman from January 1975 to January 1977, filed a claim for entitlement to service connection for bilateral hearing loss and tinnitus in March 2015. The Veteran asserted during his August 2021 Board hearing before the undersigned Veterans Law Judge that his hearing had started to decline in the last five to ten years, and that he also had developed tinnitus in that time. The Veteran's induction examination of January 1975 was silent for any hearing problems, and hearing acuity was considered normal, though no readings from an audiometer were on the examination form. The remainder of the service medical records, including a January 1977 separation examination, indicated normal hearing. The Veteran's entire record is silent for any complaint relating to hearing loss or tinnitus. First, the evidence of record demonstrates that the Veteran has a current bilateral hearing loss disability that comports with VA's definition of disability resulting from hearing impairment. For 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 of 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran was provided a VA examination in September 2015. The VA audiologist deemed the test results valid for VA ratings evaluations. The report contains minimal information concerning the Veteran's statements during examination but shows that he reported having difficulty hearing other people's voices unless he was looking straight at them. The examiner declined to make a finding of acoustic trauma in service or any routine exposure to hazardous noise, based on the Veteran's military occupational position as a Navy hospital corpsman. The Veteran denied any recreational noise exposure. Examination revealed mixed hearing loss between the two ears and sensorineural hearing loss, with both ears showing significant hearing loss at 4000 Hz and higher frequencies. For the test frequencies of 500, 1000, 2000, 3000, and 4000 Hertz, the results were 15, 5, 10, 25, and 55 for the right ear, and 5, 5, 5, 20, and 75 for the left ear. Maryland CNC testing was 98 percent for the right ear, and 98 for the left. The puretone threshold average was 24 decibels for the right ear and 26 for the left ear. This audiologist conducted additional air conduction and bone conduction testing of the Veteran's hearing, and determined such testing indicating the Veteran's hearing was in normal limits on each the right side and the left side. This examiner also noted the complaints of tinnitus by the Veteran and considered the tinnitus to have had the same etiology of the Veteran's hearing. The Veteran described his tinnitus as annoying but that he has learned to live with it. In an opinion for service connection also dated September 2015, the examiner concluded that the Veteran's bilateral hearing loss was less likely than not, less than 50 percent probability, caused by any acoustic trauma or exposure to hazardous noise in service, noting that the Veteran's January 1977 separation examination showed no complaints of hearing loss, and from the end of active service in January 1977, that he had not complained of hearing loss with VA until March 2015. This examiner also provided a negative opinion for the Veteran's claim for tinnitus, noting it was less likely than not, less than 50 percent probability, that the Veteran's claimed tinnitus was incurred in or the result of any acoustic trauma or exposure to hazardous noise in service. The examiner's rationale was that the tinnitus has not been continuous since service ended in 1977, and only started in the five to ten years, per the Veteran. The Board notes the presence of private medical records from 2014 that indicate complaints about his hearing and the presence of tinnitus, but these records do not include audiograms or any statements regarding etiology. The Board notes the Veteran received regular medical care at VA facilities as early as August 1998, and VA physical examination notes from October 2004, November 2004, November 2005, March 2006, June 2006, November 2007, November 2008, and March 2010 are expressly silent for complaints or discussion about any hearing loss or any problems with tinnitus. There are no private audiograms of record. 1. Entitlement to service connection for bilateral hearing loss disability The record establishes the Veteran has current hearing loss considered disabling for VA purposes. However, the Board does not concede hazardous noise exposure while in service. The Board notes the Veteran served in the United States Navy as a hospital corpsman at a west coast naval base, and has no documented service outside of medical facilities located in that west coast naval base. As such, the preponderance of the evidence is against the Veteran's claim of service connection for a hearing loss disability of either the left ear or the right ear. The Veteran's lay statement contrasts with a negative nexus opinion from a VA examiner and audiologist. The Board notes there is no additional evidence in the Veteran's favor, beyond his own statements, that establishes a nexus between the noise exposure in service, and the current hearing loss of the Veteran. Ultimately, in weighing medical evidence, "[i]t is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent that the Veteran has asserted his personal belief that there exists a medical relationship between his hearing loss and his service, this provides no basis for allowing the claim. The Veteran is a lay person and is not medically trained and competent to assert an opinion regarding the nexus of his in-service exposure and current hearing loss first evaluated 38 years after service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (Lance, J., concurring). See also Maxson v. West, 12 Vet. App. 453 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a long period of time post-service without symptoms may be used to infer a lack of nexus). Hence, the Veteran's lay belief regarding nexus has no probative value on the facts of this case. The simple notation of a subjective history of noise exposure does not constitute an opinion that it is the cause of the current hearing loss disability, or necessarily imply causation. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995). Thus, the preponderance of the evidence is against a finding of a nexus between the current disability and the in-service noise exposure, and therefore service connection for a bilateral hearing loss disability is not warranted on a direct basis. 38 C.F.R. § 3.303. Bilateral hearing loss is considered an organic disease of the nervous system, and therefore service connection based on the presumption in favor of chronic diseases and continuity of symptomatology are potentially applicable. Walker, 708 F.3d 1331; 38 C.F.R. §§ 3.303(b), 3.309. However, the Veteran's service treatment records are silent for a diagnosis of bilateral hearing loss during service and the only in-service audiogram, accomplished at service separation, was within normal limits. See 38 C.F.R. § 3.385. Significantly, the Veteran has not specifically asserted a continuity of symptomatology existing since service, but only his lay assertions of the belief that his hearing loss is related to service. The Veteran specifically denied any current or past hearing loss at his separation examination in January 1977. There are no private treatment records after that time that suggest the Veteran has any hearing disability. Specifically, the first evidence of hearing loss is an assertion by the Veteran when seeking VA care in 2015, approximately 38 years after his separation from service. As there is no competent and credible evidence of sufficient manifestations of bilateral hearing loss either during service or within the first post-service year, or of a continuity of symptomatology since service, service connection based on the presumption in favor of chronic diseases or continuity of symptomatology is not warranted. Walker, 708 F.3d 1331; 38 C.F.R. §§ 3.303(b), 3.309. Although the Veteran has established a current disability, the Board does not concede in-service exposure to hazardous noise, and as such the preponderance of the evidence weighs against a finding that the Veteran's bilateral hearing loss disability is causally related to his service or manifested within an applicable presumptive period. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 2. Entitlement to service connection for tinnitus The Veteran has reported that he currently has tinnitus, which he is competent to report. Jandreau, 492 F.3d at 1377; Charles v. Principi, 16 Vet. App. 370, 374 (2002) (a layperson is capable of observing tinnitus). Further, as noted in the discussion of the bilateral hearing loss disability above, the Veteran has alleged that he was exposed to loud noises as part of his military service. However, as with the bilateral hearing loss disability discussed above, the Board does not find evidence of acoustic trauma and hazardous noise exposure in service, given the Veteran's service as a hospital corpsman at a west coast naval base and no service afloat. The preponderance of the evidence is against a finding that the Veteran's tinnitus is related to service. The Veteran has stated, most recently during the September 2015 VA examination, his tinnitus was first noticed with no specific date of onset beyond "five to ten years ago" and has continued since. The Board has previously noted that the Veteran denied reports of tinnitus with his regular VA examinations and treatment visits from 1998 to March 2017. In this case, the Veteran denied any current or prior hearing or ear problems on his January 1977 audiological examination prior to his separation that same month. There is no complaint by the Veteran in the record of tinnitus until March 2015, when the Veteran complained of tinnitus. Based on these inconsistencies, the Board finds that the Veteran's statements concerning the onset of tinnitus and its persistence since to be not credible, and therefore are entitled to no probative weight. A VA audiological examination and opinion were obtained in September 2015, and the Veteran's complaints of tinnitus were noted. Tinnitus was diagnosed on this examination, and the examiner recorded the Veteran as saying that the tinnitus began in the last "five to ten years." That would mean the tinnitus began approximately 28 years after service at the earliest. The examiner also noted, however, that the Veteran did not complain of recurrent tinnitus since service, but rather described periodic and transient ear noise. The examiner indicated that it was less likely than not (less than 50 percent probability) that the Veteran's tinnitus was causally related to his active service, noting that while the Veteran reported periodic tinnitus, he also expressly denied any current or prior ear trouble on his separation from service in 1977. The examiner also noted the medical authority in the audiological field that defined tinnitus, and that she considered the Veteran's transient ear noise to be not from auditory damage or pathology. It was thus unlikely, the examiner opined, that the Veteran's complaints were consistent with noise-induced tinnitus and therefore less likely than not related to military noise exposure. There is no evidence that the examiner was not competent or credible, and as the opinion considered the Veteran's lay statements concerning onset and was based on a review of the file, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez, 22 Vet. App. 295. None of the treatment records indicate the Veteran's tinnitus is causally related to service. Based on the foregoing, the Board finds that the preponderance of the evidence is against a finding of a nexus between the current tinnitus and the Veteran's active service. As noted above, the Veteran is a layman and his statements regarding etiology of this condition have no probative weight. As such, the there is no competent and credible evidence of record concerning the presence of a nexus. As the preponderance of the evidence is against a finding of a nexus between the current tinnitus and the Veteran's in-service noise exposure, the Board finds that entitlement to service connection for tinnitus is not warranted on a direct basis. 