Citation Nr: 21013100 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 19-25 505 DATE: March 8, 2021 ORDER Service connection for tinnitus is granted. Service connection for hearing loss is denied. Service connection for a back disability is denied. Service connection for hypertension or high blood pressure is denied. Service connection for diabetes mellitus is denied. FINDINGS OF FACT 1. The Veteran’s tinnitus had its onset related to in-service noise exposure. 2. The Veteran’s hearing loss was not shown as chronic during service and did not manifest to a compensable degree within one year after active duty; continuity of symptomatology is not established; and it is not otherwise related to service. 3. The in-service event that the Veteran identifies as the primary cause of his back symptoms and current disability was not in the line of duty because it was the result of willful misconduct; current lumbar spine degenerative changes or arthritis were not shown as chronic during service and did not manifest to a compensable degree within one year after active duty; continuity of symptomatology is not established; and the current disability is not otherwise related to service. 4. The Veteran’s hypertension was not shown as chronic during service and did not manifest to a compensable degree within one year after active duty; continuity of symptomatology is not established; and it is not otherwise related to service. 5. The Veteran’s diabetes mellitus was not shown as chronic during service and did not manifest to a compensable degree within one year after active duty; continuity of symptomatology is not established; and it is not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hearing loss are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 3. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 105, 1101, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.1, 3.102, 3.301, 3.303, 3.307, 3.309. 4. The criteria for service connection for hypertension or high blood pressure are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 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 U.S. Army from June 1950 to August 1961, when was discharged under honorable conditions. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2018 rating decision that denied the Veteran’s March 2018 claims. The Veteran testified for his appeal at a Board virtual hearing in January 2021. Service Connection Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by active service, even if the condition was first diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Generally, the three-element test for service connection requires: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Presumptions apply for certain types of conditions, which are discussed below as relevant. In adjudicating the merits of such 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(b); 38 C.F.R. § 3.102. 1. Service connection for tinnitus The Veteran reports that he has had tinnitus symptoms of buzzing and ringing in the ears since service, which has varied in nature. He states that he lived with this condition over the years and did not seek treatment or realize it was considered a disability, but the condition has worsened. The Veteran asserts that these symptoms are related to hazardous noise exposure in service. See June 2018 VA examination, August 2018 notice of disagreement (NOD), January 2021 Board hearing. The Veteran is competent to identify the subjective condition of tinnitus and describe the nature and timing of his symptoms over time, as well as his in-service and post-service noise exposure and whether he wore hearing protection. A current disability is established by the Veteran’s competent reports of tinnitus. This is a subjective condition that does not require testing or a medical diagnosis. An in-service injury or event is also established. The Veteran reports hazardous noise exposure from frequent gunfire or heavy artillery firing without hearing protection during basic training and then while in a missile battalion, as well as from loud engines through his duties as a mechanic. The Veteran states that he did not have hearing protection during these events. These reports are competent and credible, as they are generally consistent with his service personnel records, including the DD Form 214, and the circumstances of his service. These records confirm that the Veteran was assigned to an Artillery firing battery and his primary military occupational specialty was a mechanic helper. His principal duties were as a track vehicle mechanic, mechanic helper, wireman, and a launch crewman. Finally, a nexus is established based on the Veteran’s competent and credible reports of ongoing recurrent tinnitus since service. Although there is some conflicting evidence, the Board resolves reasonable doubt in the Veteran’s favor. A February 2018 VA treatment record noted that the Veteran reported constant bilateral ringing in the ears for approximately 20 years, or since approximately 1998, which would be nearly 40 years after service. However, the Veteran has also reported buzzing as a tinnitus symptom and that his condition worsened over the years. It is unclear if the buzzing was present prior to the constant ringing, or if the Veteran had intermittent buzzing or ringing prior to approximately 1998. As noted above, the Veteran has otherwise reported ongoing symptoms since service. The Veteran’s service treatment records do not reflect any complaints, treatment, or diagnosis of tinnitus symptoms. At his June 1961 separation examination, he denied ear, nose, or throat trouble, and his ears were clinically normal. However, based on the Veteran’s reports for