Citation Nr: 18158944 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 10-40 840A DATE: December 18, 2018 ORDER Entitlement to increased ratings for bilateral hearing loss, currently rated 10 percent disabling prior to May 2, 2016, and rated 20 percent disabling thereafter, is denied. REMANDED The petition to reopen a claim of entitlement to service connection for a psychiatric disorder, to include emotionally unstable personality with anxiety, is remanded. FINDINGS OF FACT 1. For the period prior to May 2, 2016, the Veteran’s bilateral hearing loss manifested in no greater than Level IV hearing impairment in the right ear and Level V hearing impairment in the left ear on authorized VA audiology testing or qualifying compliant audiology testing. 2. For the period from May 2, 2016 and onward, the Veteran’s bilateral hearing loss manifested in no greater than Level VI hearing impairment in the right ear and Level IV hearing impairment in the left ear on authorized VA audiology testing or qualifying compliant audiology testing. CONCLUSIONS OF LAW 1. For the period prior to May 2, 2016, the criteria for a rating in excess of 10 percent for bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.85, Diagnostic Code 6100. 2. For the period from May 2, 2016 and onward, the criteria for a rating in excess of 20 percent for bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.85, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who had active military service from March 1966 to February 1968. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision (denying an increased rating for hearing loss) and a January 2015 rating decision (denying service connection for “emotionally unstable personality with anxiety”) of a Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In October 2015, a Travel Board hearing at the RO was held before the undersigned Veterans Law Judge (VLJ) in connection with the appeal on the hearing loss rating. A transcript of that hearing is associated with the claims file. The hearing loss rating issue was first before the Board in March 2016, when it was remanded for additional development of the evidentiary record. The Board finds that there has been substantial compliance with the directives of the March 2016 remand with regard to the hearing loss rating issue on appeal (the claims-file now contains a copy of the sought December 2014 VA audiometric testing data, and the Veteran was afforded a new VA audiology examination in May 2016). See Stegall v. West, 11 Vet. App. 268, 271 (1998). During the processing of the March 2016 remand, an August 2016 rating decision awarded an increased 20 percent rating for the Veteran’s bilateral hearing loss, effective from May 2, 2016. The Veteran’s appeal continues to seek ratings for bilateral hearing loss in excess of the 10 percent rating in effect prior to May 2, 2016, and in excess of the 20 percent rating in effect thereafter. The Board has accordingly recharacterized the issue on the title page of this decision. The hearing loss rating issue was again before the Board in August 2017, when the Board denied that claim on appeal. The Veteran appealed that denial to the United States Court of Appeals for Veterans Claims (Court). In August 2018, the Court issued an order that granted a Joint Motion for Remand (Joint Motion) of the parties, dated that same month, to vacate the Board’s August 2017 denial of the claim of entitlement to an increased rating for bilateral hearing loss and remand the matter to the Board for readjudication. The Board has addressed the concerns raised in the Joint Motion in the decision below. The Board notes that the Board’s August 2017 decision additionally addressed the issue of entitlement to service connection for residuals of a traumatic brain injury (TBI), and that issue was remanded by the Board to the RO for additional development. Thus, the TBI issue returned to the RO and was separated from the hearing loss rating issue that was denied and appealed to the Court. The hearing loss rating issue has now been returned to the Board and the undersigned VLJ for further appellate review, and it shall be addressed in this decision at this time. The TBI issue has separately also returned to the Board, but the Board’s Office of Litigation Support has determined that the TBI issue cannot be merged into this Board decision to be addressed by the Board at this time (due to a pending administrative matter concerning the TBI issue). Accordingly, the issue of entitlement to service connection for residuals of a TBI will be addressed in a separate decision at a later date. The Board’s August 2017 decision also noted that the Veteran had recently perfected an appeal seeking to establish entitlement to service connection for a psychiatric disorder, but the AOJ had not certified that issue to the Board as of that time. That issue was certified to the Board in October 2018 and shall now be addressed in this Board decision. The Board’s August 2017 decision also noted that the Veteran filed a notice of disagreement in September 2016 initiating an appeal seeking an earlier effective date for an award of service connection for tinnitus and a higher rating for Meniere’s disease. That appeal continues to await the issuance of a statement of the case (SOC) by the RO. The Board is aware of the holding in Manlincon v. West, 12 Vet. App. 238, 240 (1999), which requires the Board to remand issues to instruct the RO that the issues remain pending in appellate status (see 38 C.F.R. § 3.160(c)) and require further action. See 38 U.S.C. § 7105; 38 C.F.R. § 19.26. However, in this case, it is clear that the RO is aware of and is currently processing the appeal initiated by the September 2016 notice of disagreement, including with correspondence to the Veteran acknowledging the matter and clear documentation in the Veterans Appeals Control and Locator System (VACOLS). In an October 2015 notice of disagreement on the petition to reopen the psychiatric disorder service connection claim, the Veteran’s representative included a request that VA “consider a CUE [clear and unmistakable error] in the original denial,” and then presented contentions to support the contention that the March 1987 prior denial of the claim contained a CUE. A petition to revise the March 1987 decision on the basis of CUE is a separate claim invoking separate provisions of law than the issue on appeal featuring a petition to reopen the claim with the submission of new and material evidence. Effective March 24, 2015, when a claimant submits a communication indicating a desire to apply for VA benefits that does not meet the standards of a complete claim for benefits, the communication will be considered a request for an application form for benefits under 38 C.F.R. § 3.150(a). See 38 C.F.R. § 3.155(a). When such a communication is received, VA shall notify the claimant and the claimant’s representative of the information necessary to complete the application form or form prescribed by the Secretary. Id. To the extent that his notice of disagreement indicated a desire to apply for revision of the March 1987 RO rating decision on the basis of CUE, it does not meet the standards of a complete claim for benefits; the RO has not provided the Veteran with the information necessary to formally file the claim/petition. Although the November 2016 statement of the case makes a passing reference to the CUE contention, it does not discuss the substance of the matter and there has been no RO rating decision adjudicating the CUE issue. The Board does not have jurisdiction over the CUE issue. As the Board does not have jurisdiction over the CUE issue, it is referred to the Agency of Original Jurisdiction (AOJ) for appropriate action. See 38 C.F.R. § 19.9(b). 1. Entitlement to increased ratings for bilateral hearing loss, currently rated 10 percent disabling prior to May 2, 2016, and rated 20 percent disabling thereafter, is denied. Disability ratings are assigned in accordance with VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from a disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. When a question arises as to which of two ratings shall be applied under a particular diagnostic code, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. With a claim for an increased initial rating, separate “staged” ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). In a claim for increase in a previously established rating (as in this case), the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the evidence contains factual findings that demonstrate distinct time periods when the service connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, staged ratings are to be considered. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability ratings for hearing loss are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss disability ratings range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by puretone audiometric tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. The Rating Schedule provides a table (Table VI) to determine for rating purposes a Roman numeral designation (I through XI) for hearing impairment, based on testing (by a state-licensed audiologist) including puretone thresholds and speech discrimination (Maryland CNC test). See 38 C.F.R. § 4.85. Where the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when there is an exceptional pattern of hearing impairment (as defined in 38 C.F.R. § 4.86) the rating may be based solely on puretone threshold testing. See 38 C.F.R. § 4.85, Table VIA. The rating schedule establishes 11 auditory acuity levels designated from Level I for essentially normal hearing acuity, through Level XI for profound deafness. VA audiometric examinations are conducted using a controlled speech discrimination test together with the results of a puretone audiometric test. The horizontal lines in Table VI (in 38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The vertical columns in Table VI represent nine categories of decibel loss based on the puretone audiometric test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the horizontal row appropriate for the percentage of discrimination and the vertical column appropriate to the puretone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85) by intersecting the horizontal row appropriate for the numeric designation for the ear having the better hearing acuity and the appropriate vertical column to the numeric designation level for the ear having the poorer hearing acuity. See 38 C.F.R. § 4.85(e). The provisions of 38 C.F.R. § 4.86(a) provide that when the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 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. The provisions of 38 C.F.R. § 