Citation Nr: 21069283 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 14-17 338 DATE: November 18, 2021 ORDER Entitlement to an initial compensable evaluation for service-connected bilateral hearing loss is denied. Entitlement to an initial evaluation in excess of 10 percent for service-connected residuals of a left foot cuboid fracture (left foot disability) is denied. FINDINGS OF FACT 1. The hearing loss has been manifested by hearing acuity of no worse than level III hearing in the right ear and level I hearing in the left ear. 2. Throughout the appeal period, the Veteran's left foot disability has manifested by no more than moderate symptoms. CONCLUSIONS OF LAW 1. The criteria for an initial compensable evaluation for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 2. The criteria for a disability rating in excess of 10 percent for service-connected left foot disability have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 2003 to December 2006. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in a November 2017 hearing. These issues were previously before the Board in August 2018, when they were remanded for further development. That development was completed, and the case has since been returned to the Board for appellate review. Initially, the Board notes that the Veteran appointed a representative that is not accredited by the Board to represent them for these matters. In August 2021 the Veteran was sent a letter instructing them on how to appoint new representation, or that they may represent themselves. In September 2021, the Veteran submitted a Pro Se Election Form indicating that they wished to represent themselves, and asked that the Board proceed with the appeal. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). Here, the Veteran filed claims for service connection for bilateral hearing loss, and residuals of a left foot cuboid fracture in April 2009. Service connection was granted in an August 2009 rating decision, and the Veteran filed a timely appeal in July 2010, requesting higher evaluations. Accordingly, the Board will review evidence from April 2009 to the present. 1. Entitlement to a compensable evaluation for service-connected bilateral hearing loss Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100. To evaluate the degree of a disability from defective hearing, the rating schedule establishes eleven auditory levels from level I for essentially normal acuity through level XI for profound deafness. 38 C.F.R. § 4.85. To evaluate an individual's level of disability, Table VI is used to assign a roman numeral designation for hearing impairment based on a combination of the percent of speech discrimination and the puretone threshold average. 38 C.F.R. § 4.85(b). Table VII is used to determine the percentage evaluation by combining the roman numeral designations for hearing impairment for each ear. 38 C.F.R. § 4.85(e). If impaired hearing is service-connected in only one ear, the nonservice-connected ear will be assigned a roman number designation of level I. 38 C.F.R. § 4.85. The rating criteria for alternative ratings when an exceptional pattern of hearing is met if the puretone threshold at each of the specified frequencies of 1000, 2000, 3000 and 4000 Hertz is 55 decibels or more, an evaluation can be based either on Table VI or Table VIA, whichever results in a higher evaluation. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 hertz and 70 decibels or more at 2000 Hertz, the roman numeral designation for hearing impairment will be chosen from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher roman numeral. 38 C.F.R. § 4.86(b). In a May 2009 VA audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 5 5 20 40 17.5 LEFT 50 10 20 35 28.75 Speech audiometry revealed speech recognition ability of 96 percent bilaterally. The May 2009 VA audiological findings correspond to a level I hearing in the right ear and level I hearing in the left ear. 38 C.F.R. § 4.85, Table VI. Under Table VII, this yields a noncompensable evaluation. The Veteran submitted a September 2014 private audiological evaluation where pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 45 55 45 70 53.75 LEFT 15 5 25 30 18.75 This examination did not indicate whether any Maryland CNC speech audiometry testing was conducted. The Veteran submitted a December 2017 private audiological evaluation where pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 35 50 60 85 57.5 LEFT 10 5 25 40 20 This examination did not indicate whether any Maryland CNC speech audiometry testing was conducted. In a November 2019 VA audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 45 55 60 80 60 LEFT 15 10 30 35 22.5 Speech audiometry revealed speech recognition ability of 84 percent in the right ear and 96 percent in the left ear. The November 2019 VA audiological findings correspond to a level III hearing in the right ear and level I hearing in the left ear. 38 C.F.R. § 4.85, Table VI. Under Table VII, this yields a noncompensable evaluation. Although the Veteran provided private audiological examinations, they do not include speech discrimination results verified under Maryland CNC testing. See 38 C.F.R. § 4.85. The August 2018 Board decision remanded in part to provide the Veteran with an opportunity to authorize VA to contact their private provider to obtain clarification regarding whether speech recognition testing was conducted using the Maryland CNC Word List. In July 2019 the RO sent the Veteran a letter asking that they identify and authorize for release records from this private provider. The Veteran did not respond to this letter, and clarification was not obtained from the provider. Accordingly, these results cannot be used to support a compensable evaluation. The Board notes that the VA audiological examination reports noted above describes the effects of the Veteran's hearing impairments on their daily life. See Martinak v. Nicholson, 21 Vet. App. 447 (2007). During the May 2009 VA examination, the Veteran reported difficulty hearing in noisy environments. At the November 2017 Board hearing, the Veteran asserted that they have difficulty speaking on the phone, that they have to ask people to repeat themselves, and that it is difficult to hear others, especially in social settings. During the November 2019 VA examination, the Veteran reported difficulty hearing others, that they speak loudly, that they have trouble in loud environments, and that it has had a tremendous effect on their job. The Board finds the Veteran's lay statements competent and credible. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge); Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by showing of an interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The evaluation of hearing loss, however, is reached by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). Consideration has also been given to whether there is an exceptional pattern of hearing impairment. However, the examination report does not show puretone threshold levels that were 55 decibels or higher at each of the four frequencies, i.e., at 1000, 2000, 3000 and 4000 Hertz, nor were they 30 decibels or less at 1,000 Hertz and 70 decibels or more at 2000 Hertz. See 38 C.F.R. § 4.86(a), (b). Accordingly, the claim of entitlement to a compensable evaluation for service-connected bilateral hearing loss is denied. The Board has also considered whether referral for extraschedular consideration is indicated by the record. In exceptional cases where schedular disability ratings are found to be inadequate, consideration of an extra-schedular disability rating is made. 38 C.F.R. § 3.321(b)(1). There is a three-step analysis for determining whether an extra-schedular disability rating is appropriate. Thun v. Peake, 22 Vet. App. 111 (2008). In this case, the Veteran's symptoms and functional impairment are contemplated by 38 C.F.R. § 4.85, Diagnostic Code 6100 and 38 C.F.R. § 4.86. Diminished auditory acuity and speech recognition testing are the foundation of the schedular criteria. Although the criteria for hearing loss are strictly based on examination findings that are plugged into tables to determine the level of disability, built into this rating system is the recognition that the disability may impose functional impairment based on the Veteran's ability to understand speech. Hence, the rating is based, in part, on speech recognition (i.e., the Veteran's complaints of difficulty hearing or understanding even with their hearing aids). See 38 C.F.R. § 4.85 (a) ("An examination for hearing impairment for VA purposes... must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations will be conducted without the use of hearing aids."). Although the speech discrimination testing does not duplicate all listening situations, it offers consideration as to the level of functional impairment due to Veteran's ability to understand speech by testing without the assistance of hearing aids. The criteria of Diagnostic Code 6100 were revised in 1987 with the goal of recognizing the impact of hearing loss in higher frequencies, and to provide a more accurate picture of true hearing impairment. See Evaluation of Hearing Loss, 52 Fed. Reg. 17,607 (May 11, 1987). As a result, VA changed its testing methods and, in conjunction with the Department of Medicine and Surgery, developed amendments to 38 C.F.R. § 4.85, 4.86a, 4.87a and Tables VI and VII. In particular, puretone averaging was to be accomplished using tone bursts at 1000, 2000, 3000 and 4000 Hertz, and speech recognition was to be measured using the Maryland CNC word lists which contained words with sounds in the 3000 and 4000 Hertz range. See Evaluation of Hearing Loss, 52 Fed. Reg. 17,607. Overall, the new schedule was intended to evaluate hearing loss based on a combination of puretone averages and speech discrimination, which was thought to provide for a more accurate representation of actual hearing impairment by recognizing that individuals with slight to moderate decibel loss as determined by puretone averaging may have significant impairment of speech and vice versa. Additionally, the rating schedule was revised to accommodate language difficulties and other factors which produced inconsistent speech audiometry scores, and to recognize exceptional patterns of hearing impairment. See Evaluation of Hearing Loss, 52 Fed. Reg. 17,607. The rating criteria for hearing loss were last revised, effective June 10, 1999. See 64 Fed. Reg. 25,206 (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. See Schedule for Rating Disabilities; Diseases of the Ear and Other Sense Organs, 59 Fed. Reg. 17295 (April 12, 1994). Thus, the Board finds that functional impairment due to hearing loss that is compounded by background or environmental noise is a disability picture that is considered in the current schedular rating criteria. The Veteran's description of an inability to hear and discriminate speech has been properly measured according to pure tone averages and speech discrimination. In short, the rating criteria reasonably describe the Veteran's disability levels and symptomatology. Furthermore, if the Veteran's hearing loss impacts the ordinary conditions of daily life, this is contemplated in the schedule of ratings and is not a proper consideration for an extraschedular analysis. Given that the average impairment in earning capacity is the standard, within the current rating schedule, many Veterans receiving benefits may experience a greater or lesser impairment of earning capacity than average as a result of their disability. Thun, 22 Vet. App. at 116. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2018) (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). As the evidence preponderates against the claim, there is no reasonable doubt to be resolved. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to an evaluation in excess of 10 percent for service-connected left foot disability When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria."). The Veteran's left foot disability during the appeal period is rated under Diagnostic Code 5284, which provides ratings for Foot injuries, other, and assigns a 10 percent rating for moderate disability (the Veteran's current rating), a 20 percent rating for moderately severe disability, a 30 percent rating for severe disability, and a 40 percent rating for actual loss of use of the foot. 38 C.F.R. § 4.71a. The words moderate, moderately severe, and severe are not defined in the rating schedule. Rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. The use of terminology such as slight and moderate by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The Board notes that "Moderate," as relevant to a physical condition, is defined as "tending toward the mean or average amount" or "having average or less than average quality," or "limited in scope or effect." MERRIAM-WEBSTER'S COLLEGIATE DICTIONARY 798 (11th ed. 2012). "Severe" is defined as "very painful or harmful" or "of a great degree." Id at 1140. The term "severe" is used throughout the rating schedule, including in Diagnostic Code 5284, to indicate a very great degree of the specific listed disability, in order to differentiate between lesser (or sometimes greater) cases of that same disability within the specific diagnostic code. Within the context of Diagnostic Code 5284, which establishes a successive, tiered rating structure, it represents the highest or most extreme level. The Board notes that the diagnostic codes for the foot were amended effective February 7, 2021. DC 5284, however, was not amended. Additionally, there is no medical evidence of record dated after the effective date. Accordingly, the prior provisions apply. The Veteran underwent a VA examination in June 2009. The Veteran described their symptoms as intermittent pain, and that they use over the counter pain medication without much relief. The Veteran asserted flare ups with prolonged ambulation, running, and inclement weather, alleviated by treatment, and shoe inserts without much relief. The Veteran stated that they can walk for as far as needed, but with pain at times, and that they are able to stand for more than 30 minutes. The examiner found tenderness in the left foot, and that the gait was within normal limits. On their VA Form 9, the Veteran requested a 20 percent or higher evaluation, asserting that the condition is at least moderately severe. The Veteran reported that they have pain in their feet after only a short amount of walking or running. April 2017 private treatment records (PTRs) noted constant moderate pain. At the November 2017 Board hearing, the Veteran reported that the foot continues to hurt with any type of physical activity. They indicated that there is a lot of swelling when they fly. The Veteran stated that they sought treatment and were told rest and anti-inflammatories would help. The Veteran reported that there is a lack of range of motion. They described the pain as dull that flares up with humidity and activity and manifests as throbbing moderate pain, and sharp and shooting while golfing. During the November 2019 VA examination, the Veteran described pain with flare ups with prolonged standing, walking, jumping, and lateral movement, and described the functional loss included pain with prolonged standing and walking with lateral movement. The examiner found no pain upon examination, and noted functional loss to include pain on movement. The examiner estimated that there is approximately a five percent loss of lateral movement during flare ups and on repeated use over time. Based on the foregoing, the Board finds that the Veteran's right foot disability has been productive of no more than moderate symptoms. Even with consideration of pain on use and during inclement weather, the Veteran's left foot disability has not more nearly approximated moderately-severe foot injury. In fact, during the November 2019 VA examination, the examiner found no evidence of pain, and estimated that there would only be a 5 percent loss of lateral movement during flare ups and extended use over time. Both VA examiners considered the Veteran's reports of symptoms, the examination findings, and the assessments of impairment and functional loss when making this assessment. No other medical record suggested that the pain and the other symptoms reported by the Veteran results in additional limitation of function to a degree which more nearly approximates moderately-severe disability. The Board acknowledges that VA's General Counsel stated that Diagnostic Code 5284 is a more general diagnostic code under which a variety of foot injuries may be rated; that some injuries to the foot, such as fractures and dislocations for example, may limit motion in the subtalar, metatarsal, and metatarsophalangeal joints; and that other injuries may not affect range of motion. Thus, the VA General Counsel concluded that, depending on the nature of the foot injury, Diagnostic Code 5284 may involve limitation of motion and therefore require consideration under 38 C.F.R. §§ 4.40, 4.45, and DeLuca v. Brown, 8 Vet. App. 202 (1995). See VAOPGCPREC 9-98. In the present case, while consideration of functional loss and DeLuca is warranted, it has been contemplated in the already assigned 10 percent evaluation, since the Veteran's disability involves complaints of painful motion during the appeal. Therefore, a higher 20 percent evaluation for moderately-severe symptoms is not warranted for the Veteran's service-connected right foot disability. 38 C.F.R. § 4.71a, Diagnostic Code 5284. The Board has also considered the other Diagnostic Codes pertaining to the foot. Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991) (holding that the Board must consider all potentially applicable regulatory provisions). Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). The June 2009 VA examination noted a finding of bilateral pes cavus. Pes cavus is rated under Diagnostic Code 5278. A 10 percent rating is assigned for both unilateral and bilateral cavus where there is evidence that the great toe is dorsiflexed, with some limitation of dorsiflexion at ankle, and definite tenderness under the metatarsal heads. A 20 percent rating is assigned for unilateral pes cavus and a 30 percent rating is assigned for bilateral pes cavus where there is evidence of all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads in both feet. A 30 percent rating is assigned for unilateral pes cavus and a 50 percent rating is assigned for bilateral pes cavus where there is evidence of marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity in both feet. 38 C.F.R. § 4.71a, Diagnostic Code 5278. The criteria under Diagnostic Code 5278 are conjunctive, not disjunctive. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive in a statutory provision meant that all of the conditions listed in the provision must be met); cf. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive requirement must be met in order for an increased rating to be assigned). However, the examination only indicated that the left foot was greater than the right, and that there was tenderness at the left foot laterally. There is no indication that the great toe was dorsiflexed. The November 2019 VA examination also found a diagnosis of pes cavus, but indicated that the great toe was not affected, that there was no pain or tenderness to pes cavus, that there was no effect on the plantar fascia, and that there was no dorsiflexion and varus deformity due to pes cavus. As such, a compensable evaluation under DC 5278 would not be warranted. The November 2019 VA examination also found a diagnosis of metatarsalgia, and the examiner indicated that this is a progression of the Veteran's disability. Metatarsalgia is rated under Diagnostic Code 5279, which warrants a maximum 10 percent evaluation. If the Board were to rate the foot disability under DC 5279 for metatarsalgia, the disability would be rated at 10 percent and the rating under DC 5284 would have to be discontinued as rating under either code would require consideration of the foot pain. Rating the foot pain twice would result in impermissible pyramiding. 38 C.F.R. § 4.14. Pyramiding, the evaluation of the same disability (or the same manifestation of a disability) under different diagnostic codes, is to be avoided when rating an appellant's service-connected disabilities. Id. It is possible for an appellant to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Therefore, it would be pyramiding to consider symptoms such as pain for a disability separate from the service-connected residuals of a left foot cuboid fracture. While the Veteran can be separately service-connected for different acquired disorders, the overlapping symptoms for each separate disorder cannot be rated more than once. Finally, as arthritis, flat feet, weak foot, hammer toe, or malunion/nonunion of the tarsal/metatarsal bones have not been shown in the record, Diagnostic Codes 5002, 5276, 5277, 5282, and 5283 are not for application. See 38 C.F.R. § 4.71a. The Board is sympathetic to the Veteran's lay statements that the left foot disability is worse than currently evaluated and those statements have been considered. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to them through their senses. Layno v. Brown, 6 Vet. App. 465 (1994). They are not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's disability have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which the disability is evaluated. The medical and lay evidence has been assessed by the Board in determining the overall disability rating. As the evidence preponderates against the claim, there is no reasonable doubt to be resolved. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53 (1990). K. MILLIKAN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Rogos 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.