Citation Nr: 1320616 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 09-41 997 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES 1. Entitlement to service connection for a low back disability. 2. Entitlement to a compensable rating for a bilateral hearing loss disability. REPRESENTATION Veteran represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J.A. Flynn, Associate Counsel INTRODUCTION The Veteran served on active military duty from December 1959 to February 1964. This matter comes before the Board of Veterans' Appeals (Board) on appeal from two rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. An August 2008 rating decision, in pertinent part, continued a noncompensable disability rating for the service-connected bilateral hearing loss. A July 2009 rating decision found that new and material evidence had not been submitted sufficient to reopen the claim for service connection for a low back disorder. In November 2011, the Board reopened the Veteran's claim for service connection for a low back disorder. These matters were previously before the Board in November 2011, when the Board remanded the case for additional development of the evidence of record. As an initial matter, the Board notes that when its remand orders are not complied with, it errs as a matter of law when it fails to ensure compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). As will be discussed in further detail below, the Board finds that there has been effective compliance with the Board's remand instructions. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance.) FINDINGS OF FACT 1. The competent evidence of record does not support a finding that a relationship exists between the Veteran's currently-diagnosed low back disorder and his military service. 2. The Veteran's bilateral hearing loss disability is manifested by no worse than level II hearing acuity in the left ear and level III hearing acuity in the right ear. CONCLUSIONS OF LAW 1. The Veteran's low back disorder was not incurred or aggravated by the Veteran's active duty military service, and arthritis may not be presumed to have been. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.012, 3.159, 3.303, 3.307, 3.309 (2012). 2. The criteria for a compensable disability rating for a bilateral hearing loss disability have not been met. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 4.3, 4.85, 4.86, 4.87, Diagnostic Code 6100 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has thoroughly reviewed all the evidence in the Veteran's claims file. While the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the Veteran. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, the Board is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veterans Claims Assistance Act of 2000 (VCAA) The Board has given consideration to the VCAA, which includes an enhanced duty on the part of VA to notify a veteran of the information and evidence necessary to substantiate claims for VA benefits. See 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012). The VCAA also defines the obligations of VA with respect to its statutory duty to assist veterans in the development of their claims. See 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012). When VA receives a complete or substantially complete application for benefits, it must notify the veteran of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the veteran is expected to provide. 38 U.S.C.A. § 5103 (West 2002 & Supp. 2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if there is a favorable disposition of the claim. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.326 (2012); Dingess v. Nicholson, 19 Vet. App. 473 (2006); see also Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004). Prior to the initial adjudication of the Veteran's claims, letters dated June 2008 and June 2009 were sent to the Veteran in accordance with the duty to notify. 38 U.S.C.A. § 5103 (West 2002); 38 C.F.R. § 3.159(b)(1) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). These letters informed the Veteran of information and evidence necessary to substantiate the claims, information and evidence that VA would seek to obtain, information and evidence that the Veteran was expected to provide, and information regarding the process by which initial disability ratings and effective dates are established. The Board finds that the notice requirements have been fulfilled, and that no further notice is necessary. With respect to the duty to assist, VA has done everything reasonably possible to assist the Veteran with respect to his claims for benefits. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c) (2012). The Veteran's service treatment records, post-service private medical records, and VA treatment records have been obtained, to the extent available. The Board's November 2011 Remand directed the RO/AMC to attempt to obtain records associated with a December 1960 in-service automobile accident. The AMC undertook appropriate efforts to locate such records, and in June 2012, it issued a Formal Finding on the Unavailability of Jeep-Related Accident Records. The Board finds that the absence of these records does not prejudice the Veteran because the Board has conceded that the Veteran experienced an in-service accident. The Veteran has been provided with VA examinations. Upon review of these examination reports, with the exceptions that will be discussed in further detail below, the Board observes that the examiners reviewed the Veteran's claims file and past medical history, recorded his current complaints and