Citation Nr: 18156536 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 12-27 023 DATE: December 10, 2018 ORDER Entitlement to an increased rating for open reduction internal fixation of the right fourth and fifth metacarpals with degenerative joint disease of the right hand, currently evaluated as 10 percent disabling, is denied. Entitlement to an initial evaluation of 50 percent for right carpal tunnel syndrome, status-post release (previously evaluated as nerve involvement of the right upper extremity), prior to September 7, 2017, is granted. Entitlement to an initial evaluation in excess of 50 percent for right carpal tunnel syndrome, status-post release, is denied for the entire period on appeal. Entitlement to an increased rating for postoperative residual scarring from fractures of the right ring and little fingers, currently evaluated as 10 percent disabling, is denied. Entitlement to an initial compensable evaluation for bilateral hearing loss is denied. REMANDED Entitlement to service connection for a bilateral knee disorder is remanded. Entitlement to service connection for an acquired psychiatric disorder, including depression, to include as secondary to service-connected disabilities is remanded. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s right ring and little fingers have not been manifested by unfavorable or favorable ankylosis. 2. For the entire period on appeal, the Veteran’s right carpal tunnel syndrome has been manifested by no more than severe incomplete paralysis of the median nerve. 3. The Veteran’s right ring and little fingers and right wrist scars are linear, painful, and stable. 4. At worst, the Veteran has Level II hearing loss in the right ear and Level I hearing loss in the left ear. CONCLUSIONS OF LAW 1. The criteria for an increased rating in excess of 10 percent for a right ring and little fingers disability have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.45, 4.59, 4.71a, Diagnostic Code 5299-5223. 2. The criteria for a 50 percent rating, but no higher, for right carpal tunnel syndrome for the period prior to September 7, 2017, have been approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.124a, Diagnostic Code 8515. 3. The criteria for an initial evaluation in excess of 50 percent for right carpal tunnel syndrome for the entire period on appeal have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.124a, Diagnostic Code 8515. 4. The criteria for an evaluation in excess of 10 percent for painful, linear scars of the right ring and little fingers and right wrist have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. 3.102, 3.159, 4.1-4.14, 4.118, Diagnostic Code 7804. 5. The criteria for a compensable evaluation for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.21, 4.85, 4.86, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1987 to January 1990. These matters initially came before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision. In April 2013, the Veteran testified at a hearing before the undersigned Veterans Law Judge at the AOJ. A transcript of the hearing has been associated with the record. In December 2014 and May 2017, the Board remanded the case for further development. That development has been completed, and the case has since been returned to the Board for further appellate review. During the pendency of the appeal, in a September 2012 rating decision, the Agency of Original Jurisdiction (AOJ) increased the evaluation for the nerve involvement of the right upper extremity to 10 percent, effective from the date of service connection. In a November 2017 rating decision, the AOJ increased the evaluation for right carpal tunnel syndrome, status-post release (previously rated as nerve involvement of the right upper extremity), to 50 percent, effective from September 7, 2017. Because the AOJ did not assign the maximum disability rating possible, the appeal for higher disability evaluations for right carpal tunnel syndrome remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). In addition, in the November 2017 rating decision, the AOJ granted service connection for non-painful scars of the dorsum of the right hand (right ring and little fingers) and volar aspect of the right hand (carpal tunnel release surgery) and assigned a noncompensable evaluation, effective from May 31, 2017. Law and Analysis Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where a veteran appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of the veteran’s disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). However, where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Right Ring and Little Fingers The Veteran’s service-connected right ring and little finger disabilities have been evaluated as 10 percent disabling, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5299-5223. Hyphenated diagnostic codes, including a diagnostic code ending in the digits “99,” are used when there is no specifically applicable diagnostic code and the disability is rated by analogy. 38 C.F.R. § 4.27. Here, the Veteran’s open reduction internal fixation of the right fourth and fifth metacarpals with degenerative joint disease of the right hand is rated by analogy using the criteria for favorable ankylosis of two digits of one hand under Diagnostic Code 5223. Limitation of motion of individual digits of the hand is evaluated under 38 C.F.R. § 4.71a, Diagnostic Codes 5228-5230. As applicable to this case, the preamble to these diagnostic codes provides in particular, that: (1) For the index, long, ring, and little fingers (digits II, III, IV, and V), zero degrees of flexion represents the finger fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the wrist dorsiflexed 20 to 30 degrees, the metacarpophalangeal and proximal interphalangeal joints flexed to 30 degrees, and the thumb (digit I) abducted and rotated so that the thumb pad faces the finger pads. Only joints in these positions are considered to be in favorable position. For digits II through V, the metacarpophalangeal joint has a range of zero to 90 degrees of flexion, the proximal interphalangeal joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal joint has a range of zero to 70 or 80 degrees of flexion. 38 C.F.R. § 4.71a, Table “Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand.” (2) When two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level. (3) Evaluation of ankylosis of the index, long, ring, and little fingers: (i) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, evaluate as amputation without metacarpal resection, at proximal interphalangeal joint or proximal thereto. (ii) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position. (iii) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of more than two inches (5.1 cm.) between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as unfavorable ankylosis. (iv) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as favorable ankylosis. (5) If there is limitation of motion of two or more digits, evaluate each digit separately and combine the evaluation. Id. Under Diagnostic Code 5223, a 10 percent evaluation is assigned for favorable ankylosis of the ring and little fingers. A 20 percent evaluation is assigned for favorable ankylosis of the index and long, index and ring, or index and little fingers. C.F.R. § 4.71a. In addition, under Diagnostic Code 5227, favorable or unfavorable ankylosis of the ring finger or little finger is assigned a noncompensable rating. 38 C.F.R. § 4.71a. Under Diagnostic Code 5230, a noncompensable rating is assigned with any limitation of motion of the ring or little finger. 38 C.F.R. § 4.71a. Diagnostic Code 5010 states that traumatic arthritis is to be rated as degenerative arthritis under Diagnostic Code 5003, which in turn, states that the severity of degenerative arthritis, established by x-ray findings, is to be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints affected. When there is arthritis with at least some limitation of motion, but to a degree which would be noncompensable under a limitation-of-motion code, a 10 percent rating will be assigned for each affected major joint or group of minor joints. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is warranted if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent evaluation is authorized if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Historically, the Board notes that the Veteran injured his right hand when he punched a wall during service. The Veteran fractured his right fourth and fifth metacarpal midshafts, which required open reduction internal fixation with a bone graft from the left hip region. After a review of the evidence, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran’s right ring and little fingers. Under the rating criteria, a noncompensable evaluation is assigned for any limitation of motion of the ring or little fingers. A 10 percent evaluation is not warranted unless there is ankylosis. A 20 percent evaluation is not assigned unless the index and long, right, or little fingers are favorably ankylosed. See 38 C.F.R. § 4.71a, Diagnostic Codes 5223, 5227, 5230. In this case, there is no evidence of ankylosis of the right ring and little fingers. During a July 2011 VA examination, the examiner noted that there was no ankylosis of the right ring or little fingers. In fact, the Veteran demonstrated range of motion testing that was within normal limits for the right ring and little fingers. Specifically, he had PIP flexion from 0 to 100 degrees, MP flexion from 0 to 90 degrees, and DIP flexion from 0 to 70 degrees in the right ring and little fingers with no additional limitation of motion after repetitive range of motion testing. During a September 2017 VA examination, the examiner also reported that there was no ankylosis of the right ring or little fingers. The examiner specifically noted that no joint ankylosis was evident at all in the Veteran’s right hand. The examiner indicated that the Veteran had abnormal range of motion of his right fingers. Range of motion testing showed right ring finger MCP flexion from 0 to 45 degrees, PIP flexion from 0 to 35 degrees, and DIP flexion from 0 to 30 degrees. The Veteran demonstrated right little finger MCP flexion from 0 to 45 degrees, PIP flexion from 0 to 45 degrees, and DIP flexion from 0 to 35 degrees. He was unable to perform repetitive range of motion testing due to increased pain in the dorsum and volar aspects of his right hand. In addition, the September 2017 VA examiner opined that there was no functional impairment such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. Because there was no evidence of ankylosis of any fingers in the Veteran’s right hand, he is not entitled to a rating in excess of 10 percent under the rating criteria. See 38 C.F.R. § 4.71a, Diagnostic Codes 5223, 5227, 5230. For these reasons, the Board finds that a rating in excess of 10 percent for the Veteran’s right ring and little fingers are not warranted. Right Carpal Tunnel Syndrome The Veteran’s right carpal tunnel syndrome is currently assigned a 10 percent evaluation prior to September 7, 2017, and a 50 percent evaluation thereafter, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8515. Under that diagnostic code, mild incomplete paralysis is rated as 10 percent disabling for the major and minor extremity. Moderate incomplete paralysis is rated 30 percent disabling on the major side and 20 percent on the minor side, and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis of the median nerve, with the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand; pronation incomplete and defective, absence of flexion of the index finger and feeble flexion of the middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex the distal phalanx of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances, is rated 70 percent disabling on the major side and 60 percent on the minor side. In this case, the Veteran is right-handed. Therefore, his right upper extremity is considered major. In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the disability picture, to include the severity, frequency, and duration of the Veteran’s symptoms, as well as the resulting impairment of his right hand, is more consistent with a 50 percent rating throughout the period on appeal. In a November 2010 VA treatment note, the Veteran complained of a history of right hand numbness, primarily in his ring and little fingers. The physician noted that an October 2010 nerve conduction study showed findings compatible with moderately severe right carpal tunnel syndrome and mild ulnar tunnel syndrome. During a July 2011 VA examination, the Veteran complained of tingling, numbness, and an inability to grip in his right hand. A neurological examination revealed abnormal motor function with decreased ability to resist adduction of the right fingers, especially the index finger. In addition, the right sensory function for the cutaneous hand nerves was decreased in the right hand based on the modality of the pinprick. The July 2011 VA examiner noted that the Veteran had decreased motor strength and grasping ability in his right hand. He also noted that carpal tunnel surgery release did not improve the Veteran’s right hand strength. During a September 2017 VA examination, the Veteran described a tingling sensation in his right thumb and fingertips that intensified with use of his right hand. He stated that he spontaneously lost control of grasped items with his right hand. He also related that he had severe right hand pain and moderate paresthesias. A physical examination revealed palpable or visible muscle contraction on flexion of the right wrist, but no joint movement, and active movement against gravity on extension of the right wrist. Right hand grip strength showed active movement against gravity, and right pinching of the thumb to index finger revealed active movement with gravity eliminated. The examiner noted that the Veteran had mild incomplete paralysis of the right median nerve. The examiner noted that the Veteran’s elbow was not affected. The examiner further opined that, due to peripheral nerve conditions, there was no functional impairment of the right upper extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. However, he also stated that the Veteran was unable to use his right hand for any work situation whatsoever. He noted that the weakness and lack of range of motion, as well as the altered sensory functions of the fingers of his right hand, prevented him from using his dominant right hand. He explained that the Veteran’s impairment was severe based on his limitation in gripping motions with the right hand due to pain. He indicated that the Veteran had incomplete paralysis, but he was still able to move his right hand with grip limitations. The Board finds that the aforementioned evidence supports a 50 percent evaluation, but not higher, for the right upper extremity throughout the appeal period. For the period prior to September 7, 2017, the Board notes that an October 2010 VA nerve conduction study showed findings consistent with moderately severe carpal tunnel syndrome, and during the July 2011 VA examination, the Veteran complained of pain, numbness, weakness, and decreased grip strength. The Board also notes that, despite the September 2017 VA examiner’s opinion that the Veteran had mild incomplete paralysis of the right median nerve, he indicated that the Veteran had severe functional limitation due to pain and impaired grip. The Veteran’s reports of pain, numbness, and difficulties with use of the right hand throughout the appeal are consistent with the assigned 50 percent rating. Therefore, the Board finds that the Veteran’s symptoms have approximated a 50 percent evaluation prior to September 7, 2017. However, there was no evidence of complete paralysis of the median nerve during the appeal period. Therefore, the Board finds that a 70 percent rating has not been more nearly approximated at any time during the appeal. Scarring Right Ring and Little Fingers and Hand The Veteran is currently assigned a 10 percent rating for postoperative residual scars of the right ring and little fingers and the volar aspect of the right wrist, pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7804. Diagnostic Code 7800 pertains to scars of the head, face, or neck. As the scars are located on the Veteran’s right ring and little fingers and the volar aspect of the right wrist, Diagnostic Code 7800 is not for application in this case. Diagnostic Code 7801 pertains to burn scars or scars due to other causes not of the head, face, or neck that are deep and nonlinear. A 10 percent evaluation is contemplated for area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). Note 1 indicates that a deep scar is one associated with underlying soft tissue damage. The Veteran’s right wrist and finger scars are linear; therefore, this diagnostic code is not for application. Diagnostic Code 7802 provides a 10 percent evaluation for scars other than of the head, face, or neck that are superficial and nonlinear and involve an area or areas of 144 square inches (929 sq. cm.) or greater. Note 1 provides that a superficial scar is one not associated with underlying soft tissue damage. The Veteran’s right wrist and finger scars are linear; therefore, this diagnostic code is not for application. Under Diagnostic Code 7804, one or two scars that are unstable or painful on examination warrant a 10 percent rating. Three or four scars that are unstable or painful warrant a 20 percent rating. Five or more scars that are unstable or painful warrant a 30 percent rating. There are three notes to 38 C.F.R. § 4.118, Diagnostic Code 7804. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) indicates that scars evaluated under diagnostic codes 7800, 7801, 7802, and 7805 may also receive an evaluation under this diagnostic code, when applicable. Under Diagnostic Code 7805, scars, other (including linear scars) and other effects of scars are to be evaluated under diagnostic codes 7800, 7801, 7802, and 7804. In considering the evidence of record under the laws and regulations as set forth above, the Veteran does not meet the criteria for a higher evaluation for his right wrist and finger scars. A July 2011 VA examination noted that the Veteran had a linear scar located on the volar aspect of his right wrist that measured 6 centimeters by 0.1 centimeter. The examiner also noted that the Veteran had a linear scar on the dorsal right wrist that measured 4 centimeters by 0.1 centimeter. The scars were not painful on examination, and there was no skin breakdown. The examiner further indicated that the scars were superficial with no underlying tissue damage. The scars were not disfiguring, and they did not limit the Veteran’s motion. During a September 2017 VA scars examination, the examiner noted that the Veteran had linear scars on the dorsum of his right hand overlying the midshaft metacarpal shafts of the fourth and fifth metacarpals due to surgery on his right ring and little fingers and on the volar aspect of his right wrist due to carpal tunnel release surgery. The right dorsal hand scar measured 4.5 centimeters by 0.5 centimeter, and the right wrist scar measured 6 centimeters by 0.5 centimeter. The Veteran indicated that both scars were painful to touch. Neither scar was unstable with frequent loss of covering of skin over the scar. The evidence shows that the Veteran’s right finger and wrist scars were linear and mildly painful. No other disabling effects were identified on VA examination in July 2011 and September 2017. Under Diagnostic Code 7804, one or two scars that are unstable or painful on examination warrant a 10 percent evaluation. The Veteran only has two scars on his right hand and wrist. Therefore, the evidence does not show three or four scars that are unstable or painful to warrant a 20 percent rating under Diagnostic Code 7804. There are also no other disabling effects to warrant a higher evaluation under Diagnostic Code 7805. Thus, the Board finds that an increased evaluation is not warranted. Hearing Loss The Veteran’s bilateral hearing loss is currently assigned a noncompensable evaluation pursuant to 38 C.F.R. § 4.85, Diagnostic Code 6100. In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Evaluations of bilateral hearing loss range from noncompensable to 100 percent based on an organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by pure tone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second. The rating schedule establishes 11 auditory acuity Levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. VA audiological evaluations are conducted using a controlled speech discrimination test together with the results of pure tone audiometry tests. The vertical line in Table VI (printed in 38 C.F.R. § 4.85) represents nine categories of the percentage of discrimination based on a controlled speech discrimination test. The horizontal 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 vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the pure tone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85 and the statement of the case) by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate for the numeric designation for the level for the ear having the poorer hearing acuity. For example, if the better ear had a numeric designation of Level “V” and the poorer ear had a numeric designation of Level “VII” the percentage evaluation is 30 percent. See 38 C. F. R. § 4.85. Regulations also provide that in cases of exceptional hearing loss, i.e., when the pure tone threshold at each of the four specified frequencies (1,000, 2,000, 3,000 and 4,000 hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86 (a). The provisions of 38 C.F.R. § 4.86 (b) further provide that when the pure tone threshold is 30 decibels or less at 1,000 hertz and 70 decibels or more at 2,000, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or VIa, whichever results in the higher numeral. That numeral will then be evaluated to the next higher Roman numeral. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to a compensable evaluation for bilateral hearing loss. During a July 2011 VA examination, an audiogram revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 Average RIGHT 40 45 50 65 75 58.75 LEFT 35 35 45 55 65 50 The Maryland CNC controlled speech discrimination test revealed speech recognition of 96 percent in the right and left ears. These audiometric findings equate to Level II hearing loss in the right ear and Level I hearing loss in the left ear. See 38 C.F.R. § 4.85, Table VI. When those values are applied to Table VII, it is apparent that the currently assigned noncompensable evaluation for the Veteran’s bilateral hearing loss is correct under the provisions of 38 C.F.R. § 4.85. The Board has also considered the provisions of 38 C.F.R. § 4.86 governing exceptional patterns of hearing impairment. However, the audiological report does not demonstrate that each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) in either ear is 55 decibels or more or that pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz in either ear. Therefore, the provisions of 38 C.F.R. § 4.86 are not applicable. See 38 C.F.R. § 4.86(a), (b). Thus, the July 2011 VA audiological evaluation has resulted in findings corresponding to a noncompensable evaluation. During a February 2012 VA examination, an audiogram revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 Average RIGHT 40 45 50 65 75 58.75 LEFT 35 35 45 55 65 50 The Maryland CNC controlled speech discrimination test revealed speech recognition of 96 percent in the right and left ears. These audiometric findings equate to Level II hearing loss in the right ear and Level I hearing loss in the left ear. See 38 C.F.R. § 4.85, Table VI. When those values are applied to Table VII, it is apparent that the currently assigned noncompensable evaluation for the Veteran’s bilateral hearing loss is accurate and appropriately