his claim, he may not have thought of his tinnitus as an ear problem. His separate claim for hearing loss is addressed below. The Veteran denies any significant noise exposure after service. He identified several recreational and occupational situations with potential hazardous noise in his VA examination and the Board hearing, but he stated that he wore hearing protection devices most of the time or was otherwise shielded from the noise. The June 2018 VA examiner gave a negative nexus for tinnitus. The examiner reasoned that that there was no hearing threshold shift in pure tones from entrance to exit, although no explanation as given as to why this would be relevant to tinnitus, as opposed to hearing loss. The examiner further stated that although excessive noise exposure during service was shown, there was no evidence of complaints or treatment for tinnitus during service or until the Veteran’s claim. This VA medical opinion appears to find that the Veteran is not credible as to having had tinnitus since service, when compared with his service records. However, the credibility determination is the responsibility of the VA adjudicator, including the Board, not the medical examiner. Resolving reasonable doubt in the Veteran’s favor, his reports of tinnitus since service are credible. Therefore, this negative opinion does not consider the full history and has low probative value. An September 2018 private audiology record noted tinnitus and a history of noise exposure in the Army, but did not reference the timing of tinnitus or give a nexus. There is no need for another medical opinion because the Veteran’s lay reports are sufficient to establish entitlement to service connection. The appeal is granted. 2. Service connection for hearing loss The Veteran reports that he has had hearing loss since service. He states that he lived with this condition and did not seek treatment or realize he could receive VA disability compensation, but the condition gradually worsened. The Veteran asserts that his hearing loss is related to hazardous noise exposure in service. See June 2018 VA examination, August 2018 NOD, January 2021 Board hearing. The Veteran is competent to report observable symptoms of hearing loss, such as difficulty hearing or understanding speech, and the nature and timing of his symptoms over time, as well as the circumstances of his noise exposure. However, unlike tinnitus, he is not competent to identify whether he has actual hearing loss. A hearing loss disability requires objective testing. Pure tone thresholds above 20 decibels indicate some degree of hearing impairment, but impaired hearing must meet minimum thresholds to be considered a disability for VA compensation. See Hensley v. Brown, 5 Vet. App. 155 (1993); McKinney v. McDonald, 28 Vet. App. 15 (2016). Specifically, VA will consider impaired hearing to be a disability only when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the thresholds for at least three of those frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. A current disability is established. A June 2018 VA examination measured pure tone thresholds above 40 decibels at all levels except the 500 and 1000 Hertz levels bilaterally, as well as speech discrimination scores below 94 percent. Id. The diagnosis was bilateral sensorineural hearing loss. An in-service injury or event is also established of hazardous noise exposure from firearms and engine noise, as explained above in the analysis for tinnitus. However, a nexus is not established. In contrast to tinnitus, the reports of ongoing hearing loss since service are not credible. As explained below, the Veteran’s hearing loss was not shown as chronic during service and did not manifest to a compensable degree within one year after active duty; continuity of symptomatology is not established; and it is not otherwise related to service. The Veteran’s competent reports of continuity of hearing loss symptomatology since service are not credible because they are inconsistent with his express reports and objective evidence in contemporaneous records during and since service. The Veteran’s service treatment records do not reflect any complaints, treatment, or diagnosis of hearing loss symptoms. His June 1959 entrance examination did not include pure tone testing, but a whisper test was normal with 15/15 bilaterally. At his June 1961 separation examination, he denied ear problems, but there was no specific question as to hearing loss. Although the Veteran reported having multiple other conditions, and the physician’s summary noted several current subjective and objective complaints, no hearing difficulties were referenced. A whisper test was again normal with 15/15 bilaterally, and pure tone testing showed 5 decibels at all levels bilaterally. In August 1961, the Veteran stated that there had been no change in his physical condition since his separation examination. The normal hearing test results and lack of hearing complaints, despite other complaints, points to no noticeable hearing loss or objective hearing loss disability at that time. These records are highly probative because they were contemporaneous in time to the Veteran’s noise exposure and asserted onset of ongoing noticeable symptoms. The Veteran testified in January 2021 that he first sought treatment for hearing loss when he filed his VA claim, or in 2018. This is consistent with the Veteran’s first VA audiology consult in February 2018. As noted below, the Veteran had a private audiology consult in August 2018. However, to the extent there may be other private treatment records outstanding, there is no reasonable possibility that they could assist in substantiating the hearing loss claim, and they are unnecessary. 