Citation Nr: 20072811 Decision Date: 11/12/20 Archive Date: 11/12/20 DOCKET NO. 14-43 774 DATE: November 12, 2020 ORDER Entitlement to an increased, 10 percent disability evaluation for hemorrhoids, for the rating period prior to November 3, 2019, is granted. Entitlement to an increased disability evaluation for hemorrhoids, rated as 10 percent disabling for the rating period since November 3, 2019, is denied. Entitlement to an increased, 30 percent disability evaluation for residuals of frostbite of the right foot, for the rating period prior to November 3, 2019, is granted. Entitlement to an increased disability evaluation for residuals of frostbite of the right foot, rated as 30 percent disabling for the rating period since November 3, 2019, is denied. Entitlement to an increased, 30 percent disability evaluation for residuals of frostbite of the left foot for the rating period prior to November 3, 2019, is granted. Entitlement to an increased disability evaluation for residuals of frostbite of the left foot, rated as 30 percent disabling for the rating period since November 3, 2019, is granted. Entitlement to an increased disability evaluation for bilateral hearing loss, rated as noncompensable for the rating period prior to November 21, 2019, is denied. Entitlement to an increased disability evaluation for bilateral hearing loss, rated as 80 percent disabling for the rating period from November 21, 2019, is denied. FINDINGS OF FACT 1. Throughout the entire rating period on appeal, the Veteran’s hemorrhoids are manifested by mild to moderate, frequently recurring, internal and external hemorrhoids, without persistent bleeding, secondary anemia or fissures. 2. Throughout the entire rating period on appeal, the Veteran’s residuals of frostbite of the right foot are manifested by cold sensitivity, pain, color changes, and locally impaired sensation; the Veteran has osteoarthritis of the right foot. 3. Throughout the entire rating period on appeal, the Veteran’s residuals of frostbite of the left foot are manifested by cold sensitivity, pain, color changes, and locally impaired sensation; the Veteran has osteoarthritis of the left foot. 4. For the rating period prior to November 21, 2019, the Veteran’s bilateral hearing loss disability was manifested by no more than Level II hearing in his right ear and Level I hearing in his left ear. 5. For the rating period since November 21, 2019, the Veteran’s bilateral hearing loss disability is manifested by no more than Level IX hearing in his right ear and Level XI hearing in his left ear. CONCLUSIONS OF LAW 1. The criteria for a 10 percent disability rating, but no higher, for hemorrhoids have been met for the rating period prior to November 3, 2019. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.114, Diagnostic Code 7336 (2019). 2. The criteria for a disability rating in excess of 10 percent disability rating for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.114, Diagnostic Code 7336 (2019). 3. The criteria for a disability rating of 30 percent, but no higher, for residuals of frostbite of the right foot have been met for the rating period prior to November 3, 2019. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.7, 4.104, Diagnostic Code 7122 (2019). 4. The criteria for a disability rating in excess of 30 percent for residuals of frostbite of the right foot are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.104, Diagnostic Code 7122 (2019). 5. The criteria for a disability rating of 30 percent, but no higher, for residuals of frostbite of the left foot have been met for the rating period prior to November 3, 2019. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.7, 4.104, Diagnostic Code 7122 (2019). 6. The criteria for a disability rating in excess of 30 percent for residuals of frostbite of the left foot are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.104, Diagnostic Code 7122 (2019). 7. The criteria for a compensable disability rating for bilateral hearing loss disability are not met for the rating period prior to November 21, 2019. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.85-4.87, Diagnostic Code 6100 (2019). 8. The criteria for a disability rating in excess of 80 percent for bilateral hearing loss disability for the rating period since November 21, 2019 are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.85-4.87, Diagnostic Code 6100 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the U.S. Army from January 1971 to January 1973 and from May 1975 to May 1979. These matters come before the Board of Veterans’ Appeals (Board) on an appeal of April 2014 and March 2015 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. The April 2014 rating decision denied the Veteran’s claim of entitlement to a compensable disability rating for hemorrhoids. The March 2015 rating decision granted the Veteran an increased, 20 percent disability rating per foot, for his residuals of frostbite of the right and left feet, effective June 18, 2014, as well as denied the Veteran’s claim of entitlement to an increased, compensable disability rating for bilateral hearing loss. The Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge (VLJ) of the Board in September 2016. A transcript of that proceeding has been associated with the record. During the pendency of the appeal, in an April 2020 rating decision, the Veteran was awarded a 10 percent evaluation for his hemorrhoids, a 30 percent disability evaluation for his residuals of frostbite of the right foot, a 30 percent disability evaluation for residuals of frostbite of the left foot, and a 30 percent disability evaluation for his bilateral hearing loss; an effective date of November 3, 2019 was assigned for the grants of increased disability ratings for his residuals of frostbite and hemorrhoids, and an effective date of November 21, 2019 was assigned for the grant of an increased disability rating for his bilateral hearing loss. As the Veteran has not been granted the maximum benefits allowed, the claims for increased disability ratings remain on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In June 2018, the Board remanded the case to the Agency of Original Jurisdiction (AOJ). A supplemental statement of the case was most recently issued in April 2020. The case has since been returned to the Board for appellate review.   Duties to Notify and Assist 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). Increased Rating Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an increased disability evaluation for hemorrhoids, rated as noncompensable for the rating period prior to November 3, 2019. 2. Entitlement to an increased disability evaluation for hemorrhoids, rated as 10 percent disabling for the rating period since November 3, 2019. The Veteran's hemorrhoids are currently rated as noncompensable (0 percent) for the rating period prior to November 3, 2019 and 10 percent disabling thereafter pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7336. Under Diagnostic Code 7336, a noncompensable rating is warranted for mild or moderate external or internal hemorrhoids. For a higher, 10 percent rating, there must be evidence of large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent disability rating is warranted where there is evidence of hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. See 38 C.F.R. § 4.114, Diagnostic Code 7336. Upon reviewing the rating criteria in relation to the lay and medical evidence for consideration, the Board finds that a rating of 10 percent is warranted for the Veteran’s hemorrhoids for the entire rating period on appeal. The Veteran consistently reports recurrent internal and external hemorrhoids. At the December 2014 VA examination, the Veteran was found to have mild to moderate external hemorrhoids; a recent colonoscopy also showed non-bleeding internal hemorrhoids. The Veteran reported continuous discomfort and difficulty with bowel movements; the Veteran reported monthly flare-ups with pain affecting his ability to sit, but denied experiencing bleeding. At the November 2019 VA examination, the Veteran was found to have moderate internal and external hemorrhoids, with flare-ups; large or thrombotic, irreducible hemorrhoids, with excessive redundant tissue, evidencing frequent recurrences were also noted. The Veteran also reported experiencing rectal leakage due to a fistula, but a rectal examination was not completed. Moreover, neither examination showed evidence of persistent bleeding with secondary anemia or fissures. For these reasons, the Board finds that the evidence supports a finding of a 10 percent evaluation, but no higher, for hemorrhoids for the entire rating period on appeal. 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an increased disability evaluation for residuals of frostbite of the right foot, rated as 20 percent disabling for the rating period prior to November 3, 2019. 4. Entitlement to an increased disability evaluation for residuals of frostbite of the right foot, rated as 30 percent disabling for the rating period since November 3, 2019. 5. Entitlement to an increased disability evaluation for residuals of frostbite of the left foot, rated as 20 percent disabling for the rating period prior to November 3, 2019. 6. Entitlement to an increased disability evaluation for residuals of frostbite of the left foot, rated as 30 percent disabling for the rating period since November 3, 2019. The Veteran’s residuals of frostbite of the right foot and residuals of frostbite of the left foot are assigned a 20 percent disability rating, per foot, for the rating period prior to November 3, 2019 and a 30 percent disability rating per foot thereafter. The Veteran is rated for his residuals of frostbite of the right and left feet pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7122. See 38 C.F.R. § 4.20. Diagnostic Code 7122 governs the ratings for cold injury residuals. 38 C.F.R. § 4.104 (diseases of the cardiovascular system). Under Diagnostic Code 7122, cold injury residuals are assigned a 10 percent rating for arthralgia or other pain, numbness, or cold sensitivity. A 20 percent rating is assigned for arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis). A maximum rating of 30 percent rating is assigned for arthralgia or other pain, numbness, or cold sensitivity plus two or more of the following: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis). Note (1) to Diagnostic Code 7122 provides that amputations of fingers or toes are to be rated separately, and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy are to be rated under other diagnostic codes. Other disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud’s phenomenon, muscle atrophy, etc., are to be rated separately, unless they are used to support a rating under Diagnostic Code 7122. Note (2) to Diagnostic Code 7122 provides that each affected part (e.g. hand, foot, ear, nose) is to be separately rated and combined in accordance with 38 C.F.R. §§ 4.25, 4.26. After a review of all the evidence, the Board finds that the Veteran’s service- connected residuals of frostbite of the right and left feet more nearly approximates the criteria for a 30 percent disability evaluation for each foot for the entire rating period on appeal. The December 2014 and November 2019 VA examination reports reflect that the Veteran experiences pain, numbness, cold sensitivity, and locally impaired sensation. The Veteran also reports a history of color changes, although color changes were not found upon examination. Additionally, the Veteran was diagnosed with osteoarthritis of each foot upon x-ray at the December 2014 VA examination. The Board finds that, as the Veteran experiences pain, numbness, locally impaired sensation, and cold sensitivity, the Board finds he meets the criteria for a 30 percent evaluation for each of his feet. The Veteran is now in receipt of the highest schedular evaluation possible for the Veteran’s right and left feet, absent any separately ratable complications. The Board observes that Note (1) of Diagnostic Code 7122 states that the Veteran should be separately evaluated for peripheral neuropathy or amputations due to complications of a cold injury under other, more appropriate Diagnostic Codes. However, the record does not reflect that the Veteran’s residuals of frostbite of the right and left feet includes amputation of any fingers or toes, complications of squamous cell carcinoma, peripheral neuropathy, Raynaud’s phenomenon, or muscle atrophy; December 2014 and November 2019 VA examination reports are negative for these conditions. Likewise, the Board notes that December 2014 and November 2019 VA examination reports do not reflect that there is any evidence of arterial or venous conditions of the lower extremities; the December 2014 VA examination report indicated that the Veteran had normal deep tendon reflexes and pedal pulses, with normal color of the feet. Additionally, there is no evidence that the Veteran has peripheral neuropathy secondary to his service-connected residuals of frostbite of the right and left feet, and thus, it is not for consideration here. Accordingly, the Board finds the Veteran has not experienced any complications necessitating a separate evaluation. Thus, applying the facts to the criteria set forth above, the Veteran is entitled to a rating of 30 percent, but no higher, per foot, for his service-connected residuals of frostbite of the right and left feet for the entire rating period on appeal. 7. Entitlement to an increased disability evaluation for bilateral hearing loss, rated as noncompensable for the rating period prior to November 21, 2019. 8. Entitlement to an increased disability evaluation for bilateral hearing loss, rated as 30 percent disabling for the rating period from November 21, 2019. In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Diagnostic Code 6100, which is used to evaluate the Veteran’s bilateral hearing loss disability, provides a table for rating purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, established by a state licensed audiologist including a controlled speech discrimination and the pure tone threshold average, which is the sum of the pure tone thresholds at 1000, 2000, 3000, and 4000 Hertz, divided by four. See 38 C.F.R. § 4.85. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal row represents the ear having the poorer hearing and the vertical column represents the ear having the better hearing. Id. Under 38 C.F.R. § 4.86(a), it states that when the pure tone 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 IV or Table VIa, whichever results in the higher numeral. Each ear is to be evaluated separately. Id. The provisions of 38 C.F.R. § 4.86(b) provide that when the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be evaluated to the next higher Roman numeral. Id. Prior to November 21, 2019 At the VA audiological examination in December 2014, the pure tone thresholds, in decibels, for the right and left ears were as follows: 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right Ear: 40 40 50 80 Left Ear: 25 40 75 70 The pure tone average was 52.5 on the right and 52.5 on the left. Maryland CNC speech recognition scores were 84 percent in the right ear and 92 percent in the left ear. As required by Martinak v. Nicholson, 21 Vet. App. 447 (2007), the December 2014 examiner elicited information from the Veteran about the functional effects of his hearing loss disability. The Veteran told the examiner that he cannot hear people in a noisy environment, so he tends to avoid socializing, and that he turns the television up very loud; he also stated that he has problems hearing while on the telephone. Based upon the results of the VA audiological examinations, the Veteran is not entitled to a compensable disability rating for the entire rating period on appeal. The Veteran is assigned a Level II for the right ear and Level I for the left ear in accordance with Table VI of 38 C.F.R. § 4.85, based on the audiological findings in the December 2014 VA examination. The intersection point for a Level II (right) and Level I (left) under Table VII of 38 C.F.R. § 4.85 shows that the hearing loss does not exceed the levels contemplated for the currently assigned noncompensable (0 percent) disability rating. Thus, the audiometric evidence of record does not support a finding of entitlement to a compensable disability evaluation for the entire rating period on appeal. Additionally, the Board points out that the provisions of 38 C.F.R. § 4.86(a) (Exceptional patterns of hearing impairment) are inapplicable, as the Veteran did not have pure tone thresholds of 55 or more in the specified frequencies (1000, 2000, 3000, and 4000 Hertz) at the December 2014 VA examination. The Board also notes that the provisions of 38 C.F.R. § 4.86(b) are not applicable as both ears are not shown to manifest 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hz. Consequently, a compensable disability evaluation is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). For the rating period since November 21, 2019 At the VA audiological examination in November 2019, the pure tone thresholds, in decibels, for the right and left ears were as follows: 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right Ear: 80 85 75 85 Left Ear: 40 70 70 75 The pure tone average was 81.25 on the right and 63.75 on the left. Maryland CNC speech recognition scores were 36 percent in the right ear and 32 percent in the left ear. As required by Martinak v. Nicholson, 21 Vet. App. 447 (2007), the VA examiner elicited information from the Veteran about the functional effects of his hearing loss disability. The Veteran told the examiner that he experienced difficulty hearing in noisy environments which makes him feel socially isolated. Based upon the results of the VA audiological examination, the Board finds that the Veteran is entitled to the currently assigned 80 percent disability rating for the entire rating period on appeal. The Board notes that, in accordance with Table VI of 38 C.F.R. § 4.85, based on the audiological findings in November 2019, the Veteran is assigned Level IX for the right ear and Level XI for the left ear. The intersection point for a Level IX (right) and Level XI (left) under Table VII of 38 C.F.R. § 4.85 shows that the hearing loss does not exceed the levels contemplated for the currently assigned 80 percent disability rating. The provisions of 38 C.F.R. § 4.86(a) (Exceptional patterns of hearing impairment) do not assist the Veteran. Although the Veteran has pure tone thresholds of loss of 55 decibels or greater in the four relevant frequencies in each ear, in accordance with Table VIa, the Veteran would be assigned Level VII in the right ear and Level V in the left ear, which would result in a 30 percent disability evaluation according to Table VII. The provisions of 38 C.F.R. § 4.86(b) are also not applicable as both ears are not shown to manifest 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hz. Under these circumstances, a disability evaluation in excess of 80 percent is not warranted for the rating period since November 21, 2019. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 54-55. Additional considerations In addition, the Board has considered whether an extraschedular rating is warranted for the Veteran’s bilateral hearing loss during either of the rating periods on appeal. Ratings shall be based as far as practicable upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular ratings are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve, on the basis of the criteria set forth in this paragraph, an extraschedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). The United States Court of Appeals for Veterans Claims (Court) has clarified that there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. Thun v. Peake, 22 Vet. App. 111, 115 (2008). Initially, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. See Yancy v. McDonald, 27 Vet. App. 484 (2016); Doucette v. Shulkin, 28 Vet. App. 366 (2017); Sowers v. McDonald, 27 Vet. App. 472, 478 (2016) (“[t]he rating schedule must be deemed inadequate before extraschedular consideration is warranted”). Second, if the schedular rating does not contemplate the veteran’s level of disability and symptomatology and is found inadequate, the Board must determine whether the veteran’s disability picture exhibits other related factors such as marked interference with employment and frequent periods of hospitalization. Thun, 22 Vet. App. at 116. Third, if the first two Thun elements have been satisfied, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran’s disability picture requires the assignment of an extraschedular rating. Thun, 22 Vet. App. at 116. In other words, the first element of Thun compares a veteran’s symptoms to the rating criteria, while the second element considers the resulting effects of those symptoms; if either prong is not met, then referral for extraschedular consideration is not appropriate. Yancy, 27 Vet. App. at 494-95. With respect to the first prong of Thun, the evidence in the instant appeal does not establish such an exceptional disability picture as to render the schedular criteria inadequate. The schedular rating criteria for rating hearing loss provide for disability ratings based on audiometric evaluations, to include speech discrimination and pure tone testing. Here, the Veteran’s hearing loss symptoms and described hearing impairments are contemplated by the schedular rating criteria. The Veteran has reported symptoms of difficulty hearing speech and consequent problems with understanding conversation. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss in various contexts, as measured by both audiometric testing and speech recognition testing. The ability of the Veteran to hear sounds and voices is measured and rated by an audiometric test, as this test measures different frequencies and captures high frequency hearing loss from sources including voices, music, sirens, and certain high-pitched sounds. The ability of the Veteran to understand people, as well as the need to ask others to repeat themselves on a regular basis, is rated by a speech recognition test, as this test measures conversation comprehension, words, and missed conversations. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss, including exceptional hearing patterns which were not demonstrated in this case, and as measured by both audiometric testing and speech recognition testing. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding “that the rating criteria for hearing loss contemplate the functional effects of difficulty hearing and understanding speech”). The Board notes that it logically follows that difficulty hearing and understanding speech would impact a veteran in a variety of ways, including potential embarrassment and frustration, but the rating schedule is not written to account for every possible consequence associated with each symptom. Significantly, the Court in Doucette reviewed a similar factual situation, inasmuch as the Board had considered that claimant’s report of being embarrassed from having to ask others to repeat themselves, among other reported difficulties, in finding that the resultant effect of the reported symptoms was difficulty hearing. The Court determined that the claimant had not alleged any symptoms in that case that could be considered exceptional or unusual for a claimant suffering from hearing loss. See Id., 28 Vet. App. at 372-73. The decibel loss and speech discrimination ranges designated for each level of hearing impairment in Tables VI and VIa were chosen in relation to clinical findings of the impairment experienced by veterans with certain degrees and types of hearing disability. The regulatory history of 38 C.F.R. §§ 4.85 and 4.86 includes revisions, effective June 10, 1999. See 64 Fed. Reg. 25,202 (May 11, 1999). In forming these revisions, VA sought the assistance of the Veteran’s Health Administration (VHA) in developing criteria that contemplated situations in which a veteran’s hearing loss was of such a type that speech discrimination tests may not reflect the severity of communicative functioning these veterans experienced or that was otherwise an extreme handicap in the presence of any environmental noise, even with the use of hearing aids. VHA had found through clinical studies of veterans with hearing loss that, when certain patterns of impairment are present, a speech discrimination test conducted in a quiet room with amplification of the sounds does not always reflect the extent of impairment experienced in the ordinary environment. The decibel threshold requirements for application of Table VIa were based on the findings and recommendations of VHA. The intended effect of the revision was to fairly and accurately assess the hearing disabilities of veterans as reflected in a real-life industrial setting. 59 Fed. Reg. 17,295 (Apr. 12, 1994). The inherent purpose of the schedular rating criteria is to determine, as far as practicable, the severity of functional impact resulting from a service-connected disability, including any resultant occupational and social impairment, and therefore contemplates the Veteran’s difficulties functioning in a social environment due to hearing loss. Accordingly, the Board finds that the Veteran’s reported hearing-related difficulties are factors contemplated in the regulations and schedular rating criteria. See also Doucette, 28 Vet. App. 366. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Hallie E. Brokowsky, Counsel 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.