Citation Nr: 18144048 Decision Date: 10/23/18 Archive Date: 10/22/18 DOCKET NO. 12-06 870 DATE: October 23, 2018 ORDER Service connection for left ear hearing loss is denied. Service connection for a vision disability is denied. A higher (compensable) initial disability rating for right ear hearing loss is denied. An increased (compensable) disability rating for status post removal of right fallopian tube (hereinafter residuals of right salpingectomy) is denied. An increased disability rating in excess of 30 percent for rhinitis is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran does not have a current disability of left ear hearing loss for VA compensation purposes. 2. The Veteran does not have a current vision or eye disability, other than refractive error of the eye. 3. For the entire initial rating period on appeal, audiometric testing has revealed, at worst, Level IV hearing acuity in the right ear, and does not show deafness in the non-service-connected left ear. 4. For the entire increased rating period on appeal, the Veteran is in receipt of the maximum schedular rating of 30 percent for service-connected rhinitis. 5. For the entire increased rating period on appeal, residuals of a right salpingectomy have not required continuous treatment. CONCLUSIONS OF LAW 1. The criteria for service connection for left ear hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1154, 5103, 5103(a), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304(d), 3.307, 3.309, 3.326, 3.385. 2. The criteria for service connection for a vision disability have not been met. 38 U.S.C.§§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 4.9. 3. The criteria for a compensable disability rating for right ear hearing loss have not been met or more nearly approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.383, 4.3, 4.7, 4.10, 4.85, 4.86, 4.87, Diagnostic Code 6100. 4. The criteria for a disability rating in excess of 30 percent for rhinitis have not been met or more nearly approximated. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.97, Diagnostic Code 6513. 5. The criteria for a compensable disability rating for residuals of right salpingectomy have not been met or more nearly approximated. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.7, 4.116, Diagnostic Code 7614. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from June 1991 to April 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from various rating decisions by the Regional Office (RO) in Jackson, Mississippi. Prior to March 24, 2015, any written communication from a claimant or his or her representative expressing dissatisfaction or disagreement with an adjudicative determination by the Agency of Original Jurisdiction (AOJ) and a desire to contest the result will constitute a notice of disagreement. 38 C.F.R. § 20.201. In this case, a September 2006 rating decision denied service connection for left ear hearing loss. A statement received by VA on September 28, 2006 reflects the Veteran expressed disagreement with the portion of the September 2006 rating decision that denied service connection for hearing loss. Consequently, the September 2006 written statement was a valid notice of disagreement that was properly filed with the AOJ. As the decision notice was sent prior to March 24, 2015, the notice of disagreement did not need to be submitted on a VA Form 21-0958. 38 C.F.R. § 20.201(a)(1). As such, the September 2006 rating decision did not become final as to the issue of service connection for left ear hearing loss. 38 C.F.R. § 20.201. Subsequently, a statement of the case was issued in October 2012, followed by the Veteran filing a timely Form 9 in November 2012; therefore, the Board finds that that it has jurisdiction to proceed with adjudicating the issue of service connection for left ear hearing loss. The Veteran presented testimony before two different (undersigned) Veterans Law Judges (VLJs) as to the service connection and rating issues on appeal. The first hearing was held in December 2015 and the second hearing was in January 2018. The Veterans Law Judges who conduct hearings in a veteran’s appeal must participate in making the final determination of the claims involved. 38 U.S.C. § 7107; 38 C.F.R. § 20.707. By law, appeals can be assigned only to an individual Veterans Law Judge or to a panel of not less than three members. See 38 U.S.C. § 7102(a). When an appellant has a Board hearing before two separate Veterans Law Judges during the pendency of an appeal and these hearings covered one or more common issues, a third Veterans Law Judge is assigned to the panel after the second Board hearing has been held and the appeal is then ready for appellate review. In Arneson v. Shinseki, 24 Vet. App. 379 (2011), the United States Court of Appeals for Veterans Claims (Court) interpreted 38 C.F.R. § 20.707 as requiring that an appellant must be provided the opportunity for a hearing before all three Veterans Law Judges involved in a panel decision. In August 2018, the Board informed the Veteran of the right to a hearing before a third Veterans Law Judge. In August 2018, the Veteran waived the right to an additional Board hearing. Finally, a May 2016 Board decision found that the issue of entitlement to a TDIU had been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), and remanded the issue for initial development. Subsequently, an August 2018 Board decision, in pertinent, determined that the TDIU issue on appeal was inextricably intertwined with the service connection and rating issues that will be decided herein. While cognizant of its responsibilities under Stegall v. West, 11 Vet. App. 268 (1998), as the instant decision must once again remand the issue of entitlement to a TDIU, the Board need not address Remand compliance at this time. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). Review of the record reflects that the Veteran received adequate notice concerning the issues on appeal. As to the duty to assist, the record reflects that VA obtained VA and private treatment (medical) records, as well as Social Security Administration (SSA) records. The Veteran has received multiple VA examinations throughout the course of this appeal. The examination reports are of record. To that end, when VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. The examination reports reflect that, taken together, the VA examiners reviewed the record, conducted in person examinations with appropriate testing, and adequately answered all relevant questions. There remains no question as to the substantial completeness of the record as to the issues on appeal. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.159, 3.326(a). Any duties imposed on VA, including the duties to assist and to provide notification, have been met as set forth above. 1. Service Connection for Left Ear Hearing Loss Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. The Veteran does not have a left ear hearing loss disability as defined by VA regulatory criteria. For VA purposes, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 dB or greater, or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, Court has held that “the threshold for normal hearing is from 0 to 20 dBs [decibels], and higher threshold levels indicate some degree of hearing loss.” See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Veteran contends that service connection is warranted for left ear hearing loss resulting from in-service noise exposure. Specifically, at the January 2018 Board hearing, the Veteran testified to various in-service noise exposures, including aircraft engines. See January 2018 Board hearing transcript. After a review of the evidence, both lay and medical, the Board finds that the weight of the evidence shows that the Veteran does not have current left ear hearing loss disability as defined by the VA regulatory criteria at 38 C.F.R. § 3.385. At the December 2017, April 2013, March 2011, and December 2006 VA audiometric examinations, left ear hearing was within normal limits and speech discrimination scores for the left ear were at least were 94 percent. While the July 2014 VA examination report reflects a speech discrimination score of 92, the July 2014 VA examiner specifically assessed that the use of the speech discrimination score was unreliable due to inconsistent word recognition scores, as well as language and cognitive difficulties. The July 2014 VA examiner also assessed normal left ear hearing. Further, there is also no indication from the most recent VA examination in December 2017 that the auditory thresholds from the December 2017 VA audiometric examination, which shows that left ear hearing is not to the disability threshold of. §38 C.F.R. § 3.385, is unreliable or otherwise inadequate. The Board finds that the December 2017, April 2013, March 2011, and December 2006 VA audiometric examinations are highly probative on the question of current hearing loss disability, such that the weight of the evidence shows that the Veteran does not have a current hearing loss disability as defined by the VA regulatory criteria. Five VA examinations have been provided to measure the severity of hearing loss, and the Veteran has been notified throughout the appeal and at the Board hearing that the evidence must show current hearing loss disability before service connection may be granted; therefore, no further action is necessary to meet the requirements of the VCAA. See 38 C.F.R. § 3.655. Although the Veteran has asserted that she has current left hearing loss caused by noise exposure during service, she does not have the requisite specialized expertise in audiology to measure or diagnose a hearing loss disability for VA compensation purposes under 38 C.F.R. § 3.385, which is determined based on objective audiometric testing and controlled speech recognition testing. A hearing loss disability is diagnosed primarily on objective clinical findings, including speech recognition, and audiometric testing; thus, while the Veteran is competent under the facts of this case to relate symptoms of hearing loss that she experienced at any time, she is not competent to diagnose a hearing loss disability because such diagnosis requires specific medical knowledge and training in audiology and must be supported by objective clinical findings and audiometric testing that the Veteran is neither trained to administer nor is capable of administering to oneself, even if trained. The Veteran has not alleged, and the evidence does not otherwise indicate, that there has been a material change in the severity of claimed bilateral hearing loss since the December 2017 VA audiometric examination. In evaluating a service connection claim, evidence of a current disability is an essential element, and, where not present, the claim under consideration cannot be substantiated. See Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), citing Francisco v. Brown, 7 Vet. App. 55, 58 (1994) (“Compensation for service-connected injury is limited to those claims which show a present disability”). The Court has held that “Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143–44 (1992). See also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). Because a left ear hearing loss disability as defined by the VA regulatory criteria at 38 C.F.R. § 3.385 is not demonstrated in this case, service connection is not warranted for left ear hearing loss. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service Connection for Vision Disability The Veteran generally contends that she suffers from a vision disability, including blurry vision. The Veteran has not endorsed any trauma or injury to the eyes. See December 2015 Board hearing transcript. Regarding service connection for a vision disability, for purposes of entitlement to benefits, the law provides that refractive errors of the eyes are developmental defects and not disease or injury within the meaning of applicable legislation. See 38 C.F.R. §§ 3.303(c), 4.9. In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c). Thus, VA regulations specifically prohibit service connection for refractory errors of the eyes unless such defect was subjected to a superimposed disease or injury during service which created additional disability. See VAOPGCPREC 82-90 (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). The Board finds that the weight of the evidence is against a finding of a current eye disability, other than a refractive error of the eye. The Board finds that the evidence of record, both medical and lay, shows a current diagnosis of mild refractive error, and no other eye disability. See March 2013 VA examination report. The March 2013 VA examination report also reflects that the Veteran reported needing glasses post-service and that she did not endorse any trauma to the eye. The VA examiner did not make any diagnosis of a present eye disease or injury. The VA examiner’s only diagnosis was mild refractive error. The Board affords this opinion significant probative value. The VA examiner conducted an examination of the Veteran for the purposes of making a diagnosis of a current eye disability, specifically addressing whether there was trauma to the eye, a present eye disease or injury, or current scars. The Veteran has not contended, and the record does not otherwise show, any injury that occurred to the Veteran’s eyes while on active duty that was superimposed upon the current refractive error; therefore, the weight of the evidence does not demonstrate a current diagnosis of an eye disability, other than a refractive error of the eye, and does not demonstrate any “superimposed” injury that could aggravate the refractive error of the eye. For the reasons discussed above, the Board finds that the weight of the evidence demonstrates that the Veteran does not have a current diagnosis of an eye disability other than a refractive error of the eye, which, as discussed above, may not be granted service connection, and has not had an eye disability during the pendency of the appeal. The finding of no current disability during the pendency of the appeal renders moot all theories of entitlement. Because the Veteran does not have a current eye disability, service connection may not be granted under any theory. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Higher Initial Rating for Right Ear Hearing Loss Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating 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. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). The Veteran is in receipt of a noncompensable (0 percent) disability rating for the service-connected right ear hearing loss under 38 C.F.R. § 4.85, Diagnostic Code 6100. The Veteran is seeking a higher (compensable) rating for right ear hearing loss for the entire initial rating period on appeal. At the January 2018 Board hearing, the Veteran testified that hearing loss was worse in the right ear and that she had difficulty hearing during conversations. See January 2018 Board hearing transcript. A November 2012 statement reflects the Veteran wrote that right ear hearing loss should be rated as 40 percent disabling. Ratings for defective hearing range from noncompensable (0 percent) to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometric tests at the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz or Hz). To evaluate the degree of disability from bilateral defective hearing, the rating schedule establishes 11 auditory acuity levels designated from Level I, for essentially normal acuity, through Level XI, for profound deafness. 38 C.F.R. § 4.85. Pursuant to VA’s rating schedule, the assignment of a disability rating for hearing impairment is derived by a purely mechanical application of the rating schedule to the numeric designations derived from the results of audiometric evaluations. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Table VIA, “Numeric Designation of Hearing Impairment Based Only on Pure Tone Threshold Average,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on the pure tone threshold average. Table VIA will also be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of Section 4.86, described in the preceding paragraph. 38 C.F.R. § 4.85(c). When defective hearing is service connected in only one ear, in order to determine the percentage rating from Table VII, the non-service-connected ear will be assigned a Level I designation, pursuant to the provisions of 38 C.F.R. § 3.383. 