Citation Nr: 0005103 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 96-39 205 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Whether the veteran's claim of entitlement to service connection for a liver condition, claimed as due to exposure to ionizing radiation, is well grounded. 2. Whether the veteran's claim of entitlement to service connection for a stomach condition, claimed as due to exposure to ionizing radiation, is well grounded. 3. Whether the veteran's claim of entitlement to service connection for a condition of the pancreas, claimed as due to exposure to ionizing radiation, is well grounded. 4. Whether the veteran's claim of entitlement to service connection for a gallbladder condition, claimed as due to exposure to ionizing radiation, is well grounded. 5. Whether the veteran's claim of entitlement to service connection for a lungs condition, claimed as due to exposure to ionizing radiation, is well grounded. 6. Whether the veteran's claim of entitlement to service connection for a heart condition with hypertension, claimed as due to exposure to ionizing radiation, is well grounded. 7. Whether the veteran's claim of entitlement to service connection for hearing loss in the left ear, claimed as a condition of the left ear drum, is well-grounded. REPRESENTATION Veteran represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD M.S. Lane, Associate Counsel INTRODUCTION The veteran served on active duty from December 1945 to October 1947. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 1996 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which denied as not well grounded the veteran's claims of entitlement to service connection for conditions of the liver, stomach, pancreas, gallbladder, lungs, and heart (with hypertension), all claimed as due to exposure to ionizing radiation. The RO also denied as not well grounded a claim of entitlement to service connection for a left ear condition. In a statement submitted in July 1996, the veteran requested a personal hearing before a hearing officer at the RO. In October 1996, he withdrew this request. FINDINGS OF FACT 1. The veteran served aboard the USS Saidor during Operation Crossroads from July 1, 1946 through January 28, 1947, and was exposed to a dose of ionizing radiation calculated as 0.100 rem. 2. There is no competent medical evidence of current diagnoses related to the claimed conditions of the lungs, liver, and gallbladder, and no competent medical evidence of nexus between these claimed disabilities and exposure to ionizing radiation in service. 3. There is no competent medical evidence of record of a nexus between the veteran's in-service exposure to ionizing radiation and his coronary artery disease, hypertension, peptic ulcer disease, and pancreatitis, claimed as a heart condition with hypertension, a stomach condition, and a pancreatic condition. 4. There is no competent medical evidence of a current left ear hearing loss disability and no competent medical evidence of a nexus between this claimed disability and service. CONCLUSIONS OF LAW 1. Coronary artery disease, hypertension, peptic ulcer disease, and pancreatitis are not recognized by VA as being presumptively related to exposure to ionizing radiation. 38 C.F.R. § 3.309 (1999). 2. The veteran's claims of entitlement to service connection for conditions of the liver, stomach, gallbladder, lungs, heart (with hypertension), and pancreas, claimed as due to exposure to ionizing radiation, are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran's claim of entitlement to service connection for hearing loss of the left ear, claimed as a condition of the left eardrum, is not well grounded. 38 U.S.C.A. § 5107(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is claiming entitlement to service connection for conditions of the liver, stomach, pancreas, gallbladder, heart (with hypertension), and lungs. He essentially contends that each of these conditions is the result of exposure to radiation he allegedly experienced while serving aboard the USS Saidor during Operation Crossroads in 1946. He is also seeking entitlement to service connection for hearing loss of the left ear. In the interest of clarity, the Board will review the law, VA regulations and other authority which may be relevant to this claim; briefly describe the factual background of this case; and then proceed to analyze the claims and render a decision. Preliminary Matter The Board notes that some of the veteran's service medical records appear to be missing. The record reflects that throughout 1948 and 1949, the RO made several attempts to locate the veteran's complete service medical records, which included at least three requests made to the Bureau of Medicine and Surgery for the veteran's Navy medical records. Attempts to locate these records were unsuccessful. Many of the veteran's service medical records appear to have been permanently lost. The Board is of course aware of the decision of Hayre v. West, 188 F.3d 1327 (Fed. Cir. 1999), which held that a single request for pertinent service medical records does not fulfill the duty to assist and that inherent in the duty to assist is a requirement to notify the veteran if VA is unable to obtain pertinent service medical records so that the veteran may know the basis for the denial of his claim; may independently attempt to obtain service medical records; and may submit alternative evidence. In this case, the record reflects the RO's multiple attempts to obtain the veteran's service medical records. Moreover, the service medical records which are available do establish that he participated in Operations Crossroads during service. The veteran does not contend that he actually had the claimed disabilities during service and the service medical records would therefore shed no light on that aspect of his claim. Cf. Brock v. Brown, 10 Vet. App. 155, 161-2 (1997). Notwithstanding the above, the United States Court of Appeals for Veterans Claims (the Court) has held that in cases where records once in the hands of the government are lost, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the- doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Board's analysis has been undertaken with this heightened duty in mind. The case law does not, however, lower the legal standard for proving a claim for service connection but rather increases the Board's obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the appellant. Russo v. Brown, 9 Vet. App. 46 (1996). Relevant Law and Regulations Service connection - in general In general, applicable laws and regulations state that service connection may be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That a condition or injury occurred in service alone is not enough; there must be a current disability resulting from that condition or injury. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). For certain chronic disorders, such as cardiovascular disease and peptic ulcer disease, service connection may be granted on a presumptive basis if the disease is manifested to a compensable degree within one year following discharge. 38 U.S.C.A. § 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Service connection - radiation exposure Service connection for disability that is claimed to be attributable to exposure to ionizing radiation during service can be demonstrated by three different methods. Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are certain types of cancer that are presumptively service connected specific to radiation-exposed veterans. 38 U.S.C.A. § 1112(c); 38 C.F.R. § 3.309(d) (1999). Second, "radiogenic diseases" may be service connected pursuant to 38 C.F.R. § 3.311 (1999). Third, service connection may be granted under 38 C.F.R. § 3.303(d) when it is established that the disease diagnosed after discharge is the result of exposure to ionizing radiation during active service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). A "radiation-exposed veteran" is defined by 38 C.F.R. § 3.309(d)(3) as either a veteran who while serving on active duty or on active duty for training or inactive duty training, participated in a radiation-risk activity. "Radiation-risk activity" is defined to mean onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima, Japan or Nagasaki, Japan by United States forces during the period beginning on August 6, 1945, and ending on July 1, 1946; or internment as a prisoner of war (or service on active duty in Japan immediately following such internment) during World War II which resulted in an opportunity for exposure to ionizing radiation comparable to that of the United States occupational forces in Hiroshima or Nagasaki during the period from August 6, 1945 through July 1, 1946. 38 C.F.R. § 3.309(b)(i), (ii). The term "onsite participation" is specifically defined as: a) presence at a test site, or performance of official military duties in connection with ships, aircraft, or other equipment used in direct support of a nuclear test during the official operational period of an atmospheric nuclear test, b) presence at the test site or other test staging area to perform official military duties in connection with completion of projects related to the nuclear test including decontamination of equipment used during the nuclear test during the six month period following the official operational period of an atmospheric nuclear test, c) service as a member of the garrison or maintenance forces on Eniwetok during the periods June 21, 1951, through July 1, 1952; August 7, 1956, through August 7, 1957, or November 1, 1958, though April 30, 1959, d) assignment to official military duties at Naval Shipyards involving the decontamination of ships that participated in Operation Crossroads. 38 C.F.R. § 3.309(d)(iv). For tests conducted by the United States, the term "operational period" includes participation in Operation Crossroads for the period July 1, 1946 through May 20, 1948. 38 C.F.R. § 3.311 provides instruction on the development of claims based on exposure to ionizing radiation, and does not refer to any other types of radiation exposure. Section 3.311(a) calls for the development of a dose assessment where it is established that a radiogenic disease first became manifest after service, where it was not manifest to a compensable degree within any applicable presumptive period specified in either § 3.307 or § 3.309, and where it is contended that the disease is a result of ionizing radiation in service. "Radiogenic disease" is defined as a disease that may be induced by ionizing radiation, and specifically includes the following: thyroid cancer, breast cancer, bone cancer, liver cancer, skin cancer, esophageal cancer, stomach cancer, colon cancer, pancreatic cancer, kidney cancer, urinary bladder cancer, salivary gland cancer, multiple myeloma, posterior subcapsular cataracts, non-malignant thyroid nodular disease, ovarian cancer, parathyroid adenoma, tumors of the brain and central nervous system, cancer of the rectum, lymphomas other than Hodgkin's disease, prostate cancer, and any other cancer. 38 C.F.R. § 3.311(b)(2)(i)- (xxiv) (1999). Section 3.311(b)(5) requires that bone cancer become manifest within 30 years after exposure, and that prostate cancer become manifest 5 years or more after exposure. 38 C.F.R. § 3.311(b)(5). Service-connection - well-grounded claims The threshold question with regard to a claim for service connection is whether the claim is well grounded pursuant to 38 U.S.C.A. § 5107. In order for a claim to be well grounded, there must be competent evidence of (1) a current disability (a medical diagnosis); (2) incurrence or aggravation of a disease or injury in service (lay or medical evidence); and (3) a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Where the determinative issue involves a question of medical diagnosis or causation, only individuals possessing specialized medical training and knowledge are competent to render such an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Factual Background As noted above, many of the veteran's service medical records appear to have been lost. Included among the service medical records that are presently associated with the claims folder is a report of medical history dated at discharge in October 1947. In the report, an examiner noted that the veteran had required neither hospitalization nor treatment, and that he was physically qualified for discharge. The examiner further noted that the veteran had participated in Operations Crossroads during service. There are no pertinent medical records covering several decades after service. In August 1984, the veteran filed a claim of entitlement to service connection for a right cerebellar infarction, a nervous disorder, and headaches. He contended that these conditions were the result of exposure to radiation he experienced while serving on the USS Saidor during Operation Crossroads. In support of his claim, he submitted a VA Discharge Summary dated in April 1984 showing treatment for a right cerebellar infarction, depression, and hypertension. In a signed statement submitted in November 1984, the veteran reported that the USS Saidor was the official photographer ship for Operation Crossroads and was also the closest ship to ground zero during each explosion, although the veteran acknowledged that he did not know the precise distance between the ship and ground zero. He further reported that he was on the flight deck during these tests and that the ship had to retreat several times because of heat in the area. The veteran indicated that on one occasions he and another soldier were painting the side of the ship soon after an underwater explosion. He stated that they were immediately stripped of they clothes when they returned because they were "highly radioactive." In November 1984, the RO sent a letter to the Office of the Chief of Naval Operations requesting that the department confirm the veteran's presence at Operation Crossroads and the recorded level of his radiation exposure. In a response letter received in December 1984, the Office of the Chief confirmed that the veteran served as a Seaman Apprentice aboard the USS Saidor during Operation Crossroads in 1946. A search of Crossroads dosimetry data as well as the veteran's medical record reportedly revealed no record of radiation exposure. Because film badges were apparently not issued to the veteran during Operation Crossroads, a calculated radiation exposure based on a scientific dose reconstruction was assigned. This calculated exposure of 0.100 rem gamma reportedly covered the period of July 1, 1946 through January 28, 1947. The calculation was noted to take into account radiation exposure levels experienced while serving aboard the USS Saidor as well as the contribution of low-level radiation from the lagoon water. The Office of Chief of Naval Operations also submitted a document issued in August 1984 entitled History of USS Saidor (CVE-117) During Operation Crossroads (1946). This document describes the history of the USS Saidor from its arrival in Bikini Lagoon in May 1946 through its decontamination at Sand Diego Naval Shipyard in January 1947. The USS Saidor was designated as the photographic ship for the operation and participated in tests entitled Able (air detonation) and Baker (shallow underwater detonation). Compared to other tests, exposure for Crossroads was determined to be relatively low, with approximately 99 percent of all record radiation exposures ranging from zero to 0.5 rem gamma. The highest recorded cumulative radiation exposure recorded for any individual at Crossroads was 3.72 rem gamma. This exposure was reported to be within the present national occupational radiation exposure standards, which permitted 5.0 rem gamma per year. In a January 1985 rating decision, the RO denied the veteran's claims of entitlement to service connection for a right cerebellar infarction, a nervous disorder, and headaches. The RO determined that it could not be reasonably concluded that the veteran's disabilities were secondary to his level of radiation exposure. A VA Discharge Summary dated in January 1985 shows that the veteran was hospitalized for treatment of depression. Upon discharge, he was diagnosed with adjustment disorder with depression, a borderline personality, arteriosclerotic cardiovascular disease with hypertension status post a left cerebrovascular accident, lingular pneumonia, and erythema annulare centrifugum. In February 1995, the veteran was hospitalized with complaints of chest pains and shortness of breath. The VA physician noted a history of hypertension, hypercholesterolemia, status post CVA (cerebrovascular accident) in 1991, peripheral vascular disease, and peptic ulcer disease. Upon discharge, he was diagnosed with coronary artery disease and unstable angina, hypertension, carotid artery disease (status post CVA in 1991), and peptic ulcer disease (status post Billroth II gastrectomy). In April 1995, the veteran filed a claim of entitlement to service connection for conditions of the stomach, liver, pancreas, gallbladder, lungs, heart, and hypertension. He contended that these disabilities were all related to radiation exposure during Operation Crossroads in 1946. He also filed a claim of entitlement to service connection for a "left ear drum." In support of his claims, he submitted a copy of the August 1984 document entitled History of USS Saidor (CVE-117) During Operation Crossroads (1946). In April 1995, the veteran was again hospitalized with complaints of recurring chest pain. He also reported a history of transient left arm and left leg weakness lasting for two hours at a time. The May 1995 VA discharge summary reflects that the veteran was diagnosed with unstable angina, coronary artery disease, hypertension, a history of pancreatitis, peptic ulcer disease, BPH (benign prostatic hypertrophy), and CVA. In a statement submitted in June 1996, the veteran reported that he fell overboard on one occasion while serving aboard the USS Saidor, resulting in an overdose of radiation. He further reported that he was forced to strip to his bare skin at that time and to take four or five showers in order to wash it off. He indicated that his son was born very badly deformed and that his son eventually went blind and became paralyzed before his death at 16 years of age. The veteran contended that his son's condition was proof of his in- service exposure to radiation. The veteran also reported that during service he went to sick bay on several occasions for treatment of his left ear, and that he has now lost all of his hearing in his left ear. Analysis In light of the similar factual circumstances underlying the veteran's claims of entitlement to service connection for conditions of the liver, stomach, pancreas, gallbladder, lungs, and heart (with hypertension), the Board will combine its analysis of these claims into one discussion. Specifically, the Board will first address the potential application of presumptive service connection for radiation- exposed veterans pursuant to 38 C.F.R. § 3.309(d). The Board will then address the relevance of the "radiogenic diseases" provisions of 38 C.F.R. § 3.311. Lastly, the Board will discuss whether service connection has been established by way of proof of actual direct causation under 38 C.F.R. § 3.303(d). See Combee, 34 F.3d at 1043-1044. The Board will then separately discuss the veteran's claim of entitlement to service connection for hearing loss in the left ear, claimed as a condition of the left eardrum. Entitlement to service connection for conditions of the liver, stomach, pancreas, gallbladder, lungs, and heart (with hypertension). As noted above, in order for a claim to be well grounded, there must be competent evidence of (1) a current disability (a medical diagnosis), (2) incurrence or aggravation of a disease or injury in service (lay or medical evidence), and (3) a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza, 7 Vet. App. at 506. It must first be shown, therefore, that there is medical evidence of a current, pertinent disability. The second requirement for a well-grounded claim under Caluza is evidence of a disease or injury in service. For direct service connection, there must be medical evidence of a link between the two. This must be established by competent medical evidence. See Layno v. Brown, 6 Vet. App. 465, 4709 (1994) and cases cited therein. Presumptive service connection - radiation exposure The record reflects that the veteran served as a Seaman Apprentice aboard the USS Saidor during its participation in Operation Crossroads from July 1, 1946 through January 28, 1947. Thus, the Board finds that the veteran is considered a "radiation exposed veteran" as defined by the provisions of 38 C.F.R. § 3.309(d)(3). However, status as a radiation-exposed veteran is not sufficient, by itself, to warrant presumptive service connection under the provisions of 38 C.F.R. § 3.309. Rather, in order to warrant such a presumption, the veteran must be diagnosed with one of the presumptive diseases specifically listed under 38 C.F.R. § 3.309(d)(2). In this case, the veteran has submitted competent medical evidence showing diagnoses of coronary artery disease and hypertension, peptic ulcer disease, and a history of pancreatitis. None of these diseases are specified as one of the disabilities presumed to be related to exposure to radiation pursuant to 38 C.F.R. §§ 3.307 and 3.309. Accordingly, service connection for these diseases, claimed as a stomach condition, a pancreatic condition, and a heart condition with hypertension, cannot be granted on a presumptive basis. Furthermore, although the veteran is also seeking service connection for conditions of the lungs, gallbladder, and liver, the Board notes that there is no competent medical evidence of record of any diagnoses related to these claimed conditions. See Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) [in order for a claim to be well grounded, there must be a current disability which is related to an injury or disease which was present during service.] Thus, the Board can find no basis for applying the presumptive provisions of 38 C.F.R. § 3.309. In short, the disorders granted presumptive service connection under 38 C.F.R. § 3.309(d) for radiation exposure are specified with precision, and the disorder for which service connection is sought must be specified at 38 C.F.R. § 3.309(d) in order to enjoy the presumption of service incurrence thereunder. Because the veteran's claimed disabilities are not included among the diseases specified at 38 C.F.R. § 3.309(d), the Board finds that the veteran's claims as evaluated under the regulations governing presumptive service connection based on radiation exposure are not well-grounded. Radiogenic diseases under 38 C.F.R. § 3.311 The provisions of 38 C.F.R. § 3.311 provide for development of claims based on a contention of radiation exposure during active service and post-service development of a radiogenic disease. The provisions do not give rise to a presumption of service connection, but rather establish a procedure for handling claims brought by radiation exposed veterans or their survivors. See Ramey v. Gober, 120 F.3d 1239, 1244 (Fed. Cir. 1997). Section 3.311 essentially states that, in all claims in which it is established that a radiogenic disease first became manifest after service, and it is contended that the disease resulted from radiation exposure, a dose assessment will be made. As noted above, the veteran has been diagnosed with coronary artery disease and hypertension, peptic ulcer disease, and a history of pancreatitis. These diseases are not among the radiogenic diseases specified in section 3.311(b)(2). Because the Board can find no other competent medical evidence demonstrating that the veteran was ever diagnosed with one of the radiogenic diseases listed in 3.311(b)(2), the Board finds that the veteran's claims as evaluated under the regulations governing service connection for radiogenic diseases are not well-grounded. Direct service connection Notwithstanding the foregoing, the United States Court of Appeals for the Federal Circuit has determined that the regulations governing presumptive service connection for radiation exposure do not preclude a veteran from establishing service connection with proof of actual direct causation. Combee, 34 F.3d at 1043-1044. Accordingly, the Board will proceed to evaluate the veteran's claim under the regulations governing direct service connection. To reiterate, in order for a claim to be well grounded, there must be competent evidence of (1) a current disability (a medical diagnosis); (2) incurrence or aggravation of a disease or injury in service (lay or medical evidence); (3) a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). With respect to his claims of entitlement to service connection for a stomach condition, a heart condition with hypertension, and a pancreatic condition, the Board finds that the veteran has satisfied the first element of Caluza, medical evidence of a current disability. This conclusion is based upon VA discharge summaries dated between February 1995 and May 1995, which indicate diagnoses of coronary artery disease with hypertension, peptic ulcer disease, and a history of pancreatitis. The Board further finds that the veteran has not satisfied the second element of Caluza, incurrence in service. Absent the statutory presumption of radiation exposure, there is no competent evidence of significant radiation exposure. In determining whether a claim is well grounded, a claimant's evidentiary assertions are presumed true unless inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19, 21 (1993). Although the veteran's statements that he fell into the lagoon are presumed to be credible, he is not competent to determine the radiation dosage therefrom. The Board also finds that the veteran has failed to satisfy the third element of Caluza, as there is no competent medical evidence of record of a nexus between veteran's exposure to radiation and his claimed disabilities, including coronary artery disease, hypertension, peptic ulcer disease, and pancreatis. Although the veteran may believe that such a relationship exists, as a lay person, he is not considered competent to provide medical nexus evidence so as to render his claims well grounded. Espiritu, 2 Vet. App. at 495; Grottveit, 5 Vet. App. at 93. This includes the veteran's contention that because his son was born with a birth defect, this is proof that he, the veteran, was exposed to radiation. Furthermore, the first evidence of coronary artery disease, hypertension, and peptic ulcer disease does not appear in the record until many years after discharge from service. Thus, the Board finds the presumptive provisions of 38 C.F.R. § 3.309(a) regarding chronic diseases are not for application in this case. With respect to his claims of entitlement to service connection for conditions of the lungs, gallbladder, and liver, the Board finds that the veteran has failed to satisfy both the first and third elements of Caluza, as there is no competent medical evidence of record demonstrating current diagnoses related to these claimed conditions, no evidence of in-service incurrence, and no competent medical evidence demonstrating a nexus between these claimed disabilities and service. The Court has held that "[i]n the absence of competent medical evidence of a current disability and a causal link to service or evidence of chronicity or continuity of symptomatology, a claim is not well grounded." Chelte v. Brown, 10 Vet. App. 268 (1997). In Brammer, 3 Vet. App. at 225, the Court noted that Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability. In Rabideau, 2 Vet. App. at 143, the Court held that the failure to demonstrate that a disability is currently manifested constitutes failure to present a plausible or well-grounded claim. In short, the Board finds that there is no competent medical evidence of current diagnoses related to his claimed conditions of the liver, gallbladder, or lungs. The Board further finds that there is no competent medical evidence of a nexus between his in-service exposure to radiation and his claimed disabilities, including his coronary artery disease with hypertension, peptic ulcer disease, or pancreatitis (claimed as conditions of the heart, stomach, and pancreas). See Caluza, 7 Vet. App. at 506 (1995). The Court has held that in the absence of a causal link to service, a claim is not well grounded. See Chelte v. Brown, 10 Vet. App. 268 (1997). Therefore, the Board finds that he has not submitted well-grounded claims of entitlement to service connection pursuant to 38 U.S.C.A. § 5107(a). Thus, his claims are denied. Entitlement to service connection for hearing loss in the left ear, claimed as a condition of the left eardrum. The veteran is also seeking entitlement to service connection for hearing loss in the left ear, claimed as a condition of the left eardrum. As an initial matter, the Board notes that it is unclear from the record whether the veteran is contending that his left ear hearing loss is also related to his radiation exposure in service, or whether he is contending that his hearing loss is related to some other injury or disease incurred in service. Pertinent regulations provide that service connection for impaired hearing shall only be established when hearing status as determined by audiometric testing meets pure tone and speech recognition criteria. Audiometric testing measures threshold hearing levels (in decibels) over a range of frequencies (in Hertz). See, in general, Hensley v. Brown, 5 Vet. App. 155, 158 (1993). The determination of whether a veteran has a disability based on hearing loss is governed by 38 C.F.R. § 3.385 (1999). 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, 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 (1999). In this case, there is no competent medical evidence of a left ear hearing loss disability as defined by 38 C.F.R. § 3.385. While the veteran is competent to report symptoms such as difficulty with his hearing, he is not competent to provide a medical diagnosis of a left ear hearing loss disability as defined by 38 C.F.R. § 3.385. See Espiritu, 2 Vet. App. at 495; Grottveit, 5 Vet. App. at 93. Thus, the veteran's claim fails on the basis of the lack of a diagnosis of a current disability. See Rabideau, supra. To the extent that the veteran is contending that his left ear hearing loss is related to radiation exposure in service, the Board reiterates its analysis above with respect to the claimed conditions of the lungs, gallbladder, and liver. The Board can find no basis for applying the presumptive provisions of 38 C.F.R. § 3.309 or the radiogenic diseases provisions of 38 C.F.R. § 3.311, as there is no evidence of record demonstrating that his claimed left ear hearing loss is related to any of the diseases specified in these sections. Furthermore, to the extent that the veteran is claiming that his left ear hearing loss is related to some other incident of service, see Combee, although the veteran has reported that he was treated for his left ear while on board the USS Saidor, he has submitted no competent medical evidence of a current left ear hearing loss disability and no competent medical evidence of a nexus between that claimed disability and service. See Caluza, 7 Vet. App. at 506. In summary, the Board finds that there is no competent medical evidence of a current hearing loss disability in the left ear, and no competent medical evidence of a nexus between his claimed hearing loss disability and service, including exposure to radiation in service. For the reasons and bases expressed above, the Board finds that the veteran has not submitted a well-grounded claim of entitlement to service connection pursuant to 38 U.S.C.A. § 5107(a). Thus, his claim is denied. Additional Matter When a claim is not well grounded, the VA does not have a duty to assist the veteran in the development of facts pertaining to his claim. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). However, the VA may be obligated to advise the veteran of the evidence needed to complete the application. This obligation depends upon the particular facts of the case and the extent to which the VA has previously advised the veteran of the evidence needed to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69 (1995). In this case, the Board is not on notice of the existence of any other possible evidence that exists that, if true, would make the veteran's claims of entitlement to service connection plausible. This decision serves to inform the veteran of the kind of evidence that would be needed to make his claims well grounded. ORDER Well-grounded claims not having been submitted, the veteran's claims of entitlement to service connection for conditions of the liver, stomach, pancreas, gallbladder, heart (with hypertension), and lungs, claimed as due to exposure to ionizing radiation, is denied. A well-grounded claim not having been submitted, the veteran's claim of entitlement to service connection for hearing loss of the left ear, claimed as a condition of the left eardrum, is denied. Barry F. Bohan Member, Board of Veterans' Appeals