Citation Nr: 21002663 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 16-38 985 DATE: January 14, 2021 ORDER Entitlement to an increased rating of 50 percent for tension headaches is granted. Entitlement to an increased rating in excess of 30 percent for right eye blindness due to glaucoma is denied. Entitlement to service connection for bilateral plantar fasciitis is denied. Entitlement to service connection for a left eye disability is denied. Entitlement to an increased rating in excess of 10 percent for tinnitus is denied. Entitlement to a compensable rating for erectile dysfunction is denied. Entitlement to a total disability based on individual unemployability (TDIU) is denied. REMANDED Entitlement to a compensable rating for bilateral hearing loss, to include whether the July 2014 reduction from 10 percent to 0 percent was proper is remanded. FINDINGS OF FACT 1. The Veteran’s tension headaches manifest in very frequent prostrating and prolonged attacks productive of severe economic inadaptability. 2. The Veteran’s 30 percent rating for right eye blindness is the maximum schedular rating without anatomical loss of the eye or more reduced visual acuity of the other eye. 3. The preponderance of the evidence is against finding that bilateral plantar fasciitis began during active service or is otherwise related to an in-service injury or disease. 4. The Veteran’s left eye disability is not secondary to service-connected right eye blindness and is not otherwise related to an in-service injury or disease. 5. The Veteran is currently assigned the maximum schedular rating for his tinnitus. 6. The Veteran’s service-connected erectile dysfunction is productive of loss of erectile power, but not deformity of the penis. 7. The evidence of record does not establish that the Veteran’s service-connected disabilities rendered him unable to secure and follow a substantially gainful occupation during the applicable appeal period. CONCLUSIONS OF LAW 1. The criteria for an increased rating of 50 percent for tension headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.124a, Diagnostic Code 8100. 2. The criteria for a rating in excess of 30 percent for right eye blindness have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.25, 4.75, 4.76, 4.77, 4.78, 4.79, Diagnostic Code 6064. 3. The criteria for service connection for bilateral plantar fasciitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a left eye disability due to service or right eye blindness are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 5. The criteria establishing an evaluation in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.87, Diagnostic Code 6260. 6. The criteria for a compensable evaluation for erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.31, Diagnostic Code 7522. 7. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1974 to December 1978. These matters are on appeal to the Board of Veterans’ Appeals (Board) from an August 2014 rating decision. The claims were remanded for further development in October 2018; the Board finds the remand directives have been substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). Of note, in the Veteran’s September 2014 Notice of Disagreement, he indicated he desired to appeal service connection, effective date of award, and the evaluation of disability for each issue. As the Veteran was denied either service connection or increased rating for his claims in the August 2014 rating decision, there is no earlier effective date at issue. In reaching a decision on all issues, the Board has considered the applicability of the benefit of the doubt doctrine. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service Connection In order to prove service connection, there must be competent and credible evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the current disability and the in-service disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).  Service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); Ward v. Wilkie, 17-1204 (holding that a “permanent worsening” of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation).  1. Entitlement to service connection for bilateral plantar fasciitis The Veteran claims his diagnosed bilateral plantar fasciitis is related to service. Pes planus was noted on the Veteran’s entrance examination. In April 1976, he sought treatment for a sore heel for the prior 8 months; the assessment was a plantar wart. In November 1976, the Veteran fell down the stairs and fractured his left foot. May and October 1977 records reflect a recurrent plantar lesion, plantar wart, and corns on both feet. In his separation examination, foot trouble was noted to be “treated and resolved.” The Veteran was diagnosed with plantar fasciitis and deformity of the foot in September 2010. In his podiatry records, he reports pain in feet for several years. Subsequent podiatry records do not reflect the plantar fasciitis diagnosis. In a March 2011 statement, the Veteran explained that he began experiencing problems with his feet during parades and marching events, and he was put on marching waivers and unable to participate. He states he saw doctors in service for problems with pain in his feet, and this has been an ongoing problem. In a December 2011 VA examination, the Veteran reported being diagnosed with plantar fasciitis which has existed since 1974. He endorsed constant pain in his feet. The medical record review included the in-service treatment records of plantar warts, corns on feet, and a notation of pes planus in the entrance examination. In a post-service podiatry record, the Veteran was diagnosed with plantar fasciitis in October 2010. The examiner concluded it was less likely than not that the plantar fasciitis is related to service because there are no service records referencing plantar fasciitis, and his separation examination stated that his feet were normal. In a March 2020 VA examination, the diagnoses indicated were pes planus since 1974 and a bilateral foot strain since December 2017. The Veteran stated this condition began in 2017, yet also states it is a result of physical training and rucking for miles. The examiner concluded that after reviewing all records, it is less likely than not that the Veteran’s foot condition is related to service, including the plantar warts, callouses, and corns of the bilateral feet, and avulsion fracture of the superior aspect of the left navicular that he was treated for during service. These in-service complaints were more likely acute events without long term sequela, since there is no sign of continuation of symptomology during or after separation. The preponderance of the evidence is against finding a nexus between the Veteran’s current diagnosis and his foot complaints in service. The Board finds the March 2020 opinion especially probative as it is based on a thorough review of all evidence of record and contains a well-reasoned rationale based on the examiner’s medical expertise. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran is competent to report observable symptoms and a timeline of that symptomology, he is not competent to report on more complex medical matters such as etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As the evidence is against the Veteran’s claim, his claim is denied. 2. Entitlement to service connection for a left eye disability The Veteran claims his left eye disability is caused or aggravated by strain and overuse due to his right eye blindness. The service records reveal heavy pigmentation in the left macula in 1975. Eye trouble was noted in his separation examination, but he had no problems at the time of examination. In a February 2014 statement, the Veteran explained that his right eye disability put a lot of strain on his left eye, which waters and hurts after reading, watching TV, or looking at a computer. He is unable to drive at night. In March 2011, several statements were submitted on behalf of the Veteran. His sister recalled the Veteran coming home on leave complaining of fog or smoke in the room. His other sister recalled the Veteran having problems with his eyes in service and using eyedrops frequently. His wife recalled problems with his right eye becoming cloudy during service, but did not note problems with his left. Regarding post-service treatment records, an April 1999 record reflects ocular hypertension in the left eye. A June 2014 record found no retinopathy of the left eye. More recent Atlanta VAMC records reflect a diagnosis of “bilateral age-related cataracts” and that the left eye is “glaucoma suspect.” An April 2018 record found no retinopathy of the left eye. In a December 2011 VA examination, the Veteran was given a diagnosis of nuclear cataracts in the left eye as likely as not related to diabetes. In a July 2014 VA examination, the listed diagnoses were cataracts of the left eye, bilateral glaucoma and diabetic retinopathy, and macular degeneration of the left eye. The Veteran reported that his left eye feels overworked and strained after reading and watching TV and is especially difficult to see driving at night. He also reported limited peripheral vision and tearing. There was no visual impairment upon examination. The examiner found the Veteran’s cataracts and diabetic retinopathy were at least as likely as not related to service yet explained that the disabilities are related to diabetes. The examiner provided a thorough explanation as to why both disabilities are caused or aggravated by diabetes. However, the Veteran is not service connected for diabetes. Another VA examination was conducted in July 2020. The Veteran’s diagnosis was left eye cataract status post-surgery in 2019. There was no sign of diabetic retinopathy or macular degeneration of the left eye, and glaucoma was only indicated in the right eye. His corrected distance visual acuity in the left eye was 20/40. The examiner found the Veteran’s cataract is unrelated to any in-service event, disease, or trauma. There was no visualization of diabetic retinopathy, macular scars, or glaucoma in the left eye. In a September 2020 addendum opinion, the examiner concluded the left eye cataract has no relationship to the neovascular glaucoma and blindness in the right eye. The progression of the left cataract was not aggravated beyond its natural course by any strain or overuse of the left eye. The preponderance of the evidence is against the Veteran’s claim that his left eye disability is caused or aggravated by his service-connected right eye disability. The Board affords the 2020 opinions significant probative weight as the examiner reviewed the entire claims file and based the findings on objective evidence. See Nieves-Rodriguez, 22 Vet. App. at 304. While the Veteran is competent to report observable symptoms and a timeline of that symptomology, he is not competent to report on more complex medical matters such as etiology. See Jandreau, 492 F.3d at 1337. As the evidence is against the Veteran’s claim, his claim is denied. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.   In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a service-connected disability. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment).   Where service connection has already been established and an increase in the disability rating is at issue, it is a present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Therefore, for the non-initial increased rating claims, the Board will only consider evidence submitted one year prior to the filing of the claim for an increased rating, rather than from the initial assignment. With the exception of the erectile dysfunction claim, the Veteran filed his claim for increased ratings on November 13, 2013. Therefore, the appeal period begins November 13, 2012. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, as in this case, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran was notified that he was granted service connection for erectile dysfunction in February 2012. He submitted a claim requesting a higher rating in September 2012. Thus, the Board will consider the evidence for this claim as of March 24, 2010, the date the Veteran filed his claim for service connection. 3. Entitlement to a compensable rating for tension headaches The Veteran’s headaches are rated under 38 C.F.R. § 4.124a, Diagnostic Codes 8199-8100. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. The use of the “99” series and a hyphenated diagnostic code reflects that there is no specific diagnostic code applicable to a headache disability, and it must be rated by analogy. 38 C.F.R. § 4.20. As the rating schedule does not specifically include a rating for a tension headache disability, the Veteran has been assigned an analogous rating under Diagnostic Code 8100 for migraines, as the functions affected, anatomical localization, and symptoms are closely related. Diagnostic Code 8100 provides that migraines with characteristic prostrating attacks averaging one in two months over the last several months warrant a 10 percent rating. Migraines with characteristic prostrating attacks occurring on an average once a month over last several months warrant a 30 percent rating while migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent rating. Finally, less frequent attacks are rated as noncompensable. 38 C.F.R. § 4.124a. The rating criteria do not define “prostrating.” By way of reference, the Board notes that, according to WEBSTER'S NEW WORLD DICTIONARY OF AMERICAN ENGLISH, THIRD COLLEGE EDITION (1986), p. 1080, “prostration” is defined as “utter physical exhaustion or helplessness.” A very similar definition is found in DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1367 (28th Ed. 1994), in which “prostration” is defined as “extreme exhaustion or powerlessness.” The Veteran underwent a VA examination in July 2014. At the time of examination, he experienced headache pain on both sides of his head with sensitivity to light. The examiner indicated the Veteran had very frequent prostrating and prolonged attacks of non-migraine headaches. In a May 2017 Disability Benefits Questionnaire, the Veteran endorsed constant pulsating or throbbing pain on both sides of the head that worsens with physical activity. Associated symptoms were nausea, sensitivity to light and sound, changes in vision, sensory changes, dizziness, and disturbed concentration. The physician indicated the Veteran suffers from very frequent prostrating attacks which render him incapacitated and force him to lie down in a dark environment for hours at a time. The treatment records reflect that the Veteran has been prescribed medication for his headaches throughout the appeal period, however, there are few records reflecting complaints or treatment visits for headaches. An October 2019 treatment record reflects “occasional headache in the occipital region of his head that is aggravated when he turns his head left or right.” The note states there was no change in vision or any neurological symptoms. As this note indicates that his occasional headaches are in a different region than his tension headaches, the Board finds it likely that these complaints are separate from his tension headaches. The evidence of record indicates the Veteran suffers from very frequent prolonged prostrating attacks, which entitles him to a 50 percent rating – the maximum schedular rating available. 4. Entitlement to an increased rating in excess of 30 percent for right eye blindness due to glaucoma The Veteran currently has a 30 percent rating under Diagnostic Code 6064 for no more than light perception in one eye and 20/40 vision in the other. Pursuant to 38 C.F.R. § 4.75 (d), the evaluation for visual impairment of one eye must not exceed 30 percent unless there is anatomical loss of the eye. While the evidence reflects total blindness of the right eye, there is no anatomical loss. As the Veteran is not service connected for the left eye, visual acuity of the left eye must be considered to be 20/40 for evaluation purposes. See 38 C.F.R. § 4.75 (c). Thus, under the Veteran’s circumstances, 30 percent is the maximum schedular rating available to him under the rating criteria. 5. Entitlement to an increased rating in excess of 10 percent for tinnitus The Veteran seeks an increased rating for his service-connected tinnitus, which is currently assigned a 10 percent rating (the maximum available rating under the relevant criteria, regardless of whether perceived in one ear, both ears, or in the head). See 38 C.F.R. § 4.87, Diagnostic Code 6260, Note 2; see Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Consequently, while the Board acknowledges the Veteran’s allegations of worsening tinnitus in VA treatment records, it concludes that his service-connected tinnitus has been assigned the maximum schedular rating available for tinnitus under 38 C.F.R. § 4.87, Diagnostic Code 6260, and any claim for a higher (or separate) rating under that Diagnostic Code must be denied. 6. Entitlement to a compensable rating for erectile dysfunction Diagnostic Code 7522 awards a 20 percent rating for deformity of the penis with loss of erectile power. This is the only schedular rating provided under this diagnostic code. In every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. There is no schedular rating for loss of erectile power alone. While Diagnostic Code 7522 requires a “deformity” for a compensable rating and VA has not expressly defined this term, the United States Court of Appeals for Veterans Claims (Court) has found that the ordinary meaning of this word is appropriate, noting that a “deformity” is a “distortion of any part or general disfigurement of the body.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 478 (32d ed. 2012). The Court held that “deformity” under DC 7522 means a distortion of the penis, either internal or external. 38 C.F.R. § 4.115 (b), Diagnostic Code 7522. See Williams v. Wilkie, 30 Vet. App. 134 (2018). The record does not reflect a penile deformity. In his July 2013 and July 2014 VA examinations, the Veteran was expressly noted to have a normal penis. While the treatment records reflect the diagnosis, none indicate a deformity. Thus, as penile deformity is required for a higher rating, the Veteran’s claim must be denied. 7. Entitlement to a TDIU Entitlement to a TDIU was found to be raised by the record in the October 2018 Board decision pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). TDIU may be assigned where the veteran is unable to secure or follow a substantially gainful occupation as a result of their service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a veteran is unemployed or has difficulty obtaining employment is insufficient for TDIU purposes. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The evidence must show the veteran is incapable of performing the physical and/or mental acts required by employment by reason of their service-connected disabilities. The Court has held the phrase “unable to secure and follow a substantially gainful occupation” in 38 C.F.R. § 4.16 has two components; one economic and the other non-economic. Ray v. Wilkie, 31 Vet. App. 58, 73-74 (2019). The economic component contemplates an occupation earning more than marginal income, outside of a protected environment, as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component contemplates the veteran’s ability to follow and secure employment. In this respect, due consideration must be given to their history, education, skill and training; physical ability, both exertional and non-exertional, to perform the types of activities (e.g. sedentary, light, medium, heavy or very heavy) required by the occupation at issue; and mental ability to perform the activities required by the occupation at issue. Given sedentary is defined as “doing or requiring much sitting” the Board finds that sedentary employment is a job where the worker primarily sits down. MERRIAM-WEBSTER’S COLLEGEIATE DICTIONARY 1123 (11th ed.) (2003). In this context, appropriate factors for consideration are the veteran’s employment history, educational and vocational attainment and any other factors bearing on the issue. 38 C.F.R. §§ 3.341, 4.16. However, a veteran’s age or the impairment caused by nonservice-connected disabilities may not be considered. 38 C.F.R. §§ 3.341, 4.16, 4.19. As a preliminary matter, for TDIU consideration the veteran must meet the disability rating percentage threshold. 38 U.S.C. § 1155; 38 C.F.R. § 4.16 (a), (b). If a veteran is service connected for only one disability, that disability must be rated at 60 percent disabling or more. 38 C.F.R. §§ 4.16 (a), 4.25. If a veteran is service-connected for two or more disabilities, at least one of the disabilities must be rated at 40 percent disabling or more and the additional service-connected disabilities must bring the combined disability rating to 70 percent or more. Id.  The Veteran meets the schedular criteria as of November 13, 2013 and is service connected for the following disabilities in light of this decision: depressive disorder associated with right eye blindness (70 percent); right eye blindness (30 percent); tinnitus (10 percent); tension headaches (50 percent); erectile dysfunction (0 percent); status post right testis exploration (0 percent); and bilateral hearing loss (0 percent). In September 2020, a letter was sent to the Veteran requesting a completed VA Form 21-8940. To date, no response has been received. The record indicates the Veteran has a high school diploma and worked as a forklift driver until July 2011, at which time he quit his job due to a nonservice-connected hip injury. A Social Security document reflects that his work went “very well” until March 2011 when he fell onto his right hip. Subsequent medical records reflect the Veteran is completely disabled and unable to work due to his hip disability. He was deemed disabled by the Social Security Administration due to his hip disability in 2012. In his application, he listed the following disabilities that impair his ability to work: right hip pain and hip replacements, diabetes, hypertension, right eye blindness, hearing loss and tinnitus. The Veteran is only service connected for the latter three disabilities and does not mention headaches or depression. In the July 2014 examination for eye disabilities, the examiner concluded the Veteran’s right eye disability impacts his ability to work as it would be difficult to drive or operate machinery and see small print, and the inability to see would cause loss of depth of field and focus. In his July 2020 examination for eye disabilities, the examiner indicated the Veteran’s disabilities would not impact his ability to work. In a July 2014 examination for hearing loss and tinnitus, the examiner opined that these disabilities would impact ordinary functions of daily life with difficulty understanding conversational speech in certain environments. In a July 2014 examination for headaches, the examiner opined the Veteran’s headaches would not impair his ability to work. A May 2017 DBQ came to the opposite conclusion, determining the Veteran’s headaches render him unable to maintain substantial gainful employment due to the amount of work missed and frequent unscheduled breaks. The drafting physician also completed a residual functional capacity evaluation finding the Veteran would miss or leave early 3 or more days per month due to headaches. He would be unable to concentrate more than 3 days per month and would not stay focused for at least 7 hours of an 8-hour workday. In a November 2015 private medical opinion, Dr. H-G opined the Veteran is unemployable due to his depression. In her assessment of the Veteran, she wrote the Veteran is socially isolated and withdrawn, requiring assistance in performing his daily living tasks. His wife does the shopping, cooks, manages the finances and maintains the majority of the household chores. He suffers from chronic sleep impairment, near-continuous panic and depression, difficulty establishing and maintaining relationships, disturbances of motivation and mood, difficulty adapting to stressful circumstances including work, mild memory loss, and irritability due to his tinnitus. Due to his headaches, he has low energy, low motivation, social withdrawal and irritability. Dr. H-G states that according to the DSM, individuals with this symptomology have few friends and an inability to maintain a job. She cited to other medical literature that reflect that depression leads to occupational dysfunction and poor work-related quality of life. The Veteran submitted medical literature regarding the relationship between pain and depression. The preponderance of the evidence is against a finding that the Veteran is unemployable as a result of his service-connected disabilities. While his right eye blindness and secondary depression likely pose challenges in the workplace, the Veteran has been blind in the right eye since 2007 and continued to work as a forklift driver until 2011. Similarly, the Veteran has been service-connected for headaches, hearing loss, and tinnitus since prior to leaving the workforce, which indicates he was able to work despite these disabilities. The overall evidence shows he left the workforce and became completely disabled due to a nonservice-connected hip disability. While the Board has considered the May 2017 DBQ for headaches and Dr. H-G’s opinion, the other evidence of record does not reflect an inability to work due to headaches and depression. The Board finds it particularly probative that the Veteran himself did not indicate that headaches and depression inhibited his ability to work, but instead listed several nonservice-connected disabilities. In sum, the evidence fails to demonstrate the Veteran is precluded from employment due to his service-connected disabilities. While the Board acknowledges that his disabilities make working difficult, the evidence does not reflect that his disabilities make obtaining and maintaining gainful employment impossible, particularly considering that he worked for several years with most of his service-connected disabilities. Entitlement to a TDIU is denied. REASONS FOR REMAND Entitlement to a compensable rating for bilateral hearing loss, to include whether the July 2014 reduction from 10 percent to 0 percent was proper The Veteran’s 10 percent disability rating for bilateral hearing loss was decreased to noncompensable effective July 8, 2014, the date of his last VA examination. Several treatment records since the July 2014 examination indicate worsening hearing loss and describe his hearing loss as “profound.” As there are allegations of worsening, and a new examination would shed light on both whether an increase is warranted and whether the criteria for a reduction were met, the Board finds a new examination is warranted. Snuffer v. Gober, 10 Vet. App. 400 (1997) (When a claimant asserts, or the evidence shows, that the severity of a disability has increased since the most recent rating examination, an additional examination is appropriate). The matter is REMANDED for the following action: Schedule a new VA examination to determine the severity of the Veteran’s bilateral hearing loss. L.M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Carroll, Associate 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.