38 C.F.R. § 4.85. Under 38 C.F.R. § 3.383, compensation is payable for the combination of service-connected and non-service-connected hearing loss if there is compensable hearing impairment in the service-connected ear and the impairment of the non-service-connected ear meets the threshold requirements for hearing loss disability outlined in 38 C.F.R. § 3.385. Initially, service connection for left ear hearing loss has not been established at this time. Because the evidence does not show complete deafness in the non-service-connected left ear (see December 2017, April 2013, and March 2011 VA examination reports), the left ear will be considered normal and assigned a Level I hearing acuity for rating purposes. See 38 C.F.R. § 4.85(f). After a review of the evidence, both lay and medical, the Board finds that the weight of the competent and probative lay and medical evidence demonstrates that a compensable rating for right ear hearing loss is not warranted. For the entire initial rating period on appeal, hearing loss has been productive of no more than Level IV hearing loss in the (service-connected) right ear and Level I hearing loss in the (non-service-connected) left ear, which is commensurate with the noncompensable (0 percent) disability rating assigned under Diagnostic Code 6100. Specifically, the VA and private treatment records, the December 2017, April 2013, and March 2011 VA audiometric examination reports, and the Veteran’s lay statements are consistent with a noncompensable disability rating. At the December 2017, April 2013, and March 2011 VA audiometric examinations, speech recognition scores using the Maryland CNC Test revealed speech discrimination of 100 percent, 69 percent, and 94 percent in the right ear, respectively. The December 2017, April 2013, and March 2011 VA audiometric examination reports also reflect that the average decibel loss for the right ear was 40, 33, and 30, respectively. A 0 percent rating is derived for each VA examination from Table VII of 38 C.F.R. 4.85 by intersecting row I, the better ear, with column I, the poorer ear. 38 C.F.R. § 4.86, Diagnostic Code 6100. Such findings demonstrate that a disability rating in excess of 0 percent is not warranted for the initial rating period on appeal. 38 C.F.R. § 4.86, Diagnostic Code 6100. The July 2014 VA audiometric examination report also reflects the VA examiner could not test the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz), and, as discussed above, specifically noted that the use of speech discrimination scores was unreliable due to inconsistent word recognition scores, as well as language and cognitive difficulties. The Board acknowledges the Veteran’s general belief that the current hearing impairment warrants a higher disability rating and the reports of the impact of hearing loss on daily life, including the difficulty understanding conversations. After consideration of such contentions, the Board finds that the more probative evidence regarding the severity of hearing impairment consists of the specifically measured pure tone threshold average and speech discrimination test results, as reported in the December 2017, April 2013, and March 2011 VA audiometric examination reports by examiners who also recorded the Veteran’s contentions. The Board recognizes that the Veteran’s hearing loss interferes with hearing in conversations; however, the weight of the evidence does not demonstrate that the hearing loss disability is worse than has been recorded at the VA examinations, or that the hearing loss has functionally affected the Veteran more severely than has been discussed in the record and addressed by a medical professional. The Board concludes that the audiometric and speech recognition evidence is of great probative value, and that the Veteran’s general allegations regarding the severity of hearing loss and functional impairment do not provide a basis for a higher (compensable) rating. As such, the weight of the evidence of record supports the conclusion that the criteria for a higher (compensable) rating are not met. For these reasons, the Board finds that a higher (or compensable) rating for right ear hearing loss is not warranted. See 38 U.S.C.§ 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Increased Rating for Rhinitis Throughout the course of the appeal, the Veteran has contended generally that rhinitis has been manifested by more severe than those contemplated by the 30 percent disability rating assigned. See January 2018, December 2015 hearing transcript. Allergic rhinitis is a “general term used to denote any allergic reaction of the nasal mucosa.” Dorland’s Illustrated Medical Dictionary 1664 (31st ed. 2007). Under Diagnostic Code 6522, in pertinent part, a maximum 30 percent disability rating is assigned for allergic rhinitis with polyps. 38 C.F.R. § 4.97. In this case, the Veteran has already been favorably assigned a 30 percent rating under Diagnostic Code 6522 for rhinitis, which is the maximum schedular rating available under Diagnostic Code 6513; therefore, the Board need not consider a higher rating. 38 C.F.R. § 4.97. The Board also finds that, for the entire increased rating period, no other higher or separate rating is warranted under any of the other diagnostic codes pertaining to diseases of the nose and throat. First, the evidence of record does not demonstrate chronic sinusitis following radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain, and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries, as required for a 50 percent rating under Diagnostic Code 6510. 38 C.F.R. § 4.97. In addition, the August 2018 Board decision granted a 10 percent rating, but no higher, for sinusitis. Next, as there is no lay or medical evidence of laryngitis, a total laryngectomy, aphonia, stenosis of the larynx, injuries to the pharynx, bacteria rhinitis, rhinoscleroma, or Wegener’s granulomatosis, the Board finds that Diagnostic Codes 6518 to 6521, 6523, and 6524 do not apply. 38 C.F.R. § 4.97. 