Citation Nr: 21074652 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 16-26 305 DATE: December 15, 2021 ORDER Entitlement to service connection for a lumbar spine disorder, to include as secondary to a left hip disorder, secondary to and/or aggravated by pre-existing left femur disorder, and/or as a result of an in-service examiner's failure to diagnose a shorter left leg, is denied. Entitlement to service connection for a left hip disorder, to include as secondary to and/or aggravated by a pre-existing left femur disorder and/or as a result of an in-service examiner's failure to diagnose a shorter left leg, is denied. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as a result of asbestos exposure, is denied. Entitlement to service connection for obstructive sleep apnea (OSA) is denied. Entitlement to service connection for bilateral hearing loss is denied. FINDINGS OF FACT 1. The objective medical evidence shows a lumbar spine disorder was not incurred during active service, it is not caused by an event, injury or illness occurring in active service, and is not proximately due to, the result of or made worse beyond its natural progression by left hip disorder, a pre-existing left femur disorder, or as a result of an in-service examiner's failure to diagnose a shorter left leg. 2. The objective medical evidence shows degenerative arthritis of the lumbar spine did not manifest to a compensable degree within 1 year of separation from active service. 3. The objective medical evidence shows a left hip disorder was not incurred during active service, it is not caused by an event, injury or illness occurring in active service, and it is not proximately due to, the result of or made worse beyond its natural progression by a pre-existing left femur disorder or as a result of an in-service examiner's failure to diagnosis a shorter left leg. 4. The objective medical evidence shows COPD was not incurred during active service and it is not caused by an event, injury or illness occurring in active service, to include as a result of alleged asbestos exposure. 5. The objective medical evidence shows OSA was not incurred during active service, nor is it caused by an event, injury or illness occurring in active service. 6. The objective medical evidence shows bilateral hearing loss was not incurred during active service, nor is it caused by an event, injury or illness occurring in active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a lumbar spine disorder, to include as secondary to a left hip disorder, secondary to and/or aggravated by a pre-existing left femur disorder, and/or as a result of an in-service examiner's failure to diagnose a shorter left leg, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for a left hip disorder, to include as secondary to and/or aggravated by pre-existing left femur disorder and/or as a result of an in-service examiner's failure to diagnose a shorter left leg, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 3. The criteria for service connection for COPD, to include as a result of asbestos exposure, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The criteria for service connection for OSA have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for service connection bilateral hearing loss have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1985 to January 1986. In June 2019, the Veteran testified at a Board videoconference hearing before a Veterans Law Judge (VLJ). A transcript of the hearing is of record. The Veteran was notified in a September 2021 letter that the June 2019 VLJ was no longer with the Board. The letter informed him of his right to request another hearing and that if he did not respond within 30 days, the Board would presume he did not want another hearing. To date, no response has been received. As the Veteran did not respond within 30 days, the Board accordingly has proceeded with the appeal. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active service or that a preexisting injury or disease was aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires: (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 in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Additionally, service connection may be granted on a secondary basis for a disability which is proximately due to, the result of or made worse beyond its natural progression by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Moreover, service connection of a nonserviceconnected disease or injury will be established if an increase in severity of the nonserviceconnected disability is shown to be proximately due to or the result of a service-connected disease or injury and not due to the natural progress of the nonserviceconnected disease or injury. 38 C.F.R. § 3.310(b). The evidence must show (1) a current disability exists and (2) the current disability was the (a) proximately caused by or (b) proximately aggravated (worsened in severity beyond its natural progress) by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448-49 (1995). Certain chronic diseases may be service connected on a presumptive basis if manifested to a compensable degree in a specified period of time post-service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. That period is usually one year. 38 C.F.R. § 3.307(a)(3). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). Under 38 C.F.R. § 3.303(b), an alternative method of establishing an in-service disease or injury and a nexus for chronic diseases is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96; see Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b). 