BVA9502306 DOCKET NO. 92-03 605 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to secondary service connection for arthritis of the right temporomandibular joint. 2. Entitlement to secondary service connection for headaches. 3. Entitlement to service connection for chronic otitis media. 4. Entitlement to service connection for bilateral hearing loss. 5. Entitlement to service connection for tinnitus. 6. Entitlement to an increased evaluation for the residuals of a fracture of the right mandible with loss of motion, currently evaluated as 20 percent disabling. 7. Entitlement to an increased evaluation for the residuals of a fracture of the right mandible with sensory loss and pain, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD John J. Crowley, Associate Counsel INTRODUCTION The veteran served on active duty from June 1979 to October 1981. This matter is currently before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In April 1993, the case was remanded to the RO for additional development. The veteran has continued his appeal along with three additional issues which are currently before the Board in appellate status. In April 1994, the veteran filed a claim, requesting an earlier effective date for his combined 30 percent disability evaluation. A supplemental statement of the case was issued in May 1994, concerning this new issue; however, a substantive appeal as to that determination has not been received from the veteran, and the matter is not therefore before the Board at this time, as there is currently no subject-matter jurisdiction thereof. 38 U.S.C.A.§ 7105 (West 1991). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he is more severely disabled than he is presently evaluated. He contends that the residuals of a fracture of the right mandible has left him with the ability to open his mouth to only 5.5 millimeters without pain. The veteran contends that he should receive a 40 percent evaluation for this condition under 38 C.F.R. Part 4, Diagnostic Code 9905 (1993). He also contends that his bilateral defective hearing loss and tinnitus were the result of his service as a jet mechanic. He asserts that no hearing examination was conducted by a competent hearing specialist on VA examination in August 1984. It is further contended that the residuals of his service-connected fracture of the right mandible include arthritis and headaches. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and materials of record in the veteran's claims file. On the basis of its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim of secondary service connection for arthritis of the right temporomandibular joint is well grounded; therefore, the claim is dismissed. Further, based on a review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claims of entitlement to service connection for bilateral defective hearing, tinnitus, chronic otitis media and an increased evaluation for his service-connected fracture of the right mandible based on sensory deprivation and pain. However, it is the decision of the Board that the evidence of record supports a claim of entitlement to secondary service connection for headaches and an increased evaluation to 30 percent for residuals of a fracture of the right mandible with limited temporomandibular articulation. FINDINGS OF FACT 1. No competent medical evidence is of record indicating that the veteran has arthritis of the right temporomandibular joint or that his claim of secondary service connection therefor is meritorious on its own or capable of substantiation. 2. All available, relevant evidence necessary for an equitable disposition of the veteran's appeal on the issues of entitlement to service connection for headaches, hearing loss, tinnitus, otitis media and an increased evaluation for the residuals of a fracture of the right mandible have been obtained by the RO. 3. Current findings of headaches cannot be dissociated from the veteran's service connected residuals of a fracture of the right mandible. 4. Otitis media, sustained in service, was acute and transitory in nature. 5. No active otitis media is currently evident or shown to be related to the veteran's active service. 6. Neither hearing loss nor tinnitus were evident during service, or for years thereafter, and they are not otherwise shown to be related to service. 7. The residuals of the veteran's fracture of the right mandible are primarily manifested by limited motion of temporomandibular articulation to 14.5 millimeters with pain, sensory loss, a speech impairment, tenderness and pain. 8. No unusual or exceptional disability factors have been presented. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for arthritis of the right temporomandibular joint on a secondary basis is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. Resolving the benefit of the doubt in the veteran's favor, his current headaches are proximately due to or the result of his service-connected fracture of the right mandible. 38 U.S.C.A. § 5107(b) (West 1991); 38 C.F.R. § 3.310(a) (1993). 3. Chronic otitis media was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. § 3.303(d) (1993). 4. Bilateral hearing loss was not incurred in or aggravated by the veteran's active military service, nor may sensorineural hearing loss be presumed to have been incurred in service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (1993). 5. The veteran's tinnitus was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 1154, 5107 (West 1991); 38 C.F.R. § 3.303(d) (1993). 