Citation Nr: 18153029 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 16-19 567 DATE: November 27, 2018 ORDER Service connection for a bilateral elbow disability is denied. Service connection for a bilateral wrist/arm disability is denied. Service connection for a cervical spine disability is denied. Service connection for a bilateral knee disability is denied. Service connection for hypertension is denied. Service connection for gastroesophageal reflux disease (GERD) is denied. Service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), is denied. An initial compensable disability rating for bilateral hearing loss is denied prior to May 14, 2015. A 30 percent disability rating for bilateral hearing loss is granted from May 14, 2015 to July 17, 2016. A disability rating in excess of 50 percent for bilateral hearing loss is denied from July 18, 2016. An initial disability rating in excess of 10 percent for tinnitus is denied. REMANDED Entitlement to a total rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The evidence does not demonstrate bilateral elbow, right arm, or right knee disabilities or a diagnosis of PTSD. 2. The Veteran did not become disabled due to bilateral wrist, left arm, cervical spine, or left knee disability, hypertension, GERD, or an acquired psychiatric disability as a result of an injury or disease incurred in the line of duty during a period of ADT or due to an injury incurred in the line of duty during a period of IADT, and there is no medical nexus between the hypertension, GERD, or psychiatric disability and a service-connected disability. 3. Throughout the initial rating period prior to May 14, 2015, audiometric testing revealed, at worst, Level II hearing impairment in both ears. 4. From May 14, 2015 to July 17, 2016, audiometric testing revealed, at worst, Level VI hearing impairment in the right ear and Level VII hearing impairment in the left ear. 5. From July 18, 2016, audiometric testing revealed, at worst, Level VIII hearing impairment in both ears. 6. Throughout the initial rating period on appeal, the Veteran’s service-connected tinnitus is assigned a 10 percent rating, the maximum rating authorized under Diagnostic Code 6260. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral elbow disability have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304. 2. The criteria for service connection for a bilateral wrist/arm disability have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304. 3. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304. 4. The criteria for service connection for a bilateral knee disability have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304. 5. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304, 3.310. 6. The criteria for service connection for gastroesophageal reflux disease (GERD) have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304, 3.310. 7. The criteria for service connection for an acquired psychiatric disability, to include PTSD, have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304, 3.310. 8. The criteria for a compensable disability rating for bilateral hearing loss were not met for any part of the initial rating period prior to May 14, 2015. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code (DC) 6100. 9. Resolving reasonable doubt in favor of the Veteran, the criteria for a 30 percent disability rating for bilateral hearing loss were met during the initial rating period from May 14, 2015 to July 17, 2016. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code (DC) 6100. 10. The criteria for a disability rating in excess of 50 percent for bilateral hearing loss have not been met for any part of the initial rating period from July 18, 2016. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code (DC) 6100. 11. There is no legal basis for the assignment of a schedular evaluation in excess of 10 percent for tinnitus. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.87, Diagnostic Code (DC) 6260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the Appellant in this case, had service in the Army Reserve from April 1994 to April 2002, with basic training from May 1994 to July 1994, and various other shorter periods of active duty for training (ADT) and inactive duty for training (IADT). As discussed in more detail below, although the Veteran did not have any active duty service other than for training purposes, veteran status is achieved for his period of ADT from May 1994 to July 1994 by virtue of the grants of service connection for bilateral hearing loss and tinnitus. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a February 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The issue of TDIU has been raised during the adjudicatory process of the underlying disabilities. As such, the issue of entitlement to a TDIU is part and parcel of the claim for benefits for the underlying disability, and the Board has proper jurisdiction over it. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Service Connection 1. Service connection for a bilateral elbow, bilateral wrist/arm, cervical spine, and bilateral knee disabilities, hypertension, gastroesophageal reflux disease (GERD), and an acquired psychiatric disability, to include PTSD, is denied. The Veteran contends that he has pain in his elbows, wrists, neck, and knees from years of lifting soldiers and patients in the course of performing his duties during Reserve service. He claims that his hypertension, GERD, and PTSD were caused by stress due to his service-connected hearing loss and tinnitus and the resulting difficulty in obtaining employment, as well as to the stress of treating sick, injured, and dying soldiers during his Reserve service. For the reasons discussed below, the Board finds that service connection for the claimed disabilities is not warranted. 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; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) competent 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) competent 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 United States 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). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). 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 other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). Active military service includes active duty, any period of ADT during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of IADT during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a), (c), (d). ADT includes full-time duty in the Armed Forces performed by Reserves for training purposes. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). Presumptive periods for service connection do not apply to ADT or IADT. Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). Thus, service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty or ADT, from an injury incurred or aggravated while performing IADT, or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during a period of IADT. 38 U.S.C. §§ 101(24), 106, 1110. Special rules apply to National Guard and Reserve service. The initial determination in any claim for veterans’ benefits is whether the claimant is considered a “veteran” as defined under VA law. See Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). Service in the Reserve, even during period of ADT (or IADT), without more, will not suffice to give one “veteran” status. Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010). To warrant “veteran” status for Reserve service, the individual must (1) serve on active duty, (2) serve on a period of ADT and incur or aggravate an injury or disease during that period of ADT; or (3) serve on a period of IADT and incur or aggravate an injury during that period of IADT. Biggins, 1 Vet. App. at 478. No presumptions attach (including soundness, aggravation, or presumptive diseases) unless “veteran” status is attained; and, certain presumptions (aggravation and presumptive diseases) can never apply to periods of ADT and IADT. Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Thus, in this case, although the Veteran has claimed service connection for arthritis and hypertension, the provisions of presumptive service connection for those diseases (38 C.F.R. § 3.307 and 3.309) do not apply. In Smith v. Shinseki, the Court held that claims based on periods of ADT or IADT “can never be entitled to the presumption of service connection.” 24 Vet. App. 40, 47 (2010). The Court reasoned that “[b]y definition, the presumption of service connection applies where there is no evidence that a condition began in or was aggravated during the relevant period of service. By contrast, for a claimant whose claim is based on a period of [ADT or IADT] to establish entitlement to benefits, there must be some evidence that his or her condition was ‘incurred or aggravated’ during the relevant period of service. 38 U.S.C. § 101(24)(B). These circumstances are necessarily mutually exclusive.” Id. The Board emphasizes that the mere occurrence or notation of symptoms or a disability during ADT or IADT is not sufficient to meet the criteria for establishing “veteran” status, even if those symptoms represent the initial occurrence of symptoms, or if that diagnosis represents the initial diagnosis. In other words, the Veteran must establish that the disability actually began during a period of ADT or IADT. The Board acknowledges that “veteran” status attaches to a period of service if service connection is already in effect for another disability based on that period. Thus, as noted above, in this case, veteran status has been established for the Veteran’s period of ADT from May 1994 to July 1994, as the grant of service connection for hearing loss and tinnitus appears to have been based on noise exposure during that period of service. Regarding the applicability of the presumption of soundness to the Veteran’s periods of ADT and IADT, as the Veteran has a period of ADT for which “veteran” status has been attained (May 1994 to July 1994), the presumption of soundness is applicable to periods of ADT and IADT after July 1994. However, the presumption only applies to specific periods of qualifying National Guard or Reserve service (ADT and IADT), and only if an examination was conducted at entry into that period, and that examination revealed no “defects, infirmities, or disorders.” Smith, 24 Vet. App. at 45 – 46. Here, the only examination conducted during the Veteran’s Reserve service was at enlistment in April 1994. There are no examination reports for any specific period of ADT or IADT. Therefore, the presumption of soundness does not attach to any period of ADT or IADT after July 1994. As noted above, the presumption of aggravation can never be applied to ADT or IADT periods, nor can the presumption of service connection for arthritis or hypertension. In addition to the laws and regulations outlined above, service connection for PTSD requires: medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (conforming to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The Board also notes that VA regulations specify that the term hypertension means that the diastolic blood pressure is predominantly 90 mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104, Diagnostic Code 7101. In addition, VA regulations specify that hypertension must be confirmed by readings taken two or more times on at least three different days. Id., Note (1). Turning to the most relevant medical evidence of record, a March 1998 private treatment record indicates that the Veteran reported problems with his wrists for the last two years. He stated that he bowled four times per week and played softball four nights per week during season. He reported that he had had x-rays of his knees, wrists, and shoulders, and had a history of ganglion cyst. Of particular relevance, he stated that he was a full-time policeman and part-time paramedic. His blood pressure was 122/86. On examination, there was tenderness in between the dorsal tendons on the wrists to palpation. The doctor assessed painful wrists, probably secondary to overuse with the history of a previous ganglion cyst. The plan was to continue conservative management with ibuprofen. In August 2002, four months after separation from Reserve service, the Veteran sought treatment with a private psychologist, who noted that he was a police officer and paramedic. He reported work-related stress, social isolation, decreased energy level, anhedonia, and concentration problems. He stated that he worried all the time about work, and had difficulty falling asleep due to his worries. He reported problems remembering names since work stress began. He denied any prior mental health treatment or prior psychiatric history. The doctor assessed major depressive disorder, single episode, moderate. Private treatment records reveal that in April 2003, the Veteran sustained a work-related injury incurred when he had to lift a heavy (more than 700 lbs.) motorcycle during a motorcycle training course, which he was doing for the police force (his civilian occupation). He noted problems with left sided neck discomfort, perishoulder discomfort, periscapular discomfort, and tingling and numbness running down the left arm. He denied right arm symptoms, and denied any history of similar problems in the past. Tinel’s over the median nerve at the wrist was negative. Flexion compression testing over the median nerve at the wrist was negative. The diagnosis was probable left C6 radiculopathy/radiculitis. In September 2003, he aggravated his cervical spine condition when he was participating in a pursuit driving course for his job. He needed to reach back to his right and turn his head while driving as part of an exercise, and developed recurrent neck and left arm symptoms. A cervical spine MRI showed a small disc fragment at C6-7 to the left that would account for his discomfort. The doctor agreed to proceed with nonoperative care, but stated that he may need surgery. In December 2003, private psychology records reveal that the Veteran reported increased worry and insomnia due to a recent stressor at work. In September 2004, private treatment records show that the Veteran reported a slip and fall since he was last seen (in April) with development of left knee pain. He was being treated by another doctor and reported he may have iliotibial band friction syndrome. In December 2004, the Veteran sought treatment for chest pain, and his blood pressure was recorded at 120/66. An August 2013 private treatment record of Dr. K. indicates that it was the Veteran’s initial visit with that physician. It listed neck pain with degenerative disc disease, insomnia, GERD, hypertension, and PTSD as current diagnoses. The Veteran’s current medications included trazodone for sleep, Cymbalta, Celebrex, hydrochlorothiazide (ran out), and Prilosec. On examination, the doctor noted no depression issues. The doctor assessed hypertension under poor control. Blood pressure was 160/110, and the Veteran stated he had run out of his medicine a while ago. The doctor restarted the Veteran on hydrochlorothiazide. In February 2015, Dr. K.’s treatment records list a diagnosis of PTSD. However, the doctor noted that he had been having a lot of depression issues recently. The Veteran stated he used to take Prozac and would like to go back on that medication. Dr. K. prescribed a low dose. In a March 2015 letter, the Veteran’s private psychologist, Dr. R., wrote that she treated him from August 2002 to June 2005. His initial diagnosis was major depressive disorder, single episode, moderate. Over time, depression symptoms improved, but it was clear he had significant anxiety. As such, the later diagnosis was anxiety disorder. At the outset, after reviewing the evidence of record, lay and medical, the Board finds that the weight of the evidence demonstrates no current disabilities of the bilateral elbows, right arm, and right knee. Service and post-service treatment records are entirely negative for any signs, symptoms, reports, complaints, findings, treatment, or diagnoses of bilateral elbow, right arm, or right knee problems. The Board also finds that the weight of the evidence is against a finding that there is a current diagnosis of PTSD. None of the Veteran’s treating physicians have diagnosed PTSD using the DSM-IV or DSM-V criteria. While the treatment notes of Dr. K., who does not appear to be a psychiatrist, record a diagnosis of PTSD among his current diagnoses, there is no indication as to what criteria was used to reach that diagnosis. The Board also notes that an important basis for weighing various references to PTSD is the purpose for which they are recorded. This can generally be surmised from the context of report. See Lee v. Brown, 10 Vet. App. 336 (1997) (a medical opinion should be viewed in its full context, and not characterized solely by the medical professional’s choice of words). Simple references in the medical record that the Veteran is being followed for PTSD or noting a diagnostic history of PTSD are not presented as comprehensive diagnoses, but are presented typically in summary or list format to give treatment providers an overview of the Veteran’s various disorders, and in some cases, the medications prescribed for each. Such non-diagnostic references may be based on a discussion with the Veteran or based on a review by the clinician of the Veteran’s treatment records. Indeed, in this case, it appears that the notation of an assessment of PTSD by Dr. K. was used as an informational reference for the type of treatment the Veteran was receiving, as a description of some of his symptoms, and as a reference for the type of medication Dr. K. was prescribing rather than a formal diagnosis. Indeed, the Veteran’s private treating psychologist, Dr. R., did not diagnose PTSD during her treatment of him from 2002 to 2005, providing highly probative evidence against a finding of a current diagnosis of PTSD. Without a showing of a current disability, the claim for service connection for bilateral elbow, right arm, and right knee disabilities and PTSD must be denied. “Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability... in the absence of a proof of present disability there can be no claim.” Brammer, 3 Vet. App. at 225. The Board recognizes that the Court has held that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However, where the overall record fails to support a current disability, as is the case here, that holding would not apply. Because current bilateral elbow, right arm, and right knee disabilities and PTSD have not been shown by competent evidence, the Board does not reach the additional question of the relationship of the claimed disabilities and the Veteran’s Reserve service. Next, the Board finds that the weight of the evidence demonstrates that the Veteran did not become disabled due to a disease or injury incurred or aggravated in the line of duty during any period of ADT in the Army Reserve, or become disabled due to an injury incurred or aggravated in the line of duty during any period of IADT in the Army Reserve. Importantly, there is no line of duty investigation pertinent to any period of ADT or IADT. Moreover, the evidence of record demonstrates that the claimed cervical spine, left arm, left knee, and psychiatric disabilities were incurred following the Veteran’s separation from the Army Reserve, and were due to civilian-related incidents (e.g., work-related stress and injuries, and a slip and fall). Hypertension and GERD were diagnosed after 2004 and prior to 2013, years after any period of ADT or IADT. The Board acknowledges that the Veteran was treated for bilateral wrist pain in 1998, while he was still in the Army Reserve; however, the overuse injury appears to have been attributed to bowling and playing softball, and there is no indication that the injury was incurred during a period of ADT or IADT. Further, and the Veteran has not asserted that he incurred a specific injury or disease in the line of duty during any period of ADT or IADT. Rather, as noted above, he has stated that repetitive lifting of patients caused his claimed orthopedic disabilities, and that stress due to his service-connected hearing loss and tinnitus and the stress of treating critical care patients during Reserve service caused his hypertension, GERD, and psychiatric disability (other than PTSD). In sum, the weight of the evidence, lay and medical, demonstrates that the Veteran’s bilateral wrist, left arm, cervical spine, and left knee disabilities, hypertension, GERD, and psychiatric disability did not manifest during a period of ADT or IADT. The Board also finds that the weight of the evidence is against a finding that the Veteran’s service-connected hearing loss and tinnitus caused or aggravated his hypertension, GERD, or psychiatric disability. As discussed above, his psychiatric disability has been consistently attributed to civilian job-related stress. Moreover, there is no medical evidence to suggest that his hypertension, GERD, or psychiatric disability were caused by stress due to his lack of employment, which the Veteran believes is due to his service-connected hearing loss and tinnitus. The Board acknowledges the Veteran’s belief that his bilateral wrist, left arm, cervical spine, and left knee disabilities, hypertension, GERD, and psychiatric disability are related to his Reserve service or to his service-connected disabilities. However, his statements alone do not establish a medical nexus. Indeed, while the Veteran is competent to provide evidence regarding matters that can be perceived by the senses, he is not shown to be competent to render medical opinions on questions of etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology). As such, as a layperson, he is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the diagnosis, etiology, or causation of a specific disability. The question of diagnosis and causation, in this case, involves complex medical issues that the Veteran is not competent to address. Jandreau. Accordingly, the Board concludes that service connection for bilateral elbow, bilateral wrist/arm, cervical spine, and bilateral knee disabilities, hypertension, GERD, and an acquired psychiatric disability, to include PTSD, is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Initial Disability Ratings Disability evaluations (ratings) 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 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. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. At the time of an initial rating, separate ratings can be assigned for separate periods of time based on facts found, a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). 2. Entitlement to a higher initial disability rating for bilateral hearing loss, evaluated as noncompensably disabling prior to July 18, 2016, and as 50 percent disabling thereafter In the February 2015 rating decision on appeal, the RO granted service connection for bilateral hearing loss, and assigned a noncompensable, or zero percent, disability rating, effective from January 7, 2013, under the provisions of 38 C.F.R. § 4.85, DC 6100. During the course of this appeal, in a September 2016 rating decision, the RO granted a 50 percent disability rating, effective from July 18, 2016. The Veteran contends that he is entitled to a higher initial disability rating because of the significant impact his hearing loss had on his employment. Specifically, he states that he is unable to pass a hearing test to obtain employment. Moreover, he has stated that his left eardrum was ruptured in April 1998 when a flash grenade exploded near him at the Primary Leadership Development Course (PLDC) at Camp Williams in Utah, and that he should be compensated for that injury. For the reasons discussed below, the Board finds that a 30 percent disability rating is warranted from May 14, 2015 to July 17, 2016, but that the weight of the evidence is against a compensable disability rating prior to May 14, 2015, and against a disability rating in excess of 50 percent from July 18, 2016. As noted above, the Veteran’s hearing loss has been evaluated under 38 C.F.R. § 4.85, DC 6100. This diagnostic code sets out the criteria for evaluating hearing impairment using pure tone threshold averages and speech discrimination scores. Numeric designations are assigned based upon a mechanical use of tables found in 38 C.F.R. § 4.85, and there is no room for subjective interpretation. See Acevedo-Escobar v. West, 12 Vet. App. 9, 10 (1998); Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, and as measured by puretone audiometric tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second, or hertz (Hz). The rating criteria for hearing loss establish 11 auditory acuity levels designated from Level I for essentially normal hearing acuity, through Level XI for profound deafness. The rows in Table VI (38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The columns in Table VI represent nine categories of decibel loss based on the pure tone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the row appropriate for the percentage of discrimination and the column appropriate to the puretone decibel loss. The percentage disability evaluation is found from Table VII (38 C.F.R. § 4.85) by intersecting the row appropriate for the numeric designation for the ear having the better hearing acuity and the column appropriate to the numeric designation level for the ear having the poorer hearing acuity. For example, if the better ear has a numeric designation Level of “V” and the poorer ear has a numeric designation Level of “VII,” the percentage evaluation is 30 percent. 38 C.F.R. §§ 4.85(b), 4.87. In addition, under 38 C.F.R. § 4.86(a), when the puretone threshold at each of the four specified frequencies, 1000, 2000, 3000, and 4000 Hz, 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. Under 38 C.F.R. § 4.86(b), when the pure tone threshold is 30 decibels or less at 1000 Hz, and 70 decibels or more at 2000 Hz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results is the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Turning to the evidence of record, in August 2013, private treatment records indicate that the tympanic membranes were clear bilaterally. In January 2015, a private audiogram revealed puretone thresholds of 20, 30, 45, 70, and 105 decibels in the right ear, and 30, 25, 40, 70, and 90 decibels in the left ear at the test frequencies of 500, 1000, 2000, 3000, and 4000 Hz, respectively. Speech recognition scores were not included in the report, and thus do not allow for the assignment of a level of hearing impairment under VA regulations. The Veteran was afforded a VA audiological examination later that month, when an audiogram revealed puretone thresholds of 25, 30, 30, 70, and 105 decibels in the right ear, and 30, 35, 50, 75, and 95 decibels in the left ear at the test frequencies of 500, 1000, 2000, 3000, and 4000 Hz, respectively. Speech recognition was 92 percent in both ears. Using Table VI, the hearing impairment is Level II in both ears. This results in a zero percent disability evaluation under Table VII. See 38 C.F.R. § 4.85. Acoustic immittance, ipsilateral acoustic reflexes, and contralateral acoustic reflexes were normal in both ears. Examination of auricle and external ears was normal bilaterally. In February 2015, the treatment records of Dr. K. indicate that the Veteran reported experiencing hearing difficulties lately, and the doctor referred him to an audiologist. In May 2015, an otoscopy showed clear external auditory canals, bilaterally. An audiogram revealed puretone thresholds of 60, 50, 60, 90, and 105 decibels in the right ear, and 60, 55, 65, 100, and 100 decibels in the left ear at the test frequencies of 500, 1000, 2000, 3000, and 4000 Hz, respectively. Word recognition was 84 percent in the right ear and 88 percent in the left ear. Although it is unclear whether the audiologist used the Maryland Word List in assessing speech recognition, the Board has resolved reasonable doubt in favor of the Veteran and assumes that that list was used. Because the puretone thresholds at each of the four specified frequencies is 55 decibels or more, Table VIa is applicable and results in the higher hearing impairment levels of VI for the right ear and VII for the left ear, resulting in a 30 percent disability rating. In July 2016, the Veteran was afforded another VA audiological examination. An audiogram showed puretone thresholds of 70, 70, 80, 100, and 110 in the right ear, and 65, 75, 75, 95, and 100 decibels in the left ear at the test frequencies of 500, 1000, 2000, 3000, and 4000 Hz, respectively. Speech recognition was 78 percent in the right ear, and 80 percent in the left ear. Again, application of Table VIa results in a higher level of hearing impairment (VIII in both ears) and results in a 50 percent disability rating. The Veteran stated that he had to ask people to repeat what they said, TV volume needed to be louder, and he had decreased speech understanding in both quiet and noisy environments. In terms of functional impairment and effect on work due to his hearing loss, the Veteran described depression, panic attacks, sleep disturbances, concentration issues, and annoyance. After a review of all of the evidence, lay and medical, the Board finds that a 30 percent disability rating, but no higher, is warranted from May 14, 2015 to July 17, 2016, after which a 50 percent disability rating is assigned. Prior to May 14, 2015, the weight of the evidence is against a compensable disability rating, and from July 18, 2016, the weight of the evidence is against a rating in excess of 50 percent. The Veteran’s level of hearing loss disability, as reflected by audiometric test scores and speech recognition test scores, does not establish entitlement to a compensable disability rating for bilateral hearing loss for any part of the initial rating period prior to May 14, 2015, and does not establish entitlement to a rating in excess of 50 percent from July 18, 2016. The Board acknowledges the statements of the Veteran regarding the effect of his hearing loss disability on his daily life, including his occupation, and his contention that his hearing loss disability is worse than is reflected by the current disability ratings assigned. However, the Board finds that these statements alone do not warrant higher disability ratings prior to May 14, 2015 or from July 18, 2016. Indeed, as noted above, the audiometric test scores and speech recognition scores during these periods weigh against the assignment of higher ratings. Moreover, as noted above, the rating of hearing loss disability involves the mechanical application of the rating schedule to numeric designations assigned to official audiometric results. See Lendenmann, 3 Vet. App. at 345. To the extent that the Veteran is claiming entitlement to a higher rating because his perforated left eardrum worsened his hearing acuity, any degree of hearing impairment caused by the perforated eardrum has been taken into account by the audiograms conducted during the rating period on appeal; thus, in that regard, he is already being compensated for any hearing loss resulting from that injury. For these reasons, the Board resolves reasonable doubt in the Veteran’s favor and finds that a 30 percent disability rating for bilateral hearing loss is warranted from May 14, 2015 to July 17, 2016. However, prior to May 14, 2015, the claim for an initial compensable disability rating is denied, and from July 18, 2016, the claim for a disability rating in excess of 50 percent is denied. The Board has considered the doctrine of affording the Veteran the benefit of the doubt; however, as the preponderance of the evidence is against higher disability ratings prior to May 14, 2015 and from July 18, 2016, the record does not demonstrate an approximate balance of positive and negative evidence as to warrant the resolution of this issue on that basis. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an initial disability rating in excess of 10 percent for tinnitus In the February 2015 rating decision on appeal, the RO granted service connection for tinnitus and assigned a 10 percent disability rating, effective from January 7, 2013, under the provisions of 38 C.F.R. § 4.87, DC 6260. The Veteran has stated that his tinnitus is chronic, that it causes sleep deprivation, depression, anxiety, and severe insomnia, and results in an inability to pass hearing tests for employment purposes. He also stated he has to be sedated in order to sleep, and wants a 30 percent disability rating for his service-connected tinnitus. As noted above, the Veteran is in receipt of a 10 percent disability rating for his tinnitus throughout the initial rating period on appeal. A 10 percent disability rating represents the maximum available benefit for tinnitus under DC 6260. To the extent that the Veteran’s request for a rating in excess of 10 percent for tinnitus can be construed as a request for assignment of separate 10 percent evaluations for each ear, the Board observes that note (2) to DC 6260 provides that only a single 10 percent evaluation is to be assigned for tinnitus, whether the sound is perceived in one ear, both ears, or in the head. An increased schedular rating or assignment of a compensable evaluation for each ear is not available. The Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available for tinnitus. 38 C.F.R. §4.87, Diagnostic Code 6260. As there is no schedular basis upon which to award more than a single, 10 percent rating for tinnitus, the Veteran’s appeal must be denied on the basis of lack of legal merit. See Sabonis v. Brown, 6 Vet. App. 426 (1994). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, other than TDIU, discussed in the REMAND section of this decision. See Doucette v. Shulkin, 28 Vet. App. 366, 371 (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). REASONS FOR REMAND 1. Entitlement to a total rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. As discussed above, the Veteran has stated that his service-connected hearing loss and tinnitus prevent him from passing hearing tests necessary to obtain employment. He also described additional impact of his service-connected disabilities on his occupation, including sleep disturbances, concentration issues, and annoyance, which the July 2016 VA audiological examiner acknowledged. Moreover, since both service-connected disabilities affect his hearing, they are to be considered as one disability for the purpose of consideration of eligibility for a TDIU under 38 C.F.R. § 4.16(a), and the criteria for consideration of a TDIU under 38 C.F.R. § 4.16(a) are met from July 18, 2016. In view of these circumstances, the Board finds that it is appropriate to remand the issue of TDIU so that all the proper development and consideration may made by the AOJ in the first instance. The matter is REMANDED for the following action: 1. Provide to the Veteran all required notice and claims forms in response to the claim for TDIU. 2. After conducting the above development and any additional development deemed necessary, the RO should adjudicate the Veteran’s claim of entitlement to a TDIU. If the benefits sought on appeal cannot be granted, the Veteran should be furnished a supplemental statement of the case. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Sherrard, Counsel