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). In this case, there were no hearing loss complaints or findings until February 2018, and a March 2016 VA treatment record noted normal hearing. Although the Veteran identified an onset of his tinnitus symptoms in February 2018, he did not specify the timing of his hearing loss. During his January 2021 Board hearing, he reported gradual hearing loss. In short, evidence in service records and after service is more probative and weighs against the Veteran having chronic hearing loss symptoms or disability in either ear during service or continuously since service. He is not credible in this regard. Furthermore, to the extent the Veteran believes he has had a hearing loss disability since service, he is not competent to provide this information. To the extent that he may have had temporary hearing difficulties during or shortly after active duty 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 specialized medical knowledge of the involved auditory and neurological systems, interpretation of test results, and consideration of his credible medical history. Similarly, the criteria for the chronic disease presumption are not met due to the Board’s credibility findings as to the timing of the Veteran’s symptoms. The diagnosed sensorineural hearing loss is considered a listed chronic disease of organic disease of the nervous system. However, this disability was not shown as chronic during service, or manifested to a compensable degree during service or within the applicable presumptive period of one year after active duty discharge, and continuity of symptomatology since service without intervening cause is not established. 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a)(3). Instead, the most probative evidence shows that the Veteran’s diagnosed disability and noticeable ongoing symptoms had an onset many years after his active duty discharge in August 1961. Service connection may still be granted for a current hearing loss disability on a direct basis. However, these criteria also have not been met because the preponderance of the evidence is against finding a nexus between the current hearing loss and in-service injury, event or disease. 38 C.F.R. § 3.303(a), (d). Specifically, the Veteran is not competent to provide a nexus between his current hearing loss and service on a basis other than continuity of symptomatology. Instead, this question requires medical training to consider and interpret his medical history, including any required tests such as audiometric testing, and specialized medical knowledge of the involved auditory and neurological systems. Thus, the Board gives more probative weight to the competent medical evidence. The Veteran denies any significant noise exposure after service. He identified several recreational and occupational situations with potential hazardous noise in his VA examination and the Board hearing, but he stated that he wore hearing protection devices most of the time or was otherwise shielded from the noise. The June 2018 VA examiner gave a negative nexus that the current hearing loss was less likely than not caused by or result of an injury or event in service. The examiner reasoned that the Veteran had normal hearing shown on his June 1961 separation examination, and the pure tone thresholds were too low for any permanent significant shift in hearing thresholds to have occurred from entrance. Although there was only a whisper test and no pure tone results in the entrance examination, the examiner’s rationale explains that the separation results in themselves are evidence of no permanent significant threshold shift. The examiner stated that this showed that there was no permanent auditory damage on active duty. Additionally, there was no report of decreased hearing during service or at separation. The examiner stated that although the Veteran had hazardous noise exposure during service and the relationship between noise and auditory damage and hearing loss is well documented, auditory damage and hearing loss are not conceded based on noise exposure alone. Therefore, a nexus was not established. Although the examiner made a credibility determination, it is consistent with the Board’s credibility findings as to the timing of the Veteran’s hearing loss symptoms. The opinion is adequate and has high probative value because it is based on an accurate history and provide explanations with clear conclusions and supporting data, including application of medical expertise to the facts of this case. There is also no argument that the opinion is inadequate or other medical evidence to suggest a nexus to service. The VA opinion outweighs the lay assertions. The Veteran testified during his January 2021 hearing that his VA hearing doctor told him his hearing loss could be due to service, but it may be due to age and time. The term “could” is similar to “may” and does not show at least a 50 percent, or at least as likely as not, probability of a relationship. Therefore, this is not sufficient to establish a nexus even if it were in the Veteran’s records. An September 2018 private audiology record noted mild to severe sensorineural hearing loss bilaterally and a history of noise exposure in the Army, but did not reference the timing of noticeable or objective hearing loss or provide a nexus to service. The mere reference to a current condition and history is not a nexus. In summary, the preponderance of the evidence is against service connection for bilateral hearing loss under any reasonably raised theory. There is no reasonable doubt to resolve in the Veteran’s favor, and the appeal is denied. 