Citation Nr: 18148365 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 16-29 952 DATE: November 8, 2018 ORDER Service connection for right ear hearing loss is denied. Service connection for hypertension is denied. Service connection for a skin condition, to include papulopustular acne, is denied. Service connection for allergic rhinitis is denied. An initial rating in excess of 20 percent for degenerative arthritis of the lumbar spine is denied. An initial rating of 20 percent, but no higher, for degenerative arthritis of the cervical spine is granted. An initial rating in excess of 20 percent for arthritis of the right (dominant) shoulder is denied. A rating of 40 percent, but no higher, for testicular mass with voiding dysfunction is granted. A compensable rating for left ear hearing loss is denied. REMANDED Entitlement to service connection for a bilateral ankle disorder is remanded. Entitlement to service connection for a bilateral foot disorder, to include the Achilles tendon, is remanded. Entitlement to service connection for bilateral shin splints is remanded. Entitlement to service connection for a gastrointestinal disorder, to include gastroesophageal reflux disease (GERD), is remanded. FINDINGS OF FACT 1. The Veteran does not have a right ear hearing loss disability for VA compensation purposes. 2. The Veteran does not have diagnoses relating to hypertension or a skin disorder manifested by a rash. 3. The Veteran’s allergic rhinitis manifested years after service and is not related to service. 4. The Veteran’s lumbar spine disability has not more nearly approximated forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine; he does not have intervertebral disc syndrome of the lumbar spine. 5. The Veteran’s cervical spine disability is manifested by muscle spasms resulting in guarding severe enough to result in an abnormal gait or abnormal spinal contour, but not manifested by forward flexion of the cervical spine 15 degrees or less or unfavorable ankylosis of the entire cervical spine. 6. The Veteran’s right shoulder disability is manifested by infrequent episodes of recurrent dislocation of the scapulohumeral joint and guarding of movement only at shoulder level. Limitation of right arm motion to midway between the side and shoulder level is not shown. 7. The Veteran has urinary frequency associated with a testicular mass that is manifested by awakening to void five or more times per night. 8. Audiological testing has shown, at worst, Level I hearing acuity in the left ear. CONCLUSIONS OF LAW 1. The criteria to establish service connection for right ear hearing loss disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.385 (2017). 2. The criteria to establish service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 3. The criteria to establish service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.303 (2017). 4. The criteria to establish service connection for allergic rhinitis are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.303 (2017). 5. The criteria for a rating in excess of 20 percent rating for the lumbar spine disability are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2017). 6. The criteria for a rating of 20 percent, but no higher, for the cervical spine disability are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2017). 7. The criteria for a rating in excess of 20 percent for the right shoulder disability are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R §§ 4.40, 4.45, 4.71a, Diagnostic Codes 5200-5203 (2017). 8. The criteria for a 40 percent rating, but no higher, for a testicular mass with voiding dysfunction are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.7, 4.115a (2017). 9. The criteria for a compensable rating for left ear hearing loss disability are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code 6100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1979 to November 2000. This matter comes on appeal before the Board of Veterans’ Appeals (Board) from the May 2014 and July 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 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). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) (2017) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 Fed. Cir. 2013). 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). The U.S. Court of Appeals for Veterans Claims (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); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57(1990). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Right Ear Hearing Loss Upon review of all the evidence of record, the Board finds that the Veteran does not have a right ear hearing loss disability for VA compensation purposes. In a July 2014 VA audiological examination, puretone thresholds at the test frequencies of 500, 1000, 2000, 3000, and 4000 Hertz in the right ear were 10, 15, 10, 20, and 20, respectively. Speech discrimination in the right ear was 100 percent. The remaining evidence of record does not contain audiological testing. Because auditory thresholds in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz were not 40 decibels or greater, and the thresholds for at least three of these frequencies were not 26 or greater, the criteria to establish a current hearing loss disability in the right ear as required by 38 C.F.R. 3.385 are not met. The remaining evidence of record, to include post-service treatment records, also do not demonstrate right ear hearing loss as required by 38 C.F.R. 3.385. The Veteran is competent to report hearing difficulty; however, the audiological findings do not show that the Veteran’s right ear hearing loss is to a disabling degree as defined under 38 C.F.R. 3.385; as such, the weight of the evidence demonstrates that the Veteran’s right ear hearing loss has not met the threshold to establish current hearing loss “disability,” and the claim must be denied. 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, 3 Vet. App. 225; see also Rabideau, 2 Vet. App. 143 -44. Because the preponderance of the evidence is against the claim for service connection for right ear hearing loss, the benefit of the doubt doctrine is not for application. See 38 U.S.C. 5107; 38 C.F.R. 3.102. Hypertension and Skin Disorder The Veteran asserts that he has hypertension and a skin disorder that are related to service. Upon review of the record, the Board finds that the weight of the evidence shows that the Veteran does not have a diagnosis of hypertension or a current skin disorder. Service treatment records show that the Veteran had a skin rash in 1977 and 1980. There is no indication of hypertension in service. Importantly, the Veteran does not meet the first element of any service connection claim, namely a current disability. His post-service private and VA treatment records do not show a confirmed diagnosis of hypertension or a skin disorder. To the extent that the Veteran offers his statements as competent evidence of a current disability, such attempt fails. Although the Veteran is competent to report observable symptoms, he, as a lay person, is not competent to diagnose hypertension or a specific skin disorder, as he has not been shown to have the requisite medical knowledge, training, or experience. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). For these reasons, the Board finds that the Veteran has not met his burden of establishing the existence of a current disability. A preponderance of the evidence is against the claims for service connection for hypertension and a skin disorder, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Allergic Rhinitis The Veteran generally maintains that his allergic rhinitis is related to service. Service treatment records do not show any diagnoses of, or treatment for, allergic rhinitis. The Veteran was afforded a VA examination in July 2014 and the examiner diagnosed the Veteran with allergic rhinitis, but indicated that the condition was first diagnosed and began many years following service separation, in approximately 2004. The examiner opined that the Veteran’s allergic rhinitis was not related to service because the Veteran’s condition was diagnosed years after service. Further, the examiner observed that the Veteran had experienced one episode of sinusitis but noted that the in-service sinusitis was treated and had resolved. The Board finds the VA opinion adequate to decide the claim. The examiner reviewed the record and examined the Veteran. The opinion is assigned high probative weight. The Veteran has not submitted a competent medical opinion relating his allergic rhinitis to his military service. The Board considered the Veteran’s statements purporting to relate his allergic rhinitis to service. As a lay person, however, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorders of allergic rhinitis. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Allergic rhinitis is a medically complex disease process because of its multiple etiologies and manifests symptomatology that may overlap with other disorders. For these reasons, and upon review of all evidence of record, the Board finds that service connection is not warranted for allergic rhinitis. The Board has considered the applicability of the “benefit of the doubt” doctrine; however, the record does not demonstrate an approximate balance of positive and negative evidence as to warrant the resolution of this matter on that basis. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Disability Ratings-General Laws and Regulations Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the Veteran’s symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Any reasonable doubt regarding a degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.”). Lumbar Spine The Veteran maintains that his lumbar spine disability is more severe than what is contemplated by the currently assigned 20 percent rating. Disabilities of the spine may be rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. The Veteran’s lumbar spine disability is rated as 20 percent disabling under DC 5242 for degenerative arthritis of the spine under the General Rating Formula. The General Rating Formula provides a 20 percent rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine. Note (2) provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. See also Plate V, 38 C.F.R. § 4.71a. When rating degenerative arthritis of the spine (DC 5242), in addition to consideration of rating under the General Rating Formula, rating for degenerative arthritis under DC 5003 should also be considered. 38 C.F.R. § 4.71a. Disabilities of the spine may also be rated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. Note (1) to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. The evidence includes a May 2014 VA spine examination. At that time, forward flexion of the thoracolumbar spine was limited to 60 degrees with pain starting at 45 degrees. After repetitive-use testing, flexion was limited to 45 degrees. The examiner further indicated that the Veteran did not have ankylosis of the spine or IVDS. The examiner noted that the Veteran did not have radiculopathy of the lower extremities. The remaining evidence of record does not provide range of motion testing for the thoracolumbar spine and odes not indicated that the Veteran has ankylosis of the spine. Upon review of the evidence of record, the Board finds that a rating in excess of 20 percent under the General Formula is not warranted. In this regard, the evidence during the rating period shows that the Veteran’s thoracolumbar range of flexion was no worse than 45 degrees (even including after repetitive-use testing), which is well above the 30 degrees of flexion required for the next-higher rating. Moreover, at no time was ankylosis of the entire thoracolumbar spine noted. The Veteran’s painful limitation of motion and additional functional impairment meets the impairment contemplated by the current schedular disability rating and does not more nearly approximate functional impairment commensurate with disability rating higher than that already assigned for the rating period on appeal. Even when considering the Veteran’s pain and functional impairment following bending, the evidence of record does not establish that he has the requisite limitation of lumbar motion to warrant a higher disability rating than what is already assigned. Accordingly, the evidence of record preponderates against the assignment of a disability rating higher than 20 percent for the lumbar spine based on additional functional limitation following repetitive use or flare-ups of the joint for the rating period on appeal. Further, at no time during the appeal period has the Veteran been diagnosed with IVDS of the lumbar spine. Accordingly, a higher rating under the IVDS Formula pursuant to Diagnostic Code 5243 is not warranted. The Board also notes that the evidence does not demonstrate that the Veteran has been diagnosed with left or right lower extremity radiculopathy or any other type of potentially applicable neurological impairment; as such separate ratings are not warranted. For these reasons, the Board finds that a higher disability rating in excess of 20 percent for the Veteran’s lumbar spine disability is not warranted. Cervical Spine The Veteran maintains that his cervical spine disorder is more severe than what is contemplated by the currently assigned 10 percent rating. The General Rating Formula for Diseases and Injuries of the Spine provides a 20 percent disability rating for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent disability rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, unfavorable ankylosis of the entire cervical spine. A 40 percent disability rating is assigned for unfavorable ankylosis of the entire cervical spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. The Board finds that a higher rating of 20 percent for the cervical spine disability is warranted based on May 2014 VA evidence of muscle spasms of the cervical spine resulting in abnormal gait or abnormal spinal contour. As this manifestation is specifically contemplated by the 20 percent rating criteria, the Board finds that a rating of 20 percent is warranted. The Board however finds that a rating in excess of 20 percent is not warranted for the cervical spine disability. The Veteran has not been diagnosed with IVDS and has not been found to have forward flexion of the cervical spine 15 degrees or less or unfavorable ankylosis of the entire cervical spine. Accordingly, a rating in excess of 20 percent is not warranted. Moreover, the May 2014 VA examination report indicated that the Veteran had “mild” radiculopathy of the upper extremities. The Veteran is already in receipt of separate 20 percent ratings for radiculopathy of the right and left upper extremities under DC 8511. The Veteran does not assert and the evidence does not show that separate ratings higher than 20 percent are warranted in this case. Right Shoulder The Veteran also maintains that his right shoulder disability is more severe than what is contemplated by the currently assigned 20 percent rating. Disabilities of the shoulder and arm are rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5200 through 5203 and include ratings based on limitation of motion. For rating purposes, a distinction is made between major (dominant) and minor musculoskeletal groups. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. See 38 C.F.R. § 4.69. Here, as the evidence shows that the Veteran is right-hand dominant and thus his major extremity for rating purposes. Under Diagnostic Code 5200, which pertains to ankylosis of the scapulohumeral articulation, a 20 percent rating is warranted for favorable ankylosis with abduction to 60 degrees, a 30 percent rating is warranted for ankylosis which is intermediate between favorable and unfavorable, and a 40 percent rating is warranted where there is unfavorable ankylosis with abduction limited to 25 degrees from the side. Limitation of motion of the shoulder joint is rated under Diagnostic Code 5201. Under Diagnostic Code 5201 (major side), a 20 percent rating is warranted for limitation of arm motion to shoulder level; a 30 percent rating is warranted for limitation of arm motion to midway between the side and shoulder level; and a maximum 40 percent rating is warranted for limitation of arm motion to 25 degrees from the side. 38 C.F.R. § 4.71a. Under Plate I of 38 C.F.R. § 4.71a, normal range of motion of the shoulder is forward elevation (flexion) and abduction to 180 degrees, and internal and external rotation to 90 degrees. Diagnostic Code 5202 provides ratings for other impairment of the humerus. Recurrent dislocations of the humerus at the scapulohumeral joint are rated as 20 percent for the minor shoulder. Fibrous union of the humerus is rated as 40 percent for the minor shoulder. Nonunion of humerus (false flail joint) is rated as 50 percent for the minor shoulder. Loss of head of the humerus (flail shoulder) is rated as 70 percent for the minor shoulder. Under DC 5203 for impairment of the clavicle or scapula, a 10 percent rating is assigned for malunion or for nonunion without loose movement. When there is nonunion with loose movement, a 20 percent rating is assigned. A 20 percent rating is also assigned when there is dislocation of the clavicle or scapula. As indicated above, the Veteran’s right shoulder disability is currently rated as 20 percent disabling under 38 C.F.R. § 4.71a Diagnostic Code 5202 [impairment of clavicle or scapula]. Under Diagnostic Code 5202, a 30 percent rating is warranted for frequent episodes of recurrent dislocation and a 50 percent rating is warranted if there is a fibrous union of the humerus. The Board carefully reviewed the available VA medical records, including the May 2014 VA examination report, and finds no evidence that the Veteran’s right shoulder disability has been characterized by frequent episodes of recurrent dislocation and guarding of all arm movements, or fibrous union of the humerus, or nonunion (false flail shoulder), or loss of the humeral head (flail shoulder) during the period on appeal. The Board further finds that Diagnostic Code 5200 is inapplicable because there is no evidence of ankylosis of the Veteran’s right shoulder as required under Diagnostic Code 5200. Likewise, as the evidence does not show that the Veteran’s clavicle and scapula are impaired, the Board finds that Diagnostic Code 5203 is not applicable. With respect to Diagnostic Code 5201, the Board finds that a disability rating in excess of 20 percent is not warranted as the Veteran has not shown limitation of right shoulder motion midway between the side and shoulder level. Instead, the Veteran’s range of motion during the May 2014 VA examination was shown as flexion limited to 140 degrees, to include after repetitive-use testing. The Board recognizes the Veteran’s complaints of functional loss as a result of his shoulder disability, notably his pain. However, the Veteran was still able to demonstrate range of motion that greatly exceeds the criteria for the next higher rating. The Board finds that the 20 percent rating currently assigned contemplates any functional impairment that the Veteran experiences in his right shoulder. In light of the above, the claim for a higher schedular rating for the Veteran’s right shoulder disability must be denied. In reaching this decision, the Board finds that the preponderance of the evidence is against the claim, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Testicular Mass with Voiding Dysfunction The Veteran is currently in receipt of a noncompensable rating for a testicular mass disability prior to December 9, 2017, and a 20 percent rating thereafter. The Veteran’s testicular mass disability is rated under 38 C.F.R. § 4.115b, Diagnostic Code 7527. Under Diagnostic Code 7527, prostate gland injuries, infections, hypertrophy, postoperative residuals are rated as voiding dysfunction or urinary tract infection, whichever is predominant. In this case, the Veteran’s disability has predominantly been characterized by voiding dysfunction. 