Citation Nr: 21010819 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-41 584 DATE: February 25, 2021 ORDER Entitlement to increases in the “staged” 30 and 50 percent ratings for posttraumatic stress disorder (PTSD) are denied. Entitlement to service connection for hypertension, to include as secondary to the service-connected PTSD, is denied. Entitlement to service connection for type II diabetes mellitus is denied. Entitlement to service connection for bilateral upper extremity peripheral neuropathy, including as secondary to the type II diabetes mellitus, is denied. Entitlement to service connection for bilateral lower extremity peripheral neuropathy, including as secondary to the type II diabetes mellitus, is denied. However, entitlement to service connection for tinnitus is granted. FINDINGS OF FACT 1. Prior to January 21, 2020 the most probative evidence indicates the Veteran’s PTSD, at worst, caused occupational and social impairment with reduced reliability and productivity; from that date onwards, his PTSD has caused at most occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. The most probative evidence is against finding that his hypertension is a result of his service – including caused or aggravated by his service-connected PTSD. 3. The most probative evidence is against finding that he has type II diabetes or diabetic complications of peripheral neuropathy of his upper or lower extremities or that his reported sensory deficits and other symptoms cause functional impairment of his earning capacity to be considered a ratable disability. 4. But it is at least as likely as not that his tinnitus began during his service and has persisted ever since. CONCLUSIONS OF LAW 1. Ratings for the PTSD higher than 30 percent prior to January 21, 2020, and higher than 50 percent since, are not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC/Code) 9411. 2. The criteria are not met for entitlement to service connection for hypertension, including as secondary to the service-connected PTSD. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria are not met for entitlement to service connection type II diabetes. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria are not met for entitlement to service connection for bilateral (left and right) upper and lower extremity peripheral neuropathy, including as secondary to type II diabetes. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 5. But, resolving all reasonable doubt in the Veteran’s favor, the criteria are met for entitlement to service connection for tinnitus. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from March 1964 to March 1968. This appeal to the Board of Veterans’ Appeals (Board) is from a March 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) – which, in relevant part, confirmed and continued the 30 percent rating for the Veteran’s PTSD. The RO also denied his claims for service connection for hypertension, type II diabetes mellitus, bilateral upper and lower extremity peripheral neuropathy, and for tinnitus. Aside from appealing those denials of service connection, he also appealed for a higher rating for his PTSD. The Veteran had a hearing in September 2019 concerning these claims at the Board’s offices in Washington, DC (Central Office (CO) hearing). The undersigned Veterans Law Judge presided. The Board subsequently, in October 2019, remanded these claims back to the Agency of Original Jurisdiction (AOJ) for further development and consideration – including to obtain outstanding records pertinent to these claims and then to have the Veteran examined for medical opinions reassessing the severity of his PTSD and determining whether he has the other conditions claimed and, if confirmed he does, their cause, particularly in terms of whether directly or presumptively related to his service or secondarily related by way of a service-connected disability. The rating for the PTSD since has been “staged” because a more recent July 2020 rating decision on remand, in part, increased the rating for the PTSD to 50 percent effective January 21, 2020, which is the date of a Disability Benefits Questionnaire (DBQ) completed on remand concerning this claim. See Fenderson v. West, 12 Vet. App. 119 (1999) and Hart v. Mansfield, 21 Vet. App. 505 (2007) (indicating VA adjudicators must “stage” a rating, meaning assign different ratings at different times, if there have been occasions when the disability has been more severe than at others – irrespective of whether an initial rating, as contemplated in Fenderson, or an established rating, as contemplated in Hart). Therefore, this appeal now partly concerns whether a rating higher than 30 percent for the PTSD was warranted prior to January 21, 2020 and whether a rating higher than 50 percent has been warranted since. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993) (receipt of a higher rating, but less than maximum possible rating, does not abrogate a pending appeal). The several other claims that instead are for service connection continued to be denied, on remand, so they, too, are again before the Board. 1. Entitlement to increases in the “staged” ratings for the PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R., Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates that rating criteria; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability is resolved in the Veteran’s favor. 38 C.F.R. § 4.3. The evaluation of the same disability under several DCs, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14.   The Veteran’s PTSD with unspecified depressive disorder with anxiousness is rated under DC 9411 of the General Rating Formula for Mental Disorders. This General Rating Formula provides for a 30 percent rating when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events. A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.   