Citation Nr: 21041784 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 17-22 689 DATE: July 10, 2021 ORDER Entitlement to service connection for tinnitus is granted. Entitlement to service connection for a right foot condition, to include pes planus, hammer toes, and degenerative arthritis of the first metatarsal phalangeal (MTP) joint, is denied. Entitlement to service connection for a left foot condition, to include pes planus, hammer toes, hallux valgus, and degenerative arthritis of the first MTP joint, is denied. Entitlement to service connection for loss of sense of smell is denied. Entitlement to service connection for loss of sense of taste is denied. Entitlement to service connection for right lower extremity peripheral neuropathy is denied. Entitlement to service connection for left lower extremity peripheral neuropathy is denied. Entitlement to service connection for a right knee condition is denied. Entitlement to service connection for a left knee condition is denied. REMANDED Entitlement to service connection for bilateral sensorineural hearing loss (SNHL) is remanded. Entitlement to service connection for a bilateral eye condition is remanded. FINDINGS OF FACT 1. In affording the benefit of the doubt to the Veteran, the Board finds that he has tinnitus which is at least as likely as not attributable to in-service noise exposure. 2. The competent evidence of record does not demonstrate that the Veteran has a right or left foot condition that was incurred in or is otherwise attributable to service. 3. The competent evidence of record does not demonstrate that the Veteran has a diagnosable condition manifested by loss of sense of smell that was incurred in or is otherwise attributable to service, to include as due to presumed exposure to toxic herbicide agents. 4. The competent evidence of record does not demonstrate that the Veteran has a diagnosable condition manifested by loss of sense of taste that was incurred in or is otherwise attributable to service, to include as due to presumed exposure to toxic herbicide agents. 5. The competent evidence of record does not demonstrate that the Veteran's right or left lower extremity peripheral neuropathy was incurred in or is otherwise attributable to service, to include as due to presumed exposure to toxic herbicide agents. 6. The competent evidence of record does not demonstrate that the Veteran has a right or left knee condition that was incurred in or is otherwise attributable to service. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1111, 1112, 1153, 1154, 5107; 38C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a right foot condition have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for entitlement to service connection for a left foot condition have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. § 3.303. 4. The criteria for entitlement to service connection for a condition manifested by loss of sense of smell have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for a condition manifested by loss of sense of taste have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for entitlement to service connection for right lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 7. The criteria for entitlement to service connection for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 8. The criteria for entitlement to service connection for a right knee condition have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. § 3.303. 9. The criteria for entitlement to service connection for a left knee condition have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1968 to November 1970. To provide broader consideration on appeal, the claims of entitlement to service connection for right and left foot conditions have been clarified to include claims of bilateral pes planus, bilateral hammer toes, left hallux valgus, and bilateral degenerative arthritis of the first MTP joint. SERVICE CONNECTION Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Furthermore, certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2012); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). In addition, certain diseases associated with in-service Agent Orange exposure, to include early-onset peripheral neuropathy, are presumed to be service connected if the disease is manifested to a compensable degree within a specified time period. 38 C.F.R. §§ 3.307, 3.309. If a Veteran was exposed to an herbicide agent, including Agent Orange, during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service. 1. Tinnitus The Veteran contends generally that his tinnitus manifested in service and has continued to the present day. In the alternative, he asserts that even if his tinnitus manifested after service it is nevertheless attributable to his exposure to hazardous levels of noise while in service. The Board concludes that the Veteran has a current diagnosis of tinnitus and that, granting the Veteran the benefit of doubt, the evidence is at least in equipoise as to whether it is related to in-service noise exposure. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303(a). Initially, the Board notes that the Veteran is competent to state that he has ringing in his ears. The Board does acknowledge that the Veteran denied experiencing tinnitus when queried during the April 2015 audiology examination. However, he has otherwise consistently reported experiencing tinnitus symptomatology, to include during more contemporary VA in-patient evaluation as reflected in the record. Thus, the Board finds that he currently has tinnitus. Charles v. Principi, 16 Vet. App. 370 (2002). The only question that remains is whether the Veteran had in-service noise exposure causing the tinnitus. A review of the Veteran's DD Form 214 shows that his military occupational specialty was as mechanic, and, furthermore, that he received a national defense service medal, Vietnam service medal, and a Vietnam campaign medal reflecting that he was stationed within the Republic of Vietnam during the Vietnam War Era. Moreover, the agency of original jurisdiction (AOJ) in the April 2015 rating decision noted that the Veteran reported experiencing hazardous noise exposure in service, which he reiterated during the May 2021 hearing. Taken together, the Board finds that this evidence entails a high probability that the Veteran was exposed to hazardous levels of noise in service. As stated, the Veteran was afforded a VA audiology examination in April 2015, during which he denied experiencing symptoms of tinnitus. The examiner thus declined to set forth an opinion as to the likely etiology of the condition. Although the Board acknowledges that the Veteran denied experiencing tinnitus on the April 2015 examination, this one instance of the Veteran having denied the symptomatology is not dispositive in light of the long history of the Veteran endorsing those same symptoms both prior to and following the April 2015 examination. The fact remains that the Veteran has conceded in-service noise exposure and reported experiencing tinnitus symptoms for several years during the appeal period. The Veteran's statements are competent, credible, and probative, and, resolving doubt in his favor, the Board finds that the record reasonably supports his contentions. Consequently, service connection for tinnitus is granted in full. 38 U.S.C. § 5107 (b). 2. Right and Left Foot Conditions The Veteran seeks service connection generally for right and left foot conditions. As the evidence in support of both separately claimed conditions is largely identical, the Board will evaluate both claims together. The question for the Board is whether a right and/or a left foot condition was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed with a variety of right and left foot conditions, to include bilateral pes planus, bilateral hammer toes, left hallux valgus, and bilateral degenerative arthritis, the preponderance of the evidence is against a determination that either a right or left foot condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). A review of available service treatment records does not reflect that the Veteran complained of or received any treatment for a right or left foot condition in service. No lower extremity abnormalities were noted on the November 1970 discharge examination. On this basis, the Board finds that service connection for a right or left foot condition on a direct basis is denied. 38 C.F.R. § 3.303(a). Similarly, a review of available post-service treatment records does not reflect that the Veteran has received formal treatment for a diagnosed right or left foot condition. The Veteran was afforded a VA foot examination in April 2015, during which he reported experiencing bilateral foot numbness. He did not endorse experiencing any foot pain and acknowledged that he had not sought any care for his claimed bilateral foot complaints. An in-person evaluation revealed bilateral pes planus, bilateral hammer toes, left foot hallux valgus, and bilateral degenerative joint disease of the first MTP joint. The examiner then opined that it was less likely than not that any right or left foot condition was incurred in or otherwise attributable to service. In support thereof, the examiner noted the lack of treatment for a right or left foot condition in service and for several years after the Veteran's discharge from service. Instead, the examiner found it far more likely that the diagnosed right and left foot conditions were the result of years of weight-bearing and the general aging process. As the examiner considered the Veteran's medical history and reviewed the claims file, the Board finds her conclusions to be highly probative. Sklar v. Brown, 5 Vet. App. 140 (1993). Upon consideration of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for a right and/or left foot condition. The Veteran is certainly competent to remark on his medical history. However, there is no evidence in the record which indicates that the Veteran is competent through expertise or knowledge to conclude that his currently diagnosed right and left foot conditions are attributable to his service. Jandreau v. Nicholson, 491 F.3d 1372 (Fed. Cir. 2007). In considering the likelihood that the Veteran either incurred a right or left foot condition in service that continued to the present, or that his right and/or left foot conditions are otherwise attributable to his service, the Board relies on the highly probative opinion of the April 2015 VA examiner, who found it less likely than not that the Veteran's currently diagnosed bilateral foot conditions were attributable to service. As stated, the examiner offered the alternate etiology of the natural aging process coupled with years of physical labor as the cause of the bilateral foot conditions. The Board finds this probative opinion to far outweigh the Veteran's general assertions, unsupported as they are with no objective medical evidence. Thus, the Board finds that the preponderance of the evidence is against service connection. There is no documentation of the Veteran having experienced a right or left foot condition in service, and there is no documented diagnosis in the file prior to the April 2015 examination. Accordingly, the Board finds that service connection for a right or left foot condition based on continuity of symptomatology under 38 C.F.R. § 3.303(b) is also denied. Moreover, although service connection may be granted for a disability if it is shown that the condition is nevertheless attributable to service, the Board notes that the lack of documented treatment for a right or left foot condition for over 40 years after service is persuasive evidence tending to weigh against such a determination. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). Coupled with the highly probative opinion of the April 2015 examiner, the preponderance of the evidence is also against granting service connection for either a right or left foot condition as otherwise attributable to service pursuant to 38 C.F.R. § 3.303(d). Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claims are thus denied. 3. Loss of Sense of Smell The Veteran seeks service connection for a condition manifested by loss of his sense of smell, medically defined as anosmia, which he contends is attributable to exposure to toxic herbicide agents in service. At the outset, the Board notes that presumptive service connection for anosmia as due to toxic herbicide agent exposure is not warranted at the Veteran does not meet the requirements for such presumptive service connection. Specifically, while service in the Republic of Vietnam, and accordingly, presumed exposure to toxic herbicide agents is conceded, anosmia is not listed as a disease subject to presumptive service connection pursuant to 38 C.F.R. §§ 3.307 and 3.309. That being said, a veteran is not precluded from establishing service connection due to exposure to herbicides with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Accordingly, the question for the Board is whether a condition manifested by loss of sense of smell was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed with anosmia, the preponderance of the evidence is against a determination that a diagnosable condition manifested by loss of sense of smell began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). A review of available service treatment records does not reflect that the Veteran complained of or received any treatment for loss of sense of smell in service. No abnormalities with the Veteran's nose were noted on the November 1970 discharge examination, and he did not specifically report a history of lacking a sense of smell. On this basis, the Board finds that service connection for a condition manifested by loss of sense of smell on a direct basis is denied. 38 C.F.R. § 3.303(a). A review of available post-service treatment records reflects that the Veteran first sought treatment for loss of sense of smell through VA in August 2015. A January 2016 MRI examination revealed posttraumatic cortical encephalomalacia in both frontal lobes as well as moderate generalized cerebral cortical atrophy; as such, the Veteran's treating medical professional found that the loss of sense of smell was most likely due to a prior head injury. There are no more contemporary medical records documenting further treatment or diagnoses related to the loss of sense of smell. The Veteran was afforded a VA examination in April 2015 to evaluate his claimed loss of sense of smell and taste, during which he reported that he lost his sense of smell over 20 years prior and believed this to be attributable to his in-service herbicide exposure. The Veteran denied experiencing any nasal or sinus injury, allergic rhinitis, or cerebrovascular accident. After confirming that the Veteran did not have his sense of smell, the examiner opined that it was less likely than not that the Veteran had a diagnosable condition manifested by this loss of sense of smell that was incurred in or was otherwise attributable to service. In support thereof, the examiner noted the lack of in-service treatment for any loss of sense of smell as well as the long period of time following discharge before the Veteran sought treatment for such symptomatology. The examiner specifically noted that there was no objective evidence that the loss of sense of smell was caused by a service-related event, injury, or exposure, to include exposure to toxic herbicide agents in service. As the examiner considered the Veteran's medical history and reviewed the claims file, the Board finds her conclusions to be highly probative. Sklar, supra. During the May 2021 hearing, the Veteran contended that he had not been able to smell for many years and that this symptomatology was directly attributable to his exposure to toxic herbicide agents in service. Upon consideration of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for a condition manifested by loss of sense of smell. The Veteran is certainly competent to remark on his medical history. However, there is no evidence in the record which indicates that the Veteran is competent through expertise or training to conclude that he has a diagnosable condition manifested by loss of sense of smell that is attributable to his service. Jandreau, supra. In considering the likelihood that the Veteran's loss of sense of smell is attributable to his service, the Board relies on the highly probative opinion of the April 2015 VA examiner, who found it less likely than not that the Veteran had a diagnosable condition manifested by loss of sense of smell that was attributable to service, to include as due to the presumed exposure to toxic herbicide agents in service. The Board finds this probative opinion to far outweigh the Veteran's general assertions with regard to his loss of sense of smell, unsupported as those assertions are with no objective medical evidence. Thus, the Board finds that the preponderance of the evidence is against service connection. There is no documentation of the Veteran having experienced a loss of sense of smell in service, and there is no