1. Entitlement to service connection for a lumbar spine disorder, to include as secondary to a left hip disorder, secondary to and/or aggravated by a pre-existing left femur disorder, and/or as a result of an in-service examiner's failure to diagnose a shorter left-leg. The Veteran contends that service connection is warranted for a lumbar spine disorder. The service treatment records (STRs) show in the October 1985 enlistment examination that the examiner questioned whether the Veteran had scoliosis to the left and he included a diagnosis of scoliosis in the summary of defects and diagnoses. The Veteran denied recurrent back pain. The STRs otherwise show no complaints of, treatment for, or diagnoses for low back pain or a related low back disorder. In the October 1985 medical pre-screening examination, the Veteran reported he had a "broken leg" at age 14. In the October 1985 enlistment examination, while the examiner marked the lower extremities normal, the examiner noted under upper extremities, "limping... foot tender achilles tendon." Included in the summary of defects and diagnoses was "sore left achilles tendon," but such was initialed and marked out by the examiner. In December 1985, the Veteran complained of left leg pain lasting 2 weeks and he was assessed with muscle strain. Two weeks later, the Veteran presented with complaints of left leg trauma, now for the past 4 weeks, with persistent pain. The treatment provider assessed this complaint as a "Nonemergency." A December 1985 x-ray request shows a radiologic report of a healing fracture of the mid-shaft of the left femur, with slight overriding and medial angulation at the fracture site. A January 1986 Medical Board Report from the Great Lakes Naval Hospital shows a primary diagnosis of symptomatic old left femoral fracture. The report further noted the past history before enlistment in the Navy, as obtained from the Veteran, which showed he sustained a left femoral fracture 6 years prior, with pain off and on since that time. The Veteran mentioned the condition to the Medical Officer on the SF-93 form at the time of enlistment but was found fit for duty. He began basic training in November 1985; however, within a few days he reported to Sick Call complaining of left femoral pain, increased with activity. He was treated in December 1985 and an x-ray revealed the old healed left femur fracture. The medical officer recommended that the Veteran be discharged from the Navy. The Medical Board Report concurred and in turn recommended discharge by reason of "Erroneous Enlistment." The post-service record shows a September 2014 MRI revealed degenerative changes of the lumbar spine and the treatment provider's assessment stated "[his pain may be due to lumbar DDD [degenerative disc disease]." A VA podiatry note in October 2014 reflects diagnoses of chronic back pain and "[l]eft-leg inequality left < right, 1 inch." In June 2015, the Veteran presented to VA for a consult for the determination of the source of his chronic low back pain. At a physical therapy consult in November 2015, the Veteran reported current low back pain, which he further reported had begun within the last "10 years." He added this was "normal for me and is 8/10" on the pain scale. VA treatment notes in the period of June through December 2015 noted the Veteran's left leg is shorter than the right. The Veteran's VA treatment provider in January 2016 referred the Veteran for epidural injections for low back pain. An October 2020 VA examination report reflects a diagnosis of intervertebral disc syndrome (IVDS). The Veteran reported onset in 1984 while stationed at the Great Lakes Navy base, after he slipped and fell on some ice, injuring his back and hip for which he received treatment and pain medication. His current symptoms included constant pain and use of a walker and wheelchair. His current treatment was pain management with medications and injections in his back. The Veteran reported he could no longer walk long distances or stand or sit for long periods. The examiner noted imaging studies revealed arthritis. Other findings included radicular symptoms in the lower extremities. In addressing not only direct service connection, but also the Veteran's reports of a pre-existing left femur disorder, the possibility of any aggravation or residuals relating to lumbar spine disorder and the effects of a left hip disorder, the examiner explained in her rationale that the STRs contain no record of treatment for left hip dislocation. Moreover, although the Veteran reports he injured his left hip while in service and experienced left hip dislocation twice after service, there is no medical treatment record of the two additional occurrences. The examiner explained that the Veteran reported a history of a left femur fracture in 1981 which was treated by traction of the left leg for 6 months. The examiner observed that, medically, a malunion fracture of the left leg femur could contribute to shortening of the left leg and she noted the October 1985 prescreening examination, during which the Veteran disclosed that his left leg was broken at age 14. However, the examiner further explained that the October 1985 enlistment examination did not document a history of left femur fracture reported or the presence of a leg length discrepancy. The examiner