Citation Nr: 21030531 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 20-06 889 DATE: May 19, 2021 ORDER 1. Entitlement to service connection for a left knee disorder is denied. 2. Entitlement to service connection for a right knee disorder is denied 3. Entitlement to service connection for a lumbar spine disorder is denied 4. Entitlement to service connection for a left lower extremity nerve condition is denied. 5. Entitlement to service connection for a right lower extremity nerve condition is denied. 6. Entitlement to service connection for a left upper extremity nerve condition is denied. 7. Entitlement to service connection for a right upper extremity nerve condition is denied. 8. Entitlement to service connection for hypertension is denied. 9. Entitlement to service connection for a skin disorder is denied. 10. Entitlement to service connection for bilateral hearing loss is denied. 11. Entitlement to service connection for tinnitus is denied. FINDINGS OF FACT 1. The Veteran is not shown to have a diagnosis of a left knee disorder. 2. The preponderance of the evidence is against a finding that a right knee disorder, a lumbar spine disorder, a nerve condition of all four extremities to include bilateral lower extremity lumbar radiculopathy, bilateral upper extremity cervical radiculopathy, polyneuropathy, and right carpal tunnel syndrome, hypertension, or a skin disorder are etiologically related to the Veteran's active service. 3. The Veteran is not shown to have a right ear hearing loss disability; and the preponderance of the evidence is against a finding that the Veteran's left ear hearing loss disability is etiologically related to his active service. 4. The preponderance of the evidence is against a finding that any tinnitus is etiologically related to the Veteran's active service. CONCLUSIONS OF LAW 1. Service connection for a left knee disorder is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309. 2. Service connection for a right knee disorder is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309. 3. Service connection for a lumbar spine disorder is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309. 4. Service connection for a left lower extremity nerve condition is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309, 3.310. 5. Service connection for a right lower extremity nerve condition is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309, 3.310. 6. Service connection for a left upper extremity nerve condition is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309, 3.310. 7. Service connection for a right upper extremity nerve condition is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309, 3.310. 8. Service connection for hypertension is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309. 9. Service connection for a skin disorder is not warranted. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.304, 3.309. 10. Service connection for bilateral hearing loss is not warranted. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.385. 11. Service connection for tinnitus is not warranted. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who had active service from January 1966 to October 1967, to include service in the Republic of Vietnam. This appeal is from an October 2018 rating decision that denied the service connection claims listed on the title page of this decision. In his February 2020 VA Form 9, the Veteran requested a videoconference hearing before a Veterans Law Judge. In December 2020, the Veteran's attorney withdrew the hearing request pursuant to 38 C.F.R. § 20.704(e). This case has been advanced on the Board's docket. The Board recognizes that, in January 2020 and December 2020, the Veteran's attorney filed a request for a 90 day extension. However, the Veteran's attorney subsequently submitted written argument dated in January 2021, in which she requested that the Board consider and decide the issues on appeal based on the evidence of record. The Board finds that the 90-day extension request was withdrawn by the Veteran's attorney and will therefore proceed with adjudication of the claims on appeal, as instructed. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of: (1) a current claimed disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain listed chronic diseases (including arthritis and other organic diseases of the nervous system) may be presumed to be service connected if manifested to a compensable degree within a specified period of time following service (one year for arthritis and other organic diseases of the nervous system). 