Citation Nr: 18158814 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 15-27 367A DATE: December 18, 2018 ORDER New and material evidence having not been received, the claims to reopen entitlement to service connection for polyarthralgia and hair loss are denied. Service connection for swelling of the hands and feet, bilateral lower extremity peripheral neuropathy, bilateral upper extremity peripheral neuropathy, and vision problems are denied. A rating in excess of 40 percent for bilateral hearing loss is denied. FINDINGS OF FACT 1. A September 2008 rating decision denied claims for entitlement to service connection for polyarthralgia and hair loss; the Veteran did not perfect an appeal and no new and material evidence was submitted within one year of the rating decision. 2. Evidence received since the September 2008 rating decision is cumulative or redundant of the evidence previously of record; the additional statements, VA treatment records, examination report, and internet articles do not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for polyarthralgia. 3. Evidence received since the September 2008 rating decision is cumulative or redundant of the evidence previously of record; the additional statements and internet articles do not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for hair loss. 4. The preponderance of the evidence weighs against a finding that the Veteran has a bilateral hand and foot disorder claimed as swelling of hands and feet during the appeal period. 5. The preponderance of the evidence weighs against a finding that the Veteran’s bilateral lower extremity peripheral neuropathy was incurred within one year of active service; any bilateral lower extremity peripheral neuropathy present during the period of the claim is not etiologically related to service. 6. The preponderance of the evidence weighs against a finding that the Veteran’s bilateral upper extremity peripheral neuropathy was incurred within one year of active service; any bilateral upper extremity peripheral neuropathy present during the period of the claim is not etiologically related to service. 7. The preponderance of the evidence weighs against a finding that the Veteran has an eye disorder, claimed as vision problems, that began in active service or is otherwise etiologically related to service. 8. Throughout the appeal period, the Veteran’s hearing loss disability manifested by at worst Level VII hearing impairment in the right ear and Level VIII hearing impairment in the left ear. CONCLUSIONS OF LAW 1. The September 2008 rating decision is final. 38 U.S.C. § 7105(c) (2006); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2008). 2. New and material evidence has not been received to reopen the claim of entitlement to service connection for polyarthralgia. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 3. New and material evidence has not been received to reopen the claim of entitlement to service connection for hair loss. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 4. The criteria for service connection for a disorder described as swelling of hands and feet have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 5. The criteria for service connection for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 6. The criteria for service connection for right lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 7. The criteria for service connection for left upper extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 8. The criteria for service connection for right upper extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 9. The criteria for service connection for an eye disorder have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 10. The criteria for a rating in excess of 40 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.85, Diagnostic Code 6100, 4.86. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1953 to August 1957. In July 2016, the Veteran testified at a Board of Veterans’ Appeals (Board) hearing before the undersigned. A transcript of the hearing is associated with the record. The appeal was remanded in December 2016. In a July 2017 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) granted service connection for a cognitive disorder and a skin disability, diagnosed as basal cell carcinoma and actinic keratoses. As these actions constitute full grants of the benefits sought on appeal, the claims of entitlement to service connection for confusion and memory problems and for a skin disorder are no longer in appellate status. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Initially, the Board notes that the Veteran timely filed a substantive appeal to a January 2007 statement of the case (SOC) in response to disagreement with a May 2004 rating decision that denied claims for entitlement to service connection for peripheral neuropathy of the bilateral fingers, peripheral neuropathy of the bilateral feet, peripheral neuropathy of the bilateral legs, and vision problems. See generally 38 C.F.R. § 19.30. As such, no new and material evidence is required to consider the merits of the claims and the issues have been recharacterized from claims to reopen to claims for entitlement to service connection. See 38 C.F.R. § 3.156(a). Further, the Board notes that the United States Court of Appeals for Veterans Claims (Court) held in Clemons v. Shinseki, 23 Vet. App. 1 (2009), that the Board must consider the Veteran’s description of the claim, symptoms described, and the information submitted or developed in support of the claim when determining the scope of a claim. Id. at 5. Here, the Veteran appealed a May 2004 rating decision denying claims for entitlement to service connection for peripheral neuropathy of the bilateral hands, bilateral feet, and bilateral legs. He subsequently filed a claim for entitlement to service connection for nervous system deterioration/neuropathy that was denied in a May 2012 rating decision based on a finding of no new and material evidence to reopen the claim. However, as the Veteran’s pending claims on appeal encompass all peripheral nerve symptoms due to claimed in-service carbon tetrachloride (CTC) exposure, the Board has expanded the claims to include nervous system deterioration to be consistent with the Court’s decision in Clemons. As noted above, no consideration of whether new and material evidence has been received is required. See 38 C.F.R. § 3.156(a). As such, the issues on appeal are construed as claims of entitlement to service connection for peripheral neuropathy of the left lower extremity, right lower extremity, left upper extremity, and right upper extremity. 