Citation Nr: 21073207 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 14-39 609 DATE: December 7, 2021 ORDER Entitlement to service connection for bilateral hearing loss is granted. Entitlement to service connection for tinnitus, secondary to service connected hearing loss on a causation basis, is granted. Entitlement to service connection for obstructive sleep apnea (OSA) is granted. Entitlement to service connection for asthma is granted. Entitlement to service connection for right spermatocele due to exposure to ionizing radiation is denied. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran's bilateral hearing loss is related to service. 2. The Veteran's tinnitus is caused by his bilateral hearing loss. 3. The evidence is at least evenly balanced as to whether the Veteran's OSA had its onset during service. 4. The evidence is at least evenly balanced as to whether the Veteran's asthma had its onset during service. 5. The Veteran's right spermatocele was not caused by exposure to ionizing radiation during service, and is not otherwise related to service. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.385. 2. The criteria for service connection for tinnitus, secondary to bilateral hearing loss on a causation basis, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.310. 3. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for OSA have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for asthma have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for entitlement to service connection for a right spermatocele have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1987 to September 1991, September 2005 to December 2005, and from September 2006 to January 2007. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for, among one other thing, hearing loss and tinnitus, a February 2015 rating decision which, inter alia, denied service connection for right spermatocele, and a May 2016 rating decision which, among other things, denied service connection for asthma and OSA. In May 2014, the Veteran filed his notice of disagreement with the denials of service connection for hearing loss and tinnitus, was issued a statement of the case in October 2014, and in November 2014 perfected his appeal to the Board. In April 2015, the Veteran filed his notice of disagreement with, among other things, the denial of service connection for right spermatocele, was issued a statement of the case in July 2017, and in August 2017 perfected his appeal to the Board. In June 2016, the Veteran filed his notice of disagreement with the denials of service connection for asthma and sleep apnea, and in July 2017 was issued a statement of the case and perfected his appeal to the Board. In May 2017, the Board remanded the Veteran's claims for, among other things, tinnitus, hearing loss, and right spermatocele for additional development to include new VA examinations to determine the etiology of the disabilities. In September 2017, the RO continued its denial of the Veteran's claims for, among other things, service connection for hearing loss and tinnitus, notifying the Veteran in a supplemental statement of the case. In July 2018, the Board, among other things, remanded the Veteran's claims for service connection for hearing loss, tinnitus, asthma, OSA, and right spermatocele for new VA examinations and medical opinions. In September 2020, the RO continued its denial of the Veteran's claims for service connection for hearing loss, tinnitus, asthma, OSA, and right spermatocele, notifying the Veteran in a supplemental statement of the case. In December 2020, the Board again remanded the Veteran's claims for service connection, finding further development necessary for adjudication. In an August 2021 supplemental statement of the case, the Veteran was notified that the RO continued the denials of his claims for service connection. The Veteran requested a Board hearing with a Veterans Law Judge which was scheduled for August 24, 2021. However, in an August 2021 letter, the Veteran's attorney notified the Board that the Veteran wished to withdraw his request for a hearing. Therefore, the Board considers the hearing request withdrawn, and will proceed to adjudicate the case based on the evidence of record. See 38 C.F.R. § 20.704 (d). The Board notes that in an August 2015 rating decision, the RO granted service connection for OSA, evaluating it as noncompensable. However, in a May 2016 rating decision, the RO denied the claim for service connection for OSA, and subsequent rating decisions and code sheets indicate that service connection has not been granted. As the August 2015 decision granting service connection for OSA does not appear to have been promulgated, the Board will adjudicate the Veteran's claim for service connection for OSA. SERVICE CONNECTION Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (b). 1. Hearing Loss and Tinnitus A hearing loss disability is defined for VA compensation purposes with regard to audiologic testing involving pure tone frequency thresholds and speech discrimination criteria. 