Citation Nr: 18147558 Decision Date: 11/06/18 Archive Date: 11/05/18 DOCKET NO. 17-20 048 DATE: November 6, 2018 ORDER Entitlement to a compensable disability rating for bilateral hearing loss is denied. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for duodenal ulcer is remanded. Entitlement to service connection for a thyroid condition is remanded. FINDING OF FACT Throughout the appeal period, the Veteran’s bilateral hearing loss most approximated a noncompensable, 0 percent disability rating, with no worse than Level I hearing impairment in either ear. CONCLUSION OF LAW The criteria for a compensable disability rating for bilateral hearing loss have not been met throughout the appeal period. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.85, 4.86, Diagnostic Code 6100 (2017). INTRODUCTION The Veteran served on active duty from December 1965 to November 1967. The Board briefly notes the issue of entitlement to an increased disability rating for tinnitus is not before the Board. Though the Agency of Original Jurisdiction (AOJ) issued to the Veteran a March 2017 Statement of the Case (SOC) on this matter, VA has not received a substantive appeal on this issue. In his April 2017 VA Form 9, the Veteran limited his appeal to the Board to the issues of entitlement to service connection for hypertension, duodenal ulcer, and a thyroid condition. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran contends he is entitled to a compensable disability rating for his service-connected bilateral hearing loss. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Disability ratings for hearing loss disability are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The rating schedule establishes 11 auditory hearing acuity levels based upon average puretone thresholds and speech discrimination. See 38 C.F.R. § 4.85. For VA purposes, an examination for hearing impairment must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85(a). While the puretone audiometry test measures the ability to hear sounds, the speech discrimination test measures the ability to distinguish between words. That is, speech discrimination is a measure of how well an individual understand what he or she hears when speech is loud enough to hear comfortably. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017). Table VI, “Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination and the puretone threshold average. 38 C.F.R. § 4.85(b). Table VIa, “Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on puretone threshold average. Table VIa is used when the examiner certifies that the use of the speech discrimination test is not appropriate due to language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86. 38 C.F.R. § 4.85(c). “Puretone threshold average”, as used in Tables VI and VIa, is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz and divided by four. This average is used in all cases (including those of § 4.86) to determine a Roman numeral designation from Tables VI and VIa. 38 C.F.R. § 4.85(d). Table VII, “Percentage Evaluations of Hearing Impairment,” is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment in each ear. 38 C.F.R. § 4.85(e). Provisions for evaluating exceptional patterns of hearing impairment are as follows: (a) 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. (b) When the puretone thresholds are 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; the numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86. VA treatment records show the Veteran underwent an audiology evaluation in April 2014. The VA audiologist stated the Veteran’s speech reception thresholds were within normal limits for communication purposes, with excellent speech discrimination ability, bilaterally. Audiometric testing revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 AVG (1000-4000) RIGHT 20 35 40 45 50 42 LEFT 15 15 5 35 55 28 The April 2014 treatment record does not indicate whether the speech audiometry was performed using the Maryland CNC word list, as required by the applicable VA regulation. Thus, the April 2014 audiometric testing is not adequate for rating purposes. The Veteran was afforded a VA hearing examination in March 2015. On that occasion, the Veteran’s puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 AVG (1000-4000) RIGHT 25 25 30 40 40 34 LEFT 20 15 10 35 45 26 Speech audiometry revealed speech recognition ability of 100 percent bilaterally. Applying these values to Table VI, results in a Roman numeral designation of I (Level I) for hearing impairment, bilaterally. The intersection of row I and column I on Table VII results in a 0 percent disability rating. The Board notes the provisions of 38 C.F.R. § 4.86 for exceptional patterns of hearing impairment do not apply in this case. Neither the April 2014 nor the March 2015 audiometric testing revealed a puretone threshold of 55 decibels or higher at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz). Similarly, neither of the testings showed a puretone threshold of 30 decibels or less at 1000 Hertz and a threshold of 70 decibels or more at 2000 Hertz. Based on a full review of the record, including the above-described audiological evaluations, the Board finds a compensable rating has not been warranted for the Veteran’s hearing loss at any point during the appeal period. Although the audiological evaluations clearly show the Veteran has impaired hearing in both ears, the hearing loss has not reached a level that would warrant a 10 percent rating, which is the first compensable rating under Diagnostic Code 6100. In reaching this determination, the Board has considered the Veteran’s statements regarding his hearing loss, including the reported impact of his hearing impairment. The Veteran is competent