Citation Nr: 21008731 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 17-61 537 DATE: February 17, 2021 ORDER Service connection for bilateral hearing loss is denied. FINDINGS OF FACT 1. The Veteran had a preexisting left ear hearing loss disability at service entrance. 2. Left ear hearing loss was not aggravated during service; the current bilateral hearing loss was not shown as chronic during service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology since service is not established; and the current bilateral disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1111, 1112, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the U.S. Army from May 1967 to May 1969. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision. In a February 2019 decision, the Board granted service connection for tinnitus and denied service connection for hearing loss. The Veteran then appealed to the U.S. Court of Appeals for Veterans Claims (Court). In a July 2020 Memorandum Decision, the Court vacated and remanded the Board’s denial of service connection for hearing loss for inadequate reasons and bases. 1. Service connection for bilateral hearing loss The Veteran and his representative contend that his current hearing loss is due to frequent hazardous noise exposure from his duties as an aircraft mechanic during service from being around loud tools and aircraft engines constantly, as well as during deployment in Vietnam from small arms fire, rockets, mortars, and machine guns. He asserts that his hearing loss began during service and has continued to the present. See September 2015 statement with claim, December 2016 notice of disagreement (NOD), December 2016 representative arguments (VA Form 646). Generally, in order to establish service connection, the evidence must show: (1) a present disability; (2) an 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. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain listed chronic diseases will be presumed related to service if certain criteria are met, as discussed further below. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a)(3). There is a presumption of sound condition upon entrance into active duty service unless a defect or disorder is “noted” on the entrance examination, and there is a presumption of aggravation of a preexisting condition if the preexisting condition worsens in severity during service. Clear and unmistakable evidence is required to rebut the presumption of aggravation, to include a specific finding that the increase is due to the natural progress of the disease. 38 U.S.C. §§ 1111, 1153; 38 C.F.R. §§ 3.304(b), 3.306. There are different burdens of proof, as discussed below. There are several VA examinations and opinions in this case. The July 2020 Memorandum Decision was based, in part, on a finding of inadequate reasons and bases in the Board’s discussion of some of those examinations in the 2019 decision. To be adequate, a medical opinion must be based on consideration of an appellant’s prior history and examinations and describe the appellant’s condition in sufficient detail so that the Board’s evaluation of the claim may be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). An examiner must support the conclusions given with analysis, but the report must be read as a whole and need not “explicitly lay out the examiner’s journey from facts to a conclusion.” Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012). The examiner is not required to provide a detailed review of medical history or comment on every piece of favorable evidence in the record. Id.; see also Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement). Where the medical opinion is lacking in detail, “the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination.” Acevedo, 25 Vet. App. at 294. In adjudicating service connection claims, reasonable doubt that exists because of an approximate balance of positive and negative evidence concerning any point will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In this case, a current disability is established. Although the Veteran has not identified post-service treatment, the January 2016 VA examiner diagnosed bilateral sensorineural hearing loss, and testing met the VA disability criteria. Pure tones were above 26 decibels at multiple levels and 40 decibels or above for at least one level bilaterally; speech discrimination was also below 94 percent in the left ear, at 88 percent. See 38 C.F.R. § 3.385. The August 2017 examiner diagnosed mixed hearing loss, with both a sensorineural and conductive component, but testing also meet the VA disability criteria bilaterally. VA treatment records from January 2016 through September 2020 similarly noted current hearing loss. An in-service injury or event is also established. The Veteran’s DD Form 214 and other service personnel records confirm that he served as an aircraft mechanic or helicopter repairman, as well as that he was deployed to Vietnam from July 1968 to May 1969. VA has acknowledged that this occupation has a high