history, conducted appropriate evaluations, and rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record. Furthermore, with respect to audiological examinations, in Martinak v. Nicholson, 21 Vet. App. 447 (2007), the United States Court of Appeals for Veterans Claims (Court) noted that VA revised its hearing examination worksheets to include the effect of the veteran's hearing loss disability on occupational functioning and daily activities. See Revised Disability Examination Worksheets, Fast Letter 07-10 (Dep't of Veterans Affairs Apr. 24, 2007); see also 38 C.F.R. § 4.10 (2012). The Court also noted that even if an audiologist's description of the functional effects of the Veteran's hearing disability was somehow deficient, the Veteran bears the burden of demonstrating any prejudice caused by a deficiency in the examination. Neither the Veteran nor his representative has asserted that there is any deficiency in the examination conducted. While the Board observes that the February 2012 VA examiner did not explicitly address the functional impairment posed by the Veteran's hearing loss disability, the examiner conducted a review of the Veteran's claims file, which contains an account of the functional impairment that the Veteran's hearing loss presents. Further, the Board notes that the June 2008 VA examination report discussed the Veteran's functional problems, including difficulty understanding conversations. Thus, as contemplated by Martinak and directed by 38 C.F.R. § 4.10, the Board finds that examiners have considered the functional effects of the Veteran's hearing problems. The examination reports are therefore adequate for the purpose of rendering a decision in the instant appeal. See 38 C.F.R. § 4.2 (2012); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran presented testimony before the undersigned at a June 2011 videoconference hearing, and a transcript of this hearing is associated with the record. Thus, the duties to notify and assist have been met, and the Board will proceed to a decision. Service Connection In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. See 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). In order to establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be granted for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. See 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2012); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." For certain chronic diseases set forth in 38 C.F.R. § 3.309(a), a continuity of symptomatology is required when the condition noted during service is not shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. See 38 C.F.R. § 3.303(b) (2012); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that a "continuity of symptomatology" as specified in 38 C.F.R. § 3.303(b) affords an alternative route to service connection only for specific chronic diseases). To the extent that the Veteran's claimed low back disorder may represent a degenerative or arthritic process, arthritis is among the chronic diseases set forth in 38 C.F.R. § 3.309, and it therefore may be established based on a continuity of symptomatology. See Walker. With regard to the first Hickson element, medical evidence of a current disability, the March 2012 VA examination, among other medical evidence, demonstrates that the Veteran suffers from a lumbar strain and degenerative disc disease. The first Hickson element, medical evidence of a current disability, is met. With respect to the second Hickson element, in-service disease or injury, the Veteran's service treatment records do not indicate that he received treatment for symptoms associated with his low back in service. The Veteran did, however, receive treatment for leg abrasions and a bruised rectum after he was involved in a jeep-related accident in December 1960. Affording the Veteran the benefit of the doubt, the second Hickson element is met as to an in-service injury. Regarding the third Hickson element, medical evidence of nexus, the determination of the relationship, if any, between the Veteran's current disability and his military service, is essentially medical in nature. The Board is prohibited from exercising its own independent judgment to resolve medical questions. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Turning to the facts in the instant case, an April 1986 private treatment record indicates that the Veteran received treatment for an acute lumbosacral strain after running. The Veteran denied experiencing any serious back injury in the past, but he stated that he had been doing remodeling work that involved "quite a bit of bending and lifting." An August 1986 private treatment record indicates that the Veteran again received treatment for an acute lumbosacral strain after he lifted a heavy object and experienced sudden pain in his lower back. A May 1994 VA x-ray examination showed an essentially negative lumbar spine with minimal hypertrophic degenerative osteophytes formation at L1-L2. Chiropractic records indicate that the Veteran received treatment for his low back from February 1997 to April 2006. In December 2000, the Veteran did not complain of back pain when receiving VA treatment. In February 2001, the Veteran complained of lower back pain; the Veteran stated that he had experienced this pain for the preceding six to eight weeks. In September 2006, the Veteran complained of dull pain in the lower back, and he indicated that he had experienced this pain since 1961. In February 2008, the Veteran's former chiropractor indicated that the Veteran suffered from "spinal-related problems" that were directly related to low back stress "as he was injured in the military years before." In March 2008, the Veteran stated to a VA primary care provider that he had experienced progressively worsening symptoms associated with his back since the time of his December 1960 in-service accident. The VA clinician's impression stated that the Veteran had back pain, which "could" as likely as not be related to the Veteran's in-service accident. The Veteran received a VA examination of his low back in April 2008. The examiner found that it was less likely than not that the Veteran's low back disorder was related to his in-service jeep accident. The examiner noted that there was no evidence of any continuing problems or chronicity of care from the time of his discharge from service until August 1986. Instead, the examiner opined, the Veteran's current degenerative disease of the lumbosacral spine was most likely due to age-related degenerative changes. The Veteran's representative later argued that little probative weight should be afforded to this examination because the examiner was an anesthesiologist by training. Accordingly, the Board's November 2011 Remand indicated that an additional examination of the Veteran was required. Pursuant to the Board's Remand, the Veteran received an additional examination of his low back in March 2012. The examiner found that the Veteran's low back condition was less likely than not related to active duty service. Instead, the examiner opined that the Veteran's low back condition was more likely the result of post-service events, such as the 1986 episodes discussed above, and the risk of back pain in the general population. The examiner noted that the Veteran's x-ray results in 1994 were essentially normal. The examiner noted that back pain was the second most common symptom-related reason for physician visits in the United States, with up to 84 percent of adults experiencing low back pain at some point in their lives. An etiologic diagnosis is not established for most patients with back pain. The examiner also conducted a review of the Up-To-Date treatise database, and the examiner found that Up-To-Date did not support the finding of a connection between the Veteran's military service and his current low back disorder. The Board has also considered the lay evidence of record. For example, in his March 2008 hearing before a Decision Review Officer, the Veteran stated that for "the first 10 to 12 years," he took "elephant tranquilizers" to treat his back pain. The Veteran did not clearly indicate when he first received treatment after service for his low back pain, and he could not remember the names of doctors who treated him soon after service Upon review of the evidence, the Board observes two opinions that support a finding that the Veteran's low back disorder is related to active duty service: the February 2008 opinion of the Veteran's former chiropractor and the March 2008 statement from a VA primary care provider. The Board, however, affords each of these opinions with relatively little probative weight. Neither of the opinions was accompanied by a discussion of the pertinent evidence of record, including the lengthy period of time between the Veteran's separation from service in February 1964 and his first treatment for back pain in 1986. Neither opinion was accompanied by a rationale explaining why the Veteran's current condition was likely related to his in-service military accident. The March 2012 examiner, who found that there was not a likely connection between the Veteran's low back disorder and his military service, examined the Veteran, reviewed his claims file, reviewed the medical literature, and considered the Veteran's own contentions before arriving at the conclusion that the Veteran's low back disorder was less likely than not related to service. The Board accordingly affords the March 2012 examiner's opinion with great probative weight. To the extent that the Veteran believes that his low back disorder is related to his military service, the Board notes that the Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (that is, experiencing physical symptoms such as pain). See Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Further, under certain circumstances, lay statements may support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Indeed, VA provided the Veteran with examinations based on the competency of these observations. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, namely, the etiology of a back condition, the issue of causation of such a medical condition is a medical determination outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Thus, although the Board has carefully considered the lay contentions of record suggesting that the Veteran's low back disorder is related to his military service, the Board ultimately affords the objective medical evidence of record, which fails to find a connection between the Veteran's conditions and his military service, with greater probative weight than these lay opinions. As noted above, pursuant to 38 C.F.R. § 3.309, the Board has also considered whether the Veteran has presented a continuity of symptomatology associated with his back symptoms, and it finds that he has not done so. There is no competent medical evidence indicating that the Veteran was treated for back pain until 1986, or approximately 22 years after separation from service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (noting that it was proper to consider the veteran's entire medical history, including the lengthy period of absence of complaint with respect to the condition he now raised). Furthermore, at the time of his treatment for back pain in 1986, the Veteran stated that he had experienced back pain following an acute injury to his back. The Veteran denied having experienced serious back injury in the past. Furthermore, in February 2001, the Veteran indicated that he had experienced back pain only for the preceding six to eight weeks; this is consistent with a December 2000 treatment record indicating that the Veteran denied back pain at that time. Thus, while the Board has considered the lay contentions that the Veteran experienced back problems after military service, the Board finds that the weight of the evidence, including the Veteran's own contentions to VA care providers, does not support a finding of continuous symptoms since active duty. Thus, the medical nexus element of Hickson cannot be met via continuity of symptomatology with regard to the Veteran's claimed low back disorder. The Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. That doctrine, however, is not applicable in this case because the preponderance of the evidence is against the claims. See 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The preponderance of the competent and probative evidence of record indicates that the Veteran's low back disorder is not related to his military service. Accordingly, the third Hickson element, competent evidence of nexus, has not been satisfied. The benefit sought on appeal is accordingly denied. Increased Rating The Veteran contends that his bilateral hearing loss disability is worse than the current noncompensable evaluation reflects. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. See 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). Separate diagnostic codes identify the various disabilities. See 38 C.F.R. Part 4 (2012). When 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. See 38 C.F.R. § 4.7 (2012). Any reasonable doubt regarding the degree of disability is resolved in favor of the veteran. See 38 C.F.R. § 4.3 (2012). In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. See Fenderson v. West, 12 Vet. App. 119 (1999). The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Separate disabilities arising from a single disease entity are to be rated separately. See 38 C.F.R. § 4.25 (2012); see also Esteban v. Brown, 6 Vet. App. 259, 261 (1994). Pyramiding-the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes-is to be avoided when rating a veteran's service-connected disabilities. See 38 C.F.R. § 4.14 (2012). Disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Bruce v. West, 11 Vet. App. 405, 409 (1998) (quoting Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992)). The regulations set forth eleven auditory acuity levels, designated from Roman numerals I to XI, in escalating order of hearing impairment. See 38 C.F.R. § 4.85 (2012). The appropriate auditory acuity level is determined based on a combination of the percent of speech discrimination and the puretone threshold average. When an audiologist certifies that use of the speech discrimination test is not appropriate, then Table VIa, "Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average," is used alone to determine the auditory acuity level. In exceptional cases in which the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, Table VI or Table VIa is to be used, whichever results in the higher numeral. See 38 C.F.R. § 4.86(a) (2012). Similarly, when the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, Table VI or Table VIa is to be used, whichever results in the higher numeral. Thereafter, that numeral will be elevated to the next higher numeral. See 38 C.F.R. § 4.86(b) (2012). Once an acuity level is established for each ear, Table VII, "Percentage Evaluations for Hearing Impairment" is used to determine the appropriate disability evaluation. The appropriate evaluation is determined based on a combination of the levels of hearing impairment established for each ear. Turning to the facts in the instant case, in a June 2008 audiological examination, the following puretone results were noted (in decibels): HERTZ 1000 2000 3000 4000 LEFT 20 35 35 35 RIGHT 25 35 35 35 Puretone threshold averages were 31 decibels in the left ear and 33 decibels in the right ear. Speech discrimination scores were 90 percent in the left ear and 78 percent in the right ear. Turning now to a determination of the level of hearing acuity in each ear, this audiometric evaluation demonstrates that the Veteran had level II hearing in the left ear (between 0 and 41 average puretone decibel hearing loss, with between 84 and 90 percent speech discrimination), and level III hearing in the right ear (between 0 and 41 average puretone decibel hearing loss, with between 76 and 82 percent speech discrimination). With an acuity level determined for each ear, the Board turns to Table VII in order to determine the appropriate percentage evaluation for the Veteran's level of hearing acuity. With the poorer ear at level III hearing loss and the better ear at level II hearing loss, a 0 percent (noncompensable) rating is warranted under Diagnostic Code 6100. See 38 C.F.R. § 4.85 (2012). In a November 2010 audiological consultation, the following puretone results were noted (in decibels): HERTZ 1000 2000 3000 4000 LEFT 20 35 45 50 RIGHT 20 30 45 45 Puretone threshold averages were 38 decibels in the left ear and 35 decibels in the right ear. Speech discrimination scores were 100 percent in both ears. Turning now to a determination of the level of hearing acuity in each ear, this