3. Service connection for a back disability The Veteran reports that he has had back pain since service. He states that he operated a jackhammer, carried heavy ammunition boxes, and had back trauma from carrying a heavy field pack on a forced march. The Veteran asserts that jackhammering up a two-acre parking lot in service contributed to his current bulging disc, stating that he had to rest every 15 minutes or so due to back pain. He asserts that he never recovered. The Veteran states that he had no back problems while at rest, but after service when he tried to do physical labor it only exacerbated his back condition, and the condition worsened over time. See August 2018 NOD, January 2021 Board hearing. The Veteran is competent to report observable symptoms of a back disability, such as pain, and the nature and timing of his symptoms over time, as well as the circumstances of his in-service injuries or factual events. However, he is not competent to identify the nature or diagnosis for a back or spinal disorder. A current disability is established. VA treatment records in March 2019 reflect that X-rays showed multilevel degenerative disc disease most pronounced at L3-4, mild to moderate degenerative changes of the facets, and anterolisthesis at L4 on L5 in neutral and flexed positions. An MRI was recommended, but the Veteran declined the procedure in April 2019 because his back was feeling better with treatment. During his January 2021 Board hearing, the Veteran stated that he had a bulging disc shown by his first MRI about two years ago, and a second MRI confirmed that diagnosis and showed that his back was “slipped a little ways where there was pinching nerves.” Any such MRIs or diagnoses are not of record, and it is unclear if they were conducted by VA or private providers. The Veteran testified that all of his treatment was through VA facilities, although he was referred to an outside provider for his back at times. The Veteran’s VA treatment records also reflect treatment at various private facilities for primary care or specific conditions, and that some of those records were scanned into the VA electronic medical records system. See, e.g., records in March 2016, February 2017, February 2018, September 2018. The March 2016 record noted that the Veteran was new to VA and received private treatment. However, the Veteran has not authorized VA to obtain the non-VA records or provided them for his claim. As discussed below, the currently available medical records establish a current disability and the timing of his symptoms, and the Veteran has not stated that any private provider suggested a link between the current disability and a eligible in-service injury or event. To the extent there may be private treatment records outstanding that reference his back, there is no reasonable possibility that they could assist in substantiating the back disability claim, and a remand to obtain them is unnecessary. 38 C.F.R. § 3.159. Concerning the in-service incurrence element, the primary in-service injury or event that the Veteran identifies as the cause of his back symptoms and current disability was jackhammering up a parking lot. This was not in the line of duty because it was the result of willful misconduct, which bars service connection. For direct service connection, the injury or disease from which the claimed disability results must have been incurred in or aggravated by active military, naval, or air service “in line of duty.” If the injury or disease that was the result of the veteran’s own willful misconduct, it is not considered “in line of duty.” See 38 U.S.C. §§ 101(16), 105(a), 310, 331; 38 C.F.R. §§ 3.1(k), 3.1(m), 3.301(a). The Veteran’s service personnel records, including the DD Form 214, show that he was assigned to an Artillery firing battery and his primary military occupational specialty was a mechanic helper. His principal duties were as a track vehicle mechanic, mechanic helper, wireman, and a launch crewman. The circumstances of these assignments and duties are generally consistent with the Veteran’s reports of carrying heavy boxes and running or marching with heavy equipment. They are not consistent with his primary reported back injury or trauma from jackhammering. However, the Veteran’s service personnel records also show multiple sentences of hard labor for summary and special court martial proceedings. See records in September 1960 (hard labor for 30 days), January 1961 (hard labor for 30 days), May 1961 (hard labor for 30 days), June 1961 (hard labor for 45 days), August 1961 (hard labor for three months, approved as amended from initial sentence of six months, although the Veteran was then separated from service in August 1961). Accordingly, although the Veteran may have sustained an injury to his back while jackhammering up a parking lot, the service records show that this incident with injury or trauma to the back could only have incurred during his periods of hard labor as sentences for courts martial. Notably, the Veteran did not mention these sentences or involvement in hard labor for his claim. Therefore, the injury and any related ongoing symptoms were the result of the Veteran’s willful misconduct and were not in line of duty. Service connection cannot be granted on this basis. Otherwise, the asserted in-service injuries or events of carrying heavy loads and marching with heavy equipment are generally consistent with the circumstances of his Army service. Therefore, resolving reasonable doubt in the Veteran’s favor, the in-service incurrence of injury or disease element is met only on this basis. However, a nexus is not established. As explained below, the Veteran’s back disability