Citation Nr: 22012237 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 17-35 184 DATE: March 3, 2022 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. Entitlement to service connection for residuals of a traumatic brain injury (TBI) is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for a bilateral eye disability is remanded. FINDINGS OF FACT 1. An acquired psychiatric disorder, to include but not limited to PTSD, has not been shown to have manifested in service, within one year of active duty service, or otherwise be related to active duty for training, or an injury during a period of active duty or inactive duty for training. 2. The Veteran did not have any residuals of a traumatic brain injury (TBI) in service and has not at any time during the pendency of this claim. 3. The weight of the probative evidence is against a finding that a claimed right knee disability had onset during active duty service or active duty for training, or is otherwise related to injury during a period of active duty or inactive duty for training. 4. Resolving reasonable doubt in the Veteran's favor, tinnitus was incurred as a result of service. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for an acquired psychiatric disorder, including PTSD, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for entitlement to service connection for residuals of a TBI have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. § 3.303. 4. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1991 to March 1991, December 2001 to November 2002, and August 2005 to September 2006, with additional Reserve service. The Veteran testified before the undersigned Veterans Law Judge in June 2021. A transcript of the hearing is of record. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting service, was aggravated therein. 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or "nexus" between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent." However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Service connection for certain chronic diseases may be presumed to have been incurred in service by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Such a chronic disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. §§ 3.307(a). When a chronic disease is shown in service, sufficient to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). To be "shown in service," the disease identity must be established, and the diagnosis must not be subject to legitimate question. Walker v. Shinseki, 708 F.3d 1331, 1335 (Fed. Cir. 2013); see also 38 C.F.R. § 3.303(b). There is no "nexus" requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease. Walker, 708 F.3d at 1336. The term active military service includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 C.F.R. § 3.6 (a). The presumption of service connection outlined in 38 C.F.R. § 3.307 and § 3.309 only applies to periods of active duty and not to the Veteran's ACDUTRA or INACDUTRA with the Army National Guard because, by definition, the presumption of service connection applies where there is no evidence that a condition began in or was aggravated during the relevant period of service. With regard to a claimant whose claim is based solely on a period of ACDUTRA or INACDUTRA, however, there must be some evidence that the condition was incurred or aggravated during the relevant period of service. See Smith v. Shinseki, 24 Vet. App. 40, 45 (2010). Claims based on a period of ACDUTRA or INACDUTRA are never entitled to the presumption of service connection outlined in 38 C.F.R. § 3.307 and § 3.309 nor are they entitled to the presumption of aggravation. Smith v. Shinseki, 24 Vet. App. 40 (2010). Appellants who established veteran status for a prior period of service may be entitled to the presumption of soundness for a subsequent period of service under certain conditions. Id. at 45-46. For claims based on aggravation of a pre-existing condition during a period of ACDUTRA or INACDUTRA, the appellant must show that the condition worsened beyond its natural progression during the period of training and that the worsening was caused by the training. Id. at 48. Service connection may also be granted on a secondary basis for a condition that is not directly caused by the veteran's service. 38 C.F.R. § 3.310. In order to prevail under a theory of secondary service connection, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities and (2) the condition said to be proximately due to the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998); see also Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition, secondary service connection may also be found in certain instances when a service-connected disability aggravates another condition. See Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310 (b). Service connection may be established on a presumptive basis for a Persian Gulf veteran who exhibits objective indications of chronic disability resulting from undiagnosed illness that became manifest either during active 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, 2016, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1) (VA has adopted an interim final rule extending this date to December 31, 2016). In claims based on undiagnosed illness, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Notably, laypersons are competent to report objective signs of illness. Id. A "qualifying chronic disability" for purposes of 38 U.S.C. § 1117 is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multi symptom illness (such as chronic fatigue syndrome (CFS), fibromyalgia, or irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (C), any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i)(B). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). The Board notes that, effective July 13, 2010, VA has amended its adjudication regulations governing presumptions for certain Persian Gulf War veterans. Such revisions amend § 3.317(a)(2)(i)(B) to clarify that chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome are examples of medically unexplained chronic multi symptom illnesses and are not an exclusive list of such illnesses. Additionally, the amendment removes § 3.317(a)(2)(i)(B)(4) which reserves to the Secretary the authority to determine whether additional illnesses are 'medically unexplained chronic multi symptom illnesses' as defined in paragraph (a)(2)(ii) so that VA adjudicators will have the authority to determine on a case-by-case basis whether additional diseases meet the criteria of paragraph (a)(2)(ii). These amendments are applicable to claims pending before VA on October 7, 2010, as well as claims filed with or remanded to VA after that date. See 75 Fed. Reg. 61,997 (Oct 7, 2010). Compensation under 38 U.S.C. § 1117 shall not be paid if: (1) there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; (2) if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or (3) if there is affirmative evidence that the illness is the result of the veteran's own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(c). The Board notes that the Veteran served during in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for an acquired psychiatric disorder including PTSD The Veteran seeks service connection for an acquired psychiatric disorder, to include PTSD. He has also claimed that his substance abuse an attempt to self-medicate an acquired psychiatric disorder. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); 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. 38 C.F.R. § 3.304(f). If a stressor claimed by a veteran is related to a 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 a 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 a veteran's service, a veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. Fear of hostile military or terrorist activity means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3). When the evidence does not establish that a veteran is a combat veteran, his assertions of service stressors are not sufficient to establish the occurrence of such events. Rather, his reported service stressors must be established by official service record or other credible supporting evidence. 38 C.F.R. § 3.304(f); Pentecost v. Principi, 16 Vet. App. 124 (2002). When the claimant does not submit evidence of service or the evidence submitted does not meet the requirements of this section, VA shall request verification of service from a service department. 38 C.F.R. § 3.203. The United States Court of Appeals for Veterans Claims (Court) has held that a service department determination as to an individual's service shall be binding on VA. Duro v. Derwinski, 2 Vet. App. 530 (1992); Dacoron v. Brown, 4 Vet. App. 115, 120 (1993). The Veteran does not allege that he engaged in combat or that his stressor to support a diagnosis of PTSD is combat-related, nor is it claimed as due to fear of hostile military or terrorist activity. Rather, he asserts that he developed PTSD because service in the military was stressful. His statements regarding this issue are, at best, generalized. Service treatment records are entirely negative for complaints, treatment or diagnosis of a psychiatric disorder or document any reports of the stressful incidents. In reports of medical history in August 1989, August 1993 and July 1998, the Veteran denied loss of memory or amnesia, depression or excessive worry, or nervous trouble of any sort. On post-deployment examination in August 2006, no mental health problems were reported. At this point, it is important for the Veteran to understand that it is the Veteran himself provided factual evidence against his own claim. VA treatment records after 2013, show that the Veteran was diagnosed with alcohol abuse disorder for which he received individual psychotherapy. In June 2013, following an interview of the Veteran, a clinician ruled out a diagnosis of PTSD as the Veteran did not meet the required diagnostic criteria. PTSD screen tests were consistently negative. On VA examination in May 2014, the examiner noted that the Veteran did not describe, nor did treatment records show, any traumatic events while he was in the service that would cause symptoms associated with PTSD. He did, however, describe aspects of anxiety, especially social anxiety, and fears of rejection. He endorsed concerns over being judged by others. The examiner diagnosed severe alcohol use disorder and adjustment disorder with anxiety and depressed mood, secondary to alcohol use disorder, not shown or associated with service. The examiner opined that the Veteran's alcohol used disorder and adjustment disorder were interconnected, as the Veteran used alcohol to self-medicate, but would also then become depressed and anxious over circumstances caused by his difficulty with drinking. At the outset, the Board points out that the weight of the evidence is against a finding that the Veteran meets the criteria for a DSM diagnosis of PTSD. While the Veteran is competent to attest to his in-service experiences and observable symptoms, in light of the evidence discussed immediately above, assuming, without conceding, that the Veteran has PTSD, the evidence weighs against the claim. To the extent clinicians have noted PTSD, there is no credible evidence linking the assessment of PTSD to traumatic events in service. As the record is absent a finding of PTSD related to an in-service stressor, service connection is not warranted for PTSD. With regard to service connection for a psychiatric disorder, other than PTSD, it is acknowledged that no psychiatric disability was diagnosed during a qualifying period of service, and there is no indication that psychosis had its onset during or within one year of separation from active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. Treatment records after 2013 document complaints of anxiety and depression associated with substance abuse disorder and situational stressors including occupational and legal problems. Additionally, the VA examiner in May 2014 diagnosed severe alcohol use disorder and adjustment disorder with anxiety and depressed mood, secondary to alcohol use disorder. Based on the above, the Board must conclude that a chronic psychiatric disability did not have its onset during service and has not been continuous since that time. Owens v. Brown, 7 Vet. App. 429, 433 (1995). In so noting, the Board recognizes that the mere absence of medical records is not dispositive as to the question of continuity; the lay evidence must be considered as well. See Buchanan v. Nicholson, 451 F.3d at1335. If, however, it is determined based on reliable evidence, that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). To the extent the Veteran asserted continuity of symptomatology from service, the Board finds such statements inconsistent with the overall record, to include the service treatment records and post-service treatment records, which fail to document any related complaints until more than one year after discharge from service. See Owens, supra. In reaching the above conclusion, the Board does not rely solely on the absence of contemporaneous evidence corroborating the Veteran and appellant's reports of continuity. Instead, there is evidence in the in-service reports of medical history, where the Veteran, himself, affirmatively denied the presence of mental health problems. Even assuming, without conceding, for discussion purposes, the credibility of the Veteran and the appellant's account of in-service symptoms, the record is insufficient to link the Veteran's psychiatric disability to any aspect of the Veteran's service. On the question of a nexus between the Veteran's psychiatric disability, initially noted many years after service, and service, the evidence weighs against the claim. As noted, the VA examiner in May 2014 diagnosed severe alcohol use disorder and adjustment disorder with anxiety and depressed mood, secondary to alcohol use disorder. The Board finds the VA examiners' opinion to be highly probative. The opinion was based on a thorough review of the claims file, including the service treatment records and post-service treatment records. The examiner cited to the service and post-service treatment records, and the opinion is internally consistent and consistent with other evidence of record. Moreover, the examiner provided adequate rationale for the opinions provided. Accordingly, the VA examiner's opinion is entitled to great probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-304 (2008). Significantly, there is no competent medical opinion of record linking the Veteran's psychiatric disability to service or a service-connected disability. To the extent that the Veteran seeks entitlement to service connection for the documented, primary substance abuse disorder as directly related to service, the claim is denied as a matter of law because these are not disabilities for the purposes of VA compensation. See 38 U.S.C. § 105(a); 38 C.F.R. §§ 3.1(m), 3.301(d); see also Allen v. Principi, 237 F.3d 1368, 1381 (Fed. Cir. 2001) ("the legislative history is quite clear that Congress intended to... preclude recovery for a primary alcohol abuse disability..."). To the extent the Veteran seeks service connection for substance abuse as secondary to his adjustment disorder with anxiety and depressed mood, or as a symptom of it, as outlined above, no compensation can be awarded for a disability that is a result of the Veteran's own willful misconduct or abuse of alcohol or drugs, unless the substance abuse arises secondarily from a service-connected disability. There must be "clear medical evidence establishing that alcohol or drug abuse is caused by" the primary disability and not a result of willful wrongdoing. Allen, 237 F.3d at 1381. In this case, the Board finds the preponderance of the evidence shows that the Veteran's adjustment disorder with anxiety and depressed mood are the result of the primary substance abuse and that the exception carved out by the Federal Circuit does not apply here. In any event, with respect to the Veteran's assertion that his substance abuse is secondary to his psychiatric disability (i.e., a coping mechanism), the claim must also fail on this other premise since, for the reasons and bases already discussed, he does not have a service-connected psychiatric disability. Thus, he cannot use his psychiatric disability as a pathway to relate his alcohol use to his military service. 38 C.F.R. § 3.310; Allen, supra. The Veteran believes he has an acquired psychiatric disability, including PTSD, that was incurred in service and that his substance abuse is the result of said disability. However, unlike disabilities that may be observable as to both their incurrence and their cause, the cause of a psychiatric disability is not readily apparent to lay observation. Indeed, psychiatric diagnoses are generally the province of medical professionals. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). In reaching the above conclusions the Board has considered the applicability of the benefit of the doubt doctrine. However, as the most persuasive evidence weighs against the claim for service connection for an acquired psychiatric disorder, to include PTSD, and substance abuse, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to service connection for residuals of TBI The Veteran contends that he currently suffers from residuals of a TBI incurred in service. In statements and at hearing, the Veteran reported several injuries to the head during service, including injuring his head in September 2005 while playing basketball. Reportedly, he lost consciousness for a few seconds, but did not seek treatment at the time. In another incident, he fell and cut his head, but did not seek treatment. The Veteran also described injuring his head on an aircraft open door while working on a propeller. At the time, he was stationed in Qatar. He denied having sought treatment for his head, although he related the incident to his Master Sergeant. The Veteran claimed residuals of these head injuries, including impaired memory and headaches. Although the Veteran is competent to report that he received various head injuries during service, the service treatment records do not document any head injuries or episodes of loss of consciousness, and the Veteran denied seeking treatment for these injuries at the time. Assuming, without conceding, for discussion purposes that the credibility of the Veteran's account of head injuries during service, it is important for the Veteran to understand that it is not enough merely to show relevant injury in service since there equally has to be chronic (meaning permanent) disability owing to that injury. Under VA law, the cornerstone of a valid claim for service connection is that there must be competent and credible evidence of the present existence of the disability being claimed. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), citing Francisco v. Brown, 7 Vet. App. 55, 58 (1994) ("Compensation for service-connected injury is limited to those claims which show a present disability."); Hicks v. West, 12 Vet. App. 86, 89 (1998); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). See also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.:). See, too, Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998). A current disability means a disability shown by competent and credible evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997); Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328 (1997) (indicating VA compensation only may be awarded to an applicant who has disability existing on the date of application, not for past disability); but see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (further clarifying that this requirement of current disability is satisfied when the claimant has the disability at the time the claim for VA disability compensation is filed or during the pendency of the claim and that a claimant may be granted service connection even though the disability resolves prior to VA's adjudication of the claim). See also Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (considering the application of McClain on a recent diagnosis even predating the filing of a claim). The service treatment records do not document residuals of TBI, and an organic disease of the nervous system was not shown during service or within one year following discharge from any period of active duty service. Accordingly, competent evidence linking the current disability to service is needed to substantiate the claim. The weight of the post-service evidence, however, establishes that the Veteran has not had any residuals of a TBI, or a TBI, at any time during the pendency of this claim. VA treatment records in June 2013 noted that the Veteran may have had a mild concussion during a basketball game when he fell and hit his head. The injury was noted to have occurred several years earlier, but there was no mention of having been incurred during service. He denied seeking medical attention at the time. In July 2013, show that the Veteran complained of impaired memory initially noted during his employment at the time of the evaluation. He denied any past hospitalizations or treatment for head injury, being knocked unconscious, or being involved in any serious injuries involving head trauma. In September 2013, the Veteran reported injuring his head while playing basketball in September 2005. He also noted hitting head while working on planes. The record shows that in March 2014 the Veteran was evaluated for complaints of memory difficulties, blurry vision, depression, anxiety and seldom headaches. He reported several head injuries while deployed to Qatar 2005. His most severe head injury was incurred while playing basketball in September 2005, when he fell hitting the back of head and suffered an occipital laceration. Reportedly, he lost consciousness for less than five minutes and felt confused and dizzy for about one day. He also described having at least three or four additional head injuries and concussions with loss of consciousness, to include while stationed in Qatar working on aircraft. He stated that he sought treatment following one of these incidents and was evaluated as normal. Neurologic examination revealed no abnormalities. The clinician noted an Operation Enduring Freedom/Operation Iraqi Freedom deployment related TBI residual problems. On VA PTSD examination in May 2014, the examiner noted that cognitive testing was indicating cognitive functioning was within normal limits. No psychomotor abnormalities were noted. His speech was the normal rate, tone, and pressure. His eye contact was good. His thought process was linear and goal directed. Following a review of the claims file and an examination of the Veteran, VA psychologist diagnosed alcohol use disorder and adjustment disorder with mixed anxiety and depression. The examiner opined that the Veteran did not have subjective symptoms or any mental, physical or neurological conditions consistent with, or residuals of TBI. Here, the Board weighs the March 2014 notation of TBI with the findings of the VA examiner in May 2014 that posited no diagnosis of TBI. The March 2014 treatment note appears to have been made on the basis of the Veteran's statements alone. To the extent that the VA clinician noted a history of Operation Enduring Freedom/Operation Iraqi Freedom deployment related TBI residual problems, a bare transcription of lay history is not transformed into competent medical evidence simply because it was transcribed by a medical professional, whether that professional is a VA or private physician. LeShore v. Brown, 8 Vet. App. 406 (1995). In contrast, the VA examiner's findings were based on a review of the evidence, including the service treatment records and examination report, and examination of the Veteran, which did not substantiate a finding that the Veteran suffers from any chronic residuals of TBI. The examiner considered the complete record and the Veteran's contentions, and the VA examiner's findings are supported by the record and are consistent with other evidence of record, the service and post-service treatment records, including neurological testing performed in March 2014, which was within normal limits. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Accordingly, the opinion is of significant probative value. The Board has considered the statements from the Veteran asserting that he currently suffers from residuals of TBI. The Veteran is certainly competent to report as to the observable symptoms he experiences and their history, but he cannot diagnose TBI or any residuals thereof because of the medically complex nature of such a diagnosis. See Layno, supra; Buchanan, supra; Jandreau, supra. The ultimate questions in this case are related to an internal medical process which extends beyond an immediately observable cause and effect relationship. Id. Moreover, whether the symptoms the Veteran experienced in service or following service are in any way related to his claimed in-service head injuries is a matter that requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("Although the Veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). Simply stated, both the best medical evidence in this case, and the facts of this case, provide highly probative evidence against this claim. In summary, the Board finds that the weight of the evidence establishes that the Veteran does not have any residuals of an in-service TBI and has not at any time during the claims period. The Board has considered his lay statements, but finds he is not competent to attribute the symptoms he experiences to a TBI. Moreover, the most probative and persuasive evidence is against a finding that any current headaches, neurobehavioral and/or cognitive complaints are residuals of a TBI or due to any other in-service event or injury. Rather, the most competent and probative evidence attributed the Veteran's reported neuropsychiatric symptoms with his currently diagnosed alcohol use disorder and adjustment disorder with mixed anxiety and depression. Accordingly, the preponderance of the evidence is against the claim, and service connection is denied. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the most persuasive evidence weighs against the Veteran's claim for service connection for residuals of a TBI. As such, that doctrine is not applicable in the instant appeal, and the claim must be denied. See 38 U.S.C. § 5107(b); See Lynch, supra. 3. Entitlement to service connection for a right knee disability The Veteran seeks service connection for residuals of a right knee injury while playing sports in service. The record contains no evidence of a knee disability. The discussion below will assume (but not concede) for purposes of argument that the Veteran has a right knee disability. The service treatment records contain no complaints, history or findings consistent with a right knee disability or injury. After service, VA treatment records since 2013 recorded complaints of knee pain. On VA examination in April 2014, the Veteran reported insidious onset of right knee subpatellar pain since approximately 2006. Reportedly, he was seen once by a provider, but could not recall when. Following imaging studies, he was referred for physical therapy. Examination revealed normal range of motion of the right knee. Following an examination of the Veteran's knee with radiographic studies, the examiner found that the right knee was normal. The examiner explained that clinically and radiographically, there was insufficient evidence to support a diagnosis of an acute or chronic knee disability. Although the Veteran is competent to report that he injured his knee during service, the service treatment records fail to document any right knee injury. Assuming, without conceding, for discussion purposes that the credibility of the Veteran's account of knee injuries during service, the record is insufficient to link any claimed right knee disability to that an alleged injury (which does not seem to have occurred), or to any other aspect of his service. Additionally, arthritis of the knee was not shown in service or within one year following discharge from active-duty service, as such, service connection cannot be established for arthritis on a presumptive basis. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. Moreover, the Board reiterates that those presumptive provisions do not apply to such periods of Reserves service, including ACDUTRA or INACDUTRA. The Board notes that the first documented evidence of knee complaints was initially noted more than five years after the Veteran's discharge from active duty service. In so noting, the Board recognizes that the mere absence of medical records is not dispositive as to the question of continuity; the lay evidence must be considered as well. See Buchanan at 1336; see also Maxson at 1333. To the extent the Veteran asserted continuity of symptomatology from service, the Board finds such statements inconsistent with the overall record, to include the service treatment records. Thus, the Veteran did not adequately show that his post-service complaints of knee symptoms continued since service. Here, there is no competent and credible evidence of a nexus between the Veteran's claimed right knee disorder and a qualifying period of service. Moreover, the Veteran has failed to identify, and the record does not reveal, any injury occurring during a period of active duty, ACDUTRA or INACDUTRA. 38 U.S.C. §§ 101 (2), (22), (24); 38 C.F.R. § 3.6 (a); Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010); Acciola v. Peake, 22 Vet. App. 320, 324 (2008). The only evidence of record in support of such a nexus is the Veteran's lay opinion. To the extent the Veteran believed that his claimed right knee disorder was related to service, to include any injuries incurred therein, as a lay person, the Veteran did not have the specialized training sufficient to render such an opinion. Jandreau, 492 F.3d at 1377. The diagnoses and/or etiology of knee joint disorders require medical testing and expertise to determine. Moreover, whether the symptoms the Veteran experienced in service or following service are in any way related to his claimed disorders, is a matter that requires medical expertise to determine. See Clyburn, 12 Vet. App. at 301. Thus, the Veteran's assertions regarding the etiology of the right knee complaints, initially noted many years after service, and service, are of little probative value. In this regard, it is important for the Veteran to understand that the service and post-service treatment records provide particularly negative evidence against the claim. Additional VA medical opinion regarding the etiology of the Veteran's right knee symptoms is not indicated as there is no suggestion that the claimed disorder may be associated with service. Again, there is no competent evidence of a chronic knee disorder in service or within one year following discharge from service. Moreover, there is no competent and probative evidence to show that the Veteran had a knee disability during or contemporaneous with service and no competent and probative evidence that his claimed right knee disability is related to his service. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). The best evidence in this case, as noted above, provides evidence against the claim. In sum, the record does not reflect that a right knee disorder was shown during active duty service or within one year of separation thereof, nor is there evidence of a knee injury occurring during a period of active duty, ACDUTRA or INACDUTRA. Finally, the record is negative for any competent medical evidence in support of the claim, to include any medical opinion relating the Veteran's claimed knee condition to any incident of service. Thus, the Board must conclude that the most persuasive evidence weighs against the Veteran's claim for service connection for residuals of a right knee disability. As such, that doctrine is not applicable in the instant appeal, and the claim must be denied. See 38 U.S.C. § 5107(b); See Lynch, supra. 4. Service connection for tinnitus The Veteran seeks service connection for tinnitus due to military noise exposure. At hearing, the Veteran reported injuring his knee The Veteran is competent to testify to observable symptoms such as ringing in his ears and has done so credibly during the course of this claim, and a VA examiner in May 2014 appeared to have found the Veteran's account of current tinnitus credible. Layno v. Brown, 6 Vet. App. 465 (1994); Charles v. Principi, 16 Vet. App. 370 (2002) (finding a lay person competent to identify tinnitus). Thus, a current disability has been established. The Veteran reported acoustic trauma from jet engine and flight line noise. The Veteran's personnel form DD-214, documents his military occupational specialty (MOS) was airlift aircraft maintenance specialist, aerospace maintenance aircraft specialist and aerospace propulsion technician. The Board finds that the Veteran's competent lay account of having been exposed to military noise is consistent with his military occupational specialty. Given that the Veteran is competent to report both exposure to military noise and hearing problems thereafter (as these are experiences capable of lay observation, for which no specific expertise is required), and given that the Veteran's reports of incurring this in-service acoustic trauma are consistent with the circumstances of his service, and have remained consistent over time, the Board concludes that his in-service exposure to acoustic trauma is established. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). The service treatment records show that the Veteran was routinely exposed to hazardous noise. A Reserves examination report in May 2007 noted tinnitus. On VA examination in May 2014, the Veteran reported constant tinnitus that had onset during service. The examiner noted the Veteran's exposure to hazardous noise levels while in service. The examiner opined, based on electronic hearing testing conducted during service which did not show significant threshold shift beyond normal variability, as well as the Veteran's current audiological assessment, that the Veteran did not have hearing injury while in service and the Veteran's reported tinnitus was less likely as not caused by or a result of noise exposure while in service. In a November 2016 addendum opinion report, the examiner opined that the Veteran's reported tinnitus was less likely as not caused by or a result of noise exposure while in service. The examiner noted that delayed onset tinnitus due to noise exposure was unlikely to occur. In the absence of an objectively verifiable noise injury, the association between claimed tinnitus and noise exposure could not be assumed to exist. The examiner added that there were many potential etiologies for tinnitus. Therefore, if the tinnitus began during service, it was more likely than not caused by an unknown etiology related to some other event during military service, as opposed to military noise exposure. A veteran is competent to describe observable symptoms such as ringing in the ears. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Charles, 16 Vet. App. 370, 374-75 (2002). Here the Veteran asserts that tinnitus is associated with military noise exposure and had onset during service. The service treatment records show that the Veteran was routinely exposed to hazardous noise levels. Significantly, tinnitus was noted within a year of active duty service in 2007. The Board is cognizant that, the VA examiner provided evidence against the claim. However, because there is a current diagnosis of tinnitus, statements from the Veteran that associate tinnitus with in-service noise exposure, in-service acoustic trauma has been conceded, and tinnitus was noted within a year of the Veteran's last period of active duty service, the Board finds that the competent and credible assertions from the Veteran provides a nexus linking his current tinnitus to his in-service noise exposure, and the balance of positive and negative evidence is in relative equipoise. Resolving all reasonable doubt in the Veteran's favor, the Board finds that the competent and credible evidence creates a nexus between the Veteran's current tinnitus and active service. Therefore, service connection for tinnitus is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra. REASONS FOR REMAND 1. Entitlement to service connection for a bilateral eye disability is remanded. The Veteran contends that he has a bilateral eye disability due to service, to include as due to environmental hazards while deployed in Southwest Asia on active duty. At the Board hearing, he described eye irritation and sensitivity to light. A VA examiner in May 2017, noted mild exophoria and strabismus, and opined that the claimed conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that while the service treatment records documented a corneal abrasion in 1996, current examination showed that the corneal abrasion was acute and transitory in nature, and resolved with treatment. The examiner determined that the Veteran's strabismus was less likely than not due to the corneal abrasion. However, the examiner did not address the Veteran's contentions that he developed a bilateral eye disability, manifested by irritation and sensitivity to light, due to his exposure to environmental hazards while on active duty. Therefore, an addendum medical opinion is necessary. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his bilateral eye disability, and complete and return an appropriate authorization form for each treatment provider identified. After securing the necessary release, the AOJ should request any relevant records identified. The Veteran himself is asked to submit any pertinent records that the VA does not have. Any effort would be appreciated. 2. Obtain all relevant outstanding VA treatment records (if any). 3. Submit the claims file to an examiner with appropriate expertise for an addendum opinion report. The claims file should be made available to the examiner, who should indicate a review of the file in the examination report. Examination of the Veteran is not required unless the examiner determines that one is necessary to provide a reliable opinion. After reviewing the record, the examiner is asked to determine whether it is at least as likely as not (a probability of 50 percent or greater) that any currently diagnosed eye disability is due to the Veteran's service, to include environmental exposure in Southwest Asia. Please explain why or why not. The examiner should consider all evidence, including lay statements regarding onset and continuity of symptoms, such as eye irritation and sensitivity to light, and must provide a complete rationale for all opinions expressed. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Azizi, T. 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.