probability of hazardous noise exposure. The Veteran is also competent to report excessive noise exposure, and his described exposure is credible and would be consistent with his aircraft mechanic duties and deployment to Vietnam during wartime. See 38 U.S.C. § 1154(a); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The final element of a nexus is not established, based on either the chronic disease presumption or a lay or medical link between the current disability and service, including incurrence or aggravation of a preexisting condition for the left ear. As explained below in more detail, this claim must be denied because the Veteran’s reports of having continuous hearing loss symptoms or disability since service are not credible, and the competent evidence does not otherwise establish a relationship to service under any reasonably raised theory of service connection. This claim involves different standards of proof for establishing service connection for the Veteran’s left and right ears based on findings in his pre-service induction examination in 1967, as there was a preexisting noted left ear hearing loss. In the July 2020 Memorandum Decision, the Court acknowledged that the Board’s finding in the 2019 decision that the pure tones in a January 1967 induction examination showed a left ear hearing loss disability was adequate and proper. However, the Court noted that the Board did not address the disparity between this finding and a statement by the January 2016 VA examiner that the Veteran’s pure tones at entrance and exit from service were within normal limits. The Board must consider all relevant evidence in determining whether there was a preexisting disability. As discussed below, the evidence clearly shows a pure tone threshold of 40 decibels or above in the left ear on the Veteran’s 1967 induction examination report, which is abnormal and which shows hearing loss to a disability level for VA purposes. The examiner’s characterization of the results as within normal limits does not change the results themselves or negate the application of VA’s criteria for a disability. Instead, the notation of normal results at entrance or induction appears to have been in error for the left ear, although they were normal for the right ear. The examiner’s notation is not dispositive as to the existence of abnormal results, which are objectively shown. Instead, the medical opinion is most relevant as to the etiology of the current hearing loss conditions, which are discussed below. The Court also took issue with the Board not discussing whether the finding of bilateral hearing within normal limits at an August 1967 examination (during service) undercut a finding of a preexisting left ear disability at entrance. The Court stated that these test results were created closer in time to the Veteran’s entrance into service than the January 1967 examination showing hearing loss. Upon further review, the discussion below addresses these concerns and relevant evidence. The Veteran’s DD Form 214 reflects that he was inducted or entered into service on May 23, 1967. His Report of Medical History and Report of Medical Examination for induction both state that they were conducted on January 31, 1967, and the Report of Medical History is signed on that date. However, an audiogram report is also in the file, which is dated May 14, 1967. Additionally, a notation on the Report of Medical Examination states that no additional defects were discovered upon inspection on May 23, 1967, and the Veteran was found fit and qualified for service. That report noted a defect for item 71, which is the pure tone audiometry section, of H2, and assigned a physical profile of 2 for a hearing defect. Consistent with this medical report, a Record of Induction in the Veteran’s service personnel records notes a physical inspection and medical determination on May 23, 1967, of a physical profile of H2. Accordingly, the record shows that evidence was collected as to the Veteran’s hearing acuity and a hearing defect was noted in May 1967. In Hensley v. Brown, 5 Vet. App. 155, 157 (1993), the Court previously noted that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Under 38 C.F.R. § 3.385, a VA disability has additional requirements including higher pure tone threshold levels. For service audiograms between January 1, 1967, and December 31, 1970, the Board will consider the data under both the American Standards Association (ASA) and International Standards Organization-American National Standards Institute (ISO-ANSI) standards, unless it is clear which standard was used. As relevant for determining whether a VA disability exists under § 3.385, conversion involves adding the following to the recorded thresholds: 500 Hertz (add 15), 1000 Hertz (add 10), 2000 Hertz (add 10), 3000 Hertz (add 10), 4000 Hertz (add 5). The Veteran’s 1967 Report of Medical Examination for induction was conducted under the ASA standards, based on a handwritten notation and negative threshold results. The recorded data was -10, -10, -10, [not