was not shown as chronic during service and did not manifest to a compensable degree within one year after active duty; continuity of symptomatology is not established; and it is not otherwise related to service. The Veteran’s competent reports of continuity of back or spine symptomatology since service are not credible because they are inconsistent with his express reports and objective evidence in contemporaneous records during and since service. The Veteran’s service treatment records do not reflect any complaints, treatment, or diagnosis of back or thoracolumbar spine symptoms. At his June 1961 separation examination, there was no specific option as to recurrent back pain, but he denied ever wearing a brace or back support. He also expressly denied arthritis or rheumatism and bone, joint, or other deformity. Although the Veteran reported having multiple other conditions, and the physician’s summary noted several current subjective and objective complaints, no back problems or injuries were referenced. The Veteran was found to have a clinically normal spine. In August 1961, the Veteran stated that there had been no change in his physical condition since his separation examination. The normal spine and denial of using a back support or noticing other bone or spine-type conditions, despite other complaints, points to no noticeable back symptoms or objective back or spine disability at that time. These records are highly probative because they were contemporaneous in time to the Veteran’s asserted traumas from strenuous physical activities (as well as the timing of the ineligible jackhammering incident) and onset of symptoms. 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, 581 F.3d at 1316; Maxson, 230 F.3d at 1333; Fagan, 573 F.3d at 1289. In this case, the Veteran testified in January 2021 that he first had an MRI for his back about two years ago, or in approximately 2019. Although the Veteran reported prior private treatment for diabetes when he first sought VA care in March 2016, he did not reference any prior treatment or diagnostic studies for the back. VA treatment records reflect that he first complained of a back problem in September 2016, when he reported low back pain that was worse with lifting and had been present for greater than one year. This timing could be consistent with pain since service or for a much more recent time period. A March 2019 record then noted intermittent low back pain that was an aggravating aching pain, and the Veteran wore a back brace as needed. He specified that his low back pain began about five years ago, which would be in approximately 2014, and he never had an X-ray of his low back previously. This more specific report is consistent with the more general report of pain for greater than one year, and the Veteran had an incentive to report an accurate history to receive proper medical care. As noted above, he had back X-rays in March 2019. The Veteran only stated that his back pain had been present since service during his January 2021 Board hearing, after his VA claim had been denied twice for no nexus to service, including based on continuous symptoms since service. Potential bias may be considered as part of the credibility determinations. In his NOD as well as for VA treatment, he asserted only that his current condition is related to the reported events in service described above, not that he actually had ongoing back symptoms since service. To illustrate this distinction, an April 2019 VA MRI questionnaire reflects that the Veteran responded to a question of whether his pain or other symptoms were possibly the result of trauma or injury with “I can’t say, I don’t know” and “used a jack hammer in military, carried heavy stuff.” It is reasonable to expect that if the Veteran had symptoms since those asserted military injuries, he would have reported that timing for treatment. Instead, he expressly identified the date of onset of his pain as five years earlier in March 2019. In short, evidence in service records and after service is more probative and weighs against the Veteran having chronic back or spine symptoms or disability during service or continuously since service. He is not credible in this regard. Furthermore, to the extent the Veteran believes he has had a back disability since service, he is not competent to provide this information. To the extent that he may have had temporary back difficulties during or shortly after his asserted injuries or events in the line of duty during 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 specialized medical knowledge of the involved orthopedic or musculoskeletal and potentially the neurologic system, interpretation of test results, and consideration of his credible medical history. Similarly, the criteria for the chronic disease presumption are not met due to the Board’s credibility findings as to the timing of the Veteran’s symptoms. The diagnosed degenerative disc disease and degenerative changes of the lumbar spine may be considered a listed chronic disease of arthritis. However, this disability was not shown as chronic during service, or manifested to a compensable degree during service or within the applicable presumptive period of one year after active duty discharge, and continuity of symptomatology since service without intervening cause is not established. 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a)(3). Instead, the most probative evidence shows that the Veteran’s disability and noticeable ongoing symptoms had an onset many years after his active duty discharge in August 1961. Service connection may still be granted for a current back disability on a direct basis. However, these criteria also have not been met because the preponderance of the evidence is against finding a nexus between the current back disability and an eligible in-service injury, event or disease. 