reflects his bilateral hearing loss under the provisions of 38 C.F.R. § 4.85. The Board has also considered the provisions of 38 C.F.R. § 4.86 governing exceptional patterns of hearing impairment. However, the audiological report does not demonstrate that each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) in either ear is 55 decibels or more or that pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz in either ear. Therefore, the provisions of 38 C.F.R. § 4.86 are not applicable. See 38 C.F.R. § 4.86(a), (b). Thus, the February 2012 VA audiological evaluation has resulted in findings corresponding to a noncompensable evaluation. During a September 2017 VA examination, an audiogram revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 Average RIGHT 40 40 40 50 50 45 LEFT 30 40 40 40 50 42.5 The Maryland CNC controlled speech discrimination test revealed speech recognition of 96 percent in the right and left ears. These audiometric findings equate to Level I hearing loss in the right ear and Level I hearing loss in the left ear. See 38 C.F.R. § 4.85, Table VI. When those values are applied to Table VII, it is apparent that the currently assigned noncompensable evaluation for the Veteran’s bilateral hearing loss is accurate and appropriately reflects his bilateral hearing loss under the provisions of 38 C.F.R. § 4.85. The Board has also considered the provisions of 38 C.F.R. § 4.86 governing exceptional patterns of hearing impairment. However, the audiological report does not demonstrate that each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) in either ear is 55 decibels or more or that pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz in either ear. Therefore, the provisions of 38 C.F.R. § 4.86 are not applicable. See 38 C.F.R. § 4.86 (a), (b). Thus, the September 2017 VA audiological evaluation has resulted in findings corresponding to a noncompensable evaluation. Based on the foregoing, none of the audiological examinations show that the Veteran is entitled to a compensable evaluation. The Board has considered the Veteran’s lay assertions regarding his diminished hearing. However, the assignment of disability ratings for hearing impairment are derived by a mechanical application of the Rating Schedule to the numeric designations based on the audiology examination results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). It is clear from the Rating Schedule that a higher rating can be awarded only when loss of hearing has reached a specified measurable level. As such, an increased evaluation is not warranted. See also Doucette v. Shulkin, 28 Vet. App. 366 (2017) (the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are the effects that VA's audiometric tests are designed to measure). REASONS FOR REMAND Regarding the claim for service connection for a bilateral knee disorder, a remand is necessary to obtain a VA medical opinion. During a September 2017 VA mental disorders examination, the Veteran reported that he was hit by a car and injured his knees when he was 11-years old. Therefore, the Board finds that a medical opinion should be obtained to determine whether the Veteran’s bilateral knee disorder preexisted his military service. In addition, the Board finds that the claims for service connection for an acquired psychiatric disorder and TDIU are inextricably intertwined with the claim for service connection for a bilateral knee disorder. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). See also Gurley v. Peake, 528 F.3d 1322 (Fed. Cir. 2008) (remand of inextricably intertwined claims was warranted for reasons of judicial economy even in absence of administrative error). The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his knees and any psychiatric disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA treatment records. 2. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any current right and left knee disorders that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should review all pertinent records associated with the claims file, including the service treatment records, post-service medical records, and lay assertions. The examiner should identify any current bilateral knee disorders. For each diagnosis identified, the examiner should state whether the disorder clearly and unmistakably preexisted the Veteran’s service. In responding to this question, the examiner is advised that “clear and unmistakable” means that the conclusion is undebatable, unconditional, and unqualified, and cannot be misinterpreted or misunderstood. The examiner should specifically address the Veteran’s report that he injured his knees in a car accident when he was 11-years old. See September 2017 VA mental disorders examination. If so, the examiner should state whether the knee disorder increased in severity during service. If so, the examiner should indicate whether the increase in severity was consistent with the natural progression of the disorder or whether the increase represented a permanent worsening or “aggravation” of the disorder beyond its natural progression. In responding to this question, the examiner should note that temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted with symptoms, has worsened. If a bilateral knee disorder did not clearly and unmistakably preexist the Veteran’s military service, the examiner should state whether it is at least as likely as not that the disorder manifested during service or is otherwise causally or etiologically related thereto, to include any symptomatology or injury therein. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions should be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, the examiner should review copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file. 3. The examiner should ensure that the VA examination report complies with the directives of this remand. After completing the foregoing development, the AOJ should conduct any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Osegueda, Counsel