Citation Nr: 21062911 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 18-38 016 DATE: October 12, 2021 ORDER Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to October 30, 2019 is denied. Entitlement to a compensable rating for bilateral hearing loss is denied. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy is denied. REMANDED Entitlement to a rating in excess of 20 percent for lumbar spine degenerative disc disease from June 5, 2015 is remanded. Entitlement to a rating in excess of 10 percent for left knee chondromalacia with tendinopathy is remanded. Entitlement to a rating in excess of 10 percent for limitation of flexion of the thigh residual of left hip bursitis and iliotibial band syndrome is remanded. Entitlement to a compensable rating for limitation of extension of the thigh residual of left hip bursitis and iliotibial band syndrome is remanded. Entitlement to a rating in excess of 10 percent for limitation of flexion of the thigh, residual of right hamstring strain, is remanded. Entitlement to a compensable rating for limitation of extension of the thigh, residual of right hamstring strain, is remanded. FINDINGS OF FACT 1. For the period prior to October 30, 2019, the Veteran's PTSD manifested itself by symptoms no greater than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. The Veteran's hearing loss was manifested by hearing acuity of no worse than Level II hearing impairment in the right ear and Level II hearing impairment in the left ear. 3. The Veteran's radiculopathy of the left lower extremity manifested as no worse than moderate incomplete paralysis. CONCLUSIONS OF LAW 1. For the period prior to October 30, 2019, the criteria for a rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110; 38 C.F.R. §§ 3.102, 4.130, Diagnostic Code 9411. 2. The criteria have not been met for a compensable rating for bilateral hearing loss. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 3. The criteria have not been met for a rating in excess of 20 percent for left lower extremity radiculopathy. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.7, 4.124a Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from May 2011 to May 2015. The Veteran also served a period of active duty for training (ACDUTRA) from July 2007 to August 2007. This issue comes before the Board of Veterans' Appeals (Board) on appeal from September 2015 and December 2019 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is of record. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Board notes that while the regulations require review of the recorded history of a disability by the adjudicator to ensure an accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the Veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). It is also noted that staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119 (1999), Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder PTSD prior to October 30, 2019 is denied. A September 2015 granted an increased rating to 30 percent, effective June 5, 2015. A December 2019 rating decision granted an increased rating to 50 percent for PTSD, effective October 30, 2019. The Veteran contends that he is entitled to a higher rating prior to October 30, 2019. In claims for increased disability compensation, the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if a claim is received by VA within one year of that date. Otherwise, the effective date will be the date of receipt of claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). From May 5, 2015 to October 29, 2019, the Veteran's mental disorder has been rated under Diagnostic Code 9410, Other Specified Anxiety Disorder, and from October 30, 2019 the Veteran's PTSD has been rated under Diagnostic Code 9411, which are both rated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under the General Rating Formula for Mental Disorders, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130. A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for even greater occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran's psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency must assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. The Veteran's actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Turning to the evidence, the Veteran was afforded a VA PTSD examination in September 2014. Based on the clinical evaluation and a review of the Veteran's claims file, the examiner reported that the Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria. She reported that his symptoms were consistent with Unspecified Trauma and Stressor Related Disorder due to a combination of reported combat stress and premilitary trauma related to the death of his mother from colon cancer when he was 12 years old. The examiner concluded that a mental condition had been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: anxiety and chronic sleep impairment. The Veteran reported he cannot sleep with loud thunderstorms cannot sleep. He reported no mental health treatment prior to the day before the examination. He was not anxious all the time, just with storms. He reported being started easily. His energy and appetite were "ok," and he did not experience depression. He reported that his combat experience was a significant event in his life. He reported having anxiety from indirect fire and rockets, though it was not on his mind unless it storms. An August 2015 VA psychiatry consult reported that the Veteran was working in law enforcement as a volunteer deputy. He reported that he gets anxiety from thunder that he does not expect. He reported he has always been a people person, so he is not bothered by crowds. He is more easily irritated since combat. Although he had problems with sleep after discharge, he was now sleeping 6-7 hours a night. He denied depression and suicidal ideation. His thought processes were goal directed. His memory and cognition were grossly intact, and his insight and judgment were good. The Veteran was afforded another VA mental disorders examination in September 2015. Based on the clinical evaluation and a review of the Veteran's claims file, the examiner diagnosed the Veteran with "Unspecified Trauma and Stressor Related" under DSM-5 criteria. The Veteran reported that he lived alone but had been in a good relationship for 8 months. He maintains relations with his father and three older sisters. He reported that he was also in touch with "service buddies." The examiner opined that the Veteran had symptoms resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with routine behavior, self-care, and conversation. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: anxiety and chronic sleep impairment. A January 2016 VA mental health note reported that the Veteran had increased startle reaction and he endorsed anxiety. Overall, he seemed "to be coping okay." He denied suicidal ideation. His thought processes were goal directed. His memory and cognition were grossly intact, and his insight and judgment were good. A June 2016 VA treatment note addendum drafted by a staff physician reported that the Veteran was not interested in medications. He stated it is helpful to stop by a few times a year to talk with someone. The Veteran reported he is doing well overall, has good support system, has never experienced any "life altering events," and enjoys his work. He stated he has no immediate concerns and is not interested in therapy at this time. A May 2018 VA nursing note reported the Veteran's responses to screening questions. The Veteran reported that, over the past two weeks, he had not felt down or depressed or had not felt little interest or pleasure in doing things. The Veteran reported he had not had nightmares about a stressful event in the past month. The Veteran reported that, in the past month, he had not tried hard not to think about a stressful event or went out of his way to avoid situations that reminded him of the event. The Veteran reported that, in the past month, he had been constantly on guard, watchful, or easily startled. The Veteran reported that, in the past month, he had not felt numb or detached from others, activities, or his surroundings. An April 2019 VA nursing note reported the Veteran's responses to screening questions. The Veteran reported he had not had nightmares about a stressful event in the past month. The Veteran reported that, in the past month, he had not tried hard not to think about a stressful event or went out of his way to avoid situations that reminded him of the event. The Veteran reported that, in the past month, he had been constantly on guard, watchful, or easily startled. The Veteran reported that, in the past month, he had not felt guilty or unable to stop blaming himself or others for the stressful event or any problems the event may have caused. The Veteran reported, over the last 2 weeks, he had not been bothered at all by thoughts that he would be better off dead or of hurting himself in some way. An April 2019 VA primary care note indicated that the Veteran was employed by the city of Murfreesboro. He reported that he was doing well overall. The Veteran was afforded another VA PTSD examination in October 2019. Based on the clinical evaluation and a review of the Veteran's claims file, the examiner diagnosed the Veteran with PTSD and alcohol use disorder under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and inability to establish and maintain effective relationships. Veteran reported that he lives alone on a farm with some animals as his family is all in Minnesota. He reported having several friends. The Veteran works for the city of Murfreesboro as a patrol officer and does trainings all the time in law enforcement. He reported that he is not currently in treatment but has had some counseling sessions with his pastor. He denied suicidal ideation or any mental health hospitalizations. He reported having chronic restless sleep, social withdrawal, problems concentrating, and significant trouble relaxing. He has felt down, depressed, and hopeless. He reported often feeling anxious, on edge and having excessive worries. He had problems trusting others and establishing relationships. He also reported having some outbursts at work that have resulted in problems advancing on the police force. At the Veteran's August 2020 Board hearing, the Veteran testified that "I wouldn't say things have necessarily gotten better, but things haven't necessarily got dramatically worse by any means." He believes his condition is the same was when he separated from service and, therefore, a rating of 50 precent is warranted for the period since service. As chronicled above, for the period prior to October 30, 2019, the Veteran clearly experienced psychiatric symptomatology as a result of his PTSD with symptoms such as anxiety and sleep impairment. However, the objective evidence of record does not establish that his PTSD was manifested by occupational and social impairment with reduced reliability and productivity prior to October 30, 2019. In support of such finding, the Board assigns great probative value to the September 2014 and September 2015 VA medical examinations. The September 2014 VA examiner, a licensed psychiatrist, thoroughly reviewed the Veteran's mental history and diagnosed the Veteran with unspecified trauma and stressor related disorder under DSM-5 criteria. The examiner opined that the Veteran had a mental condition that had been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. The September 2015 VA examiner, a licensed psychiatrist, thoroughly reviewed the Veteran's mental history and diagnosed the Veteran with unspecified trauma and stressor related disorder under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. Additionally, the Board has taken into consideration the frequency, severity, and duration of the Veteran's symptoms of PTSD during the appellate period, as well as his statements regarding his assessment of the severity of his symptoms. However, the symptoms presented here, and their resulting effects, do not rise to the level of the next higher ratings in excess of 30 percent. In consideration of occupational functioning, an August 2015 VA psychiatry consult reported that the Veteran was working in law enforcement as a volunteer deputy. In June 2016, he reported that he enjoyed his work and stated he had no immediate concerns and was not interested in therapy at this time. An April 2019 VA primary care note indicated that the Veteran was employed by the city of Murfreesboro and was doing well overall. In October 2019, the Veteran reported that he worked for the city of Murfreesboro as a patrol officer and "does trainings all the time in law enforcement." The Board finds that such findings are not consistent with a higher 50 percent rating for occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete task); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. For these reasons, the Board finds that, prior to October 30, 2019, the Veteran's PTSD has not been manifested by symptomatology more nearly approximating the criteria for a 50 percent disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9411. The benefit-of-the-doubt doctrine is not for application, and an increased rating under this code is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the claim for a rating in excess of 50 percent for the Veteran's PTSD, from April 11, 2012 to December 4, 2019, must be denied. 2. Entitlement to a compensable rating for bilateral hearing loss is denied. A May 2015 rating decision granted service connection for bilateral sensorineural hearing loss and assigned an initial rating of 0 percent, effective May 5, 2015. A September 2015 rating decision denied entitlement to an increased rating. The Veteran disagrees with the assigned rating for his bilateral sensorineural hearing loss and seeks a higher rating under 38 C.F.R. § 4.85, Diagnostic Code 6100. Under Diagnostic Code 6100, ratings for hearing loss are determined in accordance with the findings obtained on audiometric examination. Evaluations of hearing impairment range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1,000; 2,000; 3,000; and 4,000 Hertz (cycles per second). To evaluate the degree of disability from hearing impairment, the rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Diagnostic Code 6100. As set forth in the regulations, Tables VI, VIa, and VII are used to calculate the rating to be assigned. See 38 C.F.R. § 4.85, Diagnostic Code 6100. Hearing tests will be conducted without hearing aids, and the results of above-described testing are charted on Table VI and Table VII. See 38 C.F.R. § 4.85. The Veteran received a VA audio examination in September 2014. A VA audiological evaluation revealed pure tone thresholds, in decibels, for the right ear at 10 (500 Hz), 10 (1000 Hz), 20 (2000 Hz), 25 (3000 Hz), 75 (4000 Hz), and for the left ear at 5 (500 Hz), 5 (1000 Hz), 5 (2000 Hz), 40 (3000 Hz), 70 (4000 Hz). Speech audiometry revealed speech recognition ability of 90 percent in the right ear and 90 percent in the left ear. The examiner reported that the Veteran's hearing loss impacted ordinary conditions of life, including ability to work. The examiner documented that the Veteran reported he often has to ask people to repeat themselves. Based on the September 2014 audiogram results, with the utilization of Table VI, the Veteran has Level II hearing impairment in the right ear and Level II hearing impairment in the left ear. Application of those findings to Table VII, results in a noncompensable disability rating under 38 C.F.R. § 4.85, Diagnostic Code 6100. The Veteran received another VA audio examination in September 2015. A VA audiological evaluation revealed pure tone thresholds, in decibels, for the right ear at 10 (500 Hz), 10 (1000 Hz), 15 (2000 Hz), 35 (3000 Hz), 70 (4000 Hz), and for the left ear at 10 (500 Hz), 5 (1000 Hz), 15 (2000 Hz), 5 (3000 Hz), 75 (4000 Hz). Speech audiometry revealed speech recognition ability of 94 percent in the right ear and 92 percent in the left ear. The examiner reported that the Veteran's hearing loss impacted ordinary conditions of life, including the ability to work. The examiner documented that the Veteran reported he often needs repetition in conversation, especially when there is other noise in the room or if the speaker has a soft voice. Based on the September 2015 audiogram results, with the utilization of Table VI, the Veteran has Level I hearing impairment in the right ear and Level I hearing impairment in the left ear. Application of those findings to Table VII, results in a noncompensable disability rating under 38 C.F.R. § 4.85, Diagnostic Code 6100. The Veteran received another VA audio examination in October 2019. A VA audiological evaluation revealed pure tone thresholds, in decibels, for the right ear at 10 (500 Hz), 10 (1000 Hz), 15 (2000 Hz), 40 (3000 Hz), 75 (4000 Hz), and for the left ear at 10 (500 Hz), 10 (1000 Hz), 10 (2000 Hz), 55 (3000 Hz), 80 (4000 Hz). Speech audiometry revealed speech recognition ability of 100 percent in the right ear and 100 percent in the left ear. The examiner reported that the Veteran's hearing loss impacted ordinary conditions of life, including the ability to work. The examiner documented that the Veteran reported he needs to lean forward to hear soft-spoken people and has problems in a variety of situations, including background noise situations. He sometimes feels left out of conversations and needs to ask people to repeat quite frequently. Based on the October 2019 audiogram results, with the utilization of Table VI, the Veteran has Level I hearing impairment in the right ear and Level I hearing impairment in the left ear. Application of those findings to Table VII, results in a noncompensable disability rating under 38 C.F.R. § 4.85, Diagnostic Code 6100. At the Veteran's August 2020 Board hearing, the Veteran testified that he often has to ask others to repeat themselves. He reported he was issued noise-canceling hearing aids that he does not like to wear. The Veteran stated that the audio testing results were not an accurate reflection of the real-world impacts of his hearing loss. At no time during the appeal period has the Veteran's hearing loss disability been shown to rise to the level of symptomatology required to support a higher rating. The evaluation for hearing loss is based on objective testing. Thus, the objective VA examination report does not support an assignment of a disability rating in excess of what the Regional Office has already awarded a noncompensable rating for the entirety of the appeal period. As such, a compensable rating is not warranted. Although the Board does not doubt the sincerity of the Veteran's belief regarding the severity of his hearing loss, as a lay person without the appropriate medical training or expertise, he simply is not competent to provide a probative opinion on a medical matter, such as the severity of a current disability as evaluated in the context of the rating criteria. See Bostain v. West, 11 Vet. App. 124, 127 (1998). The Board in no way discounts the difficulties the Veteran experiences as a result of his hearing loss. However, it must be emphasized that the assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. Therefore, the Board has no discretion and must make a finding on the rating schedule based on the results of the audiological evaluation of record. Lendenmann v. Principi, 3 Vet. App. 345 (1992). The Board is bound by law to apply VA's rating schedule based on the Veteran's audiometry results. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Board acknowledges that, at the Veteran's August 2020 Board hearing, he stated that the audio testing results were not an accurate reflection of the real-world impacts of his hearing loss. The VA Schedule of Disability Ratings will apply unless there are exceptional or unusual factors that would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). According to the regulation, an extraschedular disability rating is warranted based upon 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 that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). The Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance. When the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for completion of the third step a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. 38 C.F.R. § 3.321(b)(1). The Board notes that, in Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the Court held that, relevant to VA audiological examinations, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. The Court's rationale in requiring an examiner to consider the functional effects of a Veteran's hearing loss disability involves the potential application of 38 C.F.R. § 3.321(b) in considering whether referral for an extra-schedular rating is warranted. Specifically, the Court noted that, "[u]nlike the rating schedule for hearing loss, 38 C.F.R. § 3.321(b) does not rely exclusively on objective test results to determine whether a referral for an extra[-]schedular rating is warranted. The Secretary's policy [requiring VA audiologists to describe the effect of a hearing disability on a Veteran's occupational functioning and daily activities] facilitates such determinations by requiring VA audiologists to provide information in anticipation of its possible application." Martinak, 21 Vet. App. at 455. According to the most recent VA examination of record, conducted in October 2019, the VA examiner indicated that the Veteran's hearing loss impacts ordinary conditions of daily life, including the ability to work. The examiner documented that the Veteran reported he needs to lean forward to hear soft-spoken people and has problems in a variety of situations, including background noise situations. He sometimes feels left out of conversations and needs to ask people to repeat quite frequently. At his August 2020 Board hearing, the Veteran also described difficulties hearing and having to ask others to repeat themselves. The Board finds that both the Veteran and the VA examiner described impairment which is not exceptional or unusual. Rather, difficulty hearing is the type of impairment directly anticipated with a grant of service connection for hearing loss. Moreover, there is no evidence of any marked interference with employment or frequent hospitalization secondary to the Veteran's service-connected hearing loss disability. 38 C.F.R. § 3.321(b)(1). Therefore, a referral for extra-schedular consideration is therefore not required. In conclusion, the preponderance of the evidence is against a compensable rating for the period on appeal. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy is denied. A September 2015 rating decision granted an increased rating from 10 percent to 20 percent for the Veteran's left lower extremity radiculopathy, effective June 5, 2015. The Veteran contends that he is entitled to a higher rating due to the severity of symptoms related to his left lower extremity radiculopathy. The Veteran's left lower extremity radiculopathy is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under this code, a 10 percent evaluation is warranted for mild incomplete paralysis of the sciatic nerve of the lower extremity. A 20 percent evaluation is warranted for moderate incomplete paralysis of the sciatic nerve of the lower extremity. A 40 percent evaluation is warranted for moderately severe incomplete paralysis of the sciatic nerve of the lower extremity. A 60 percent evaluation is warranted for severe incomplete paralysis, with marked muscular atrophy, of the sciatic nerve of the lower extremity. An 80 percent evaluation is warranted for complete paralysis of the sciatic nerve of the lower extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term "incomplete paralysis" indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of this nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Complete paralysis of the sciatic nerve is indicated where the foot dangles and drops, there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The Veteran was provided a VA examination of his thoracolumbar spine in September 2015. The Veteran reported constant pain, spasm, radiculopathy of his left lower extremity, which involved the left sciatic nerve. The examiner reported the Veteran's left lower extremity exhibited severe constant pain, moderate numbness, and moderate paresthesias or dysesthesias. The examiner characterized the left lower extremity radiculopathy as moderate. The Veteran was provided another VA examination of his thoracolumbar spine in October 2019. The Veteran reported constant dull-throbbing ache that radiates to the left lower extremity that is sharp-shooting and lasts a few minutes intermittently. The examiner reported the Veteran's left lower extremity exhibited severe constant pain, moderate numbness, and moderate paresthesias or dysesthesias. The examiner characterized the left lower extremity radiculopathy as moderate. The Board gives great probative weight to the September 2015 and October 2019 examination findings. These findings were based on in-person examinations of the Veteran's radiculopathy. Considering all the evidence, the Board finds the Veteran's radiculopathy symptoms more consistent with moderately severe severity. The evidence does not support that the Veteran's radiculopathy of the left lower extremity produced moderately severe incomplete paralysis to warrant a rating in excess of 40 percent. Moreover, the regulations state that when the involvement is wholly sensory, the rating should be, at most, the moderate degree. In consideration of the above, the Board finds that the preponderance of the evidence weighs against a disability rating for the Veteran's left lower extremity radiculopathy in excess of 20 percent. Consequently, the benefit-of-the-doubt rule does not apply and entitlement to an increased rating as described above, is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). REASONS FOR REMAND 1. Entitlement to a rating in excess of 20 percent for lumbar spine degenerative disc disease from June 5, 2015 is remanded. The Board finds that a remand is necessary before a decision on the merits of the claim can be reached. A September 2015 rating decision granted an increased rating from 10 percent to 20 percent for the Veteran's lumbar spine degenerative disc disease, effective June 5, 2015. The Veteran contends that he is entitled to higher ratings due to the severity of symptoms related to his lumbar spine disability. The Veteran was provided a VA examination in September 2015. The Board finds that the September 2015 examination was inadequate as the examiner failed to estimate the degree of additional range-of-motion loss after repeated use over time. If an examination does not take place during a flare-up or after repeated use, the examiner should attempt to offer an estimate derived from information procured from relevant sources, including the Veteran's lay statements. An examination that fails to attempt to ascertain adequate information from relevant sources regarding frequency, duration, characteristics, severity, or functional loss during flare-ups or after repeated use will be considered inadequate. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). There is no indication that the September 2015 examiner made any attempt to ascertain adequate information from relevant sources to provide an estimate of the degree of additional range-of-motion loss after repeated use over time. The Veteran was provided another VA examination of his thoracolumbar spine in October 2019. The Veteran reported he had daily pain in his lower back that is a constant dull-throbbing ache that radiates to the left lower extremity causing sharp-shooting pain that lasts a few minutes intermittently. The Veteran reported his low back pain increases with bending, squatting, sitting, or standing for prolonged periods of time. He was unable to sleep on his stomach or unable to lift items. The Veteran reported having flare-ups of back pain. He reported having severe pain that lasted 2 or 3 days after working back to back shifts, which happened 3 or 4 times a month. He reported that it took a week and a few treatments of massage, adjustments, and acupuncture to get his pain under control. A review of range of motion testing showed forward flexion of 0 to 80 degrees, extension from 0 to 20 degrees, right lateral flexion from 0 to 25 degrees, left lateral flexion from 0 to 25 degrees, right lateral rotation from 0 to 25 degrees, and left lateral rotation from 0 to 20 degrees. The examiner reported that pain was noted on all movements during the examination that resulted in functional loss. The functional loss was described as decreased range of motion that interfered with bending and lifting. The Veteran was able to perform repetitive-use testing with at least three repetitions with no functional loss. The examination was not conducted immediately after repetitive use over time. The examiner stated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner stated that neither pain, weakness, fatigability, nor incoordination significantly limit functional ability with repeated use over a period of time. The examination was not conducted during a flare-up. The examiner stated that the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. The examiner stated that neither pain, weakness, fatigability, nor incoordination significantly limit functional ability with flare-ups. The examiner was unable to describe any functional loss in terms of range of motion for the following reasons: "After further review of the order request, DBQ, physical exam, reported history and subjective complaints, relevant evidence of record and using my medical knowledge and expertise, there remains no basis to offer additional losses of function or motion when it comes to flare ups." The examiner reported the following additional factors contributing to disability: interference with sitting, interference with standing, and weakened movement due to muscle or of peripheral nerves injury. The examiner reported that the Veteran's degenerative arthritis of the spine and radiculopathy of the left lower extremity cause decreased endurance and increased fatigue. The Board finds that the VA examination performed in October 2019 was inadequate. The examiner indicated that the Veteran exhibited pain during range of motion testing that caused functional loss on all movements but did not specify the degree at which pain began, as required for an adequate assessment under VA case law. See, e.g., DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). The Veteran had previously expressed concern that pain experienced during range of motion testing was not being acknowledged. In July 2018, the Veteran submitted correspondence along with his substantive appeal in which he expressed that his rating was dependent on how he performed at his examination and was asked to bend "even when I said I feel pain and it's not comfortable." The Veteran stated that had he been rated for where the pain started on forward flexion, he would have received a higher rating for his back disability. The Board notes that the Veteran's September 2014 VA examination report reflects objective evidence of pain at points before he completed all assessed movements during range of motion testing. Range of motion testing revealed 75 degrees forward flexion, with objective evidence of painful motion at 35 degrees; 30 degrees extension, with objective evidence of painful motion at 10 degrees; 30 degrees right lateral flexion, with objective evidence of painful motion at 10 degrees; 40 degrees left lateral flexion, with objective evidence of painful motion at 10 degrees; 30 degrees right lateral rotation, with objective evidence of painful motion at 15 degrees; and 30 degrees left lateral rotation, with objective evidence of painful motion at 15 degrees. In consideration of the inadequacy of the October 2019 examination, the Board finds that a remand is warranted for a new VA examination to ascertain the current severity of the Veteran's service-connected lumbar spine disability. 2. Entitlement to a rating in excess of 10 percent for left knee chondromalacia with tendinopathy is remanded. The Board finds that a remand is necessary before a decision on the merits of the claim can be reached. A September 2015 rating decision denied a rating in excess of 10 percent for left knee chondromalacia with tendinopathy. The Veteran contends that he is entitled to a higher rating due to the severity of symptoms related to his left knee disability. The Veteran was provided a VA examination in September 2015. The Board finds that the September 2015 examination was inadequate as the examiner failed to estimate the degree of additional range-of-motion loss after repeated use over time. If an examination does not take place during a flare-up or after repeated use, the examiner should attempt to offer an estimate derived from information procured from relevant sources, including the Veteran's lay statements. An examination that fails to attempt to ascertain adequate information from relevant sources regarding frequency, duration, characteristics, severity, or functional loss during flare-ups or after repeated use will be considered inadequate. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). There is no indication that the September 2015 examiner made any attempt to ascertain adequate information from relevant sources to provide an estimate of the degree of additional range-of-motion loss after repeated use over time. The Veteran was provided another VA knee examination in October 2019. The Veteran described his current symptoms as constant bilateral knee pain. He reported that the pain is worse with prolonged sitting, standing, walking, running, jarring activity, repetitive activity, and weight bearing activity. He reported that he did not experience flare-ups. A review of range of motion testing showed flexion from 0 to 85 degrees and extension from 85 to 0 degrees. The examiner reported that the Veteran exhibited pain with both flexion and extension that causes functional loss. The Veteran was able to perform repetitive-use testing with at least three repetitions with no functional loss. The examination was not conducted immediately after repetitive use over time. The examiner stated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner stated that pain, weakness, fatigability, or incoordination do not significantly limit functional ability with repeated use over a period of time. The examiner was unable to describe any functional loss in terms of range of motion for the following reasons: "Following further review of the Veteran's records and giving consideration to their subjective complaints and objective exam findings, given my clinical knowledge and medical expertise, there remains no rational basis to make a notation regarding any additional losses of function or motion when it comes to repeated use over time." The examination was not conducted during a flare-up. The examiner stated that the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. The examiner stated that pain, weakness, fatigability, or incoordination do not significantly limit functional ability with flare-ups. The examiner reported the following additional factors contributing to disability: interference with sitting, interference with standing, and weakened movement due to muscle or of peripheral nerves injury. The examiner reported that the Veteran's degenerative arthritis of the spine and radiculopathy of the left lower extremity cause decreased endurance and increased fatigue. The Board finds that the VA examination performed in October 2019 was inadequate. The examiner indicated that the Veteran exhibited pain during range of motion testing that caused functional loss on all movements but did not specify the degree at which pain began, as required for an adequate assessment under VA case law. See, e.g., DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). The Veteran had previously expressed concern that pain experienced during range of motion testing was not being acknowledged. In July 2018, the Veteran submitted correspondence along with his substantive appeal in which he expressed that his rating was dependent on how he performed at his examination and was asked to bend "even when I said I feel pain and it's not comfortable." The Veteran stated that had he been rated for where the pain started on forward flexion, he would have received a higher rating for his left knee disability. The Board notes that the Veteran's September 2014 VA examination report reflects objective evidence of pain at a point before he completed flexion during range of motion testing. Range of motion testing revealed forward flexion of 120 degrees, with objective evidence of painful motion at 85 degrees. In consideration of the inadequacy of the October 2019 examination, the Board finds that a remand is warranted for a new VA examination to ascertain the current severity of the Veteran's service-connected left knee disability. 3. Entitlement to a rating in excess of 10 percent for limitation of flexion of the thigh residual of left hip bursitis and iliotibial band syndrome is remanded. 4. Entitlement to a compensable rating for limitation of extension of the thigh residual of left hip bursitis and iliotibial band syndrome is remanded. 5. Entitlement to a rating in excess of 10 percent for limitation of flexion of the thigh, residual of right hamstring strain, is remanded. 6. Entitlement to a compensable rating for limitation of extension of the thigh, residual of right hamstring strain, is remanded. The Board finds that a remand is necessary before a decision on the merits of the claims can be reached. A September 2015 rating decision denied (1) a rating in excess of 10 percent for limitation of flexion of the thigh residual of left hip bursitis and iliotibial band syndrome, (2) a compensable rating for limitation of extension of the thigh residual of left hip bursitis and iliotibial band syndrome, (3) a rating in excess of 10 percent for limitation of flexion of the thigh, residual of right hamstring strain, and (4) a compensable rating for limitation of extension of the thigh, residual of right hamstring strain. The Veteran contends that he is entitled to a higher rating due to the severity of symptoms related to his left and right hip disabilities. The Veteran was provided a VA examination in September 2015. The Board finds that the September 2015 examination was inadequate as the examiner failed to estimate the degree of additional range-of-motion loss after repeated use over time. If an examination does not take place during a flare-up or after repeated use, the examiner should attempt to offer an estimate derived from information procured from relevant sources, including the Veteran's lay statements. An examination that fails to attempt to ascertain adequate information from relevant sources regarding frequency, duration, characteristics, severity, or functional loss during flare-ups or after repeated use will be considered inadequate. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). There is no indication that the September 2015 examiner made any attempt to ascertain adequate information from relevant sources to provide an estimate of the degree of additional range-of-motion loss after repeated use over time. The Veteran was provided another VA examination of the hip and thigh in October 2019. The Veteran reported that his left hip pops out 4 to 5 times a month. He has increased pain and difficulty standing on his left leg when this. He reported experiencing increased pain, decreased range of motion with exercising, running, significant walking, and cycling. The Veteran reported experiencing flare-ups of the hips, which he described as increased pain with increased range of motion activities such as walking, running, cycling. He reported he also had pain when standing or sitting too long in one spot. The Veteran reported experiencing functional loss/functional impairment with his hip and thigh disabilities, which he described as decreased endurance, increased fatigue, and increased pain with significant walking, cycling, running, and sitting or standing in one spot for too long. Range of motion testing of the right hip showed flexion to 115 degrees, extension to 25 degrees, abduction to 40 degrees, adduction to 20 degrees, internal rotation to 35 degrees, and external rotation to 55 degrees. Pain was noted that did not cause functional loss with flexion, extension, abduction, and external rotation. Range of motion testing of the left hip showed flexion to 110 degrees, extension to 20 degrees, abduction to 35 degrees, adduction to 20 degrees, internal rotation to 35 degrees, and external rotation to 50 degrees. Pain was noted that did not cause functional loss with all movements. The Veteran was able to perform repetitive-use testing with at least three repetitions with no functional loss. The examination was not conducted immediately after repetitive use over time. The examiner stated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner stated that neither pain, weakness, fatigability, nor incoordination significantly limit functional ability with repeated use over a period of time. The examination was not conducted during a flare-up. The examiner stated that the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. The examiner stated that neither pain, weakness, fatigability, nor incoordination significantly limit functional ability with flare-ups. The examiner was unable to describe any functional loss in terms of range of motion for the following reasons: "After further review of the order request, DBQ, physical exam, reported history and subjective complaints, relevant evidence of record and using my medical knowledge and expertise, there remains no basis to offer additional losses of function or motion when it comes to flare ups." The examiner reported that weakened movement was an additional factor contributing to the left and right hip disabilities. The Board finds that the VA examination performed in October 2019 was inadequate. The examiner indicated that the Veteran exhibited pain during range of motion testing but did not specify the degree at which pain began, as required for an adequate assessment under VA case law. See, e.g., DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). The Veteran had previously expressed concern that pain experienced during range of motion testing was not being acknowledged. In July 2018, the Veteran submitted correspondence along with his substantive appeal in which he expressed that his rating was dependent on how he performed at his examination and was asked to bend "even when I said I feel pain and it's not comfortable." The Veteran stated that had he been rated for where the pain started on forward flexion, he would have received a higher rating for his hip disabilities. The Board notes that the Veteran's September 2014 VA hip and thigh examination report reflects objective evidence of pain at a point before he completed flexion during range of motion testing. Range of motion testing revealed forward flexion of 120 degrees, with objective evidence of painful motion at 85 degrees. The range of motion testing did not include abduction, adduction, external rotation, and internal rotation. At the Veteran's September 2015 VA hip and thigh examination, after range of motion testing was performed, the examiner reported that there was painful motion that caused functional loss with flexion, extension, abduction, adduction, external rotation, and internal rotation. However, the examiner did not report the point at which pain began on any movements. In consideration of the inadequacy of the October 2019 examination, the Board finds that a remand is warranted for a new VA examination to ascertain the current severity of the Veteran's service-connected left and right hip disabilities. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. Schedule the Veteran for an appropriate examination to ascertain the current severity of his service-connected lumbar spine disability. The contents of the entire electronic claims file, to include a complete copy of the remand, must be made available to the designated individual, and the examination report should include discussion of the Veteran's documented medical history and assertions. 4. The examiner should conduct range of motion testing of the lumbar spine disability (expressed in degrees) on both active motion and passive motion and in both weight-bearing and non-weight-bearing. If pain on motion is observed, the examiner should indicate the point at which pain begins. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, the examiner should clearly explain the basis for this decision. 5. In addition, the examiner should indicate whether, and to what extent, the Veteran experiences functional loss of the lumbar spine due to pain or other symptoms during flare-ups or with repeated use. To the extent possible, the examiner should express any additional functional loss in terms of additional degrees of limited motion. If the examiner concludes that an estimate of the range of motion during flare-ups cannot be provided without resorting to mere speculation, the examiner must support that opinion with a full and complete explanation as to why the examiner cannot provide the requested opinion without resort to mere speculation. 6. Schedule the Veteran for an appropriate examination to ascertain the current severity of his service-connected left knee disability. The contents of the entire electronic claims file, to include a complete copy of the remand, must be made available to the designated individual, and the examination report should include discussion of the Veteran's documented medical history and assertions. 7. The examiner should conduct range of motion testing (expressed in degrees) of the left knee on both active motion and passive motion and in both weight-bearing and non-weight-bearing. If pain on motion is observed, the examiner should indicate the point at which pain begins. The same range of motion testing should also be accomplished for the right knee (for comparison purposes). If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, the examiner should clearly explain the basis for this decision. 8. In addition, the examiner should indicate whether, and to what extent, the Veteran experiences functional loss of the left knee due to pain or other symptoms during flare-ups or with repeated use. To the extent possible, the examiner should express any additional functional loss in terms of additional degrees of limited motion. If the examiner concludes that an estimate of the range of motion during flare-ups cannot be provided without resorting to mere speculation, the examiner must support that opinion with a full and complete explanation as to why the examiner cannot provide the requested opinion without resort to mere speculation. 9. Schedule the Veteran for an appropriate examination to ascertain the current severity of his service-connected left and right hip disabilities. The contents of the entire electronic claims file, to include a complete copy of the remand, must be made available to the designated individual, and the examination report should include discussion of the Veteran's documented medical history and assertions. 10. The examiner should conduct range of motion testing of the left and right hips (expressed in degrees) on both active motion and passive motion and in both weight-bearing and non-weight-bearing. If pain on motion is observed, the examiner should indicate the point at which pain begins. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, the examiner should clearly explain the basis for this decision. 11. In addition, the examiner should indicate whether, and to what extent, the Veteran experiences functional loss of the left and right hips due to pain or other symptoms during flare-ups or with repeated use. To the extent possible, the examiner should express any additional functional loss in terms of additional degrees of limited motion. If the examiner concludes that an estimate of the range of motion during flare-ups cannot be provided without resorting to mere speculation, the examiner must support that opinion with a full and complete explanation as to why the examiner cannot provide the requested opinion without resort to mere speculation. 12. After the development described above, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any determination remains unfavorable to the appellant, send the appellant and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Moore, 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.