ANKLE IMPAIRMENT OF

JAMES A. DEFRANK · 2024 · Case ID: 24033311

MIXED

Summary

The Veteran served from November 1984 to November 1988 and again from January 1992 to March 1992. The Veteran appealed the denial of service connection for bilateral hearing loss and the denial of an increased rating for his left ankle disability. The Board granted an initial 20 percent rating for the left ankle disability, finding that the Veteran's symptoms, including pain and marked limitation of motion, more closely approximated the criteria for a 20 percent rating under Diagnostic Code 5271, applying the benefit of the doubt. The Board considered both prior and current rating criteria for the ankle, ultimately finding the 20 percent rating warranted based on the Veteran's credible reports and objective findings of limited range of motion. However, the Board denied service connection for bilateral hearing loss, concluding that the Veteran did not have a current diagnosis of hearing loss that met VA regulatory standards. While the Veteran reported hearing difficulties and the Board found his reports credible, the audiometric testing results did not meet the threshold for a compensable disability. The Board noted that lay testimony regarding hearing loss is not competent to establish the diagnosis, and the VA examinations, while showing some abnormalities, did not meet the regulatory criteria for bilateral hearing loss.

Rationale

Veteran's left ankle disability diagnosed as left lateral collateral ligament sprain.; Board considered prior and current rating criteria for ankle disability.; Benefit of the doubt applied due to credible reports and objective findings of marked limitation of motion.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5271

Docket No.

17-26 421

Full Decision Text

Citation Nr: 24033311
Decision Date: 11/21/24 Archive Date: 11/21/24

DOCKET NO. 17-26 421
DATE: November 21, 2024

ORDER

Entitlement to an initial 20 percent rating for left lateral collateral ligament sprain is granted.

Entitlement to service connection for bilateral hearing loss is denied.

FINDINGS OF FACT

1. The Veteran's left lateral collateral ligament sprain symptoms more nearly approximate the criteria for marked limited motion..

2. The evidence of record does not demonstrate a bilateral hearing loss disability, as defined by VA regulations.

CONCLUSIONS OF LAW

1. The criteria for an initial 20 percent disability rating for left lateral collateral ligament sprain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5271.

2. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.385.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from November 1984 to November 1988 and January 1992 to March 1992.

These matters come to the Board of Veterans' Appeals (Board) on appeal from April 2016 and January 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO) that, in pertinent part, denied service connection for bilateral hearing loss and an initial disability rating in excess of 10 percent for left lateral collateral ligament sprain (heretofore referred to as "left ankle disability").

In March 2020, the Veteran testified at a hearing before the undersigned Acting Veterans Law Judge. A copy of the hearing transcript is of record.

Thereafter, in December 2020, the Board remanded the matters for additional development. During the pendency of the appeal, a January 2018 rating decision granted the Veteran a separate 10 percent rating for left foot plantar retrocalcaneal spurs effective March 15, 2017. The matters return for further appellate review in the instant appeal.

As an initial matter, although it appears that additional service records were obtained and associated with the Veteran's claims file in December 2022. Yhe Board notes that the Veteran's service treatment records had been associated with his claims file in October 2017. As such, the Board finds that they were reviewed by VA at the time of it issued the May 2021 supplemental statement of the case (SSOC). As such, reconsideration of the claims is not warranted. See 38 C.F.R. § 3.156(c). Moreover, the Veteran, through his representative, has waived initial consideration of additional evidence by the agency of original jurisdiction. See August 2020 correspondence. As such, the Board proceeds in its consideration of the matters.

1. Entitlement to an initial rating in excess of 10 percent for left ankle disability

The Veteran contends that he is entitled to higher disability rating for his left ankle disability, diagnosed as left lateral collateral ligament sprain. The Veteran's left ankle disability has been assigned a 10 percent rating. 38 C.F.R. § 4.71a, DC 5271.

Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 C.F.R. Part 4.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. See 38 C.F.R. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R
regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. See 38 C.F.R. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3.

Evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss, taking into account any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions regarding the avoidance of pyramiding do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including flare ups. See 38 C.F.R. § 4.14. However, those provisions should only be considered in conjunction with the diagnostic codes predicated on limitation of motion. 38 C.F.R. §§ 4.40, 4.45.

Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be "staged." Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show distinct period where the service-connected disability exhibits symptoms that would warrant different ratings).

Notably, the criteria for limited motion of the ankle joint under Diagnostic Code 5271 have changed during the period covered by this appeal, effective February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes, 5251).

If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied.

Under the previous criteria of Diagnostic Code 5271, a 10 percent disability rating is assigned where the evidence shows moderate loss of ankle motion. A 20 percent disability rating is assigned where there is evidence of marked loss of ankle motion. Id.

Under the revised criteria of Diagnostic Code 5271, a 20 percent rating is warranted for marked limitation of motion (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion), and a 10 percent rating is warranted for moderate limitation of motion (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion). See 38 C.F.R. § 4.71a, Diagnostic Code 5271 (2021).

Limitation of motion of the ankle is rated under Diagnostic Codes 5270 and 5271. Normal ranges of motion of the ankle are dorsiflexion from zero degrees to 20 degrees, and plantar flexion from zero degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II.

The terms "moderate" and "marked" are not defined in VA regulations, and the Board must arrive at an equitable and just decision after having evaluated the evidence. 38 C.F.R. § 4.6 (2021).

Factual Background and Analysis

The Veteran was afforded two VA examinations for his left ankle disability. See November 2016 and February 2021 VA examination. He also submitted a private examination. See August 2020 medical treatment records.

During the November 2016 VA
the ankle are dorsiflexion from zero degrees to 20 degrees, and plantar flexion from zero degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II.

The terms "moderate" and "marked" are not defined in VA regulations, and the Board must arrive at an equitable and just decision after having evaluated the evidence. 38 C.F.R. § 4.6 (2021).

Factual Background and Analysis

During the November 2016 VA examination, the Veteran reported experiencing steady pain rated at 3 to 6 on a scale of 0 - 10. In addition, the Veteran reported that pain in his ankle slowed his work performance down at times and excessive walking, stooping, or squatting provokes ankle pain. Upon examination, his initial range of motion (ROM) with dorsiflexion was limited to 15 degrees with pain that did not result in or cause functional loss, and plantar flexion limited to 45 degrees. The Veteran did not report flare-ups and observed repetitive use testing revealed no additional loss of function or ROM. The examiner noted there was no reduction in muscle strength, no muscle atrophy, no ankylosis, no suspected instability or dislocation, and no "shin splints", stress fractures, achilles tendonitis, achilles tendon rupture, mal-union of calcaneus (os calcis) or talus (astragalus), nor talectomy (astragalectomy). The Veteran endorsed occasional use of a soft over-the-counter ankle brace and taking Advil 200 mg one to two times per day, as needed. The examiner noted November 2016 radiographic imaging (X-ray) that showed plantar and retrocalcaneal spurs but was otherwise negative. In addition, the examiner noted mild inversion of the left foot while in standing position.

During the February 2021 VA examination, the Veteran reported ankle pain, tingling, and extreme pain in the mornings. In addition, the Veteran reported that he experienced constant pain and used muscle relaxers, which made him drowsy, and he could not concentrate. He specifically reported taking meloxicam, tizanidine, and Advil. He further reported that he was unable to put weight on his left foot due to increased pain, had difficulties standing on his left foot for a prolonged time, and could not walk for a prolonged time. He endorsed constant use of an ankle brace for stability, or he would twist his ankle, especially going downstairs or a curb. In addition, the Veteran reported his ankle was swollen in the morning if he was not wearing his brace. Upon examination, his initial active and passive ROM with dorsiflexion was limited to 10 degrees with pain, and plantar flexion limited to 30 degrees with pain. The examiner did not note limitation of motion specifically attributable to pain, weakness, fatigability, or incoordination, but otherwise noted pain on weight-bearing, and pain on active and passive motion in both plantar and dorsiflexion. There was no objective evidence of crepitus nor localized tenderness or pain on palpation of the joint or associated soft tissue noted. Observed repetitive use testing revealed no additional loss of function or ROM. The examiner noted that procured evidence (statements from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with repeated use over time or during flare-ups. Otherwise, the examiner indicated that the Veteran's disability caused interference with sitting and standing, swelling, disturbance of locomotion, and instability in station, noting that the Veteran had increased pain with walking, twisting ankle, and swelling causing pain. There was no muscle atrophy, no ankylosis, and joint stability testing of the Veteran's left ankle was negative. The examiner did not note "shin splints", stress fractures, achilles tendonitis, achilles tendon rupture, mal-union of calcaneus (os calcis) or talus (astragalus), nor talectomy (astragalectomy), nor surgical procedures. The Veteran endorsed constant use of an ankle brace for instability and ankle sprain, and to decrease swelling. The examiner noted an April 2021 X-ray with normal findings. The examiner indicated that the Veteran left foot imbalance was due to his bone spur causing pain and that though the Veteran reported difficulty standing and walking for prolonged periods, that it did not significantly limit functional ability.

In addition, the Veteran's June 2020 private examination showed ROM with dorsiflexion limited to 16 degrees with pain, and plantar flex
achilles tendonitis, achilles tendon rupture, mal-union of calcaneus (os calcis) or talus (astragalus), nor talectomy (astragalectomy), nor surgical procedures. The Veteran endorsed constant use of an ankle brace for instability and ankle sprain, and to decrease swelling. The examiner noted an April 2021 X-ray with normal findings. The examiner indicated that the Veteran left foot imbalance was due to his bone spur causing pain and that though the Veteran reported difficulty standing and walking for prolonged periods, that it did not significantly limit functional ability.

In addition, the Veteran's June 2020 private examination showed ROM with dorsiflexion limited to 16 degrees with pain, and plantar flexion limited to 26 degrees. See August 2020 medical treatment records. The private examination also included ROM for inversion limited to 17 degrees and eversion limited to 6 degrees. However, there was no indication of normal inversion and eversion. The examiner also noted that the Veteran's left ankle revealed laxity of the talofibular ligament, and decreased range of motion. In addition, the examiner noted tenderness of the plantar fascia and in the calcaneus. The examiner opined that the Veteran's marching with heavy weights and parachute landing jump falls cause traumatic arthritis and ligament laxity. However, there were no radiographic findings of arthritis in the left ankle noted. In addition, the private examiner noted that the Veteran endorsed that he had pain in his ankles and feet, that his ankles give way, that they invert easily, especially going from flat earth to gravel to grass.

Moreover, during his March 2020 Board hearing, the Veteran reported that his left ankle disability gave him "significant issues," which he described as "some pain and less range of motion at certain times."

Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that an initial 20 percent rating for a left ankle disability is warranted.

As mentioned above, "moderate" and "marked" are not defined by the Code under the old rating criteria while the new rating criteria (for the period since February 7, 2021), defines marked limitation of motion as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion.

Again, "marked" is defined as "noticeable; obvious; appreciable; distinct; conspicuous." See Webster's New World Dictionary, Third College Edition (1988) at 828. "Moderate" is defined as "of average or medium quality, amount, scope, range, etc." Id. at 871.

In light of the Veteran's competent and credible reports of pain to which the Board has accorded significant probative value, and the fact that at a point during the appeal period the Veteran's left ankle dorsiflexion was 10 degrees, and his plantar flexion was 26 degrees, the Board affords the Veteran the benefit of the doubt and finds that his overall disability picture more nearly approximates the criteria for a 20 percent rating based on marked limitation of motion, when taking into account DeLuca factors.

Thus, the Board resolves reasonable doubt in the Veteran's favor and finds that the evidence of record shows that the Veteran's left ankle symptoms more nearly approximate the criteria for marked limited motion. Consequently, resolving reasonable doubt in the Veteran's favor, the Veteran's entitlement to an evaluation of 20 percent, but no higher, for a left ankle disability is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5271 (2021).

However, the Board does not find that an initial rating in excess of 20 percent is warranted for the Veteran's left ankle disability.

According to 38 C.F.R. § 4.71a, Diagnostic Code 5271, the maximum schedular evaluation available for limited motion of the ankle is a 20 percent evaluation. As noted, the Veteran's left ankle disability has been awarded this maximum 20 percent evaluation for the period under appeal.

The only diagnostic codes (Diagnostic Codes 5270 and 5272) for ankle disorders that offers a potentially higher rating than the Veteran's current 20 percent rating is for ankylosis of the ankle. However, while VA examination reports indicate that the Veteran's left ankle ranges of motion are reduced, his ankle is not ankylosed.

The Board also notes that the private examination indicated that a separate 10 percent rating for left ankle traumatic arthritis is warranted. See August 2020 medical treatment records. However, X-ray imaging of the
available for limited motion of the ankle is a 20 percent evaluation. As noted, the Veteran's left ankle disability has been awarded this maximum 20 percent evaluation for the period under appeal.

The Board also notes that the private examination indicated that a separate 10 percent rating for left ankle traumatic arthritis is warranted. See August 2020 medical treatment records. However, X-ray imaging of the Veteran's left ankle has shown no evidence of arthritis in his left ankle. See April 2021 radiology report. As such, the Board finds that a separate rating for arthritis in the left ankle is not warranted. In addition, the private examination indicated that the Veteran's left ankle disability should be assigned a 10 percent under DC 5262 for impairment of the tibia and fibula. In this regard, the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." Butts v. Brown, 5 Vet. App. 532, 538 (1993). However, the Veteran's neither the current diagnosis nor the relevant medical history suggests that the Veteran's disability is due to nonunion or malunion of his tibia and fibula, nor has the private provider explained why the Veteran's left ankle disability should be rated under DC 5262. Rather, the evidence indicates that the Veteran's left ankle disability is for his diagnosed left lateral collateral ligament sprain, which affects his ankle's motion, DC 5262 is not applicable. As such, the Board finds that DC 5271 is the appropriate and applicable criteria for the Veteran's left ankle disability.

The Board has also considered whether an increased or additional disability rating may be assigned for the Veteran's left ankle disability under alternative diagnostic codes pertaining to disability of the ankle.

Diagnostic Code 5273 pertains to malunion of os calcis or astragalus, which has not been shown at any time during the appeal. Finally, as there is no evidence that the Veteran's left talus bone has been removed, Diagnostic Code 5274 for astragalectomy is not applicable. Thus, the Veteran is not entitled to an increased or additional rating under Diagnostic Codes 5003, 5010, 5270, 5272, 5273, or 5274.

Again, the Board notes that a rating in excess of 20 percent requires ankylosis of the ankle. Such impairment was simply not documented as the Veteran did not have any type of ankylosis, including in consideration of functional loss due to pain on motion, weakness and fatigability.

Since the Veteran's left ankle is not ankylosed as he has demonstrated the ability to flex, the criteria for an increased 30 percent evaluation have not been met. Thus, the Board finds that the current initial 20 percent evaluation adequately portrays any functional impairment, pain, and weakness that the Veteran experiences as a consequence of use of his left ankle disability.

As a result, the Board finds that an initial 20 percent rating, but no higher, is warranted as the Veteran's left ankle disability is manifested by pain and marked limitation of motion, without ankylosis.

2. Entitlement to service connection for bilateral hearing loss

The Veteran contends that he has a bilateral hearing loss disability due to or as a result of his service.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§1110, 1131, 5107; 38 C.F.R. §3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

In addition, certain chronic diseases, including organic diseases of the nervous system, may also be established on a presumptive basis by showing that such a 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. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service
or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Finally, for the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

Upon review of the evidence, the Board concludes that the Veteran does not have a current diagnosis of hearing loss and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Veteran was twice afforded a VA audiological examination. See March 2016 and February 2021 VA examination.

The March 2016 VA examination revealed the following pure tone thresholds, in decibels:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 20 20 20 25

LEFT 20 20 25 25 25

Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 96 percent in the left ear. The Board notes the examiner indicated that the inter-test consistency was "fair" and concluded that the results were reliable for rating purposes. The Board also notes that the examiner concluded that the Veteran's hearing was normal. Nevertheless, although the Veteran demonstrated abnormal hearing bilaterally, the Board finds the pure tone threshold values of the audiological examination remain highly probative as to the question of whether the Veteran has bilateral hearing loss as the definition of the disability is based on the objective findings of the pure tone audiometry test as opposed to the examiner's diagnosis. Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (the threshold for normal hearing is from 0 to 20 decibels, and that higher threshold levels indicate some degree of hearing loss); 38 C.F.R. § 3.385.

Then, in February 2021, the VA examination revealed the following pure tone thresholds, in decibels:

HERTZ

500 1000 2000 3000 4000

RIGHT 15 5 5 15 10

LEFT 5 5 10 15 15

Speech audiometry revealed speech recognition ability of 94 percent in the right ear and 96 percent in the left ear. The Board notes the examiner concluded that the results were reliable for rating purposes.

Unfortunately, as shown above, the audiometric testing of record has not reflected auditory thresholds of 40 decibels or greater, or auditory thresholds for at least three of the relevant frequencies of 26 decibels or greater, or Maryland CNC speech recognition scores of less than 94 percent. As such, the Board finds that the Veteran does not have bilateral hearing loss for rating purposes. 38 C.F.R. § 3.385.

In reaching this determination, the Board does not question the sincerity of the Veteran's reports that his hearing loss impedes communication, or that he experiences tinnitus and acknowledges that, as a lay person, he is competent to report that he has difficulty hearing. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board does find the Veteran's reports credible. Unfortunately, as a layperson, the Veteran does not have the requisite expertise to provide a competent opinion as to whether he has a current hearing loss disability in accordance with VA regulations, as such matters require medical expertise. 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). Specifically, the results of an audiogram administered by a state-licensed audiologist is the only type of evidence deemed competent to show a hearing impairment for VA purposes. Here, the audiogram results show no such impairment.

In sum, absent any current diagnosis of a hearing loss disability, an award of service connection for bilateral hearing loss is not warranted. As the evidence is not in approximate balance, the benefit-of-the-doubt rule is inapplicable and the claim of service connection for bilateral hearing loss must be denied. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021); 38 C.F.R. § 3.102.

The Board notes the Veteran and his representative's contentions regarding the etiology of the claimed bilateral hearing loss disability. To the extent that the Veteran and his representative themselves contend that a medical relationship exists between the Veteran's claimed bilateral hearing loss disability and his service, the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In the instant case, however, the Board finds that a bilateral hearing loss disability is not a disability subject to lay diagnosis as this diagnosis requires medical training. More significantly, the Veteran and his representative do not have the medical expertise to provide an opinion regarding the claimed bilateral hearing loss disability etiology. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the VA examiners provided detailed rationales in support of their opinions and cited to the relevant evidence. For this reason, the VA examiners' opinions are the most probative evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (noting that a factor for assessing the probative value of a medical opinion includes the thoroughness and detail of the opinion).

Thus, the Veteran and his representative's assertions that there is a relationship between the claimed bilateral hearing loss disability and the Veteran's service are not sufficient in this instance and are outweighed by other probative evidence of record. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

James A. DeFrank

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board D. Shorafa

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.

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