to report his symptoms and describe the impairment associated with his hearing loss; however, these statements do not provide the specific information required for rating purposes. As noted above, the assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations based on the audiology examination results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Consequently, the evidence does not support a higher rating for the Veteran’s bilateral hearing loss at any time during the period of the claim. In sum, the Board finds the preponderance of the evidence is against the Veteran’s claim of entitlement to a compensable rating for bilateral hearing loss; as such, the benefit of the doubt doctrine is not for application and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND The Board notes that VA must provide a medical examination or obtain a medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2) (2012); 38 C.F.R. § 3.159 (c)(4)(i) (2017). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, disease or injury is a low threshold. McLendon, 20 Vet. App. at 83. The Veteran seeks service connection for hypertension, duodenal ulcer, and a thyroid condition, which he contends originated in service and continues to the present. Specifically, he alleges these conditions are the result of an illness incurred during his active service. The medical evidence of record reflects a current diagnosis of hypothyroidism, hypertension, and peptic ulcer disease. The Veteran’s Service Treatment Record (STR) shows he received in-service treatment on several occasions and was diagnosed with pharyngitis in June 1967. Additionally, the Veteran’s separation exam reflects a reading of elevated diastolic blood pressure. Moreover, the Veteran is competent to report on the onset and recurrent symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (providing that a veteran is competent to report on that of which he or she has personal knowledge). In this case, no VA examination has been obtained to address the Veteran’s claim of entitlement to service connection for hypertension, duodenal ulcer, and a thyroid condition. Under the circumstances outlined above, the Board finds VA must provide such examination pursuant to McLendon. Furthermore, in a February 2015 letter, the Veteran’s private physician stated she had been treating the Veteran since August 2012 for his conditions of peptic ulcer disease, hypothyroidism, and hypertension. However, these treatment records have not been associated with the Veteran’s file. The Board acknowledges that these treatment records may contain information bearing on the Veteran’s claims. Thus, the AOJ must take appropriate action to obtain the above-described evidence and associate it with the Veteran’s file. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims, to include the above-described private treatment records, as well as any recent or additional treatment records related to the claimed disabilities. If any requested records are not available, the file should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Then, schedule the Veteran for a VA examination by a clinician with sufficient expertise to diagnose and determine the nature and etiology of the Veteran’s claimed hypertension, duodenal ulcer, and thyroid condition. All pertinent evidence of record must be made available to and reviewed by the examiner. Any required studies should be performed, and all clinical findings should be reported in detail. Based on a review of the evidence of record, lay statements, and examination results, the examiner should state an opinion with respect to: • Whether the Veteran’s hypertension was at least as likely as not (a 50 percent probability or greater) incurred in service, or is otherwise etiologically related to his active service, to specifically include as result of an illness incurred during service. In providing this opinion the examiner must specifically address the reading of elevated diastolic blood pressure during the Veteran’s separation exam. • Whether any diagnosed thyroid condition was at least as likely as not (a 50 percent probability or greater) incurred in service, or is otherwise etiologically related to his active service, to specifically include as result of an illness incurred during service. In providing this opinion the examiner must specifically address the Veteran’s diagnosis of pharyngitis in June 1967. • Whether any diagnosed peptic ulcers condition was at least as likely as not (a 50 percent probability or greater) incurred in service, or is otherwise etiologically related to his active service, to specifically include as result of an illness incurred during service. For the purposes of these opinions, the examiner should note the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including events and symptoms. If there is a medical basis to support or doubt the history provided by the veteran, the examiner should provide a fully reasoned explanation. The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case. Further, the examiner must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community at large. 3. Finally, undertake any other development determined to be warranted, and readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran’s satisfaction, the Veteran should be furnished an appropriate Supplemental Statement of the Case and be afforded the requisite opportunity to respond. If necessary, return the case to the Board for further appellate action. By this remand, the Board intimates no opinion as to any final outcome warranted. The Appellant need take no action until she is otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999). T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Martinez, Associate Counsel