6. With resolution of the benefit of the doubt in the veteran's favor, the criteria for a rating of 30 percent for the residuals of a fracture of the right mandible, based on limitation of motion, have been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 3.321(b), 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, Part 4, Diagnostic Codes 9904 and 9905 (1993). 7. The criteria for a rating in excess of 10 percent for the residuals of a fracture of the right mandible, based on sensory loss and pain, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b), 4.2, 4.3, 4.7, 4.10, 4.14, 4.20, 4.40, Part 4, Diagnostic Code 8207 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The threshold question is whether the veteran has presented evidence of well-grounded claims; that is, claims that are plausible and meritorious on their own or capable of substantiation. If he is not, his appeals must fail. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet.App. 78 (1990). If he has not submitted evidence of well-grounded claims, there is no duty to assist him in developing facts pertinent to those claims. 38 U.S.C.A. § 5107(a). The veteran is seeking service connection for arthritis of the right temporomandibular joint and headaches secondary to the service-connected residuals of a right mandible fracture. Under the law, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a) (1993). While the veteran was treated for headaches prior to the fracture of the right mandible during his active service, based on his own statements, there is no assertion that his current headaches or arthritis were present during his active service or that he is seeking service connection therefor on a direct basis. I. Background The veteran's service personnel records reveal that he was a tactical aircraft maintenance specialist. On February 1979 examination for entrance into active duty, the following threshold hearing levels, in decibels, were reported on audiometric testing: HERTZ 500 1000 2000 3000 4000 RIGHT 20 15 10 5 10 LEFT 15 15 10 5 10 Audiometric testing measures threshold hearing levels (in decibels) (dB) over a range of frequencies in Hertz (Hz); the threshold for normal hearing is from 0 dB to 20 dB, a higher threshold indicates some degree of hearing loss. Hensley v. Brown, 5 Vet.App. 155, 157 (1993) (citing CURRENT MEDICAL DIAGNOSIS AND TREATMENT 1101-11 (Stephen A. Schroeder et al. eds., 1988)). On audiometric examination in September 1979, the following threshold hearing levels were reported: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 5 5 5 LEFT 15 15 0 5 5 On January 1980 audiometric testing, the following results were reported: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 5 10 10 LEFT 15 15 10 10 15 At a September 1980 test, the following threshold hearing levels were reported on audiometric testing: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 0 5 10 LEFT 10 5 5 5 5 In February 1981, the veteran was treated for otitis media. No further treatment for this condition over the remainder is noted. In April 1981, the veteran was treated for a displaced right mandibular angle fracture after being struck by another person at the Union Station Bar in Mesa, Arizona. X-ray studies that month revealed an oblique fracture coursing through the body of the mandible on the right. The fracture involved the base of the second molar on the right. No additional abnormalities were found. The veteran underwent surgery to correct this condition and was returned to light duty that month. At his September 1981 separation examination, the veteran described his health as "excellent." Significantly, the veteran denied any hearing loss. On examination, a three centimeter surgical scar was noted on the mandible. The veteran had full strength and range of motion of the right mandibular angle. At his September 1981 examination for separation from active duty, the following threshold hearing levels were reported on audiometric testing: HERTZ 500 1000 2000 3000 4000 6000 RIGHT 15 10 10 15 0 0 LEFT 10 10 5 10 0 0 Following the veteran's October 1981 discharge from active service, he filed a claim for VA compensation for the residuals of a broken jaw in June 1984. At that time, he made no reference to the presence of any hearing loss, tinnitus, otitis media, arthritis or headaches. In June 1984, the veteran was treated as an outpatient at a VA facility for a sinus problem, which he indicated caused him frequent headaches. At an August 1984 VA medical examination, the veteran complained of bad sinuses with pain in his eyes, blurred vision, headaches and a partial feeling in his mouth. Examination revealed a lack of full sensation on the veteran's right cheek. Significantly, the veteran's ear canals were found to be clear and the tympanic membranes were described as intact. There was no objective hearing loss noted by the examiner. The final diagnosis was status post fracture of the jaw with surgical repair and residual sensory loss and recurrent pain. Recurrent sinus congestion was also noted. X-ray studies of the veteran's mandible under multiple projections revealed surgical wiring indicating previous fracture with no other bony radiopathology seen. In an August 1984 RO rating decision, service connection for postoperative residuals of a fracture of the right mandible with residual sensory loss and recurrent pain was granted, and a 10 percent evaluation was assigned. In a March 1985 statement, Edwin D. Farrar, D.D.S., stated that the veteran had been examined with a complaint of severe pain in the temporomandibular joint and right posterior submandibular area with pain radiating to the temporal and auricular areas. He also stated that the veteran had three episodes of an "open-lock" of his jaw. Clinical examination revealed a prognathic mandible with resulting malocclusion, severe tenderness to palpation of the right submandibular area, the right floor of the mouth and the right lateral pterygoid muscle. A diagnosis of myofascial pain dysfunction with possible internal derangement of the temporomandibular joint was made along with a prognathic mandible. At an April 1991 VA dental consultation, the veteran indicated that he suffered from a paralysis of the right facial nerve with paralysis of the right anterior two-thirds of the tongue and the right face. This condition caused him to spill liquids when drinking. He complained of increasingly severe headaches, involuntary twitching of the right eye and ringing of the right ear. Since his injury in service, he noted experiencing severe headaches and pain in the right temporomandibular joint. In order to sleep he used Darvocet, Motrin and Robaxin. Previous X-rays had revealed calcification of the stylohyoid ligament. On examination, it was reported that the veteran could occlude his teeth with pain and had approximately 50% limitation on opening. His speech was impaired secondary to paresthesia of the tongue and limited opening. Significantly, the examiner noted that the veteran had a preexisting arch-sized discrepancy and prognathism which was apparently greatly aggravated by his injury. In a May 1991 rating decision, the veteran's evaluation for residuals of his right mandible fracture was divided into two separate evaluations: Postoperative residuals of a fractured right mandible with limited range of motion, evaluated as 10 percent disabling; and postoperative residuals of a fracture of the right mandible with sensory loss and pain, evaluated as 10 percent disabling. In April 1993, the Board remanded the case to the RO for additional evidentiary development. At a July 1993 VA dental examination, the examiner noted that the veteran's mouth opened to 5.5 millimeters and, with pain, would open to 14.5 millimeters. The mouth could reportedly be "forced open" by the examiner to 26.4 millimeters. X-ray studies did not reveal the presence of arthritis of the right temporomandibular joint. The VA examiner offered the opinion that the veteran's complaints of headaches and pain resulted from his severe prognathism. Of record is a May 1993 audiometric evaluation from the Beckley Hearing Center, received in August 1993, indicating that the veteran had mild conductive hearing loss, bilaterally. On October 1993, in a VA audiometric examination, the following threshold hearing levels were reported on audiometric testing: HERTZ 500 1000 2000 3000 4000 RIGHT 60 65 60 65 60 LEFT 50 45 50 50 45 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and 100 percent in the left ear. The audiological test results indicated moderate sensorineural hearing loss bilaterally. Speech discrimination scores were described as "excellent." In an October 1993 VA audio-ear disease examination, the veteran complained of tinnitus and bilateral hearing loss which he indicated he had noticed for the last six years. On examination, the examiner noted neurosensory hearing loss with slight retraction of the tympanic membrane in the right ear and the possibility of previous serious otitis media and adherence. The examiner noted the right tympanic membrane was slightly concave, sunken and the middle ear thickened. He noted the possibility of a previous infection in the right ear. The left tympanic membrane was normal. No active ear disease was present. The diagnosis was neurosensory hearing loss which was possibly "exaggerated" according to audiological findings. Also mentioned was a previous serous otitis media of the right ear. In a January 1994 rating decision, the veteran was awarded a 20 percent evaluation for the postoperative residuals of a fracture of the right mandible with loss of motion under 38 C.F.R. Part 4, Diagnostic Code 9905. II. Entitlement to Secondary Service Connection for Arthritis of the Right Temporomandibular Joint Unlike civil actions, the VA benefit system requires more than just an allegation. The claimant must submit supporting evidence. Furthermore, the evidence must be sufficient to justify a belief by a fair and impartial individual that the claim is plausible. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). The evidence submitted by the veteran in support of his claim of entitlement to service connection for arthritis secondary to his service-connected residuals from a fracture of the right mandible consists of his own statements. No examiner has supported his assertion that arthritis has any relationship to this service- connected condition. Furthermore, there has been no objective medical evidence presented indicating that the veteran currently has arthritis of the right temporomandibular joint. The July 1993 VA dental examination revealed no evidence of arthritic changes to the temporomandibular joints. The United States Court of Veterans Appeals (Court) has recently issued several important cases concerning the basis for a well- grounded claim. The Court has held that a lay party is not competent to provide probative evidence as to matters requiring expertise arrived at by specialized medical education. Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). Moreover, the Court has held that where the determinative issue involves medical causation or diagnosis, there must be competent medical evidence supporting a claim to make it "plausible" and, thus, well grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). The veteran's lay assertion is to the effect that a causal link exists between his service-connected disability and the alleged subsequent development of headaches or arthritis are neither competent or probative of the issue in question. Indeed, in Moray v. Brown, 5 Vet.App. 211 (1993), the Court noted that lay persons are not competent to offer medical opinions and, therefore, those opinions do not even serve as a basis for a well-grounded claim. In this case, there is no competent medical evidence of record to support the contention that there is a relationship between the veteran's service-connected residuals of a fracture to the right mandible and any claimed arthritis. As indicated earlier, although a claim may not be conclusive, it must be accompanied by evidence sufficient to justify a belief by a fair and impartial individual that it is well grounded. 38 U.S.C.A. § 5107(a); Tirpak, 2 Vet.App. at 611 (emphasis added). "To be well grounded, a claim 'need not be conclusive,' ... but must be accompanied by evidence that suggests more than a purely speculative basis for granting entitlement to the requested benefits." Dixon v. Derwinski, 3 Vet.App. 261, 262-63 (1992). The mere assertion that a current disability is of a certain etiology, absent supporting evidence, is insufficient to form the base of a claim upon which service connection may be granted. Espiritu, 2 Vet.App. at 494. In order for the veteran to be granted service connection for a disability, there must be evidence of the existence of the disability, as well as the evidence tending to link the present disability to a disease or injury indicated incident to service. In Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992), the Court, finding no evidence of a current disability, held that the claim was not plausible and, therefore, not well grounded. In this case, there is no current evidence that the veteran has arthritis of the right temporomandibular joint. As noted earlier, under the controlling law and decisions of the Court, the initial burden is on the shoulders of the veteran to demonstrate that the claim is well grounded. See Murphy, 1 Vet.App. at 81. In light of the discussion above, the application of law to the facts in this case mandates the conclusion that the veteran's claim of secondary service connection for arthritis of the right temporomandibular joint is not well grounded. When the Board addresses in its decision a question that has not been addressed by the RO as, in this case, the question of whether the veteran's claims are well grounded, it must be considered whether the veteran has been given adequate notice to respond and, if not, whether the veteran has been prejudiced thereby. Bernard v. Brown, 4 Vet.App. 384 (1993). However, in light of the implausibility of the veteran's claim on this issue and the failure to meet the initial burden in the adjudication process, the Board concludes that he has not been prejudiced by the decision herein. In this decision, by dismissing his claim as not well grounded, the veteran is not burdened with a prior final adjudication on the merits. Thus, if he is able to submit a well-grounded claim in the future, he will not be faced with the higher hurdle of providing new and material evidence to reopen his claim following a prior final adjudication. 38 U.S.C.A. §§ 5108, 7104, 7105 (West 1991); McGinnis v. Brown, 4 Vet.App. 239, 244 (1993). III. Entitlement to Secondary Service Connection for Headaches With regard to the veteran's other claims, he is competent to testify as to his symptoms of increased difficulty and other symptoms referable to the service-connected residuals of the fracture of the right mandible. Accordingly, the Board finds his claims for increased evaluations for the residuals of a fracture of the right mandible to be well grounded. See King v. Brown, 5 Vet.App. 19 (1993). In view of the October 1993 VA audiological examination which found evidence of hearing loss, the Board finds that the claim that exposure to aircraft noise during service caused hearing loss and tinnitus is plausible, and thus well-grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). Further, based on the fact that the veteran was treated during service for otitis media and that the October 1993 VA examination noted a previous serous otitis media condition, the undersigned finds that this claim is also well grounded. Finally, based on the July 1993 VA dental examination report which concluded that his headaches were linked to his severe prognathism, a condition marked by the abnormal protrusion of the mandible, the undersigned finds that this claim is also well- grounded within the meaning of 38 U.S.C.A. § 5107. However, while the veteran can certainly provide an eyewitness account of his symptoms, he is not competent to offer evidence that requires medical knowledge, such as a diagnosis of arthritis where none is indicated or as to the cause an arthritic condition. Espiritu, 2 Vet.App. at 494. The Board is satisfied that the VA has met its duty to assist the veteran in the development of all facts pertinent to his well-grounded claims, as described by 38 U.S.C.A. § 5107(a). Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1131 (West 1991). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that not pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1993). As noted above, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a). At a July 1993 VA dental examination, the VA examiner offered the opinion that the veteran's complaints of headaches were apparently associated with his severe prognathism. While the undersigned notes that earlier the veteran appeared to relate his headaches to a sinus condition, the Board must find that the positive evidence in favor of allowance is at least equal to the negative evidence against an allowance. Therefore, with an approximate balance of positive and negative evidence regarding the merits of this issue, the veteran must be accorded the benefit of the doubt. 38 U.S.C.A.§ 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49, 53-56 (1990). Consequently, service connection for headaches secondary to the veteran's service- connected right mandible fracture is warranted. IV. Entitlement to Service Connection for Hearing Loss As noted above, service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1131 (West 1991). If the disorder is a chronic disease, such as sensorineural hearing loss, service connection may be granted if manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). Entitlement to service connection for impaired hearing is subject to the additional requirement of 38 C.F.R. § 3.385 (1993), which provides that service connection for impaired hearing shall not be established when hearing status meets pure tone and speech recognition criteria. Hearing status shall not be considered service connected when the thresholds for the frequencies of 500, 1,000, 2,000, 3,000, and 4,000 Hertz (Hz) are all less than 40 decibels (dB); the thresholds for at least three of these frequencies are 25 dB or less; and the speech recognition scores using the Maryland CNC test are 94 percent or better. In the veteran's case, his audiometric testing results obtained at the time of his separation from service clearly would not meet the requirement of a service-connected hearing disability under 38 C.F.R. § 3.385. However, the Court, in Hensley v. Brown, 5 Vet.App. 155 (1993), indicated that § 3.385 does not preclude service connection for a current hearing disability where hearing was within normal limits on audiometric testing at separation from service. As stated by the Court, "[i]f evidence should sufficiently demonstrate a medical relationship between the veteran's inservice exposure to loud noise and his current disability, it would follow that the veteran incurred an injury in service; the requirements of § 1110 would be satisfied." Id. at 160 (citing Godfrey v. Derwinski, 2 Vet.App. 352 (1992)). Applying this analysis to the instant case, it is clear that § 3.385 does not prohibit an award of service-connected disability compensation for the veteran's bilateral hearing loss. The October 1993 VA audiometric examination revealed threshold hearing levels of 40 dB or more at all tested frequencies for both of the veteran's ears. Section 3.385, as relevant here, prohibits a finding of hearing disability only where threshold hearing levels at 500, 1,000, 2,000, 3,000, and 4,000 Hz are all less than 40 dB and at least three of those levels are 25 dB or less. 38 C.F.R. § 3.385 (1993) (emphasis added). Where, as here, any of the relevant threshold levels are 40 dB or more, a determination as to whether the current hearing loss is service connected must be made under the statutory and regulatory provisions governing service connection generally, and the determination of the level of disability to be assigned to any such service-connected hearing loss will be made under 38 C.F.R. § 4.85 (1993). Because the application of the governing law and regulation pertinent to service connection yields identical analyses with respect to both the veteran's left and right ear hearing, it is appropriate to discuss these claims in conjunction. Pursuant to the standards of § 3.385, the veteran's hearing bilaterally was first shown to be mildly abnormal on private audiometric evaluation in May 1993, conducted more than 10 years following active service. Moderate sensorineural hearing loss, bilaterally, was diagnosed on VA examination conducted in October 1993. The veteran's hearing was within normal limits at all times in service, and at the time of his service separation medical examination. Of great significance is the fact that the veteran specifically denied hearing loss during the course of his separation medical examination. The veteran described his health as "excellent." Further, in his June 1984 initial claim for VA disability benefits, the veteran made no mention of hearing loss, tinnitus or otitis media. Moreover, at the August 1984 VA medical examination, he expressed no complaint of any hearing loss. On the basis of the veteran's failure to report hearing loss shortly after service, with his specific denial of hearing loss at his service separation examination, and his failure to report a hearing loss condition at the August 1984 VA examination, the Board concludes that the weight of evidence is clearly against the claim of service connection for bilateral hearing loss. With regard to the veteran's contention that no hearing examination was performed by any competent hearing specialist in August 1984, the undersigned observes that the determination in this case is based only partially on the August 1984 examination's negative findings of hearing loss. The veteran's own statements at the time of his service separation examination carry greater weight than his current statements made pending a claim for VA compensation benefits. Further, the service medical records also make clear that the veteran's in-service hearing was at all times normal, i.e., never exceeding 20 db. Further, evidence of the presence of sensorineural hearing loss first came to light in this case more than one year after the veteran's separation from service. The undersigned also notes the medical history compiled during the October 1993 VA examination, which was to the effect that the veteran had stated he had noticed his hearing loss only for the last six years. In summary, given that there was no abnormal hearing noted in service, and the veteran's current hearing loss has not been associated with his active military service by competent medical evidence, the Board concludes that the weight of the evidence is clearly against the veteran's claim of service connection for bilateral hearing loss. V. Entitlement to Service Connection for Tinnitus The veteran's service medical records reveal no complaints or clinical findings with respect to tinnitus. No remarks by the veteran concerning tinnitus were made during the veteran's service separation examination of September 1981 or during the VA medical examination conducted in August 1984. As noted above, the veteran failed to claim entitlement to service connection for tinnitus during his initial claim for compensation benefits in June 1984. Further, the veteran first complained of tinnitus to the VA more than 10 years after his separation from active service, and it first became clinically evident in April 1991. Although the veteran asserts that he has had ringing in his ears since service, the merits of his service-connected claim must be examined on the basis of the evidence adduced in support of the claim. Without any clinical evidence of the alleged tinnitus, the Board must conclude that the veteran is presenting only his recollections. In assessing the credibility of such lay evidence, the Board finds no basis to doubt the good faith with which it is offered; yet, it is aware of the general frailty of human memory over time. The test of credibility, therefore, is not whether this is how the veteran remembers remote events, but whether the recollection is accurate and of such probative value as to outweigh other evidence of record. In this case, the Board finds that the documentary evidence prepared contemporaneously with these events is entitled to greater probative weight. See Biggins v. Derwinski, 1 Vet.App. 474, 476-77 (1991). Simply stated, the clinical evidence of greatest probative weight neither shows tinnitus in service nor continuity of symptomatology post service that would evidence a nexus between the veteran's current tinnitus and his period of service. As noted above, the findings on service separation examination showed neither complaints, statements of history nor clinical evidence of tinnitus. The veteran did not mention tinnitus for more than 10 years after his discharge from service. It is, therefore, significant, that the veteran claimed to have tinnitus as the result of exposure to aircraft noise during service more than 10 years after such exposure. The Board finds, therefore, that the veteran's evidence, which includes only his statements and testimony in support of his claim, is not entitled to the credibility or weight to be given the more contemporaneous clinical evidence. In the absence of competent evidence linking the veteran's current tinnitus to service, the Board concludes that the weight of evidence is clearly against the claim of service connection for tinnitus. VI. Entitlement to Service Connection for Chronic Otitis Media With regard to the veteran's claim of entitlement to service connection for otitis media, the Board notes that the veteran was treated for one episode of this condition in February 1981. However, the veteran faces the same obstacle which has obstructed his claims of service connection for hearing loss and tinnitus: He reported no complaints symptomatic of otitis media at his service separation medical examination in September 1981. Further, he reported no recurrence of otitis media when he first claimed VA compensation benefits in June 1984. Moreover, and most significantly, clinical evaluations of the veteran's ears during the veteran's separation examination in September 1981 and on August 1984 VA medical examination noted no ear abnormalities. Since the intervening examinations found the veteran's tympanic membranes to be normal, and chronic otitis media was not evident on recent VA medical examination conducted in October 1993, the undersigned must conclude that the veteran's otitis media in service was acute and transitory in nature and healed without residuals. Although the veteran is entitled to the benefit of the doubt where the evidence supporting the grant of the claim and the evidence supporting the denial of the claim are in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claims of entitlement to service connection for both hearing loss, tinnitus and otitis media. VII. Entitlement to an Increased Evaluation for the Residuals of a Fracture of the Right Mandible Based on Loss of Motion Disability evaluations are determined by the application of a schedule of ratings which is based on average industrial impairment. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Limitation of motion of the temporomandibular articulation warrants a 40 percent evaluation when the inter-incisal range is limited from 0 to 10 millimeters; a 30 percent evaluation is warranted when the inter-incisal range is limited from 11 to 20 millimeters; and, a 20 percent evaluation may be assigned when the inter-incisal range is limited from 21 to 30 millimeters. 