Citation Nr: 1319326 Decision Date: 06/13/13 Archive Date: 06/21/13 DOCKET NO. 10-36 044 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an increased rating for bilateral hearing loss, rated as non-compensable prior to October 11, 2011 and 10 percent subsequent to October 11, 2011. REPRESENTATION The Veteran represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran and his wife ATTORNEY FOR THE BOARD Russell P. Veldenz, Counsel INTRODUCTION The Veteran had active service from March 1956 to March 1960. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. A Travel Board hearing was held at the RO in March 2011 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. During the pendency of the appeal, in a rating decision in November 2011, the RO increased the rating for bilateral hearing loss from noncompensable (0 percent) to 10 percent, effective October 2011, the date of a VA examination. The Veteran continued his appeal for a higher rating. AB v. Brown, 6 Vet. App. 35, 38 (1993). In August 2011, May 2012, and December 2012, the Board remanded the case to the RO for additional development. As the requested development has been completed, no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The issues of entitlement to compensation under 38 U.S.C.A. § 1151 (West 2002) for residuals of a perforated left ear drum, claimed as due to Department of Veterans Affairs (VA) lack of proper care/negligence in providing outpatient treatment in August 2009 and service connection for a disorder causing dizziness have been raised by the record, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. At the November 2009 VA audiology examination, the Veteran's bilateral hearing loss was manifested by Level I hearing loss in the right ear, and by Level VI hearing loss in the left ear. 2. At the August 2010 VA audiology examination, the Veteran's bilateral hearing loss was manifested by Level I hearing loss in the right ear, and by Level VI hearing loss in the left ear. 3. At the October 2011 VA audiology examination, the Veteran's bilateral hearing loss was manifested by Level II hearing loss in the right ear, and by Level VI hearing loss in the left ear. CONCLUSION OF LAW 1. Prior to October 11, 2011, the criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.85, Diagnostic Code 6100 (2012). 2. Since October 11, 2011, the criteria for a rating in excess of 10 percent for bilateral hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.85, Diagnostic Code 6100 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate the claims. Duty to Notify Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. Also, the VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: 1) veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006). In a claim for increase, the VCAA notice requirements are the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009) (interpreting 38 U.S.C.A. § 5103(a) as requiring generic claim-specific notice and rejecting Veteran-specific notice as to effect on daily life and as to the assigned or a cross-referenced Diagnostic Code under which the disability is rated). The VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The RO provided pre- adjudication VCAA notice by letter, dated in October 2008. The notice included the type of evidence needed to substantiate the claims for increase, namely, evidence that the symptoms had increased. The Veteran was notified that VA would obtain service treatment records, VA records, and records from other Federal agencies, and that he could submit other records not in the custody of a Federal agency, such as private medical records or with his authorization VA would obtain any non-Federal records on his behalf. The notice included the provisions for the effective date of a claim and for the degree of disability assignable. As for content of the VCAA notice, the documents complied with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002) (identifying evidence to substantiate a claim and the relative duties of VA and the claimant to obtain evidence); of Charles v. Principi, 16 Vet. App. 370, 374 (2002) (identifying the document that satisfies VCAA notice); of Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004) (38 C.F.R. § 3.159 notice); of Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006) (notice of the elements of the claim); and of Vazquez-Flores v. Peake, 580 F.3d 1270 (Fed. Cir. 2009) (evidence demonstrating a worsening or increase in severity of a disability and the effect that worsening has on employment). Further VCAA notice is not required. Duty to Assist Under 38 U.S.C.A. § 5103A, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim. The RO has obtained service treatment records, VA records, records from private medical caregivers, and afforded the Veteran VA examinations in November 2009, August 2010, and October 2011, and a hearing before the undersigned in March 2011. The reports of the VA examinations included a review of the Veteran's medical history, including his service treatment records, an interview and an examination of the Veteran, as well as sufficient findings to rate disability. The Board acknowledges an argument raised by the Veteran's service representative that the VA examination reports are inadequate. The service representative notes that the standard instructions for a VA audiology examination requires speech discrimination testing to begin at 40 dB and if necessary the starting level will be adjusted upwards at least 5 dB until