tested], -5 in the right ear and -10, -10, -10, [not tested], and 45 in the left ear from 500 to 4000 Hertz, with the 3000 Hertz level not tested. These readings convert to 5, 0, 0, [not tested], 0 in the right ear and 5, 0, 0, [not tested], and 50 in the left ear under the ISO standards. Therefore, these results were normal for the right ear and met the VA disability criteria at the 4000 Hertz for the left ear under both standards. Thus, the induction report noted a hearing defect (H2) in the defect section and the physical profile. The May 14, 1967, audiogram shortly before the Veteran was inducted indicates that the ISO units were used, so no conversion is needed. The graph appears to reflect pure tone threshold decibel readings at the 500, 1000, 2000, 3000, and 4000 Hertz levels for the right ear of 10, 10, 5, possibly 15 or 20 at 3000 Hertz, and possibly 30 or 40 at 4000 Hertz, respectively. The readings appear higher than noted in the Report of Medical Examination and to potentially show a disability if the 4000 Hertz reading is 40 decibels. Decibel readings for the left ear appear to be 15, 20, 15, 20 or possibly 25 at 3000 Hertz, and 20 at 4000 Hertz, respectively. These readings appear lower than in the Report of Medical Examination that noted a hearing defect and showed an abnormal reading only in the left ear, and the May 1967 readings would not meet the VA disability criteria for the left ear. abnormal lower and appear within normal limits, with only a possible impairment above 20 decibels at the 3000 Hertz level, but no readings to meet the VA disability criteria. An August 1967 Report of Medical Examination for flying class III qualification shows pure tone thresholds that were conducted under the ASA standards because they include negative results. For the right ear, thresholds were -10, -10, -5, 0, and 0 at 500 to 4000 Hertz. For the left ear, the results are somewhat illegible but appear to show thresholds of 0, 0, 0, 0, and 5 from 500 to 4000 Hertz. These readings convert to 5, 0, 5, 10, and 5 for the right ear and 15, 10, 10, 10, and 10 for the left ear under the ISO-ANSI standards. These results were normal bilaterally under both standards, and the Veteran was assigned a physical profile for hearing of 1 for no defect. Nevertheless, because this evidence was after his entry into service, it is not relevant for determining whether there was a preexisting disability. The presumption of sound condition attaches only where there has been an induction examination in which the claimed disability was not detected. Verdon v. Brown, 8 Vet. App. 529, 535 (1996). As the Veteran’s condition was detected or noted on the pre-service examination, subsequent resolution does not negate this. Although there is some disparity between the 1967 Report of Medical Examination for induction and the Board’s interpretation of the May 1967 audiogram graph, the Board resolves reasonable doubt in the Veteran’s favor to find that he did not have a preexisting right ear hearing loss disability. Therefore, the general standards for service incurrence apply to the right ear, as set forth in Shedden, supra. There is also some disparity in between the 1967 Report of Medical Examination for induction and the apparent readings from the May 1967 audiogram graph. Nevertheless, the Report of Medical Examination expressly found a hearing defect and assigned a physical profile for hearing based on objective testing that was abnormal for the left ear. Therefore, the evidence reflects that a left ear hearing loss disability was “noted” by the medical report. The Veteran denied noticing hearing loss in a Report of Medical History in January 1967, indicating that he was not aware of any symptoms. Nevertheless, the impairment at the VA disability level was still diagnosed or “noted” upon clinical examination and testing. Even if a condition was asymptomatic at the time of induction, if the condition is “noted” on the induction medical examination report, then it was detected and the presumption does not attach. Verdon, 8 Vet. App. at 535. Accordingly, despite having no noticeable hearing loss symptoms, the Veteran did have a noted left ear hearing loss disability in his 1967 induction examination, and the presumption of soundness does not attach. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Because the presumption of soundness does not apply, the Veteran may only bring a claim for aggravation of his left ear hearing loss. Smith v. Shinseki, 24 Vet. App. 40, 47-48 (2010). He has the burden of showing a worsening of the disability in service to trigger the presumption of aggravation. Horn v. Shinseki, 25 Vet. App. 231, 235 n.6 (2012); Wagner v. Principi, 370 F.3d 1089, 1095-96 (Fed. Cir. 2004). Temporary or intermittent flare-ups of a preexisting condition during service are not sufficient to constitute aggravation unless the underlying condition, as distinguished from the symptoms, worsened. The evidence must show a lasting worsening of the condition, meaning an increase in severity that existed at the time of separation from service and still exists currently. Hunt v. Derwinski, 1 Vet. App. 292, 296-97 (1991); Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002). Similarly, where there is a noted preexisting condition that was asymptomatic at entry, and there is an exacerbation of symptoms in service, this does not constitute evidence of aggravation. Green v. Derwinski, 1 Vet. App. 320, 323 (1991). The Veteran has not provided details concerning the degree of any noticeable left ear hearing loss or increase during service. In his claim and NOD, he stated only that his hearing loss began in service and has been present since that time. As discussed below, the Board finds that the Veteran has not shown a worsening of his left ear hearing loss during service, and the presumption of aggravation is not triggered. Furthermore, he is not credible as to having had an onset of chronic symptoms or disability during service or continuity of symptoms since service. There is information contradicting these reports in the Veteran’s service records. For his August 1967 flight examination physical, the Veteran expressly denied having ear, nose, or throat troubles and hearing loss in the Report of Medical History. As noted above, he was also assigned a physical profile of 1 for hearing at that time, indicating no defect based on the pure tone threshold testing. Service records also reflect treatment for ear pain or infection at times. An October 1967 record diagnosed early left ear otitis media, and the Veteran’s left ear canal was noted to be plugged with cerumen (ear wax). In January 1968 and January 1969, he was treated for mild or minimal left ear otitis externa. However, there were no other complaints concerning the ears or hearing loss during service. In a Report of Medical History for his May 1969 separation examination, the Veteran again expressly denied having hearing loss, although he did report having ear, nose, or throat trouble. The physician’s summary noted that the Veteran’s positive answers were reviewed and were found to be of no medical significance. The Report of Medical Examination found clinically normal hearing and reflects pure tone thresholds within normal limits of 10, 10, 5, 10, and 15 in the right ear and 15, 15, 15, 20, and 20 in the left ear from 500 to 4000 Hertz, respectively. It is unclear whether these results were conducted under the ASA or ISO-ANSI standard. For comparison, if they were done under the ASA standards, these readings would convert to 25, 20, 15, 20, and 20 in the right ear and 30, 25, 25, 30, and 25 in the left ear under the ISO-ANSI standard. These results would show some degree of hearing impairment, but no VA disability. However, the finding of no hearing defect and no physical profile at the time the tests were conducted suggests that the ISO-ANSI standards were used at the time, such that no conversion is needed for comparison and the lower recorded readings control. The Veteran’s reports in his service records are highly probative because they were contemporaneous in time to his noise exposure and asserted onset of his noticeable symptoms. It is reasonable to expect that the Veteran would have reported hearing difficulties when he was treated for ear pain or infection if it existed at those times because he was being examined for ear problems, but he did not mention hearing difficulties at those times. It is also reasonable to expect that the Veteran would have reported hearing difficulties at his separation examination if they were present at that time or during service, particularly since he did report the ear trouble for which he had sought treatment. Instead, the Veteran expressly denied current or prior hearing loss at separation and was found to have clinically normal ears and hearing based on objective pure tone testing. Therefore, the absence of a report, and more importantly the express denial of noticeable hearing loss, weighs against its existence at those times. The objective medical evidence of clinically normal ears and hearing tests within normal limits at the separation examination also contradicts the existence of hearing loss or a disability at that time. In the July 2020 Memorandum Decision, the Court found that the 2019 Board decision provided inadequate reasons and bases for the adverse credibility determination as to the Veteran having had continuous symptoms of hearing loss since service. The Court took issue with the Board finding that the Veteran would have reported hearing loss at his separation examination if it were present during service, but also finding that he had a VA disability in the left ear at his induction examination even though he also denied having hearing loss at that time. The difference between these two situations is that the contemporaneous evidence showed objectively abnormal hearing during the 1967 induction examination, but objectively normal hearing during the 1969 separation examination. As noted above, the Veteran also had objectively normal hearing at his August 1967 flight physical. For all three of these examinations, the Veteran denied subjectively noticing any hearing loss in his Report of Medical History. These reports point toward him not noticing the existence of any hearing difficulties prior to service, a few months after entrance into service, and at his separation from service. As also noted above, whether or not the condition was subjectively symptomatic or noticeable from the Veteran’s lay person point of view prior to service, the evidence established an actual left ear hearing loss disability for induction in 1967. In other words, the contemporaneous and highly probative evidence in service showed clinically detectable left ear hearing loss prior to service that the Veteran did not notice, and no clinically detectable right or left ear hearing loss during service, as well as no hearing loss symptoms noticed by the Veteran during service. The claims file also includes post-service medical records dated since 2015. Private treatment records from May 2015 to July 2015 do not reference hearing loss symptoms or timing. VA treatment records include a May 2016 new patient visit for the primary care clinic. At that time, the Veteran denied auditory (or hearing loss) symptoms on system review. However, he reported post-service noise exposure through working as roofer or in construction for 25 years, some early factory work, and truck driving. He also reported military noise exposure in Vietnam as the crew chief on a helicopter, mechanic, and door gunner. The Veteran did not mention having hearing difficulties during or since service. The Veteran’s reports for treatment after service are highly probative because he had an incentive to give an accurate history as to the nature and timing of symptoms and exposures to receive proper care. It is reasonable to expect that the Veteran would have reported having hearing difficulties during service or on a continuous basis since service when he reported noise exposure during service. However, he did not do so. Instead, he denied auditory symptoms and also reported having a significant amount of noise exposure for more than 25 years after service. These notations point toward the Veteran not having symptoms since service. Significantly, the Veteran first reported hearing loss symptoms for his VA benefits claim after many years of post-service noise exposure, and there is no identified post-service treatment. Again, private and VA records since 2015 reflect treatment for other conditions, but not hearing loss. The lack of treatment or corroborating medical evidence for many years may be considered as one of several factors in determining whether a disability was incurred during service. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Fagan v. Shinseki, 573 F.3d 1282, 1289 (Fed. Cir. 2009). As discussed further below, in a September 2017 addendum opinion, a VA examiner stated that the Veteran’s left ear hearing loss was not aggravated during service and, in fact, appeared to have resolved based on the separation examination results within normal limits. The examiner applied medical expertise to the Veteran’s factual and medical history consistent with the Board’s findings as to the nature and timing of his noise exposure, hearing loss symptoms, and detectable hearing loss based on objective testing. Therefore, this opinion is highly probative. The Veteran has not met his burden to show worsening of his preexisting left ear hearing loss during service to trigger the presumption of aggravation. Instead, the most probative and credible evidence reflects that any potential hearing complaints during service, to include as related to his left ear infections, were only temporary or intermittent. Accordingly, the presumption of aggravation does not arise. Moreover, the VA examiner’s opinion is clear and unmistakable evidence of no worsening beyond the natural progression of the preexisting hearing loss. Additionally, to the extent the Veteran believes that his left ear hearing loss was aggravated during service to result in his current condition, he is not competent to offer an opinion in this regard. This question is medically complex, as it requires specialized medical knowledge of the involved neurologic or auditory bodily systems and application to the Veteran’s factual and medical history. Jandreau, 492 F.3d at 1377. This is particularly true in a case like this one where the evidence reflects that the Veteran had military noise as well as post-service noise exposure for many years through his civilian occupation. There is no other medical opinion suggesting aggravation during service. Therefore, service connection for left ear hearing loss based on aggravation of the preexisting disability is not shown. Concerning the right ear, the January 2016 VA examiner opined that the Veteran’s hearing loss was less likely than not incurred during service because his hearing was within normal limits based on testing at service entrance and separation, as well as relevant medical literature. The examiner cited to the American College of Occupational Medicine Noise and Hearing Conservation Committee as stating that noise induced hearing loss will not progress once the noise exposure has stopped. There is no indication of reliance on the 2006 Institute of Medicine (IOM) study that contained qualifying or contradictory findings and may not be adequate to support a negative opinion. Cf. McCray v. Wilkie, 31 Vet. App. 243 (2019). As relevant to both the ears, otherwise in the report, the January 2016 examiner diagnosed sensorineural hearing loss in the frequency range from 500 to 4000 Hertz, but did not check the option for “significant changes in hearing thresholds in service.” This option has three asterisks next to it (***), and the key for that notation states that a significant change in hearing thresholds may indicate noise exposure or acoustic trauma. This essentially indicates that there was no permanent or significant threshold shift during service. Additionally, the Veteran reported a relevant history of suffering a head trauma after service and receiving treatment and a family history of hearing loss, stating “My brother has the same problem I have.” Reading the report as a whole, these notations provide additional context for the examiner’s negative nexus opinion, including no changes to show acoustic trauma in service and relevant factors of head trauma and family history. As noted above, the 2016 examiner did not note the Veteran’s preexisting left ear hearing loss as shown at induction and, instead, inaccurately stated that pure tones (bilaterally) were within normal limits at entrance. Nevertheless, this opinion remains highly probative concerning the etiology of his right ear hearing loss, which was within normal limits on the induction examination as stated by the examiner. The cited medical literature as to the potential effects of in-service noise exposure, as well as information as to any threshold shifts in service and relevant factors other than in-service noise exposure also remain highly probative. Another VA examination was provided in August 2017 to address the Veteran’s preexisting left ear hearing loss. In an initial report, this examiner noted the left ear hearing loss shown in the 1967 service induction examination and that recent audiograms showed significantly worse hearing levels. The examiner diagnosed mixed hearing loss bilaterally, stating that there appeared to be both a conductive and sensorineural hearing loss component, and that canal collapse may possibly play a role in the conductive component. The examiner also noted that the notch at the 4000 Hertz level in the Veteran’s service induction examination would suggest noise exposure prior to service from recreational shooting. The examiner considered the Veteran’s noise exposure during service as a helicopter crew chief, as well as his reported noise exposure after service through construction work (which he reported for 25 years). Additionally, although the service records noted treatment for a left ear infection, the separation examiner noted that the Veteran’s complaints of ear, nose, or throat trouble were not medically significant at that time. There is also no indication of canal collapse in post-service treatment. In the August 2017 initial report, the examiner stated that there was a permanent positive threshold shift greater than normal measurement for both ears. She opined that the sensorineural component of the Veteran’s preexisting left ear hearing loss was aggravated beyond its natural progression by service, and the right ear hearing loss was at least as likely as not incurred during service, due to noise exposure through the Veteran’s duties as a helicopter crewman. However, the rationale for these opinions was that there was no “legible evidence to the contrary,” in that the examiner found the results of testing of the Veteran’s hearing after his induction examination during service, including at his May 1969 separation examination, to be illegible. These opinions have very low probative value because they are based on an inaccurate history. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In a September 2017 addendum opinion, after reviewing the legible reports of pure tone testing during service, this examiner stated that the Veteran had normal hearing at all frequencies as of May 1969. She opined that Veteran’s preexisting left ear hearing loss at 4000 Hertz was not aggravated by service and, in fact, appears to have resolved by 1969. The examiner also stated for the right ear that if the hearing thresholds were normal at separation then the loss demonstrated currently on exam was less likely than not a consequence of the military noise exposure. This is consistent with the January 2016 examiner’s opinions and the medical literature cited in that report concerning the effects of noise exposure. Therefore, these opinions have high probative value because they are based on an accurate history and provide explanations with clear conclusions and data. Id. In the July 2020 Memorandum Decision, the Court found that the 2019 Board decision provided inadequate reasons and bases as to potentially favorable evidence of a threshold shift in service. The Court found that “the evidence indisputably shows” a shift in thresholds between the Veteran’s entrance and separation from service, but neither the Board nor the two examiners in 2016 and 2017 addressed such a shift. The Court stated that this “may mean nothing, but it could be important,” and it is the Board’s province to make such a determination. Before the Court, the Veteran argued that the VA examiners and the Board failed to address a threshold shift, citing to Hensley v. Brown, 5 Vet. App. 155 (1993) and the definition of a “standard threshold shift” under the Occupational Safety and Health Administration (OSHA) regulations. However, the Board is bound by regulations that are promulgated VA, not regulations by other agencies or administrations. See 38 C.F.R. § 19.5; see also Beaty v. Brown, 6 Vet. App. 532, 538 (1994) (finding no authority for the Board to apply Social Security Administration regulations that have not been adopted by the VA Secretary). Additionally, there are no VA regulations, statutes, or binding case law, to include Hensley, that require either the Board or a medical examiner to discuss whether there was a threshold shift during service. Instead, Hensley provides that hearing loss may be attributable to service even if a disability is not shown at service entrance. 5 Vet. App. at 160. The Board has considered the Veteran’s claim under this theory, but the evidence does not show a lay or medical link to service. Moreover, the Board disagrees that there was a significant or permanent threshold shift or that the examiners did not consider this possibility in forming their conclusions and opinions. As noted above, a medical examiner’s reports should be read as a whole, and the examiner is not required to provide a detailed review of the Veteran’s history or comment every piece of potentially favorable evidence. The opinion rationale need not be overly explicit or detailed, and the Board may draw non-medical inferences from the overall report if the opinion is lacking in detail. See Monzingo, 26 Vet. App. at 105-107; Acevedo, 25 Vet. App. at 293-94. The 2016 examiner had the option of diagnosing a significant threshold shift during service, which the form notes could reflect noise exposure or acoustic trauma. However, the examiner did not check that diagnosis for either ear, and she gave a negative opinion based on legible reports of pure tones. Thus, to the extent there was a threshold shift during service, the opinion analysis and notations in the report as a whole reflect that it was found to be not significant enough to demonstrate acoustic trauma or a nexus between the current disability and service. As also noted above, the August 2017 examination report stated that there was a “permanent positive threshold shift (worse than reference threshold) greater than normal measurement variability” for both ears. However, that examiner expressly found that this notation was based on the report of testing at separation being illegible. This has very low probative value and does not establish the existence of a threshold shift. As in the 2016 report, this examiner also had the option of diagnosing a significant threshold shift during service, which the form notes could reflect noise exposure or acoustic trauma, but did not do so. The September 2017 addendum report then considered the legible separation report, which is in the claims file, and gave a negative nexus based, in part, on bilateral hearing within normal limits shown by testing at both entrance and separation from service. As with the 2016 examination, to the extent there was a threshold shift during service, this examiner’s opinion analysis based on legible reports and notations in the reports as a whole also reflect that the shift or change was found to be not significant enough to demonstrate acoustic trauma or a nexus to service. The Veteran’s representative made arguments of examination inadequacy to the Board in December 2017, although he did not specify which examination. The representative asserted that the examiner improperly based the opinion on no complaints of hearing loss in service records, but that no medical reason was given for such complaints to have been documented in the service records and the Board as fact-finder cannot rely on the absence of evidence as substantive negative evidence. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011). The representative also asserted that the examiner improperly based the opinion solely on a lack of corroborating medical records during service and did not consider the lay reports concerning symptoms. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). These arguments are unpersuasive. It is the Board’s role, not the examiner’s, to provide reasons and bases and make credibility determinations as the fact-finder; the examiner’s role is to make medical determinations. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007), rev’d on other grounds sub nom. Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). The credibility discussion above explains why it would be expected for the Veteran to have reported hearing loss during service if present, and how he made contrary reports at his separation examination. In addition, the 2016 and 2017 VA examination reports reflect a review of the claims file, although the original 2017 report did not notice the legible copies of service examinations at first. This review would include the lay reports as to symptoms, and the 2017 original report considered the Veteran’s reports of both in-service and post-service noise exposure, as well as relevant factors of head trauma and a family history of hearing loss unrelated to service. The opinions provided were based on the records and medical literature as applied to the Veteran’s history, consistent with the Board’s credibility determinations concerning the timing of symptoms. Accordingly, the examinations were adequate, including as to any threshold shifts. The Veteran’s representative also asserted that the Veteran gave competent and credible reports of having hearing loss symptoms since service and that this should warrant service connection; however, the Board finds those reports not credible. There is no other medical evidence to suggest a link between the current disability and service. The VA examiners’ negative opinions are adequate and outweigh the nexus assertions by the Veteran and his representative, which are not competent. Therefore, service connection is not warranted on a direct basis. 38 C.F.R. § 3.303. The criteria for the chronic disease presumption also have not been met. To the extent the Veteran has sensorineural hearing loss, this is considered a listed chronic disease of organic disease of the nervous system under 38 C.F.R. § 3.309(a). However, the Board finds that this disability was not chronic during service, or manifested to a compensable degree during service or within the applicable presumptive period of one year after discharge (by May 1970), and there was not continuity of symptomatology since service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a)(3). As discussed above, although the Veteran is competent to report experiencing observable hearing difficulties consistently since service, these reports are not credible because they are inconsistent with his express subjective reports and objective evidence through testing in contemporaneous records during service. The service records are highly probative because they were contemporaneous in time to the noise exposure and asserted symptoms. They contradict the Veteran’s reports decades later for the purposes of his VA claim, and they weigh against him having chronic hearing loss symptoms or a disability that began during service. The lack of complaints of hearing loss or treatment until decades after service, and after many years of post-service noise exposure, also weighs against continuity. As summarized above, there was no medical diagnosis or notation of any relevant complaints in service records; the Veteran expressly denied hearing loss, his ears were clinically normal, and pure tone thresholds were within normal limits at separation from service; he had no treatment for many years after service; and he had many years of post-service hazardous noise exposure through several occupations. Considering all of this evidence together, the Board finds the Veteran’s reports of continuous hearing loss symptoms since service to be not credible. See Buchanan, 451 F.3d at 1336-37; Fountain, 27 Vet. App. at 272; Maxson, 230 F.3d at 1333. Therefore, the Veteran did not have noticeable subjective or objective hearing loss symptoms or disability manifested to a compensable degree within one year after service discharge, or by May 1970. Furthermore, although the Veteran believes he has had a hearing loss disability since service, he is not competent to provide an opinion in this regard. To the extent that he had temporary hearing difficulties during or shortly after service for which he did not seek treatment, the Veteran is not competent to determine that these symptoms were manifestations of chronic disease. Instead, this issue requires medical knowledge of the auditory and neurological systems, interpretation of diagnostic testing, and consideration of his history. Jandreau, 492 F.3d at 1377. In summary, the Veteran’s bilateral hearing loss was not chronic or manifest to a compensable degree during service or within the presumptive period, there was not continuity of symptomatology after service, and the current bilateral hearing loss disability was not otherwise incurred or aggravated due to in-service injury or disease. As the preponderance of the evidence is against service connection, there is no reasonable doubt to resolve in the Veteran’s favor, and the appeal is denied. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Wheatley 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.