4.86(b) provide that when the puretone threshold is 30 decibels or less at 1,000 Hertz, and 70 decibels or more at 2,000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever result provides the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. If impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I, subject to the provisions of § 3.383. The Board notes that it has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as to the claim being decided. The Veteran filed the claim on appeal, seeking an increased disability rating for bilateral hearing loss in January 2010. The issue of entitlement to an increased rating requires consideration of a period beginning 1 year prior to the January 2010 claim; thus, the period for consideration begins in January 2009. (The effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date, otherwise, date of receipt of claim. 38 C.F.R. § 3.400(o)(2).) A June 2010 VA audiology examination was arranged for the Veteran in connection with the claim on appeal, but the report of this examination indicates that “the Veteran declined to complete the audio evaluation.” An August 2012 VA audiological examination report was completed for the purposes of evaluating the Veteran’s hearing acuity in each ear. The August 2012 VA examination report reveals that relevant puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/A 40 55 80 80 LEFT N/A 40 55 75 85 The Board notes that the decibel threshold recorded for 2000 Hz in the left ear was originally typed in as “5,” but appears to have been corrected by handwritten marking by the VA examiner to “55.” The Board has accepted the “55” entry, which is more favorable to the Veteran in this case. The Veteran’s average pure tone threshold for the right ear was 63.75 decibels with a word recognition score of 76 percent. His average pure tone threshold for the left ear was 63.75 decibels with a word recognition score of 72 percent. (The Board notes that the electronically prepared report shows a lower “51” decibels average pure tone threshold for the left ear, but this was calculated automatically with inclusion of the erroneous entry of the “5” decibel threshold for the left ear at 2000 Hz. The Board has calculated 63.75 decibels average pure tone threshold for the left ear based upon the corrected information, which is more favorable to the Veteran.) Applying 38 C.F.R. § 4.85, Table VI to the August 2012 VA audiology data: the Veteran’s right ear hearing loss is a Level IV impairment, and the left ear hearing loss is a Level V impairment. The Board has considered the provisions of 38 C.F.R. § 4.86, and finds that they do not apply as no exceptional pattern of hearing impairment is shown. Applying the hearing levels from Table VI to Table VII, based on the results of the August 2012 audiometric examination findings, a 10 percent rating is derived. A December 2014 VA audiological examination report associated with examination of the Veteran has been obtained and associated with the claims-file in accordance with the directives of the Board’s March 2016 remand. The December 2014 VA audiometric report shows only limited testing was performed at that time, with speech recognition testing performed using material other than the Maryland CNC list required for rating purposes. The December 2014 examination report reveals that relevant puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/A 40 50 70 65 LEFT N/A 35 45 65 80 The December 2014 report specifically states that it is “NOT ADEQUATE FOR RATING PURPOSES.” The Board observes that the corresponding written VA treatment report states that for both ears “[w]ord-recognition ability is excellent,” with “(92% correct) at a 85 dB HL monitored live-voice presentation level” for the right ear and “(92% correct) at a 90 dB HL monitored live-voice presentation level.” The live-voice testing is not qualifying compliant audiology testing for rating purposes. Reports from July 2015 VA medical treatment of the Veteran’s complaint of various episodic symptoms including hearing loss include an audiogram depicting the Veteran’s hearing acuity levels at the time in a graphical format. However, as the audiometry results are conveyed in straightforward graphs, the Board finds that it, as the finder of fact, can interpret the charts to determine the numeric values of the puretone levels for adjudication purposes. See Kelly v. Brown, 7 Vet. App. 471 (1995) (the U.S. Court of Appeals for Veterans Claims (Court) held that it could not interpret the results of an audiograph because interpretation requires a factual finding, which is not the role of the Court in the first instance, and further indicated that the Board was empowered to make such factual findings in the first instance). The July 2015 VA audiogram reveals that relevant puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT N/A 50 65 80 85 LEFT N/A 40 50 75 85 A separate associated narrative report describes that “[r]ight hearing thresholds and word recognition is significantly worse than the December 2014 audiogram,” while “[l]eft hearing thresholds are not significantly different.” No qualifying word recognition testing results adequate for rating purposes was included, and the reference comparison to the December 2014 word recognition testing results suggests the that live-voice testing was again used such that any scores would be inadequate for use