5. Increased Rating for Right Salpingectomy Throughout the course of the appeal, the Veteran has contended generally that right salpingectomy residuals have been manifested by more severe symptoms than those contemplated by the noncompensable disability rating assigned. At the January 2018 Board hearing, the Veteran testified to experiencing a painful, heavy menstrual cycle, as well as cramping. At the December 2015 Board hearing, the Veteran testified to experiencing a painful, heavy menstrual cycle. Under Diagnostic Code 7614 for disease, injury, or adhesions of the fallopian tube, a noncompensable rating is assigned for symptoms that do not require continuous treatment. A 10 percent rating is assigned for symptoms that require continuous treatment, and a 30 percent rating is assigned for symptoms not controlled by continuous treatment. 38 C.F.R. § 4.116, Diagnostic Code 7614. After a review of the evidence, both lay and medical, the Board finds that the weight of the competent and probative lay and medical evidence demonstrates that a compensable rating for right salpingectomy residuals is not warranted. For the entire increased rating period on appeal, right salpingectomy residuals have not required continuous treatment, which is commensurate with the noncompensable (0 percent) disability rating assigned under Diagnostic Code 7614. The evidence of record includes an August 2013 VA examination report reflecting the VA examiner assessed that the right salpingectomy did not require treatment and/or medication. The August 2013 VA examiner also did not any discern functional limitation. In addition, a December 2017 VA examination report reflects the VA examiner assessed that right salpingectomy residuals did not require treatment and or medication. See December 2017 VA examination report. Such findings demonstrate that a disability rating in excess of 0 percent is not warranted. 38 C.F.R. § 4.116, Diagnostic Code 7614. The Board also finds that no other higher or separate rating is warranted under any of the other diagnostic codes pertaining to diseases of the fallopian tube. The Veteran is already service-connected for an abnormal menstrual cycle. See August 2018 Board decision. As such, the menstrual cycle symptoms, to include pain, cramping, and irregular menstruation, are rated as part of the separately service-connected abnormal menstrual cycle disability, so may not be considered again in the rating for the service-connected right salpingectomy, as to do so would constitute pyramiding in violation of 38 C.F.R. § 4.14. Extraschedular Referral Consideration The Board has considered whether the Veteran or the record has raised the question of referral for an extraschedular rating adjudication under 38 C.F.R. § 3.321(b) for any period for the rating issues on appeal. See Thun v. Peake, 22 Vet. App. 111 (2008). After review of the lay and medical evidence of record, the Board finds that the question of an extraschedular rating has not been made by the Veteran or raised by the record as to the hearing loss or fallopian tube rating issues on appeal for any period. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016), citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff’d, 226 Fed. App. 1004 (Fed. Cir. 2007) (holding that when 38 C.F.R. § 3.321(b)(1) is not “specifically sought by the claimant nor reasonably raised by the facts found by the Board, the Board is not required to discuss whether referral is warranted”). The Board also finds that all the symptomatology and impairment caused by the allergic rhinitis is specifically contemplated by the schedular rating criteria, and no referral for extraschedular consideration is required. The Veteran’s allergic rhinitis has been manifested allergic rhinitis with polyps. The rating criteria specifically provide for ratings based on the presence of nasal obstruction (38 C.F.R. § 4.97, Diagnostic Code 6522). In this case, comparing the Veteran’s disability level and symptomatology of the allergic rhinitis to the rating schedule, the degree of disability throughout the entire period under consideration is contemplated by the rating schedule and the assigned rating is, therefore, adequate. Throughout the appeal, the Veteran also has reported and referenced other nasal symptoms such as headaches and nasal discharge; however, such symptoms are rated as part of the separately service-connected sinusitis and service-connected headache disabilities, so may not be considered again in the rating for the service-connected allergic rhinitis disability, as to do so would constitute pyramiding in violation of 38 C.F.R. § 4.14. REASONS FOR REMAND 6. TDIU As discussed above, the May 2016 Board decision found that the issue of entitlement to a TDIU had been raised, and remanded the issue for initial development. See Rice, 22 Vet. App. 447. To date, the AOJ has not adjudicated TDIU in the first instance. See Stegall, 11 Vet. App. 268. Accordingly, upon Remand, the AOJ should adjudicated TDIU in the first instance. The matter is REMANDED for the following action: 1. The AOJ should send the Veteran VCAA notice that addresses a claim for a TDIU and an individual unemployability claim form (VA Form 21-8940) and request that the form be completed. The AOJ should take any additional development as deemed necessary. 2. Associate with the record all VA treatment records not already of record pertaining to the treatment of the service-connected disabilities. 3. Adjudicate the issue of entitlement to a TDIU. If the benefits sought remain denied, the Veteran should be issued a Statement of the Case. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals C. BRUCE Chief Veterans Law Judge Board of Veterans’ Appeals J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Tenney, Associate Counsel