38 C.F.R. § 3.303. Tinnitus is an organic disease of the nervous system, and is therefore considered a chronic disease for VA purposes and service connection based on the presumption in favor of chronic diseases and continuity of symptomatology is applicable in this case. Fountain v. McDonald, 27 Vet. App. 258, 27172 (2015). However, as noted above, there is no competent and credible evidence that tinnitus had its onset either in service or within the first post-service year. While the Veteran has stated that his tinnitus had its cause in service, he denied any current or history of ear trouble in the January 1977 separation examination and a report of medical history. Service treatment records are silent for a diagnosis or complaints of tinnitus during service, and the first post-service record noting a complaint of any hearing disability is from March 2015 on the Veteran's written claim, approximately 38 years after his separation from service. As there is no competent and credible evidence of manifestations either in service or within the first post-service year, entitlement to service connection for tinnitus based on the presumption in favor of chronic diseases or continuity of symptomatology is not warranted in this case. Walker, 708 F.3d 1331; 38 C.F.R. §§ 3.303(b), 3.309. The preponderance of the evidence weighs against a finding that the Veteran's tinnitus is causally related to his service or manifested within an applicable presumptive period. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz, 274 F.3d at 1364; Gilbert, 1 Vet. App. at 5557; 38 C.F.R. § 3.102. For these reasons, the claim is denied. Evidence and Analysis Hypertension The Veteran originally claimed entitlement to service connection for hypertension in March 2015. He contended that he had had hypertension since leaving active service in 1977 based on one in-service report of a high blood pressure reading. The Veteran's service treatment records contain one mention, complaint, or treatment for hypertension, in July 1976 where an elevated blood pressure reading was recorded, with a notation for "pressure/nerves." The Veteran's separation examination from January 1977 notes no problems at all with hypertension. VA provided the Veteran with a compensation and pension examination in December 2015 to address his hypertension claim. The examiner diagnosed the Veteran with essential hypertension, with an original diagnosis date of September 2013, based on a VA treatment note. The examiner noted the Veteran's statement during the examination that he thought his hypertension originated around 1993. This VA examiner provided a negative opinion for service connection, saying it was less likely than not, less than 50 percent probability, that the Veteran's hypertension was related to service. The examiner noted the one July 1976 high blood pressure reading, but qualified that single event as insignificant for a diagnosis of hypertension. The Veteran did not have a history of diastolic blood pressure elevation to predominantly 100 or more in his claims file. The Veteran could not recall any symptoms related to hypertension or the medications that might be used to treat it, and said he was not currently taking any medication for the hypertension itself. The Board finds the December 2015 VA examination and opinion to be of great probative value. Indeed, the examiners considered the Veteran's contention, the claims file, and clinical medical evidence before providing a negative opinion in each instance. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner's negative opinion was supported by a sufficiently clear and well-reasoned medical rationale and was consistent with the verifiable facts regarding the Veteran's contentions. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005). The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disability is related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; "[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge." Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to testify about his symptoms relating to his claimed hypertension disability. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of a hypertension disability. See 38 C.F.R. § 3.159(a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno v. Brown, 6 Vet. App. 465 (1994); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his assertions to that effect are of no probative value. In addition, the Board finds that the 38-year gap in time between the Veteran's last date of active service, in January 1977, to his claim or an initial evaluation by any medical provider regarding his hypertension in March 2015 to be probative of a lack of nexus between the diagnosed current disability and active service. A negative inference may be drawn from the absence of complaints or treatment for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board notes the presence of private medical records from 2014 that indicate complaints about his hearing and the presence of possible hypertension, but these records do not include further examination or any statements regarding etiology. There is no competent medical opinion of probative value in favor of a positive nexus to service from any VA or private medical examiner. Upon review of the record, the Board concludes that entitlement to service connection for a hypertension disability is not warranted. The Board notes a current diagnosis of the hypertension disability, and thus the requirement for a current disability is shown. The Board acknowledges the Veteran's contentions, and the Veteran's post-service statements are noted. However, the Veteran's service medical records, to include all examinations, are silent for any existing chronic hypertension or related condition at the time of separation, and, and there is no competent evidence to tie the current assertion to any in-service disease or injury. A December 2015 VA examiner has extensively discussed all of the Veteran's hypertension claims and evidence. The VA examiner who provided the negative nexus opinion opined with sufficient rationale that the Veteran's hypertension disability is not related back to active service, in any regard. The Board thus finds the Veteran fails the third prong of the test for entitlement to direct service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran's claimed hypertension disability was not incurred in service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a hypertension disability on a direct or presumed basis, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Setter, 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.