Citation Nr: 21013902 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 16-24 944 DATE: March 10, 2021 ORDER 1. New and material evidence having been received, the application to reopen the claim for service connection for a right ankle disability is granted. The appeal is granted to this extent only. 2. New and material evidence having been received, the application to reopen the claim for service connection for a right foot disability is granted. The appeal is granted to this extent only. 3. New and material evidence having been received, the application to reopen the claim for service connection for a lung disability, to include fibrosis, is granted. The appeal is granted to this extent only. 4. The reopened claim of entitlement to service connection for a right ankle disability is denied. 5. The reopened claim of entitlement to service connection for a right foot disability is denied. 6. The reopened claim of entitlement to service connection for a lung disability, to include fibrosis, is denied. 7. Entitlement to a compensable rating for bilateral hearing loss prior to June 11, 2014, is denied. REMANDED 8. Entitlement to a compensable rating for bilateral hearing loss since June 11, 2014, is remanded. FINDINGS OF FACT 1. A November 2008 rating decision denied service connection for a right ankle disability based on a finding of no current right ankle disability. The Veteran filed a Notice of Disagreement (NOD) in December 2008, and a Statement of the Case (SOC) was issued in May 2009. The Veteran did not timely perfect an appeal to the Board after receipt of the May 2009 SOC, therefore, the December 2008 rating decision became final. 2. Evidence received since the November 2008 rating decision that denied service connection for a right ankle disability, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection and raises a reasonable possibility of substantiating the claim. 3. A November 2008 rating decision denied service connection for a right foot disability based on a finding of no current right foot disability. The Veteran filed an NOD in December 2008, and a SOC was issued in May 2009. The Veteran did not timely perfect an appeal to the Board after receipt of the May 2009 SOC, therefore, the December 2008 rating decision became final. 4. Evidence received since the November 2008 rating decision that denied service connection for a right foot disability, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection and raises a reasonable possibility of substantiating the claim. 5. A November 2008 rating decision denied service connection for a lung disability based on a finding of no current lung disability. The Veteran filed an NOD in December 2008, and a SOC was issued in May 2009. The Veteran did not timely perfect an appeal to the Board after receipt of the May 2009 SOC, therefore, the November 2008 rating decision became final. 6. Evidence received since the November 2008 rating decision that denied service connection for a lung disability, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection and raises a reasonable possibility of substantiating the claim. 7. The preponderance of the evidence is against a finding that the Veteran’s current right ankle disability had its onset in service or is otherwise related to service. 8. The preponderance of the evidence is against a finding that the Veteran’s current right foot disability had its onset in service or is otherwise related to service. 9. The preponderance of the evidence is against a finding that the Veteran’s current lung disability, to include fibrosis, had its onset in service or is not otherwise related to service. 10. VA audiometric testing (contracted Disability Benefits Questionnaire (DBQ)) in June 2014 revealed a 39 decibel puretone threshold average in the right ear and 31 decibel puretone threshold average in the left ear. Speech discrimination was measured at 80 percent in the right ear and 86 percent in the left ear. No worse than Level III hearing loss in the right ear and Level II hearing loss in the left ear has been shown prior to June 11, 2014. CONCLUSIONS OF LAW 1. The November 2008 rating decision denying service connection for a right ankle disability is final. As evidence received since the November 2008 rating decision is new and material, the criteria for reopening the claim of entitlement to service connection for a right foot disability are met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156(a), 20.1103. 2. The November 2008 rating decision denying service connection for a right foot disability is final. As evidence received since the November 2008 rating decision is new and material, the criteria for reopening the claim of entitlement to service connection for a right foot disability are met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156(a), 20.1103. 3. The November 2008 rating decision denying service connection for a lung disability is final. As evidence received since the November 2008 rating decision is new and material, the criteria for reopening the claim of entitlement to service connection for a lung disability are met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156(a), 20.1103. 4. The criteria for entitlement to service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for entitlement to service connection for a right foot disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 6. The criteria for entitlement to service connection for a lung disability, to include fibrosis, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 7. The criteria for a compensable disability rating for a bilateral hearing loss disability prior to June 11, 2014, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.85, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1965 to January 1969. In November 2020, the Veteran provided testimony in a virtual Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the hearing transcript is associated with the claims file. During the November 2020 Board hearing, the Veteran’s representative requested an extension of 90 days to submit new evidence, to include Disability Benefits Questionnaires (DBQs). The undersigned VLJ informed the Veteran and his representative that there are private DBQs submitted in January and February 2019 associated with the claims file for the disabilities on appeal, however, she noticed that there were no records from the Veteran’s discharge until 2009. The Veteran’s representative requested additional time to submit any missing records. The undersigned VLJ informed the Veteran and his representative that the record was left open for 90 days, until February 10, 2021, to submit additional records and to upload a document to the claims file if additional time is needed for development of the claims. No additional records were submitted and neither the Veteran nor his representative requested a subsequent extension to submit records. Thus, the Board will proceed with adjudication below. New and Material Evidence Prior unappealed decisions of the Regional Office (RO) are final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.160(d), 20.302(a), 20.1103. The Board does not have jurisdiction to consider a claim that has become final before it determines that new and material evidence has been presented, irrespective of what the regional office may have determined with respect to new and material evidence. Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996). If, however, new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. An appeal consists of a timely filed Notice of Disagreement (NOD), and after a Statement of the Case (SOC) has been furnished, a timely filed Substantive Appeal. 38 C.F.R. § 20.200. A Substantive Appeal consists of a properly completed VA Form 9 (Appeal to the Board of Veterans’ Appeals) or correspondence containing the necessary information. 38 C.F.R. § 20.202. As a general rule, a substantive appeal must be filed within 60 days of the mailing of the SOC or within one year of the notice of the decision being appealed, whichever is later. 38 U.S.C. § 7105(d)(1); 38 C.F.R. § 20.302(b). New evidence means existing evidence not previously submitted to agency decision makers. 38 C.F.R. § 3.156(a). Material evidence means existing evidence that, by itself or considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. New and material evidence need not be received as to each previously unproven element of a claim in order to justify reopening thereof; the threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). 1. Whether new and material evidence has been received to reopen the previously-denied claim for service connection for a right ankle disability. Entitlement to service connection for a right ankle disability was denied in a November 2008 rating decision. The Veteran filed a timely NOD in December 2008. In May 2009, an SOC was issued that denied service connection for a right ankle disability. The Veteran was notified of the denial and his appellate rights, however, did not timely perfect an appeal (submit a substantive appeal (VA Form 9)) after receipt of the May 2009 SOC. The Veteran’s VA Form 9 was submitted in March 2010, which is more than 60 days of the mailing of the SOC and more than one year of the notice of the decision being appealed. In a March 2010 letter, VA notified the Veteran that his VA Form 9 was untimely. As such, the Veteran did not perfect an appeal to the Board and the November 2008 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. The November 2008 rating decision denied service connection for a right ankle disability on the basis that there was no evidence of a current diagnosis or disability. Since the November 2008 rating decision, there have been two VA examinations in February 2009 and August 2014, and the Veteran has submitted a January 2019 Disability Benefits Questionnaire (DBQ) from a private physician, which provide evidence of a right ankle disability. Given that the threshold for substantiating a claim to reopen is low, this evidence, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection for a right ankle disability and raises a reasonable possibility of substantiating the claim. The Board finds that this new evidence is also material. Thus, the claim for service connection for a right ankle disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. Whether new and material evidence has been received to reopen the previously-denied claim for service connection for a right foot disability. Entitlement to service connection for a right ankle disability was denied in a November 2008 rating decision. The Veteran filed a timely NOD in December 2008. In May 2009, a SOC was issued that denied service connection for a right foot disability. The Veteran was notified of the denial and his appellate rights, however, did not timely perfect an appeal (submit a substantive appeal (VA Form 9)) after receipt of the May 2009 SOC. The Veteran’s VA Form 9 was submitted in March 2010, which is more than 60 days of the mailing of the SOC and more than one year of the notice of the decision being appealed. In a March 2010 letter, VA notified the Veteran that his VA Form 9 was untimely. As such, the Veteran did not perfect an appeal to the Board and the November 2008 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. The November 2008 rating decision denied service connection for a right foot disability on the basis that there was no evidence of a current diagnosis or disability. Since the November 2008 rating decision, there have been two VA examinations in February 2009 and August 2014, and the Veteran has submitted a January 2019 Disability Benefits Questionnaire (DBQ) from a private physician, which provide evidence of a right foot disability. Given that the threshold for substantiating a claim to reopen is low, this evidence, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection for a right foot disability and raises a reasonable possibility of substantiating the claim. The Board finds that this new evidence is also material. Thus, the claim for service connection for a right foot disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. Whether new and material evidence has been received to reopen the previously-denied claim for service connection for a lung disability. Entitlement to service connection for a right ankle disability was denied in a November 2008 rating decision. The Veteran filed a timely NOD in December 2008. In May 2009, a SOC was issued that denied service connection for a lung disability. The Veteran was notified of the denial and his appellate rights, however, did not timely perfect an appeal (submit a substantive appeal (VA Form 9)) after receipt of the May 2009 SOC. The Veteran’s VA Form 9 was submitted in March 2010, which is more than 60 days of the mailing of the SOC and more than one year of the notice of the decision being appealed. In a March 2010 letter, VA notified the Veteran that his VA Form 9 was untimely. As such, the Veteran did not perfect an appeal to the Board and the November 2008 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. The November 2008 rating decision denied service connection for a lung disability on the basis that there was no evidence of a current diagnosis or disability. Since the November 2008 rating decision, there has been a VA examination in August 2014 and the Veteran has submitted a January 2019 Disability Benefits Questionnaire (DBQ) from a private physician, which provide evidence of a lung disability. Given that the threshold for substantiating a claim to reopen is low, this evidence, when considered by itself or in connection with evidence previously assembled, relates to an unestablished fact necessary to substantiate the claim for service connection for a lung disability and raises a reasonable possibility of substantiating the claim. The Board finds that this new evidence is