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Under 38 C.F.R. § 3.303(b) where a condition in service is noted, but is not, in fact, shown chronic, or where a diagnosis of chronicity may be legitimately questioned, service connection may be established by showing continuity of symptomatology. The continuity of symptomatology provisions of 38 C.F.R. § 3.303(b) apply only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. To substantiate a claim of secondary service connection, the record must show (1) a current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) that the already service-connected disability caused or aggravated the disability for which service connection is sought. Wallin v. West, 11 Vet. App. 509 (1998). The Veteran's service record shows he had service in the Republic of Vietnam. As such, he was presumed to have been exposed to herbicide agents. Bilateral Knee Disorders and Lumbar Spine Disorder The Veteran asserted that his bilateral knee disorders and lumbar spine disorder are due to his active service. The Veteran's service treatment records (STRs) do not show any complaints, treatment, or diagnosis of knee disorders or a lumbar spine disorder (or injury) during his active duty service. At his January 1966 entrance physical, the Veteran had a normal examination of his lower extremities and spine. At his October 1967 separation physical, he had a normal examination of his lower extremities and spine. At his separation physical, he specifically denied having recurrent back pain, a "trick" or locked knee, or arthritis or rheumatism. The Veteran's post-service medical records show he experienced burns to his back in June 2003. He requested a right knee brace in March 2011. He first complained of back pain in 2012 and was diagnosed with lumbar spine arthritis by x-ray in September 2012. He was first diagnosed with right knee arthritis by a September 2019 x-ray. Regarding the Veteran's right knee disorder and lumbar spine disorder, he has not submitted any medical evidence supporting that he has diagnosed right knee and lumbar spine disabilities, which are, or may be, etiologically related to his active duty service. His STRs do not note any chronic knee or back complaints, treatment, or diagnosis, and he specifically denied having recurrent back pain, a "trick" or locked knee, or arthritis or rheumatism on separation physical evaluation. The Veteran's claimed disabilities of the right knee and lumbar spine were not manifested during his active service. Therefore, service connection for these conditions on the basis that it became manifest during a period of active service, on a presumptive basis (as a chronic disease under 38 U.S.C. §§ 1112, 1137), or based on continuity under 38 C.F.R. § 3.303(b), is not warranted. The Veteran has not presented any competent medical evidence supporting his assertion that these conditions were due to his active service. His unsupported assertions that he has disabilities of the right knee and lumbar spine that were incurred in service have no probative value. He is a layperson, and does not cite to supporting clinical data or medical principles or treatise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Regarding the Veteran's service connection claim for a left knee disorder, the threshold requirement for substantiating a claim of service connection is that there must be competent evidence of the disability for which service connection is sought. In the absence of proof of a current disability, there is valid claim for service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Veteran's reported symptoms alone do not establish the presence of a current disability in the absence of any indication or contentions that these reported symptoms result in functional impairment of earning capacity. See Wait v. Wilkie, 33 Vet. App. 8, 17 (2020); Saunders v. Wilkie, 866 F.3d 1356 (2018). Rather, the above evidence and analysis reflects that the most probative evidence shows that the Veteran does not currently have left knee disorder. As such, that threshold requirement is not met. The Veteran, through his representative, asserted that he should have been afforded a VA examination for as to his claimed bilateral knee and lumbar spine disabilities. The record does not include (he has not submitted or identified for VA to obtain) any competent medical evidence that any knee or lumbar spine disorder might be related to his active service. The Veteran's STRs do not document any knee or back injuries, complaints, treatment, or diagnosis during the Veteran's active service. In addition, he specifically denied having knee and back symptoms at his separation physical. The Veteran's own assertions that his knee and lumbar spine disorders were due to his active service have little probative value. He is a layperson, and the questions presented are medical in nature. See Jandreau, 492 F.3d 1372. Consequently, development for an examination to determine if he has a left knee disorder, right knee disorder, or lumbar spine disorder that could be related to his service is not necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). In addition, the Veteran's representative also asserted that the Veteran was found to be involved in combat, and as such, 38 C.F.R. § 3.304(d) applies. The Board recognizes that the Veteran was granted service-connection for posttraumatic stress disorder (PTSD) based on a finding that he served in a danger area in Vietnam and that his reported stressors were consistent with his military service. However, his service personnel records do not document that he was involved in any combat. Furthermore, for a veteran who engaged in combat with the enemy, the Secretary of VA shall accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service. See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). The provisions of 38 U.S.C. § 1154 do not obviate the requirement that a veteran must submit medical evidence of a causal relationship between his current condition and service. Here, the Veteran's personnel records do not document that he was involved in combat. Furthermore, he