Citation Nr: 21064731 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-09 088 DATE: October 21, 2021 ORDER Entitlement to service connection for right ear hearing loss is granted, subject to controlling regulations governing the payment of monetary awards. Entitlement to an initial rating higher than 10 percent for a surgical scar associated with residuals of inguinal hernia is denied. Entitlement to an initial compensable rating for residuals of right inguinal hernia is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), to include on an extraschedular basis pursuant to 38 C.F.R. § 4.16 (b), is remanded. FINDINGS OF FACT 1. The evidence is at least in equipoise as to whether the Veteran's diagnosed right ear hearing loss is etiologically related to his active service. 2. The most probative evidence of record shows that the Veteran's inguinal hernia has been manifested by an easily reducible bulge. 3. The most probative evidence of record indicates that the Veteran's inguinal hernia surgical scar does not limit function and is painful, but not unstable. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for right ear hearing loss have been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.385. 2. The criteria for an initial compensable rating for residuals of right inguinal hernia have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. § 4.114, Diagnostic Code (DC) 7338. 3. The criteria for an initial rating higher than 10 percent for a surgical scar associated with residuals of inguinal hernia are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from April 1998 to April 2002 and from March 2003 to October 2003. These matters are on appeal from November 2013 and December 2016 rating decisions. In April 2019, the Veteran testified before the undersigned Veterans Law Judge at a video conference hearing. The hearing transcript is of record. In July 2019 and June 2020 these matters were remanded by the Board for further development. The service connection and increased rating claims are now ready for adjudication. Service Connection Claim Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In addition, certain diseases, such as sensorineural hearing loss, are presumed to have been incurred in service if manifested to a compensable degree within one year after service. The presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). When chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim for such diseases. 38 C.F.R. § 3.303 (b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran asserts that he has right ear hearing loss that is related to exposure to gunfire, artificial fragmentation, and artillery during service. He had a military occupational specialty (MOS) of rifleman, security force guard, and military police officer. In this regard, the Veteran's claimed exposure to acoustic trauma during service is consistent with the circumstances, conditions, and hardships of his service, and is credible. See 38 U.S.C. § 1154 (b). Hearing impairment is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz 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 service treatment records (STRs) are void of any diagnosis of hearing loss for VA purposes. Post-service, on July 2016 VA hearing loss and tinnitus Disability Benefits Questionnaire (DBQ) examination the examining audiologist diagnosed right ear sensorineural hearing loss, but concluded that the Veteran had normal hearing in the left ear. However, the results did not show right or left ear hearing loss for VA compensation purposes. The examiner opined that the hearing loss was less likely than not caused by or related to noise exposure in service, because the Veteran's hearing was normal at the time of his in-service audiometric examination in February 1998 and at the time of his last service audiological examination in March 2003. During his April 2019 Video Conference hearing, the Veteran testified that he was in combat environments during service in security forces and the infantry where he was exposed to artillery and flash bangs without the benefit of hearing protection. He reported that he had right and left ear hearing loss and argued that the July 2016 audiological examination was inadequate, because the examiner did not really inquire about his hearing loss. Accordingly, in July 2019 the Board remanded the claim for an adequate examination to include consideration of the Veteran's lay statements. The Board indicated that if the Veteran's reports were discounted, the examiner should provide a reason for doing so. Pursuant to the Board's remand, on January 2020 VA hearing loss and tinnitus the Veteran reported that he first noticed hearing loss after 2006 following heavy combat. Military noise exposure included gunfire, artificial fragmentation, and artillery. The Veteran was provided hearing protection, but initially had to fire his new weapon without hearing protection. Post-service, he reported that he worked for the government and was exposed to gunfire and explosions where hearing protection was mandated. After a thorough review of the claims file and an examination of the Veteran, the examining audiologist diagnosed sensorineural hearing loss in the right ear. However, 2000 Hz was the only auditory threshold that was less than 26 decibels, specifically 20 decibels, and the speech recognition score was 94 percent. These audiometric results support a diagnosis of right ear hearing loss for VA purposes. 38 C.F.R. § 3.385. The examining audiologist opined that right ear hearing loss is not related to service. The rationale was that there was no significant permanent shift in hearing thresholds beyond test variability from auditory damage on active duty from conceded noise. There was no report of complaint/treatment for hearing decrease in the STRs or at separation. Although noise exposure is conceded and the relationship of noise, auditory damage and hearing loss is well-established, but are not conceded based on noise alone. There must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology. The examining audiologist stated that no evaluation was reported at separation. However, evaluations performed in March 2005 (following his separation date) show normal hearing sensitivity. The Veteran reported the onset of tinnitus during service in 2000 after a round of shooting following a training week. The examining audiologist related tinnitus to service based on conceded noise during active duty. Service connection for tinnitus was granted in an April 2020 rating decision. In a June 2020 remand, the Board noted that the examiner found that the Veteran's hearing loss was not related to his service based on the rationale that there was no significant permanent shift in hearing thresholds from entrance to separation. The examiner cited to a March 2005 audiological evaluation conducted soon after separation that showed normal hearing. However, the Board found that the evidence did not support a March 2005 VA audiological evaluation was performed which was significant as it appeared the examiner relied on an incorrect factual premise for her opinion. The Board remanded the claim for an etiological opinion from a VA clinician to address any shifts of acuity threshold found in the STRs and discuss relevant evidence including in-service noise exposure post-service noise exposure, and the progression of the Veteran's hearing impairment. Pursuant to the Board's remand, on November 2020 VA hearing loss and tinnitus DBQ examination, the examining audiologist diagnosed sensorineural hearing loss in the right ear. Auditory thresholds were greater than 26 decibels at 3000 Hz and 4000 Hz with a speech recognition score of 100%. These audiometric results do not support a diagnosis of right ear hearing loss for VA purposes. 38 C.F.R. § 3.385. However, the VA audiologist opined that the Veteran's right ear hearing loss was related to service. The rationale was that the entrance examination of February 1998 revealed normal hearing. The separation examination from his first period of service in 2001 revealed normal hearing. There was no separation examination from 2003 from the Veteran's second period of service. The Veteran reported a decrease in hearing during active duty. Noise exposure on active duty was conceded based on his MOS of military police officer which had a moderate probability of hazardous noise exposure. The hearing loss noted on examination was consistent with noise-induced hearing loss and was beyond the normal progression for age. The examiner opined that there was no evidence to confirm or deny a significant shift in hearing thresholds or auditory damage from conceded noise. In the absence of proof otherwise, the Veteran's hearing loss was related to acoustic trauma from noise exposure. In November 2020 the AOJ requested an addendum from an appropriate clinician regarding the etiology of the Veteran's claimed right ear hearing loss, including consideration of any shifts of acuity thresholds in the STRs. The clinician was also asked to address relevant evidence such as in-service noise exposure, post-service noise exposure, and the nature and progression of the Veteran's hearing impairment. On December 2020 VA hearing loss and tinnitus DBQ examination, the examining audiologist diagnosed sensorineural hearing loss in the right ear. Auditory thresholds for all five frequencies from 500, 1000, 2000, 3000, or 4000 Hz were greater than 26 decibels with a speech recognition score of 100%. These audiometric results support a diagnosis of right ear hearing loss for VA purposes. 38 C.F.R. § 3.385. However, the examining audiologist opined that the Veteran's right ear hearing loss was not related to service. The rationale was that the Veteran had normal sensitivity on enlistment and no examination at separation in 2002. However, STRs are negative for transient shifts in thresholds. Noise exposure as a marine rifleman was conceded. The examiner further opined that given the lack of evidence suggesting cochlear damage, it is less likely than not that hearing loss resulted from noise exposure during active duty. On further review of the medical opinion, the Board finds that the examiner failed to consider the Veteran's credible lay statements and testimony regarding the onset of his right ear hearing loss. Accordingly, the December 2020 VA medical opinion is inadequate for adjudication purposes. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Miller v Wilkie, 32 Vet. App. 249, 259-60 (2020). Resolving all doubt in favor to the Veteran, the Board finds that the criteria for service connection for right ear hearing loss are met. See 38 U.S.C. § 1507; 38 C.F.R. § 3.102. The nature and extent of this disability caused by service is not currently before the Board. Increased Rating Claims 1. Inguinal hernia The Veteran contends that his service-connected residuals of right inguinal hernia repair are more severe than his noncompensable rating would indicate. The Veteran's residuals of right inguinal hernia repair are rated under DC 7338. Under this code, a noncompensable rating is warranted where the inguinal hernia is small, reducible, or without true hernia protrusion, or not operated, but remediable. A 10 percent evaluation is warranted where the inguinal hernia is postoperative recurrent, readily reducible, and well-supported by truss or belt. A 30 percent evaluation is warranted for a small hernia, which is postoperative and recurrent or unoperated irremediable, and not well-supported by a truss, or not readily reducible. A 60 percent evaluation is warranted for a large, postoperative, recurrent hernia that is not well-supported under ordinary conditions and not readily reducible, when considered inoperable. A Note to the Diagnostic Code indicates that 10 percent is added for bilateral involvement, providing the second hernia is compensable. 38 C.F.R. § 4.114. Turning to the evidence on July 2016 VA hernias DBQ the Veteran presented with a history of a bulge in the right inguinal area diagnosed as an inguinal hernia. In November 2000, he underwent a herniorrhaphy on the right side after which he developed a pulling sensation with physical activity, especially twisting movements. On examination no hernia was detected. The Veteran had no other pertinent physical findings, complications, conditions, signs, or symptoms related to his hernia. The examiner opined that the Veteran's hernia disability did not impact his ability to work. In his February 2017 substantive appeal the Veteran stated that his hernia surgery resulted in complications to include internal bleeding, blood clot, abnormal scar, stretched scrotum, and swollen testicle. At the April 2019 hearing, the Veteran's representative identified residuals of his inguinal hernia, including an internal blood clot, swollen testicles, stretched scrotum, and an abdominal scar. The Veteran testified that he had some erectile dysfunction since he was 21 years old. Pursuant to the Board's July 2019 remand, on January 2020 VA hernias DBQ examination the Veteran was diagnosed with residuals of a hernia. The Veteran presented with a history of medical care in October 2000 with complaints of a right inguinal bulge for the past 4 months. The examination noted an easily reducible bulge. The Veteran stated that he developed internal bleeding after surgery and had to undergo another surgery to stop the bleeding. After the second surgery he stated that he developed severe bruising on the right side of his body and right testicle. He was discharged from the hospital then readmitted for severe pain and remained in the hospital for several days. In November 2000, a resolving scrotal hematoma was noted. However, he continued to treat with his private physician for continued pain and tenderness. On examination there was no true hernia protrusion or any indication for a supporting belt. The examiner opined that the hernia disability impacted his ability to work. He was employed as a security contractor for the federal government. He missed no more than one week of work in the last 12 months. Current symptoms included constant right lower inguinal pain along the incision line. Pain was described as very tender to touch and a feeling of a deep bruise. Pain was rated a 5 out of 10 on the pain scale, unless twisting at the waist. Pain suddenly spiked to a 6 or 7 out of 10 during twisting motion. Pain was described as a rubber band being pulled through a hole. The area surrounding the incision became very irritated when wearing heavy body armor and gun belt as part of his occupation. The scrotal sac was enlarged due to a hematoma. In June 2020, the Board remanded the claim for a VA examiner to evaluate the Veteran's reported hernia, residuals of a stretched scrotum, swollen testicles, and erectile dysfunction. For each symptom, the examiner was asked to opine as to whether it was related to his inguinal hernia. Pursuant to the Board's remand, on October 2020 VA hernias DBQ examination the examiner diagnosed inguinal hernia. The Veteran presented with symptoms of a constant dull achiness in the right groin rated a 4 to 5 out of 10 on the pain scale. Pain became very sharp and spiked from 6 to 7 out of 10 with twisting motions or lifting/carrying heavier items. The Veteran felt a pulling sensation in the surgical area which "[felt] like rubber band being pulled through a hole." When the twisting motion stopped, sharp pain stopped. The incision became very irritated when wearing any type of belt due to rubbing. Right scrotal sac was larger than the left side. There was internal pain under the incision with deep palpation. On examination, no hernia was detected and there was no indication for support. The right scrotal sac was noted to be longer than the left side. The examiner opined that the hernia disability impacted his ability to work as a federal security contractor. However, he lost no more than one week of employment in the last 12 months. Wearing body armor and gun belts could cause constant friction along the incision causing pain, tenderness, and irritability. On June 2021 VA male reproductive organs DBQ examination the examiner noted that the hernia repair, complicated by large hematoma that extended to the scrotum, had resolved. His current symptom included a painful scar and erectile dysfunction. The examiner opined that the erectile dysfunction was likely due to aging. The examiner further opined that residuals of a stretched scrotum and swollen testicles did not warrant a diagnosis. The examiner explained that the Veteran had a large hematoma that extended into the scrotum which completely resolved without any residual. His scrotum was not stretched and his testicles were not swollen. On June 2021 VA hernias DBQ examination the examiner diagnosed an inguinal hernia. He presented with a history of inguinal herniorrhaphy since 2000. There were no other pertinent physical findings, complications, signs, or symptoms related to the hernia. The examiner opined that the hernia disability did not impact the Veteran's his ability to work. The examiner stated that there was a worsening of the Veteran's symptoms, but no additional diagnosis was rendered. Additional disabilities were found which the examiner opined were unrelated to the service-connected hernia and had resolved. After review of the evidence, the Board finds that an initial compensable rating for residuals of right inguinal hernia is not warranted. The Board finds that there are no indications that the Veteran's right inguinal hernia is postoperative recurrent, readily reducible, and well-supported by truss or belt. On July 2016 VA examination no hernia was detected. On January 2020 VA examination an easily reducible bulge was noted. On October 2020 VA examination no hernia was detected and there was no indication for support. Accordingly, the evidence of record does not show that the Veteran's right inguinal hernia warrants the assignment of an initial compensable rating. The Board has considered whether the Veteran's claimed residuals of hernia repair, to specifically include erectile dysfunction, swollen testicles, and residuals of a stretched swollen, warrant the assignment of a higher rating, but finds that they do not. Pursuant to the Board's June 2020 remand, the examiner opined that the Veteran's erectile dysfunction was likely due to aging. The examiner further opined that residuals of stretched scrotum and swollen testicles, did not warrant a diagnosis. The examiner explained that the Veteran had a large hematoma that extended into the scrotum which completely resolved without any residual. The examiner further stated that the Veteran's scrotum was not stretched and his testicles were not swollen. Accordingly, the Board finds that the evidence does not support a finding that an initial compensable rating is warranted for the Veteran's residuals of right inguinal hernia. 2. Hernia surgical scar In evaluating skin and scar residuals, the Board notes that effective August 13, 2018, VA amended its regulations governing skin disabilities. VA's intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018). Disabilities of this nature are rated under disfigurement to the head, face, and neck (DC 7800), scars (DC 7801-7805) or dermatitis (DC 7806), whichever is the most predominant. The scar regulations were revised effective August 13, 2018 and these new regulations apply to claims that were pending on August 13, 2018 (as here), if the new regulations are more favorable to the Veteran's case. Thus, the Board will discuss both the old and new scar regulations and apply the more favorable criteria to the Veteran's claim where appropriate. 38 C.F.R. § 4.118, Codes 7800-05. A review of the newly revised rating criteria for scars shows that only Codes 7801 and 7802 were revised. However, as none of the VA examinations or post-service treatment records show that the Veteran's scar is deep and nonlinear; associated with underlying soft tissue damage in an area or areas exceeding 6 square inches (39 sq. cm.); superficial and nonlinear; and is not associated with underlying soft tissue damage in an area or areas of 144 square inches (929 sq. cm.) or greater, Diagnostic Codes 7801 and 7802 are inapplicable and do not warrant the assignment of a separate or higher rating for the scar. 38 C.F.R. § 4.118, DCs 7801 and 7802 (in effect before and after August 13, 2018). The rating criteria under Codes 7800, 7804 and 7805 were not changed in the new revisions (only the header of Code 7805 was revised) and applicable to the Veteran's claim. 38 C.F.R. § 4.118. Diagnostic Code 7800 provides ratings for scars of the head, face, or neck and is not applicable in this case as Diagnostic Code 7800 does not provide a rating for a left flank or abdominal scar. Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars; or one or two painful or unstable scars with at least one scar being both painful and unstable, warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Diagnostic Code 7805 provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under DCs 7800-04 under an appropriate DC. 38 C.F.R. § 4.118. The Veteran contends that his service-connected inguinal hernia surgical scar is more severe than his initial 10 percent rating would indicate. The Veteran's surgical scar is rated under DC 7804. Procedurally, a December 2016 Decision Review Officer decision granted service connection and assigned a noncompensable rating for a surgical scar effective July 24, 2013, under DC 7802. In a November 2020 rating decision the RO increased the rating for the Veteran's inguinal surgery scar from noncompensable (zero percent) to 10 percent, effective July 24, 2013, under DC 7804. However, as this grant does not represent a total grant of benefits sought on appeal, the claim for increase remains before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Turning to the evidence, on July 2016 VA DBQ examination there was a scar in the right inguinal area that measured 8 centimeters by .5 centimeters. At the April 2019 hearing, the Veteran testified that there was "tight pain on the scar" and that the scar was hard. When he twisted it felt like a rubber band being stretched. The scar was "indented." On January 2020 VA examination there was a build-up of a scar under the incision line causing tenderness. The scar measured 9.0 cm by .1 cm. It was not painful or unstable, did not have a total area equal to a greater than 39 sq cm, and was not located on the head, face, or neck. On October 2020 VA scars/disfigurement DBQ examination the Veteran's scar was noted to be well-healed and stable with normal coloration, but became irritated with prolonged friction. On examination there was a build-up of scar tissue under the incision line causing tenderness. The scar measured 9.0 cm by .1 cm. It was not painful or unstable, have a total area equal to a greater than 39 sq cm, or located on the head, face, or neck. The right inguinal area scar was slightly tender to the touch. It was not unstable with frequent loss of coverage of skin over the scar. The scar is located on the anterior truck, right inguinal area. It was tender to palpation with no underlying tissue damage. The examiner opined that the scar impacted the Veteran's ability to work as a federal security contractor. He lost no more than one week of employment in the last 12 months. Wearing body armor and gun belts caused constant friction along the incision causing pain and tenderness. After review of the evidence, the Board does not find that the Veteran is entitled to an initial 20 percent rating for his right inguinal hernia surgical scar. There is no competent evidence to suggest that the Veteran's scarring is manifested by three or four scars that are unstable or painful scars. In addition, there is no evidence that the inguinal hernia surgical scar resulted in functional or occupational impairment or limitation of the abdomen or torso. As such, the Board also finds that the preponderance of the evidence is against an initial rating higher than 10 percent, for an inguinal hernia surgical scar. Additional considerations In this case, the Veteran is competent to report complaints such as pain and tenderness, as these observations come to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board also acknowledges the Veteran's belief that his symptoms are of such severity as to warrant a higher rating and has taken these contentions seriously. He is not, however, competent to identify a specific level of disability of his surgical scar according to the appropriate diagnostic code. On the other hand, such competent evidence concerning the nature and extent of the Veteran's surgical scar has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluation. The medical findings (as provided in the examination reports) directly address the criteria under which this disability is evaluated. The Board acknowledges that in the August 2021 Brief the Veteran's representative stated that the Veteran's increased ratings were "in fact warranted with extraschedular consideration." However, the Board finds that referral for extra-schedular consideration is not appropriate. In the April 2021 Brief and the Board hearing, the Veteran's representative asserted entitlement to extra-schedular ratings but did not identify specific symptoms not considered by the rating criteria or otherwise explain why the rating criteria are inadequate to rate the Veteran's disability picture. In Thun v. Peake, 22 Vet. App. 111, 115 (2008), the Court of Appeals for Veterans' Claims (Court) set out a three-part test for determining when referral for extra-schedular consideration is warranted, based on the language of 38 C.F.R. § 3.321(b)(1). In Long v. Wilkie, 33 Vet. App. 167 (2020), the Court explained that the first step in Thun requires truly exceptional or unusual symptoms, which are incapable of evaluation by conventional rating means. The Veteran's symptoms consist of pain and tenderness which are all common symptoms of inguinal hernia surgery and scarring and compensated by the ratings assigned. The evidence does not show exceptional or unusual symptoms incapable of evaluation with the rating criteria. Thus, referral for extra-schedular consideration is not warranted. See Long, 33 Vet. App. at 167; see also Chudy v. O'Rourke, 30 Vet. App. 34, 39 (2018). Finally, with the exception of TDIU claim addressed in the remand below, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). (Continued on the next page) REASONS FOR REMAND TDIU The Veteran contends that his service-connected left knee and residuals of right inguinal hernia disabilities contribute to his inability to work. See May 2020 Brief. Initially, the Board notes that the Veteran's current employment status is unclear and the Veteran has not provided VA with a completed Form 21-8940. On remand, a VA Form 21-8940 should be completed to fully develop his claim. At the April 2019 hearing, the Veteran testified that while working as a contractor he has difficulties due to residuals of the inguinal hernia. On January 2020 VA knee and lower leg conditions DBQ examination the examiner opined that the Veterans left knee disability impacted his ability to perform any type of occupational task. However, he lost no more than one week of employment in the last 12 months due to his left knee disability. On October 2020 VA examination the examiner opined that the hernia disability impacted his ability to work as a federal security contractor. However, at this time the Veteran does not meet the schedular requirements for consideration of a TDIU. 38 C.F.R. § 4.16 (a). The Board may not assign an extraschedular rating in the first instance because the authority for doing so is vested in VA's Director of Compensation Service. The Board may, however, consider whether remand to the RO for referral to the Director of Compensation Service is warranted. See 38 C.F.R. § 4.16 (b). Because there is evidence that the Veteran has been unable to work due to his service-connected left knee disability and he did not meet schedular criteria, the Veteran's TDIU claim must be referred for extraschedular consideration of TDIU. See Wages v. McDonald, 27 Vet. App. 233, 236 (2015). The matters are REMANDED for the following actions: 1. Rate the now service-connected right ear hearing loss disability. 2. Contact the Veteran and verify his employment history and send the Veteran a VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability, to be fully completed and returned to VA. 3. Then, after reviewing the record and conducting any additional development deemed necessary, in accordance with 38 C.F.R. § 4.16 (b), refer this case to the Director, Compensation and Pension Service (C&P) for consideration of an extra-schedular TDIU award (38 C.F.R. § 4.16 (b). This referral should include a full statement of the Veteran's service-connected disabilities, as well as his employment, educational, and medical histories. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Adams, 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.