Citation Nr: 18142237 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 17-59 082 DATE: October 15, 2018 ORDER Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for high cholesterol is denied. Entitlement to service connection for high blood pressure is denied. Entitlement to service connection for a stomach condition is denied. Entitlement to service connection for diabetes is denied. Entitlement to service connection for an acquired psychiatric disorder, including anxiety and depression, to include as secondary to service-connected bilateral hearing loss, is granted. Entitlement to a rating in excess of 50 percent prior to July 11, 2016, and in excess of 70 percent since July 11, 2016, for bilateral hearing loss is denied. REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The evidence does not show complaint of or treatment for a back injury during service, and the evidence indicates onset after separation due to a post-service injury. 2. The evidence of record does not show a current right hip disability. 3. The evidence of record does not show complaint of or treatment for a left knee disability during the Veteran’s period of service. 4. The evidence of record does not show complaint of or treatment for a right knee disability during the Veteran’s period of service. 5. The Veteran’s high cholesterol manifests as a laboratory test result not resulting in an earning capacity limiting disability. 6. The evidence of record does not show complaint of or treatment for high blood pressure during the Veteran’s period of service or one year after separation. 7. The evidence of record does not show complaint of or treatment for a stomach condition during the Veteran’s period of service. 8. The evidence of record does not show complaint of or treatment for diabetes during the Veteran’s period of service. 9. The evidence of record indicates that the Veteran has an acquired psychiatric disorder, including anxiety and depression, that is at least as likely as not the result of the Veteran’s service-connected bilateral hearing loss. 10. Prior to July 11, 2016, the Veteran’s hearing loss was manifested by hearing levels of no worse than Level IX in the right ear and Level VI in the left ear, and after July 11, 2016, the Veteran’s hearing loss was manifested by hearing levels of no worse than Level X in the right ear and Level IX in the left ear. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. 2. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303. 3. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. 4. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. 5. The criteria for service connection for high cholesterol have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. 6. The criteria for service connection for high blood pressure have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.309. 7. The criteria for service connection for a stomach condition have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. 8. The criteria for service connection for diabetes have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. 9. The criteria for service connection for an acquired psychiatric disorder, including anxiety and depression, to include as secondary to service-connected bilateral hearing loss, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.310. 10. The criteria for a rating in excess of 50 percent prior to July 11, 2016, and as 70 percent since July 11, 2016, for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.25 4.85, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty in the United States Navy from February 1957 to January 1960. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be established for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d at 1372. Where a veteran served continuously for ninety (90) days or more during a period of war, or during peacetime service after December 31, 1946, and a disease enumerated by the regulations become manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1110, 1133; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established for disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310 (2016); Allen v. Brown, 7 Vet. App. 439. 1. Service connection for a low back disability The Veteran contends that his back disability is due to his period of service. The Board finds that there is no nexus between the Veteran’s current back disability and his period of service such that service connection would be warranted. The Veteran’s VA medical treatment records indicate January 2013 treatment for a low back disability. The Veteran’s service treatment records are silent on complaint of or treatment for a back injury. An April 1985 post-service private medical record indicates that the Veteran sought treatment for his back. The examiner stated that the Veteran reported onset approximately 14 to 15 years prior, and described the injury as work-incurred, wherein the Veteran was jerked by a rope which was attached to a falling tree limb. In a July 2016 VA examination, the examiner determined that it was less likely than not that the Veteran’s current back disability was incurred in or caused by his period of service. The examiner explained that there was no documentation that indicate injuries or complaint during military service of such significance that they would be responsible for the current diagnosis. The examiner also reported that historical information indicated onset of lower back pain somewhere between 1970 and 1983. The examiner went on to note that there is no documentation of “back strain” during service that would be at least as likely as not to cause problems beginning 10 years after discharge. Therefore, the examiner concluded that the Veteran’s current back disability was not due to his period of service. After review of the record, the Board finds that the evidence weighs heavily against a finding of service connection for a low back disability. The record indicates onset after service. Moreover, the only medical opinion of record states that the Veteran’s current back disability is less likely to be related to his period of service. Therefore, service connection is not warranted. The Board recognizes the Veteran’s contention that his low back disability resulted from his period of service. Although lay persons are competent to provide opinions on some medical issues, the specific issue of determining the etiology of the Veteran’s back disability falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In this regard, while the Veteran can competently report observed symptoms, any opinion regarding whether his back condition was related to his period of service requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Board assigns no probative weight to the Veteran’s assertions that his back disability was due to his service. For the foregoing reasons, the Board finds that the preponderance of the evidence is against a grant of service connection for a low back disability. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. 2. Service connection for a right hip disability The Veteran contends that his claimed right hip disability is due to his period of service. The Board finds that there is insufficient evidence to warrant service connection for a right hip disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a right hip disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). While the Veteran believes he has a current diagnosis of a right hip disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Finally, the Board is cognizant of the recent holding in Saunders v. Wilkie which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders v. Wilkie, No. 17-1466 (Fed. Cir. 2018). In sum, pain alone resulting in functional impairment is in fact a disability, and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. However, the Veteran does not claim, nor do his medical records show that he experiences, any functional impairment due to his subjective right hip pain. As such, the Veteran’s right hip pain does not amount to a functional impairment of earning capacity, and Saunders is not applicable in this case. 3. Service connection for a left knee disability The Veteran contends that his claimed left knee disability is due to his period of service. The Board finds that there is insufficient evidence to warrant service connection for a left knee disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has evidence of current treatment for the Veteran’s left knee, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Specifically, the Veteran’s service treatment records do not show complaint of or treatment for a left knee injury during his period of service. Having not met the second criteria of an in-service incident, service connection for a left knee disability is not warranted. While the Veteran believes that his left knee disability is related to his period of service, the Board reiterates that the preponderance of the evidence weighs against findings that complaint of or treatment for an in-service left knee injury occurred. 4. Service connection for a right knee disability The Veteran contends that his claimed right knee disability is due to his period of service. The Board finds that there is insufficient evidence to warrant service connection for a right knee disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has evidence of current treatment for the Veteran’s right knee, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Specifically, the Veteran’s service treatment records do not show complaint of or treatment for a right knee injury during his period of service. Thus, service connection for a right knee disability is not warranted. While the Veteran believes that his right knee disability is related to his period of service, the Board reiterates that the preponderance of the evidence weighs against findings that complaint of or treatment for an in-service right knee injury occurred. 5. Service connection for high cholesterol The Veteran contends his high cholesterol is due to his period of service. The Veteran’s VA medical records show findings of hyperlipidemia. The Board notes that hyperlipidemia and elevated cholesterol are laboratory findings and are not disabilities in and of themselves for which VA compensation benefits are payable. There is no evidence of record suggesting the Veteran’s elevated cholesterol or hyperlipidemia causes any impairment of earning capacity. Service connection can only be granted for a disability resulting from disease or injury. See 38 U.S.C. § 1110. As high cholesterol manifests only as a test result, service connection for high cholesterol is not warranted. 6. Service connection for high blood pressure The Veteran contends that his high blood pressure is due to his period of service. The Board finds that the evidence of record is insufficient to establish that service connection for high blood pressure is warranted. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has evidence of current treatment for high blood pressure, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Specifically, the Veteran’s service treatment records do not indicate complaint of or treatment for high blood pressure during service. Moreover, while hypertension may be considered for presumptive service connection under 38 C.F.R § 3.309, the record does not indicate manifestation of hypertension within one year of the Veteran’s separation from service. Therefore, service connection is not warranted. While the Veteran believes that his high blood pressure is related to his period of service, the Board reiterates that the preponderance of the evidence weighs against findings that complaint of or treatment for an in-service high blood pressure occurred or presumptive service connection based on manifestation within a year of separation from service. 7. Service connection for a stomach condition The Veteran contends that his claimed stomach condition is due to his period of service. The Board finds there is insufficient evidence such that service connection for a stomach condition is warranted. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has evidence of current treatment for stomach acid, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Specifically, the Veteran’s service treatment record does not establish complaint of or treatment for a stomach condition during the Veteran’s period of service. Thus, service connection for a stomach condition is not warranted. While the Veteran believes that his stomach condition is related to his period of service, the Board reiterates that the preponderance of the evidence weighs against findings that complaint of or treatment for an in-service stomach condition occurred. 8. Service connection for diabetes The Veteran contends that his diabetes is due to his period of service. The Board finds there is insufficient evidence such that service connection for diabetes is warranted. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has evidence of current diagnosis of diabetes, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). While the Veteran believes that his diabetes is related to his period of service, the Board reiterates that the preponderance of the evidence weighs against findings that complaint of or treatment for diabetes during service occurred. 9. Service connection for an acquired psychiatric disorder, including anxiety and depression, to include as secondary to service-connected bilateral hearing loss The Veteran contends that his psychiatric disorder, to include anxiety and depression, is secondary to his service-connected hearing loss. The Board finds that the evidence of record is sufficient to establish service connection for an acquired psychiatric disorder. In a May 2018 private medical examination, the examiner determined that the Veteran has a current diagnosis of depressive disorder, and it is at least as likely as not proximately due to his service-connected bilateral hearing loss. The examiner explained that review of relevant mental health records, supportive lay statements and evidence-based research strongly suggests that the Veteran has a depressive disorder due to medical conditions, with anxious distress features which more likely than not is caused by his service-connected bilateral sensorineural hearing loss and tinnitus. The examiner noted that though the Veteran had several other non-service-connected physical conditions which contributed to his mental conditions, it would be extremely difficult to determine which condition was the biggest factor contributing to his mental health condition. The examiner went on to state that all physical conditions contribute equally to the Veteran’s depression and anxiety symptoms. As the evidence of record indicates that the Veteran’s service-connected hearing loss results, in part, in the Veteran’s acquired psychiatric disorder, the Veteran is given the benefit of the doubt. For these reasons, service connection is warranted. Increased Rating 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. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 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; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, otherwise the lower rating will apply, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. See Fenderson v. West, 12 Vet. App. 119 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods based on the facts found- a practice known as “staged” ratings. In general, all disabilities, including those arising from a single disease entity, are rated separately, and disability ratings are then combined in accordance with 38 C.F.R. § 4.25. 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. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In accordance with 38 C.F.R. §§ 4.1, 4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the Veteran’s service-connected disability. The Board has found nothing in the historical record that would lead to the conclusion that the current evidence of record is not adequate for rating purposes. A rating in excess of 50 percent prior to July 11, 2016, and 70 percent from July 11, 2016 and thereafter for bilateral hearing loss The Veteran contends his bilateral hearing loss is such that it warrants a rating in excess of 70 percent. The Board finds that the Veteran’s hearing loss disability more closely approximates to a 50 percent disabling rating prior to July 11, 2016, and a 70 percent rating from July 11, 2016 and thereafter, such that an increased rating is not warranted. In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Evaluations of bilateral hearing loss range from noncompensable to 100 percent based on an organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by puretone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second. The rating schedule establishes 11 auditory acuity Levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. VA audiological evaluations are conducted using a controlled speech discrimination test together with the results of puretone audiometry tests. The vertical line in Table VI (printed in 38 C.F.R. § 4.85) represents nine categories of the percentage of discrimination based on a controlled speech discrimination test. The horizontal columns in Table VI represent 9 categories of decibel loss based on the puretone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the puretone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85 and the statement of the case) by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate for the numeric designation for the level for the ear having the poorer hearing acuity. See 38 C.F.R. § 4.85. Further, additional considerations apply when exceptional patterns of hearing impairment are demonstrated. Exceptional patterns of hearing impairment occur when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. In that situation, 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. 38 C.F.R. § 4.86(a). Also, when the average 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 considered separately. 38 C.F.R. § 4.86 (b). In addition to dictating objective test results, a VA audiologist must describe the functional effects caused by a hearing disability in his or her final report. Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In this case, the VA examiners noted functional impact from the Veteran’s hearing loss. Turning to the evidence, in a September 2014 VA examination, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 60 75 90 95 105 LEFT 55 65 75 70 80 The average pure tone threshold was 91 in the right ear and 73 in the left ear. His word recognition score using the Maryland CNC test was 64 percent in the right ear and 94 percent in the left ear. These audiometric findings equate to Level VIII hearing in the right ear and Level II in the left ear. See 38 C.F.R. § 4.85, Table VI. The Board notes that both ears showed an exceptional pattern of hearing loss as well, and Table VIA can be applied for both ears. In applying Table VIA to the examination, a level IX hearing is provided for the right ear, and a level VI is provided for the left ear. In a February 2016 VA examination, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 35 55 60 75 75 LEFT 40 55 50 65 65 The average pure tone threshold was 66 in the right ear and 59 in the left ear. His word recognition score using the Maryland CNC test was 76 percent in the right ear and 70 percent in the left ear. These audiometric findings equate to Level IV hearing in the right ear and Level V in the left ear. The Board notes that both ears showed an exceptional pattern of hearing loss as well, and Table VIA can be applied for both ears. In applying Table VIA to the examination, a level V hearing is provided for the right ear, and a level IV is provided for the left ear. In a July 2016 VA examination puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 60 75 85 100 105 LEFT 60 70 70 75 75 The average pure tone threshold was 91 in the right ear and 73 in the left ear. His word recognition score using the Maryland CNC test was 40 percent in the right ear and 42 percent in the left ear. These audiometric findings equate to Level X hearing in the right ear and Level IX in the left ear. The Board notes that both ears showed an exceptional pattern of hearing loss as well, and Table VIA can be applied for both ears. In applying Table VIA to the examination, a level IX hearing is provided for the right ear, and a level VI is provided for the left ear. After review of the evidence, the Board finds that, even when considering an exceptional pattern of hearing impairment, prior to July 11, 2016, the evidence does not establish that the Veteran’s symptoms were so severe that his puretone threshold and word recognition results would result in a rating in excess of 50 percent based on Table VII hearing impairment percentage evaluation under the provisions of 38 C.F.R. § 4.85. Likewise, the July 2016 VA examination shows hearing loss that more closely approximates to a 70 percent rating, and there is no other evidence of record that indicates that a higher rating is warranted. Therefore, a rating of 50 percent prior to July 11, 2016 and 70 percent from July 11, 2016, and thereafter, for bilateral hearing loss, is appropriate. The Board notes that the Veteran is competent to report observations about the severity of his symptomatology. See Jandreau v. Nicholson, 492 F.3d 1372, and 1376-77 (Fed. Cir. 2007). The Board finds these lay statements to be credible and consistent with the ratings assigned. To the extent he argues his symptomatology is more severe, the Veteran’s statements must be weighed against the other evidence of the record. Here, the specific examination findings of trained health care professionals and documented medical treatment records are of greater probative weight than the more general lay assertions that a higher rating is warranted. REASONS FOR REMAND 1. Service connection for sleep apnea is remanded. The Veteran has asserted that his sleep apnea is due to his acquired psychiatric disorder. As service connection for the Veteran’s acquired psychiatric disorder has been granted, a medical opinion is needed to determine whether the Veteran’s sleep apnea is proximately due to or aggravated by the Veteran’s service-connected disability. Thus, a remand is necessary. 2. A TDIU is remanded. In a June 2018 appellate brief, the issue of a TDIU was raised. In Rice v. Shinseki, the United States Court of Appeals for Veterans Claims (Court) held that when entitlement to a TDIU is raised during the adjudicatory process of the underlying disability, it is part of the claim for benefits for the underlying disability. Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the Veteran is seeking entitlement to a TDIU as a component of his claim for a higher initial rating for his service-connected hearing loss. The May 2018 private medical opinion provides inadequate information regarding the Veteran’s inability to work. The examiner determined that the Veteran’s depressive disorder did not cause total social and occupational impairment. The examiner also stated that the Veteran’s mental and physical conditions, to include his non-service-connected disabilities, contributed to his inability to work but could not determine the extent of the service-connected disabilities’ contributions. Moreover, the Board notes that while the issue of TDIU has been raised, a formal application is not of record. Therefore, a remand is necessary. The matter is REMANDED for the following action: 1. Invite the Veteran to submit a formal application for TDIU and submit any evidence showing that his service-connected disabilities render him unemployable. 2. Schedule the Veteran with the appropriate examiner to determine the nature and etiology of his sleep apnea. The examiner shall consider all other medical records associated with this file during review. The examiner(s) is asked to offer an opinion on the following: Determine whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s sleep apnea is proximately due to or aggravated by the Veteran’s service-connected depressive disorder. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Ford, Associate Counsel