documented diagnosis in the file prior to the April 2015 examination. Accordingly, the Board finds that service connection for a condition manifested by loss of sense of smell based on continuity of symptomatology under 38 C.F.R. § 3.303(b) is denied. Moreover, although service connection may be granted for a disability on an indirect basis if it is shown that the condition is nevertheless attributable to service, the Board notes that the lack of documented treatment for a loss of sense of smell for over 40 years after service is persuasive evidence tending to weigh against such a determination. See Buchanan, supra. Coupled with the highly probative opinion of the April 2015 examiner, the Board concludes that the preponderance of the evidence is also against granting service connection for a condition manifested by loss of sense of smell as otherwise attributable to service pursuant to 38 C.F.R. § 3.303(d). The claim in total is thus denied. 4. Loss of Sense of Taste The Veteran seeks service connection for a condition manifested by loss of his sense of smell, medically defined as hypogeusia, which he contends is attributable to exposure to toxic herbicide agents in service. At the outset, the Board notes that presumptive service connection for hypogeusia as due to toxic herbicide agent exposure is not warranted at the Veteran does not meet the requirements for such presumptive service connection. Specifically, while service in the Republic of Vietnam, and accordingly, presumed exposure to toxic herbicide agents is conceded, hypogeusia is not listed as a disease subject to presumptive service connection pursuant to 38 C.F.R. §§ 3.307 and 3.309. That being said, a veteran is not precluded from establishing service connection due to exposure to herbicides with proof of direct causation. Combee, supra. Accordingly, the question for the Board is whether a condition manifested by loss of sense of taste was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed with hypoguesia, the preponderance of the evidence is against a determination that a diagnosable condition manifested by loss of sense of taste began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). A review of available service treatment records does not reflect that the Veteran complained of or received any treatment for loss of sense of taste in service. No abnormalities with the Veteran's mouth were noted on the November 1970 discharge examination, and he did not specifically report a history of lacking a sense of taste. On this basis, the Board finds that service connection for a condition manifested by loss of sense of taste on a direct basis is denied. 38 C.F.R. § 3.303(a). A review of available post-service treatment records reflects that the Veteran first sought treatment for loss of sense of taste through VA in August 2015. A January 2016 MRI examination revealed posttraumatic cortical encephalomalacia in both frontal lobes as well as moderate generalized cerebral cortical atrophy. As such, the Veteran's treating medical professional found that the loss of sense of smell was most likely due to a prior head injury. No specific findings regarding a loss of sense of taste were made pursuant to this MRI examination, and there are no more contemporary medical records documenting further treatment or diagnoses related to the loss of sense of taste. The Veteran was afforded a VA examination in April 2015 to evaluate his claimed loss of sense of taste, during which he reported that he would intermittently lose his sense of taste and believed this to be attributable to his in-service herbicide exposure. The Veteran denied experiencing any nasal or sinus injury, allergic rhinitis, or cerebrovascular accident. After confirming that the Veteran had only a partial sense of taste, the examiner opined that it was less likely than not that the Veteran had a diagnosable condition manifested by this loss of sense of taste that was incurred in or was otherwise attributable to service. In support thereof, the examiner noted the lack of in-service treatment for any loss of sense of taste, as well as the long period of time following discharge before the Veteran sought treatment for such symptomatology. The examiner specifically noted that there was no objective evidence that the loss of sense of taste was caused by a service-related event, injury, or exposure, to include exposure to toxic herbicide agents in service. As the examiner considered the Veteran's medical history and reviewed the claims file, the Board finds her conclusions to be highly probative. Sklar, supra. During the May 2021 hearing, the Veteran contended that he had not been able to taste for many years and that this symptomatology was directly attributable to his exposure to toxic herbicide agents in service. Upon consideration of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for a condition manifested by loss of sense of taste. The Veteran is certainly competent to remark on his medical history. However, there is no evidence in the record which indicates that the Veteran is competent through expertise or knowledge to conclude that he has a diagnosable condition manifested by loss of sense of taste that is attributable to his service. Jandreau, supra. In considering the likelihood that the Veteran's loss of sense of taste is attributable to his service, the Board relies on the highly probative opinion of the April 2015 VA examiner, who found it less likely than not that the Veteran had a diagnosable condition manifested by loss of sense of taste that was attributable to service, to include as due to the presumed exposure to toxic herbicide agents in service. The Board finds this probative opinion to far outweigh