in a disability rating assignment. The reports from this examination do not suggest that the Veteran’s hearing loss may be appropriately rated without consideration of word recognition scores, and no pertinent exceptional pattern of hearing loss contemplated by 38 C.F.R. § 4.86 is shown. The findings presented in the July 2015 report are not adequate for use in this schedular rating assignment analysis. The Board observes that the July 2015 report concerns an array of episodic symptoms, including involving the Veteran’s ears, that have been associated with the Veteran’s separate diagnosis of Meniere’s disease. Service connection was granted for the Veteran’s Meniere’s disease by a June 2016 RO rating decision, and the Veteran is now in receipt of a separate disability rating contemplating his impairment associated with the Meniere’s disease. Other evidence, including the Veteran’s testimony at his October 2015 Board hearing, suggests that the Veteran has experienced fluctuations in his hearing acuity at times; these symptom patterns have also been associated with the Veteran’s service-connected Meniere’s disease. The Board in this case is considering all of the Veteran’s service-connected hearing impairment (of any etiology) shown by qualifying audiology examination evidence for the purposes of assigning disability ratings in this decision. A May 2016 VA audiological examination report was completed for the purposes of evaluating the Veteran’s hearing acuity in each ear. The May 2016 VA examination report reveals that relevant puretone thresholds, in decibels, were as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT N/A 50 65 80 90 LEFT N/A 40 55 75 90 The Veteran’s average pure tone threshold for the right ear was 71.25 decibels with a word recognition score of 68 percent. His average pure tone threshold for the left ear was 65 decibels with a word recognition score of 76 percent. Applying 38 C.F.R. § 4.85, Table VI to the May 2016 VA audiology data: the Veteran’s right ear hearing loss is a Level VI impairment, and the left ear hearing loss is a Level IV impairment. The Board has considered the provisions of 38 C.F.R. § 4.86, and finds that they do not apply as no exceptional pattern of hearing impairment is shown. Applying the hearing levels from Table VI to Table VII, based on the results of the August 2012 audiometric examination findings, a 20 percent rating is derived. The Board notes that in Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007), the Court held that an examining VA audiologist must describe the functional effects caused by a hearing disability in his or her final report. Martinak, 21 Vet. App. at 455. The August 2012 VA examination report notes that the Veteran reported: “[if] more than one person is talking, I cannot understand the words. My wife constantly tells me to turn the tv down. I don’t understand people if they are not looking at me.” The May 2016 VA examination report notes that the Veteran reported: “difficulty understanding speech, especially in the presence of background noise and without visual cues.” The Board observes that the reported symptoms represent the type of loss of hearing acuity contemplated by the schedular rating criteria for hearing loss, and do not raise a question of other bases of compensation in this case. None of the other medical evidence of record presents findings significantly contrary to those in the most detailed evidence discussed above featuring specialized audiometric measurements of the Veteran’s hearing acuity. Nor does any other evidence of record otherwise probatively indicate that the criteria for an increase of the disability ratings for hearing loss are met in this case. This case presents the Board with a situation in which all of the probative competent audiological evidence shows audiometric data that fail to meet the quantitative criteria for ratings in excess of those assigned in this case. The audiometric reports of record reflect the testing and reporting of trained audiology professionals who are competent to prepare such reports. The Board notes that there is no indication that the audiometric reports of record are anything but reliable. The Board finds that the audiometric reports discussed above are highly probative evidence in evaluating the severity of the Veteran’s hearing loss. The August 2012 and May 2016 VA examination reports discussed above are not contradicted by any other probative evidence (no evidence of record shows audiometric findings meeting the criteria for higher ratings for hearing loss during either stage of the appeal). Thus, the Board finds the VA examination reports to be persuasive in showing that the Veteran’s hearing loss has not met the criteria for higher ratings during the period for consideration. Concerns Presented by the August 2018 Joint Motion The August 2018 Joint Motion concludes that the Board’s August 2017 decision “erred when it provided an inadequate statement of reasons or bases for its determination.” In this regard, the Joint Motion described that “BVA determined that Appellant was not entitled to an effective [date] prior to May 2, 2016, for a 20% rating, because the evidence of record shows that he first satisfied the criteria under 38 C.F.R. § 4.85, Table VI, based on the December 2014 VA audiological test results....” The Joint Motion noted that “BVA explained that the test results did not qualify for purposes of [] meeting the specific criteria in 38 C.F.R. § 4.85 because they were based on ‘live-voice testing.’” The Joint Motion found: “the Board failed to address why an effective date earlier than May 2, 2016, for the increased 20% rating, was not appropriate.” The Joint Motion explains: [t]his Court has held that the ‘effective date should not be assigned mechanically based on the date of a diagnosis. Rather, all of the facts should be examined’ to determine ‘when the increase... can be ascertained.’ Swain v. McDonald, 27 Vet. App. 219, 224 (2015) (quotations and citations omitted) (addressing whether the requirement of 38 C.F.R. § 4.85(a) that an examination for hearing impairment purposes ‘include a controlled speech discrimination test (Maryland CNC)’ means that the effective date of a claim for an increased disability rating for hearing loss may not be earlier than the date on which the veteran obtained the Maryland CNC test showing an increased disability rating was warranted.). The Joint Motion further discussed that: In this case, the Board selected the date of the May 2, 2016, VA examination as the effective date for a 20% rating without any further analysis. In this regard, the puretone threshold results from the December 2014 VA examination are almost identical to those in the May 2016 examination.... The fact that the December 2014 examination was not adequate to assign a rating[] does not change the fact that it is evidence of a worsening of the veteran’s condition that should have been evaluated in assigning the effective date in this case. The Joint Motion indicates that the Board must “explain why the December 2014 examination does not evidence ‘the earliest date as of which it is ascertainable that an increase in disability had occurred.’” To address the Joint Motion’s concern, the Board first finds that the December 2014 VA audiometric report presents data that is not “almost identical to those in the May 2016 examination.” Notably, each and every one of the eight data points accounting for the Veteran’s hearing thresholds in the pertinent frequencies in his two ears is lower (reflecting better hearing acuity) in the December 2014 VA audiometric data than the corresponding hearing threshold shown in the May 2016 audiometric examination report. All but one of the hearing thresholds was 10 or more decibels lower (reflecting better hearing acuity) in December 2014 than in May 2016, and one of the hearing thresholds was as much as 25 decibels lower in December 2014. Furthermore, all but one of the eight data points accounting for the Veteran’s hearing thresholds in the pertinent frequencies in his two ears is lower (reflecting better hearing acuity) in the December 2014 VA audiometric data than the corresponding hearing thresholds shown in the August 2012 VA audiological examination report. The lone exception is a hearing threshold that is identical in the two reports. Notably, as discussed above, the August 2012 VA audiological examination report was adequate for rating purposes and demonstrated that the Veteran’s hearing loss at that time met the criteria for no higher than a 10 percent rating. The December 2014 audiometric data reflecting lower hearing thresholds (better hearing acuity) than those shown in the August 2012 VA examination report offers no meaningful evidence of an ascertainable increase in disability meeting the criteria for a rating in excess of 10 percent. The Board also notes that each and every one of the eight data points accounting for the Veteran’s hearing thresholds in the pertinent frequencies in his two ears is lower (reflecting better hearing acuity) in the December 2014 VA audiometric data than the corresponding hearing threshold shown in the July 2015 VA audiometric data discussed above. The Joint Motion presents no direct assertion that the July 2015 VA audiometric data suggests a basis for an earlier effective date for a 20 percent rating. The Joint Motion’s discussion focuses exclusively upon the December 2014 VA audiometric data as a potential basis for earlier entitlement to a 20 percent rating. However, the Board briefly notes that it has considered the possibility that the authors of the Joint Motion were contemplating the July 2015 VA audiometric data and perhaps erroneously referred to the December 2014 report instead (although the reference is made repeatedly and consistently). Nevertheless, the Board does not find that the evidence makes it factually ascertainable that the increase in severity of hearing loss to the level warranting a 20 percent rating occurred by any identifiable date prior to May 2, 2016. Evidence such as the July 2015 audiometric report that is inadequate for rating purposes could hypothetically support finding that the pertinent increase shown in May 2016 was factually ascertainable at an earlier date if the overall evidentiary record otherwise indicated that the criteria for the higher rating were met at the earlier time. However, in this case there is no evidence indicating that the Veteran’s speech discrimination functioning at any identifiable time prior to May 2016 met the criteria for a 20 percent rating in connection with qualifying audiometry from any identifiable time prior to May 2016. The Board is otherwise unable to draw inferences from the evidence to ascertain that the Veteran’s hearing loss met the criteria for a 20 percent rating prior to May 2016. The evidence of record, including the Veteran’s testimony at his October 2015 Board hearing, indicates that the Veteran experienced fluctuations in his hearing acuity with a pathology involving Meniere’s disease. The rating criteria for a 20 percent rating requires impairment expressed in a form including results from Maryland CNC speech discrimination testing (with exceptions not applicable in the Veteran’s case). Expression of the Veteran’s impairment in an applicable form is not presented with the July 2015 examination report. Although the July 2015 examination report presents pertinent audiometric data, the Board is unable to draw an inference regarding what the hypothetical results of Maryland CNC speech discrimination testing would have been if the testing had been performed at that time. The Veteran’s hearing impairment is shown to have been subject to fluctuations, and the Board cannot infer that his speech discrimination at the time of the July 2015 examination would be expected to match or predictably relate to the level shown in records of Maryland CNC testing from other times. The Board finds that the Veteran’s speech discrimination functioning in July 2015 is not factually ascertainable in connection with the audiometric evidence from July 2015 or other evidence of record. The Board finds that the evidence does not make it factually ascertainable that the pertinent increase in severity of the Veteran’s hearing loss was present on any identifiable date prior to May 2, 2016. Accordingly, no increased rating (or change in the effective date of the existing rating increase to 20 percent) is warranted in this case. Neither the Veteran nor his/her representative has raised any other issues associated with his hearing loss rating, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND 1. The petition to reopen a claim of entitlement to service connection for a psychiatric disorder, to include emotionally unstable personality with anxiety, is remanded. As discussed above, the Veteran’s representative has raised a claim of entitlement to revision of the March 1987 RO rating decision denying service connection for a psychiatric disorder. The March 1987 RO rating decision is the decision that would otherwise be identified as the prior final denial of service connection for a psychiatric disorder pertinent to the Veteran’s petition to reopen adjudication of that claim for service connection. Before the Board can consider the question of whether the Veteran is entitled to reopening of the claim of service connection for the psychiatric disorder, the RO must first process his request for an application form for benefits under 38 C.F.R. § 3.150(a), and, if the Veteran completes the appropriate form, adjudicate the question of whether there was CUE in the March 1987 RO rating decision denying service connection for the psychiatric disorder, provided the Veteran. This is because the issues are inextricably intertwined, and a favorable decision on the CUE claim would impact the application to reopen the claim of entitlement to service connection. The Court has held that two issues are inextricably intertwined when they are so closely tied together that a final decision cannot be rendered unless both issues have been considered. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). (The Board also observes that the psychiatric disorder service-connection claim may be intertwined with the TBI service connection claim that remains pending in appellate status, further preventing final appellate review of the issue at this time.) The matter is REMANDED for the following action: 1. Provide the Veteran and his representative with the information and forms necessary to for him to formally file the petition for revision of the March 1987 denial of service connection for a psychiatric disorder on the basis of clear and unmistakable error (CUE); the Veteran’s representative announced a desire to file such a claim in October 2015 correspondence. The Veteran should be provided an opportunity to respond. If the Veteran properly files a formal claim/petition on the matter, adjudicate the issue of whether there was CUE in the March 1987 rating decision that denied service connection for a psychiatric disorder. In so doing, the RO should consider the merits of the October 2015 arguments of the Veteran’s representative alleging CUE in the March 1987 rating decision. If the Veteran’s petition for revision of the March 1987 rating is denied, notify the Veteran of his procedural and appellate rights, including that he must file a notice of disagreement to initiate an appeal for Board review of the petition for revision of the March 1987 decision on the basis of CUE. 2. After completion of the above, readjudicate the issue remaining on appeal featuring the petition to reopen (with new and material evidence) the claim of entitlement to service connection for a psychiatric disorder, to include emotionally unstable personality with anxiety. The adjudication should consider the outcome of any inextricably intertwined petition to revise the March 1987 decision on the basis of CUE (if the Veteran formally files such a petition after receiving instructions, as discussed in directive #1, above). If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Barone, Counsel