has not specified how any involvement in combat (which has not been shown) resulted in any knee and lumbar spine disorders. Finally, the Veteran has not submitted any nexus opinion evidence regarding any knee or lumbar spine disorder. Accordingly, the provisions of 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(d) are not applicable. Accordingly, the preponderance of the evidence is against the Veteran's service connection claims for a left knee disorder, a right knee disorder, and a lumbar spine disorder. Therefore, the appeal in these matters must be denied. A Nerve Condition of all Four Extremities The Veteran asserted that he has a nerve condition of all four extremities due to his active service. The Veteran's STRs do not show findings or a diagnosis of any nerve condition during his active service. At his January 1966 entrance physical, he had a normal examination of his upper and lower extremities. Likewise, at his October 1967 separation physical, he had a normal examination of his upper and lower extremities. At his separation examination, he specifically denied having any neuritis or paralysis. The Veteran's post-service medical records show that in March 2003, he experienced burns to his face, chest, back, and right upper extremity after burning yard waste with gasoline. He was diagnosed with neuropathy in July 2003. A February 2004 EMG/NCS diagnosed the Veteran with polyneuropathy. In November 2012, he was diagnosed with bilateral lower extremity lumbar spine radiculopathy. On July 2018 VA examination, the Veteran reported that his neuropathy was due to herbicide agent exposure. After reviewing the claims file and interviewing and examining the Veteran, the examiner diagnosed the Veteran with polyneuropathy, bilateral lower extremity lumbar radiculopathy, bilateral upper extremity cervical radiculopathy, and right carpal tunnel syndrome. The examiner opined that the Veteran's bilateral lower extremity nerve condition was less likely than not due to his active service. The examiner reported that bilateral lower extremity lumbar radiculopathy was not a presumptive condition due to herbicide agent exposure. The examiner reported that the Veteran's occupation as a mechanic, wear and tear over time, and the aging process all contributed to his lower extremity nerve condition. The examiner opined that the Veteran's bilateral upper extremity nerve condition was less likely than not due to his active service. The examiner reported that bilateral upper extremity cervical radiculopathy, polyneuropathy, carpal tunnel syndrome, and residuals of burns were not presumptive conditions due to herbicide agent exposure. The examiner reported that the Veteran's occupation as a mechanic, wear and tear over time, and the aging process all contributed to his upper extremity nerve condition. It is not in dispute that the Veteran has a current diagnosis of a nerve condition of all four extremities. However, a nerve condition of all four extremities was not then found or diagnosed during his active service, and on service separation examination his upper and lower extremities were found to be normal. In addition, the Veteran denied having any neuritis or paralysis at separation from active service. Thus, service connection for a nerve condition of all four extremities on the basis that such was first shown in service and has been in existence since is not warranted. As the Veteran is not service connected for a lumbar spine disorder or a cervical spine disorder, service connection for bilateral lower extremity lumbar spine radiculopathy or service connection for bilateral upper extremity cervical spine radiculopathy on a secondary basis is not warranted. Whether, considering the factual data, the Veteran's nerve condition of all four extremities may be etiologically related to his service is, for the most part, a medical question, that requires medical expertise. See Jandreau, 492 F.3d 1372. The Veteran has not submitted any competent (medical opinion or treatise) evidence supporting that his nerve condition of all four extremities is etiologically related to his active service. Because he is a layperson, his own opinion in the matter has no probative value. The Board finds that the most probative evidence in the record regarding the etiology of the Veteran's nerve condition of all four extremities is in the opinions of the July 2018 VA examiner. The opinions reflect familiarity with the Veteran's claims file (what is shown therein), and in particular his complete medical history. The provider concluded that the Veteran's nerve condition of all four extremities was less likely than not related to the Veteran's active duty service. The rationale provided cited to supporting clinical data, including that the Veteran's occupation as a mechanic, wear and tear over time, and the aging process contributed to the Veteran's nerve condition of all four extremities. The Board finds the opinion to be persuasive. The Board also notes that the Veteran was not entitled to presumptive service connection for a nerve condition of all four extremities. Presumptive service connection due to herbicide agent exposure would be granted if the Veteran was diagnosed with early-onset peripheral neuropathy. The record contains no objective medical diagnosis of early-onset peripheral neuropathy. The Veteran has been