Citation Nr: 18153602 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 16-37 190 DATE: November 28, 2018 ORDER The petition to reopen the claim of service connection for a left shoulder disability is denied. The petition to reopen the claim of service connection for a right shoulder disability is denied. Entitlement to service connection for a low back disability is denied. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD is denied. Entitlement to a compensable rating for the period on appeal for service-connection bilateral hearing loss is denied. FINDINGS OF FACT 1. The RO denied the Veteran’s claim for service connection for bilateral shoulder disabilities in April 2011. The Veteran did not perfect his appeal in a timely manner and the appeal became final. 2. New and material evidence has not been associated with the claims file related to the Veteran’s bilateral shoulder disabilities since the April 2011 rating decision. 3. The Veteran’s low back disability did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 4. The Veteran’s obstructive sleep apnea did not manifest in service and is not otherwise etiologically related to an in-service injury, event, or disease. 5. The Veteran’s hypertension did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 6. Throughout the appeal period, the Veteran had no worse than level II hearing in the right and left ears. CONCLUSIONS OF LAW 1. The criteria for reopening the claim of service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 (2017). 2. The criteria for reopening the claim of service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5108 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 (2017). 3. The criteria for entitlement to service connection for a low back disability have not been met. 38 U.S.C. §§ 1101, 1110, 1137, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2017). 4. The criteria for entitlement to service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1101, 1110, 1137, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017). 5. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1137, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2017). 6. The criteria for entitlement to a compensable rating for the period on appeal for service-connection bilateral hearing loss have not been met. 38 U.S.C. § 1101, 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1969 to October 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April 2011 and August 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. In July 2016, the Veteran requested a videoconference hearing, which was scheduled for November 2016. The Veteran failed to appear for the scheduled hearing, and provided no reason for missing the hearing. Therefore, the Veteran’s request for a hearing is considered withdrawn. The RO adjudicated the issues of entitlement to service connection for a low back disability, hypertension, and sleep apnea as claims to reopen previously denied claims. The RO initially denied service connection for all issues on appeal in an April 2011 rating decision. The Veteran filed a timely notice of disagreement (NOD) for these issues. A statement of the case (SOC) was issued in September 2011 regarding the issues of service connection for a low back disability, hypertension and sleep apnea. The Veteran did not submit a VA Form 9 in response to the September 2011 SOC. However, in March 2012, the Veteran submitted a second NOD, expressing continued disagreement with the RO’s decision to deny his claims. A subsequent April 2012 SOC addressed the remaining issues on appeal, but the Veteran did not submit a timely VA Form 9 or perfect his appeal with any filing in lieu of a VA Form 9. Although outside of the 60-day window for perfecting an appeal, the second NOD was received within a year of the original rating decision. Therefore, the Board interprets the March 2012 NOD as a timely perfection of the Veteran’s appeals regarding the issues of entitlement to service connection for a low back disability, hypertension, and sleep apnea. The Board finds that there is no prejudice to the Veteran in adjudicating his claims, as the RO has already considered the claims on the merits. The RO granted the request to reopen based on new and material evidence, and denied the claim on the merits in August 2014. Furthermore, as no SOC had yet been issued regarding hearing loss or shoulder disabilities at the time of the March 2012 decision, the NOD did not perfect those appeals. Service Connection Service connection may be granted for a disability resulting from a 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 also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 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). 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 id.; 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 aggravated by, a service-connected disease or injury. To prevail on the issue of secondary service connection, 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). Degenerative joint disease and hypertension are considered by VA to be “chronic diseases” listed under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) apply. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); see also Fountain v. McDonald, 27 Vet. App. 258 (2015). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. Where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; see also 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. In the case of a veteran who engaged in combat with the enemy in a period of war, lay evidence of in-service incurrence or aggravation of a disease or injury shall be accepted if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the lack of official record of such incurrence or aggravation. See 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d); Libertine v. Brown, 9 Vet. App. 521, 524 (1996); Collette v. Brown, 82 F.3d 389, 392-94 (Fed. Cir. 1996). Based primarily on the Veteran’s receipt of the Vietnam Service Medal with two Bronze Stars, the Board finds that the Veteran engaged in combat with the enemy. Therefore, the Board finds that the combat rule is for application in this case. In rendering a decision on appeal, the Board must also 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). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. at 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. See Barr, 21 Vet. App. at 303. Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. See Jandreau, 492 F.3d 1372, 1377. Entitlement to service connection for a low back disability The Veteran contends his low back disability is the result of a September 1970 motor vehicle accident in service. See April 2011 Statement in Support of Claim. Upon clinical evaluation during the Veteran’s October 1971 separation examination, his spine was normal. The Veteran reported his condition as “good.” A February 2010 VA treatment record notes the Veteran complained of chronic low back pain for approximately 5-6 years. There was no history of a back injury. A VA MRI in March 2010 revealed a right paramedian disc protrusion superimposed on a broad-based disc bulge, right greater than left ligamentum flavum hypertrophy, and bilateral facet arthrosis contributing to mild bilateral neural foraminal stenosis. A VA MRI in October 2013 noted degenerative changes of the lumbar spine. After a review of the lay and medical evidence, the Board finds the preponderance of the evidence against the Veteran’s claim. The Veteran’s low back disability did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101(3), 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Service treatment records are negative for any complaints, injury, diagnoses, or treatment for a low back disorder, and the Veteran’s testimony as to incurring a low back injury involves an incident that occurred in California prior to deployment and thus does not fall under the combat presumption of 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(d). There is no corroborating evidence of this in-service back injury. Indeed, the October 1971 separation examination, a clinical evaluation of the Veteran’s spine was normal. As such, and for the reasons discussed below, the Board finds that the evidence weighs against a finding of an in-service back injury. The Board also finds that the evidence of record does not establish any clinical manifestations of a low back disability to a degree of 10 percent or more within the applicable time period; as such, the criteria for presumptive service connection on the basis of a chronic disease have not been satisfied. See 38 C.F.R. § 3.307(a)(3). Regarding whether presumptive service connection may be granted on the basis of continuity of symptomatology in conjunction with 38 C.F.R. § 3.303(b), there is no evidence of continuous symptoms pertaining to a lumbar spine disorder since separation. Although now, pursuant to his claim for VA compensation benefits, the Veteran maintains that he had back problems since service, the objective evidence shows that the Veteran never reported any problems consistent with a lumbar spine disorder for many years following service separation. The earliest indication of low back pain was in February 2010—approximately 39 years after separation from service. Therefore, the Board finds that there is no continuity of symptomatology with respect to the Veteran’s low back disability. Service connection may be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s low back disability is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). There is no documented evidence of a motor vehicle accident in the Veteran’s service treatment records, and there is no objective medical evidence relating the Veteran’s current low back disability to any aspect of his active service, to include the claimed motor vehicle accident. Further, the Veteran had provided inconsistent accounts relating to his low back pain. The Veteran reported in a February 2010 VA treatment record that his low back pain manifested approximately 5-6 years prior, and denied a history of back injury. However, in April 2011 correspondence, the Veteran reported that his low back pain was due to a motor vehicle accident in service. Such inconsistencies reported during the claim period, in the context of being inconsistent with post-service histories by the Veteran make it doubtful that the more recent account of any in-service low back injury is accurate. See Cromer v. Nicholson, 19 Vet App. 215 (2005) (upholding Board’s denial of service connection and finding that a veteran’s recent post-service account that was inconsistent with earlier account of was not credible because it was first made years after service). For these reasons, the Board finds the Veteran’s more recent accounts of an in-service low back injury to be inconsistent with, and outweighed by, other lay and medical evidence of record, which includes the Veteran’s own reported history denying a history of back injury, so as not to be credible. Although the Veteran believes his low back disability is related to service, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires specialized training for a determination as to diagnosis and causation, and is therefore not susceptible to lay opinions on etiology. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). There is no objective medical evidence establishing a nexus between the Veteran’s service and his low back disability. In light of these findings, the Board concludes that service connection for a low back disability is not warranted. In reaching these conclusions, 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, 1 Vet. App. at 53-56. Entitlement to service connection for obstructive sleep apnea and hypertension The Veteran contends that his obstructive sleep apnea and hypertension are the result of his service-connected PTSD. See April 2011 Statement in Support of Claim. However, the preponderance of the evidence is against the claims and they are denied. The Veteran’s October 1971 separation examination was normal. The Veteran reported his condition as “good.” The Veteran underwent a sleep study in October 2009 and was subsequently diagnosed with obstructive sleep apnea. A December 2009 VA treatment record notes the Veteran has had hypertension since 2007. After a review of the lay and medical evidence, the Board finds the preponderance of the evidence against the Veteran’s claims. There is no objective medical evidence relating the Veteran’s obstructive sleep apnea and hypertension to his PTSD. The Veteran has not articulated a theory of entitlement outside of his general claim that these conditions are related. Further, the Veteran’s hypertension did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101(3), 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The Veteran’s service treatment records are absent of any complaints of, symptoms of, or treatment for hypertension. The Veteran’s health was deemed normal throughout his service treatment records. VA treatment records indicate he has had hypertension since 2007—approximately 36 years after separation from service. Therefore, the Board finds that there is no continuity of symptomatology with respect to the Veteran’s hypertension. As obstructive sleep apnea is not a chronic condition under 3.309, the presumptive provisions are not applicable. Service connection may be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s obstructive sleep apnea and hypertension are related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). There is no objective medical evidence relating the Veteran’s obstructive sleep apnea and hypertension to his active service. The Veteran himself does not contend that his obstructive sleep apnea and hypertension are a result of his active service, and states that these conditions are due to his PTSD. While the Veteran believes his obstructive sleep apnea and hypertension are related to his service-connected PTSD, he is not competent to provide a nexus opinion in this case. These issues are medically complex, as they require specialized training for a determination as to diagnosis and causation, and are therefore not susceptible to lay opinions on etiology. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). There is no objective medical evidence establishing a nexus between the Veteran’s service, PTSD, and his hypertension and obstructive sleep apnea. In light of these findings, the Board concludes that service connection for obstructive sleep apnea and hypertension is not warranted. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Whether new and material evidence has been received sufficient to reopen the claim of service connection for bilateral shoulder disabilities VA may reopen a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). “New” evidence is evidence not previously submitted to agency decision makers and “material” evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether the evidence presented or secured since the prior final disallowance of the claim is new and material, the credibility of the evidence is generally presumed. Cox v. Brown, 5 Vet. App. 95, 98 (1993); Justus v. Principi, 3 Vet. App. 510, 513 (1992). VA is required to review for newness and materiality only the evidence submitted by a claimant since the last final disallowance of the claim on any basis, whether a decision on the underlying merits or, a petition to reopen. Evans v. Brown, 9 Vet. App. 273, 283 (1996). In Shade v. Shinseki, 24 Vet. App. 100 (2010), the United States Court of Appeals for Veterans Claims (Court) held that § 3.159(c)(4) does not require new and material evidence as to each previously unproven element of a claim for the claim to be reopened and the duty to provide an examination triggered. In a fact pattern where a prior denial was based on lack of current disability and nexus, the Court found that newly submitted evidence of a current disability was, in concert with evidence already of record establishing an injury in service, new and material and sufficient to reopen the claim and obtain an examination. Regardless of any RO determinations that new and material evidence has been submitted to reopen service connection, the Board must still determine whether new and material evidence has been submitted in this matter. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). Here, the Board finds that new and material evidence has not been received sufficient to reopen the Veteran’s claims. The RO denied service connection for bilateral shoulder disabilities in April 2011. The RO noted the Veteran’s bilateral shoulder arthralgia, but reasoned that the evidence failed to show current diagnosed bilateral shoulder conditions which were incurred in, or were related to, military service. The evidence of record at the time of the April 2011 rating decision included the Veteran’s service treatment records, VA and private treatment records, and personal statements. The Veteran filed an NOD with this decision in March 2012. The RO issued an SOC in April 2012. However, the Veteran’s VA Form 9 was untimely, and therefore, he did not properly perfect his appeal. The Veteran filed his VA Form 9 in July 2012—more than 60 days after issuance of the SOC and more than a year from the April 2011 rating decision. 38 C.F.R. § 19.32. Accordingly, the April 2011 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.1103. The evidence received since the April 2011 rating decision consists of the Veteran’s personal statements, appellate arguments, and VA treatment records. For the reasons given below, the Board finds that it is cumulative and redundant of the evidence of record at the time of the last final denial and thus does not constitute new and material evidence to reopen the claims. A February 2013 VA treatment record notes the Veteran complained of bilateral shoulder pain, indicating his symptoms began approximately 5 years prior. An August 2014 VA treatment record notes an ongoing diagnosis of chronic bilateral shoulder arthralgia. These treatment records are cumulative in nature, and therefore not new and material. The Veteran’s original claim considered evidence that the Veteran had a current diagnosis of bilateral shoulder arthralgia. However, none of those treatment records indicated a nexus to the Veteran’s service. While the medical evidence associated with the claims file is new, it is not material in substantiating the Veteran’s claim. None of the evidence supports the contention that the Veteran’s bilateral shoulder disabilities are related to his active service. The medical evidence received since the last final denial does not raise a reasonable possibility of substantiating the Veteran’s claims. In July 2012, the Veteran stated his bilateral shoulder disabilities are service-connected had have adversely compromised his quality of life. The Board finds the Veteran’s statement claiming his bilateral shoulder disabilities are etiologically related to his active service to be cumulative in nature, and therefore, not new. The Veteran did not provide any additional information to corroborate his claim. Prior to the April 2011 rating decision, the Veteran asserted he believed his bilateral shoulder disabilities were etiologically related to his active service. The Veteran’s accounts of shoulder pain following the April 2011 rating decision are cumulative of the content previously presented to support his claim. The Veteran’s continued assertion that his bilateral shoulder disabilities are a result of his active service is the same argument previously advanced before the RO. When determining whether a claim should be reopened, the credibility of the newly submitted evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). However, the additional evidence submitted since the April 2011 rating decision is not material as it does not show evidence of a possible nexus between the Veteran’s bilateral shoulder disabilities and his active service. As new and material evidence has not been received, the Veteran’s claims of entitlement to service connection for bilateral shoulder disabilities are not reopened. Entitlement to a compensable rating for the period on appeal for service-connection bilateral hearing loss Disability 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. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. Mechanical application of the Rating Schedule to the numeric designations for audiometry evaluations determines disability ratings for hearing impairment. Lendenmann v. Principi, 3 Vet. App. 345 (1992). An examination for VA compensation purposes 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). Table VI, “Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination,” determines a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination (horizontal rows) and the puretone threshold average (vertical columns). The Roman numeral designation is located at the point where the percentage of speech discrimination and puretone threshold average intersect. 38 C.F.R. § 4.85(b). “Puretone threshold average,” as used in Tables VI and VIa, is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four. This average is used in all cases (including those in § 4.86) to determine the Roman numeral designation for hearing impairment from Table VI or VIa. 38 C.F.R. § 4.85(d). Table VII, “Percentage Evaluations for Hearing Impairment,” determines a percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal rows represent the ear having the better hearing and the vertical columns the ear having the poorer hearing. The percentage evaluation is located at the point where the row and column intersect. 38 C.F.R. § 4.85(e). When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, or the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86. 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 the puretone threshold average. Table VIa will be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86. 38 C.F.R. § 4.85(c). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Equal weight is not accorded to each piece of evidence contained in the record, and not every item of evidence has the same probative value. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Ultimately, VA must determine whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Id. Upon VA audiological evaluation in August 2014, puretone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 35 40 65 70 52.5 LEFT 30 35 65 70 50 Speech audiometry revealed speech recognition ability of 84 percent in the right ear and of 86 percent in the left ear. These audiometric findings, as applied to Table VI, yield Roman numeral designations of II for the right and left ears. The Roman numeral designation for the right ear (II) along with the assigned Roman numeral designation for the left ear (II), entered into Table VII produce a zero percent disability rating for hearing impairment. Audiometric testing results from the VA examinations are probative and appear valid for rating purposes. The Veteran is competent to describe the effects of his hearing loss on his daily functioning, such as having difficulty understanding other people. However, disability ratings are derived by a mechanical application of the rating schedule. Lendenmann, 3 Vet. App. at 349. Thus, the Board has no discretion in this matter and must predicate its determination on the basis of the results of the audiological examinations of record. Here, mechanical application of the Rating Schedule to the audiometric findings does not establish entitlement to a compensable disability rating. The preponderance of the evidence is against a finding of entitlement to a compensable disability rating for bilateral hearing loss. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. J. GALLAGHER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Duthely, Associate Counsel