A 100 percent rating is warranted for total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms listed after that phrase are not intended to constitute an exhaustive list, but rather are to serve as mere examples of the type and degree of the symptoms, or their effects, whichg would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002) (VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment). In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court) held that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Id. When evaluating the level of disability of a mental disorder, the rating agency shall consider the extent of social impairment but shall not assign an evaluation based solely on the basis of social impairment. The focus of the rating process is on industrial impairment from the service-connected psychiatric disorder, and social impairment is significant only insofar as it affects earning capacity. 38 C.F.R. §§ 4.126, 4.130. The Veteran underwent a VA examination for his PTSD in February 2016 in response to his claim for a higher rating for this service-connected disability. He reported having been married since 1975 and having a good relationship with his only son. The Veteran reported being laid off from his regular job in 2000 but having worked odd jobs for the Coast Guard since. He reported attending bible group and groups at the Veterans Center weekly and volunteering weekly at a food pantry but otherwise mostly keeping to himself. He endorsed symptoms of depressed mood, anxiety, and chronic sleep impairment. The examiner diagnosed PTSD and unspecified depressive disorder and opined that it caused the Veteran occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. The Veteran since has undergone another VA examination for his PTSD in January 2020, while this claim was on remand. During this more recent mental status evaluation, he reported depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The examiner again diagnosed PTSD but surmised that it now causes the Veteran occupational and social impairment with reduced reliability and productivity. Based on the results of those mental status evaluations, and the other relevant evidence in the file, prior to January 21, 2020, the Veteran’s PTSD, at most, caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. At no time during this initial period did his PTSD cause occupational and social impairment with reduced reliability and productivity, in turn, warranting a higher 50 percent rating. Since January 21, 2020, when he had the additional VA examination, on remand, the Veteran’s PTSD at most has presented a disability picture indicative of occupational and social impairment with reduced reliability and productivity (so which is contemplated by the higher 50 percent rating he now has for his PTSD during this succeeding period from the date of that examination onwards). That examination was the first indication he met the requirements for this higher 50 percent rating, so the date of that examination marks the “date of entitlement” to this higher 50 percent rating. If, as here, the increase in severity of the disability occurred after the date of claim, the effective date is the date of the increase. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(1)(2); see also Harper v. Brown, 10 Vet. App. 125 (1997); VAOPGCPREC 12-98 (1998). Occupational and social impairment with deficiencies in most areas has not been shown, such as to in turn warrant a higher 70 percent, nor has total occupational and social impairment been shown to in turn warrant an even greater 100 percent rating. Accordingly, a schedular rating higher than 30 percent is not warranted prior to January 21, 2020, and a schedular rating exceeding 50 percent has not been warranted since January 21, 2020. While the constellation of the Veteran’s symptoms has included depressed mood and anxiety, he notably has remained able to live independently and care for his personal needs and maintain other healthy social relationships – including, notably, with his family and with others in a church setting and in his volunteer activities. At all times he has been observed to be adequately groomed, correctly oriented (to time, place, person and situation) and has shown appropriate thought processes. He has been found able to fully and independently perform activities of daily living (ADLs). He has denied suicidal and homicidal ideation, even contemplation of it. See Bankhead v. Shulkin, 29 Vet. App. 10 (2017) (holding that the mere presence of suicidal ideation, alone, may cause occupational and social impairment with deficiencies in most areas (so as to, in turn, warrant a 70 percent disability rating under 38 C.F.R. § 4.130). In short, he is adequately compensated for his PTSD both prior to and since January 21, 2020, such that an increase in his ratings before and after that date is not warranted. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 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 relevant disease or an injury; and (3) a causal relationship (“nexus”) between the present disability and the disease or injury incurred or aggravated during service. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain diseases are considered “chronic”, per se, including hypertension, type II diabetes mellitus, and tinnitus, and may be presumed to have been incurred in service if they manifested to at least 10-percent disabling (compensable degree) within a year of the Veteran’s discharge from service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Service connection also may be established on a secondary basis for disability that is proximately due to, or the result of, or being aggravated by a service-connected disability. Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) indication the current disability was either (a) caused or (b) is being aggravated by the service-connected disability. See 38 C.F.R. § 3.310(a) and (b); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Board must fully consider the lay evidence of record. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A layperson is competent to report on the onset of disability and, when applicable, continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, supra.   