Citation Nr: 18143467 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 12-30 606A DATE: October 19, 2018 ORDER Service connection for a left shoulder disability is denied. Service connection for asthma is denied. An initial compensable rating for bilateral pes planus with plantar fasciitis is denied. An initial compensable rating for bilateral hearing loss is denied. FINDINGS OF FACT 1. The competent credible clinical evidence of record is against a finding that the Veteran has a left shoulder disability causally related to active service. 2. Asthma clearly and unmistakably pre-existed active service. 3. There is clear and unmistakable evidence that asthma was not aggravated by active service (i.e., any increase in disability was due to the natural progression of the condition). 4. Bilateral pes planus with plantar fasciitis is not manifested by a moderate disability with objective evidence of weight-bearing line over or medial to great toe, inward bowing of the tendo achilles pain on manipulation and use of the feet. 5. The Veteran has had no worse than level I hearing loss in the right and left ear. CONCLUSIONS OF LAW 1. The criteria for service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1101, 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for asthma have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. 3. The criteria for the assignment of a compensable disability rating for bilateral pes planus with plantar fasciitis have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Codes 5276, 5284. 4. The criteria for entitlement to a compensable disability rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.10, 4.85, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection The Veteran served in the Army National Guard from April 23, 1978 to November 30, 1978, and from February 2003 to November 2004. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in the line of duty or for aggravation of a pre-existing injury or disease in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires (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) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Left shoulder The Veteran avers that she has a left shoulder disability due to her second period of active service (February 2003 to November 2004). Specifically, the Veteran asserts that she strained her shoulder performing in-service duties, such as tying down straps and using chains and binders to secure vehicles or other materials on her truck. 08/11/2008 VA 21-4138 Statement in Support of Claim. The Veteran testified that during service she was carrying a box, tripped over a rope and fell injuring her shoulder and leg. 07/08/2016 Hearing Testimony at 13. The first element of a claim for service connection is that there must be evidence of a current disability. An April 2009 VA examination reflects a diagnosis of left shoulder with probable rotator cuff tear and possible nerve impingement. Based on the foregoing competent evidence, the Board finds that the first element has been met. The second element of a claim of service connection on a direct basis is evidence of in-service incurrence or aggravation of an injury or disease. Service treatment records do not reflect any treatment for the left shoulder; rather, she sought treatment related to the right shoulder. A July 2003 treatment record reflects injury to her neck, right shoulder, lower leg and back. 08/20/2014 STR-Medical at 4, 6. A January 2004 treatment record reflects right shoulder muscle stiffness. Id. at 13. At the Board hearing, the Veteran testified that while she did not seek in-service treatment related to the left shoulder, both shoulders bothered her at that time. 07/08/2016 Hearing Testimony at 25. An April 2008 treatment record reflects the Veteran’s complaints of pain in her left shoulder going down to her elbow for 2 to 3 weeks. She denied a history of trauma. There was no evidence of acute osseous pathology involving the left shoulder. 12/24/2008 Medical Treatment Record-Government Facility. A June 2008 treatment record reflects follow-up of left shoulder and neck pain. She underwent physical therapy but still complained of limited range of motion of the left shoulder. An MRI showed small full-thickness tear in one of the rotator cuff tendons as well as degenerative arthritis. The impression was chronic left shoulder pain, secondary to left rotator cuff tear with possible contribution from cervical radiculitis. 04/06/2009 Medical Treatment Record-Government Facility at 11-12. An August 2008 treatment record reflects the Veteran’s complaints of ongoing left shoulder pain and decreased range of motion. She reported that when raising her arm, she can feel a sharp pain down the arm. She reported neck pain, but the main site of pain is in the left shoulder itself. The assessment was chronic left shoulder and neck pain, likely multifactorial from old rotator cuff tear and cervical radiculitis. Id. at 9-10. A September 2008 treatment record reflects the Veteran’s complaints of left shoulder pain and trouble moving it. An MRI showed partial thickness tear. The examiner’s assessment was persistent symptoms of left shoulder pain. Id. at 6-7. At the April 2009 VA examination, the Veteran told the examiner that she could not recall a specific injury but thinks pulling on the seatbelt shoulder strap repeatedly while a truck driver in Iraq may have torn her tendon in her shoulder. 