Citation Nr: 21003951 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 18-01 498 DATE: January 25, 2021 ORDER Service connection for left ear hearing loss is denied. An initial rating higher than 0 percent for right ear hearing loss is denied. FINDINGS OF FACT 1. The Veteran has a current left ear hearing loss disability. 2. The Veteran had noise exposure associated with his duties as a steam plant operator during active service. 3. The Veteran’s left ear hearing was normal during active service, with no significant puretone threshold shift on audiometric testing between entrance and separation. 4. The Veteran’s left ear hearing loss has not been linked to in-service noise exposure or a disease or injury incurred or aggravated in service, and is not shown to have manifested to a compensable degree within a year of separation. 5. The Veteran’s right ear hearing loss has been manifested by puretone threshold averages and speech discrimination scores warranting a Roman numerical designation no higher than VIII; his nonservice-connected left ear hearing loss is assigned a Roman numeral designation of I. CONCLUSIONS OF LAW 1. The criteria for service connection for left ear hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 2. The criteria for an initial rating higher than 0 percent for right ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.3 4.85, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1963 to June 1967. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the matters for further development in February 2020. The Veteran testified at a hearing before the undersigned Veterans Law Judge in January 2020. A transcript of the hearing is of record. Service Connection Service connection generally will be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § § 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection on a direct basis, the evidence must show: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link between the current disability and the disease or injury incurred or aggravated in service (the “nexus” element). Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). For the chronic diseases listed in 38 C.F.R. § 3.309(a), including hearing loss as an organic disease of the nervous system, service connection may alternatively be established with evidence of chronicity of the disease during service or during a presumptive period following service separation. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015). For conditions noted during service (or in the presumptive period) but not shown to be chronic at the time, a continuity of symptomatology after service is required to support the claim. 38 C.F.R. § 3.303(b). When chronicity or continuity is established, subsequent manifestations of the same chronic disease at any later date, no matter how remote in time from the period of service, will be service connected unless clearly attributable to causes unrelated to service (“intercurrent” causes). Id. In addition, where a veteran served continuously for 90 days or more during a period of war, or after December 31, 1946, there is a presumption of service connection for sensorineural hearing loss as an organic disease of the nervous system if the disease manifested to a degree of 10 percent or more within one year from the date of separation from service, even if there is no evidence of the disease during the service period itself. 38 U.S.C. § § 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). This presumption may be rebutted by affirmative evidence to the contrary. 38 C.F.R. § 3.307(d). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) (when the evidence supports the claim or is in relative equipoise, the claim will be granted).   Left Ear Hearing Loss For the following reasons, the Board finds that the criteria for service connection for the Veteran’s left ear hearing loss have not been met. A left ear hearing loss disability is established. In this regard, impaired hearing is defined as a disability for VA compensation purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is from 0 to 20 decibels; higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Here, the April 2017 and March 2020 VA examination reports show puretone threshold results from audiometric testing higher than 40 degrees at one or more of the relevant frequencies. They also show speech discrimination scores lower than 94 percent. Accordingly, the criteria for a left ear hearing loss disability are satisfied. See 38 C.F.R. § 3.385. Regarding in-service noise exposure, the Veteran states he was exposed to noise eight to ten hours a day as a steam plant operator. See January 2020 Hearing Transcript. His DD 214 reflects that he served in the Air Force with a military occupational specialty (MOS) as a heating systems specialist and plant operator. The Board observes that in the April 2017 rating decision, the RO found that the Veteran’s MOS was sufficient to establish noise exposure that could cause acoustic trauma. Accordingly, based on the circumstances of the Veteran’s service as a heating systems specialist and plant operator, the Board finds it credible he had in-service noise exposure. See 38 C.F.R. § 3.303(a) (providing that the places, types, and circumstances of service must be considered in claims for service connection). The credible evidence does not show that the Veteran’s left ear hearing loss manifested in service or soon after separation. The July 1963 enlistment examination report includes an audiogram showing puretone thresholds of 0 from 500 to 4000 Hertz. The Board has considered the fact that given the date of the July 1963 enlistment audiogram, it may have been recorded in American Standards Association (ASA) units. More recent audiograms record puretone thresholds in units established by the International Standards Organization (ISO)-American National Standards Institute (ANSI), which represent the current standard. Conversion from ASA to ISO-ANSI units is accomplished by adding 15 decibels at 500 Hz, 10 decibels at 1000 Hz, 2000 Hz, and 3000 Hz, and 5 decibels at 4000 Hz. Assuming that the July 1963 audiogram is based on ASA units, if it is converted to ISO-ANSI units, it would show 15 decibels (dB) at 500 Hertz (Hz), 10 dB at 1000 Hz, 10 dB at 2000 Hertz, 10 dB at 3000 Hz, and 5 dB at 4000 Hz. The April 1967 separation examination report includes an audiogram showing puretone thresholds of 10 dB at 500 Hz, 10 dB at 1000 Hz, 5 dB at 2000 Hz, and 5 dB at 4000 Hz. Again, the audiogram does not specify whether it was recorded in ASA or ISO-ANSI units. If the audiometric results were recorded in ASA units, then after conversion the Veteran’s puretone thresholds would be 25 dB at 500 Hz, 20 dB at 1000 Hz, 15 dB at 2000 Hz, 15 dB at 3000 Hz, and 10 dB at 4000 Hz. Thus, if in fact the April 1967 audiometric results were recorded in ASA units, then converting them to ISO-ANSI units would show some hearing loss at 500 Hz, as the puretone threshold at that frequency, after conversion, is above 20 decibels. See Hensley, 5 Vet. App. at 157. However, such hearing loss would not be severe enough to constitute a disability at the time for VA compensation purposes. See 38 C.F.R. § 3.385. Moreover, whether the April 1967 audiogram was recorded using ASA or ISO-ANSI units, comparison with the July 1963 audiogram shows that there was not a puretone threshold shift greater than 10 decibels at any of the relevant frequencies. As discussed below, in the March 2020 VA medical opinion, the examiner found that there was not a significant puretone threshold shift. The April 1967 examination report also shows that the Veteran’s ears, including auditory acuity based on the audiometric findings, were clinically evaluated as normal. In the April 1967 separation report of medical history, the Veteran denied a history of hearing loss or ear trouble. There are no post-service medical records in the file until August 2010, when the Veteran established care at VA. The VA treatment records show that in November 2010, he requested a hearing test and possible hearing aid for his right ear, reporting chronic hearing loss, worse in the right ear than the left. He was seen for an initial audiology consultation in December 2010. At that time, according to the record, he related a history of noise exposure both during and after active service. More specifically, he related a history of military noise exposure from working in the boiler room, of occupational noise exposure from working in a boiler room and during proving ground testing of ammunition and explosives, and of recreational noise exposure from hunting as well as use power tools and chainsaws. He stated that his hearing had gradually declined over the years, and had always been worse in the right ear. He recalled having hearing tests every day when he worked for the “proving ground.” In November 2014, after transferring to a VA facility in a different state, the Veteran was seen for an audiological consultation, and stated that his hearing loss had been present “since military.” At the January 2020 Board hearing, when asked whether he noticed he was having trouble hearing during active service, he responded, “Yes. Then later on . . . when I first started having problems, so . . . I don’t know. That’s been a long time ago.” When asked again if he noticed that he could not hear during service, he replied, “Yea . . . [W]hen I was in the military, we had a hearing test every year [or so], and they told me then it was starting to fade.” The Board finds the Veteran’s statements are not sufficient to establish that his hearing loss manifested in service, and are outweighed by the service treatment records. The Veteran’s testimony was somewhat equivocal on the issue, as he stated “I don’t know . . . That’s been a long time ago.” Moreover, although he stated he was told during active service that his hearing was “starting to fade,” the April 1967 separation examination report shows that the Veteran’s hearing was clinically evaluated as normal. The Board also notes that the Veteran’s reference to his hearing being tested every year in the military seems to be related to post-service employment at a “proving ground” testing ammunition and explosives, which the December 2010 VA audiology consultation record suggests was in a civilian capacity with use of the word “occupational” as distinguished from “military.” Indeed, his service personnel records do not indicate that he had this role during active service; rather, they show that he was assigned to the boiler room as a heating specialist and boiler operator. Further, the service treatment records appear complete, and do not show hearing evaluations apart from those conducted at entrance and separation. In other words, they do not show yearly hearing evaluations, or any hearing evaluations other than at entrance and separation. Finally, while the Veteran has stated he noticed an onset of hearing loss during service, he denied a history of hearing loss in the April 1967 report of medical history at separation. These records are more probative than the Veteran’s more recent statements, made several decades later. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant). Thus, as the service treatment records conflict with the Veteran’s recent statements, and as those statements are somewhat equivocal on the issue, the Board finds the latter are not sufficient or credible to establish an in-service onset of hearing loss, and are outweighed by the service treatment records. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (holding that when determining whether lay evidence is satisfactory, the Board may properly consider, among other things, its consistency with other evidence submitted on behalf of the Veteran); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (the Board has the "authority to discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence"). The preponderance of the evidence weighs against a link between the Veteran’s current left ear hearing loss disability and his period of service, including in-service noise exposure. In this regard, the Court has held that section 3.385 of the regulations, which defines the criteria for establishing a hearing loss disability, does not preclude service connection for a current hearing loss disability where hearing was within normal limits on audiometric testing at separation from service. Hensley, 5 Vet. App. at 159. “Therefore, when audiometric test results at a veteran’s separation from service do not meet the regulatory requirements for establishing a ‘disability’ at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service.” Id. at 160. The Veteran has not submitted competent evidence supporting a link between his current left ear hearing loss disability and his in-service noise exposure. Because he is not shown to have a medical background or expertise, he is considered a lay person in the field of medicine. Lay testimony is competent as to matters capable of lay observation or within a person’s first-hand experience, and may be competent evidence with respect to both the diagnosis of a medical condition and its etiology or cause. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). However, lay testimony is not competent with respect to determinations that cannot be made based on lay observation alone due to their medical or scientific complexity. Id; Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board must determine on the specific facts of each case whether lay testimony is competent on the matter at issue, or whether medical evidence is required. Davidson, 581 F.3d at 1316; Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011). In this case, whether the Veteran’s hearing loss may be linked to noise exposure in service is a determination that requires medical evidence, as a cause-and-effect relationship cannot be observed through the senses alone given the length of time that elapsed between the Veteran’s service and the onset of his hearing loss some time later. Thus, the Veteran’s unsupported lay opinion is not competent evidence on this issue, and therefore is not probative. See Layno, 6 Vet. App. at 470-71. A VA audiological examination was performed most recently in March 2020. In the examination report, the examiner opined that the Veteran’s left ear hearing loss is less likely than not related to active service. In explanation, the examiner stated that the Veteran’s service treatment records showed normal hearing in the left ear at entrance and separation, and there was no significant threshold shift at any frequency. In this regard, the examiner cited the Institute of Medicine (IOM) report, “Noise and Military Service: Implications for Hearing Loss and Tinnitus,” which states (as quoted by the examiner): “There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one’s lifetime, long after the cessation of that noise exposure. Although the definitive studies to address this issue have not been performed, based on the anatomical and physiological data available on the recover process following noise exposure, it is unlikely that such delayed effects occur.” The examiner concluded that, therefore, based on the objective evidence in the form of the in-service audiograms, there is no evidence on which to conclude that the Veteran’s current left ear hearing loss was caused by or resulted from his active service, including in-service noise exposure. The examiner also cited a research study which, according to the examiner, showed that hazardous noise exposure has an immediate effect on hearing; there is no delayed onset and the hearing loss is not progressive or cumulative. In an August 2020 addendum to the March 2020 opinion, the examiner provided a fuller explanation as to why lack of a significant puretone threshold shift during service supported the conclusion reached in that opinion. The examiner cited medical literature stating that there must be a sufficient change in audiometric thresholds to determine that the difference is attributable to a change in hearing sensitivity as opposed to testing variability due to measurement error. Applying that principle to the Veteran’s case, the examiner found that changes in the puretone thresholds in the Veteran’s left ear between entrance and separation were within the range of test-retest variability, and not indicative of a noise-induced shift in hearing. The March 2020 VA medical opinion, in conjunction with the August 2020 addendum, is probative, as it represents the conclusion of a medical professional specializing in hearing impairment, is based on a review of the Veteran’s pertinent medical history, and is supported by a thorough explanation. As noted above, the Veteran has not submitted medical evidence supporting a link between his left ear hearing loss and in-service noise exposure. In the January 2021 brief, the Veteran, through his representative, quoted an excerpt from a medical article which he states supports the proposition that noise-induced hearing loss can have a delayed onset following such noise exposure. The article is titled “Adding Insult to Injury: Cochlear Nerve Degeneration After ‘Temporary’ Noise-Induced Hearing Loss,” THE JOURNAL OF NEUROSCIENCE, November 11, 2009, S. Kujawa and M. C. Liberman. The quotation is as follows: “The present results contradict these fundamental assumptions by showing that reversibility of noise-induced threshold shifts masks progressive underlying neuropathology that likely has profound long-term consequences on auditory processing.” The benefit-of-the-doubt rule applies to assessments of scientific evidence or theories. Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). Thus, while the Board may consider the extent to which a scientific theory is accepted in the scientific community when evaluating the evidence of record, it cannot demand a level of acceptance greater than the level of proof required by the benefit-of-the-doubt rule. Id. ; see 38 C.F.R. § 3.102 ; Gilbert, 1 Vet. App. at 55. At the same time, medical evidence that is speculative, general or inconclusive in nature has little probative value. Cf. Obert v. Brown, 5 Vet. App. 30, 33 (1993). Moreover, treatise evidence generally provides little support for a claim unless it is accompanied by a medical opinion which favorably applies the principles of the article to the specific facts of the case. See Sacks v. West, 11 Vet. App. 314, 317 (1998). Medical articles or treatise evidence, standing alone, can provide support if they discuss generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least a plausible argument for causality based upon objective facts rather than an unsubstantiated lay medical opinion. Id. (citing Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996)); see also Libertine v. Brown, 9 Vet. App. 521, 523 (1996). In this case, even if the article cited in the January 2021 brief provides support for the proposition that noise-induced hearing loss may develop some time after the noise exposure, it is not accompanied by a medical opinion applying its findings to the facts of this case. It thus provides little support for the claim. See Sacks, 11 Vet. App. at 317. Neither the Veteran nor his representative is shown to have the expertise to apply the findings in that article to the facts of this case. The January 2021 brief does not otherwise explain why consideration of that article would alter the audiologist’s conclusion in the March 2020 opinion. In this regard, the January 2021 brief states that the article calls into question the premise that a delayed onset of hearing loss following noise exposure would not be related to such noise exposure. However, the March 2020 opinion was not based solely or even principally on the delayed onset of the Veteran’s hearing loss following in-service noise exposure, but rather on the in-service audiograms showing that no noise-related changes to his hearing occurred at the time. As the examiner’s opinion suggests, a significant puretone threshold shift during service would have supported a finding of noise-related changes to the Veteran’s hearing, and thus potentially a relationship to his current hearing loss, even if his hearing remained within normal limits at separation. The Board also notes that the excerpt of the article quoted in the January 2021 brief concerns the “reversibility of noise-induced threshold shifts.” As discussed above, the evidence does not show that a noise-induced threshold shift ever occurred in the Veteran’s case. Whether such occurred and was then followed by the puretone thresholds reverting to normal by separation would clearly be speculative. In any event, the Board finds that the VA examiner has the expertise to determine which medical sources to draw from in formulating the medical opinion. The examiner based the March 2020 opinion based on a different medical source, namely the IOM report “Noise and Military Service: Implications for Hearing Loss and Tinnitus.” It is within the province of the examiner’s medical expertise to find the IOM report sufficiently persuasive or definitive to rely on without considering other sources that may potentially put its conclusions into question. By contrast, as the Veteran and his representative do not have such expertise, the argument in the January 2021 brief that the article cited therein calls the March 2020 opinion into question is not competent or probative evidence. See Jandreau, 492 F. 3d at 1376-77. It is very possible, for example, that the examiner is aware of that article, but did not find it sufficiently persuasive or definitive to address it, or found that it simply did not apply in this case or alter the conclusion reached, even if otherwise persuasive with respect to its findings, which may not have been based on data analogous to the facts of this case such that it could be relied on in addressing the questions presented to the examiner. For these reasons, an examiner need not address any and every medical article that may include findings at variance or at least in tension with the sources the examiner has consulted in order to render an adequate and probative opinion. The case would be different, of course, if the article cited in the January 2021 brief were accompanied by a competent medical opinion conflicting with the March 2020 VA examiner’s opinion. In sum, the preponderance of the evidence weighs against a link between the Veteran’s current left ear hearing loss disability and his period of service, including in-service noise exposure. Consequently, the criteria for service connection on a direct basis are not satisfied. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). As the evidence shows that the Veteran’s hearing loss did not manifest during service, and as the record does not show that it manifested within a year of separation, service connection cannot be established based on chronicity during service or a continuity of symptoms after discharge, or on a presumptive basis for hearing loss that manifests to a compensable degree within a year of separation. See 38 C.F.R. §§ 3.303(b), 3.307. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.  Increased Rating VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally, 38 C.F.R. § Part IV. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The percentage ratings represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected disabilities in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Diagnostic codes in the rating schedule identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. All reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Because the level of disability may have varied over the course of the claim, the rating may be “staged” higher or lower for segments of time during the period under review. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Evaluation of Hearing Loss The Board finds that the criteria for a rating higher than 0 percent for the Veteran’s right ear hearing loss have not been satisfied, for the reasons that follow.   A. Rating Criteria for Hearing Loss Hearing loss is evaluated under 38 C.F.R. § 4.85, Diagnostic Code (DC) 6100. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85(a). Examinations will be conducted without the use of hearing aids. Id. Table VI (in 38 C.F.R. § 4.85) is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination and the puretone threshold average. 38 C.F.R. § 4.85(b). The puretone threshold average is the sum of the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz, divided by four. § 4.85(d). The Roman numeral designation is located at the point where the horizontal column corresponding to the percentage of discrimination and the vertical column corresponding to the puretone threshold average intersect. § 4.85(b). Table VIa is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on the puretone threshold average. 38 C.F.R. § 4.85(e). Table VIa will be used when the examiner certifies that the use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86 (discussed below). Table VII (in 38 C.F.R. § 4.85) is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. 38 C.F.R. § 4.85(e). The horizontal rows represent the ear having the better hearing and the vertical columns the ear having the poorer hearing. Id. The percentage evaluation is located at the point where the row and column intersect. Id. There are alternative criteria for certain exceptional patterns of hearing loss. Specifically, if the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b). B. Analysis Preliminarily, the Board notes that service connection is only in effect for the Veteran’s right ear hearing loss. Service-connected hearing loss in one ear only is entitled to special consideration for paired organs. Specifically, where there is hearing impairment compensable to a degree of 10 percent or more in one ear as a result of a service-connected disability, and nonservice-connected hearing impairment in the other ear that is not the result of the Veteran’s own willful misconduct and which meets the criteria for a disability under 38 C.F.R. § 3.385, the rate of compensation shall be paid as if the combination of the disabilities were the result of the service-connected disability. 38 U.S.C. § 1160(a)(3); 38 C.F.R. § 3.383(a)(3). In other words, in such a case, the Veteran may be compensated as if hearing loss in both ears were service connected. In determining whether a compensable rating may be assigned the service-connected ear, the nonservice-connected ear is initially assigned a value of Roman numeral I in Table VII. 38 C.F.R. § 4.85(f). The service-connected ear must then have a numeric value of either X or XI, as determined by Table VI or Table VIA (as applicable), in order to be assigned a compensable rating. See id., DC 6100, Table VII (combination of Level I and either Level X or Level XI results in a 10 percent rating). The April 2017 VA examination report reflects audiometric testing results showing puretone thresholds for the right ear of 60 decibels (dB) at 1000 Hertz, 65 dB at 2000 Hertz, 60 dB at 3000 Hertz, and 65 dB at 4000 Hertz. The puretone threshold average was 63 dB. The speech discrimination score was 48 percent. Because the April 2017 audiogram shows puretone threshold at each of the four specified frequencies of 55 decibels or more, the Roman numeral designation for the right is obtained from either Table VI or Table VIa, whichever results in the higher numeral. 38 C.F.R. § 4.86(a). In this case, a designation of V is obtained from Table VIa based on a puretone threshold range of 63 to 69 decibels. A designation of VIII is obtained from Table VI based on the combination of the Veteran’s puretone threshold average and speech discrimination score. Thus, application of Table VI affords the higher designation. The nonservice-connected left ear hearing loss is assigned a designation of I in Table VII. See 38 C.F.R. § 4.85(f). The point where designations VIII and I intersect in Table VII yields a rating of 0 percent. 38 C.F.R. § 4.85, DC 6100. The March 2020 VA audiological examination report shows puretone thresholds for the right ear of 65 dB at 1000 Hertz, 70 dB at 2000 Hertz, 65 dB at 3000 Hertz, and 70 dB at 4000 Hertz. The puretone threshold average was 68 dB. The speech discrimination score was 60 percent. Because the March 2020 audiogram shows puretone threshold at each of the four specified frequencies of 55 decibels or more, the Roman numeral designation for the right is obtained from either Table VI or Table VIa, whichever results in the higher numeral. 38 C.F.R. § 4.86(a). In this case, a designation of V is obtained from Table VIa based on a puretone threshold range of 63 to 69 decibels. A designation of VII is obtained from Table VI based on the combination of the Veteran’s puretone threshold average and speech discrimination score. Thus, application of Table VI affords the higher designation. The nonservice-connected left ear hearing loss is assigned a designation of I in Table VII. See 38 C.F.R. § 4.85(f). The point where designations VII and I intersect in Table VII yields a rating of 0 percent. 38 C.F.R. § 4.85, DC 6100. Accordingly, the criteria for a rating higher than 0 percent for the Veteran’s right ear hearing loss have not been met. Because it is noncompensable, special consideration of the Veteran’s right ear hearing loss based on paired organs is not warranted. See 38 U.S.C. § 1160(a)(3); 38 C.F.R. § 3.383(a)(3). As the preponderance of the evidence is against a higher rating, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rutkin, 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.