diagnosed with bilateral lower extremity lumbar radiculopathy, bilateral upper extremity cervical radiculopathy, polyneuropathy, carpal tunnel syndrome, and residuals of burns. Therefore, the presumption of service connection for exposure to herbicide agents has not been triggered. Accordingly, the preponderance of the evidence is against the Veteran's service connection claims for a left lower extremity nerve condition, a right lower extremity nerve condition, a left upper extremity nerve condition, and a right upper extremity nerve condition. Therefore, the appeal in these matters must be denied. Hypertension The Veteran asserted that his hypertension is due to his active service. For VA compensation purposes, the term "hypertension" means that the diastolic blood pressure is predominantly 90 mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. Multiple blood pressure readings are required to confirm the diagnosis of hypertension with two or more readings on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. The Veteran's STRs do not show any complaints, treatment, or diagnosis pertaining to hypertension. At his January 1966 entrance physical, his blood pressure was 120/80. At his October 1967 separation examination, his blood pressure was 124/70 and he had a normal examination of his heart. He also specifically denied having any high blood pressure. The Veteran's post-service medical records show he was diagnosed with hypertension in March 2002, over three decades after his separation from service. On July 2018 VA examination, the Veteran reported that he had been on blood pressure medications for a long time. After review of the claims file and interview and examination of the Veteran, the examiner reported that the Veteran was diagnosed with hypertension in 1985. The examiner opined that the Veteran's hypertension was less likely than not due to his active service. The examiner reported that hypertension was not a presumptive condition due to herbicide agent exposure. The examiner reported that the Veteran's ethnic background, cigarette use, and poor diet were more likely the cause of his hypertension. The Veteran's hypertension was not manifested during his active service. Therefore, service connection for hypertension on the basis that it became manifest during a period of active service, on a presumptive basis (as a chronic disease under 38 U.S.C. §§ 1112, 1137), or based on continuity under 38 C.F.R. § 3.303(b), is not warranted. The Veteran has not presented any competent medical evidence supporting his assertion that his hypertension was due to his active service. The Board finds the July 2018 VA examiner's opinion to be probative evidence in the matter. The examiner included rationale that cited to clinical evidence in the record, including that hypertension was not diagnosed during the Veteran's active service and not diagnosed until 1985 (at the earliest), which is almost two decades after his separation from active service. The VA examiner opined that the Veteran's hypertension was more likely due to his ethnic background, cigarette use, and poor diet. The rationale of the opinion is consistent with what is shown by the evidentiary record. The Veteran's own opinion that his hypertension was due to his active service, to include any herbicide agent exposure, is not probative evidence in the matter. As discussed above, the Veteran has not submitted any competent medical evidence supporting his assertion. Furthermore, the July 2018 VA examiner specifically reported that the Veteran's hypertension was not due to his active service, to include herbicide agent exposure and was more likely due to the Veteran's ethnic background, cigarette use, and poor diet. The Board also observes that hypertension is not that disease that is capable of diagnosis by lay observation, it is diagnosed based on examination by a medical provider. The etiology of hypertension is a medical question beyond the realm of common knowledge. See Jandreau, 492 F.3d 1372, 1377. The Veteran is a layperson, and has not presented any competent (medical) evidence supporting his asserted theory of entitlement. The Board also notes that the Veteran is not entitled to presumptive service connection for his hypertension. Hypertension is not a disease subject to presumptive service connection. 38 C.F.R. § 3.309. Therefore, the presumption of service connection for exposure to herbicide agents has not been triggered. Accordingly, the preponderance of the evidence is against the Veteran's service connection claim for hypertension. Therefore, the appeal in the matter must be denied. Skin Disorder The Veteran asserted that he has a skin disorder due to his active service. The Veteran's STRs show that at his January 1966 entrance physical and his October 1967 separation physical, he had normal examinations of his skin. In addition, at his separation physical, he specifically denied having any skin diseases. The Veteran's post-service medical records show that in in November 2001, he had a normal examination of his skin. In March 2003, he experienced burns to his face, chest, back, and right upper extremity after burning yard waste with gasoline. In April 2010, he denied having any rashes or lesions. In October 2010, on examination he had no skin rashes or lesions other than burn scars. In June 2011, he reported