also material. Thus, the claim for service connection for a lung disability is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to service connection for a right ankle disability The Veteran asserts that service connection for a right ankle is warranted because it was incurred in or is otherwise related to his military service. During the November 2020 Board hearing, the Veteran testified that when he was on the flight line, after having just parked an aircraft, someone else on the flight reversed / backed-up the plane, which went over the back of his right foot. See also December 2008 Notice of Disagreement. After a careful review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding that service connection for a right ankle disability is warranted. The reasons follow. As to evidence of a current disability, the Veteran has a current right ankle disability. The Veteran proffered a January 2019 private Disability Benefits Questionnaire (DBQ), which reflects a positive deltoid ligament test and pain in the right ankle. A diagnosis of a right ankle strain in 1966 and 1968 are noted in the August 2014 VA examination report (DBQ). A February 2009 VA examination report also shows a diagnosis of chronic strain of right ankle and status post injury of the right foot. Accordingly, the first element of a service-connection claim is met. As to evidence of an in-service disease or injury, the Veteran’s service treatment records from November 1966 show that an aircraft rolled on the Veteran’s right foot, which resulted in a severe sprain and soft tissue injury. Thus, the second element of a service-connection claim has been met. The Veteran has met the first two elements of service connection with a current disability and evidence of the in-service event of an aircraft rolling over his right foot. That fact notwithstanding, however, the Board finds that service connection for a right ankle disability is not warranted because the preponderance of the evidence is against a finding to establish the required nexus between the disability and the Veteran’s military service. Service treatment records in November 1966 indicate that an aircraft towing tug rolled on the Veteran’s right foot while he was on base and on duty. A sprain of the right ankle was diagnosed. An x-ray showed no gross fracture but marked swelling and tenderness in the bilateral collateral ligament. The examination of the right foot and ankle showed normal bony structure. An impression of severe sprain and second-degree soft tissue injury was noted, and the Veteran was given a short leg cast and crutches. Days after, it was noted in service treatment records that the Veteran “feels well,” his cast was removed, and he was treated with ace wrap and was placed on light duty. A June 1968 Report of Medical Examination reflects a normal clinical evaluation of the lower extremities and the feet. A 1966 soft tissue injury to the right ankle is noted with no complications and no sequalae. The Veteran’s August 1968 Report of Medical Examination for purposes of separation shows a normal clinical evaluation of the feet and lower extremities. The 1966 soft tissue injury to the right ankle is again noted with no complications and no sequalae. In the accompanying August 1968 Report of Medical History, the Veteran denied that he ever had or had at the time “foot trouble.” Thus, two examinations within two months of each other showed that the Veteran’s right ankle was clinically normal at those times, and the past ankle injury was specifically mentioned in both examination reports, where a finding of no complications and no sequalae was written, which would show that the Veteran was not having right ankle symptoms at those times in 1968. Subsequently, a November 1968 service treatment record indicates that the Veteran twisted his left ankle and an x-ray found that the bones appeared normal but there was soft tissue swelling laterally. The Veteran was afforded a VA examination for his claimed right ankle disability in February 2009. He reported that in 1966 he twisted his right ankle and was in a cast for several weeks and subsequently re-injured his right ankle and foot in 1966 when a tug rolled over his foot on the flight line. He stated that he was in a cast for several weeks after that injury as well. The Veteran reported that since that time he has had some tightness in the right foot and ankle area which is intermittent and occurred on average once per month, lasted for minutes to hours or until he can manipulate the position of his ankle, which will cause a popping sensation that resolves the tightness. The Veteran denied any effect of the ankle on his daily activities and flare-ups. The examiner opined that it is less likely than not that the Veteran’s right ankle disability is a result of the injury in service. She referenced the November 1966 injury to the right ankle when an aircraft towing tug rolled on the right foot and a diagnosis of injury of, sprain of, right ankle. The examiner noted that a Report of Medical Examination for the purpose of separation in August 1968 documented normal feet and normal lower extremity and mentioned a soft tissue injury to the right ankle with an indication of no complications and no sequela. The examiner stated that she also reviewed the remainder of the claims file, and there are no indications of private medical records to indicate that the Veteran followed-up with a physician for complaints of a right ankle disability. She added that the VA medical records were also reviewed and did not indicate that the Veteran presented for treatment for a right ankle condition. The examiner stated that it is evident that the Veteran had an injury to his right foot and ankle in 1966, however, neither service medical records or intervening medical records over the next 40 years indicate that there is an ongoing or chronic disability or condition affecting the right foot or ankle. Therefore, the examiner opined that chronicity of the condition is not established nor is a link established between the occurrence in service and the current condition. An x-ray of the right ankle in February 2009 showed that the bones and joints of the right ankle were intact without evidence of fracture, dislocation, or osseous mass lesion. There were no significant degenerative changes noted and the soft tissues were normal without evidence of swelling or other pathology. The Veteran was afforded another VA examination in September 2014. The Veteran reported that his right ankle condition began with a severe right ankle sprain to the right foot in November 1966 with soft tissue injury when an aircraft towing tug rolled on his foot and ankle, which had gotten worse since. The examiner provided the opinion that it is less likely than not that the Veteran’s current right ankle disability was incurred in and/or caused by military service. He provided the rationale that there is evidence in the service treatment record that in November 1966 the Veteran had a towing tug roll over his right foot and ankle and he did have an injury to the ankle and foot. However, on separation examination, the injury to the right foot and ankle is mentioned with no complications and no sequelae at the time of discharge. The examiner added that there is no evidence in the service treatment records that showed the right foot/ankle had been seen on a regular basis or that it had become a chronic problem. There is also no evidence after discharge that shows continuity of care for the right ankle and/or foot. Further, the examiner noted the February 2009 x-rays of the right ankle and right foot with impressions of normal right ankle and degenerative changes noted on the metatarsophalangeal joint of the great toe otherwise normal. In January 2019, the Veteran provided a private DBQ for the right ankle which noted diagnoses of lateral collateral ligament sprain and deltoid ligament sprain dated November 1966 and November 1968 respectfully. The history of the Veteran’s right ankle was reported as an initial injury on the flight line when the foot was ran over by tug in 1966 and re-injured in 1968 when he stepped out of hanger door and sprained his ankle again. The private physician opined that it is more likely than not that the Veteran’s current right ankle disability was caused by his military service due to the injuries that occurred on the flight line when his foot was ran over by a tug and when he stepped out of a hanger door severely spraining the ankle. She stated that the Veteran was diagnosed with a possible deltoid ligament tear, but the records do not show confirmation of the tear and just detail a severe ankle sprain. She added that the Veteran reported ankle pain continued after discharge and continued to limit tolerance with functional activities and had a positive deltoid ligament test confirming continued chronic symptoms over the deltoid ligament. The Board finds the January 2019 opinion to be of no probative value as it is based on an inaccurate factual premise that after the November 1966 airplane tug injury to the right ankle, the Veteran experienced a subsequent injury to the right ankle in November 1968. However, service treatment records document an injury to the left ankle in November 1968 where the Veteran twisted his left ankle. November 1968 service treatment records include an x-ray of the left ankle, which indicate that the bones appear normal and that there was soft tissue swelling laterally. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise is not probative). The Board finds that the medical opinions offered by the VA examiners in February 2009 and September 2014 to be highly probative, as the examiners had reviewed the evidence of record, including the service treatment records, and recognized that the Veteran’s right ankle was injured in service in November 1966 when the aircraft towing tug rolled on his foot and ankle. The nexus opinions were consistent with each other and explained how each concluded that the right ankle disability was not related to service, with citations to specific records, to include the August 1968 Report of Medical Examination, which showed a normal clinical evaluation of the feet and lower extremities, documented the 1966 right ankle injury and specifically noted no complications and no sequelae at the time of discharge. The first post-service documentation of a complaint of the right ankle was the Veteran’s initial claim for service connection in April 2008, which is 39 years after separation from service, which does not tend to show a nexus between the current disability and service. The Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disability at issue. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Veteran has not provided competent evidence in support of a nexus between his military service, and a right ankle disability. Lay evidence may be competent to establish medical etiology or nexus. However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to.” The Veteran is not medically trained and is therefore not qualified to competently opine about medical etiology of an ankle disability, in relation to his military service. Ankle disabilities require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. Therefore, the Board finds that the lay assertions proffered by the Veteran lack probative value. Therefore, given the reasons above, the Board finds that the most probative evidence of record is the opinion of the February 2009 and September 2014 examiners. The VA examination reports and medical opinions collectively provide competent and probative evidence that weigh against the Veteran’s claim because the examiners reviewed the claims file, interviewed the Veteran, performed appropriate examinations, and provided medical opinions supported by well-reasoned rationale with citations to the relevant medical records. Monzingo v. Shinseki, 26 Vet. App. 97, 105-106 (2012). Absent competent and probative evidence of a nexus between the Veteran’s service and his right ankle disability; the Board finds that his current right ankle disability was not incurred in service and it is not otherwise related to active service. Accordingly, service connection for a right ankle disability is not warranted. The preponderance of the evidence is against the claim for service connection for a right ankle disability, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for a right foot disability The Veteran asserts that service connection for a right foot is warranted because it was incurred in or is otherwise related to his military service. During the November 2020 Board hearing, the Veteran testified that when he was on the flight line, after having just parked an aircraft, someone else on the flight reversed / backed-up the plane, which went over the back of his right foot. See also December 2008 Notice of Disagreement. After a careful review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding that service connection for a right foot disability is warranted. The reasons follow. As to evidence of a current disability, the Veteran has a current right foot disability. The Veteran proffered a January 2019 private Disability Benefits Questionnaire (DBQ), which reflects right foot pain and diagnoses of crush injury in November 1966 and plantar fasciitis in January 2019. A diagnosis of a right foot contusion in 1966 and 1968 are noted in the August 2014 VA examination report (DBQ). A February 2009 VA examination report also shows a diagnosis of status post injury of the right foot. Accordingly, the first element of a service-connection claim is met. As to evidence of an in-service disease or injury, the Veteran’s service treatment records from November 1966 show that an aircraft rolled on the Veteran’s right foot, which resulted in a severe sprain and soft tissue injury. Thus, the second element of a service-connection