the Veteran's general assertions with regard to his loss of sense of taste, unsupported as those assertions are with no objective medical evidence. Thus, the Board finds that the preponderance of the evidence is against service connection. There is no documentation of the Veteran having experienced a loss of sense of taste in service, and there is no documented diagnosis in the file prior to the April 2015 examination. Accordingly, the Board finds that service connection for a condition manifested by loss of sense of taste based on continuity of symptomatology under 38 C.F.R. § 3.303(b) is denied. Moreover, although service connection may be granted for a disability on an indirect basis if it is shown that the condition is nevertheless attributable to service, the Board notes that the lack of documented treatment for a loss of sense of taste for over 40 years after service is persuasive evidence tending to weigh against such a determination. See Buchanan, supra. Coupled with the highly probative opinion of the April 2015 examiner, the Board concludes that the preponderance of the evidence is also against granting service connection for a condition manifested by loss of sense of taste as otherwise attributable to service pursuant to 38 C.F.R. § 3.303(d). Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim in total is thus denied. 5. Right and Left Lower Extremity Peripheral Neuropathy The Veteran seeks service connection for right and left lower extremity peripheral neuropathy, which he contends is attributable to exposure to toxic herbicide agents in service. As the evidence in support of both separately claimed conditions is largely identical, the Board will evaluate both claims together. At the outset, the Board notes that presumptive service connection for peripheral neuropathy as due to toxic herbicide agent exposure is not warranted at the Veteran does not meet the requirements for such presumptive service connection. Specifically, while presumed exposure to toxic herbicide agents is conceded and early-onset peripheral neuropathy is listed as a disease subject to presumptive service connection pursuant to 38 C.F.R. §§ 3.307 and 3.309, the condition must become manifest within one year of the presumed exposure. As will be discussed in further detail below, the Veteran's peripheral neuropathy did not manifest for many years after his discharge from service and presumed exposure to toxic herbicide agents; therefore, neither the right nor left lower extremity peripheral neuropathy conditions are subject to presumptive service connection. That being said, a veteran is not precluded from establishing service connection due to exposure to herbicides with proof of direct causation. Combee, supra. Accordingly, the question for the Board is whether right and/or left lower extremity peripheral neuropathy was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed with right and left lower extremity peripheral neuropathy, the preponderance of the evidence is against a determination that either condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). A review of available service treatment records does not reflect that the Veteran complained of or received any treatment for symptomatology that may be attributed to right or left lower extremity peripheral neuropathy in service. No lower extremity abnormalities were noted on the November 1970 discharge examination. On this basis, the Board finds that service connection for right or left lower extremity peripheral neuropathy on a direct basis is denied. 38 C.F.R. § 3.303(a). A review of available post-service treatment records reflects that the Veteran denied experiencing any neurological symptomatology when he first established care through VA in June 2014. A January 2016 neurology consultation note shows that the Veteran reported a long history of experiencing right toe numbness. This was not attributed to any neuropathy, however. The Veteran was diagnosed with probable posttraumatic cortical encephalomalacia in both frontal lobes as well as moderate generalized cerebral cortical atrophy. A March 2017 outpatient record shows that the Veteran reported experiencing bilateral lower extremity weakness and again endorsed a long history of right big toe numbness. The treating medical professional also noted a history of chronic peripheral neuropathy, "reportedly from agent orange." The most contemporary available record reflecting treatment for neuropathy is a September 2018 consultation note in which it was recorded that the Veteran continued to experience chronic left lower extremity neuropathy. The Veteran was afforded a VA peripheral nerves examination in April 2015, during which he reported that he experienced bilateral big toe numbness as well as occasional bilateral leg numbness. He acknowledged that he did not seek care for this symptomatology prior to establishing treatment through VA in June 2014. After an in-person evaluation, the examiner confirmed a diagnosis of bilateral lower extremity radiculopathy. The examiner then opined that it was less likely than not that right and/or left lower extremity peripheral neuropathy was incurred in or otherwise attributable to service. In support thereof, the examiner noted the lack of in-service treatment for any symptomatology that may be attributable to lower extremity neuropathy, as well as the long period of time following discharge before the Veteran sought treatment for such symptomatology. The examiner specifically noted that there was no objective evidence that either right or left lower extremity peripheral neuropathy was caused by a service-related event, injury, or exposure, to include exposure to toxic herbicide agents in