38 C.F.R. § 3.385. For purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. Id. The Veteran's personnel records reflect that he participated as a member of the firefighting team, magazine ammunition handler, dry cleaning machine operator, and laundry press operator among other things. The Veteran's September 1987 medical examination report upon enlistment reflects normal ears and his September 1987 audiological examination reads as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 20 20 5 LEFT 15 20 20 20 20 A September 1987 audiology examination reflected pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 15 10 10 LEFT 10 15 20 20 35 The Veteran's undated medical examination report upon discharge is normal, his undated medical history report upon discharge indicates that he is in "good health", and his audiological examination results are as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 20 20 5 LEFT 15 20 20 20 20 An April 2005 National Guard enlistment examination report reflects pure tone thresholds as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 15 10 10 LEFT 10 15 15 10 20 The report indicated that the Veteran suffered from hearing loss. November 2012 VA treatment records reflect that the Veteran reported ringing in his ears for 2 weeks, and stated that he cannot hear when people speak in a low tone. A May 2014 audiology note reflects that the Veteran reported periodic unilateral tinnitus in his right ear which began 2 years prior, and stated that he has trouble hearing at work and at home. A May 2014 audiological report reflects pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 50 55 60 60 65 LEFT 75 65 75 85 90 January 2017 VA treatment records reflect that the Veteran reported hearing loss present for at least 10 years. He stated that it started when he was in the service and around multiple explosions, and reported that he would shoot guns often without hearing protection during service. He also said that he has had a buzzing type sound in his ears, more so in his right ear than his left, for about a year. The records reflect that the Veteran had no features of increased intracranial pressure causing tinnitus, and it was thus suspected that his tinnitus is secondary to his hearing loss, secondary to history of ototrauma from loud noises. May 2017 VA treatment records indicate that the Veteran has tinnitus and hearing loss which the physician opined was likely secondary to his history of ototrauma from loud noises. On the authorized audiological evaluation in August 2017 pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 30 35 35 35 35 LEFT 35 40 50 40 35 Speech audiometry revealed speech recognition ability of 68 percent in the right ear and of 52 percent in the left ear. The evaluation indicated that the Veteran reported difficulty understanding speech, particularly in areas of background noise. The examining audiologist opined that the Veteran's hearing loss was not at least as likely as not (at least a 50 percent probability) caused by, or a result of an event in military service, noting that the Veteran reports exposure to shooting, an artillery base, nuclear ship, and sleeping quarters, and reported target shooting when younger. The audiologist reported that when comparing the Veteran's hearing thresholds from entrance to separation, his thresholds were within normal limits, and stated that while the Veteran had noise exposure in service, it did not result in hearing loss that meets criteria for service connection as one cannot rule out contributions from his civilian occupation and the aging process. The Veteran also reported constant bilateral tinnitus that is worse in his right ear, and which began around 2016. The audiologist opined that the Veteran's tinnitus was less likely than not (less than a 50 percent probability) caused by, or a result of military noise exposure, noting that the Veteran reported onset in 2016, and stating that the Veteran's service treatment records are silent for any concern, diagnosis, or treatment of tinnitus during service. In a September 2017 addendum opinion, the audiologist noted that the Veteran's service treatment records show that the Veteran did not have a significant shift or worsening of his hearing from 1987 to 2009, and the thresholds were within test-retest reliability on those dates. She stated that there is mild loss in 1987 at 6000 Hz which is also present in 2009, which had not worsened in either ear. She noted hearing thresholds within normal limits bilaterally on the hearing tests conducted in September 1987 and March 2009, and opined that the Veteran's hearing loss which clearly and unmistakably existed prior to service at 6000 Hz only, clearly and unmistakably was not aggravated beyond its natural progression by an in-service event, injury, or illness. On the authorized audiological evaluation dated April 2019, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 30 40 40 40 40 LEFT 35 40 50 45 40 The Veteran reported that he had difficulty understanding normal conversational speech without hearing aid use. The audiologist was unable to determine a speech discrimination score, but opined that the Veteran's hearing loss was not at least as likely as not (at least a 50 percent probability) caused by, or a result of an event in military service. The audiologist stated that there is evidence that he did not suffer hearing loss caused by, or a result of an event in service, and evidence he did not suffer aggravation of a pre-existing hearing loss at 6000 Hz during service. The audiologist noted that the Veteran enlisted with mild hearing loss at 6000 Hz, and thresholds at 500 to 4000 Hz were within normal limits at entrance and separation without significant decrease beyond normal progression and test retest variability. She stated that hearing loss due to service was ruled out by comparison audiograms, consistent with the Veteran's report of hearing loss onset approximately 5 years earlier, and noted that the Veteran's mild to moderate sensorineural hearing loss across the entire frequency region is not consistent with noise induced hearing loss. The audiologist noted that the Institute of Medicine concluded that there is insufficient scientific evidence for delayed onset of hearing loss secondary to military noise exposure, as hearing loss or aggravation of pre-existing hearing loss should occur at the time of the exposure. She reported that there is not sufficient evidence from longitudinal studies to determine whether permanent noise induced hearing loss can develop years after military noise exposure. She concluded that if hearing is normal on discharge and there is no permanent significant threshold shift or aggravation greater than normal progression and test re-test variability during military service, then there is no basis on which to conclude that a current hearing loss is causally related to military service, including noise exposure. Thus, there is no nexus between any current hearing loss and military service, regardless of the cause of the hearing loss. The audiologist noted that the Veteran reported onset of tinnitus approximately "5 years ago", and opined that the Veteran's tinnitus is at least as likely as not (at least a 50 percent probability) a symptom associated with hearing loss. The audiologist reported that the Veteran's onset of tinnitus is 20 years post military noise exposure, and that tinnitus secondary to noise exposure should occur at the time of the exposure. She stated that there is no reported tinnitus during service to support his claim, and that the Veteran has post military onset of hearing loss that likely caused the tinnitus. The audiologist concluded that considering all of the evidence, she cannot be 50 percent or more certain that tinnitus resulted from military noise exposure. In an April 2019 addendum, the audiologist noted the Veteran's pure tone thresholds from February 1992 and March 2009, and reported that the results are consistent with his separation examination in 1992 as well as with his entrance examination in 1987, proving that it is less likely than not (less than a 50 percent probability) that pre-existing hearing loss, at 6000 Hz only, was aggravated beyond normal progression during active duty, as hearing thresholds were nearly unchanged 22 years after the Veteran entered service, and 18 years after separation from service. The Veteran's statements regarding noise exposure are consistent with the circumstances of service as a member of the firefighting team, among other duties, and confirm an in-service event. His April 2019 audiological evaluation reflects a current bilateral hearing loss disability as the audiologist notes auditory thresholds of 40 dB or greater in both the right and left ear. The remaining issue is whether there is a nexus between the Veteran's reported military noise exposure and his current bilateral hearing loss. To this end, the audiologists who provided the September 2017 addendum opinion, and the April 2019 audiology evaluation both indicated that the Veteran suffered from hearing loss at 6000 Hz upon enlistment. A Veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). In other words, "[w]hen no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry." Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). The Veteran's September 1987 medical examination report upon enlistment reflects elevated pure tone thresholds at 6000 Hz for both the right and left ear. However, the Board notes that for a hearing loss disability to have pre-existed service, the level of hearing impairment must meet the criteria to be considered a "disability" under 38 C.F.R. § 3.385, which the hearing loss at 6000 Hertz does not. See McKinney v. McDonald, 28 Vet. App. 15 (2016). Accordingly, the Veteran is presumed to have been sound upon entry into active duty service, and his claim must be addressed only on the basis of direct service connection, and not aggravation of a pre-existing disability. The evidence is at least evenly balanced as to whether the Veteran's bilateral hearing loss was due to in-service noise exposure. While the September 2017 and April 2019 audiologists opined that the Veteran's bilateral hearing loss was less likely than not (less than a 50 percent probability) due to in-service noise exposure, the audiologists, at least in part, based their opinions on the fact that the Veteran's audiological examination upon separation from service indicate no threshold shift during service, and that thresholds at 500 to 4000 Hz were within normal limits at entrance and separation. However, the opinions are flawed because normal hearing upon separation is not necessarily fatal to a claim for service connection for hearing loss. Ledford v. Derwinski, 3 Vet. App. 87 (1992). Alternately, the Veteran has provided competent and credible statements with respect to his hearing loss disability, stating that he has suffered from hearing loss since active duty, and the January 2017 and May 2017 physicians reported that the Veteran's hearing loss was likely due to history of ototrauma during service. While the January 2017 and May 2017 physicians did not provide extensive rationales to support their opinions, considering their opinions as a whole and in the context of the evidence of record, the physicians found that the nature of the Veteran's military service and events that occurred therein, and subsequent symptoms, made it likely that they had resulted in his current bilateral hearing loss. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). The evidence includes both positive and negative nexus opinions regarding the etiology of the Veteran's bilateral hearing loss. The evidence is, thus, at least evenly balanced as to whether the Veteran's current bilateral hearing loss disability is related to service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for bilateral hearing loss is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As for the Veteran's claim for service connection for tinnitus, the Board notes that tinnitus is a disability capable of lay observation, and the Veteran has offered competent, credible evidence that he experiences tinnitus. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) ("ringing in the ears is capable of lay observation"). While the August 2017 and April 2019 audiologists opined that the Veteran's tinnitus was less likely than not caused by, or a result of military noise exposure, the January 2017 reported that the Veteran's tinnitus was likely secondary to hearing loss. Additionally, the April 2019 audiologist opined that opined that the Veteran's tinnitus is at least as likely as not (at least a 50 percent probability) a symptom associated with hearing loss and provided a thorough rationale based on an accurate characterization of the evidence of record to support her opinion. Therefore, her opinion is afforded significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). The preponderance of the evidence thus reflects that the Veteran's tinnitus was caused by his now service connected bilateral hearing loss. Therefore, service connection for tinnitus is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. OSA In a January 2016 letter, the Veteran's fellow servicemember reported sleeping in the same berthing as the Veteran, and witnessed him snoring loudly while he was asleep to the point that it woke up most of the people in the berthing area. August 2016 VA treatment records reflect that the Veteran had diagnosed OSA which was treated with a continuous positive airway pressure (CPAP) machine every night. A September 2020 disability benefits questionnaire (DBQ) reflects that the Veteran had a diagnosis of OSA and that he reported that he began snoring loudly while on active duty. The Veteran stated that he had a positive sleep study in 2015 and uses a CPAP to treat his OSA. The PA opined that the Veteran's OSA was less likely than not (less than a 50 percent probability) incurred in, or caused by an inservice injury, event, or illness, stating while the Veteran stated he began snoring loudly on active duty, there are no service treatment records showing treatment for snoring, insomnia, or any sleep issues while on active duty. The PA also noted that no sleep study was performed during active duty to prove a diagnosis of OSA, and that OSA was diagnosed in 2015, many years after active duty service. While the September 2020 PA opined that the Veteran's OSA was less likely than not (less than a 50 percent probability) related to service, she based her opinion on a lack of treatment for OSA in service, or a diagnosis of OSA until several years after service which is an impermissible basis upon which to find that OSA is not related to service. Buchanan v. Nicholson, 451 F. 3d 1331, 1337 (Fed. Cir. 2006). Therefore, the September 2020 opinion is inadequate, and afforded no probative value. The Veteran's competent, credible lay statements, as well as those of his fellow servicemember, reflect that the symptoms that later served as the basis for the sleep apnea diagnosis were the same as those he experienced in service. Thus, the sleep apnea had its onset in service and service connection is warranted on this basis. 38 C.F.R. § 3.303 (a) ("service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces"). To the extent that the grant of service connection in this case is based primarily on lay evidence, "nothing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself." Buchanan, 451 F.3d at 1335; Maples v. Wilkie, No. 18-2016 (mem dec. Feb. 11, 2019) (vacating the Board's denial of a claim for service connection for sleep apnea and finding that the Veteran's "lay statements could be evidence sufficient to support his claim, and the mere fact that there is no medical evidence about his snoring does not, by itself, render his lay statements insufficient"); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (memorandum decisions may be cited or relied upon for any persuasiveness or reasoning it contains). For the above reasons, the evidence is at least evenly as balanced as to whether the Veteran has OSA that had its onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for OSA is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Asthma Undated service treatment records reflect that the Veteran suffered from asthma as an infant. The Veteran's September 1987 medical examination report upon enlistment is normal, with no indication that he suffered from asthma, or asthma symptomatology upon enlistment, thus he is presumed sound upon enlistment as to respiratory illnesses and symptomatology. October 1987 service treatment records reflect treatment for pneumonia. January 1989 service treatment records reflect treatment for nasal congestion and mild cough. May 1991 service treatment records reflect treatment for upper respiratory infection and some bronchospasm, with the Veteran reporting chest tightness and cough. May 2015 post-service treatment notes indicate that the Veteran has been experiencing shortness of breath since the age of 25, or for approximately 23 years, and that he was previously told that he had bronchitis. In a September 2020 DBQ, the examining physician's assistant (PA) opined that the Veteran's asthma was less likely than not (less than a 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness stating that the Veteran's service treatment records show treatment for an upper respiratory infection and pneumonia, but that these conditions resolved. She noted that the Veteran's reserve enlistment examination from January 2009 is silent for asthma or inhaler use, and that the Veteran was not diagnosed with asthma until many years after his active duty time. The PA reported that there are no medical records showing a diagnosis within one year of service, and medical records reflect that the Veteran was diagnosed with asthma in 2015. The PA noted a diagnosis of asthma with the Veteran reporting that he has had asthma for many years which he treated with inhalers. The evidence is at least evenly balanced as to whether the Veteran's asthma was incurred in service. As previously discussed, the Veteran is presumed sound upon entry into service, has a current diagnosis of asthma as reflected by the September 2020 DBQ, and has provided competent and credible lay evidence that he suffered from asthma symptoms, including shortness of breath, which have continued since he was 25. Based on the Veteran's statements, his asthma symptomatology would have had their onset in service, or shortly thereafter, such that it would be reasonable to conclude that his current asthma was incurred during service. There is no evidence of record that suggests