Citation Nr: 1319147 Decision Date: 06/12/13 Archive Date: 06/21/13 DOCKET NO. 06-20 829 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to an initial compensable rating for bilateral hearing loss. REPRESENTATION Appellant represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD L. Kirscher Strauss, Counsel INTRODUCTION The Veteran served on active duty from January 1968 to September 1969. This matter comes before the Board of Veterans' Appeals (Board) from an October 2005 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, which in pertinent part denied service connection for right ear hearing loss and granted service connection for left ear hearing loss and assigned an initial noncompensable rating, effective March 14, 2005. In June 2008, May 2009, November 2010, July 2011, and October 2012, the Board remanded the claim on appeal to the RO via the Appeals Management Center (AMC) in Washington, DC for additional development. The development has been completed, and the case is before the Board for final review. In a May 2012 rating decision, the RO granted service connection for right ear hearing loss, effective from March 14, 2005, the date the Veteran's claim of service connection for hearing loss was received. Accordingly, the issue on appeal has been recharacterized to include entitlement to an initial compensable rating for hearing loss of both ears. FINDINGS OF FACT 1. Competent and persuasive medical evidence of record reflects that the May 2010 private audiological examination findings are invalid. 2. The most probative evidence reflects that bilateral hearing loss is manifested by no worse than Level II hearing loss in the right ear and Level I hearing loss in the left ear. CONCLUSION OF LAW The criteria for an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION VCAA The Veterans Claims Assistance Act of 2000 (VCAA) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012)) redefined VA's duty to assist a claimant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The notice requirements of the VCAA require VA to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, VA will attempt to obtain. 38 C.F.R. § 3.159(b). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include the AMC). Id.; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). Insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. See Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (holding that VCAA notice errors are reviewed under a prejudicial error rule). In this case, the appeal arises from the initial award of service connection. In Dingess, the Court held that in cases in which service connection has been granted and an initial disability rating and effective date have been assigned, the typical service connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Dingess, 19 Vet. App. at 490-91; see also 38 C.F.R. § 3.159(b)(3)(i) (2012). Thus, because the notice that was provided before service connection was granted was sufficient, VA's duty to notify in this case has been satisfied. See generally Turk v. Peake, 21 Vet. App. 565 (2008) (holding that where a party appeals from an original assignment of a disability rating, the claim is classified as an original claim, rather than as one for an increased rating); see also Shipwash v. Brown, 8 Vet. App. 218, 225 (1995); see also Fenderson v. West, 12 Vet. App. 119 (1999) (establishing that initial appeals of a disability rating for a service-connected disability fall under the category of "original claims"). The Board also finds that VA has complied with all assistance provisions of the VCAA, to include substantial compliance with the prior remands. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Veteran was provided with numerous VA examinations, the examiners discussed the functional effects of his bilateral hearing loss, and the January 2011 and November 2012 VA examiners reviewed and discussed the discrepancies between a May 2010 private audiological examination and VA examinations. The evidence of record contains service treatment records, post-service VA and private outpatient treatment records, VA examination reports, records from the Social Security Administration, and lay statements from the Veteran and family members. There is no indication of relevant, outstanding records that would support the Veteran's claim. 38 U.S.C.A. § 5103A(c); 38 C.F.R. § 3.159(c)(1)-(3). VA has considered and complied with the VCAA provisions discussed above. The Veteran was notified and aware of the evidence needed to substantiate the claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between the Veteran and VA in obtaining such evidence. The Veteran was an active participant in the claims process by submitting evidence and argument. Therefore, he was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notice is not shown to have affected the essential fairness of the adjudication or to cause injury to the Veteran. Pelegrini, 18 Vet. App. at 121. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See Conway, 353 F.3d at 1374, Dingess, 19 Vet. App. 473; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). Criteria & Analysis Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; assigning the higher rating where there is a question as to which of two evaluations apply and where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where the appellant has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability, separate ratings can be assigned for separate periods of time based on the facts found-a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). The Board notes that this issue involves the Veteran's dissatisfaction with the initial rating for his hearing loss disability assigned following the grant of service connection, and staged ratings are to be considered. The Veteran is assigned a noncompensable rating for bilateral hearing loss pursuant to 38 C.F.R. § 4.85, Diagnostic Code 6100 (2012). The assignment of disability ratings for service-connected hearing impairment is derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Evaluations for defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests (using the Maryland CNC) together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 Hertz. The rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal auditory acuity to Level XI for profound deafness. See 38 C.F.R. § 4.85 (2012). Table VI, "Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination," is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination (horizontal rows) and the puretone threshold average (vertical columns). (CONTINUED ON NEXT PAGE) Table VI Numeric designation of hearing impairment based on puretone threshold average and speech discrimination. % of discrim- ination Puretone Threshold Average 0-41 42-49 50-57 58-65 66-73 74-81 82-89 90-97 98+ 92-100 I I I II II II III III IV 84-90 II II II III III III IV IV IV 76-82 III III IV IV IV V V V V 68-74 IV IV V V VI VI VII VII VII 60-66 V V VI VI VII VII VIII VIII VIII 52-58 VI VI VII VII VIII VIII VIII VIII IX 44-50 VII VII VIII VIII VIII IX IX IX X 36-42 VIII VIII VIII IX IX IX X X X 0-34 IX X XI XI XI XI XI XI XI Table VIA* Numeric designation of hearing impairment based only on puretone threshold average Puretone Threshold Average 0-41 42-48 49-55 56-62 63-69 70-76 77-83 84-90 91-97 98-104 105+ I II III IV V VI VII VIII IX X XI *This table is for use only as specified in §§ 4.85 and 4.86. Table VII, "Percentage Evaluations for Hearing Impairment," is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal rows represent the ear having the better hearing and the vertical columns the ear having the poorer hearing. The percentage evaluation is located at the point where the row and column intersect. See 38 C.F.R. § 4.85, Diagnostic Code 6100 (2012). Table VII Percentage evaluation for hearing impairment (Diagnostic Code 6100) Poorer Ear Better Ear XI 100 X 90 80 IX 80 70 60 VIII 70 60 50 50 VII 60 60 50 40 40 VI 50 50 40 40 30 30 V 40 40 40 30 30 20 20 IV 30 30 30 20 20 20 10 10 III 20 20 20 20 20 10 10 10 0 II 10 10 10 10 10 10 10 0 0 0 I 10 10 0 0 0 0 0 0 0 0 0 XI X IX VIII VII VI V IV III II I Federal regulation also addresses exceptional patterns of hearing impairment. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next highest Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b) (2012). In March 2005 lay statements, the Veteran's son reported that the Veteran's hearing loss progressively worsened over the years, and his wife related that sounds in his ears create problems for him hearing what others are saying to him and cause more difficulty complying to work orders. In correspondence from the Veteran, he stated that he experiences severe hearing loss noted by his doctor, that he constantly hears popping and roaring in his ears, and that he has difficulty hearing unless he is wearing his hearing aids. In support of his March 2005 claim for service connection for hearing loss, the Veteran submitted private audiological evaluation reports dated in November 1998 and May 2002 from L. Lipman, M.S., CCC-A. In a March 2005 letter, the audiologist indicated that the Veteran was first seen in 1998, had bilateral sensorineural hearing loss, and was fitted for hearing aids. She also opined that the Veteran's high frequency sensorineural hearing loss was consistent with the factors he described during military service that could have contributed to his hearing difficulties. In September 2005 the Veteran underwent a VA audiology examination. Pure tone thresholds, in decibels, were reported as follows: HERTZ A 1000 B 2000 C 3000 D 4000 A+B+C+D AVG. RIGHT 20 45 65 65 49 LEFT 20 35 55 65 44 Speech audiometry revealed speech recognition ability of 92 percent in the right ear and 96 in the left