04/20/2009 VA Examination at 6. Upon examination, the examiner diagnosed left shoulder with probable rotator cuff tear and possible nerve impingement. Id. at 12. The examiner did not provide an etiological opinion. In July 2018, the Veteran underwent a VA examination. The Veteran reported increasing pain to the left shoulder after pulling down on truck stairs in 2003. She was evaluated and prescribed Motrin. In 2009, she had increasing pain and was diagnosed with a rotator cuff tear. The examiner diagnosed left rotator cuff tendonitis and glenohumeral joint osteoarthritis. The examiner provided a negative etiological opinion. The examiner noted that there was a notation of “neck/shoulder pain” and the assessment was “trapezius strain” but a specific shoulder was not specified. The examiner stated that the Veteran was diagnosed and treated for a left shoulder condition in 2009, approximately 4 years after active duty service. Based on review of service treatment records, there was no evidence of a specific diagnosis or chronic and ongoing treatment of the left shoulder during her period of active duty. Her left shoulder tendonitis is as likely related to age, life events and repetitive motion activities while performing her occupation. The VA examiner added that the medical evidence did not support the Veteran’s contention. Regarding direct service connection, as detailed, service treatment records from her second period of active service do not reflect any complaints of, or treatment, for a left shoulder disability, and for that matter service treatment records from her first period of active service also do not reflect any complaints or, or treatment, for a left shoulder disability. There is no competent medical evidence that the Veteran’s left shoulder disability is causally related to her period of active service from February 2003 to November 2004. Moreover, as detailed, the July 2018 VA examiner found that her current disability is not due to service. The Board has reviewed the clinical evidence of record and finds no clinical opinion that causally relates the Veteran’s left shoulder disability to active service. Also, the lapse of time between service separation and the earliest documentation of current disability is a factor for consideration in deciding a service connection claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). While the Board acknowledges that the absence of any corroborating medical evidence supporting assertions, in and of itself, does not render lay statements incredible, such absence is for consideration in determining credibility. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (noting that the absence of contemporaneous medical documentation may go to the credibility and weight of Veteran’s lay testimony, but the lack of such evidence does not, in and of itself, render the lay testimony incredible). See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In the present claim, not only is there a lack of competent medical evidence, but there is also evidence that the Veteran did not report any left shoulder symptomatology until approximately four years after separation from service. Thus, the Board finds that several factors weigh against direct service connection. The Veteran may sincerely believe that her left shoulder disability is due to service; however, the Board notes that the Veteran has not been shown to possess the requisite training or credentials needed to render a competent opinion in this regard. As such, her lay opinion does not constitute competent medical evidence and lacks any probative value. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In sum, the Board finds that the preponderance of the probative, competent evidence weighs against a nexus on a direct basis. As such, service connection for a left shoulder disability is not warranted. Asthma A Persian Gulf veteran is defined as a veteran who served on active duty in the Armed Forces in the Southwest Asia Theater of operations during the Persian Gulf War. See 38 U.S.C. § 1117(f); 38 C.F.R. § 3.317(d). A “qualifying chronic disability” includes (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. See 38 C.F.R. § 3.317(a)(2); see also 75 Fed. Reg. 61995-97 (2010); see also 76 Fed. Reg. 41696-98 (July 15, 2011). In this case, these provisions do not apply as a diagnosis of asthma has been shown. VA law provides that a veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where clear and unmistakable evidence establishes that an injury or disease existed prior to service and was not aggravated by service. 