service. As the examiner considered the Veteran's medical history and reviewed the claims file, the Board finds her conclusions to be highly probative. Sklar, supra. During the May 2021 hearing, the Veteran stated that his leg would sometimes give out while he was walking, which he attributed to his lower extremity neuropathy. Upon consideration of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for right or left lower extremity peripheral neuropathy. The Veteran is certainly competent to remark on his medical history. However, there is no evidence in the record which indicates that the Veteran is competent through expertise or knowledge to conclude that his currently diagnosed right and left lower extremity peripheral neuropathy is attributable to his service. Jandreau, supra. In considering the likelihood that the Veteran's currently diagnosed lower extremity peripheral neuropathy is attributable to his service, the Board relies on the highly probative opinion of the April 2015 VA examiner, who found it less likely than not that the Veteran's neuropathy was attributable to service, to include as due to the presumed exposure to toxic herbicide agents in service. The Board finds this probative opinion to far outweigh the Veteran's general assertions with regard to the lower extremity peripheral neuropathy, unsupported as those assertions are with no objective medical evidence. Furthermore, while the Board acknowledges that the Veteran's treating physician at the VA once reported that the lower extremity peripheral neuropathy was associated with agent orange exposure, this appears to simply be a self-report by the Veteran, and in any event is wholly unsupported by any rationale. As such, it offers no probative value for the Board's ultimate decision. Thus, the Board finds that the preponderance of the evidence is against service connection. There is no documentation of the Veteran having experienced right or left lower extremity peripheral neuropathy in service, and there is no documented diagnosis in the file prior to the April 2015 examination. Accordingly, the Board finds that service connection for right or left lower extremity peripheral neuropathy based on continuity of symptomatology under 38 C.F.R. § 3.303(b) is denied. Moreover, although service connection may be granted for a disability on an indirect basis if it is shown that the condition is nevertheless attributable to service, the Board notes that the lack of documented treatment for right or left lower extremity peripheral neuropathy for over 40 years after service is persuasive evidence tending to weigh against such a determination. See Buchanan, supra. Coupled with the highly probative opinion of the April 2015 examiner, the Board concludes that the preponderance of the evidence is also against granting service connection for either right or left lower extremity peripheral neuropathy as otherwise attributable to service pursuant to 38 C.F.R. § 3.303(d). Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claims in total are thus denied. 6. Right and Left Knee Conditions The Veteran seeks service connection generally for right and left knee conditions. As the evidence in support of both separately claimed conditions is largely identical, the Board will evaluate both claims together. The question for the Board is whether a right and/or a left knee condition was incurred in service or is otherwise attributable to an in-service injury, event, or disease. After a review of the claims file, the Board concludes that, while the Veteran has been diagnosed with right and left knee degenerative joint disease, the preponderance of the evidence is against a determination that either a right or left knee condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (b), (d). A review of available service treatment records does not reflect that the Veteran complained of or received any treatment for knee symptomatology in service. No lower extremity abnormalities were noted on the November 1970 discharge examination. On this basis, the Board finds that service connection for a right or left knee condition on a direct basis is denied. 38 C.F.R. § 3.303(a). A review of available post-service treatment records reflects that the Veteran began reporting experiencing left knee pain in March 2017. A November 2017 outpatient record indicates that he was provisionally diagnosed with left knee degenerative joint disease. The Veteran was afforded a VA knee examination in April 2015, during which he reported that his right knee would give way at times. He did not endorse experiencing any knee pain or swelling bilaterally and did not report any left knee symptomatology. An in-person evaluation revealed degenerative joint disease of the right knee and no abnormalities of the left knee. The examiner then opined that it was less likely than not that the right knee degenerative joint disease was incurred in or otherwise attributable to service. In support thereof, the examiner noted the lack of treatment for right knee symptomatology in service and for several years after the Veteran's discharge from service. Instead, the examiner found it far more likely that the diagnosed right knee degenerative joint disease was the result of years of weight-bearing and the general aging process. The examiner did not offer an opinion as to the likely etiology of the left knee condition. As the examiner considered the Veteran's medical history and reviewed the claims file, the Board finds her conclusions to be highly probative. Sklar, supra. The Veteran did not offer any specific testimony during the May 2021 hearing regarding his claimed knee conditions other than to state that he hit his knee when he fell about