Citation Nr: 20003553 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 14-41 700 DATE: January 15, 2020 ORDER An initial 10 percent rating, prior to April 16, 2019, for a right hip disability is granted, subject to the laws and regulations governing the payment of monetary benefits, A rating in excess of 10 percent, from April 16, 2019, for a right hip disability is denied. A rating in excess of 10 percent, prior to April 16, 2019, for a right knee disability is denied. A 30 percent rating, effective from April 16, 2019, for a right knee disability is granted, subject to the laws and regulations governing the payment of monetary benefits. A rating in excess of 10 percent, prior to April 16, 2019, for a cervical spine disability is denied. A 30 percent rating, effective from April 16, 2019, for a cervical spine disability is granted, subject to the laws and regulations governing the payment of monetary benefits. A compensable rating for bilateral hearing loss is denied. REMANDED Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Prior to April 16, 2019, the Veteran’s right hip disability was manifested by pain, stiffness, some limitation of motion, and painful motion. 2. For the entire appeal period, the Veteran’s right hip disability has been manifested by no more than pain, limitation of motion, painful motion, stiffness, crepitus, slightly reduced strength, limits on walking, standing, and sitting and limits on activities; but flexion limited to 45 degrees or less; extension limited to 5 degrees or less; adduction limited to cannot cross legs; or rotation limited to cannot toe-out more than 15 degrees, has not been shown. 3. Prior to April 16, 2019, the Veteran’s right knee disability was manifested by reports of pain and stiffness, tenderness and periodic swelling, full to slightly limited range of motion, and limits on prolonged walking, standing, and sitting, but no limitation of extension, ankylosis, or objective evidence of subluxation or instability has been shown. 4. Effective from April 16, 2019, the Veteran’s right knee disability has been manifested by extension limited to 20 degrees but has not resulted in extension limited to 30 degrees or more, flexion limited to 60 degrees or less, ankylosis, or impairment of the tibia and fibula. 5. Prior to April 16, 2019, the Veteran’s cervical spine disability was manifested by no more than complaints of pain and some decreased range of motion; but did not result in forward flexion greater than 15 degrees but less than 30 degrees; or combined range of motion of the cervical spine not greater than 170 degrees, or ankylosis; and no objective evidence of other related neurological abnormalities. 6. Effective from April 16, 2019, the Veteran’s cervical spine disability has been manifested by flexion limited to 20 degrees on range of motion testing, and to 15 degrees after repetitive-use testing; there have, however, been no findings of ankylosis, and other than separately service-connected radiculopathy of the upper extremities, there has been no objective evidence of other related neurological abnormalities. 7. The Veteran has no worse than Level III hearing acuity in each ear, and he does not have an exceptional pattern of hearing loss in either ear. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran’s favor, prior to April 16, 2019, the criteria for an initial 10 percent rating, for the service-connected right hip disability, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes (DCs) 5251, 5252, 5253. 2. The criteria for a rating in excess of 10 percent for the service-connected right hip disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, DCs 5251, 5252, 5253. 3. Prior to April 16, 2019, the criteria for a rating in excess of 10 percent, for the service-connected right knee disability, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, DCs 5010, 5257, 5260, 5261. 4. Effective from April 16, 2019, the criteria for a 30 percent rating, but no higher, for the service-connected right knee disability, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, DCs 5010, 5257, 5260, 5261. 5. Prior to April 16, 2019, the criteria for a rating in excess of 10 percent, for the service-connected cervical spine disability, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, DCs 5237, 5242. 6. Effective from April 16, 2019, the criteria for a 30 percent rating, but no higher, for the service-connected cervical spine disability, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, DCs 5237, 5242. 7. The criteria for an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.85, 4.86, DC 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1973 to April 1974 and from December 1974 to May 1999. In January 2018, the Veteran testified at a videoconference hearing at the Regional Office (RO) before the undersigned Veterans Law Judge. In April 2018, the Board remanded this matter for additional development. In an August 2019 rating decision, the RO granted a 10 percent rating for the service-connected right hip disability, and granted a 20 percent rating for the service-connected cervical spine disability, both effective from April 16, 2019. If the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel to that claim for an increased rating is whether TDIU is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009). In that regard, during the VA examination in April 2019, the examiner completed an individual unemployability statement regarding the Veteran’s right hip disability, finding he was unable to perform sedentary work in a normal 8-hour work day. As entitlement to a TDIU rating has been raised, the issues on appeal have been re-characterized. Increased Rating Claims Disability ratings are determined by application of the VA Schedule for Rating Disabilities, which is based on average impairment of earning capacity. Separate diagnostic codes identify various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 1. Entitlement to a compensable rating prior to April 16, 2019, and a rating in excess of 10 percent effective from April 16, 2019, for a right hip disability. The Veteran contends he should be entitled to a compensable rating prior to April 16, 2019, and a rating in excess of 10 percent from that date, for his service-connected right hip disability, which has been rated under DC 5252. Pursuant to DC 5252, a 10 percent rating is warranted when flexion of the thigh is limited to 45 degrees. A 20 percent rating is for application when flexion of the thigh is limited to 30 degrees. 38 C.F.R. § 4.71a, DC 5252. Limitation of motion of the hip may be also rated under DC 5251 which provides a maximum 10 percent rating for limitation of extension of the thigh that is limited to 5 degrees. 38 C.F.R. § 4.71a. DC 5253 provides that where adduction is limited such that the Veteran cannot cross legs, a 10 percent rating is warranted. Where rotation is limited such that the Veteran cannot toe-out more than 15 degrees of the affected leg, a 10 percent rating is warranted. Where abduction is lost beyond 10 degrees, a 20 percent rating is warranted. 38 C.F.R. § 4.71a. Normal ranges of hip motion are flexion from 0 degrees to 125 degrees and abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. After reviewing the record prior to April 16, 2019, the Board concludes that the competent and credible evidence of record supports the grant of a 10 percent rating for the entire appeal period for the Veteran’s service-connected right hip disability, but no higher. In that regard, in a March 2012 letter, a private physician, Dr. C. noted the Veteran had been seen for right hip pain. He reported pain on full range of right hip motion. In April 2012, the Veteran reported that his right hip pain interfered with his sleep. On September 2012 VA examination, the Veteran reported he had right hip pain off and on for the past 10 years. He reported flare-ups involving stiffness, twice a year, that lasted less than a day and limited his overall ability to walk or stand for prolonged periods. Range of right hip motion was recorded as flexion to 110 degrees, extension to 25 degrees, external rotation to 50 degrees, and internal rotation to 35 degrees, with pain at the end ranges of motion. Abduction loss was not beyond 10 degrees. The Veteran was able to do repetitive use testing, with no additional loss of right hip motion. The examiner noted that the Veteran had functional impairment of the right hip, noting contributing factors included less movement than normal and weakened movement. Right hip strength was slightly reduced. The examiner stated that the Veteran’s hip impacted his ability to work, noting limitations on lifting, walking, sitting, and standing. VA treatment records show that in September 2013, the Veteran was seen for right hip pain. It was noted he had decreased range of motion and the pain kept him from sleeping and participating in activities he used to do, such as bike riding. In January 2014, he reported his right hip was painful, with most of the pain being with internal rotation. In September 2014, he again reported right hip pain. Examination of the right hip revealed no tenderness to palpation and discomfort with internal rotation. In August 2015, it was noted he had an injection at the last visit to determine if the pain was in his hip or back, and he reported the pain was gone. In August 2015, he also started doing physical therapy for his hip. In October 2015, it was noted he was able to tolerate all activities well, had no complaints of right hip pain, and reported doing a HEP (home exercise program). Accordingly, prior to April 16, 2019, while compensable limitation of right hip motion was not shown on objective examination, pursuant to DC 5251, 5252, 5253, or any of the other diagnostic codes pertaining to limitation of motion of the hip, the record also shows that the Veteran reported having right hip pain, stiffness, flare-ups, and limitations on walking ,sitting, and standing; and objective examinations also showed limitation of hip motion, painful motion, and slight reduction in hip strength. In light of the foregoing it is clear that the Veteran experienced hip pain as well as functional limitations due to his right hip. In cases where a Veteran has pain upon motion, a compensable rating under 38 C.F.R. § 4.59 is for consideration when there is evidence of painful motion even without actual limitation of motion or loss of motion that is noncompensable. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Thus, resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a 10 percent rating, but no higher, was approximated prior to April 16, 2019. 38 C.F.R. § 4.7, 4.40, 4.45, 4.59. In considering whether a rating in excess of 10 percent is warranted for the service-connected right hip disability, the Board notes that on the VA examination in April 2019, the Veteran reported his right hip pain had progressively worsened since separation, with increased stiffness. He denied flare-ups. He reported functional impairment of the hip joint, described as being unable to do prolonged walking, standing, and sitting. Range of right hip motion was flexion to 75 degrees, extension to 20 degrees, abduction to 25 degrees, adduction to 10 degrees, external rotation to 35 degrees, and internal rotation to 15 degrees. The examiner noted that the pain noted on examination caused functional loss. There was sharp pain on palpation and movement of the right hip, described as moderate. Examination also revealed evidence of pain on weight bearing, objective evidence of crepitus, pain on passive range of motion, but no evidence of pain when non-weight bearing. The Veteran was able to perform repetitive use testing, with no additional loss of motion. Right hip strength was slightly reduced. It was noted that he regularly used a cane due to right hip internal derangement. The examiner indicated that the right hip impacted the Veteran’s ability to work, but noted the Veteran was retired, and unable to do prolonged walking, standing, or sitting. Accordingly, in reviewing the record, the Board finds that the criteria for a rating in excess of 10 percent for the service-connected right hip disability have not been met or approximated at any point during the appeal period. 38 C.F.R. § 4.7. In that regard, the competent evidence of record does not show malunion of the femur with moderate knee or hip disability, flexion limited to 30 degrees, limitation of abduction with motion lost beyond 10 degrees, flail hip joint, or ankylosis, even considering the Veteran’s reports of pain and functional limitations. 38 C.F.R. § 4.40, 4.45, 4.59, 4.71, DC 520, 5252, 5253, 5254, 5255. Therefore, the Board finds that the degree of impairment due to the Veteran’s service-connected right hip disability is adequately reflected by the 10 percent rating assigned under the provisions in 38 C.F.R. § 4.59. 2. Entitlement to a rating in excess of 10 percent for a right knee disability. The Veteran contends he should be entitled to a higher rating for his service-connected right knee disability. After reviewing the record, the Board concludes that a 30 percent rating is warranted effective from April 16, 2019, for the service-connected right knee disability, however, the preponderance of the evidence does not support the grant of a rating in excess of 10 percent prior to April 16, 2019. Review of the record shows that the Veteran’s service-connected right knee disability has been rated under DCs 5010-5257. DC 5010 provides that traumatic arthritis is rated as for degenerative arthritis. 38 C.F.R. § 4.71a, DC 5010. Under DC 5003, degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003. Pursuant to DCs 5003, 5010, a rating in excess of 10 percent is not available absent x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a. DC 5257 provides for a 10 percent rating for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A maximum 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, DC 5257. A claimant who has arthritis or limitation of motion and instability of a knee, may be rated separately under DCs 5003 and 5257. Any separate rating must be based on additional disabling symptomatology that meets the criteria for a compensable rating. VAOPGCPREC 23-97 (1997); VAOPGCPREC 9-98 (1998). DC 5260 provides for a 10 percent rating when flexion of the leg is limited to 45 degrees. A 20 percent rating is for when flexion of the leg is limited to 30 degrees. A maximum 30 percent rating is for when flexion of the leg is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. DC 5261 provides a 10 percent rating when extension of the leg is limited to 10 degrees. A 20 percent rating is warranted when extension is limited to 15 degrees. A 30 percent rating is warranted when extension is limited to 20 degrees. A 40 percent rating is warranted when extension is limited to 30 degrees. 38 C.F.R. § 4.71a, DC 5261. Full range of motion of the knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. The Board initially finds that in light of the Veteran’s right knee extension limited to 20 degrees on the 2019 VA examination, a 30 percent rating is warranted effective from April 16, 2019, for the service-connected right knee disability. In that regard, on the VA examination on April 16, 2019, the Veteran reported his knee pain had progressively worsened, he had multiple joint injections, and his pain was exacerbated by weather changes. He also reported knee stiffness, swelling, and giving out. He denied flare-ups, but reported functional impairment described as being unable to do prolonged walking, sitting, or standing. Right knee flexion was to 75 degrees and extension to 20 degrees, with pain on motion. The examiner indicated that the pain caused function loss, and there was dull pain on palpation of the right knee and with movement. There was no right knee pain on passive range of motion testing, or when the joint was used in a non-weight bearing position. The Veteran was able to perform repetitive use testing, with no additional loss of function or motion. His right knee exhibited slightly reduced strength on motion. No atrophy was noted. He did not have a history of recurrent subluxation or lateral instability of the right knee, but there was a history of recurrent effusion. Right knee swelling was noted on examination, and the Veteran reported recurrent swelling. Joint stability testing of the right knee was normal, and it was noted that he did not have recurrent patellar dislocation. He regularly used a knee brace and a cane. The examiner stated that the Veteran’s right knee condition impacted his ability to perform any type of occupational task, but also noted he was retired. The examiner noted no basis to offer an opinion regarding additional loss of function or motion with repetitive use or during a flare up. Accordingly, in view of the finding of right knee extension limited to 20 degrees on the VA examination in April 2019, a 30 percent rating is warranted effective from April 16, 2019, for the service-connected right knee disability. The Board has considered the Veteran’s complaints of pain and limits on walking, sitting, or standing, however, the objective evidence does not support a finding that his right knee pain and limitation of motion, have been associated with such additional functional limitation as to warrant increased compensation pursuant to provisions of 38 C.F.R. §§ 4.40, 4.45, or the holding in DeLuca v. Brown, 8 Vet. App. 202 (1995). Rather, the Board finds that his complaints of pain and functional limitations are contemplated in the 30 percent rating currently being assigned. The Board has also considered whether a rating in excess of 30 percent may be warranted for the Veteran’s right knee disability under another applicable diagnostic code, but finds that right knee extension limited to 30 degrees or more (DC 5261), ankylosis (DC 5256), or impairment of the tibia and fibula (DC 5262), has not been shown, from April 16, 2019. 38 C.F.R. § 4.71. With regard to the evidence of record prior to April 16, 2019, the Board finds that the preponderance of the evidence does not support the grant of a rating in excess of 10 percent for the service-connected right knee disability. In that regard, on the VA examination in November 2010, the Veteran reported he had knee stiffness and loss of range of motion. On the physical examination the range of right knee motion was mostly within normal limits. He also reported aching right knee pain, but no swelling, instability, or locking. He reported no true flare-ups, no inflammatory joint disease, no incapacitating events, and no brace. His daily activities were affected and he limited his walking. Examination of the right knee revealed no tenderness or swelling, and he was able to flex to 130 degrees and fully extend. Repeat flexion and extension of the knee, both actively and passively, produced pain and weakness, but no fatigue or alteration of range of motion. Lateral and medial stress on the right knee showed no laxity of the collateral ligaments, a negative anterior and posterior drawer sign which indicated intact anterior and posterior cruciate ligaments, and a negative McMurray’s sign. It was noted that he ambulated without appearance of discomfort. In a letter dated in March 2012, a private physician, Dr. C. indicated seeing the Veteran for right knee pain, and slight crepitus was noted. He slightly favored his right leg, but was able to walk on his toes and heels, as well as tandem walk. VA treatment records show that in January 2014, the Veteran was seen for follow up for right knee pain. Examination of the right knee revealed tenderness to palpation, no effusion, no laxity, and full range of motion. In April 2014, the Veteran reported that his right knee occasionally had the sensation of giving away. In September 2014, the Veteran reported that the steroid injection did not provide pain relief, and reported that his anterior deep knee pain was aggravated with prolonged sitting. Examination of the right knee showed no effusion, redness, and range of motion was intact. In June 2015, he reported having a knee injection three months prior, which was still helping considerably. In August 2015, he was seen for follow up and it was noted that he had no pain with knee range of motion. In November 2017, the Veteran was seen for right knee pain, and reported he recently had a CSI (corticosteroid injection) that was still giving him relief and wore a knee brace with pain relief. Examination of the right knee revealed no erythema or effusion, tenderness, flexion to 90 degrees with pain, and full extension. While a review of the record prior to April 16, 2019 shows that the Veteran complained of right knee pain and stiffness, with tenderness and periodic swelling noted, the limitation of motion findings recorded do not meet the requirements for the next higher rating under DC 5260 or DC 5261, as extension was primarily assessed as normal and flexion, while decreased, was assessed as normal to no worse than limited to 90 degrees. Moreover, the Veteran’s right knee pain and additional functional limitations were considered in the assignment of the current 10 percent rating, in the absence of compensable limitation of motion. See 38 C.F.R. § 4.59. As such, the objective evidence does not support a finding that the Veteran’s right knee pain and limitation of motion with pain was associated with such additional functional limitation as to warrant increased compensation pursuant to provisions of 38 C.F.R. §§ 4.40, 4.45, or the holding in DeLuca. Also, prior to April 16, 2019, a rating in excess of 20 percent is not warranted for instability or subluxation of the right knee under DC 5257, because the record shows that although on one occasion the Veteran reported his right knee occasionally had the sensation of giving away, he also denied instability, and objective examinations showed no laxity or instability of the right knee joint. The Board has also considered whether additional separate ratings are warranted for the Veteran’s service-connected right knee disability, both prior to and effective from April 16, 2019. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. Lyles v. Shulkin, 29 Vet. App. 107 (2017). In this case, the Board finds that DC 5258 (dislocation of semilunar cartilage), DC 5259 (removal of semilunar cartilage), DC 5262 (impairment of the tibia and fibula) and DC 5263(genu recurvatum) are not applicable because the record does not show the Veteran has any of those conditions. Also, a separate rating for instability or subluxation is not warranted pursuant to DC 5257. Although the Veteran regularly wore a knee brace for pain, and on at least two occasions reported his right knee was giving out, the objective stability testing on VA examinations and VA treatment records revealed normal findings. Additionally, neither limitation of flexion or extension is shown to be of such a degree that a separate compensable rating should be assigned under DC 5260 or DC 5261. 3. Entitlement to a rating in excess of 10 percent prior to April 16, 2019, and a rating in excess of 20 percent effective from April 16, 2019, for a cervical spine disability. The Veteran contends he should be entitled to higher ratings prior to and effective from April 16, 2019, for his service-connected cervical spine disability, which has been evaluated pursuant to DCs 5237, 5242, under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a. After reviewing the record, the Board finds that the preponderance of the evidence is against a finding that the Veteran warrants a rating in excess of 10 percent prior to April 16, 2019, for his service-connected cervical spine disability. From that date, however, the Board finds that a 30 percent rating is warranted. Under the General Rating Formula, a 10 percent rating is assigned for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or combined range of motion of the cervical spine greater than 170 degrees but not greater than 333 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is for forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. A 40 percent is for unfavorable ankylosis of the entire cervical spine. Id. For VA compensation purposes, normal forward flexion of the cervical spine is 0 to 45 degrees, extension is 0 to 45 degrees, left and right lateral flexion are 0 to 45 degrees and left and right lateral rotation are 0 to 80 degrees. The normal combined range of motion of the cervical spine is 340 degrees. 38 C.F.R. § 4.71a. Review of the record prior to April 16, 2019, shows that on a VA examination in November 2010, the Veteran reported aching neck pain, but had no flare-ups, no inflammatory joint disease, no incapacitating events, and no indication of radiculopathy or bowel or bladder dysfunction. He reported no effect on daily activities. Examination revealed no tenderness or muscle spasm of the cervical spine. Range of cervical motion testing revealed flexion and extension to 45 degrees, right and left lateral flexion to 45 degrees, and right and left lateral rotation to 80 degrees. Repetitive motion of the neck in all ranges of motion, both actively and passively, revealed pain at the endpoint, but no weakness or fatigue and no alteration in range of motion. There was no indication of upper extremity radiculopathy, sensory deprivation, muscle wasting, loss of strength, or atrophy. In a letter dated in March 2012, a