having blisters on his legs in the summer over the previous 10 years. In July 2011, November 2011, and February 2013, his skin was normal. The first medical evidence of a diagnosis of a skin disorder is not until October 2015. The Veteran reported having skin lesions for the past two years. He was diagnosed with prurigo nodularis. In August 2017, there was evidence of healed burn scars and a small area of hypopigmentation near his left wrist. In May 2019, and December 2019, he had no rashes. On July 2018 VA examination, the Veteran reported that he had dry skin on his legs due to herbicide agent exposure during his active service. After review of the claims file and interview and examination of the Veteran, the examiner diagnosed the Veteran with atopic dermatitis and prurigo nodularis. The examiner opined that the Veteran's skin disorder was less likely than not due to his active service. The examiner reported that atopic dermatitis and prurigo nodularis were not presumptive conditions due to herbicide agent exposure. The examiner reported that the Veteran's ethnic background, skin/environmental allergies, and aging were more likely the cause of the Veteran's skin disorder. The examiner reported that medical literature did not contain sufficient evidence showing that the Veteran's skin disorder was the result of herbicide agent exposure. It is not in dispute that the Veteran has a current diagnosis of a skin disorder. However, a skin disorder was not found or diagnosed during the Veteran's military service, and on service separation examination as his skin was found to be normal. In addition, the Veteran denied having any skin diseases at separation from active service. Thus, service connection for a skin disorder on the basis that such was first shown in service and has been in existence since is not warranted. Whether, considering the factual data, the Veteran's current skin disorder may be etiologically related to his service is a medical question, that requires medical expertise. See Jandreau, 492 F.3d 1372. The Veteran has not submitted any competent (medical opinion or treatise) evidence supporting that his skin disorder is etiologically related to his active service. Because he is a layperson, his own opinion in the matter has no probative value. The Board finds that the most probative evidence in the record regarding the etiology of the Veteran's skin disorder, is in the opinion of the July 2018 VA examiner. The opinion reflects familiarity with the Veteran's claims file (what is shown therein), and in particular his complete medical history (as it relates to a skin disorder). The examiner concluded that the Veteran's skin disorder was less likely than not related to his active duty service, to include his herbicide agent exposure. The rationale provided cited supporting clinical data, including that the Veteran's skin disorder had a more likely etiology of being due to his ethnic background, skin/environmental allergies, and aging. The Board finds the opinion to be persuasive. The Board also notes that the Veteran is not entitled to presumptive service connection for his skin disorder. Presumptive service connection due to herbicide agent exposure would be granted if the Veteran was diagnosed with chloracne or other acneform disease consistent with chloracne or soft-tissue sarcoma. The record contains no objective medical diagnoses of these conditions. The Veteran has not been diagnosed with chloracne or soft-tissue sarcoma. Therefore, the presumption of service connection for exposure to herbicide agents has not been triggered. Accordingly, the preponderance of the evidence is against the Veteran's service connection claim for a skin disorder. Therefore, the appeal in the matter must be denied. Bilateral Hearing Loss The Veteran asserted that he has bilateral hearing loss due to his active service. There is no evidence in the record showing that the Veteran had hearing loss during his active duty service. At his January 1966 entrance physical, audiometry testing showed the following: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 0 LEFT 0 0 0 0 At the Veteran's October 1967 separation physical, audiometry testing showed the following: HERTZ 500 1000 2000 3000 4000 RIGHT 0 0 0 5 LEFT 0 0 0 10 In addition, at his October 1967 separation physical, he specifically denied having any hearing loss or ear trouble. The Veteran's post-service medical records do not contain any audiometry test results showing he had hearing loss in either ear. In fact, at examinations in April 2010 and October 2010, he denied having any changes in hearing. In January 2017 and October 2019, his hearing was noted to be intact. Audiometry on July 2018 VA examination showed the following: HERTZ 500 1000 2000 3000 4000 RIGHT 5 15 15 30 35 LEFT 5 5 15 45 50 The Veteran's speech discrimination (by Maryland CNC list) was 94 percent in the right ear and 96 percent in the left ear. Accordingly, the Veteran did not have right ear hearing loss. Regarding the Veteran's left ear hearing loss, the examiner indicated that the Veteran did not have a permanent positive threshold shift greater than normal measurement variability at any frequency between 500 and 6000 hertz in the left ear during his active service. The examiner opined that the Veteran's left ear hearing loss was less likely than not due to any noise exposure during his active service. The examiner reported that the Veteran was a cook during his active service, which had a low probability of noise exposure. The examiner reported that the Veteran's hearing levels at his separation from active service were well within normal limits. The examiner reported that the Veteran was a truck driver for 15 years and that noise induced hearing loss for a truck driver was well documented in medical studies and research. Regarding the Veteran's right ear, the evidence of record for consideration does not include any other official audiometry that show or suggest the Veteran has right ear hearing loss disability. The threshold matter that must be address in this matter is whether the Veteran has a hearing loss disability in his right ear. If he does not, he has not presented a valid claim for service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). Under 38 C.F.R. § 4.85, hearing loss disability must be established by specified audiometric studies. Hearing loss disability (for VA compensation purposes) is defined in 38 C.F.R. § 3.385. Under § 3.385, a hearing loss disability is shown when audiometry in the frequencies of 500, 1000, 2000, 3000 and 4000 hertz finds a puretone threshold of 40 decibels or higher at any of those frequencies; when the puretone thresholds at 3 of the specified frequencies are higher than 25 decibels; or when speech discrimination is less than 94 percent. Here, the only audiometry suitable for rating purposes during the pendency of the instant claim was on July 2018 VA examination. While it found speech discrimination of 94 percent in the right ear, it was not less than 94 percent. Puretone threshold testing found elevated above 25 decibels at 2 (but critically, not 3) of the 5 frequencies in the right ear. The Veteran has not submitted any audiometry showing he has a hearing loss disability in the right ear. While he is competent to observe he perceives diminished hearing acuity, under governing regulation, he is not competent to establish he has a hearing loss disability by his own observation. As a hearing loss disability in the Veteran's right ear is not shown, he has not met the threshold legal requirement for substantiating a claim of service connection for such disability. Regarding the Veteran's left ear, it is not in dispute that he now has a left ear hearing loss disability (as defined in 38 C.F.R. § 3.385), as such disability was found on VA examination. What remains for consideration is whether or not the current left ear hearing loss is etiologically related to his service, which is a medical question. The evidence shows that the Veteran did not have a left ear hearing loss disability in service, and that left ear hearing loss was not manifested to a compensable degree within a year following his discharge from service. Accordingly, service connection for the current left ear hearing loss on the basis that such manifested in service and persisted is not warranted. Furthermore, as left ear hearing loss was not shown to have been manifested in service or in the first post-service year, the chronic disease presumptive provisions of 38 U.S.C. §§ 1112, 1137 and 38 C.F.R. §§ 3.307, 3.309 do not apply. The Board has also considered whether service connection for left ear hearing loss based on continuity of symptomatology is warranted, but continuity of symptomatology was not demonstrated by the evidence in the record. The first evidence of left ear hearing loss in the record is not until the audiometry testing at the July 2018 VA examination. Previously, the Veteran denied having any changes in hearing and his hearing was noted to be intact. Therefore, the Board finds that service connection for left ear hearing loss based on continuity of symptomatology is not warranted. The preponderance of the evidence is also against a finding that the Veteran's current left ear hearing loss may otherwise be etiologically related to his service. Regarding the dispositive factor of a nexus between the current left ear hearing loss and service/exposure to noise therein, the Board finds the July 2018 VA examination report most probative. The report reflects close review of the Veteran's claims file and includes rationale that cites to accurate factual data and medical literature. The Board has considered the assertions of the Veteran's representative. The representative asserted that since the Veteran was granted PTSD due to his combat experiences in Vietnam, but the VA examiner's opinion was based on the Veteran's occupation as a cook in service, the opinion should be revisited. The Veteran was granted service connection for PTSD based on a finding that he served in a danger area in Vietnam and that the Veteran's reported stressors were consistent with his military service. The Veteran's personnel records do not document that the Veteran was involved in any combat. Furthermore, while the Veteran may have been exposed to military noise such as weapons fire, any military noise exposure is not at issue. For service connection to be warranted it must be shown that such military noise exposure actually caused a hearing loss disability for VA purposes. The VA examiner opined that the Veteran's left ear hearing loss was less likely than not due to his active service, to include any military noise exposure. This opinion is consistent with the Veteran's STRs, which did not show hearing loss for VA purposes and that the Veteran specifically denied having any hearing loss or ear trouble at his separation physical. Furthermore, the VA examiner reported that the Veteran was a truck driver for 15 years after his separation from active service, and that hearing loss in truck drivers had been well documented in medical studies and research. The Veteran has not submitted any competent medical evidence showing that his left ear hearing loss was due to his active service. While he is competent to observe he perceives diminished hearing acuity, under governing regulation, he is not competent to establish the etiology of his left ear hearing loss as this is a medical question that is beyond the scope of common knowledge, and requires medical expertise. Here, the only medical evidence in the record that directly addresses that question is the opinion of the July 2018 VA examiner (against the claim). The opinion reflects familiarity with the accurate factual record and the opinion is based on information elicited directly from the Veteran and cites to supporting clinical data and medical principles. Explaining that the Veteran's reported left ear hearing loss was less likely than not due to his active service, to include any military noise exposure. The preponderance of the evidence is against a finding that the Veteran's current left ear hearing loss is etiologically related to his service, to include any military noise exposure. Accordingly, the preponderance of the evidence is against the Veteran's service connection claim for bilateral hearing loss. Therefore, the appeal in the matter must be denied. Tinnitus The Veteran asserted that he has tinnitus due to his active duty service. There is no evidence in the record showing that the Veteran had tinnitus during his active duty service. At his January 1966 entrance physical and his October 1967 separation physical, he had a normal examination of his ears, and he specifically denied having any ear trouble. The Veteran's post-service medical records do not show any complaints, treatment, or diagnosis of tinnitus. On July 2018 VA examination, the Veteran reported that his tinnitus began around 2016. After review of the claims file and interview and examination of the Veteran, the examiner diagnosed the Veteran with tinnitus. The examiner opined that the Veteran's tinnitus was less likely than not due to his active service. The examiner reported that the Veteran's onset of tinnitus was close to 50 years after his separation from active service. The examiner reported that the Veteran was a cook in service, which indicated he had a low probability of noise exposure. There is no evidence in the record showing that the Veteran had tinnitus during his active duty service. His STRs do not show any complaints, treatment, or diagnosis of tinnitus during his active service. In addition, at his October 1967 separation physical, he had a normal examination of his ears and specifically denied having any ear trouble. The claims file also does not show a noise trauma injury in service. While tinnitus (as an organic disease of the nervous system) may be presumed to be service connected if manifested as such in service, manifested within the first post-service year, or by showing continuity, here the evidence does not show tinnitus was manifested in service or in the first post-service year, or that there has been continuity of tinnitus since service. 38 U.S.C. §§ 1112, 1137; 38 C.F.R. § 3.309(a). The Veteran's own account on July 2018 VA examination that he first noticed tinnitus about 2016 (almost 50 years after his active duty service). His self-reported history of the tinnitus (no other is available) is strong probative evidence against a chronic disease presumptive theory of entitlement. There is no evidence in the record to the contrary, and the Board finds that service connection for tinnitus on a chronic disease presumptive basis is not warranted. What remains for consideration is whether there is competent evidence in the record that the Veteran's tinnitus is somehow otherwise shown to be etiologically related to his service. The etiology of tinnitus where onset in service, manifestation in the first post-service year, and continuity are not shown (whether it may be due to disease or injury in remote service) is a medical question that is beyond the scope of common knowledge, and requires medical expertise. Here, the only medical evidence in the record that directly addresses that question is the opinion of the July 2018 VA examiner (against the claim). The opinion reflects familiarity with the accurate factual record and the opinion is based on information elicited directly from the Veteran and cites to supporting clinical data and medical principles. Explaining that the Veteran's reported onset of tinnitus was almost 50 years after his separation from active service, the examiner clarified why the Veteran's tinnitus was less likely than not due to his active service. Considering the foregoing, the Board finds that the preponderance of the evidence is against the Veteran's service connection claim for tinnitus. Therefore, the appeal in this matter must be denied. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berryman, 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.