38 C.F.R. § 3.303(a), (d). Specifically, the Veteran is not competent to provide a nexus between his current back disability and service on a basis other than continuity of symptomatology. Instead, this question requires medical training to consider and interpret his medical history, as well as specialized medical knowledge of the involved systems. The Veteran testified during his January 2021 Board hearing that his VA doctor told him that his current back disability could have been related to service. A mere possibility of a connection is insufficient to show a nexus for a VA claim. The term “could” is similar to “may” and does not show at least a 50 percent, or at least as likely as not, probability of a relationship. Moreover, the Veteran’s VA treatment records reflect that he reported injuries in service from jackhammering and carrying heavy equipment. Thus, any such opinion from his VA provider likely considered the ineligible jackhammering incident. Therefore, this is not sufficient to establish a nexus even if it were in the Veteran’s records. Accordingly, there is no medical evidence indicating that a current back disability may be related to service. The Veteran’s broad conclusory statements as to the cause of his current disability, without a showing of continuity of symptomatology, are insufficient to trigger the need for a VA examination or medical opinion. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); Waters v. Shinseki, 601 F.3d 1274, 1276-77 (Fed. Cir. 2010). In summary, the preponderance of the evidence is against service connection for a current back disability under any reasonably raised theory. There is no reasonable doubt to resolve in the Veteran’s favor, and the appeal is denied. 4. and 5. Service connection for hypertension or high blood pressure; service connection for diabetes mellitus The Veteran makes some related assertions as to his hypertension and his diabetes. In his August 2018 NOD, the Veteran asserted that he had high blood pressure during service, but it was not checked. He argued that his diabetes was caused by fumes from paint and other solvents or chemicals as a mechanic during service. During his January 2021 Board hearing, the Veteran testified that he did not know if he had diabetes in service, but he “just figured it was the beginning of it.” The Veteran and his wife reported that his first medical diagnosis of diabetes was in 1988 or 1989 or the early 1990s, and also that his diabetes “came on” about 15 years ago, which would be in approximately 2006. The Veteran testified that he believes his diabetes is “probably due to being overweight,” and he wasn’t overweight during service. The Veteran reported having high blood pressure for “several years,” and he did not know if his hypertension was due to service or part of his diabetes. He stated that he believes that his high blood pressure and diabetes may be related to service because of the required diet and work schedule. The Veteran is competent to report observable potential symptoms of a hypertension and diabetes, and the nature and timing of his symptoms over time, as well as the circumstances of his in-service injuries or factual events. However, he is not competent to identify the nature or diagnosis for either of these disorders. A current disability is established. VA treatment records since March 2016 reflect essential hypertension and type II diabetes mellitus, as diagnosed previously. As noted above, the Veteran testified during his January 2021 Board hearing that all of his treatment was through VA facilities, except for referral for his back, but his VA treatment records from March 2016 through September 2018 also reflect treatment at various private facilities for primary care or specific conditions including diabetes and hypertension. However, the Veteran has not authorized VA to obtain the non-VA records or provided them for his claim. As discussed below, the currently available records establish the timing of his symptoms and diagnoses, and the Veteran has not stated that any private provider suggested a link between the current disabilities and service. To the extent there may be private treatment records outstanding that reference his hypertension or diabetes mellitus, there is no reasonable possibility that they could assist in substantiating the disability claims, and a remand to obtain them is unnecessary. 38 C.F.R. § 3.159. The in-service incurrence element is not established. As noted above, the Veteran has not asserted that he had a diagnosis of hypertension or diabetes or symptoms in service. The Veteran may have had some exposure to chemical fumes as a mechanic, but he has not described any noticeable symptoms. Service treatment records also do not refect any complaints, treatment, or diagnosis related to these conditions. The Veteran’s representative asserted during his Board hearing that a blood pressure systolic reading of 145 may have shown hypertension. However, that was reading of 145/70 was during the Veteran’s June 1959 service enlistment examination, prior to service, although no diagnosis or defect was noted. The basis for the Veteran’s assertions that his diet and work schedule during service resulted in his later diagnoses of hypertension and diabetes are unclear. However, he has specified that he was not overweight during service, and obesity as an intermediate step to secondary service connection has not otherwise been raised. Additionally, a nexus is not established. As explained below, the Veteran’s