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). New and Material Evidence The Veteran’s initial claims for service connection for polyarthralgia and hair loss were denied in a September 2008 rating decision. The Veteran disagreed with the decision and a SOC was issued in February 2010. As the Veteran did not perfect an appeal within 60 days of receipt of the February 2010 SOC, the September 2008 rating decision is final. 38 U.S.C. § 7105(c) (2006); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2008). In August 2011, the Veteran’s representative sent in additional statements indicating the Veteran sought service connection for loss of hair and aching bones and joints throughout the body due to CTC exposure; and the Veteran clarified that he was seeking to reopen the claims in September 2011. See generally 38 U.S.C. § 5108 (if a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim). The September 2008 rating decision denied service connection for polyarthralgia, claimed as aching joints, due to finding insufficient evidence to establish a link between polyarthralgia and military service, to include CTC exposure. Service connection for hair loss was denied due to finding insufficient evidence to establish a disability for VA compensation purposes or a link between any current hair loss to military service, to include CTC exposure. The evidence associated with the record at the time of the rating decision included the Veteran’s service treatment records (STRs), January 2008 VA examination reports addressing hair loss and polyarthralgia, internet articles on effects of CTC exposure, and the Veteran’s and fellow service-members’ lay statements. With regard to the claim to reopen service connection for polyarthralgia, The Board concludes that evidence added to the record since the prior September 2008 denial is not new and material. See 38 C.F.R. § 3.156 (new evidence is defined as existing evidence not previously submitted to agency decision makers and material evidence means 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 previously of record, and must raise a reasonable possibility of substantiating the claim.). The new evidence includes VA treatment records, additional articles on CTC exposure, a May 2018 VA bones examination report. The new evidence does not raise a reasonable possibility of substantiating the claim as the statements on the nature and extent of CTC exposure and the chemical’s possible effects on the body are redundant of prior statements and articles of record. In addition, VA treatment records indicate ongoing treatment for numerous bone and joint complaints but do not indicate any etiological link between polyarthralgia and the Veteran’s service or CTC and a May 2018 examination diagnosed arthritis that was not related to service, to include CTC exposure. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010) (the threshold to reopen the claim is low); Justus v. Principi, 3 Vet. App. 510, 513 (1992) (such evidence is presumed credible solely for the purpose of determining whether new and material evidence has been submitted). With regard to the claim to reopen service connection for hair loss, the Board also concludes that evidence added to the record since the prior September 2008 denial is not new and material. The evidence includes the Veteran’s statements regarding the nature and extent of his exposure to CTC, additional internet articles on carbon tetrachloride, and VA treatment records. The Board finds the statements and articles related to CTC reflects redundant evidence that were of record at the time of the prior denial, specifically, that he was exposed to CTC in active service and details on the potential effects of such exposure. While the Veteran continues to contend that he was exposed to CTC and has indicated his belief that such exposure caused hair loss, there is no evidence non-cumulative evidence of record showing that the Veteran has a current disorder evidenced by hair loss related to his active service. See 38 C.F.R. § 3.156(a). Therefore, as new and material evidence has not been submitted, reopening of these claims are not warranted. See Shade, 24 Vet. App. at 118. Accordingly, the claims to reopen the issues of entitlement to service connection for polyarthralgia and hair loss are denied. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as other organic diseases of the nervous system, which includes peripheral neuropathy. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). 1. An eye disorder The Veteran contends he has vision problems due to CTC exposure during active service. He reported that his visual acuity significantly degraded with periods of obscured vision and cataracts. STRs indicate 20/20 vision at enlistment in August 1951 and in-service eye consultations reported an astigmatism was treated with corrective lens in October 1956, with separation reports of medical history positive for eye trouble and a June 1957 discharge examination report noting 20/20 vision. See 38 C.F.R. § 3.303(c) (refractive error of the eye is not a disease or injury for purposes of service connection). The Board finds the preponderance of the evidence weighs against a finding that the Veteran has a current eye disorder related to active service. Rather, a December 2017 VA examination report diagnosed early dry age-related macular degeneration, nuclear sclerotic cataracts, and refractive errors and, as noted above, refractive errors of the eye may not be service-connected for compensation purposes. 38 C.F.R. § 3.303(c). Moreover, the December 2017 examiner determined that there was no potential relationship possible between CTC exposure and the Veteran’s current correctable vision status. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight of the opinions are within the province of the adjudicator); see also Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (factors for assessing the probative value of a medical opinion are the physician’s access to the claims folder and the thoroughness and detail of the opinion). The other evidence of record is generally consistent with the above. September 2007 VA treatment records note complaints of blurry vision and assessed hyperopia, presbyopia, early dry age-related macular degeneration, ocular hypertension, and early cataracts and a March 2016 VA optometry note assessed hyperopia, presbyopia, cataracts, and macular mottling with no evidence of retinopathy due to diabetes. The Board acknowledges the Veteran’s contentions that his eye problems at least partially related to CTC exposure, but affords such opinion no probative weight as there is no indication that he has the training or experience required to render a competent opinion requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Additionally, the Board notes that the Veteran submitted multiple articles and medical literature outlining the effects of CTC exposure on the body and indicating a link between CTC exposure to symptomatology such as immediate blurred vision. Specifically, a public health statement for CTC indicated harm was based on multiple factors such as dose, duration, age, sex, diet, and lifestyle and explained that effects on humans were known for high-exposure of short duration but not for long-term low level exposure and that such effects were immediately present and may be seen in the liver, kidneys, and nervous system. National Institute for Occupational Safety and Health reports provided recommendations for workplace safety when using CTC and outlined health effects on humans to include blurring of vision soon after exposure and case studies indicated vision improved after exposures; additional internet articles indicated CTC may irritate the eyes on contact. However, the Board finds the literature to be less probative than the VA medical opinion against the claim as the articles and generic medical literature do not address the specific facts of this case. The Board finds the VA examiner’s opinion to be the most probative evidence of record. In summary, the preponderance of the evidence weighs against a finding that the Veteran has an eye disorder related to service, to include CTC exposure. Thus, the claim for service connection is denied. 2. Disorder claimed as swelling of hands and feet The Veteran initiated a claim for service connection for swelling of his hands and feet and reported that his feet, hands, and lower legs often swelled and caused discomfort; he explained that recognized symptoms of CTC poisoning included swelling of hands or feet and indicated that he believed he had such symptoms due to CTC exposure in service. STRs are negative for any complaints or treatment for hand and feet swelling. His June 1957 discharge examination report found normal upper and lower extremities other than a healed scar and normal feet. He testified that he began noticing swelling in his hands and feet around 20 years after separation from service and that doctors were not sure what caused the swelling. The Board notes that the Veteran’s symptoms of tingling and numbness in his hands and feet are addressed separately in the claims for lower extremity peripheral neuropathy below. With respect to whether the Veteran has a current disability, the Board finds the competent evidence does not demonstrate that the Veteran had a diagnosis of a hand and foot disorder characterized by swelling at any time during the appeal period. The medical records are negative for any diagnosis related to reports of hand and foot swelling and the Veteran has not indicated that he was diagnosed with an associated disability. See Jandreau, 492 F.3d at 1377. Rather, the Veteran reported he was observed for about a week in July 2011 for any residual disability due to CTC exposure and although the War-Related Illness and Injury Study Center program (WRIISC) treatment records document his reports of hand and feet swelling, the treatment providers declined to provide an associated diagnosis for such complaints. Therefore, as Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability during the period of the appeal, and the preponderance of the evidence is against a finding of a current diagnosis of a disorder for hand and foot swelling, it is unnecessary to address the remaining elements of the claim for service connection. See 38 U.S.C. §§ 1110, 1131; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In summary, the preponderance of the evidence is against a finding that the Veteran has a hand and foot disability characterized by swelling during the period of the appeal and the claim for service connection is denied. 3. Peripheral neuropathy The Veteran contends his nervous system was affected by CTC exposure in active service. Specifically, he reported symptoms of tingling and numbness diagnosed as polyneuropathy of the bilateral upper and lower extremities and indicates that the disorder is due to CTC exposure. STRs are negative for any complaints or treatment for peripheral neuropathy affecting any extremity. The Veteran’s June 1957 discharge examination report is also negative for any nerve abnormalities. Initially, the Board finds the preponderance of the evidence against a finding that the Veteran’s peripheral neuropathy of the bilateral upper and/or lower extremities was incurred during his active service or within one year of separation from service in August 1957. VA treatment records reflect evidence of peripheral polyneuropathy was noted on an electromyogram study in September 2003, with a related October 2003 VA treatment record noting the Veteran began experiencing symptoms of numbness and tingling in his feet and hands about four years prior. In addition, the Veteran reported in a July 2011 VA WRIISC consultation that symptoms of numbness in his feet began around 1996 that progressed into pain and later affected his hands. As such, the probative evidence of record establishes that the Veteran’s peripheral neuropathy of the bilateral upper and/or lower extremities was not present in service or within one year of separation from active service. Rather, the evidence demonstrates that symptoms of peripheral neuropathy began around 1996 and the Veteran has not alleged that he was diagnosed or treated for peripheral neuropathy in service or within one year after his August 1957 discharge from service. See 38 C.F.R. § 3.303(b); Walker, 708 F.3d at 1338. Further, the probative evidence of record weighs against a finding that peripheral neuropathy of the bilateral upper and/or lower extremities is related to the Veteran’s active service, to include CTC exposure. Specifically, the Board finds the March 2018 VA examination report and medical opinion to be highly probative evidence against the claim. See Guerrieri, 4 Vet. App. at 470-71; see also Prejean, 13 Vet. App. at 448-49. The opinion reflects a review of the evidence, to include the Veteran’s lay statements, and provides a persuasive rationale that the Veteran’s peripheral neuropathy was unrelated to CNC exposure in active service. The examiner confirmed the diagnosis of chronic distal peripheral sensory polyneuropathy of the bilateral lower extremities with symptoms initiating in approximately 2000 and noted that the Veteran did not identify any neurologic or acute medical problems at time of his discharge. The examiner further explained that a review of current medical literature on CNC and other organic solvents did not include the substance in literature on toxic peripheral neuropathy. The examiner noted that CNC could result in acute and chronic liver and renal problems, but current medical literature did not include peripheral neuropathy as a related disorder. The examiner concluded that the Veteran’s onset of peripheral neuropathy more than 40 years after active service along with current medical literature that did not establish an identified relationship between peripheral neuropathy and CTC made it less likely than not that his currently diagnosed peripheral neuropathy was due to active service and CTC exposure. The March 2018 examination and medical opinion are generally consistent with other evidence of record, to include a January 2008 VA general medical examination report noting the Veteran’s contentions on deterioration of his nervous system but finding peripheral neuropathy likely idiopathic without a known cause and a March 2018 VA diabetic neuropathy examination that found idiopathic peripheral neuropathy pre-dated a diagnosis of diabetes such that he less likely than not had a significant diabetic peripheral neuropathy. Further, a November 2003 VA treatment record indicated it was difficult to determine an etiology of the Veteran’s length-dependent axonal neuropathy but that CTC exposure would not produce a late-onset neuropathy of that type and a November 2005 VA treatment provider indicated review of National Institutes of Health literature on acute symptoms of CTC exposure, noted the Veteran’s discussions of symptoms appeared to be more recent and many years after his acute CTC exposure, and found many of his symptoms compatible with symptoms of aging. The Board notes that the Veteran submitted multiple articles and medical literature outlining the effects of CTC exposure on the body and indicating a link between CTC exposure to nervous system degeneration and finds such literature does not contradict the March 2018 VA medical opinion. Specifically, a public health statement for CTC explained that effects on humans were known for high-exposure of short duration but not for long-term low level exposure and that such effects were immediately present and may be seen in the nervous system, to include the brain, with effects such as headache, dizziness, sleepiness that usually disappear within a few days after exposure stops. National Institute for Occupational Safety and Health reports outlined health effects on humans to include observed neurological involvement soon after exposure described as cell damage in cerebellum tissue; additional internet articles indicated CTC’s effects on the nervous system were related to the brain and included headaches, dizziness, sleepiness, nausea, and vomiting. The Board acknowledges that a July 2011 VA WRIISC consultation determined that peripheral neuropathy had unclear etiology but found remote exposure to CTC could be a contributor, but affords the opinion less probative value than the other medical opinions of record because the treatment provider does not support the conclusion with a rationale. Further even through July 2011 VA pain management records indicate the Veteran had a history of progressive chemically-induced small fiber neuropathy and a January 2017 VA podiatry treatment record noted peripheral neuropathy was diagnosed with an inference that the Veteran was exposed to neurotoxic chemicals that may have caused neuropathy, the Board notes that the treatment records do not provide a clear etiological determination or rationale and are therefore also afforded limited probative weight. The Board also acknowledges the Veteran’s lay statements that he became very ill in service and shortly thereafter due to CTC exposure and that his peripheral neuropathy is a symptom of such CTC exposure. Although the Veteran may sincerely believe that his peripheral neuropathy is related to service and specifically to CTC exposure in service, there is no indication that he has the training or experience required to render a competent opinion linking the disorder to service. See Jandreau, 492 F.3d at 1377. The Board finds the March 2018 VA examiner’s opinion to be the most probative evidence of record. Notably, the VA examiner was aware of the Veteran’s reported history yet was unable to offer a positive opinion after a review of the Veteran’s complaints and history. In summary, the preponderance of the evidence is against a finding that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities is related to his active service, to include CTC exposure, and service connection may not be presumed. Thus, the claims for service connection are denied. Increased rating for bilateral hearing loss Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Service connection for bilateral hearing loss was granted in an October 2003 rating decision and assigned a 30 percent evaluation that was continued in a December 2005 rating decision. In a July 2006 rating decision, the evaluation was increased to 40 percent, effective January 2006. In August 2011, the Veteran reported hearing impairment and loss of hearing that was clarified in September 2011 to be a claim for an increased rating of the disability. The Board finds the Veteran’s bilateral hearing loss does not warrant a rating in excess of 40 percent at any time during the period on appeal. See 38 C.F.R. § 4.85, Tables VI and VII, Diagnostic Code 6100 (evaluations of bilateral defective hearing range from non-compensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz)). The rating schedule establishes 11 auditory hearing acuity levels designated from Level I, for essentially normal hearing acuity, through Level XI, for profound deafness, to evaluate the degree of disability from bilateral service-connected defective hearing. See also Lendenmann v. Principi, 3 Vet. App. 345 (1992) (disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing). The results of a September 2011 audiological examination, as measured by a puretone audiometry test, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 60 65 70 70 66 LEFT 60 70 80 80 72 When the audiometry test results and Maryland CNC speech recognition scores of 66 percent in the right ear and 52 percent the left ear were applied to Table VI, the September 2011 testing resulted in a Level VII Roman numeral designation of the right ear and a Level VIII Roman numeral designation for the left ear. The results are a 40 percent disability rating when the above Roman Numeral designations are mechanically applied to Table VII. 38 C.F.R. § 4.85. As the Veteran exhibits an exceptional pattern of hearing impairment, the puretone threshold averages are also assigned values under Table VIA, resulting in a Level V designation of the right ear and a Level VI designation of the left ear that produces a less favorable disability rating when mechanically applied to Table VII. 38 C.F.R. § 4.86(a) (an exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies is 55 decibels or more). In addition, the results of a June 2015 audiological examination, as measured by a puretone audiometry test, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 60 65 75 75 69 LEFT 60 65 75 75 69 The testing resulted in a Level IV designation of the right ear and a Level IV designation for the left ear when the audiometry test results and Maryland CNC speech recognition scores of 82 percent in the right ear and 78 percent in the left ear were applied to Table VI. The examiner noted speech recognition scores improved since the 2011 examination and explained that the scores may be due to a more comfortable listening level than prior testing. When the above Roman Numeral designations are mechanically applied to Table VII, the results are a 10 percent disability rating. 38 C.F.R. § 4.85. The puretone threshold averages are also evaluated by Table VIA due to the exceptional pattern of hearing impairment, for Level V Roman numeral designations bilaterally and a 20 percent disability rating when mechanically applied to Table VII. 38 C.F.R. § 4.86(a). Finally, a April 2017 audiological examination reported puretone audiometry test results, as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 75 70 65 75 71 LEFT 75 70 70 75 73 The testing resulted in a Level VII designation of the right ear and a Level VIII designation for the left ear when the audiometry test results and speech recognition scores of 64 percent in the right ear and 52 percent in the left ear were applied to Table VI. The April 2017 testing resulted in a 40 percent disability rating. 38 C.F.R. § 4.85. When evaluated for his exceptional pattern of hearing impairment, the puretone threshold averages resulted in a Level VI designation bilaterally under Table VIA and a less favorable disability rating when mechanically applied to Table VII. 38 C.F.R. § 4.86(a). Based on the above, the Board concludes that the preponderance of the evidence weighs against a finding that a higher rating is warranted and the Veteran’s 40 percent evaluation reasonably encompasses the Veteran’s disability level and symptomatology. See 38 C.F.R. § 4.85, Diagnostic Code 6100. The Board acknowledges that the Veteran reported his hearing loss impacts the ordinary conditions of his daily life, that his hearing comprehension is worse than reported in an audiological examination because he has difficulty with ambient noise, and that his wife constantly complains that he cannot hear or understand her, the television, or other conversations. Such contentions also reflected in the September 2011, June 2015, and April 2017 examination reports. However, the Court has held that 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 precisely the effects that VA’s audiometric tests are designed to measure. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The situations noted by the Veteran in this case amount to functional effects of decreased hearing and difficulty understanding speech. Therefore, the preponderance of the evidence is against a finding that the Veteran’s bilateral hearing loss warrants a rating in excess of 40 percent. Lendenmann, 3 Vet. App. 345. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Odya-Weis, Counsel