38 C.F.R. § 4.115b, Diagnostic Code 7527. Voiding dysfunction may be rated based on urinary leakage, frequency, or obstructed voiding. For evaluations based on urinary leakage, due to continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, a 60 percent rating is warranted for voiding dysfunction requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day. A 40 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed 2 to 4 times per day. A 20 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed less than 2 times per day. Id. For evaluations based on urinary frequency, a 40 percent rating is warranted for daytime voiding interval less than one hour, or awakening to void five or more times per night. Daytime urinary frequency intervals between one and two hours or nocturia three or four times a night warrants a 20 percent rating. A 10 percent evaluation is warranted for daytime voiding interval between two and three hours, or; awakening to void two times per night. Id. Obstructive voiding symptomatology with marked obstructive symptomatology with any one or combination of: post void residuals greater than 150 cc, a markedly diminished peak flow rate of less than 10 cc/sec, recurrent urinary tract infections secondary to obstruction, or stricture disease requiring periodic dilatation every two to three months, warrants a 10 percent rating. Urinary retention requiring intermittent or continuous catheterization warrants a 30 percent rating. The evidence includes a July 2014 VA examination report where it was noted that the Veteran did not require the use of absorbent material. Urinary frequency resulted in daytime voiding every 1-2 hours, and nighttime awakening to avoid occurred 5 or more times per night. The Veteran also had marked hesitancy, but no other symptomology of obstructive voiding was noted. During an October 2016 VA examination, it was again noted that the Veteran did not require the use of absorbent materials. Urinary frequency resulted in daytime voiding every 2-3 hours, and nighttime awakening to avoid occurred twice a night. In a December 9, 2017 statement, the Veteran indicated that he was now voiding six or more times a night. The Veteran was afforded another VA examination in January 2018. At that time, the Veteran reported that the course of his condition since onset had remained the same. Moreover, it was noted that the Veteran required the use of absorbent material that needed to be changes less than two times a day. Urinary frequency resulted in daytime voiding every 2-3 hours, and nighttime voiding resulted in awakening two times per night. He also had marked hesitancy, but no other symptomology of obstructive voiding was noted. Upon review of the evidence of record, the Board finds that the evidence is at least in equipoise as to whether a 40 percent rating for the Veteran’s disability is warranted for the entire rating period. As noted above, for evaluations based on urinary frequency, a 40 percent rating is warranted for awakening to void five or more times per night. The evidence, to include the July 2014 VA examination and the Veteran’s December 2017 statement, indicates that the Veteran awakens to void 5 or more times a night. The Veteran is competent to report his urinary frequency as this is capable of lay observation. Accordingly, a 40 percent rating is granted for urinary frequency associated with the Veteran’s testicular mass. A 40 percent rating is the maximum available for urinary frequency. A higher rating is available for urinary leakage; however, the Veteran is not entitled to a rating higher than 40 percent because the evidence, to include his lay statements, does not show that his disability requires the use of an appliance or the wearing of absorbent materials that must be changed more than 4 times per day. As such, the Board finds that a 40 percent rating, but no higher, is warranted for the entire rating period on appeal. Left Ear Hearing Loss The Veteran is service connected for a left ear hearing loss disability, which is rated as zero percent disabling. He contends that a compensable rating is warranted. The Board has reviewed all the evidence of record, and for the reasons discussed below, the criteria for a compensable rating for left ear hearing loss have not been met for the entire initial rating period on appeal. The evidence includes a July 2014 VA audiological evaluation where pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 LEFT 20 15 50 35 Speech audiometry revealed speech recognition ability of 96 percent in the left ear. Applying these values to the rating criteria results in a numeric designation of level I in the left ear. As the Veteran’s right ear is not service-connected, a Level I designation has been assigned to determine the percentage evaluation from Table VII. Application of the levels of hearing impairment in each ear to Table VII at 38 C.F.R. § 4.85 produces a noncompensable rating. That is, the combination of level I in the nonservice-connected right ear with level I in the left ear results in a zero percent rating. The Board notes that puretone thresholds reported on the audiological evaluations discussed above were not 55 decibels or more at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) and were not recorded at 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz in either ear. Thus, the provision of 38 C.F.R. § 4.86 for exceptional patterns of hearing impairment do not apply in this case. The remaining evidence of record does not contain any other audiological testing. The Board considered and weighed the lay statements submitted by the Veteran and his inability to hear well. He is competent to describe his hearing loss. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, his description of his service-connected disability must be considered in conjunction with the clinical evidence of record as well as the pertinent rating criteria. In this regard, the Board emphasizes that ratings are derived by a mechanical application of the rating schedule. Lendenmann, 3 Vet. App. 349. Thus, the Board has based its determination on the results of the audiology studies of record. Here, mechanical application of the rating schedule to the audiometric findings does not establish entitlement to a compensable evaluation for left ear hearing loss. Moreover, and specifically in respect to hearing loss, an audiologist must fully 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 examiner addressed functional effects of hearing loss by noting that the Veteran reported had difficulty hearing in conversation. Therefore, the functional effects of his hearing loss disability are adequately addressed in the record. For these reasons, the Board finds that a compensable rating for left ear hearing loss is not warranted. REASONS FOR REMAND Bilateral Ankle, Bilateral Foot, and Bilateral Shin Splints Service treatment records show that the Veteran was struck by a Humvee in 1990 resulting in a broken right collar bone, a left foot fracture, ankle pain, and broken ribs. The Veteran contends that he has a bilateral ankle, bilateral foot (to include the Achilles tendons), and bilateral shin splints as a result of the in-service injury. Despite the in-service injury and the Veteran’s assertions, he has not yet been afforded a VA examination. A remand is warranted in order to obtain an examination and medical opinion regarding the nature and etiology of the Veteran’s claimed disorders. GERD The Veteran maintains that his GERD first manifested in service. Service treatment records include an October 1988 record, which noted that the Veteran complained of blood in his stool and blood from his mouth while sleeping. He also complained of stomach pain, burning in the chest, and hemoptysis for the past 5-6 months. The Veteran indicated that his chest pain was worse after a meal. An assessment of gastric reflux was noted with hemoptysis gastritis. The Veteran was afforded VA examinations in July 2014 pertaining to his claimed disorder. At that time, the examiner diagnosed the Veteran with GERD and indicated that the condition was first diagnosed and began many years following service separation, i. e., (2003). The examiner opined that the Veteran’s GERD is not related to service as the Veteran’s condition was diagnosed years after service. Further, the examiner stated that “the medical records reviewed make no mention of hemoptysis gastritis.” The Board finds the VA medical opinion to be inadequate as service treatment records clearly demonstrate that the Veteran was seen for gastric reflux with hemoptysis during service in 1988. A new opinion is therefore required. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. 2. Then, schedule the Veteran for a VA examination(s). The examiner must review all pertinent documents in the record and obtaining a complete medical history from the Veteran. Then, the examiner should provide the following: (a.) List all current diagnoses pertaining to the Veteran’s ankles, feet, and shins. (b.) For each current diagnosis, provide an opinion as to whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the foot disorder had its origin in service or is in any way related to the Veteran’s service, to include the 1990 Humvee accident. (c.) All opinions should be accompanied by a clear rationale. 3. Obtain a medical opinion regarding the likely etiology of the Veteran’s GERD disability. The examiner must review all pertinent documents in the record. The examiner should provide the following: (a.) State whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s GERD had its origin in service or is in any way related to the Veteran’s service, to include the October 1988 treatment note where the Veteran was assessed as having gastric reflux was noted with hemoptysis gastritis. (b.) All opinions should be accompanied by a clear rationale. 4. Then, readjudicate the remanded claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Casadei, Counsel