hypertension and diabetes mellitus are not shown as chronic during service and did not manifest to a compensable degree within one year after active duty; continuity of symptomatology is not established; and are not otherwise related to service. At his June 1961 separation examination, the Veteran reported a family history of his father having diabetes and heart trouble, but he denied a personal history of high blood pressure or having sugar or albumin his urine. Blood tests for sugar and albumin were negative (normal), and his blood pressure was measured at 118/66, or within normal limits. Although the Veteran reported having multiple other conditions, and the physician’s summary noted several current subjective and objective complaints, no blood pressure or diabetes-type symptoms or problems were referenced. In August 1961, the Veteran stated that there had been no change in his physical condition since his separation examination. Hypertension and diabetes are conditions that require medical diagnoses based on testing. The normal tests and denial of relevant conditions or symptoms, despite other complaints, points to no noticeable hypertension or diabetes or objective diagnoses of either condition at that time. These records are highly probative because they were contemporaneous in time to the Veteran’s asserted events and disease onset. 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, 581 F.3d at 1316; Maxson, 230 F.3d at 1333; Fagan, 573 F.3d at 1289. In this case, the Veteran and his wife testified in January 2021 that his diabetes was diagnosed or had its onset in the late 1980s or 1990s. The Veteran stated that he has had hypertension for “several years,” for which he was taking medication, and he wasn’t sure if it is related to his diabetes. This suggests that his hypertension was diagnosed after or close in time to his diabetes, and an onset or diagnosis for “several years” would be inconsistent with having hypertension for about 50 years since his service discharge in 1961. VA treatment records reflect that in March 2016 the Veteran reported having type 2 diabetes mellitus and using insulin for control, and that he had essential hypertension that was under good control. A January 2017 treatment record noted that the Veteran reported having a diagnosis of diabetes for over 15 years, which would be since at least 2002. Overall, the lay and medical evidence establishes an earliest date of symptoms and diagnosis or treatment in the 1980s, more than 20 years after the Veteran’s discharge from service in August 1961. In short, evidence in service records and after service is more probative and weighs against the Veteran having chronic hypertension or diabetes symptoms or disability during service or continuously since service. Continuity is not established. Furthermore, to the extent the Veteran believes he has had hypertension or diabetes during or since service that was not medically diagnosed, he is not competent to provide this information. To the extent that he may have had temporary elevated blood pressure or symptoms that may be attributed to diabetes 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 specialized medical knowledge of the involved hematologic or cardiologic and endocrine systems, interpretation of test results, and consideration of his credible medical history. Similarly, the criteria for the chronic disease presumption are not met due to the Board’s credibility findings as to the timing of the Veteran’s symptoms. The Veteran’s hypertension and diabetes mellitus are listed chronic diseases. However, these disabilities were not shown as chronic during service, or manifested to a compensable degree during service or within the applicable presumptive period of one year after active duty discharge, and continuity of symptomatology since service without intervening cause is not established. 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a)(3). Instead, the most probative evidence shows that the Veteran’s disabilities and any noticeable ongoing symptoms for hypertension and diabetes had an onset many years after his active duty discharge in August 1961. Service connection may still be granted for current hypertension and diabetes on a direct basis. However, these criteria also have not been met because the preponderance of the evidence is against finding a nexus between the current disabilities and an in-service injury, event or disease. 38 C.F.R. § 3.303(a), (d). Specifically, the Veteran is not competent to provide a nexus between his current hypertension or diabetes and service on a basis other than continuity of symptomatology. Instead, this question requires medical training to consider and interpret his medical history, as well as specialized medical knowledge of the involved bodily systems. There is no medical evidence indicating that current hypertension or diabetes may be related to service. The Veteran has not asserted that any VA or private doctor told him that his hypertension or diabetes are related to service, only that he believes the conditions may be related to service (or to each other) as summarized above. The Veteran’s broad conclusory statements as to the cause of his current disabilities, without a showing of continuity of symptomatology, are insufficient to trigger the need for a VA examination or medical opinion. McLendon, 20 Vet. App. at 81; Waters, 601 F.3d at 1276-77. In summary, the preponderance of the evidence is against service connection for current hypertension or diabetes mellitus under any reasonably raised theory. There is no reasonable doubt to resolve in the Veteran’s favor, and the appeals are 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.