the maximum level of performance is determined. Once the level of maximum performance is determined, the speech recognition score is tested. In this instance, as the VA examiners did not record whether the speech recognition scores had to be adjusted from the starting level of 40 dB, the Veteran's service representative argues the reports are inadequate. The Board notes that there is no requirement a VA examiner record the level used for the speech recognition scores for purposes of the rating report. Furthermore, there is a presumption of regularity that government officials "have properly discharged their official duties." Ashley v. Derwinski, 2 Vet. App. 62, 64 (1992) (quoting United States v. Chem. Found. Ind. 272 U.S. 1, 14-15 (1926). The Board may presume that VA medical staff competently discharged their duties. See Rizzo v. Shinseki, 580 F.3d 1288, 1292 (Fed. Cir 2009) (confirming that the presumption of regularity does not only apply to procedural matters, but also applies to the competency of medical professionals). This presumption of regularity in the administrative process may be rebutted by clear evidence to the contrary. Schoolman v. West, 12 Vet. App. 307, 310 (1999). There is no clear evidence that the VA examiners did not follow VA regulations and procedures, including adjusting the decibel level until a Maryland CNC test could be conducted. As will be discussed, the examination report contains the findings of the audiological VA examinations, including findings or results of the puretone thresholds and the Maryland CNC speech discrimination scores. Other then the assertions of the service representative, the evidence does not reflect irregularities in the way VA examinations were conducted or reported. The service representative's contention that the examiner did not adjust the level for the Maryland CNC test is not the clear evidence to the contrary that would be sufficient to rebut the presumption of regularity. Instead, it is reasonable that the VA examiner conducted the examination properly and the Board finds that the presumption that the examiner adhered to VA regulations and procedures in determining the level of severity of the Veteran's hearing loss is not rebutted. Therefore, the Board concludes that the VA examinations are adequate. 38 C.F.R. § 4.2; see Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). As noted, the Board previously remanded this matter in August 2011, May 2012, and December 2012. The record indicates that the Veteran was seen on VA outpatient treatment on September 1, 2009, and on October 5, 2009, for treatment of his service-connected bilateral hearing loss. Although puretone audiometric testing was conducted by VA audiologists at both of these outpatient treatment visits in September and October 2009, the Veteran's VA outpatient treatment records initially contained the written interpretation of the results but the actual puretone audiometric testing results themselves were not included. In addition, the Veteran's service representative, in October 2012, stated that a VA audiological examination dated February 17, 2010, has been associated with the file, but the examination report was not included in the file before the Board. The remands directed that the missing documents be associated with the file. The September 2009 puretone audiometric testing results were associated with the file in October 2011. In April 2013, the RO learned from VAMC that no document recording the October 2009 puretone audiometric testing exists or is available. Further, there is no evidence that the Veteran's hearing was tested in February 2010. Accordingly, the RO determined further efforts would be futile and notified the Veteran in April 2013. See 38 C.F.R. § 3.159 (c)(2). The Board therefore finds that VA fulfilled the duty to assist as to documents regarding the October 2009 and February 2010 hearing evaluations. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) recently held that 38 C.F.R. § 3.103(c)(2) (2010) requires that the Veterans Law Judge who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, during the Board hearing, the Veteran was assisted at the hearing by an accredited representative from the Disabled American Veterans. That representative stated he would start the hearing by questioning the Veteran and his wife regarding the level of severity of his hearing loss. The representative and the Veterans Law Judge (VLJ) asked questions to ascertain the extent of the hearing loss and its functional impact upon the Veteran both at home and in various out door or public situations. No pertinent evidence that might have been overlooked and that might substantiate the claim was identified by the Veteran or the representative. The hearing focused on the elements necessary to substantiate the claim, and the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claim for an increased rating for hearing loss. Neither the representative nor the Veteran has suggested any deficiency in the conduct of the hearing. Therefore, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. § 3.103(c)(2), or to the extent the VLJ did not expressly state the elements of the claim that were lacking to substantiate the claim for an increased rating for bilateral hearing loss, such error is harmless as his representative stated what had to be shown and both the Veteran and representative also demonstrated actual knowledge of what was needed to prove the claim. As the Veteran has not identified any additional evidence pertinent to the claim and as there are no additional records to obtain, the Board concludes that no further assistance to the Veteran in developing the facts pertinent to the claims is required to comply with the duty to assist. Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). In evaluating service-connected hearing loss, disability evaluations are derived from a mechanical application of the rating schedule to numeric designations assigned after audiometric evaluations are performed. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Evaluations of bilateral hearing loss range from noncompensable (0 percent) to 100 percent based on organic impairment of hearing acuity. To evaluate the degree of disability from defective hearing, the rating schedule establishes eleven auditory acuity levels designated from I for essentially normal acuity, through XI for profound deafness. 38 C.F.R. § 4.85, Tables VI, VII. Audiological examinations used to measure impairment must be conducted by a state-licensed audiologist and must include both a controlled speech discrimination test (Maryland CNC) and pure tone audiometric tests. 38 C.F.R. § 4.85(a). The Ratings Schedule provides a table for rating purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, based upon a combination of the percent of speech discrimination (horizontal rows) and the pure tone threshold average (vertical columns), which is the sum of the pure tone thresholds at 1000, 2000, 3000, and 4000 Hertz, divided by four. See 38 C.F.R. § 4.85, Diagnostic Code 6100. The Roman numeral designation is located at the point where the percentage of speech discrimination and puretone threshold average intersect. 38 C.F.R. § 4.85(b). Where there is an exceptional pattern of hearing impairment as defined in 38 C.F.R. § 4.86, the rating may be based solely on puretone threshold testing (using Table VIa). When the pure tone 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 pure tone 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 higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b). Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal row represents the ear having the poorer hearing and the vertical column represents the ear having the better hearing. The percentage evaluation is located at the point where the row and column intersect. 38 C.F.R. § 4.85(e). The Veteran contends that his service-connected bilateral hearing loss is more disabling than currently evaluated. At the time the Veteran filed his claim for a higher rating, the bilateral hearing loss was evaluated as noncompensable and since October 2011, evaluated as 10 percent disabling under 38 C.F.R. § 4.85, Diagnostic Code (DC) 6100 (2011). The Board notes that the Veteran's hearing was evaluated by VA in September 2009 and although the puretone thresholds were tested and the results documented, it appears that there was no documentation for speech recognition including whether the Maryland CNC Test was performed as required under 38 C.F.R. §§ 3.385, 4.85. The Board therefore finds that the report is not adequate to rate the Veteran's bilateral hearing loss disability. 38 C.F.R. § 3.326. The results were interpreted as the right ear having a moderate to moderate-severe mixed hearing loss and the left ear having a moderate-severe to profound loss. Both ears had excellent discrimination. The diagnosis was long standing hearing loss. In a similar manner, it appears that the Veteran's hearing was evaluated in October 2009, but there is no documentation as to the actual test results. The results were interpreted as the right ear having a moderate to moderate-severe mixed hearing loss and the left ear having a moderate-severe to profound mixed hearing loss. Both ears had excellent discrimination. Although the actual test results are not available for the Board's review for rating purposes, the Board finds no harm has occurred to the Veteran that the full test results for the September and October 2009 evaluations are not available as the interpretations were recorded and the Veteran's hearing was tested a month later in a VA examination, which provides an examination suitable for rating purposes. The Veteran underwent a VA audiological examination in November 2009. The Veteran stated it was difficult to hear all the time. The VA examiner interpreted the results as mixed moderate-severe results in the right ear and mixed severe hearing loss in the left ear. He concluded the hearing loss caused severe communication loss. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 45 45 55 55 60 LEFT 60 70 65 80 75 The pure tone averages were 54 decibels for the right ear and 73 decibels for the left ear. Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 90 percent in the left ear. As the pure tone threshold is 55 decibels or greater at 1000 Hertz, 2000 Hertz, 3000 Hertz, and 4000 Hertz for the left ear, the audiological results meet the requirements for exceptional patterns of hearing impairment. Therefore, the Roman numeral designation is determined using either Table VI or Table VIa, whichever results in the higher numeral. When applying the pure tone averages and the speech recognition scores to Table VI, the left ear is assigned a Level III. When applying the pure tone averages to Table VIa, the left ear is assigned a Level VI. As Table VIa results in a higher numeral, a Level VI is assigned for the left ear. As the audiological results do not meet the requirements for exceptional patterns of hearing impairment regarding the right ear, the Veteran's right ear hearing must be evaluated using Table VI. When applying the pure tone averages and the speech recognition scores to Table VI, the right ear is assigned a Level I. The Board then applies those levels to Table VII, which results in a noncompensable (0 percent) evaluation for the bilateral hearing loss. As such, a compensable disability rating for bilateral hearing loss is not warranted based on the November 2009 examination results. The Veteran underwent a second VA audiological examination in August 2010. The VA examiner diagnosed moderate-severe mixed hearing loss in the right ear and moderate-severe to severe mixed hearing loss in the left ear. Speech recognition was excellent in both ears. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 55 40 55 55 60 LEFT 75 65 55 85 75 The pure tone averages were 53 decibels for the right ear and 70 decibels for the left ear. Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 94 percent in the left ear. As the pure tone threshold is 55 decibels or greater at 1000 Hertz, 2000 Hertz, 3000 Hertz, and 4000 Hertz for the left ear, the audiological results meet the requirements for exceptional patterns of hearing impairment. Therefore, the Roman numeral designation is determined using either Table VI or Table VIa, whichever results in the higher numeral. When applying the pure tone averages and the speech recognition scores to Table VI, the left ear is assigned a Level II. When applying the pure tone averages to Table VIa, the left ear is assigned a Level VI. As Table VIa results in a higher numeral, a Level VI is assigned for the left ear. As the audiological results do not meet the requirements for exceptional patterns of hearing impairment regarding the right ear, the Veteran's right ear hearing must be evaluated using Table VI. When applying the pure tone averages and the speech recognition scores to Table VI, the right ear is assigned a Level I. The Board then applies those levels to Table VII, which results in a noncompensable (0 percent) evaluation for the bilateral hearing loss. As such, a compensable disability rating for bilateral hearing loss is not warranted based on the November 2009 examination results. The Veteran underwent a third VA audiological examination in October 2011. The right ear had a moderate to moderately severe mixed hearing loss and the left ear had a moderate-severe to severe mixed hearing loss. Both ears had excellent speech recognition. Pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 50 45 60 60 65 LEFT 70 65 65 75 80 The pure tone averages were 58 decibels for the right ear and 71 decibels for the left ear. Speech audiometry revealed speech recognition ability of 100 percent bilaterally. As the pure tone threshold is 55 decibels or greater at 1000 Hertz, 2000 Hertz, 3000 Hertz, and 4000 Hertz for the left ear, the audiological results meet the requirements for exceptional patterns of hearing impairment. Therefore, the Roman numeral designation is determined using either Table VI or Table VIa, whichever results in the higher numeral. When applying the pure tone averages and the speech recognition scores to Table VI, the left ear is assigned a Level II. When applying the pure tone averages to Table VIa, the left ear is assigned a Level VI. As Table VIa results in a higher numeral, a Level VI is assigned for the left ear. As the audiological results do not meet the requirements for exceptional patterns of hearing impairment regarding the right ear, the Veteran's right ear hearing must be evaluated using Table VI. When applying the pure tone averages and the speech recognition scores to Table VI, the right ear is assigned a Level II. The Board then applies those levels to Table VII, which results in a 10 percent evaluation for the bilateral hearing loss. As such, a disability rating in excess of 10 percent for bilateral hearing loss is not warranted based on the October 2011 examination results. The Board notes that, as to the November 2009 examinations and the October 2011 examinations, the examiners described the functional effects caused by the hearing loss disability. See Martinak v. Nicholson, 21 Vet. App. 447, 454-55 (2007). The Veteran reported that his hearing loss caused severe communication problems. Further the Veteran testified that his hearing aids provide at best adequate help. He has additional problems when there is background noise. Without his aids, he has great difficulty and with back ground noise, he has to pay real close attention to the speaker. His wife testified that if they are out of their home, he does not always hear her even if she is real close to him and that she and the Veteran watch TV separately where she finds that she must turn up the volume on her TV to drown out the volume of his TV which is turned to the maximum volume setting. The Veteran has trouble hearing storm warning sirens and can sleep through an alarm at night. He also has some problems hearing sirens while driving. The Veteran cannot use a regular house phone and must use a speaker. The Board acknowledges the Veteran's contentions regarding impact of his hearing loss on his daily activities, and VA's obligation to resolve all reasonable doubt in the Veteran's favor. As noted previously, however, because assignment of disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometry evaluations are rendered, there is no doubt as to the proper evaluations to assign. Lendenmann