38 U.S.C. § 1111. The presumption of soundness attaches only where there has been an induction examination during which the disability about which the veteran later complains was not detected. See Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). The regulations provide expressly that the term “noted” denotes “[o]nly such conditions as are recorded in examination reports,” and that “[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions.” 38 C.F.R. § 3.304(b). When no pre-existing medical condition is noted upon entry into service, a Veteran is presumed to have been sound upon entry. 38 U.S.C. § 1111; Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). The law further provides that the burden to show no aggravation of a pre-existing disease or disorder during service is an onerous one that lies with the government. See Cotant v. Principi, 17 Vet. App. 116, 131 (2003); Kinnaman v. Principi, 4 Vet. App. 20, 27 (1993). Importantly, the VA Office of the General Counsel determined that VA must show by clear and unmistakable evidence that there is a pre-existing disease or disorder and that it was not aggravated during service. See VAOPGCPREC 3-03 (July 16, 2003). The claimant is not required to show that the disease or injury increased in severity during service before VA’s duty under the second prong of this rebuttal standard attaches. Id. The Board must follow the precedent opinions of the General Counsel. 38 U.S.C. § 7104(c). If the presumption of soundness applies, the burden then shifts to the Government to rebut the presumption by clear and unmistakable evidence that the disability was both preexisting and not aggravated by service. Wagner, 370 F.3d at 1096; Bagby, 1 Vet. App. at 227. Accordingly: Once the presumption of soundness applies, the burden of proof remains with the Secretary on both the preexistence and the aggravation prong; it never shifts back to the claimant. In particular, even when there is clear and unmistakable evidence of preexistence, the claimant need not produce any evidence of aggravation in order to prevail under the aggravation prong of the presumption of soundness... the burden is not on the claimant to show that her disability increased in severity; rather, it is on VA to establish by clear and unmistakable evidence that it did not or that any increase was due to the natural progress of the disease. Horn v. Shinseki, 25 Vet. App. 231, 235 (2012). “The Federal Circuit has made clear that the Secretary may rebut the second prong of the presumption of soundness through demonstrating, by clear and unmistakable evidence, either that (1) there was no increase in disability during service, or (2) any increase in disability was due to the natural progression of the condition.” Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009) (citing Wagner, 370 F.3d at 1096). This burden must be met by “affirmative evidence” demonstrating that there was no aggravation. See Horn, 25 Vet. App. at 235. The burden is not met by finding “that the record contains insufficient evidence of aggravation.” Id. In adjudicating this claim, the Board must assess the Veteran’s competence and credibility. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368- 69 (2005). In Barr v. Nicholson, 21 Vet. App. 303 (2007), the Court emphasized that lay testimony is competent if it is limited to matters that the witness has actually observed and is within the realm of the witnesses personal knowledge. See 38 C.F.R. § 3.159(a)(2) (“Competent lay evidence means any evidence not requiring that the proponent have specialized education, training or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person.”). The Veteran asserts that her pre-existing asthma was aggravated by her Persian Gulf service. Her DD Form 214 reflects that she had 1 year and 3 months of foreign service in the Persian Gulf, specifically Iraq and Kuwait, and her military occupational specialty (MOS) was transport operator. A February 2003 Report of Medical History reflects that the Veteran reported that she has asthma and had experienced shortness of breath during her early asthma years but no longer has that problem. 08/20/2014 STR-Medical at 18. The medical professional noted that she has a history of asthma which is controlled with Serevent and Accolate. She has not had a wheezing episode for more than 10 years. Id. at 19, 21. A February 2003 consultation reflects that the Veteran had no limitations due to her asthma. Id. at 41, 45. An October 2003 treatment record reflects that the Veteran sought treatment for an upper respiratory infection. Id. at 78. A June 2004 treatment record reflects that the Veteran complained of a cough for several days. A history of asthma was noted. Id. at 40, 98. Asthma was noted on the February 2003 examination, albeit controlled with medication. Thus, the Veteran’s contemporaneous statements at the time of the February 2003 examination and the in-service examiner’s notation that her asthma was controlled with medication supports a finding that her asthma pre-existed her second period of active service. Likewise, the July 2018 VA examiner stated that the Veteran’s self-report of childhood asthma and documentation of asthma prior to military service reflects that her asthma pre-existed service. The Board finds that the foregoing evidence combines to clearly and unmistakably show that the Veteran’s asthma pre-existed service. Thus, the Veteran was not presumed sound with regard to her asthma. The question then becomes whether her pre-existing asthma was not aggravated beyond the natural progression by active service. The Veteran reported to the April 2009 VA examiner that she had asthma as a child and she developed asthma again when she entered the National Guard in 1997. She reported taking daily medicines for her asthma since 1995. She reported that she has not had any asthma attacks requiring emergency room visits or hospitalizations since she was 10 years old. She reported that she is symptom free and has no attacks as long as she takes her medications. The Veteran did not specifically report any symptomatology during her second period of active service. The examiner diagnosed mild COPD which responds to inhalers. The Veteran reported to the July 2018 VA examiner that she developed asthma when she was 10 years old. She reported that during her deployment in 2003 she had problems with dyspnea and was prescribed an Albuterol MDI. Thereafter, she had been evaluated by the VA and prescribed Albuterol and Singulair. She has been seen by a pulmonologist for the last 20 years. The examiner diagnosed asthma. The VA examiner opined that her pre-existing asthma was not aggravate beyond its natural progression by service citing to the in-service medical records: 02/03 physical demonstrates medications to include Serevent, Albuterol and Accolate; 02/03 documentation of ‘well controlled asthma;’ 02/03 history of asthma, no limitations, runs 5k races; 03/04 evaluation for refill of asthma medications; 06/04 treatment for dry cough; 05/04 refill of medications. The examiner also acknowledged the Veteran’s private pulmonary treatment records. The examiner stated that the Veteran’s current examination and PFTs are consistent with a diagnosis of asthma. She uses Albuterol MDI 2 to 3 times per day. She is evaluated by her pulmonologist every 12 months. Based on the information, the examiner opined that there is no evidence of permanent aggravation of her pre-existing asthma beyond its natural progression. The medical evidence does not support the Veteran’s contention. Also, citing to causes of childhood asthma and risk factors for asthma, the examiner opined that the Veteran’s asthma is not related to Gulf War exposure. As detailed, the 2018 clinician stated that the Veteran’s pre-existing asthma was not aggravated beyond its natural progression by in-service event, injury or illness. In support of this, the examiner noted that the medical records clearly document that the Veteran has had asthma since childhood, thus this condition existed prior to service. The examiner reviewed the service treatment records from her second period of active service and found no evidence that the Veteran’s asthma was aggravated or underwent an increase in severity while on active duty. In formulating a negative opinion, the examiner also considered her Gulf War exposures. The Board finds that the July 2018 VA examiner’s opinion is the most probative of record as it is based on a review of the evidence and a clear rationale is provided in support of the conclusions. Given the depth of the examination report, and the fact that the opinion was based on a review of the applicable record, the Board finds such opinion is probative and material to the Veteran’s service connection claim. Based on the examiner’s opinion, the Board concludes that the Veteran’s pre-existing asthma did not undergo an increase in severity during or due to service. There is no contrary medical opinion of record. The Board has given consideration to the lay contentions of the Veteran, documented in her service treatment records, and post-service statements, to include those documented in post-service treatment records. In light of her lay assertions, and given the complexity of the medical question involved, an opinion was sought which does not provide the basis for granting service connection based on aggravation of a pre-existing condition. For the reasons stated above, the Board finds that the medical evidence and opinion outweighs the lay contentions of the Veteran. For these reasons, the preponderance of the evidence is against the claim and entitlement to service connection for asthma is not warranted. Increased Rating Bilateral pes planus with plantar fasciitis The Veteran’s bilateral pes planus has been rated 0 (zero) percent disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5276. Under 38 C.F.R. § 4.71a, Diagnostic Code 5276, a 0 percent disability rating is