audiometric evaluation demonstrates that the Veteran had level I hearing in both ears (between 0 and 41 average puretone decibel hearing loss, with between 92 and 100 percent speech discrimination). With an acuity level determined for each ear, the Board turns to Table VII in order to determine the appropriate percentage evaluation for the Veteran's level of hearing acuity. With both the poorer and better ear at level I hearing loss, a 0 percent (noncompensable) rating is warranted under Diagnostic Code 6100. See 38 C.F.R. § 4.85 (2012). In a February 2012 audiological examination, the following puretone results were noted (in decibels): HERTZ 1000 2000 3000 4000 LEFT 10 30 35 45 RIGHT 15 30 35 35 Puretone threshold averages were 30 decibels in the left ear and 29 decibels in the right ear. Speech discrimination scores were 100 percent in both ears. Turning now to a determination of the level of hearing acuity in each ear, this audiometric evaluation demonstrates that the Veteran had level I hearing in both ears (between 0 and 41 average puretone decibel hearing loss, with between 92 and 100 percent speech discrimination). With an acuity level determined for each ear, the Board turns to Table VII in order to determine the appropriate percentage evaluation for the Veteran's level of hearing acuity. With both the poorer and better ear at level I hearing loss, a 0 percent (noncompensable) rating is warranted under Diagnostic Code 6100. See 38 C.F.R. § 4.85 (2012). The Board has also considered the provisions of 38 C.F.R. § 4.86 governing exceptional patterns of hearing impairment. Neither of the Veteran's ears has ever demonstrated an exceptional pattern of hearing loss. While the puretone threshold has always been fewer than 30 decibels at 1000 Hertz, it has not been 70 decibels or more at 2000 Hertz. Similarly, the puretone threshold at each of the four specified frequencies has never been 55 decibels or greater. See 38 C.F.R. § 4.86(a) (2012). To the extent that the Veteran contends that his hearing loss is more severe than the current noncompensable evaluation, the Board observes that the Veteran is competent to report symptoms such as difficulty hearing soft voices, high frequencies, and difficulty discriminating during conversations. See Layno v. Brown, 6 Vet. App. 465, 467-69 (1994) (stating that the veteran as a lay person is competent to report information of which he has personal knowledge, that is, information that he can gather through his senses.) Despite the competence of the Veteran's observation, a higher schedular rating for hearing loss requires not only a description of symptoms, but greater objectively-measured levels of hearing loss. In short, the Board concludes that the preponderance of the evidence is against granting an increased evaluation for the Veteran's service-connected bilateral hearing loss disability. The Board further finds that there have been no distinct periods of time during which the Veteran's disability was compensable. He is accordingly not entitled to receive a "staged" rating. Extra-Schedular Considerations In addition, the Board has considered whether the Veteran is entitled to a greater level of compensation on an extra-schedular basis. Ordinarily, the VA Schedule will apply unless there are exceptional or unusual factors that render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). In Thun v. Peake, the Court set forth a three-step inquiry to determine a veteran's entitlement to an extra-schedular rating. See 22 Vet. App. 111 (2008). 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 Veteran's level of disability and symptomatology and is found to be inadequate, the Board must determine whether the Veteran'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, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating. In this case, it is not necessary to go any further than the first step of the Thun analysis. The rating criteria are not inadequate, and it does not appear that the Veteran has an "exceptional or unusual" disability; he merely disagrees with the assigned evaluation for his level of impairment. In other words, he does not have any symptoms from his service-connected hearing loss that are unusual or different from those contemplated by the schedular criteria. Indeed, the February 2012 examiner found that the Veteran's hearing loss did not impact the ordinary conditions of his daily life, including his ability to work. See Martinak, 21 Vet. App. at 455. The available schedular evaluations for the service-connected disabilities are adequate. Referral for extra-schedular consideration is not warranted. Further inquiry into extra-schedular consideration is moot. See Thun. The Board also notes that the Court has held that the issue of a total disability rating based on individual unemployability (TDIU) is part of an increased rating claim when a request for TDIU is reasonably raised by the record. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). However, in the present case, the Veteran has not explicitly raised the issue of TDIU. Likewise, the record does not reasonably raise the issue of TDIU. The Veteran has not argued, and the record does not reflect, that his service-connected noncompensable hearing loss and tinnitus, evaluated as 10 percent disabling, renders him unemployable. In light of the foregoing, the Board finds that entitlement to TDIU has not been raised. ORDER Service connection for a low back disability is denied. A compensable disability rating for bilateral hearing loss is denied. ____________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs