Citation Nr: 21014989 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 19-32 723 DATE: March 16, 2021 ORDER The appeal of the issue of entitlement to service connection for a heart disorder is dismissed. Service connection for a psychiatric disorder, diagnosed as posttraumatic stress disorder (PTSD), is granted. Service connection for a skin disorder, diagnosed as tinea versicolor, is granted. Service connection for headaches is granted. Service connection for bilateral hearing loss is granted. Service connection for tinnitus is granted. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for chronic fatigue syndrome is remanded. Entitlement to service connection for joint pain is remanded. Entitlement to service connection for bilateral eye disorders is remanded. FINDINGS OF FACT 1. At the January 2020 hearing before the Board, the Veteran withdrew his appeal concerning the issue of entitlement to service connection for a heart disorder. 2. The Veteran’s psychiatric disorder, diagnosed as PTSD, had its onset in service. 3. The Veteran’s skin disorder, diagnosed as tinea versicolor, had its onset in service. 4. The Veteran’s headaches had their onset in service. 5. The Veteran’s current bilateral hearing loss had its onset in service. 6. The Veteran’s current tinnitus had its onset in service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal of the issue of entitlement to service connection for a heart disorder have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for service connection for a psychiatric disorder, diagnosed as PTSD, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. 3. The criteria for service connection for a skin disorder, diagnosed as tinea versicolor, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.317. 4. The criteria for service connection for headaches have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.317. 5. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317, 3.385. 6. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1117, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.317, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Navy from August 1983 to May 1987 and from June 1990 to June 1993, including service in Southwest Asia. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a March 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for a psychiatric disorder, to include PTSD and insomnia (listed as an acquired psychiatric disorder, to include insomnia). As there are multiple other psychiatric diagnoses of record, the Board finds that it is more appropriate to characterize the claim broadly as one of entitlement to service connection for a psychiatric disorder, to include PTSD and insomnia. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). By this decision, the RO also denied service connection for a heart disorder (listed as heart condition); a skin disorder, to include tinea versicolor (listed as tinea versicolor, claimed as a skin rash); headaches; bilateral hearing loss; tinnitus; hypertension; chronic fatigue syndrome; joint pain; and bilateral eye disorders (listed as vision loss). In November 2020, the Veteran appeared at a Board hearing before the undersigned Veterans Law Judge. At the hearing, the undersigned Veterans Law Judge agreed to hold the record open for a period of 90 days to provide the Veteran the opportunity to submit additional evidence. 1. Withdraw Claim The Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the Veteran or by his or her authorized representative. 38 C.F.R. § 20.204. At the November 2020 Board hearing, the Veteran withdrew his appeal as to the issue of entitlement to service connection for a heart disorder. Thus, there remain no allegations of errors of fact or law for appellate consideration as to that issue. As such, the Board does not have jurisdiction to review the appeal, and the issue of entitlement to service connection for a heart disorder is dismissed. 2. Psychiatric Disorder, to include PTSD and insomnia Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). The term “active military, naval, or air service” includes active duty, any period of active duty for training during which the individual was disabled or died from a disease or injury incurred in or aggravated in the line of duty, and any period of inactive duty training during which the individual was disabled or died from an injury incurred in or aggravated in the line of duty. 38 U.S.C. § 101 (24). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., under the criteria of DSM-IV); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f). Further, 38 C.F.R. § 3.304(f) provides that if a stressor claimed by a Veteran is related to the Veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of [PTSD] and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. The Veteran served in the Southwest Asia Theater of Operations during the Persian Gulf War, on or after August 2, 1990. 38 U.S.C. § 1110. Therefore, service connection may also be established under 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Under those provisions, service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia Theater of Operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1). Under 38 C.F.R. § 3.317, compensation may be warranted on a presumptive basis for disabilities due to undiagnosed illness as well as medically unexplained chronic multisymptom illnesses. See 38 C.F.R. § 3.317 (a). This means that even if a Veteran’s symptoms are attributed to a known clinical diagnosis, the presumptive provisions related to Gulf War service still apply. In particular, the term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, or disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). Therefore, even if a multisymptom illness has a diagnosis, consideration should still be given as to whether the disability has no known etiology, or has a known, partially understood etiology. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. Id. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). The Veteran contends that he has as psychiatric disorder, to include PTSD and insomnia, that is related to service. He maintains that he began having psychiatric problems a few months before he left the military and that he is diagnosed with PTSD due to his experiences while serving in the Persian Gulf. He essentially asserts that he suffered from psychiatric problems a few months before he left the military and since that time. The Veteran argues that his claimed psychiatric disorder, to include PTSD and insomnia, is the result of his service in Southwest Asia and should be considered under the provisions of 38 C.F.R. § 3.317. The Veteran served on active duty in the Navy from August 1983 to May 1987 and from June 1990 to June 1993, including in Southwest Asia. His DD Form 214 for his period of active duty from August 1983 to May 1987 indicates that he had eight months and fourteen days of sea service. His occupational specialty is listed as a system organizational maintenance technician for two years and eleven months. The Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 do not show treatment for any psychiatric problems. His service treatment records for his period of active duty from June 1990 to June 1993 also do not specifically show treatment for any psychiatric problems. Post-service VA treatment records show treatment for variously diagnosed psychiatric disorders, including PTSD; PTSD, unspecified; PTSD related to military sexual trauma (MST); PTSD/depression/suicidal ideation; a generalized anxiety disorder; an anxiety disorder, unspecified; and anxiety related to a previous traumatic experience. A January 2018 VA psychiatric examination report includes a notation that the Veteran’s claims file was reviewed. The Veteran reported that he was in the Navy from 1983 to 1993 and that his occupational specialty was in heating, ventilation, and air conditioning. He stated that he also served in Desert Storm/Shield with the same occupational specialty during his deployment. He indicated that he had no current or past mental health treatment, and that he wasn’t taking psychotropic medications, including sleep aids. The Veteran related that it would take him forty-five minutes to an hour to initiate sleep on average, that he was sometimes physically uncomfortable, and that he would sometimes ruminate on the day’s events and planning for the next day. He stated that he would sometimes jerk awake at night, and that he had slight hypervigilance. It was noted that he reported that he did not remember any dreams or nightmares. As to a diagnosis, the examiner indicated that the Veteran did not presently have, and that he had never been diagnosed with, a mental disorder. The examiner maintained that based on a chart review and an interview, there was no sufficient evidence for the Veteran to meet the diagnostic criteria for insomnia, or for any other sleeping disorder diagnosis. VA treatment reports dated in November 2019 show that the Veteran was diagnosed by VA psychologists and psychiatrists with PTSD, unspecified, and PTSD related to MST, as a result of his service during the Persian Gulf War. In a statement received in May 2020, the Veteran’s ex-wife reported that she had known the Veteran since they went to high school together. She stated that they dated in high school and that the Veteran joined the Navy after high school and she didn’t talk to him again until he left the Navy in 1993, when they dated again and got married. The Veteran’s ex-wife indicated that during the time they were married, after the Veteran left the Navy, she heard him complain of ailments and that she witnessed the ailments personally. She referred to ailments including the Veteran being tired all the time and not sleeping. The Veteran’s ex-wife stated that he would wake up in a cold sweat, and that he would awake in a jerking motion. The Board observes that the Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 do not specifically show treatment for psychiatric problems. Additionally, his service treatment records for his period of active duty from June 1990 to June 1993 do not specifically show treatment for psychiatric problems. The Board notes, however, that post-service treatment records show that the Veteran was treated for variously diagnosed psychiatric disorders, including PTSD; PTSD, unspecified; PTSD related to military sexual trauma (MST); PTSD/depression/suicidal ideation; a generalized anxiety disorder; an anxiety disorder, unspecified; and anxiety related to a previous traumatic experience. The Board further observes that the Veteran has reported that he began having psychiatric problems a few months before he left the military. The Board also notes that the Veteran’s ex-wife has reported that after the Veteran came back from the service, he had ailments, including being tired all the time and not sleeping, and waking up in a cold sweat. The Board observes that the examiner, pursuant to a January 2018 VA psychiatric examination report, following a review of the claims file, indicated that the Veteran did not presently have, and that he had never been diagnosed with, a mental disorder. The examiner maintained that based on a chart review and an interview, there was no sufficient evidence for the Veteran to meet the diagnostic criteria for insomnia, or for any other sleeping disorder diagnosis. The Board notes that although the examiner found that the Veteran did not have any psychiatric disorders, the Veteran’s post-service VA treatment records clearly show that he was treated for numerous psychiatric problems. Additionally, the examiner did not address the Veteran’s reports of psychiatric problems during service and since that time. The Board observes that the Veteran is competent to report that he had psychiatric problems during his periods of service and since that time. See Davidson, 581 F.3d at 1313. Therefore, the Boards finds that the opinions provided by the examiner, pursuant to the January 2018 VA psychiatric examination report, are not probative in this matter. The Board observes that the Veteran is currently diagnosed with a psychiatric disorder, diagnosed as PTSD. The Board finds the Veteran’s reports of psychiatric problems months before he left the military, and since that time to be credible. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). Additionally, the Board notes that November 2019 VA treatment reports show that the Veteran was diagnosed by VA psychologists and psychiatrists with PTSD, unspecified, and PTSD related to MST, as a result of his service during the Persian Gulf War. In light of the Veteran’s service in the Gulf War, the Board finds that service connection for a psychiatric disorder, diagnosed as PTSD, is granted. The Board notes that the there is no probative evidence of record relating any other psychiatric diagnoses to the Veteran’s period of service. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see also Clemons, 23 Vet. App. at 1. As the Board has granted service connection for a psychiatric disorder, diagnosed PTSD, on a direct basis, it need not address any other theories of service connection. 3. Skin Disorder, to include Tinea Versicolor The Veteran contends that he has a skin disorder, to include tinea versicolor, that is related to service. He specifically maintains that he had a skin disorder that would come and go, and that he noticed it before he got out of the military. The Veteran indicates that he had a skin rash right after he got back from the Persian Gulf and that it eventually worsened. He also states that he was around chemicals during his periods of service. The Veteran essentially asserts that he suffered from skin problems, to include tinea versicolor, during his period of active duty from June 1990 to June 1993, and since that time. The Veteran further asserts that his claimed skin disorder, to include tinea versicolor, is the result of his service in Southwest Asia and should be considered under the provisions of 38 C.F.R. § 3.317. The Veteran served on active duty in the Navy from August 1983 to May 1987 and from June 1990 to June 1993, including in Southwest Asia. His DD Form 214 for his period of active duty from August 1983 to May 1987 indicates that he had eight months and fourteen days of sea service. His occupational specialty is listed as a system organizational maintenance technician for two years and eleven months. The Veteran’s DD Form 214 for his period of active duty from June 1990 to June 1993 indicates that he had one year, five months, and ten days of sea service. His occupational specialty is listed as an aviation structural mechanic. He received decorations, including the Kuwait Liberation Medal and the Southwest Asia Service Medal, with one Bronze Star. The Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 do not specifically show treatment for skin problems. His service treatment records for his period of active duty from June 1990 to June 1993 also do not specifically show treatment for skin problems. Post-service VA treatment records, including a VA examination report, show treatment for multiple skin problems, including Minocycline-induced hyperpigmentation of the right lower extremity; seborrheic dermatitis; papulopustular rosacea; a history of severely dysplastic nevi; and tinea versicolor. A March 2018 VA skin diseases examination report includes a notation that the Veteran’s claims file was reviewed. The examiner reported that the Veteran was claiming a skin rash due to Gulf War exposures. The examiner stated that the Veteran’s service treatment records were silent for skin problems. It was noted that the Veteran’s VA records reveal treatment for a rash on the buttocks and chest in 2014, with a diagnosis of tinea. The examiner related that the Veteran was given an antifungal medication, at that time, with limited success. The examiner indicated that the Veteran currently had a rash on his chest, back, buttocks, and legs. The examiner reported that the rash was raised and pruritic, and that the Veteran stated that it was worse with high heat temperatures. The diagnosis was tinea versicolor. The examiner reported that the Veteran’s service treatment records were silent for skin problems, and that his post-service treatment records were silent for many years. The examiner indicated that the etiology of the fungus of tinea versicolor was less likely as not related to the Veteran’s active duty service and/or Gulf War exposures. A March 2018 VA Gulf War general medical examination, by the same examiner who performed the March 2018 VA skin diseases examination, includes a notation that the Veteran’s claims file was reviewed. The examiner reported that the Veteran’s medical history included skin diseases. The examiner indicated that there were no illnesses for which no etiology was established. It was noted that there were no additional signs or symptoms that may represent an undiagnosed illness or a diagnosed medically unexplained chronic multisymptom illness. The examiner also reported that there were no functional impacts of additional signs or symptoms that may represent an undiagnosed illness or a diagnosed medically unexplained chronic multisymptom illness. In a statement received in May 2020, the Veteran’s ex-wife reported that she had known the Veteran since they went to high school together. She stated that they dated in high school and that the Veteran joined the Navy after high school and she didn’t talk to him again until he left the Navy in 1993, when they dated again and got married. The Veteran’s ex-wife indicated that during the time they were married, after the Veteran left the Navy, she heard him complain of ailments and saw the ailments personally. She stated that the Veteran had a rash across his chest, stomach, and face. The Board observes that the Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 do not show treatment for any skin disorders. Additionally, his service treatment records for his period of active duty from June 1990 to June 1993 do not show any treatment for skin problems. The Board notes, however, that post-service treatment records show that the Veteran was treated for multiple skin problems, including Minocycline-induced hyperpigmentation of the right lower extremity; seborrheic dermatitis; papulopustular rosacea; a history of severely dysplastic nevi; and tinea versicolor. The Board notes that the Veteran has reported that that he had a skin rash right after he got back from the Persian Gulf, that it eventually worsened, and that he has had skin problems since that time. The Veteran’s ex-wife has also stated that during the time they were married, after the Veteran left the Navy, she heard him complain of ailments and saw the ailments personally, including a rash across his chest, stomach, and face. The Board observes that the March 2018 VA skin diseases examination report relates a diagnosis of tinea versicolor. The examiner, following a review of the claims file, found that the etiology of the fungus of tinea versicolor was less likely as not related to the Veteran’s active duty service and/or Gulf War exposures. The examiner also provided negative opinions, pursuant to a March 2018 Gulf War general medical examination report. The Board notes that the examiner did not address the Veteran’s reports of skin problems after he got back from the Persian Gulf and since that time. The Veteran is competent to report skin problems during service and since service. See Davidson, 581 F.3d at 1313. The examiner also did not address the statements from the Veteran’s ex-wife concerning him having a rash after he left the Navy. Therefore, the Board finds that the opinions provided by the examiner, pursuant to the March 2018 VA skin diseases examination report, as well as the March 2018 Gulf War general medical examination report, are not probative in this matter. The Veteran is diagnosed with a skin disorder, diagnosed tinea versicolor. The Board finds the Veteran’s reports of skin problems since he got back from the Persian Gulf during service to be credible. See Jandreau, 492 F.3d at 1372 (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board also finds that the statements from the Veteran’s ex-wife to be credible. Resolving any doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise regarding whether his skin disorder, diagnosed as tinea versicolor, commenced during his periods of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a skin disorder, diagnosed as tinea versicolor. Therefore, service connection for a skin disorder, diagnosed as tinea versicolor, is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. 4. Headaches Service connection is now in effect for as PTSD and for a skin disorder, diagnosed as tinea versicolor. The Veteran contends that he has headaches that are related to service. He specifically maintains that he has headaches that began right before he got out of the military. The Veteran reports that his headaches began after he left the Persian Gulf and have continued since that time. The Veteran further asserts that his claimed headaches are the result of his service in Southwest Asia and should be considered under the provisions of 38 C.F.R. § 3.317. The Veteran served on active duty in the Navy from August 1983 to May 1987 and from June 1990 to June 1993, including in Southwest Asia. His DD Form 214 for his period of active duty from August 1983 to May 1987 indicates that he had eight months and fourteen days of sea service. His occupational specialty is listed as a system organizational maintenance technician for two years and eleven months. The Veteran’s DD Form 214 for his period of active duty from June 1990 to June 1993 indicates that he had one year, five months, and ten days of sea service. His occupational specialty is listed as an aviation structural mechanic. He received decorations, including the Kuwait Liberation Medal and the Southwest Asia Service Medal, with one Bronze Star. The Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 do not specifically show treatment for headaches. His service treatment records for his period of active duty from June 1990 to June 1993 also do not specifically show treatment for headaches. Post-service VA treatment records show treatment for a mild headache; headaches; a history of cervicogenic headaches; and for cervicogenic headaches. A March 2018 VA Gulf War general medical examination includes a notation that the Veteran’s claims file was reviewed. The examiner did not specifically refer to the Veteran’s claimed headaches. The examiner indicated that there were no illnesses for which no etiology was established. It was noted that there were no additional signs or symptoms that may represent an undiagnosed illness or a diagnosed medically unexplained chronic multisymptom illness. The examiner also reported that there were no functional impacts of additional signs or symptoms that may represent an undiagnosed illness or a diagnosed medically unexplained chronic multisymptom illness. In a statement received in May 2020, the Veteran’s ex-wife reported that she had known the Veteran since they went to high school together. She stated that they dated in high school and that the Veteran joined the Navy after high school and she didn’t talk to him again until he left the Navy in 1993, when they dated again and got married. The Veteran’s ex-wife indicated that during the time they were married, after the Veteran left the Navy, she heard him complain of ailments and saw the ailments personally. She stated that the Veteran had frequent headaches. The Board observes that the Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 do not show treatment for headaches. Additionally, his service treatment records for his period of active duty from June 1990 to June 1993 do not show any treatment for headaches. The Board notes that post-service treatment records show treatment for headaches on numerous occasions, with diagnoses of a mild headache; headaches; a history of cervicogenic headaches; and cervicogenic headaches. The Board observes that the Veteran has reported that his headaches began after he left the Persian Gulf during service and have continued since that time. The Veteran’s ex-wife has also stated that during the time they were married, after the Veteran left the Navy, she heard him complain of ailments and saw the ailments personally, including frequent headaches. The Board observes that a March 2018 VA Gulf War general medical examination report has negative etiological opinions. The Board notes, however, that the examiner did not address the Veteran’s claims headaches. Therefore, the opinions provided by the examiner are not probative in this matter. The Board notes that the Veteran is currently diagnosed with headaches. The Board finds the Veteran’s reports of headaches during and since his period of active duty from June 1990 to June 1993 to be credible. See Jandreau, 492 F.3d at 1372 (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board also finds the statements from the Veteran’s ex-wife to be credible. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran has headaches that had their onset during his periods of service, to specifically include his period of active duty from June 1990 to June 1993. Therefore, service connection for headaches is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service. 5. Bilateral Hearing Loss and Tinnitus Impaired hearing will be considered to be a disability for VA purposes when the thresholds for any of the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz are 40 decibels or more; the thresholds for at least three of these frequencies are 26 decibels; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2016). One requirement for service connection is the current existence of the claimed disability. With regard to hearing loss, 38 C.F.R. § 3.385 defines what constitutes the current existence of a hearing loss disability. For service connection, it is not required that a hearing loss disability by the standards of 38 C.F.R. § 3.385 be demonstrated during service, although a hearing loss disability by the standards of 38 C.F.R. § 3.385 must be currently present, and service connection is possible if such current hearing loss disability can be adequately linked to service. Ledford v. Derwinski, 3 Vet. App. 87 (1992). The Veteran contends that he has bilateral hearing loss and tinnitus that are related to service. He specifically maintains that he has bilateral hearing loss and tinnitus as a result of acoustic trauma while serving as an aircraft mechanic. The Veteran reports that he was exposed to loud noise while serving on the flight deck. He also states that he slept on the third deck of a ship, which was right below the flight deck, and that he could hear landing and other noises, etc. He further indicates that he was exposed to acoustic trauma from generators, helicopters, and jet engines. The Veteran maintains that he suffered from ringing in the ears since he was in the military, and that his hearing continued to worsen while he was on active duty. The Veteran essentially asserts that his bilateral hearing loss and tinnitus were first experienced during service and have continued since that time. The Veteran served on active duty in the Navy from August 1983 to May 1987 and from June 1990 to June 1993, including in Southwest Asia. His DD Form 214 for his period of active duty from August 1983 to May 1987 indicates that he had eight months and fourteen days of sea service. His occupational specialty is listed as a system organizational maintenance technician for two years and eleven months. The Veteran’s DD Form 214 for his period of active duty from June 1990 to June 1993 indicates that he had one year, five months, and ten days of sea service. His occupational specialty is listed as an aviation structural mechanic. He received decorations, including the Kuwait Liberation Medal and the Southwest Asia Service Medal, with one Bronze Star. The Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 indicate that the Veteran underwent several audiograms, but the audiograms do not show a hearing loss disability in either ear as defined by 38 C.F.R. § 3.385. There is no specific evidence of hearing loss within the year after service as required for the presumption of service connection. The Veteran’s service treatment records for his period of active duty from June 1990 to June 1993 reflect that he underwent several audiograms, but the audiograms do specifically not show a hearing loss disability in either ear as defined by 38 C.F.R. § 3.385. Such records do indicate that the Veteran was treated for bilateral ear problems and that he reported decreased hearing in the right ear on one occasion. There is no specific evidence of hearing loss within the year after service as required for the presumption of service connection. Such records do not show treatment for tinnitus. A May 1989 treatment entry notes that the Veteran reported that his ears ached. He stated that he had been swimming and that he had decreased hearing in the right ear. The examiner indicated that the Veteran had cerumen impaction, bilaterally. The assessment was cerumen impaction. A November 1989 hospital physical examination report indicates that the Veteran was in a marked amount of pain. The examiner reported that the Veteran’s ears were reddened and retracted, that the Veteran’s “EMs” were full, and that his oral cavity had trismus and that it could only be opened about an inch. It was noted that the Veteran also had marked swelling of the trigone area, which extended into the soft palate, with marked edema of the uvula. The impression was severe pharyngitis versus a parapharyngeal space abscess. A post-service VA examination report shows that the Veteran has bilateral hearing loss under the provisions of 38 C.F.R. § 3.385, and that he also has tinnitus. Post-service private and VA treatment records show treatment for sensorineural hearing loss and tinnitus. In a statement received in May 2020, the Veteran’s ex-wife reported that she had known the Veteran since they went to high school together. She stated that they dated in high school and that the Veteran joined the Navy after high school and she didn’t talk to him again until he left the Navy in 1993, when they dated again and got married. The Veteran’s ex-wife indicated that during the time they were married, after the Veteran left the Navy, she heard him complain of ailments and saw the ailments personally. She stated that the Veteran could not hear out of his left ear and that he would hear noise in both of his ears. The Veteran’s ex-wife maintained that he could here fine when he left for the Navy. The evidence of record does show that the Veteran was exposed to in-service acoustic trauma and that he has been currently diagnosed with bilateral hearing loss, under the provisions of 38 C.F.R. § 3.385, and with tinnitus. The Board notes that there are negative opinions of record, as to the etiology of the Veteran’s bilateral hearing loss and/or tinnitus, pursuant to a January 2018 VA audiological examination report, and a positive opinion, as to right ear tinnitus, pursuant to a June 2018 statement from a VA nurse practitioner. A January 2018 VA audiological examination report includes a notation that the Veteran’s claims file was reviewed. The examiner reported results that were indicative of bilateral hearing loss as defined by 38 C.F.R. § 3.385. The diagnoses were sensorineural hearing loss, in the frequency range of 500 to 4000 Hertz, in the right ear, and sensorineural hearing loss, in the frequency range of 500 to 4000 Hertz, in the left ear. Tinnitus was also diagnosed. The examiner indicated that the Veteran’s right ear hearing loss was not at least as likely as not caused by, or a result of, an event during his military service. The examiner reported that the Veteran was on duty from August 1983 to May 1987, and from June 1990 to June 1993. The examiner stated that all of the audiograms in the file, including referenced hearing conservation audiogram dated in August 1983, and the separation audiogram in May 1993, show normal right ear hearing from 500 to 6000 Hertz. It was noted that right ear hearing loss did not exist prior to service. The examiner also found that the Veteran’s left ear hearing loss was not at least as likely as not caused by, or a result of, an event during his military service. The examiner reported that a reference hearing conservation audiogram in August 1983 shows hearing in the left ear to be within normal limits from 500 to 3000 Hertz, with a mild loss at 4000 Hertz, and from 6000 to 8000 Hertz. The examiner stated that all audiograms, including at the separation examination in May 1990, show the mild loss at 4000 Hertz in the left ear only. The examiner indicated that there were no service treatment records when comparing the reference examination in 1983 and the separation examination in 1993. The examiner maintained that, therefore, the Veteran entered active duty with mild hearing loss in the left ear at 4000 Hertz, and that it was not aggravated beyond the normal progression during his military service. The examiner specifically stated that the Veteran’s left ear hearing loss existed prior to service, and that the pre-existing left ear hearing loss was not aggravated beyond the normal progression during military service. The examiner further indicated that the Veteran’s tinnitus was less likely than not caused by, or a result of, military noise exposure. The examiner reported that there was no mention of tinnitus in the service treatment records. The examiner maintained that without evidence to support a tinnitus claim, it was more likely that the Veteran’s tinnitus began after his military service. A June 2018 statement from a VA nurse practitioner indicates that The Veteran’s service treatment records confirm his occupational specialty as an aviation structural mechanic. The nurse practitioner reported that in the Veteran’s credible lay statements, he reported a history of frequent and recurrent noise exposure in the moderate to high decibel ranges, not only from his occupational specialty, but from various other sources while undergoing general military training and other non-occupational specialty activities, during service. It was noted that, pursuant to the duty occupational specialty noise exposure listing, the Veteran’s occupational specialty shows a high probability of acoustic trauma and his acoustic trauma should be conceded per VA regulations. The nurse practitioner indicated that the Veteran had a current formal diagnosis of right ear tinnitus. It was noted that the Veteran’s diagnosis was based on subjective complaints of constant, high-pitched, ringing in the right ear, especially in a quiet place, as well as a history of acoustic trauma. The nurse practitioner reported that the Veteran’s enlistment examination reveals that he entered service with no hearing impairment. The nurse practitioner stated that there was no documentation of prior complaints of tinnitus, and that the Veteran was afforded the presumption of soundness for his hearing and his ears upon his entrance into the military, as there was no history of ear pathology, hearing loss, or tinnitus, upon his entrance into the military and his audiograms were within normal limits. The nurse practitioner stated that the Veteran reported that he was an aviation structural mechanic and that his position entailed working on air conditioning in airplanes. It was noted that the Veteran stated that he was exposed to frequent varying levels of noise trauma from generators, helicopters, jet engines, flight line noises, and airplanes. The nurse practitioner stated that the Veteran also related that he had noise exposure during basic training when he was required to use weaponry, such as pistols. The nurse practitioner indicated that the Veteran maintained that he was not always able to wear hearing protection devices, and that he currently reported a high-pitched ringing in his right ear, which was constant. The nurse practitioner referred to several medical treatises and opined that the Veteran’s auditory condition, to include right ear tinnitus, was at least as likely as not due to, and/or related to, military acoustic trauma during service. The Board observes that the examiner, pursuant to the January 2018 VA audiological examination, following a review of the claims file, found that the Veteran’s right ear hearing loss was not at least as likely as not caused by, or a result of, an event during his military service. The examiner stated that all of the audiograms in the file, including referenced hearing conservation audiogram dated in August 1983, and the separation audiogram in May 1993, show normal right ear hearing from 500 to 6000 Hertz. The examiner also found that right ear hearing loss did not exist prior to service. The examiner further indicated that the Veteran’s left ear hearing loss was not at least as likely as not caused by, or a result of, an event during his military service. The examiner reported that a reference hearing conservation audiogram in August 1983 shows hearing in the left ear to be within normal limits from 500 to 3000 Hertz, with a mild loss at 4000 Hertz, and from 6000 to 8000 Hertz. The examiner stated that all audiograms, including at the separation examination in May 1990, show the mild loss at 4000 Hertz in the left ear only. The examiner indicated that there were no service treatment records when comparing the reference examination in 1983, and the separation examination in 1993. The examiner maintained that, therefore, the Veteran entered active duty with mild hearing loss in the left ear at 4000 Hertz, and that it was not aggravated beyond the normal progression during his military service. The examiner also maintained that the Veteran’s tinnitus was less likely than not caused by, or a result of, military noise exposure. The examiner reported that there was no mention of tinnitus in the service treatment records, and that without evidence to support a tinnitus claim, it was more likely that the Veteran’s tinnitus began after his military service. The Board observes that the examiner essentially found that the Veteran’s right ear hearing was not related to service because all his in-service audiograms show normal hearing. The Board notes, however, that in regard to the Veteran’s bilateral hearing loss, the absence of documented hearing loss, as defined by VA, while in service is not fatal to a claim for service connection. See Ledford, 3 Vet. App. at 87. Additionally, when a Veteran does not meet the regulatory requirements for a disability at separation, he can still establish service connection by submitting evidence that a current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155, 159-160 (1993). The examiner also found that the Veteran’s entered active duty with mild hearing loss in the left ear at 4000 Hertz, and that it was not aggravated beyond the normal progression during his military service. The examiner specifically stated that a reference hearing conservation audiogram in August 1983 shows hearing in the left ear to be within normal limits from 500 to 3000 Hertz, with a mild loss at 4000 Hertz, and from 6000 to 8000 Hertz. The Board observes, however, that all of the Veteran’s service treatment record show fail to show a hearing loss disability in either ear as defined by 38 C.F.R. § 3.385. As such, the presumption of soundness applies. McKinney v. McDonald, 28 Vet. App. 15, 21 (2016) (holding that where the degree of hearing loss noted on a veteran’s entrance medical examination does not meet VA’s definition of a “disability” for hearing loss under 38 C.F.R. § 3.385, the veteran is entitled to the presumption of soundness); 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b), 3.385. The Board further notes that the examiner did not address the Veteran’s reports of hearing loss and tinnitus during and since service. The Veteran is competent to report hearing problems and ringing in the ears during service and since that time. See Davidson, 581 F.3d at 1313. Therefore, the Board finds that the examiner’s opinions, pursuant to the January 2018 VA audiological examination report have no probative value in this matter. The Board observes that the nurse practitioner, pursuant to the June 2018 statement, following a review of the claims file, found that the Veteran’s auditory condition, to include right ear tinnitus, was at least as likely as not due to, and/or related to, military acoustic trauma during service. The Board observes that the nurse practitioner essentially only addressed the Veteran’s right ear tinnitus. The nurse practitioner did not address the Veteran’s claims for right ear hearing loss and left ear hearing loss, or for bilateral tinnitus, to include left ear tinnitus. The Board notes that although the nurse practitioner’s opinion is more supported by the evidence of record, it is limited because it solely addressed right ear tinnitus. The Veteran is competent to report hearing problems and ringing in the ears during his periods of active duty and since that time. Davidson, 581 F.3d at 1313. Moreover, the Board finds that the Veteran’s reports of noise exposure during his period of service, and hearing problems and tinnitus since that time to be credible. See also Jandreau v. Nicholson, 492 F.3d 1372 (2007). The Board also finds the statements from the Veteran’s ex-wife that he had ailments after his period of service, including that he could not hear out of his left ear and that he would hear noise in both of his ears, to be credible. Resolving any doubt in the Veteran’s favor, the Board finds that the Veteran has bilateral hearing loss and tinnitus that had their onset during his period of service. Service connection for bilateral hearing loss and for tinnitus is warranted. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for hypertension; chronic fatigue syndrome; joint pain; and for bilateral eye disorders. As discussed above, the Board has granted service connection for a psychiatric disorder, diagnosed as PTSD; a skin disorder, diagnosed as tinea versicolor; headaches; bilateral hearing loss; and for tinnitus. Given this change in circumstances, and to accord the Veteran due process, the RO should readjudicate the issues of entitlement to service connection for hypertension; chronic fatigue syndrome, joint pain; and for bilateral eye disorders. The Veteran contends that he has hypertension; chronic fatigue syndrome; joint pain; and bilateral hearing loss, that are all related to service. The Veteran further maintains that his claimed disorders are the result of his service in Southwest Asia and should be considered under the provisions of 38 C.F.R. § 3.317. The Veteran served on active duty in the Navy from August 1983 to May 1987 and from June 1990 to June 1993, including in Southwest Asia. His DD Form 214 for his period of active duty from August 1983 to May 1987 indicates that he had eight months and fourteen days of sea service. His occupational specialty is listed as a system organizational maintenance technician for two years and eleven months. The Veteran’s DD Form 214 for his period of active duty from June 1990 to June 1993 indicates that he had one year, five months, and ten days of sea service. His occupational specialty is listed as an aviation structural mechanic. He received decorations, including the Kuwait Liberation Medal and the Southwest Asia Service Medal, with one Bronze Star. The Veteran’s service treatment records for his period of active duty from August 1983 to May 1987 do not show treatment for hypertension; chronic fatigue syndrome; joint pain; or for right and left eye disorders. His service treatment records for his period of active duty from June 1990 to June 1993 also do not specifically show treatment hypertension; chronic fatigue syndrome; joint pain; and for right and left eye disorders. The Veteran’s post-service treatments records show treatment for hypertension and for numerous eye disorders. Such records do not specifically show treatment for chronic fatigue syndrome or for a disability manifested by joint pain. The Veteran was afforded a VA hypertension examination in March 2018 and a VA chronic fatigue examination in March 2018. The Board finds that the opinions provided, pursuant to those examination reports, respectively, are inadequate. For example, none of the respective opinions addressed whether any diagnosed conditions were caused or aggravated by the Veteran’s now service-connected disabilities. Additionally, the respective opinions did not properly address the provisions of 38 C.F.R. § 3.317. The Board notes that the Veteran has not been afforded VA examinations, as to his claims for service connection for joint pain and for bilateral eye disorders. In light of the above, the Board finds that the Veteran should be afforded a VA examination with the opportunity to obtain responsive etiological opinions, following a thorough review of the record, as to his claims for service connection for hypertension; chronic fatigue syndrome; joint pain; and for bilateral eye disorders. Such an examination must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for hypertension; chronic fatigue syndrome; joint pain; and bilateral eye disorders, since November 2019. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptoms of his claimed hypertension; chronic fatigue syndrome; joint pain; and bilateral eye disorders. He should be afforded an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the nature, onset and etiology of his claimed hypertension; chronic fatigue syndrome; joint pain; and bilateral eye disorders. The claims file must be reviewed by the examiner. Based on the results of the examination, the examiner is asked to address each of the following questions: (a) Please state whether the symptoms of each claimed condition are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (b) Is the Veteran’s disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis? (c) If, after examining the Veteran and reviewing the claims file, it is determined that the Veteran’s disability pattern is either (1) a diagnosable chronic multisymptom illness with a partially explained etiology, or (2) a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to a presumed environmental exposures experienced by the Veteran during service in Southwest Asia. (d) Is it at least as likely as not that any diagnosed disorder had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (e) If not directly related to service on the basis of questions (b)-(d), is any medical condition proximately due to, the result of, or caused by any service-connected disability(ies)? (f) If not caused by another medical condition, has any disorder been aggravated by any service-connected disability(ies)? If yes, was that increase in severity due to the natural progress of the disease. In responding to the above inquiries, please acknowledge and discuss any reports by the Veteran of treatment for his claimed disabilities during and since service. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. D. Regan, 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.