claim has been met. The Veteran has met the first two elements of service connection with a current disability and evidence of the in-service event of an aircraft rolling over his right foot. That fact notwithstanding, however, the Board finds that service connection for a right foot is not warranted because the preponderance of the evidence is against a finding to establish the required nexus between the disability and the Veteran’s military service. Service treatment records in November 1966 indicate that an aircraft towing tug rolled on the Veteran’s right foot while he was on base and on duty. A severe sprain of the right foot and soft tissue injury was noted. An x-ray showed no gross fracture but marked swelling and tenderness in the bilateral collateral ligament. The examination of the right foot and ankle showed normal bony structure. An impression of severe sprain and second-degree soft tissue injury was noted, and the Veteran was given a short leg cast and crutches. Days after, it was noted in service treatment records that the Veteran “feels well,” his cast was removed, and he was treated with ace wrap and was placed on light duty. A June 1968 Report of Medical Examination reflects a normal clinical evaluation of the lower extremities and the feet. A 1966 soft tissue injury to the right ankle is noted with no complications and no sequalae. The Veteran’s August 1968 Report of Medical Examination for purposes of separation shows a normal clinical evaluation of the lower extremities and feet. The 1966 soft tissue injury to the right ankle is again noted with no complications and no sequalae. In the accompanying August 1968 Report of Medical History, the Veteran denied that he ever had or had at the time “foot trouble.” Thus, two examinations within two months of each other showed that the Veteran’s right foot was clinically normal at those times, and the past ankle injury was specifically mentioned in both examination reports, where a finding of no complications and no sequalae was written, which would show that the Veteran was not having right foot symptoms at those times in 1968. This fact was confirmed on the August 1968 Report of Medical History, when the Veteran denied a history of foot problems at that time. The Veteran was afforded a VA examination for his claimed right foot disability in February 2009. He reported that in 1966 he twisted his right ankle and was in a cast for several weeks and subsequently re-injured his right ankle and foot in 1966 when a tug rolled over his foot on the flight line. He stated that he was in a cast for several weeks after that injury as well. The Veteran reported that since that time, he has had some tightness in the right foot and ankle area which is intermittent and occurred on average once per month, lasted for minutes to hours or until he can manipulate the position of his ankle, which will cause a popping sensation that resolves the tightness. The Veteran denied any effect of the foot on his daily activities and flare-ups. The examiner opined that it is less likely than not that the Veteran’s right foot disability is a result of the injury in service. She referenced the November 1966 injury to the right ankle when an aircraft towing tug rolled on the right foot and a diagnosis of injury of, sprain of, right ankle. She also noted another service treatment record that gives a diagnosis of severe sprain, right foot, soft tissue injury with the case of accident being aircraft tug rolled on right foot. The examiner noted that the August 1968 Report of Medical Examination documented normal feet and normal lower extremity and mentioned a soft tissue injury to the right ankle with an indication of no complications and no sequela. The examiner stated that she also reviewed the remainder of the claims file and there are no indications of private medical records to indicate that the Veteran followed-up with a physician for complaints of a right foot disability. She added that the VA medical records were also reviewed and did not indicate that the Veteran presented for treatment for a right foot condition. The examiner stated that it is evident that the Veteran had an injury to his right foot and ankle in 1966, however, neither service medical records or intervening medical records over the next 40 years indicate that there is an ongoing or chronic disability or condition affecting the right foot or ankle. Therefore, the examiner opined that chronicity of the condition is not established nor is a link established between the occurrence in service and the current condition. An x-ray of the right foot in February 2009 showed early degenerative changes at the metatarsophalangeal joint of the great toe without evidence of hallux valgus. The remaining bones and joints of the right foot were intact without evidence of fracture, dislocation, or osseous mass lesion. There were no significant degenerative changes noted and no signs of coalition. The soft tissues were well maintained and were within normal limits. The Veteran was afforded another VA examination in September 2014. The Veteran reported that his right foot condition began when his foot was run over by a tug. The examiner provided the opinion that it is less likely than not that the Veteran’s current right foot disability was incurred in and/or caused by military service. He provided the rationale that there is evidence in the service treatment record that in November 1966 the Veteran had a towing tug roll over his right foot and ankle and he did have an injury to the ankle and foot. However, on separation examination, the injury to the right foot and ankle is mentioned with no complications and no sequelae at the time of discharge. The examiner added that there is no evidence in the service treatment records that showed the right foot/ankle had been seen on a regular basis or that it had become a chronic problem. There is also no evidence after discharge that shows any continuity of care for the right ankle and/or foot. Further, the examiner noted the February 2009 x-rays of the right ankle and right foot with impressions of normal right ankle and degenerative changes noted on the metatarsophalangeal joint of the great toe otherwise normal. In January 2019, the Veteran provided a private DBQ for the right foot which noted diagnoses crush injury and plantar fasciitis dated November 1966 and January 2019, respectfully. The history of the Veteran’s right foot was reported as an injury on the flight line when the back of his foot was run over by tug, then backed off and that his right foot/ankle pain has been present ever since. The private physician opined that it is more likely than not that the Veteran’s current right foot disability was caused by his military service due to the injury when his foot was run over by a tug. She stated that the Veteran presented with continued pain, decreased weightbearing, and need for a cane, which limited tolerance with activities. The Board accords the most probative weight to the opinions by the February 2009 and September 2014 examiners. The examiners had reviewed the evidence of record, including the service treatment records, and recognized that the Veteran’s right foot was injured in service in November 1966 when the aircraft towing tug rolled on his foot and ankle. The nexus opinions were consistent to each other and explained how each concluded that the right foot disability was not related to service, with citations to specific records, to include the August 1968 Report of Medical Examination for purposes of separation, which showed a normal clinical evaluation of the feet and lower extremities, and documented the 1966 right ankle injury and specifically noted no complications and no sequelae at the time of discharge. The first post service documentation of a complaint of the right ankle was the Veteran’s initial claim for service connection in April 2008, which is 39 years after separation from service, which does not tend to show a nexus between the current disability and service. The Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disability at issue. See Maxson, 230 F.3d at 1333. The Board finds the January 2019 opinion to be of diminished value as it is not supported by a well-reasoned rationale and did not consider all the relevant evidence that the Board has found to be credible, to include the June 1968 and August 1968 Reports of Medical Examination that showed normal clinical evaluations of the Veteran’s feet approximately two years following the injury. See Reonal, 5 Vet. App. at 460-61 The Veteran has not provided competent evidence in support of a nexus between his military service, and a right foot disability. Lay evidence may be competent to establish medical etiology or nexus. However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to.” The Veteran is not medically trained and is therefore not qualified to competently opine about medical etiology of a foot disability, in relation to his military service. Foot disabilities require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. Therefore, the Board finds that the lay assertions proffered by the Veteran lack probative value. Therefore, given the reasons above, the Board finds that the most probative evidence of record is the opinion of the February 2009 and September 2014 examiners. The examination reports and medical opinions collectively provide competent and probative evidence that weigh against the Veteran’s claim because the examiners reviewed the claims file, interviewed the Veteran, performed appropriate examinations, and provided medical opinions supported by well-reasoned rationale with citations to the relevant medical records. Monzingo, 26 Vet. App. at 105-106. Absent competent and probative evidence of a nexus between the Veteran’s service and his right foot disability; the Board finds that his current foot ankle disability was not incurred in service and it is not otherwise related to active service. Accordingly, service connection for a right foot disability is not warranted. The preponderance of the evidence is against the claim for service connection for a right foot disability, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Entitlement to service connection for a lung disability, to include fibrosis. The Veteran asserts that service connection for a lung disability is warranted because it was incurred in or is otherwise related to his military service. During the November 2020 Board hearing, the Veteran testified that he had fibrosis of the lung due to chemical exposure from different types of cleaners and solvents in service, to include JP4, JBK, and hydraulic fluid. See also December 2015 statement, March 2010 statement and December 2008 NOD. After a careful review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding that service connection for a lung disability is warranted. The reasons follow. As to evidence of a current disability, the Veteran has a current lung disability. The Veteran proffered a January 2019 private Disability Benefits Questionnaire (DBQ), which reflects diagnoses of asbestosis and Agent Orange exposure (herbicide) in 1966 and also pulmonary fibrosis. A February 2009 VA examination report also shows a diagnosis of restrictive lung disease, specifically fibrosis of the lungs in 2014. The Board has reviewed the record, including service treatment records and post-service medical records and finds that the preponderance of the evidence is against a finding that a lung disability had its onset in service or is otherwise related to service. The Veteran’s service treatment records are silent for any diagnosis, symptoms, or treatment of a lung disability. The Veteran specifically denied that he ever had or had at the time “asthma;” “shortness of breath;” “pain or pressure in chest;” and “chronic cough” in the August 1968 Report of Medical History for purposes of separation. The Veteran checked “no” to whether he had ever had any illness or injury other than those already noted. Additionally, on this form, when the Veteran signed the document, he certified the facts he reported. The Veteran completed this form contemporaneously with his service, which the Board finds makes this document highly probative and accurate as to what the Veteran experienced and did not experience in service. Further, June 1968 and August 1968 Reports of Medical Examination reveal normal clinical evaluations of the lungs and chest and no lung disabilities are noted by the examiner. For these reasons, the Board does not find that the Veteran had symptoms of a lung disability in service. The Veteran has not offered probative and competent evidence establishing a nexus between his current lung disability and service. The Veteran testified during the November 2020 Board hearing that he was exposed to chemicals including JP4, JBK, and hydraulic fluid daily for four years in service. During the August 2014 VA examination (contracted DBQ), the Veteran reported his condition began in 2004 with coughing and shortness of breath and to date, he was unsure if it was formally diagnosed. The Veteran reported to the examiner that he worked around and breathed in JP4, Methyl Ethyl Ketone, and 86-O2 sealant. The examiner opined that it is less likely than not that the Veteran’s current lung disability with shortness of breath was incurred in and/or caused by the Veteran’s military service. The examiner provided the rationale that after reviewing the service treatment records, VA medical records, and all other records available for review, there is no evidence that the Veteran had any lung conditions while serving in the military and had no lung conditions since discharge that have become chronic in nature. The Board finds that while the Veteran the Veteran is competent to report that he has been around such substances given his military occupational specialty (MOS) as an aircraft