v. Principi, 3 Vet. App. 345; 38 C.F.R. § 4.85, Tables VI, VIA, and VII, Diagnostic Code 6100. The RO and the Board are bound by applicable laws, and regulations promulgated by the VA. 38 U.S.C.A. § 7104(c); 38 C.F.R. § 20.101(a). Consideration of factors wholly outside the schedular rating criteria would constitute error as a matter of law. Massey v. Brown, 7 Vet. App. 204, 207-208 (1994); Pernorio v. Derwinski, 2 Vet. App. 625, 628 (1992). No audiological examinations since October 11, 2011 are of record. For these reasons, the Board finds that the criteria for a compensable rating before the October 11, 2011 VA examination and for a disability rating in excess of 10 percent since October 11, 2011 for bilateral hearing loss have not been met or approximated at any time during the period on appeal, 38 C.F.R. § 4.85, Diagnostic Code 6100, and as the benefit of the doubt rule is not applicable, the claim must be denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Extraschedular Consideration The Board also has considered whether the criteria for referral for extraschedular disability rating are met. An extraschedular disability rating is warranted when the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (2011); see Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet App 111 (2008), there is a three-step inquiry for determining whether a Veteran is entitled to an extraschedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the Board must determine whether the claimant's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether the Veteran's disability picture requires the assignment of an extraschedular rating. In this case, the Veteran reported decreased hearing acuity causing communication problems especially with background noise and hearing warning sirens. The Veteran received audiological examinations that appropriately measured the Veteran's hearing loss levels, both as indicated by audiometric testing at specified levels, and as measured by speech recognition test scores. The speech recognition testing is schedular rating criteria recognition of an inability to hear some words in normal conversation. Stated another way, the schedular criteria recognizes the communication difficulties that arise with hearing loss. In a similar manner, the puretone threshold scores recognizes that hearing loss means a Veteran may not hear certain sounds at times such as sirens. The Board notes that the decibel loss and speech discrimination ranges designated for each level of hearing impairment in Tables VI and VIA were chosen in relation to clinical findings of the impairment experienced by veterans with certain degrees and types of hearing disability. The Veteran has not asserted and the Board has not found any reason to doubt the accuracy of the audiological examinations. Additionally, the findings appropriately apply to the criteria set forth in the Rating Schedule. As the Veteran's hearing loss was appropriately measured and applied, the Board finds that the Rating Schedule contemplates all aspects of his disability, so that referral for extraschedular consideration is not warranted regarding the claim for increased rating for bilateral hearing loss. The schedule is intended to compensate for average impairments in earning capacity resulting from service-connected disability in civil occupations. 38 U.S.C.A. § 1155. The degrees of disability specified in the rating schedule are generally considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. In this case, the problems reported by the Veteran are specifically contemplated by the criteria discussed above, including the effect on his daily life. Thus, the Veteran's hearing disability, as tested at VA under controlled circumstances and pursuant to standardized procedures, meets VA criteria that is designed for the type of real-world impairment experienced by the Veteran. The evidence submitted by the Veteran does not place his symptomatology outside of that contemplated by the rating schedule or make application of the rating schedule impracticable in this case. In the absence of exceptional factors associated with the Veteran's bilateral hearing loss, the Board finds that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). For this reason, the Board finds that the Rating Schedule measures and contemplates all aspects of the Veteran's disabilities, so is adequate to rate the Veteran's service-connected bilateral hearing loss, so that referral for extraschedular consideration is not warranted. Total Disability Based Upon Individual Unemployability (TDIU) During the appeal period, the Veteran has not expressly raised and the record does not reasonably raise a claim for total disability rating for compensation based on individual unemployability. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (in a claim for increase, where the Veteran expressly raises a claim for a total disability rating on the basis of individual unemployability or the claim is reasonably raised by the record, the claim is not a separate claim, but a part of a claim for increase). Therefore, in the circumstances of this case, the Board declines to take jurisdiction over a total disability rating claim. ORDER Entitlement to a compensable rating before October 11, 2011 and for a disability rating in excess of 10 percent since October 11, 2011 for bilateral hearing loss is denied. ____________________________________________ ROBERT C. SCHARNBERGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs