Citation Nr: 21065834 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 20-11 117 DATE: October 27, 2021 ORDER Entitlement to a 70 percent rating, but no higher, for posttraumatic stress disorder (PTSD) is granted. Entitlement to a compensable rating for bilateral hearing loss is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's PTSD more nearly approximated the criteria for a 70 percent rating, causing occupational and social impairment with deficiencies in most areas, but not total social and occupational impairment. 2. The Veteran's bilateral hearing loss was manifested by no worse than Level II hearing loss in his right ear and Level IV hearing loss in his left ear, resulting in a non-compensable disability rating. CONCLUSIONS OF LAW 1. The criteria for a 70 percent rating, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for a compensable disability rating for bilateral hearing loss disability are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.85-4.87, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Navy from July 1964 to September 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision issued by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). Increased Ratings Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical, as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods of time based on facts found, a practice known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. For an increase in disability compensation, the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within one year from such date. Otherwise, the effective date will be the date of receipt of claim. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (o)(2). In order for entitlement to an increase in disability compensation to arise, the disability must have increased in severity to a degree warranting an increase in compensation. See Hazan v. Gober, 10 Vet. App. 511, 519 (1992). Thus, determining whether an effective date assigned for an increased rating is correct or proper under the law requires: (1) a determination of the date of the receipt of the claim and (2) a review of all the evidence of record to determine when an increase in disability was "ascertainable." Hazan, 10 Vet. App. at 521. 1. Entitlement to an Increased Disability Rating for PTSD The Veteran filed his increased rating claim for PTSD on September 13, 2018 and an increase in disability was ascertainable at least one year prior to this filing. Accordingly, the appeal period begins on September 13, 2017. 38 C.F.R. § 3.400 (o)(2). The Veteran is in receipt of a 50 percent disability rating for PTSD under 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula, a 50 percent rating is assigned when a veteran's psychiatric disability causes 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-term 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; or difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130. A 70 percent evaluation is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the 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. 38 C.F.R. § 4.130. The maximum schedular rating of 100 percent is warranted when 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; and memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the Veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126 (a). The rating agency shall assign an evaluation based on all 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. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation on the basis of social impairment. 38 C.F.R. § 4.126 (b). Symptoms listed in the General Rating Formula are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, which would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the diagnostic code. Id. Instead, VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment. Id. Factual Background Turning to the evidence, treatment records from 2018 and 2019 reveal that the Veteran had engaged in medication management and counseling on a frequent and consistent basis. During all of his visits, the Veteran presented with essentially normal mental status with the exception of his mood. He was oriented to time, person, place, and situation. He was adequately groomed. He was pleasant and cooperative, and he exhibited good eye contact. He also exhibited normal speech and no evidence of psychomotor retardation or agitation. He exhibited organized and goal directed thoughts and he did not exhibit signs of paranoia, delusions, ideas of reference, obsessions, or compulsions. He denied having any hallucinations or suicidal thoughts and his insight and judgment appeared intact. However, these records also reveal that the Veteran experienced persisting symptoms of nightmares, avoidance, anger, lack of patience, depression, and anxiety, which were described by a treating psychiatric nurse as problematic. This practitioner indicated that the Veteran's symptoms are managed well at times, but at other times, they become intense. In September 2017, the Veteran reported that he wanted to visit a friend in Colorado, but he was unable to do so because of anxiety. He elaborated that he is uncomfortable being away from home for more than a few days and would not fly or drive that far. The Veteran also reported that a movie he watched recently triggered traumatic memories of a ship fire during service. The Veteran exhibited notable improvement to his mood during a visit in November 2017. However, he complained of persisting irritability and frustration due to his chronic back pain during a visit in December 2017. He also complained of irritability during a visit in January 2018. At this time, he complained of become short tempered with salespeople in stores. He complained of having days with depressed moods and indicated that he tries to keep himself distracted. He also reported a few nights of bad nightmares after watching a movie about war. When the Veteran returned for treatment in March 2018, he reported that it had been a bad month for him. He was grieving the sudden death of a friend and dealing with the anniversary of the suicide of another friend who was also a veteran. He indicated that he tries to keep himself busy to cope with his sadness. The Veteran continued to experience grief and reported the death of a family member during a treatment visit in April 2018. He also reported having a low frustration tolerance in this visit. He complained that simple daily things always go wrong, and he reported that he gets very upset and angry over it. He elaborated that he gets upset with workers at stores when they cannot help him. The Veteran also continued to experience difficulty managing frustration and irritability. In May 2018, he reported that he was doing extensive work on his home, tearing up and redoing his basement. He reported being frustrated over the work and takes it out on his wife. In July 2018, the Veteran's symptoms worsened, and he reported having a bad month. He elaborated that he enlisted in the military and experienced the ship fire in July. He also indicated that his mother died in July. At this time, his treating psychiatric nurse noted that he continued with problematic PTSD symptoms, which included nightmares, avoidance, anger, lack of patience, depression, and anxiety. The Veteran's symptoms persisted, and he reported in August 2018 that he has difficulty every year surrounding the anniversary date of the ship fire. In counseling, he discussed attempts to cope with his memories, which are always present but worse during the anniversary period. He elaborated that he tries to keep himself distracted, but that it only works for a period of time. He also reported that he becomes easily annoyed with other people's behavior and has difficulties dealing with generalized joint and muscle pain. In October 2018, the Veteran was provided a VA examination to assess the nature and severity of his PTSD. The examiner provided diagnoses of PTSD and major depressive disorder and concluded that it is possible to differentiate the symptoms attributable to each diagnosis. For PTSD, the examiner noted symptoms of depressed mood, chronic sleep impairment, flattened affect, disturbances of mood and motivation, difficulty establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work-like setting. The examiner named the same symptoms for the Veteran's major depressive disorder and concluded that memory loss is also attributed to the Veteran's depression. Upon examination, the Veteran's mood appeared stable, but his affect was irritable when he discussed his interactions with others. He voiced many complaints about healthcare personnel, bureaucracy, and technology. He indicated that he gets very easily annoyed with many things. He also reported that he has had altercations with his neighbor who has animals that trespass on his property. However, he was pleasant and cooperative with the examiner and his appearance was neat and well-groomed. The Veteran reported that he has not had any psychiatric hospitalizations or history of suicide attempts. However, he indicated that he things of death a great deal, particularly since his friends have been dying off. During this examination, the Veteran reported that he has good relationships with all his family members, which includes his wife of 54 years, three adult children, 10 grandchildren, and 8 great-grandchildren. He also reported that he shoots pool weekly and belongs to a competitive gun club. He indicated that he also belongs to the VFW and American Legion, but he is less active with these organizations than he has been in the past. With respect to work, he reported that he retired in 2004 and has not had any other employment. During retirement, he indicated that he held officer positions in the VFW and American Legion for a number of years and made clocks that he sold at craft shows. However, he reported that he has stopped performing these activities and currently keeps himself busy by making wood crafts for family members. From this evidence, the examiner concluded that the Veteran has occupational and social impairment with reduced reliability and productivity. The examiner further concluded that moderate impairment can be attributed to each diagnosis. In a November 2018 Notice of Disagreement, the Veteran reported that his PTSD is worse because he has more and more death surrounding him. He also reported having difficulty with mood swings and feeling edgy. Meanwhile, a psychiatry note from June 2021 reveals that the Veteran's PTSD symptoms have persisted. At this time, the Veteran reported that he becomes frustrated and agitated by everything. He elaborated that everything he tries to do is complicated and does not work out easily. He further reported that he gets so frustrated that he wonders if "this is all worth it." At this time, the Veteran had a PCL-5 score of 50. He also had a PHQ-9 score of 13 and a GAD-7 score of 15, which is indicative of moderate depression and anxiety. However, the Veteran did report that he recently spent time with a close friend, who he always looks forward to seeing, and he indicated that he had a good time. On examination, the Veteran exhibited a frustrated mood. Otherwise, his mental status was normal. He was oriented to person, place, time, and situation. He was pleasant and cooperative during the interview. He made good eye contact and his speech was normal. There was no evidence of psychomotor retardation or agitation. His thought content was negative for paranoia, delusions, ideas of reference, obsessions, or compulsions. Veteran denied hallucinations and suicidal thoughts. His remote and recent memory was intact as was his insight and judgment. Analysis The Veteran maintains that he is entitled to at least a 70 percent rating for his psychiatric disability. Based on the above evidence of record, the Board agrees and concludes that a 70 percent rating is warranted for the entirety of the appeal period. However, a rating higher than 70 percent is not warranted at any time during the appeal period. The October 2018 VA examiner concluded that the Veteran has occupational and social impairment with reduced reliability and productivity, which corresponds to a 50 percent rating. However, the examiner also concluded that the Veteran has difficulty adapting to stressful circumstances (including work or a worklike setting), which is contemplated in the 70 percent rating criteria. Treating records also reveal that the Veteran has experienced heightened frustration and irritability with others, which can reasonably be expected to cause difficulty with impulse control. Additionally, treating records reveal that the Veteran reported having passive suicidal ideation due to his difficulties managing frustration and irritability. These symptoms are more closely aligned with a finding of occupational and social impairment in most areas, which corresponds to a 70 percent rating. These records also demonstrate that the Veteran's symptoms cause occupational and social impairment with deficiencies in most areas. Treating records reveal that the Veteran's symptoms have been described as intense at times and are triggered by things that remind him of traumatic events during service, including anniversaries, the deaths of friends, family, and fellow veterans, and movies about to war. During these periods, he experiences heightened irritability and frustration. In this regard, it is noteworthy that the Veteran has had altercations with his neighbor and has reported taking his frustrations out on his wife. Furthermore, treating records reveal that the intensity of the Veteran's symptoms persisted through 2021 and cause difficulty with performing tasks. From this evidence, the Board concludes that the Veteran's symptoms more nearly approximated the criteria for a 70 percent disability rating. However, the Board also finds that a rating greater than 70 percent is not warranted at any time during the period on appeal. There is no evidence on record that the Veteran experiences gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, or intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. Throughout the appeal period, the Veteran's mental status was essentially normal in treating and examining visits. He was oriented to time, person, place, and situation. He was adequately groomed. He was pleasant and cooperative, and he exhibited good eye contact. He exhibited normal speech and no evidence of psychomotor retardation or agitation. He exhibited organized and goal directed thoughts and he did not exhibit signs of paranoia, delusions, ideas of reference, obsessions, or compulsions. He denied having any hallucinations and his insight and judgment appeared intact. Furthermore, the Veteran has maintained relationships with family and friends. He has also engaged in numerous extracurricular activities throughout the appeal period. For example, he reported in October 2018 that he plays pool weekly and belongs to a competitive gun club. He also reported that he goes to the club on Saturdays and spends time with a close friend who comes to visit him from Colorado. Additionally, the Veteran has reported in treating visits that he hunts regularly, and he engaged in an extensive project redoing the basement of his home. This evidence suggests that the Veteran does not have total occupational and social impairment. Thus, the Board finds that a rating higher than 70 percent is not warranted. In sum, the Board concludes that a 70 percent rating is warranted for the entire appeal period. However, the preponderance of evidence is against a finding that a rating greater than 70 percent is warranted at any time during the appeal period. Accordingly, a 70 percent rating, but no higher, is granted. 2. Entitlement to an increased rating for bilateral hearing loss For the entire appeal period, the Veteran has been in receipt of a noncompensable rating for his bilateral hearing loss. The disability is evaluated under 38 C.F.R. § 4.85, Diagnostic Code 6100. In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. Lindenmann v. Principi, 3 Vet. App. 345, 349 (1992). Evaluations of bilateral hearing loss range from noncompensable to 100 percent based on an organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by puretone audiometric tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second. The rating schedule establishes 11 auditory acuity Levels designated from Level I for essentially normal hearing through Level XI for profound deafness. VA audiological evaluations are conducted using a controlled speech discrimination test together with the results of puretone audiometry tests. The vertical line in Table VI (printed in 38 C.F.R. § 4.85) represents nine categories of decibel I loss based on the puretone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to puretone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85 and the statement of the case) by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate for the numeric designation of the level for the ear having the poorer hearing acuity. For example, if the better ear had a numeric designation of Level "V," and the poorer ear had a numeric designation of Level "VII," the percentage evaluation is 30 percent. 38 C.F.R. § 4.85. Regulations also provide that in cases of exceptional hearing loss, i.e., when the puretone threshold at each of the four specified frequencies (1,000, 2,000, 3,000, and 4,000 hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.85 (a). The provisions of 38 C.F.R. § 4.86(b) further provide that when the puretone threshold is 30 decibels or less at 1,000 hertz and 70 decibels or more at 2,000 hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or VIa, whichever results in the higher numeral. That numeral will then be evaluated to the next higher Roman numeral. Factual Background The Veteran was provided with a VA examination in October 2018 to assess the nature and severity of his bilateral hearing loss. The Veteran's hearing was tested and the puretone thresholds (in decibels) were as follows: Hertz 1000 2000 3000 4000 Right Ear 40 50 70 75 Left Ear 45 70 75 70 The pure tone average was 58.75 on the right and 65 on the left. Maryland CNC speech recognition scores were 98 percent in the right ear and 90 percent in the left ear. As required by Martinak v. Nicholson, 21 Vet. App. 447 (2007), the October 2018 examiner elicited information from the Veteran about the functional effects of his hearing loss disability. The Veteran reported having difficulty understanding people and hearing the television. He indicated that he is able to hear but not clearly and he has difficulty hearing from a distance. In November 2018, the Veteran asserted that this testing was not an accurate assessment of his hearing loss. He elaborated that his hearing was tested in a soundproof booth with a headset on and no background noise, which would clearly make it easier to hear. His hearing was tested again in June 2021, and additional impairment was noted. The audiologist noted that a comparison from the 2018 evaluation reveals that the Veteran's thresholds are stable, but the Veteran's understanding abilities are reduced in his left ear. Testing at this time revealed the following: Hertz 1000 2000 3000 4000 Right Ear 45 55 75 75 Left Ear 45 55 75 75 The pure tone average was 62.5 on the right and 68.75 on the left. Maryland CNC speech recognition scores were 92 percent in the right ear and 78 percent in the left ear. Analysis Based upon the results of the VA audiological examination, the Veteran is not entitled to a compensable disability rating. The audiological findings in June 2021 result in a level II assigned for the right ear and a level IV assigned for the left ear in accordance with Table VI of 38 C.F.R. § 4.85. The intersection points for a Level II (right) and Level IV (left) under Table VII of 38 C.F.R. § 4.85 shows that the hearing loss does not exceed the levels contemplated for the currently assigned noncompensable (0 percent) disability rating. Thus, the audiometric evidence of record does not support a finding of entitlement to a compensable disability evaluation for the entire rating period on appeal. Furthermore, neither VA examination established an exceptional pattern of hearing impairment as the Veteran did not exhibit puretone thresholds of loss at 55 or greater at each of the four specified frequencies (1000, 2000, 3000, 4000) 38 C.F.R. § 4.86(a). Additionally, the provisions of 38 C.F.R. § 4.86(b) are not applicable as both ears were not shown to manifest 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hz in either examination. Thus, the audiometric evidence of record does not support a finding of entitlement to a compensable disability evaluation for the entire rating period on appeal. The Board is sympathetic to the Veteran's claims, however, the auditory threshold and speech discrimination evidence provided to the Board does not demonstrate that the Veteran's hearing loss warrants a compensable rating. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1991). In reaching this conclusion, the Board notes that the Veteran maintains that the audiological testing does not adequately account for his hearing loss, which is worse in the presence of background noise. The Board also notes that the June 2021 VA audiologist documented functional impairment from hearing loss, resulting in increased television volume, trouble understanding in conversation with one or two people in noise, trouble understanding in a group setting with background noise, and feeling frustrated from the amount of hearing loss present. Additionally, the Board concludes that an extraschedular rating is not warranted for the Veteran's bilateral hearing loss. Ratings shall be based as far as practicable upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular ratings are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve, on the basis of the criteria set forth in this paragraph, an extraschedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321 (b)(1). The United States Court of Appeals for Veterans Claims (Court) has clarified that there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. Thun v. Peake, 22 Vet. App. 111, 115 (2008). Initially, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. See Yancy v. McDonald, 27 Vet. App. 484 (2016); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding that either the veteran must assert that a schedular rating is inadequate or the evidence must present exceptional or unusual circumstances); Sowers v. McDonald, 27 Vet. App. 472, 478 (2016) ("[t]he rating schedule must be deemed inadequate before extraschedular consideration is warranted"). Second, if the schedular rating does not contemplate the veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether the veteran's disability picture exhibits other related factors such as marked interference with employment and frequent periods of hospitalization. Thun, 22 Vet. App. at 116. Third, if the first two Thun elements have been satisfied, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran's disability picture requires the assignment of an extraschedular rating. Thun, 22 Vet. App. at 116. In other words, the first element of Thun compares a veteran's symptoms to the rating criteria, while the second element considers the resulting effects of those symptoms; if either prong is not met, then referral for extraschedular consideration is not appropriate. Yancy, 27 Vet. App. at 494-95. With respect to the first prong of Thun, the evidence in the instant appeal does not establish such an exceptional disability picture as to render the schedular criteria inadequate. The schedular rating criteria for rating hearing loss provide for disability ratings based on audiometric evaluations, to include speech discrimination and pure tone testing. Here, the Veteran's hearing loss symptoms and described hearing impairments are contemplated by the schedular rating criteria. The Veteran has reported symptoms of difficulty hearing and consequent problems with understanding conversation. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss in various contexts, as measured by both audiometric testing and speech recognition testing. The ability of the Veteran to hear sounds and voices is measured and rated by an audiometric test, as this test measures different frequencies and captures high frequency hearing loss from sources including voices, music, sirens, and certain high-pitched sounds. The ability of the Veteran to understand people, as well as the need to ask others to repeat themselves on a regular basis, is rated by a speech recognition test, as this test measures conversation comprehension, words, and missed conversations. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss, including exceptional hearing patterns which were not demonstrated in this case, and as measured by both audiometric testing and speech recognition testing. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding "that the rating criteria for hearing loss contemplate the functional effects of difficulty hearing and understanding speech"). The Board notes that it logically follows that difficulty hearing and understanding speech would impact a veteran in a variety of ways, including frustration from difficulty hearing, but the rating schedule is not written to account for every possible consequence associated with each symptom. In Doucette, the Court reviewed a similar factual situation, inasmuch as the Board had considered that claimant's report of being embarrassed from having to ask others to repeat themselves, among other reported difficulties, in finding that the resultant effect of the reported symptoms was difficulty hearing. The Court determined that the claimant had not alleged any symptoms in that case that could be considered exceptional or unusual for a claimant suffering from hearing loss. See Id., 28 Vet. App. at 372-73. The decibel loss and speech discrimination ranges designated for each level of hearing impairment in Tables VI and VIa were chosen in relation to clinical findings of the impairment experienced by veterans with certain degrees and types of hearing disability. The regulatory history of 38 C.F.R. §§ 4.85 and 4.86 includes revisions, effective June 10, 1999. See 64 Fed. Reg. 25,202 (May 11, 1999). In forming these revisions, VA sought the assistance of the Veteran's Health Administration (VHA) in developing criteria that contemplated situations in which a veteran's hearing loss was of such a type that speech discrimination tests may not reflect the severity of communicative functioning these veterans experienced or that was otherwise an extreme handicap in the presence of any environmental noise, even with the use of hearing aids. VHA had found through clinical studies of veterans with hearing loss that, when certain patterns of impairment are present, a speech discrimination test conducted in a quiet room with amplification of the sounds does not always reflect the extent of impairment experienced in the ordinary environment. The decibel threshold requirements for application of Table VIa were based on the findings and recommendations of VHA. The intended effect of the revision was to fairly and accurately assess the hearing disabilities of veterans as reflected in a real-life industrial setting. 59 Fed. Reg. 17,295 (Apr. 12, 1994). The inherent purpose of the schedular rating criteria is to determine, as far as practicable, the severity of functional impact resulting from a service-connected disability, including any resultant occupational and social impairment, and therefore contemplates the Veteran's difficulties functioning in a social environment due to hearing loss. Accordingly, the Board finds that the Veteran's reported hearing-related difficulties are factors contemplated in the regulations and schedular rating criteria. See also Doucette, 28 Vet. App. 366 (holding that "the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are precisely the effects that VA's audiometric tests are designed to measure... an inability to hear or understand speech or to hear other sounds in various contexts... are contemplated by the schedular rating criteria"). Accordingly, the Board finds that a compensable rating for bilateral hearing loss is not warranted and the Veteran's claim is denied. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Beech, 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.