maintenance specialist, as a lay individual, he is not competent to provide a diagnosis of a lung disability based on his exposure to these substances and thus the statements are not competent evidence to establish a nexus between his current fibrosis and service. Lay evidence may be competent to establish medical etiology or nexus. However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to.” The Board notes that the Veteran first made a claim for shortness of breath in April 2008, more than 39 years after his January 1969 separation from service. The Veteran also has document a complaint of a cold cough and chest congestion for the preceding three weeks, as shown in February 1998 VA medical records. This is still over 29 years after service and shows that the Veteran’s lungs were clear at the time. The Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue. See Maxson, 230 F.3d at 1333. A diagnosis of a lung disability requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. Therefore, the Board finds that the lay assertions proffered by the Veteran lack probative value. The Veteran has proffered a January 2019 private DBQ opinion. The private physician opined that it is more likely as not that the Veteran’s respiratory conditions as noted above [in the DBQ] are presumptive and attributable to his exposure to environmental chemicals, JP4 fuels, and herbicides (Agent Orange) while serving on active duty both at Kirkland Air Force Base in 1965 to 1969 and while TDY (Temporary Duty Assignment) in Vietnam in 1967 serving in I Corps. The Board finds the January 2019 opinion to be of diminished probative value as it is not supported by a well-reasoned rationale and did not consider all the relevant evidence that the Board has found to be credible, to include the June 1968 and August 1968 Reports of Medical Examination that showed normal clinical evaluations of the Veteran’s lungs and chest near service discharge. See Reonal, 5 Vet. App. at 460-61. The private physician indicated that the Veteran’s respiratory conditions are presumptive and attributable to environmental chemicals, JP4 fuels, and herbicides (Agent Orange), however, pulmonary fibrosis is not a presumptive condition associated with herbicide exposure. 38 C.F.R. § 3.309(e). Moreover, while exposure to herbicides based on service in Vietnam is raised by the record in the January 2019 DBQ, the Board finds the preponderance of the evidence is against the Veteran being exposed to herbicides during service. Although the Veteran reported TDY (Temporary Duty Assignment) in Vietnam in his April 2008 claim and an April 2008 statement, the Veteran did not make this assertion in subsequent statements. The Veteran has claimed his breathing problems/ lung disability as due to the chemicals and fuel he was exposed to in a December 2008 NOD, March 2010 statement, during the August 2014 VA examination, December 2015 statement, and during the November 2020 hearing. The Veteran’s Certificate of Release or Discharge (DD Form 214) reflects that the Veteran had no foreign and/or sea service. The Veteran’s service treatment record associated with the claims file indicates that a Personnel Information Exchange Systems (PIES) request was made in May 2008 to furnish pages from the personnel file showing unit of assignment, dates of assignment, participation in combat operations, wounds in action, awards and decorations and official travel outside the U.S. It was noted that all requested records were mailed and that all service information has been verified as correct. These records show “none 20 Aug 65” under “Foreign Service” and a “chronological listing of service” does not reflect service in Vietnam. There is also no presumption of “secondary exposure” to herbicide agents based on being near or working on aircraft that flew over Vietnam or handing of equipment that was once used in Vietnam. Thus, the Board finds that the preponderance of the evidence is against a finding that the Veteran had service in Vietnam for a presumption of herbicide exposure to attach. Therefore, given the reasons above, the Board finds that the most probative evidence of record is the opinion of the September 2014 examiner. The examination report and medical opinion provides competent and probative evidence that weigh against the Veteran’s claim because the examiner reviewed the claims file, interviewed the Veteran, performed an appropriate examination, and in forming his medical opinion that is supported by a well-reasoned rationale, the examiner considered the Veteran’s reported exposure to substances as an aircraft mechanic as the Veteran had reported it to him during the examination, which was the same contention the Veteran testified to during the November 2020 Board hearing. Absent competent and probative evidence of a nexus between the Veteran’s service and his current lung disability; the Board finds that his current lung disability was not incurred in service and it is not otherwise related to active service. Accordingly, service connection for a lung disability is not warranted. The preponderance of the evidence is against the claim for service connection for a lung disability, to include fibrosis, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Entitlement to a compensable rating for bilateral hearing loss prior to June 11, 2014. The Veteran is seeking a compensable disability rating for his bilateral hearing loss disability. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Diagnostic Codes (DCs) are assigned by the rating officials to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. See 38 C.F.R. § 4.7. When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. See id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of a veteran. 38 C.F.R. § 4.3. Hearing loss is evaluated under 38 C.F.R. § 4.85, DC 6100 using a mechanical formula. Disability ratings for service-connected hearing loss range from noncompensable to 100 percent and are determined by inserting numbers, which are assigned based on the results of audiometric evaluations, into Table VI in DC 6100. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Rating Schedule establishes eleven Roman numeral auditory acuity levels that range from Level I (essentially normal hearing acuity) to Level XI (profound deafness). Id. The level of auditory acuity is based on the average puretone threshold (derived from the results of puretone audiometric tests in the frequencies 1000, 2000, 3000, and 4000 Hertz) and organic impairment of hearing acuity (measured by controlled speech discrimination test; Maryland CNC). See 38 C.F.R. § 4.85, Table VI. The columns in Table VI represent nine categories of decibel loss as measured by puretone threshold averages. The rows in Table VI represent nine categories of organic impairment of hearing acuity as measured by speech discrimination tests. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the column that represents the relevant puretone threshold average with the row that represents the relevant speech discrimination test result. Id. Exceptional patterns of hearing impairment are provided for in 38 C.F.R. § 4.86 (2018). When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear is evaluated separately. 38 C.F.R. § 4.86(a). The percentage evaluation is derived from Table VII in 38 C.F.R. § 4.85 by intersecting the row that corresponds to the numeric designation for the ear with better hearing acuity (as determined by Table VI) and the column that corresponds to the numeric designation level for the ear with the poorer hearing acuity (as determined by Table VI). For example, if the better ear has a numeric designation Level of “V” and the poorer ear has a numeric designation Level of “VII,” the percentage evaluation is 30 percent. See id. The Board finds that the Veteran’s bilateral hearing loss disability did not meet the criteria for at least a compensable disability rating prior to June 11, 2014. Given the Veteran’s submission of private audiological testing in February 2019 and his testimony in the November 2020 Board hearing, which is suggestive of a worsening of the disability, the Board will afford the Veteran a new VA examination in order to establish the severity of his bilateral hearing loss thereafter in the remand portion of this decision below. In June 2014, the Veteran underwent an audiological examination (contracted Disability Benefits Questionnaire (DBQ)), which showed that the Veteran’s puretone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 25 30 50 50 39 (38.75) LEFT 25 35 35 35 31 (31.25) Speech discrimination tests used the Maryland CNC word list and revealed speech recognition ability of 80 percent in the right ear and 86 percent in the left ear. Using the right ear puretone average of 39 decibels from June 2014 examination and a speech recognition score of 80 percent; the right ear received a designation of III under Table VI. See 38 C.F.R. § 4.85. Because the left ear had a puretone average of 31 decibels and speech recognition score of 86 percent, it received a designation of II under Table VI. See id. Table VIa will not be taken into consideration for the either the right or left ear because the puretone threshold in decibels are not above 55 decibels for each of the frequencies 1000, 2000, 3000, and 4000 Hertz bilaterally. See 38 C.F.R. § 4.86(a). The intersection of row II for the better ear and column III for the poorer ear on Table VII established that under the June 2014 examination, the Veteran’s hearing loss is entitled to a zero percent or a noncompensable disability rating. See 38 C.F.R. § 4.85, DC 6100. In the examination report, the examiner noted that the Veteran reported difficulty hearing and understanding what people say. The Veteran is competent to describe the effects of his hearing loss on his daily functioning, such as having difficulty understanding speech clearly, including as reported during the June 2014 examination. The Board finds the Veteran’s statements and testimony are credible. The Veteran has been provided objective, controlled speech discrimination tests using the appropriate VA-approved Maryland CNC word list during his audiological examination. The speech discrimination test specifically assesses word comprehension and assigns a speech recognition ability percentage. The disability ratings are derived by a mechanical application of the rating schedule which incorporates both the puretone threshold average and the speech recognition ability percentage. Lendenmann, 3 Vet. App. at 349. The examination results establish no more than a noncompensable or zero percent disability rating. The Board has considered the functional impact of the Veteran’s disability and the results of the audiological examinations of record. Mechanical application of the Rating Schedule to the audiometric findings does not establish entitlement to a compensable disability rating at any point of the appeal period prior to June 11, 2014. In Doucette v. Shulkin, 28 Vet. App. 366 (2017), the U.S. Court of Appeals for Veterans Claims held that the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are precisely the effects that VA’s audiometric tests are designed to measure. Thus, when a claimant’s hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the schedular rating criteria. The Veteran does not report any symptoms associated with this disability that are not contemplated by the rating criteria or have otherwise been left uncompensated or unaccounted for by his assigned schedular rating. 38 C.F.R. §§ 4.85, 4.86, DC 6100. As such, referral for extraschedular consideration is not warranted. The preponderance of the evidence is against the claim for a higher rating for the Veteran’s bilateral hearing loss disability. The impairment associated with this disability is contemplated by the rating criteria, which consider the average impairment resulting from a service-connected disability. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Absent audiometric and speech discrimination scores showing that the Veteran’s hearing loss disability meets the schedular criteria for an increased rating, his reported functional impairment does not warrant a higher rating than is already assigned. See 38 C.F.R. § 4.85; Lendenmann, 3 Vet. App. at 349. Thus, the benefit-of-the-doubt rule does not apply, and entitlement to a compensable disability rating for a bilateral hearing loss disability prior to June 11, 2014. is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. REASONS FOR REMAND 8. Entitlement to a compensable rating for bilateral hearing loss since June 11, 2014, is remanded. The Veteran contends that his bilateral hearing loss disability is worse than the disability rating currently assigned. The Veteran was last afforded a VA examination (contracted Disability Benefits Questionnaire (DBQ)) in June 2014 in order to establish the severity of his service-connected bilateral hearing loss disability on appeal. The Veteran’s submission of private audiological testing in February 2019 and his testimony in the November 2020 Board hearing is suggestive of a worsening of the disability. The private audiologist noted that that controlled speech discrimination tests provided were the Maryland CNC test, however, the report does not indicate whether the speech discrimination and puretone audiometry tests performed were valid for VA disability rating purposes. See 38 C.F.R. § 4.85(a). Therefore, the Board must remand this matter to afford the Veteran an opportunity to undergo VA examinations to assess the current nature, extent and severity of the bilateral hearing loss disability on appeal. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to evaluate the current severity of his service-connected bilateral hearing loss disability. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Cheng, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.