ear. Applying the above results to Table VI, a puretone threshold average of 49 decibels and a speech discrimination of 92 percent in the right ear results in Level I hearing for that ear. A puretone threshold average of 44 decibels and a speech discrimination of 96 percent in the left ear results in Level I hearing for that ear. Under Table VII, a Level I for the right ear combined with a Level I for the left ear results in a noncompensable evaluation. The Veteran was also afforded a VA ear disease examination in October 2005. During that examination, he subjectively reported a long history of bilateral, progressive hearing loss and a 10 to 20 year history of bilateral, progressive tinnitus, which was constant and severe at the present examination. The Board notes that service connection is in effect for tinnitus. Following a review of the claims file, including the September 2005 VA examination, the examiner diagnosed bilateral high frequency sensorineural hearing loss and remarked that the Veteran's current employment, social, and daily activity functioning should not be adversely affected by his current bilateral hearing loss or tinnitus. During a March 2006 VA PTSD examination, the Veteran reported that he had had about 50 jobs, the longest lasting about a year and a half. Following a review of the claims file and examination of the Veteran, the examiner opined that the Veteran was unable to function well either in an employment situation or in a social situation, and in his state he could be considered virtually unemployable, although he continued to struggle to keep his current job. During a May 2006 VA ENT consultation, the Veteran reported tinnitus and hearing loss and having digital hearing aids, which he did not use because everything was so noisy. In October 2006 correspondence, the Veteran's wife indicated that the Veteran avoids noisy places due to his hearing loss because such places make his ears roar and head hurt. She expressed concern that his impairment added to his difficulties with work because he does not hear when someone gives him instructions or information. In a separate statement, the Veteran described in detail how a chronic prostate problem affects his job and also reported that loss of sleep from his prostate and hearing problems had caused difficulty concentrating at work. The Veteran was seen for a VA audiological consultation in November 2006. Following audiometric testing, the audiologist summarized that there had been no significant change since the previous evaluation in September 2005. Pure tone thresholds, in decibels, were reported as follows: HERTZ A 1000 B 2000 C 3000 D 4000 A+B+C+D AVG. RIGHT 25 45 65 65 50 LEFT 25 40 55 70 48 Speech audiometry revealed speech recognition ability of 92 percent in the right ear and 96 in the left ear. Applying the above results to Table VI, a puretone threshold average of 50 decibels and a speech discrimination of 92 percent in the right ear results in Level I hearing for that ear. A puretone threshold average of 48 decibels and a speech discrimination of 96 percent in the left ear results in Level I hearing for that ear. Under Table VII, a Level I for the right ear combined with a Level I for the left ear results in a noncompensable evaluation. Hearing aids were issued in December 2006. In August 2008 the Veteran underwent another VA audiology examination. Pure tone thresholds, in decibels, were reported as follows: HERTZ A 1000 B 2000 C 3000 D 4000 A+B+C+D AVG. RIGHT 25 45 55 65 48 LEFT 25 45 55 70 49 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 100 in the left ear. Applying the above results to Table VI, a puretone threshold average of 48 decibels and a speech discrimination of 96 percent in the right ear results in Level I hearing for that ear. A puretone threshold average of 49 decibels and a speech discrimination of 100 percent in the left ear results in Level I hearing for that ear. Under Table VII, a Level I for the right ear combined with a Level I for the left ear results in a noncompensable evaluation. Records from the Social Security Administration, which were received in November 2012, revealed that disability benefits were awarded based on the primary diagnosis of status post right hip replacement and the secondary diagnosis of spondylosis and that the Veteran's disability began for SSA purposes in July 2008. In an October 2008 function report, the Veteran indicated that had "60 [percent] hearing loss [sic] wears hearing aids (service connected) [sic]." Addressing how well he followed spoken instructions, he reported, "Ok [sic] if heard correctly. Hearing impairment sometimes causes me to miss parts." An October 2008 field office disability report indicated that the Veteran had no hearing difficulty during the face-to-face interview. In a July 2009 letter, the Veteran's private audiologist (Lipman) reported that the Veteran's hearing loss would interfere with communication in a variety of situations and that he would experience difficulty understanding speech especially in the presence of any background noise. She elaborated that the Veteran would have difficulty working in an environment with background noise because he would need to ask customers to repeat themselves, it would be difficult to understand speech clearly on the telephone, and it would be difficult to hear clearly instructions from superiors. The audiologist also described effects of the Veteran's hearing loss on his family and daily living situations. In August 2009 the Veteran underwent another VA audiology examination. Pure tone thresholds, in decibels, were reported as follows: HERTZ A 1000 B 2000 C 3000 D 4000 A+B+C+D AVG. RIGHT 25 45 55 70 49 LEFT 30 50 60 70 53 Speech audiometry revealed speech recognition ability of 84 percent in the right ear and 92 in the left ear. Applying the above results to Table VI, a puretone threshold average of 49 decibels and a speech discrimination of 84 percent in the right ear results in Level II hearing for that ear. A puretone threshold average of 53 decibels and a speech discrimination of 92 percent in the left ear results in Level I hearing for that ear. Under Table VII, a Level II for the right ear combined with a Level I for the left ear results in a noncompensable evaluation. Subjectively, the Veteran reported that he had difficulty understanding speech, particularly his wife's voice and while on the phone at work. He reported that 90 percent of his work was on the phone. The Veteran was also afforded a VA ENT examination on the same day in August 2009 by the same otolaryngologist who performed the October 2005 examination. The Veteran stated that he did not believe his hearing was worse or better in one ear more than the other. He related that his primary issue was related to the telephone because he had to turn the telephone volume up to his highest setting and individuals with whom he would converse complained that he was speaking too loudly. He stated that he currently wore hearing aids in both ears. Following a review of the claims folder and examination, the examiner commented that the Veteran's high frequency sensorineural hearing loss in the left ear would create issues mostly related to understanding, although amplification should be of significant benefit. The examiner opined that the current level of hearing impairment should not affect employability and would certainly not render him unemployable. The examiner added that based on the current information, he did not believe an extraschedular rating would be appropriate. In August 2009 correspondence, the Veteran expressed concern about the adequacy of the August 2009 VA ENT examination. In November 2009, the Veteran applied for a total disability rating based on individual unemployability (TDIU). Information in support of his claim included VA progress notes related to prostate problems and the recommendation for possible urological surgery and a letter from the Social Security Administration regarding disability benefits. In December 2009, he specifically claimed entitlement to a TDIU due to service-connected posttraumatic stress disorder (PTSD) (rated as 70 percent disabling), prostatitis (rated as 40 percent disabling), and tinnitus (rated as 10 percent disabling). Information from the Veteran's employer indicated that he worked full-time as a customer service associate at a home improvement store from August 2004 to July 2008, and his employment was terminated in February 2009 because he used over 240 days of leave. An October 2008 private orthopedic treatment record revealed that he had right hip surgery in July 2008. An April 2010 rating decision granted the claim for TDIU benefits. In December 2009 and in subsequent correspondence, the Veteran's wife again described the Veteran's steady decrease in his ability to hear and difficulty with crowds or any place with external noises and inability to hear unless facing the speaker. The Veteran was seen by another private audiologist, A. Musani, Au.D., in May 2010. The Veteran stated that his hearing loss made him unable to understand speech, especially in the presence of noise or in groups. Puretone thresholds, in decibels, were reported in audiogram format, and a January 2011 VA examiner interpreted the results as follows: HERTZ A 1000 B 2000 C 3000 D 4000 A+B+C+D AVG. RIGHT 75 80 85 90 83 LEFT 60 70 90 95 79 The evaluation report did not include controlled speech discrimination test findings using the Maryland CNC, but the audiologist indicated that word recognition was poor bilaterally based on other test methods. In a separate, 38-page letter, however, the audiologist reported that a recorded Maryland CNC word list was used to determine a performance intensity function; the Veteran had a score of 84 percent in the right ear and 86 percent in the left ear. The audiologist concluded that a significant decrease in hearing was observed from previous VA tests as supplied in the Veteran's medical and [claims] file. He also opined that the Veteran's hearing loss was a result of exposure to excessive levels of noise while in the military, and the subsequent 37 pages of his letter included pictures of weapons and aircraft and discussion of the Veteran's military duties, exposure to Agent Orange, and numerous articles regarding noise exposure and hearing loss. Applying the above results to Table VI, a puretone threshold average of 83 decibels and a speech discrimination of 84 percent in the right ear results in Level IV hearing for that ear. A puretone threshold average of 79 decibels and a speech discrimination of 86 percent in the left ear results in Level III hearing for that ear. Under Table VII, a Level IV for the right ear combined with a Level III for the left ear results in a 10 percent evaluation. Because the puretone threshold at each of the four specified frequencies was 55 or more on private audiological examination in May 2010, consideration under Table VIa is also warranted based on this apparent exceptional pattern of hearing impairment. Applying the above results to Table VIa, a puretone threshold average of 83 decibels in the right ear results in a Level VII hearing for that ear. A puretone threshold average of 79 decibels for the left ear results in a Level VII for that ear. Under Table VII, a Level VII for the right ear combined with a Level VII for the left ear results in a 40 percent evaluation. The Veteran underwent additional VA audiological examinations subsequent to the May 2010 private examination. In January 2011, the Veteran reported difficulty hearing in all situations and stated the hearing loss had diminished the quality of his life. Puretone thresholds, in decibels, were reported as follows: HERTZ A 1000 B 2000 C 3000 D 4000 A+B+C+D AVG. RIGHT 35 55 65 70 56 LEFT 35 55 65 70 56 Speech audiometry revealed speech recognition ability of 94 percent in the right ear and 92 percent in the left ear. Applying the above results to Table VI, a puretone threshold average of 56 decibels and a speech discrimination of 94 percent in the right ear results in Level I hearing for that ear. A puretone threshold average of 56 decibels and a speech discrimination of 92 percent in the left ear results in Level I hearing for that ear. Under Table VII, a Level I for the right ear combined with a Level I for the left ear results in a noncompensable evaluation. The January 2011 VA audiologist reviewed the claims file and, as noted, interpreted the audiogram results from the May 2010 private examination. The VA audiologist observed that review of previous audiological examinations showed significant discrepancies between the reported thresholds for VA examination in August 2009, the private examination in May 2010, and the current examination. She noted, for example, that puretone averages on VA examination in August 2009 of 49 decibels in the right ear and 52 decibels in the left ear were in good agreement with the current examination with puretone averages of 56 decibels in the right ear and 56 decibels in the left ear, but not the private 2010 examination with puretone averages of 82.5 and 79 decibels. The audiologist emphasized that the Veteran had speech awareness of 35 decibels at the current examination and was able to repeat spondee words consistently (speech reception threshold) at 40 decibels. In contrast, the private examination reported that he could not repeat words until 60 decibels, and the lowest puretone threshold for speech range was 60 decibels. The VA audiologist stated that it is not possible for the Veteran to be able to repeat words consistently at 20 decibels below his reported puretone thresholds. Therefore, the private audiology examination results from May 2010 should be considered invalid and likely an exaggeration of the Veteran's true hearing loss. The VA examiner reported that the Veteran's hearing loss may result in some difficulty understanding speech in difficult listening situations, such as in the presence of background noise, when he cannot see speakers' faces, or over the phone, but should not preclude employment. With amplification and with reasonable accommodations as specified in the Americans with Disabilities Act, this hearing loss should not significantly affect vocational potential or limit participation in most work activities. The examiner noted that the Veteran was able to participate in case history interview and test result explanation without amplification, which had been provided by VA. The examiner added that the interview was conducted one-on-one in a quiet area; however, the examiner was able to use conversational level speech and the Veteran responded appropriately to questions. The January 2011 VA audiologist reviewed the Veteran's claims file again in March 2012 and opined that the right ear hearing loss was also related to military service. In November 2012, the Veteran underwent a final VA examination by another audiologist. Puretone thresholds, in decibels, were reported as follows: HERTZ A 1000 B 2000 C 3000 D 4000 A+B+C+D AVG. RIGHT 30 50 55 60 49 LEFT 30 45 60 65 50 Speech audiometry revealed speech recognition ability of 94 percent in each ear. Applying the above results to Table VI, a puretone threshold average of 49 decibels and a speech discrimination of 94 percent in the right ear results in Level I hearing for that ear. A puretone threshold average of 50 decibels and a speech discrimination of 94 percent in the left ear results in Level I hearing for that ear. Under Table VII, a Level I for the right ear combined with a Level I for the left ear results in a noncompensable evaluation. The Veteran described the impact of his hearing loss as difficulty understanding others, including his grandchildren and wife, particularly in noisy situations. In a December 2012 addendum, the November 2012 examiner reviewed the claims file and compared the 2010 private audiological evaluation with the November 2012 VA audiological evaluation. The examiner noted that the 2010 private audiogram indicated very poor word recognition scores bilaterally and explained that these scores were obtained at an intensity level that would have been barely audible to the Veteran based on the puretone results of the same test. The examiner also noted that performance intensity function was not obtained. She explained that standard audiometric testing of word recognition would have been done at levels AT LEAST 30 to 40 decibels above SRT, but the 2010 examination was done at 10 decibels above SRT on this test. (Emphasis in original). For the foregoing reasons, the examiner concluded that the word recognition scores on the 2010 private examination were not valid. In comparison, the examiner explained that the November 2012 audiometric examination revealed a mild sloping to severe high frequency sensorineural hearing loss bilaterally with excellent word recognition scores without any visual cues. Performance intensity function was performed. The Veteran was cooperative and the examination was consistent and reliable. The examination was also consistent in configuration to the previous VA examinations. The examiner concluded that with this degree of high frequency hearing loss, the Veteran would likely perform reasonably well in a quiet environment. He would have some difficulty in the presence of background noise, and would benefit from visual cues and amplification. She added that the Veteran currently wears VA issued hearing aids. The examiner concluded that based on her experience, review of the rating schedule, puretone test results, and the excellent word recognition scores obtained, the current noncompensable rating for hearing loss and 10 percent rating for tinnitus were appropriate. Finally, the examiner concurred with the opinion given by [the VA ENT examiner] in 2009 that "an extraschedular rating would be indicated at this time." The Board has reviewed the medical and lay evidence of record, but finds that the preponderance of the evidence is against the claim for an initial compensable rating for bilateral hearing loss. Initially, the Board acknowledges that the Veteran is competent to attest to a perceived increase in hearing loss, and lay people such as the Veteran's wife and son are competent to report their observations regarding the effects of the Veteran's hearing loss. The Veteran's perception, however, and the observations of other lay people are not a reliable gauge of the extent of his hearing loss disability as hearing loss for VA compensation purposes is measured by audiometric findings. See 38 C.F.R. §§ 4.85, 4.86. The Board notes that the VA examinations in 2005, 2008, 2009, 2011, and November 2012 were conducted in accordance with 38 C.F.R. § 4.85(a) and are highly probative. The Board acknowledges that in Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007), the United States Court of Appeals for Veterans Claims (Court), noted that VA had revised its hearing examination worksheets to include the effect of the veteran's hearing loss disability on occupational functioning and daily activities. The August 2009, January 2011, and November and December 2012 VA examiners' reports, in particular, included the reported effects of the Veteran's hearing loss on his daily functioning. Specifically, the August 2009 ENT examiner, the January 2011 examiner, and the November and December 2012 examiner collectively believed the Veteran would have some difficulty understanding speech in difficult listening situations, such as in the presence of background noise, when he cannot see speakers' faces, or over the phone, and that he would benefit from visual cues and amplification. These statements are consistent with the lay statements from the Veteran and his wife in which they described the extent of the effects of his disability to include difficulty hearing in crowds or any place with external noises, difficulty on the telephone, and difficulty hearing unless facing the speaker. Accordingly, the VA examinations provided the requisite information concerning the functional impact of his hearing loss and included objective examination data in accordance with the requirements set forth in 38 C.F.R. § 4.85(a). The Board acknowledges the Veteran's complaints regarding the functional impact of his hearing loss on his daily life, but the assignment of disability ratings for hearing impairment is derived from a mechanical formula based on levels of puretone threshold average and speech discrimination. The findings on examination are more probative than the lay contentions as to the extent of hearing loss. The Board also considered the May 2010 private audiological evaluation, but finds that it is entitled to little, if any, probative value with respect to the current severity of the Veteran's hearing loss disability. First and foremost, both the January 2011 and November 2012 (including December 2012 addendum) VA examiners concluded that the private audiology examination results from May 2010 should be considered invalid. Each audiologist provided a detailed medical rationale supporting her conclusion. The January 2011 examiner also noted that the May 2010 audiology results were inconsistent with testing results in 2009 and on the current examination. The Board finds that the conclusions of the 2011 and 2012 VA examiners are persuasive and probative evidence regarding the invalidity of the May 2010 private audiological testing results because both opinions were based on a review of the claims file, audiological examination, and supported by a medical rationale that is consistent with the medical evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value to a medical opinion). In this regard, the Board emphasizes that the May 2010 private audiological findings are anomalous with the other audiological testing data throughout the appeal period, which consistently reflect objective findings that result in a noncompensable disability rating. In summary, the most probative evidence indicates that the Veteran's hearing loss falls clearly within the criteria for a noncompensable evaluation for the duration of the claim. Therefore, the assigned noncompensable rating for bilateral hearing loss is proper throughout the appeal period and a higher rating for bilateral hearing loss is denied. As a final matter, the Board has considered whether the Veteran's bilateral hearing loss disability presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of an extraschedular rating is warranted. See 38 C.F.R. § 3.321(b)(1) (2012); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating schedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Here, the rating criteria reasonably describe the Veteran's disability level and symptomatology, and provide for higher ratings for more severe hearing loss than is shown by the evidence. Thus, the Veteran's disability picture is contemplated by the rating schedule, and the assigned schedular evaluation is, therefore, adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Consequently, referral for extraschedular consideration is not warranted. The Board notes that the November 2012 VA examiner in the December 2012 addendum concurred with the August 2009 VA ENT examiner that "an extraschedular rating would be indicated at this time." The Board finds that the December 2012 addendum appears to contain a clerical error by omitting the word "not." In fact, the August 2009 examiner believed that an extraschedular rating was not warranted, and the December 2012 language indicating that the examiner concurred expresses agreement. Moreover, based on the November 2012 audiological examination findings, which were consistent with audiological test findings on VA examination in 2005, August 2008, August 2009, January 2011, and on VA audiological consultation in November 2006, a conclusion that the Veteran's hearing impairment reflected an exceptional pattern or disability picture that would warrant a referral for extraschedular consideration would be unsupported and contradicted by the competent medical evidence of record. In reaching the conclusions above, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim for a higher rating, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). ORDER Entitlement to a compensable rating for bilateral hearing loss is denied. ____________________________________________ JAMES L. MARCH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs