Citation Nr: 21005905 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 15-14 347 DATE: February 2, 2021 ORDER New and material evidence having been submitted, the claim of service connection for a right knee disorder is reopened. Service connection for a right knee disorder is denied. Service connection for bilateral hearing loss is denied. Service connection for tinnitus is granted. FINDINGS OF FACT 1. A 1984 Board of Veterans’ Appeals (Board) decision is final with respect the Veteran’s claim of service connection for a right knee disorder. 2. The preponderance of the evidence is against finding that the Veteran’s current right knee disorder was incurred in service. 3. The preponderance of the evidence is against finding that the Veteran’s current bilateral hearing loss was incurred in service. 4. Resolving any doubt in favor of the Veteran, his current tinnitus was incurred in service. CONCLUSIONS OF LAW 1. New and material evidence sufficient to reopen the Veteran’s claim of service connection for a right knee disorder has been received. 38 U.S.C. §§ 5103, 5103A, 5107, 5108; 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326 (a). 2. The criteria to establish service connection for a right knee disorder have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. 3. The criteria to establish service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.303, 3.304, 3.309, 3.385. 4. The criteria to establish service connection for tinnitus have been approximated. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.303, 3.304, 3.309, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January to May 1977 and from May 1979 to April 1980. In August 2018, the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge. The undersigned noted the issues on appeal and engaged in a colloquy with the Veteran toward substantiation of the claims. See Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A copy of the hearing transcript is in the claims file. In March 2019, the Board remanded this matter for additional evidentiary development. All actions ordered by the remand have been accomplished. Review of the completed development reveals that substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998). 1. Reopening the claim of service connection for a right knee disorder based on new and material evidence. Generally, absent the filing of a Notice of Disagreement (NOD) within one year of the date of mailing of the notification of the initial review and determination of a veteran's claim and the subsequent filing of a timely substantive appeal, a rating determination is final and is not subject to revision upon the same factual basis. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 20.200, 20.300, 20.1103. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The provisions of 38 C.F.R. § 3.156 (a) create a low threshold, with the phrase “raises a reasonable possibility of substantiating the claim” enabling rather than precluding reopening and not constituting a third requirement that must be met before the claim is reopened. Shade v. Shinseki, 24 Vet. App. 110 (2010); Evans v. Brown, 9 Vet. App. 273, 283 (1996). See Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). In a June 1984 Board decision, VA denied service connection for a right knee disorder, finding that there was no evidence of a right knee injury or condition that occurred during the Veteran’s active service. The Veteran did not appeal the 1984 Board decision within one year, and accordingly it became final. 38 C.F.R. § 3.156 (b). In June 2012, the Veteran filed an application to reopen his claim for service connection for a right knee disorder. Additional documentation received since June 2012 includes a May 2014 VA knee examination, an August 2017 non-VA disability benefits questionnaire (DBQ), VA and non-VA treatment records, and lay statements. In his statements and in the August 2017 DBQ, the Veteran reported that he injured his right knee during service and has had pain since 1979. He also alleged that a March 1977 service treatment record documenting an unspecified knee injury related to his right knee, not his left. Notably, the 1984 Board decision had previously viewed the same March 1977 STR and concluded that it referred to the left knee. Accordingly, the Veteran’s contentions are “new,” as they had not been made and thus were not considered at the time of the 1984 Board decision. When determining whether a claim should be reopened, the credibility of the newly submitted evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). On its face, the newly submitted evidence is of such significance that, when considered for the limited purpose of reopening the Veteran’s claim, it raises a reasonable possibility of substantiating his claim for service connection when considered with the previous evidence of record. As new and material evidence has been received, the claim for service connection for a right knee disorder is reopened. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “To establish a right to compensation for a present disability, 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)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection for impaired hearing is subject to the requirements of 38 C.F.R. § 3.385, which provides that impaired hearing will be a disability only if at least one of the thresholds for the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; the thresholds for at least three of the frequencies are greater than 25 decibels; or speech recognition scores using the Maryland CNC Test are less than 94 percent. See Hensley v. Brown, 5 Vet. App. 155 (1993). Tinnitus is defined as a ringing in the ears, and it is a disorder that is uniquely identifiable by the senses of the person experiencing it. It is a condition that is “simple” in nature in that respect, and thus, is a disability that can be diagnosed by the person experiencing the condition. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). That is, the confirmation of the existence of tinnitus does not require any medical expertise (i.e. is not “complex” in nature), and assuming the allegations of the Veteran are credible, testimonial evidence of an origin of the condition in service can be used to support a claim for service connection. Certain disorders listed as “chronic” in 38 C.F.R. § 3.309 (a) and 38 C.F.R. § 3.303 (b) are capable of service connection based on a continuity of symptomatology without respect to an established causal nexus to service. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Sensorineural hearing loss and tinnitus, as organic diseases of the nervous system, are “chronic diseases” listed under 38 C.F.R. § 3.309 (a). Arthritis is also among the chronic diseases listed. Therefore, the presumptive service connection provisions based on “chronic” in-service symptoms and “continuous” post-service symptoms under 38 C.F.R. § 3.303 (b) apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. 38 C.F.R. § 3.303 (b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, sensorineural hearing loss and tinnitus, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309 (a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for a right knee disorder. The Veteran was diagnosed with right knee osteoarthritis in August 2017. He contends his current right knee condition originated in service. Service treatment records (STRs) do not explicitly reference any injury to the right knee. A December 1976 Report of Medical History noted the Veteran had surgery on his left knee for torn cartilage in 1971, prior to entering service. He did not report any injury or condition involving his right knee at that time. The attending clinician recommended an orthopedic evaluation but cleared the Veteran for active duty. In a January 1977 orthopedic record, the Veteran reported injuring his left knee playing football in 1971 and later undergoing a meniscectomy. The attending clinician noted the prior left knee injury had healed well, and the Veteran was then able to participate in all sports without difficulty. The Veteran did not report any right knee symptoms at that time. A March 1977 medical record noted that the Veteran hit a board and his knee hurt. The record did not specify which knee was involved. The Veteran’s knee was swollen and tender but had good movement. The impression was a bruise and the Veteran was given a knee brace. In a later statement, the Veteran asserted that this March 1977 record referred to a right knee injury during basic training. An April 1977 Report of Medical History noted a thumb injury during basic training but was silent for reports of an injury of either knee. The Veteran denied ever having had “swollen or painful joints,” or ““trick” or locked knee” at that time. In his May 1979 Report of Medical Examination, the Veteran’s clinical lower extremity evaluation was normal. The report noted the Veteran had a left knee scar from a prior meniscectomy but was silent as to any abnormalities or findings related to the right knee. In a Report of Medical History of the same date, the Veteran denied ever having had “swollen or painful joints,” or a “trick or locked knee.” In his March 1980 Report of Medical History at service separation, the Veteran continued to deny symptoms in either knee and reported he was then in good health. He denied ever being advised to have any operations. In his separation physical, the Veteran’s lower extremities were noted to be normal, and his lower extremities were assigned a “1” under the PULHES system, indicating a high level of fitness. See Odiorne v. Principi, 3 Vet. App. 456, 457 (1992); ((observing that the “PULHES” profile reflects the overall physical and psychiatric condition of the veteran’s capacity and stamina (“P”); upper extremities (“U”); lower extremities (“L”); hearing (“H “); eyes (“E”) and psychiatric condition (“S”); assessed on a scale of 1 (high level of fitness) to 4 (a medical condition or physical defect which is below the level of medical fitness for retention in the military service)). The Veteran’s STRs are highly probative both as to his subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Veteran’s then-state of physical fitness and are akin to statements of diagnosis or treatment. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board’s decision); see also LILLY’S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (many state jurisdictions, including the federal judiciary and Federal Rule 803 (4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rationale that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care). Private medical records indicate that the Veteran sought emergency medical care after injuring his right knee in June 1981. The Veteran reported that he tore his right knee cartilage approximately one year earlier, during active service. However, the June 1981 emergency room (E.R.) record reflects that the Veteran hurt his right knee playing basketball one month previously (i.e. approximately one year and one month after he was discharged from active duty). The attending clinician gave a provisional diagnosis of a potential torn meniscus of the right knee. A later June 1981 progress note reflects an impression of “reinjured right knee cartilage.” In that note, the Veteran continued to report that he injured his right knee in service one year prior, was “examined for surgery,” but declined surgery at that time. As noted above, the STRs do not reference a right knee injury or that the Veteran was advised to have surgery on either knee during service. Private hospital records reflect that the Veteran underwent a right knee arthroscopic procedure in June 1983. The Veteran filed his initial claim of service connection for a bilateral knee condition in April 1982. An August 1983 rating decision denied his claims, finding that there was no documented right knee condition during active service. In his September 1983 substantive appeal (VA Form 9), the Veteran asserted that he injured his right knee at Fort Knox in July 1979. He did not provide any other details regarding the alleged injury. At the November 1983 Board hearing, the Veteran testified he had torn left knee cartilage before service and that he was told to “take it easy.” He indicated his knee bothered him “a lot,” in service but he did not complain about it. The Veteran reported that he reinjured his left knee during basic training and a doctor bandaged it. The Veteran testified that he reinjured his left knee while playing football in service. He reported being “struck” above the left knee and experiencing swelling, pain, and walked with a limp. He indicated that he sought medical attention and doctors informed him that X-rays did not reveal a fracture, although he was asked if he wanted an operation. The Veteran stated he declined an operation at that time, but his left knee became more swollen two or three days later. He testified that he experienced left knee pain for about a year after the injury and used crutches and bandages during that time. The Veteran denied any other treatment for bilateral knee issues other than a checkup. The Veteran specifically testified that he did not injure his right knee during service. He stated his right knee gave him “a little problem” during basic training in 1977, but he “dealt with it.” He denied any specific trauma to the right knee from 1979 to 1980 and reiterated that the only trouble he had with his right knee was during basic training. When questioned about medical records noting a 1971 pre-service left knee football injury, the Veteran alleged the records were incorrect—he asserted it was his right knee, not his left, that was injured in 1971 and required surgery at that time. However, his testimony is contradicted by the December 1976 and April 1977 reports of medical history noting a 1971 left knee medial meniscectomy, torn cartilage, and a surgical scar. Additionally, the January 1977 orthopedic record reflects that the Veteran reported injuring his left knee in 1971 while playing basketball and having a meniscectomy at that time. In a December 1983 statement, the Veteran asserted that he “sustained a blow above the right knee” during service, and strenuous duties aggravated his knee condition. This statement contradicts the Veteran’s hearing testimony from a month earlier that he did not injure his right knee in service. As stated above, the Board previously denied service connection for a right knee disorder in a June 1984 decision. In that decision, the Board found that there was no documentation of a right knee disorder during active duty, and that the first documentation of a right knee condition was the June 1981 basketball injury. Notably, the Board indicated the only knee injury documented in service was the March 1977 left knee injury during basic training. In June 2012, the Veteran filed an application to reopen his claim of service connection for a right knee disorder only. At the May 2014 VA knee examination, the Veteran continued to report injuring his right knee while on active duty. He reported he was offered “surgery/repair” but declined at that time. The Veteran stated he was discharged home and sought care at a non-VA hospital, where he was diagnosed with a bucket handle tear of the right medial meniscus in 1983. The VA examiner was not asked to discuss the etiology (cause) of the Veteran’s right knee condition. In an April 2015 Statement in Support of Claim (VA Form 21-4138), the Veteran alleged that the March 1977 STR noting an unspecified knee injury referred to a right knee injury during training. This statement conflicts with the Veteran’s 1984 hearing testimony where he specifically denied having a right knee injury in service. Accordingly, it has low probative value. In an August 2017 non-VA Disability Benefits Questionnaire (DBQ), the Veteran reported that he injured his right knee during military work and has had pain since 1979. The examiner diagnosed the Veteran with right knee osteoarthritis but did not provide any further discussion or analysis of the cause of the Veteran’s right knee condition. At the August 2018 Board hearing, the Veteran reported that he “smashed” his right knee against a wall during drills in basic training. He stated he went to sick call, was advised to have surgery, but waited to do so until after he was discharged. He stated he had surgery on his right knee at a VA medical facility shortly after separation, in approximately 1984. The preponderance of the evidence is against finding that the Veteran’s current right knee disorder was incurred in or aggravated by service. In reaching its decision, the Board has considered the Veteran’s allegations of a right knee injury in service, but finds these statements are not credible as they are not consistent with the contemporaneous medical evidence. See Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration a claimant’s statements, it may consider whether self-interest may be a factor in making such statements); see also Caluza v. Brown, 7 Vet. App. 498 (1995), aff’d, 78 F.3d 604 (Fed Cir. 1996) (holding that, in weighing credibility of lay evidence VA may consider such elements as interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, desire for monetary gain, and demeanor of the witness). The Veteran has given several inconsistent and contradictory statements regarding an alleged right knee injury in service. At the November 1983 Board hearing, he specifically denied injuring his right knee during service, despite previously alleging in a September 1983 statement that he injured his right knee at Fort Knox in 1979. Additionally, he contradicted multiple service medical records when he asserted that his 1971 pre-service cartilage tear and surgery were for his right knee instead of his left. Further, the Veteran testified at the 1984 hearing that he was struck above his left knee playing football and was offered surgery but later testified at the November 2018 hearing that that he was offered surgery in service for his right knee. In either case, there is no notation in the service medical records that the Veteran was advised to have surgery on either knee. The Board may draw inferences against the claimant from the absence of documentation when there is logical reason to suppose that the event or condition would have been recorded. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012). The absence of a record of an event which would ordinarily have been recorded gives rise to a legitimate negative inference that the event did not occur. See AZ v. Shinseki, 731 F.3d 1301, 1315 (Fed. Cir. 2013). Here, the Board finds that if the Veteran had a right knee injury in service that was severe enough that doctors advised him to undergo surgery, that fact would have been documented in his service medical records. The probative value of the Veteran’s allegations is significantly outweighed by the contemporaneous medical evidence which is silent for any right knee condition or injury. As indicated above, the STRs are highly probative as to the Veteran’s then-state of physical fitness. See Rucker, supra. The same cannot be said for the Veteran’s allegations made after filing the instant claim, which are inconsistent with his prior allegations and the STRs. See Caluza, supra. As there is no credible evidence of a right knee injury in service, nor any probative medical evidence showing a link between the Veteran’s current right knee osteoarthritis and any injury in service, the claim will be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 3. Service connection for bilateral hearing loss. VA treatment records indicate that the Veteran was diagnosed with bilateral sensorineural hearing loss in December 2010. The Veteran contends his military occupational specialty (MOS) of Food Service Specialist exposed him to acoustic trauma while in service. At the August 2018 Board hearing, he reported he was stationed with an infantry unit and was frequently exposed to weapons fire without proper hearing protection. He reported his hearing has gradually worsened since. Service treatment records (STRs) indicate that the Veteran had mild right-sided hearing loss prior to entering service. At his December 1976 medical examination at induction, the Veteran demonstrated a pure tone threshold of 40 decibels at the 4000 Hz frequency range, which constitutes hearing loss for VA purposes. See 38 C.F.R. § 3.385, supra. However, he denied ever having had hearing loss on his December 1976 report of medical history. A May 1979 periodic examination report notes “mild” high frequency hearing loss in the right ear. However, a June 1979 audiogram indicated normal hearing. The Veteran continued to deny ever having had hearing loss in his March 1980 report of medical history. Notably, a March 1980 audiogram at discharge reflects that the Veteran’s hearing improved. His pure tone thresholds were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 5 10 Not tested 20 LEFT 0 0 10 Not tested 10 As indicated above, the Veteran’s STRs are highly probative as they are generated with a view towards ascertaining the Veteran’s then-state of physical fitness and are akin to statements of diagnosis or treatment. See Rucker, supra. Post-service VA treatment records indicate that the Veteran’s hearing has been periodically evaluated from December 2010 to the present. A September 2013 VA audiogram report states that the Veteran had normal hearing in the right ear through 1000 Hz, normal hearing in the left ear through 2000 Hz, and mild to severe hearing loss bilaterally in the 3000-8000 Hz range. In a December 2014 VA audiological record, the Veteran reported occasional bilateral tinnitus but denied any changes in his hearing. He reported occasional tinnitus but denied that it was bothersome to daily activities. The VA audiologist noted the Veteran’s hearing test revealed a threshold shift and recommended a follow-up evaluation. A March 2016 VA audiology record indicates the Veteran had moderate high frequency bilateral hearing loss which was worse in the right ear. At the April 2016 VA hearing loss examination, the Veteran’s pure tone thresholds were: HERTZ 500 1000 2000 3000 4000 RIGHT 15 20 40 70 85 LEFT 10 20 20 25 55 The Veteran’s speech recognition scores were 94 percent for the right ear and 96 percent for the left. The VA examiner indicated the Maryland CNC word list was used. Based on these findings, the examiner diagnosed bilateral sensorineural hearing loss in the frequency ranges of 500-4000 Hz and 6000 Hz. After reviewing the Veteran’s claims file, including in-service audiological examinations, service treatment records and private treatment records, the VA examiner opined that the Veteran’s current hearing loss was less likely than not caused by or a result of in-service noise exposure. The examiner first noted that the Veteran’s MOS of Food Service Specialist had a low probability for hazardous noise exposure. The examiner also noted that in-service audiograms indicated the Veteran’s mild high frequency hearing loss predated service, and actually improved when the Veteran was discharged in March 1980. The examiner concluded there was no objective evidence of a permanent positive threshold shift in hearing in either ear during service. In a July 2016 letter, a non-VA physician (S.W., M.D.) stated the Veteran’s current hearing loss is secondary to the Veteran’s noise exposure during active service. S.W. indicated he had treated the Veteran for many years but did not explain his conclusion that the Veteran’s current hearing loss is related to service. Thus, the July 2016 letter is conclusory and has little probative value. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion depends upon whether it is factually accurate, fully articulated, and contains sound reasoning for the conclusion, not the mere fact that the claims file was reviewed); see also Stefl v. Nicholson, 21 Vet. App. 120, 124-125 (2007) (holding that “a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor’s opinion”). In an October 2017 statement, the Veteran challenged the April 2016 VA examiner’s findings, arguing that the examiner failed to fully consider the Veteran’s noise exposure in service. The Veteran stated that, while he was a Food Service Specialist, he was attached to an infantry unit and was constantly exposed to gunfire as a result. He argued that his preexisting hearing loss was aggravated by noise exposure in service. Alternatively, he argued that his tinnitus developed in service and caused his hearing loss. In a June 2017 VA otolaryngology record, the Veteran reported his hearing loss was worse in one ear and attributed his hearing loss in both ears to noise exposure in service. He also reported intermittent high-pitched tinnitus. The attending clinician indicated a diagnosis of asymmetric hearing loss and noted the condition was stable since 2014. The examiner noted that she discussed possible etiologies of hearing loss with the Veteran, including military noise exposure and/or a Cerebellopontine angle (CPA) lesion (a type of tumor in the ear). The examiner ordered magnetic resonance imaging (MRI) later in June 2017 which was negative for CPA lesions or any other abnormalities of the internal auditory canal. At the August 2018 Board hearing, the Veteran alleged that he began having difficulty hearing after being exposed to gunfire in service. He stated he began to notice ringing in his ears and had difficulty hearing music and television. The Veteran reported his hearing was tested at the beginning of his period of reserve service and that he was told he had hearing loss. He alleged that in 2017, a VA medical provider told him his hearing loss was related to service, although he could not recall the name of the provider or the month when he was told. The Veteran was afforded 60 days from the date of the hearing to provide additional evidence in support of his claim but did not do so. The preponderance of the evidence is against the claim. While the failure to meet the criteria for hearing loss at the time of separation from active service is not necessarily a bar to service connection for a hearing loss disability, the Veteran has not submitted any probative medical evidence that his current hearing loss is related to service. Heuer v. Brown, 7 Vet. App. 379 (1995). The probative medical evidence indicates the Veteran’s hearing improved during service and he was not diagnosed with hearing loss until over 35 years after service separation. The Veteran has continuously asserted throughout the appeal that his current bilateral hearing loss was caused by hazardous noise exposure during service. As stated above, the Veteran is competent to report observable symptomatology of his condition but, as a layperson, he is not competent to render an opinion establishing a nexus between his current hearing loss and military noise exposure. See Jandreau supra, 492 F.3d; Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Unlike tinnitus, sensorineural hearing loss requires specialized training for determinations as to diagnosis and causation and is therefore not susceptible to lay opinions on etiology (cause). Additionally, the Veteran’s contention that he had hearing loss in service is significantly outweighed by his service audiograms which reflect that his hearing improved, rather than deteriorated, in service. He consistently denied hearing loss in his in-service reports of medical history. The STRs are highly probative as they are akin to statements of diagnosis or treatment. See Rucker, supra. Accordingly, the Veteran’s contention that his preexisting mild hearing loss was aggravated during service is without merit. Since the Veteran’s bilateral hearing loss disability was not incurred in service, nor diagnosed within the presumptive period after discharge, the claim for service connection is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 4. Service connection for tinnitus. Veteran contends he was routinely exposed to loud noise from firearms during service, and that his in-service noise exposure caused constant ringing in his ears. He is competent to report that tinnitus was incurred in service and it has existed from service to the present. See 38 C.F.R. § 3.159(a)(2); Jandreau, supra. The Veteran’s service treatment records do not refer to tinnitus or ringing of the ears, although he did not specifically deny those symptoms. Post-service medical records reflect that the Veteran first reported tinnitus to a VA medical provider in December 2014. At the April 2016 VA hearing loss examination, the Veteran reported recurrent tinnitus stating that symptoms began in 2004. The 2016 VA examiner concluded the Veteran’s tinnitus was not likely related to service, noting that STRs did not show any positive threshold shifts in hearing or a diagnosis of tinnitus. (Continued on the next page)   In an October 2017 statement, the Veteran denied stating to the 2016 examiner that his tinnitus began in 2004 and reiterated that his tinnitus began in service and has continued since. The Board finds the medical evidence is in relative equipoise regarding the etiology of the Veteran’s current tinnitus. The 2016 VA examination report did not address the Veteran’s presumed credible accounts of military noise exposure and his reports of ringing in his ears continuously since service. Unlike bilateral hearing loss, tinnitus does not require specialized training in order to diagnose. Resolving any doubt in the Veteran’s favor, service connection for tinnitus is granted. 38 U.S.C. § 5107 (b); Gilbert, supra. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hiaasen 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.