When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for hypertension, including as secondary to the already service-connected PTSD The Veteran contends that his hypertension is caused or aggravated by his service-connected PTSD, so the primary basis of this claim is rooted in the notion of secondary service connection. To try and help him show this necessary correlation, the Veteran was afforded a VA examination in March 2016. He reported having first received a diagnosis of hypertension in the 1980s (so, admittedly, long after his military service had ended in March 1968, even well beyond the one-year presumptive grace period following conclusion of his service) and having been on medication since then to treat it. He continued to take medication for his hypertension, both at the time of that VA examination and still today. His average blood pressure reading during that examination was 135/84. His hypertension did not impact his ability to work. The examiner indicated the Veteran’s hypertension was less likely than not related to or caused by his PTSD. The examiner reasoned that there are no studies directly relating PTSD to hypertension as a precipitant or cause. Since, however, two opinions are required for secondary service connection claims (meaning considering both causation and aggravation), the Veteran consequently since has undergone another VA examination for his hypertension in January 2020, while this claim was on remand. This time he reported hypertension since 1968 as a result of his PTSD. He reported taking continuous medication to manage his hypertension. The examiner confirmed the diagnosis of hypertension but, concerning the additional consideration of whether the service-connected PTSD aggravates it, the examiner first conceded that he was unable to determine a baseline severity of the Veteran’s hypertension prior to the alleged aggravation. However, despite that, the examiner concluded the Veteran’s hypertension is less likely than not aggravated by his service-connected PTSD. The examiner reasoned that hypertension and PTSD are not medically related. The examiner also concluded that the Veteran’s hypertension was less likely than not incurred in or caused by his service. The examiner reasoned that there is no objective medical evidence that the Veteran’s hypertension is a result of an event, disease, or injury incurred in service – including exposure to herbicide agents. The latter comment was to address any notion the hypertension is the result of exposure to Agent Orange during the Veterans service. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). There is no equally or certainly no more probative (competent and credible) medical nexus opinion refuting that VA examiners’ unfavorable conclusions of no correlation between the Veteran’s service and service-connected disability (PTSD) and his later diagnosed hypertension. The Board has considered his lay statements and pleadings regarding the origin or cause of his hypertension. But, while he is certainly competent to report on his symptoms, he does not have the competence to ascribe his symptoms to a particular diagnosis and provide a probative opinion regarding their etiology, especially in terms of whether related or attributable to his service or to his service-connected disability (PTSD). This determination is outside the realm of his lay competence since the condition at issue is medically complex, not instead merely simple. 38 C.F.R. § 3.159(a)(1) and (a)(2). See also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court’s conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert’s opinion more probative on the issue of medical causation). For these reasons and bases, the preponderance of the evidence is against this claim, so there is no reasonable doubt to resolve in the Veteran’s favor, meaning this claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for type II diabetes mellitus 4. Entitlement to service connection for bilateral (meaning left and right) upper and lower extremity peripheral neuropathy, including as secondary to type II diabetes mellitus, i.e., as a complication of it The Veteran contends that he has diabetes as a result of his service as well as peripheral neuropathy of all four extremities because of his diabetes. The Board ultimately finds that there is no current diagnosis of diabetes or peripheral neuropathy upon which to predicate these claims for service connection. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of a present disability there can be no valid claim). A current disability means a disability shown by competent and credible (i.e., probative) evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997). At the very least, the evidence must show that, at some point during the appeal period, the Veteran has had the disability for which benefits are being claimed. McClain v. Nicholson, 21 Vet. App. 319 (2007) (a claim for service connection may be granted if a diagnosis of a chronic disability was made during the pendency of the appeal, even if the most recent medical evidence suggests that the disability has resolved); see also Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (considering the application of McClain on a recent diagnosis even predating the filing of a claim). Here, the post-service treatment records show no probative evidence of a current diagnosis of diabetes at any point during the period on appeal or proximate to this. Private treatment records from February 2008 indicate the Veteran had no history of diabetes. Since, however, there was at least suggestion the Veteran was “pre-diabetic”, the Board remanded these claims in October 2019 – partly to determine whether that suggestion he was “pre-diabetic” had progressed to the point that he is now what could be considered as having outright diabetes. A VA examiner charged with making this important determination indicated in January 2020, on remand, that the Veteran still does not meet the criteria for a