assigned for pes planus (flat foot acquired) mild symptoms relieved by built-up shoe or arch support; a 10 percent disability rating is assigned for pes planus, regardless of whether the condition is unilateral or bilateral, where there is evidence of moderate symptoms with the weight-bearing line over or medial to the great toe, inward bowing of the tendon Achilles, pain on manipulation and use of the feet; a 20 percent disability rating for unilateral pes planus or a 30 percent disability rating for bilateral pes planus is assigned where there is a severe condition with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indications of swelling on use, characteristic callosities; a 30 percent disability rating for unilateral pes planus or a 50 percent disability rating for bilateral pes planus requires a pronounced condition manifested by marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement, severe spasm of the tendon Achilles on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. Based upon the evidence of record, the Board finds that a compensable disability rating is not warranted for any period contemplated by this appeal. An April 2009 VA examination reflects the Veteran’s complaints of occasional plantar surface pain in the morning when she first puts her feet on the floor and it lasts until she walks around. She has some morning weakness and stiffness that resolves after ambulation. She denied swelling, heat, and redness but does have some fatigability and lack of endurance associated with prolonged standing. At rest and walking, she does not have any symptoms. She has symptoms with prolonged standing. She treats with Advil and Tylenol. She denied flare-ups. She wears shoe inserts but denied using prosthetics such as corrective shoes. She has never had surgery. She was able to stand and it does not limit her from walking. Her only limitation is she cannot run because the plantar surface of her feet gets severe pain with running. On examination, the feet were warm to touch and there was hair on the toes. She had 2 plus dorsalis pedis and posterior tibial pulses. There was no edema, erythema, or warmth of the joints or soft tissue of the foot. There was some point tenderness to palpation of the plantar aspect of the foot between the balls of the distal part of the foot. She had low arches but no other foot deformity. There was no abnormality in alignment of the Achilles tendon. The nails were neatly trimmed and of normal color. There was no rash. There was no joint laxity or instability. There was no abnormal shoe wear. Posture while standing, squatting, supination, pronation, and rising on toes and heels was normal. An x-ray examination showed suspected bilateral pes planus with tiny plantar calcaneal bone spurs. The examiner diagnosed bilateral pes planus and mild plantar fasciitis. The July 2018 VA examiner opined that the finding of degenerative joint disease of her bilateral feet on x-ray examination is not a natural progression of her pes planus and plantar fasciitis. As the examination reports do not more nearly approximate moderate pes planus with weight-bearing line over or medial to the great toe, inward bowing of the tendo achilles, pain on manipulation and use of the feet; nor marked deformity, severe pes planus, swelling on use, or characteristic callosities, a compensable rating is not warranted. Likewise, marked pronation, extreme tenderness of plantar surfaces, marked inward displacement and severe spasm of the tendon Achilles on manipulation is not shown by the competent medical evidence, to include upon 2009 and 2018 VA examinations. The treatment records on file also do not reflect manifestations that would support a higher rating. Thus, there is no basis for the assignment of a rating in excess of 10 percent per Diagnostic Code 5276. While the Veteran has complained of weakness and stiffness with fatigability and lack of endurance, the Board finds that her symptoms and any functional limitations, which she reported only to be running, are contemplated by the currently assigned rating. In this regard, the record reflects that she denied any flare-ups. Again, a noncompensable rating is warranted for mild symptoms relieved by built-up shoe or arch support. The relevant competent evidence also reflects that her gait was normal. The Board finds that 38 C.F.R. §§ 4.40, 4.45 and 4.59 do not provide a basis for an increased rating for any period contemplated by this appeal. See DeLuca, 8 Vet. App. at 204-07. Bilateral hearing loss The Rating Schedule provides a table for ratings purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, established by a state-licensed audiologist including a controlled speech discrimination test (Maryland CNC), and based upon a combination of the percent of speech discrimination and the puretone threshold average which is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four. 38 C.F.R. § 4.85. 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. Id. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher. 38 C.F.R. § 4.86(b). 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. A noncompensable evaluation is provided where hearing in the better ear is I and hearing in the poorer ear is I through IX; where hearing in the better ear is II, and hearing in the poorer ear is II to IV; or where there is level III hearing in both ears. A 10 percent disability rating is warranted where hearing in the better ear is I, and hearing in the poorer ear is X to XI; or where hearing in the better ear is II, and hearing in the poorer ear is V to XI; or where hearing in the better ear is III, and hearing in the poorer ear is IV to VI.. 38 C.F.R. § 4.85, Table VII, Diagnostic Code 6100. Pertinent case law provides that the assignment of disability ratings for hearing impairment are to be derived by the mechanical application of the Ratings Schedule to the numeric designations assigned after audiometry evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). In this case, the Veteran has been assigned a noncompensable evaluation throughout the rating period on appeal. The Board finds no basis for an award of a higher rating, as discussed below. In April 2009, the Veteran underwent a VA audiological evaluation. Pure-tone thresholds for the ears were as follows: HERTZ 1000 2000 3000 4000 RIGHT 15 15 25 30 LEFT 15 10 20 40 The pure tone average in both ears was 21 decibels. Speech recognition scores (Maryland CNC) were 96 percent in both ears. Such findings translate to level I hearing in both ears. 38 C.F.R. § 4.85, Table VI. Applying Table VII, Diagnostic Code 6100, this equates to a 0 (zero) percent disability rating.   In July 2017, the Veteran underwent a VA audiological evaluation. Pure-tone thresholds for the ears were as follows: HERTZ 1000 2000 3000 4000 RIGHT 15 25 40 50 LEFT 15 15 35 45 The pure tone average in the right ear was 33 decibels in in the right ear and 28 decibels in the left ear. Speech recognition scores were 92 percent in both ears. Such findings translate to level I hearing in both ears. 38 C.F.R. § 4.85, Table VI. Applying Table VII, Diagnostic Code 6100, this equates to a 0 (zero) percent disability rating. The Board acknowledges the Veteran’s statements and testimony regarding her hearing loss. The rating criteria are intended to compensate for the impairment resulting from the hearing loss disability. 38 C.F.R. §§ 4.1, 4.85. However, the pertinent and objective evidence of hearing impairment does not approximate the criteria for a compensable disability rating. Lendenmann, 3 Vet. App. at 349 (noting that when VA assigns a schedular disability rating to a veteran’s hearing loss, it generally is required by law to base its decision entirely on audiometric testing results); 38 C.F.R. § 4.85, Tables VI and VII, Diagnostic Code 6100. Applying the audiologic test results most favorable to the Veteran to the regulatory criteria, the Board is compelled to conclude that the preponderance of the evidence is against entitlement to a compensable disability rating for bilateral hearing loss disability. Thus, there is no reasonable doubt to be resolved. The United States Court of Appeals for Veterans Claims (Court) recently discussed extraschedular consideration in the context of bilateral hearing loss: [T]he Court holds that the [schedular] rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are precisely the effects that VA’s audiometric tests are designed to measure. Thus, when a claimant’s hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the schedular rating criteria. However, as the rating criteria do not otherwise discuss, let alone account for, other functional effects, such as dizziness, vertigo, ear pain, etc., the Court cannot conclude that the rating schedule, on its face, contemplates effects other than difficulty hearing or understanding speech. Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017) (emphasis added). The Court further noted that “a hearing loss claimant could provide evidence of numerous symptoms, including—for purposes of example only—ear pain, dizziness, recurrent loss of balance, or social isolation due to difficulties communicating, and the Board would be required to explain whether the rating criteria contemplate those functional effects.” Id. at 371. While acknowledging the functional effects and limitations associated with her hearing loss, in consideration of Doucette, the Board finds that the schedular rating contemplates the effects of the Veteran’s service-connected bilateral hearing loss as they are related to functional effects of decreased hearing and difficulty communicating. (Continued on the next page)   In summary, for the reasons and bases expressed above, the Board has concluded that a compensable rating is not warranted for bilateral hearing loss and the benefit of the doubt is not applicable. Accordingly, the benefit sought on appeal is denied. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.W. Kreindler, Counsel