38 C.F.R. Part 4, Diagnostic Code 9905. With regard to the veteran's contention that his mandible is severely displaced, the veteran's current disability evaluation of 20 percent represents the maximum rating for severe displacement of the mandible under Diagnostic Code 9904. In evaluating service-connected disabilities, the Board considers the current examination report in light of the whole recorded history to ensure that the current rating accurately reflects the elements of the disability. 38 C.F.R. § 4.2. Under 38 C.F.R. § 4.14 (1993), the evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestations under different diagnoses is to be avoided. However, based on the unusual circumstances of this case, the undersigned agrees that the evaluation of the residuals of a fracture of the right mandible under two separate evaluations based on limitation of motion and sensory loss with pain is appropriate. However, the undersigned must note that pursuant to § 4.14, the veteran's symptoms associated with one of these evaluations may not be used as a method of increasing the veteran's evaluation in the second evaluation. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet.App. 55 (1994). On the basis of the July 1993 VA dental examination, the undersigned notes that the veteran was able to open his mouth to14.5 millimeters with pain in the right temporomandibular joint, and to 26.4 millimeters when "forced open" by the examiner. It has been contended in essence that it should be found that the veteran is capable of moving his mouth to only 5.5 millimeters, the point at which it was indicated that he was able to open his mouth during the VA examination without pain. However, the regulations are not in agreement therewith. The evaluation is based on the veteran's inter-incisal range of motion as it actually exists, not the range at which the veteran feels comfortable in opening his mouth. By the same token, the fact that a VA examiner was recently able to "force" or pry open the veteran's mouth to slightly more than 26 millimeters is not deemed determinative in this case. Accordingly, resolving the benefit of any doubt in the veteran's favor, an increased evaluation for this disability determined to be appropriate to 30 percent, based on his recently demonstated limitation of inter- incisal motion to 14.5 millimeters with pain. VIII. Entitlement to an Increased Evaluation for the Residuals of a Fracture of the Right Mandible Based on Sensory Loss and Pain Under 38 C.F.R. Part 4, Diagnostic Code 8207, a 30 percent evaluation is warranted for complete paralysis of the seventh (facial) cranial nerve. Incomplete but severe paralysis of the seventh cranial nerve warrants a 20 percent evaluation and moderate incomplete paralysis of the seventh cranial nerve warrants a 10 percent evaluation. Evaluation under Diagnostic Code 8207 is dependent upon the relative loss of facial muscles. Id. The VA examination of July 1993 noted the veteran's complaints of paresthesia affecting the right lower lip, right lower chin and right cheek. 38 C.F.R. § 4.123 (1993) states that neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for the injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Based on the current objective medical evidence of record the undersigned finds that the veteran's sensory loss with pain warrants a 10 percent evaluation for moderate incomplete paralysis of the seventh cranial nerve. Recent VA examinations have made no findings with regard to organic changes and there is no evidence that the veteran currently suffers from organic changes associated with his service connected condition. The veteran's complaints of pain and tenderness are contemplated by his current evaluation. In light of the foregoing, the Board finds that the preponderance of evidence is against the veteran's claims for an increased evaluation for the residuals of a fracture of the right mandible based on both limitation of motion and sensory loss and, consequently, the doctrine of reasonable doubt does not apply. The Board has considered the provisions of 38 C.F.R. § 3.321(b)(1); however, the evidence fails to show that the disabilities at issue are so exceptional or unusual as to warrant the assignment of an extraschedular evaluation. The Board has also considered all other potential applicable provisions of 38 C.F.R. Part 3 and 4 (1993), whether or not they have been raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). However, there is no section that provides a basis upon which to assign a higher disability evaluation for the reasons discussed herein. ORDER The claim of entitlement to service connection for arthritis of the right temporomandibular joint on a secondary basis is dismissed. Service connection for headaches secondary to the residuals of a fracture of the right mandible is granted. The claim of entitlement to service connection for hearing loss, tinnitus and chronic otitis media is denied. The claim of entitlement to an increased evaluation of 30 percent for the residuals of a fracture of the right mandible based on limitation of motion is granted. The claim of entitlement to an evaluation in excess of 10 percent for the residuals of a fracture of the right mandible based on sensory loss is denied. J.F. GOUGH Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.