noted that although in the Veteran was treated for left leg pain in December 1985, x-rays revealed a healing left femur fracture and the Veteran in fact had been treated for left femur fracture which existed prior to entry to active service. The examiner conceded that it could not be determined if a leg length discrepancy or a low back condition was noted prior to leaving service as there is no separation examination to review. However, the examiner found that there was no evidence of structural scoliosis in the diagnostics provided or non-structural scoliosis in any treatment record. Furthermore, all diagnostics of the hip were negative for pathology and "[a] diagnostic showing some degree of pathology would be expected with repeated dislocations of the hip..." Additionally, there was no record of a back injury or treatment for a back injury while in service, degenerative changes of the spine were not diagnosed until 2014 and, without repeated treatments for back pain during service or with concurrence of left hip pain, the evidence did not support the that the lower back disorder was related to an in-service occurrence or event. Thus, the examiner opined that the Veteran's lumbar spine disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. Here, the Board finds the October 2020 examiner's opinion persuasive as the opinion is informed by a thorough review and analysis of the Veteran's service treatment records and post-service treatment records and based on medical expertise. Therefore, the Board assigns the opinion greater probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is factually accurate, fully articulated, and based on sound reasoning for the conclusion). The Board has carefully considered the Veteran's lay statements that his lumbar spine disorder is related to an altered gait from his left hip disorder. The Board is well aware that lay persons are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Veteran has not shown that he has the training necessary to render a nexus opinion in this case. Therefore, the Board gives more probative weight to the October 2020 VA opinion as discussed above, which found that the prominence of the hip dislocations would have been evident at the time had it caused his lumbar spine disorder. See generally Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the central issue in assessing the adequacy of an opinion is whether the examiner was informed of the relevant facts in rendering a medical opinion). Arthritis, as associated with lumbar spine disorder, may be eligible for presumptive service connection as a "chronic disease" under 38 C.F.R. § 3.309(a). In a June 2015 VA consult note, the treatment provider diagnosed lumbar degenerative disc disease and the October 2020 VA examiner noted available imaging studies document arthritis. However, the STRs do not show diagnosis of lumbar spine arthritis during service or within a year of separation from active service. Looking to the possibility of continuity of symptomatology to establish a nexus between any in-service event, injury or illness, to include as due to left hip disorder, and arthritis as a subsequent chronic disease, the Board finds the Veteran's statements that he's had back pain since service to be not credible. Treatment records show that the earliest the Veteran complained of back pain was in September 2012, after he fell and sprained his back. Onset was noted to be acute, and the Veteran did not report a history of prior back pain. As onset was more than two decades after separation from service, the presumption of service connection for arthritis as a chronic disease, associated with lumbar spine disorder, is not available to the Veteran. In sum, the preponderance of the evidence is against finding that the Veteran's low back disability had its onset during service or is otherwise related to service or injury sustained during service. Furthermore, as discussed below, the Board is denying service connection for a left hip disability, so service connection for a low back disability secondary to a left hip disability is also not warranted. As the preponderance of the evidence is against the claim for service connection for a low back disability, the benefit of the doubt doctrine is not for application and the claim must be denied. 2. Entitlement to service connection for left hip disorder, to include as secondary to and/or aggravated by a pre-existing left-femur disorder and/or as a result of an in-service examiner's failure to diagnosis a shorter left-leg. The Veteran contends that service connection is warranted for a left hip disorder. The STRs show the October 1985 enlistment examiner found normal lower extremities. Additionally, the Veteran reported no past or current arthritis, rheumatism, or bursitis, bone, joint or other deformity or any lameness. The STRs, which do show complaints of left leg pain, overall show no complaints, treatment or diagnoses for a left hip disorder or related disorders. The post-service record shows in February 2015, the Veteran reported that his limp had returned. The Veteran's treatment provider subsequently referred him to VA physical therapy. An April 2015 VA mental health note contains the Veteran's report of having dislocated his left hip in service, as well as rupturing his "hip drum." In a June 2015 orthopedic surgery consult at VA, the Veteran reported a history of hip pain "for several years," that he dislocated his hip while in the military, and that he dislocated his hip twice after he was discharged. However, an MRI of both hips were "negative for any hip pathology, so we may not have any treatment to offer. His pain may be due to lumbar DDD." When presenting to VA in November 2015, the Veteran reported current hip pain, which had begun within the last "10 years." As stated above, VA treatment notes in the period of June through December 2015 noted the Veteran left leg is shorter than the right. Although continuing to report left hip pain, a left hip MRI at VA in February 2016 revealed negative results. Looking again to the Veteran's testimony and reports, the Veteran reported the hip injury occurred when slipping on ice and falling during active service. In his Board hearing testimony, he added a remark, noted by the transcriber as "inaudible," but seems to suggest, after falling, something or someone in turn fell on him. He further testified an in-service treatment provider several months later "popped" his dislocated hip back in place, he still had difficulty walking a few days later, that other examiners never noticed his left leg was about a half inch shorter than the right leg, and that his symptoms have been worsening. He further reported a VA treatment provider said his left hip disorder was "probably" is due to the in-service dislocation, and another VA treatment provider stated the in-service physician should not have popped the hip back in place without referring first to x-rays. The Veteran underwent a VA examination for hip and thigh conditions in October 2020, in which the examiner diagnosed trochanteric pain syndrome in both hips and left unequal limb length. The Veteran reported onset in 1984 while stationed at the Great Lakes Navy base, after he slipped and fell on some ice, injuring his back and hip for which he received treatment and pain medication. His current symptoms included constant pain and use of a walker and wheelchair. His current treatment is pain management with medications and injections in his back. He reported could not walk long distances or stand or sit for long periods. The examiner noted imaging studies of the hip were negative for arthritis. After examining the Veteran and reviewing the claims file, the examiner noted the STRs were silent for a hip location during service and were silent for dislocations after service. The examiner explained that had the Veteran experienced repeated dislocations, it would be expected to see some degree of pathology on diagnostic imaging. However, all imaging studies of the Veteran's hip were negative for pathology. The examiner indicated that the Veteran broke his leg at age 14 prior to service, and that a malunion fracture of the left femur could contribute to the shortening of the leg. The examiner found that the Veteran's current left hip condition was most likely related to a leg length discrepancy that was caused by the left leg femur fracture that existed prior to service. Thus, the examiner opined that the Veteran's left hip condition was less likely than not incurred in or caused by service. Here, the Board finds the October 2020 examiner's opinion persuasive as the opinion is informed by a thorough review and analysis of the Veteran's service treatment records and post-service treatment records and based on medical expertise. Therefore, the Board assigns the opinion greater probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is factually accurate, fully articulated, and based on sound reasoning for the conclusion). The Board notes, as did the October 2020 examiner, that there is no record of treatment in the STRs and no post-service record showing treatment of a disorder. The Board does not doubt the competency of any of Veteran's reports pertaining to his current left hip pain, but the record also presents a conflicting report by the Veteran as to onset. Specifically, in a visit to VA in November 2015, he stated his left hip pain had begun only within the prior 10 years, approximately 19 years after separation from active service. Furthermore, as the October 2020 VA examiner found, had the Veteran experienced multiple dislocations, some degree of pathology would be found upon diagnostic testing. Here, the record shows treatment for left hip pain beginning, at most, approximately 19 years after separation from active service. Furthermore, the Veteran's statements concerning the nature and etiology of his left hip pain are inconsistent with the objective medical evidence of record. Additionally, the October 2020 examiner attributed his hip pain to a preexisting condition. Thus, continuity or nexus between the Veteran's current disability and service is not established. For these reasons, the Board finds the preponderance of the evidence is against the claim for service connection for left hip disorder on any basis. The benefit of the doubt doctrine is not for application, and the Veteran's claim must be denied. 3. Entitlement to service connection for COPD, to include as a result of asbestos exposure. The Veteran contends that service connection is warranted for COPD. The STRs show that the October 1985 enlistment examiner found the Veteran's lungs and chest to be normal. In January 1986, the Veteran complained of headache, sore throat, congestion, and a temperature for the past day. On examination, his ear canals were clear with no redness, the treatment provider noted white exudate from the Veteran's nose and his throat exhibited post-nasal drip and slight redness. The treatment provider assessed the Veteran with an upper respiratory infection. A January1986 emergency record several days later shows the Veteran presented with symptoms of rhinorrhea for 4 days, but, on examination, his lungs were clear, as was his skin. The treatment provider diagnosed an upper respiratory infection. The STRs otherwise show no complaints, treatment, or diagnoses for COPD, respiratory, or asbestos-related disorders. The post-service record shows a March 2015 VA treatment note in which the treatment provider's impression included that the Veteran's COPD was poorly controlled, and he further noted the Veteran's "nicotine dependence." In a VA primary care physician note in April 2015, the treatment provider noted the Veteran's medical history of COPD causing dyspnea on exertion. The Veteran also reported chest pain related to COPD. In an April 2015 primary care telephone note, the treatment provider observed "it is plausible" that prescribed beta-blocker heart medication may be worsening the Veteran's COPD symptoms and the Veteran was so informed. His primary care physician's August 2015 impression included COPD. A September 2015 VA neurologist's note, upon examination, noted the Veteran's shortness of breath to be associated with his COPD. When presenting to a VA emergency department with various symptoms in November 2015, the Veteran reported he experiences shortness of breath from COPD and the treatment provider noted the Veteran is a smoker. A VA pre-operative note in August 2016 noted, based on the Veteran's reports, a 70-pack a year history of smoking. Other VA treatment records note a 1.5-pack per day history. An April 2017 VA note indicates the Veteran was still smoking and a January 2021 note indicates the same. In the October 2020 VA examination for respiratory conditions, the examiner diagnosed COPD. The Veteran reported smoking 1 pack of cigarettes per day for 42 years and he used supplemental oxygen daily for an estimated 10-12 hours per day. He reported onset of COPD in 1984, when he was painting walls in his dormitory, with shortness of breath and he was treated with inhaler pills and oxygen. He reported he was unable to walk very far for too long and he would be "winded," as well as being unable to exercise or pick up his grandchildren. After examining the Veteran and reviewing the claims file, the examiner noted that the STRs documented upper respiratory infections on two separation occasions, and each resolved with appropriate treatment. The examiner noted the Veteran's Board hearing testimony, in which he stated that he was treated for several upper respiratory infections, given an inhaler, and also asked to complete a pulmonary function test. The examiner noted the Veteran's reports that he was informed his COPD was related to asbestos exposure. However, the examiner noted that while there were two encounter notes in the STRs regarding diagnosis of and treatment for upper respiratory infections, neither listed an inhaler as part of treatment, there was no record of an in-service pulmonary function test or diagnosis of COPD, nor was there documented asbestos exposure. The examiner concluded by observing, "Throughout the record, it is well documented that the veteran is a smoker and has smoked one pack of cigarettes per day for an estimated 42 years as is reported by the veteran during exam. The veteran smokes cigarettes currently. Per review of the medical literature, smoking is cited as the leading cause of chronic obstructive pulmonary disease. Given the veteran's tobacco history, the most likely cause of his chronic obstructive pulmonary disease is long term smoking of cigarettes." Thus, the examiner opined that COPD was less likely than not (less than 50 percent probability) incurred in, caused by, or related to service, to include the Veteran's alleged exposure to asbestos. Here, the Board finds the October 2020 examiner's opinion persuasive as the opinion is informed by a thorough review and analysis of the Veteran's service treatment records and post-service treatment records and based on medical expertise. Therefore, the Board assigns the opinion greater probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is factually accurate, fully articulated, and based on sound reasoning for the conclusion). The Board notes that the Veteran, as a lay person, is competent to report on matters observed or within his personal knowledge. See 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303 (2007). The Veteran is also competent to testify as to observable symptoms or injury residuals. Thus, the Veteran is competent to state that he experiences shortness of breath. However, although the Board recognizes that the Veteran is competent to report his symptoms, Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007), the Board finds his competency to relate a complex rationale as to the etiology of his COPD is limited, as he lacks the education and experience necessary to do so. As such, the Board gives more probative weight to the competent medical evidence as described above, which attributes the Veteran's COPD to his history of smoking rather than to his in-service respiratory infections and alleged asbestos exposure. As shown by the summary of the record above for this disorder and consistent with the October 2020 VA examiner's findings on examination and opinions, there is again no evidentiary basis on which to establish a causal relationship between current COPD and an injury during active service. For the reasons stated and based on the objective medical evidence, the Board finds the preponderance of the evidence is against the claim for service connection for COPD, to include as a result of alleged asbestos exposure, and the benefit of the doubt doctrine is not for application. The Veteran's claim must be denied. 4. Entitlement to service connection for OSA. The Veteran contends that service connection is warranted for obstructive sleep apnea (OSA). The STRs show the October 1985 examiner found on examination of the Veteran's mouth and throat that his tonsils were surgically absent, but otherwise found no further abnormality. Additionally, the Veteran reported no past or current frequent trouble sleeping. However, although the Veteran did report past or current ear, nose and throat trouble, no disorder was specified by the Veteran or the examiner. The STRs otherwise show no complaints of, treatment for, or diagnoses of OSA or related sleep or throat disorders. The post-service record shows a VA treatment note in September 2014 which indicated that the Veteran had undergone sleep studies in August and September 2012, both diagnosing OSA, with the former study noting the Veteran's sleep apnea was mild to moderate. When presenting in April 2014 for private treatment for a skin disorder on his left finger, the Veteran reported severe snoring and fatigue, resulting in daytime sleepiness. Treatment notes further found the Veteran's body-mass index (BMI) was 37.33. VA treatment records between June and December 2015 include OSA among the Veteran's reports and documented medical history. In the period of January through December 2015, VA active problems lists for the Veteran include OSA syndrome, as well as the treatment records noting the Veteran's obesity. A December 2019 addendum to a VA pulmonary consult note includes diagnoses of OSA and treatment-emergent central apnea (temporary cessations of breathing during sleep). The treatment provider also noted the Veteran will have to change treatment to "adaptive servo ventilation" (adjustments to air pressure based on the detection of pauses in breathing). Looking to the Veteran's Board hearing testimony, he first noted during active service he and fellow service members constantly made jokes about their own snoring causing others to wake. He added his snoring worsened and he was tested, although it appears from his testimony that he was not referring to in-service testing, but sometime after active service. He added he was prescribed a continuous positive airway pressure machine (CPAP) in 2009, but "[t]hey didn't really say" if his OSA was linked to service. In the October 2020 VA examination for sleep apnea, the examiner diagnosed OSA and treatment-emergent central apnea. The Veteran reported onset in 2008, with excessive snoring, daytime somnolence, fatigue, and occasional inability to concentrate. He further noted current symptoms of continued occasional concentration difficulty and falling asleep when driving. The examiner noted the Veteran's most recent sleep study was in December 2019 at VA with the same diagnoses as above. The examiner explained that the Veteran's STRs show no evidence of treatment for sleep apnea during active service, they do not confirm a sleep apnea diagnosis or any related symptoms during active service and there is no sleep study on file to confirm OSA until 2012. Thus, the examiner opined that OSA was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. Here, the Board finds the October 2020 examiner's opinion persuasive as the opinion is informed by a thorough review and analysis of the Veteran's service treatment records and post-service treatment records and based on medical expertise. Therefore, the Board assigns the opinion greater probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is factually accurate, fully articulated, and based on sound reasoning for the conclusion). The Board notes that the Veteran, as a lay person, is competent to report on matters observed or within his personal knowledge. See 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303 (2007). The Veteran is also competent to testify as to observable symptoms or injury residuals. Thus, the Veteran is competent to state that he may have snored during service. However, although the Board recognizes that the Veteran is competent to report his symptoms, Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007), the Board finds his competency to relate a complex rationale as to the etiology of his OSA is limited, as he lacks the education and experience necessary to do so. As such, the Board gives more probative weight to the competent medical evidence as described above. The record of evidence does not demonstrate a connection between the Veteran's current OSA and active service. The STRs do not show in-service reports, complaints, treatment, or diagnoses pertaining to OSA. The Veteran did not seek treatment for this disorder upon separation from active service, nor in the years following. Rather, the Veteran was not diagnosed with OSA until at the earliest, 2008, two decades after separation from service. For the foregoing reasons and based on the objective medical evidence, the Board finds the preponderance of the evidence is against the claim for service connection for OSA. The benefit of the doubt doctrine is not for application, and the claim must be denied. 5. Entitlement to service connection for bilateral hearing loss. The Veteran contends that service connection is warranted for bilateral hearing loss. For the purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 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 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 threshold for normal hearing is "from 0 to 20 dB and higher threshold levels indicate some degree of hearing loss." See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). In the October 1985 enlistment examination, the examiner found normal ear drums but also noted the Veteran's report of having had a tube inserted in his ears at age 6, but with no sequelae. Audiometric findings upon examination were as follows: RIGHT EAR 500 Hz 20 dB 1000 20 2000 0 3000 20 4000 10 LEFT EAR 500 Hz 20 dB 1000 20 2000 0 3000 25 4000 10 No speech discrimination test results, whether by 'whispered-voice" testing or otherwise, are included. Additionally, the Veteran reported no past or current hearing loss. November 1985 audiometric findings served as a "reference audiogram," and were as follows: RIGHT EAR 500 Hz 15 dB 1000 15 2000 0 3000 15 4000 10 LEFT EAR 500 Hz 15 dB 1000 15 2000 5 3000 20 4000 15 No speech discrimination test results are included. The examiner noted, "Tubes age 8." The post-service record shows VA treatment records between June and December 2015 contain Veteran's reports and medical history references to hearing loss. In the period of January through December 2015, VA active problems lists for the Veteran included mixed hearing loss, unilateral and sensorineural hearing loss, unilateral. In a February 2016 VA audiology examination for hearing aids, the clinician summarized his findings by diagnosing right ear mild-to-moderately-severe conductive hearing loss and left ear moderate conductive hearing loss, with a right-ear speech discrimination score of 84 percent and 88 percent for the left ear. The Veteran testified at the June 2019 Board hearing he underwent firearms training during active service, no hearing protection was ever provided, he noticed hearing loss in service, as he had difficulty understanding others, and at some later date, he was informed his eardrums were "pretty scarred up" and appeared to have been "ruptured at one time," but he does not remember any treatment in service. In a July 2020 VA examination, the examiner's audiometric findings were as follows: RIGHT EAR 500 Hz 25 dB 1000 25 2000 25 3000 40 4000 40 Average (1000 4000) 32.50 LEFT EAR 500 Hz 50 dB 1000 50 2000 45 3000 55 4000 40 Avg. 46.25 Maryland CNC speech discrimination test scores were 100 percent for the right ear and 98 percent for the left. The examiner noted the Veteran's reports of having difficulty hearing the television, as well as people talking in conversations, and "I find myself having to read lips." The examiner diagnosed mixed hearing loss in each ear. The examiner noted that the Veteran's hearing loss did not exist prior to service. The examiner explained that there were no indications of hearing loss or decreased thresholds during military service, as the military-administered hearing tests were within normal limits. She further explained that typically, hearing loss associated with noise exposure will demonstrate changes in hearing thresholds at or just after noise exposure. Here, there were no changes noted during military service. Thus, the examiner opined that the Veterans hearing loss was not at least as not (50 percent probability or greater) caused by or a result of an event in military service. Here, the Board finds the July 2020 examiner's opinion persuasive as the opinion is informed by a thorough review and analysis of the Veteran's service treatment records and post-service treatment records and based on medical expertise. Therefore, the Board assigns the opinion greater probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is factually accurate, fully articulated, and based on sound reasoning for the conclusion). The Board notes that the Veteran, as a lay person, is competent to report on matters observed or within his personal knowledge. See 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303 (2007). The Veteran is also competent to testify as to observable symptoms or injury residuals. Thus, the Veteran is competent to state that he experiences hearing loss. However, although the Board recognizes that the Veteran is competent to report his symptoms, Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007), the Board finds his competency to relate a complex rationale as to the etiology of his hearing loss is limited, as he lacks the education and experience necessary to do so. As such, the Board gives more probative weight to the competent medical evidence as described above. As shown by the summary of the record above for this disorder and consistent with the July 2020 VA examiner's findings on examination and opinions, there is again no evidentiary basis on which to establish a causal relationship or nexus between current bilateral hearing loss and noise exposure during active service. For these reasons and based on the objective medical evidence, the Board finds the preponderance of the evidence is against the claim for service connection for bilateral hearing loss. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Stephanie M. Owen Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Franke, Associate 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.