the Veteran lacks credibility; therefore, the Board will resolve any such discrepancy in the light most favorable to the Veteran considering the pro-claimant nature of Veterans law and with the understanding that it would be unreasonable to expect the Veteran to recollect the exact moment his asthma commenced several years after the fact. While the September 2020 PA opined that the Veteran's asthma was less likely than not (less than a 50 percent probability) incurred in, or caused by an in-service injury, event, or illness, the PA based her opinion primarily on the lack of medical records reflecting treatment for, or a diagnosis of asthma for many years after service which is impermissible. Buchanan, 451 F. 3d at 1331. Therefore, the September 2020 DBQ is afforded no probative value. As previously discussed, "nothing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself." Buchanan, 451 F.3d at 1335. For the foregoing reasons, the evidence is at last evenly balanced as to whether the Veteran's current asthma was incurred in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for asthma is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 4. Right Spermatocele February 2015 VA treatment records indicate that the Veteran was found to have a spermatocele on a December 2014 ultrasound. In a July 2019 Report of General Information, the Veteran stated that he was on a nuclear powered guided missile cruiser, the USS Virginia during service, and worked right above the nuclear reactor. He stated that the TRD Radiation dosimeter was high more than once. He also reported doing damage control for the USS Iowa when its turret exploded, killing 47 men. As previously noted, the Veteran's personnel records reflect that he participated as a member of the firefighting team, magazine ammunition handler, dry cleaning machine operator, and laundry press operator among other things. The Veteran's DD-214 reflects that his military occupational specialty (MOS) was as a barber and that he served aboard the USS Virginia. A March 2020 letter from the Naval Dosimetry Center revealed no reports of occupational exposure to ionizing radiation pertaining to the Veteran, but indicated that the registry did not maintain records for non-ionizing forms of radiation. Based upon a preponderance of the evidence of record, the Board finds that the Veteran's right spermatocele is not attributable to in-service exposure to ionizing radiation and service connection must be denied. The evidence of record reflects that the Veteran served upon the USS Virginia during service, and while the Veteran's DD-214 indicates that his MOS was as a barber, the Veteran has competently reported that his duties included assisting with damage control for the USS Iowa, and also that his TRD Radiation dosimeter was high during his time aboard the USS Virginia. There is no indication that the Veteran lacks credibility, thus his statements regarding his duties and experiences during service are afforded significant probative weight. However, while the Veteran reports high dosimeter radiation readings during service, the Naval Dosimetry Center indicated that there were no reports of exposure to ionizing radiation pertaining to the Veteran. While the Veteran is competent to report his experiences during service, there is no evidence which suggests that he has the education or expertise to determine whether or not he was exposed to ionizing radiation during service, thus his contentions as to his exposure to ionizing radiation during service are not competent and are outweighed by the findings of the Naval Dosimetry Center that the Veteran was not exposed to ionizing radiation. The Board notes that a theory of entitlement to service connection due to exposure to non-ionizing forms of radiation has not been raised by the Veteran or the record, and that the provisions of 38 C.F.R. § 3.311 would only apply to exposure to ionizing radiation. Additionally, in disability compensation claims, VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold under McLendon is low. While the evidence reflects that the Veteran has a right spermatocele, thus satisfying the criteria of competent evidence of a current disability during the period on appeal, as noted, the evidence of record indicates that the Veteran was not exposed to ionizing radiation during service, and does not reflect that the Veteran's right spermatocele occurred in service as it was first documented in December 2014, more than 7 years after discharge from service. Thus, there is no evidence establishing that an event, injury, or disease occurred in service, therefore no examination is necessary to adjudicate the Veteran's claim of entitlement to service connection for right spermatocele. With regards to the Veteran's lay assertions, the Board acknowledges the Veteran's belief that he is entitled to service connection for right spermatocele due to exposure to ionizing radiation. However, the Veteran's assertions regarding his radiation exposure are outweighed by the probative evidence found in the March 2020 Naval Dosimetry Center letter. The Veteran's intuition as to his level of exposure is not sufficient to outweigh the findings of the Naval Dosimetry Center, which are based on scientific evidence, that the Veteran was not exposed to ionizing radiation during service. The issue of entitlement to service connection for right spermatocele on any other basis has not been raised by the Veteran or reasonably raised by the evidence of record, and the Board therefore need not address any other theory of entitlement. Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) ("Where a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory"). For the foregoing reasons, the Board finds that service connection for a right spermatocele due to ionizing radiation exposure is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Maddox, 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.