diagnosis of diabetes. Lab work conducted in conjunction with that examination found that his hemoglobin A1c level was 5.6, which is not even considered to fall within with the “pre-diabetic” range so certainly not ranged needed for a diagnosis of diabetes. Thus, the Veteran has not shown he has this claimed disease, much less owing to anything that occurred during his military service. He, therefore, has not met this most fundamental requirement of this claim. Turning next to the bilateral upper and lower extremity peripheral neuropathy the Veteran claims is a complication of his diabetes, it necessarily follows there also cannot be this etiologic link inasmuch as he has not first established that he has diabetes. In other words, by simple logic, he cannot have bilateral upper and lower extremity peripheral neuropathy because of a condition (i.e., diabetes) that, itself, has not been shown to exist. But also consider, irrespective of that, the post-service treatment records contain no probative evidence of a diagnosis of peripheral neuropathy in any extremity, upper or lower. VA medical records from April 2009 found no demonstrable evidence of sensory neuropathy. Moreover, the VA examination in January 2020 found normal strength and reflexes in all four of the Veteran’s extremities and consequently also did not result in a diagnosis of upper or lower extremity peripheral neuropathy. He also did not have “early onset” peripheral neuropathy as contemplated by 38 U.S.C. § 1116 and 38 C.F.R. §§ 3.307(a)(6), 3.309(e) that, in turn, would allow for presuming it was incurred during his service as a result of exposure to herbicides (including the dioxin in Agent Orange).   To qualify for entitlement to compensation, a Veteran must prove the existence of a disability and one that has resulted from a disease or an injury that occurred during active service. See Sanchez-Benitez v. Principi, 259 F.3d 1356 (2001). Symptoms alone are not a disability for which service connection may be granted. See id. A more recent Federal Circuit Court case held that a diagnosis is not required to meet the current disability requirement and that pain, alone, can constitute disability if it causes impairment in earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). This holding does away with the notion, including cited in Sanchez-Benitez, that “pain alone is not disability” in all circumstances, but this concept is still valid in that a Veteran still needs to show disability due to disease or injury in service to get service connection. Despite his assertions that he has diabetes and associated bilateral upper and lower extremity peripheral neuropathy, the Veteran has not offered any competent and credible medical evidence supporting his assertions nor has he demonstrated that he has the knowledge, training, or education required to diagnose these type of medical disabilities – which are complex not, instead, merely simple conditions. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When, as here, the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there necessarily can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The Board therefore finds that service connection for diabetes and for peripheral neuropathy of the upper and lower extremities is not warranted as there is no current diagnosis of these claimed disabilities or the required showing of impairment in earning capacity if considering the “pain” scenario discussed in Saunders as akin, here, to the extent the Veteran claims he has noteworthy symptoms (e.g., sensory deficits, numbness in his extremities, or whatever).   5. Entitlement to service connection for tinnitus The Veteran contends that he suffers from tinnitus owing to his military service. He credibly testified during his hearing that he repeatedly was exposed to gunfire and explosions during his service, without hearing protection, especially while stationed in Vietnam. Consequently, noise exposure in service and consequent injury (acoustic trauma) is conceded. 38 U.S.C. § 1154(a) and (b); 38 C.F.R. § 3.304(d). He also credibly testified during his hearing that his tinnitus began during his service and has persisted since, therefore, has been recurrent. Tinnitus is “a noise in the ear, such as ringing, buzzing, roaring, or clicking.” See Dorland’s Illustrated Medical Dictionary 1714 (28th ed. 1994). Tinnitus is often subjective in nature; indeed, because of its inherently subjective nature, even a layman such as the Veteran is considered competent to report the observable manifestations of this condition like this ringing, buzzing, roaring, or clicking sound mentioned. He is competent to provide evidence regarding tinnitus, as it is a condition readily apparent through the senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Because tinnitus is “subjective,” its existence is generally determined by whether the claimant claims to experience it. Indeed, for VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002). For this reason, the Board finds that the Veteran is competent to report experiencing ringing in his ears, in other words that he has tinnitus. Moreover, as noise exposure and consequent injury (acoustic trauma) during his service has been conceded, the Board finds his competent statements regarding his tinnitus also are credible and, therefore, ultimately probative. Rucker v. Brown, 10 Vet. App. 67, 74 (1997).   The Board acknowledges the opinion of the February 2016 VA examiner that the Veteran’s tinnitus was less likely than not caused by his service. But the Veteran also has competently and credibly testified under oath during his hearing that he began experiencing tinnitus in service and that it has persisted since. Accordingly, after resolving all reasonable doubt concerning this in his favor, service connection for tinnitus is being granted. 38 C.F.R. § 3.102; see also Alemany v. Brown, 9 Vet. App. 518, 519 (1996). KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Baronofsky 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.