two months prior to the date of the hearing. Upon consideration of the record, the Board finds that the preponderance of the evidence is against a determination that service connection is warranted for a right and/or left knee condition. The Veteran is certainly competent to remark on his medical history. However, there is no evidence in the record which indicates that the Veteran is competent through expertise or knowledge to conclude that his currently diagnosed right and left knee conditions are attributable to his service. Jandreau, supra. In considering the likelihood that the Veteran either incurred a right or left knee condition in service that continued to the present, or that his currently diagnosed right and left knee degenerative joint disease is otherwise attributable to his service, the Board relies on the highly probative opinion of the April 2015 VA examiner, who found it less likely than not that the Veteran's right knee condition was attributable to service. As stated, the examiner offered the alternate etiology of the natural aging process coupled with years of physical labor as the cause of the right knee condition. The Board finds this probative opinion to far outweigh the Veteran's general assertions with regard to the right knee condition, unsupported as they are with no objective medical evidence. The Board does acknowledge that the April 2015 VA examiner dismissed a diagnosis of a left knee condition, and consequently did not offer an opinion as to the likely etiology of any left knee condition. However, in light of the lack of any in-service treatment for a left knee condition, and the Veteran's highly probative and generally applicable opinion regarding the likely etiology of the right knee condition, the Board finds VA does not have a duty to provide an addendum examination to evaluate the nature and likely etiology of the claimed left knee condition, as there is every indication that a chosen examiner would apply the same rationale to dismiss a connection between the left knee condition and service. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Thus, the Board finds that the preponderance of the evidence is against service connection. There is no documentation of the Veteran having experienced a right or left knee condition in service, and there is no documented diagnosis in the file prior to the April 2015 examination. Accordingly, the Board finds that service connection for a right or left knee condition based on continuity of symptomatology under 38 C.F.R. § 3.303(b) is denied. Moreover, although service connection may be granted for a disability on an indirect basis if it is shown that the condition is nevertheless attributable to service, the Board notes that the lack of documented treatment for a right or left knee condition for over 40 years after service is persuasive evidence tending to weigh against such a determination. See Buchanan, supra. Coupled with the highly probative opinion of the April 2015 examiner, the Board concludes that the preponderance of the evidence is also against granting service connection for either a right or left knee condition as otherwise attributable to service pursuant to 38 C.F.R. § 3.303(d). The claims in total are thus denied. REASONS FOR REMAND 1. SNHL The Veteran contends that his bilateral SNHL was incurred in or is otherwise attributable to service. He was afforded a VA audiology examination in April 2015, during which he underwent audiometric testing to evaluate puretone thresholds and to attempt to obtain word discrimination scores. The examiner was able to procure puretone threshold testing results but noted that he could not test word recognition due to language difficulties and/or inconsistent recognition scores. Despite the lack of word recognition scores the examiner still endorsed a diagnosis of bilateral hearing loss for VA compensation purposes. The examiner then opined that it was less likely than not that the Veteran's hearing loss was incurred in or otherwise attributable to service. In support thereof, the examiner noted that the "flat" hearing loss configuration reflected on the Veteran's November 1970 separation audiology examination did not appear to be accurate and did not reflect true noise-induced hearing loss. The examiner also noted that the Veteran exhibited puretone thresholds that were at the same level or even slightly improved when compared with those recorded during the November 1970 separation examination. The examiner did not explain why this particular phenomenon weighed against a determination that the current hearing loss was attributable to service. The Board cannot rely on this examination or etiology opinion, as the April 2015 examiner did not provide a sufficient explanation to justify not utilizing the word recognition scores. On remand, the Veteran must be newly afforded audiometric testing to attempt to procure both puretone threshold and word recognition results. If such results cannot be procured, the examiner must explain why with a detailed rationale. In addition, the Board cannot rely on the April 2015 opinion, as the examination did not provide a sufficient rationale to support the findings. To begin, the examiner did not explain why the inaccurate separation examination, if it indeed is unreliable, nevertheless makes it less likely that the Veteran's current hearing loss is attributable to service. Put another way, even if the Veteran had "normal" hearing at the time of separation and there was no threshold shift during service, the examiner must still explain why this is clinically significant-especially in light of the fact that service connection for a hearing loss disability may be awarded even if such disability did not manifest during service. See 38 C.F.R. § 3.303(d); see also Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Furthermore, the examiner did not explain why the lack of a threshold shift between separation and the April 2015 examination also weighs against a determination that service-connection is warranted. A new examination and opinion that thoroughly explains why the Veteran's current hearing loss disability is, or is not, related to in-service acoustic trauma is needed. 2. Bilateral eye condition The Veteran seeks service connection for a bilateral eye condition, which he contends is attributable to exposure to toxic herbicide agents in service. The Veteran was afforded a VA eye examination in April 2015, during which he was diagnosed with bilateral anisometropia, right eye amblyopia, and right eye monocular exotropia. The examiner identified each of these conditions as congenital disease and thus not subject to service connection. Accordingly, the examiner did not offer an opinion as to the likely etiology of any bilateral eye condition, to include a discussion of whether any diagnosed eye condition was attributable to service. VA medical records dating from after the April 2015 examination reflect that the Veteran has continued to receive care through VA for vision impairment and other eye disorders. Most recently, a March 2020 eye consultation reflects diagnoses of amblyopia, with a possible refractive and strabismic etiology, nuclear cataracts, macular drusen, blepharitis, refractive error with presbyopia, and epiretinal membrane. Although some of these diagnoses are considered congenital conditions, other of these conditions are not, and are therefore subject to potential service connection as attributable to service. Accordingly, remand is necessary in order to afford the Veteran a new eye examination to identify diagnoses that accounts for all of his ophthalmological symptomatology and then sets forth an opinion or opinions which adequately addresses the likely etiology of any diagnosed eye condition, to include a discussion of whether any diagnosed condition is likely attributable to conceded in-service exposure to toxic herbicide agents. In addition, on remand, a separate opinion must determine whether any diagnosed condition that is identified as congenital in nature nevertheless contributed to additional eye disability due to a superimposed injury or disease during service. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA audiology examination with a qualified VA examiner for the purpose of evaluating the nature and likely etiology of the claimed hearing loss disability. A copy of the claims file should be made available to and reviewed by the examiner. Any clinical testing deemed necessary should be scheduled. The examiner is asked to first determine whether the Veteran has hearing loss in either ear pursuant to the diagnostic criteria as set out in 38 C.F.R. § 3.385. If any component of the testing is found to be untenable, the examiner should explain why this is so with a thorough rationale. Then, if SNHL is confirmed in either ear, the examiner should determine whether it is at least as likely as not (a 50 percent of greater probability) that the Veteran's current bilateral hearing loss disability is related to his period of active duty service. If it is less likely than not that the Veteran's current hearing loss disability is related to his period of service, the examiner should discuss why this is the case, to include the clinical significant of any "normal" in-service hearing test results, as well as the lack of permanent pure tone threshold shifts during service. The examiner must provide any and all opinions as to etiology in the form of a probability and must provide a complete rationale for any opinion express. The Veteran's lay contentions as to acoustic trauma must be considered in full. The Board is aware of the complications resulting from COVID-19 in scheduling an examination, and if necessary, a telehealth examination may be considered. 2. Schedule the Veteran for a VA eye examination with a qualified VA examiner for the purpose of evaluating the nature and likely etiology of the claimed bilateral eye condition or conditions. A copy of the claims file should be made available to and reviewed by the examiner. Any clinical testing deemed necessary should be scheduled. The examiner is asked to first identify any currently diagnosed eye conditions, to include amblyopia, presbyopia, nuclear cataracts, macular drusen, blepharitis, epiretinal membrane, anisometropia, and/or monocular exotropia. Then, the examiner should determine whether it is at least as likely as not (a 50 percent of greater probability) that any diagnosed eye condition is related to the Veteran's period of active duty service, to specifically include as attributable to conceded in-service exposure to toxic herbicide agents. If any identified eye disability is congenital or developmental in nature, such must be clearly stated. If it is at least as likely as not that there is a superimposed injury or disease that has resulted in additional eye disability, this must also be clearly stated. The examiner must provide any and all opinions as to etiology in the form of a probability and must provide a complete rationale for any opinion express. The Veteran's lay contentions as to his history of ophthalmological impairment must be considered in full. The Board is aware of the complications resulting from COVID-19 in scheduling an examination, and if necessary, a telehealth examination may be considered. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Collins, 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.