private physician, Dr. C., indicated the Veteran reported intermittent neck pain for the past five years, and that his right arm tired easily for the past five years. He reported than an MRI of the cervical spine four years ago showed a pinched nerve in his neck. Examination revealed moderate limitation of neck movement, with marked limitation of lateral bending of the neck to either side. Dr. C. noted the Veteran complained of neck pain, radiating down the left arm, most likely due to cervical spondylosis with radiculopathy. VA treatment records show that in September 2013, the Veteran was seen for cervical pain, and it was noted that he had decreased range of motion in the neck in all areas. It was noted that he had a past medical history of cervical radiculopathy to the right arm. On examination, he reported a history of neck pain, with arm weakness on the right, but no numbness or tingling. Based upon review of the evidence, the Board finds that the preponderance of the evidence is against a finding that a rating in excess of 10 percent is warranted for the service-connected cervical spine disability at any time prior to April 16, 2019. In particular, objective findings on the VA examination in 2010 as well as treatment records do not meet or approximate forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, combined range of motion of the cervical spine not greater than 170 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. The Board has also considered the Veteran’s complaints of cervical/neck pain, as well as potential additional limitation of functioning resulting therefrom; however, on the VA examination in 2010, it was noted he had full range of motion of the neck, with pain at the endpoints, and was able to perform repetitive motion testing, after which no weakness, fatigue, or alteration in range of motion was shown. There was also no indication of muscle wasting, loss of strength, or atrophy. Although later treatment records showed he had limitations in cervical motion, there was insufficient objective evidence to conclude that the Veteran’s cervical pain and related symptoms were associated with such additional functional limitations as to warrant a rating in excess of 10 percent prior to April 16, 2019. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, supra. In that regard, the Board notes that the degree of impairment due to his service-connected cervical spine disability is adequately reflected by the 10 percent rating, which was assigned under 38 C.F.R. § 4.59. Additionally, prior to April 16, 2019, although the Veteran reported right arm weakness, and there was a notation of a past history of cervical radiculopathy, and a private physician found that the Veteran’s complaint of neck pain radiating down to the left arm was most likely due to cervical spondylosis with radiculopathy, there was no objective evidence or finding of related neurological manifestations of his cervical spine disability. With respect to whether a rating in excess of 20 percent is warranted, effective from April 16, 2019, the Board finds that the competent evidence supports such a finding. In that regard, on a VA examination in April 2019, the Veteran reported his cervical injury in service had progressed, with increased pain stiffness, numbness, and tingling to the right arm with a weak grip. He denied flare-ups, but reported functional impairment of the cervical spine, described as having difficulty doing overhead work and being unable to sit for prolonged periods. Range of motion testing revealed forward flexion to 20 degrees, extension to 30 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 20 degrees, with pain on range of motion causing functional loss. Examination revealed sharp pain radiating to the right arm with movement and palpation of the cervical spine, and right upper extremity radiculopathy was noted. He was able to perform repetitive use testing, with additional loss of motion after three repetitions, including forward flexion to 10 degrees, extension to 20 degrees, and right and left lateral flexion and rotation to 10 degrees. It was also noted that he had guarding of the cervical spine resulting in abnormal gait or abnormal spinal contour. In light of the foregoing, the Board finds that although the Veteran’s cervical flexion was limited to 20 degrees on range of motion testing, it was also noted that after repetitive-use testing, his cervical flexion was further limited to 15 degrees. Accordingly, resolving reasonable doubt in the Veteran’s favor, the Board finds that based on the additional limitation of motion after three repetitions of motion, the criteria for a 30 percent rating have been met, for his cervical spine disability, effective from April 16, 2019. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, supra. Regarding whether an even higher rating is warranted, however, the Board notes that there have been no findings of ankylosis, or that the extent of his disability more nearly approximated unfavorable ankylosis, even when considering his complaints of pain and limitations on activities. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, supra. Additionally, the Board notes that other than separately service-connected radiculopathy of the right upper extremity, there has been no objective evidence of any other related neurological abnormalities. 4. Entitlement to a compensable rating for bilateral hearing loss. The Veteran contends he should be entitled to a compensable rating for his bilateral hearing loss. Disability ratings for service-connected hearing impairments are determined through a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are made. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Regulations set forth eleven auditory acuity levels, designated from Roman numerals I to XI, in escalating order of hearing impairment. 38 C.F.R. § 4.85. The appropriate auditory level is identified as the point where the percentage of speech discrimination and pure tone threshold average intersect. Id. The most probative evidence of record consists of VA audiological tests conducted in 2015 and 2019. The March 2015 audiological test revealed pure tone thresholds in decibels (dB), at 1000, 2000, 3000, and 4000 Hertz (Hz) were as follows, for the right ear: 35, 50, 70, and 80, for an average of 59, and for the left ear: 30, 50, 60, and 70, for an average of 53. The speech recognition scores, using the Maryland CNC Test, were 84 percent in the right ear and 88 percent in the left ear. The April 2019 audiological test revealed pure tone thresholds, in dBs, at 1000, 2000, 3000, and 4000 Hz were as follows, for the right ear: 20, 35, 50, and 65, for an average of 43, and for the left ear: 25, 35, 50, and 65, for an average of 44. The speech recognition scores were 88 percent in the right ear and 80 percent in the left. When pure tone threshold averages and speech recognition scores from the VA examination in 2015 are applied to Table VI, the numeric designation of hearing impairment for the right ear is level III, and left ear is Level II. When these designations are applied to Table VII (Percentage Evaluation for Hearing Impairment-Diagnostic Code 6100), the Veteran’s hearing loss disability is rated 0 percent disabling. 38 C.F.R. § 4.85, DC 6100. When pure tone threshold averages and speech recognition scores from the VA examination in 2019 are applied to Table VI, the numeric designations of hearing impairment for the right ear is level II and the left ear is Level lII. When these designations are applied to Table VII, his hearing loss disability is rated 0 percent disabling. 38 C.F.R. § 4.85, DC 6100. The Board also notes that 38 C.F.R. § 4.86, which addresses exceptional patterns of hearing loss, is not applicable herein. Additionally, consideration has been given to the Veteran’s competent statements regarding hearing loss, however, evaluation of hearing loss is reached by a mechanical application of the rating schedule, after audiometric evaluations are rendered. Lendenmann v. Principi, supra. Finally, the Board notes that in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability. See Martinak v. Nicholson, 21 Vet. App. 447 (2007). In that regard, in March 2015 and April 2019, the VA examiners concluded that the Veteran’s hearing loss impacted his ordinary conditions of daily life, including ability to work. In March 2015, it was noted that the Veteran reported it was difficult to understand speech when there was competing noise, if he did not see a speaker’s face, if he was not close to the speaking source, or if the lighting was not good. In April 2019, the Veteran reported he needed people to repeat themselves, and he had to increase his volume to a much too high level to watch television and/or talk on the phone, and he struggled to understand speech and receive pertinent conversational information when in noise-rich environments. It was also noted that miscommunication with family, friends, and co-workers led to aggravation. Accordingly, the VA examiners have appropriately considered the functional impact of the Veteran’s hearing loss, but the overall evidence fails to support assignment of a compensable rating. Notably, the Veteran’s complaints of difficulty hearing amount to hearing loss, which is contemplated by the schedular criteria. REASONS FOR REMAND 1. Entitlement to a TDIU rating. As noted above, the issue of entitlement to a TDIU rating has been raised and is part of the Veteran’s appeal. As this issue has not been addressed by the Agency of Original Jurisdiction (AOJ), a remand is necessary for the Veteran to be provided appropriate notice of what is required to substantiate a claim for TDIU, and asked to submit an Application for Increased Compensation Based on Unemployability. (Continued on Next Page) The matters are REMANDED for the following action: Complete any appropriate notice and assistance for the claim for a TDIU rating. Request that the Veteran complete and submit VA Form 21-8940, Application for Increased Compensation Based on Unemployability. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Casula The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.