Citation Nr: 21072484 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 20-07 650 DATE: December 3, 2021 ORDER An initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is denied. The reduction from 70 percent to 30 percent for bilateral hearing loss, effective May 1, 2018, was proper, and the appeal is denied. REMANDED The issue of entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The severity, frequency, and duration of the Veteran's symptoms did not more closely approximate occupational and social impairment with reduced reliability and productivity. 2. The reduction of the Veteran's hearing loss to 30 percent was made in compliance with due process laws and regulations; his hearing loss has had actual improvement, which is reasonably certain to be maintained under the ordinary conditions of life. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 30 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for a reduction in the rating for bilateral hearing loss from 70 percent to 30 percent, effective May 1, 2018, are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105, 3.344, 4.85, DC 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1965 to August 1969. This case is before the Board of Veterans' Appeals (Board) on appeal from February 2017 and February 2018 rating decisions from a Department of Veterans Affairs (VA) Regional Office (RO). Although a later February 2018 rating decision restored the rating of PTSD to 30 percent, the issue of an initial increased rating remained in appellate status, as the maximum schedular rating had not been assigned for the entire period on appeal. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993). In October 2021, the Veteran testified at a Board hearing. The transcript of the hearing has been associated with the record. Increased Rating 1. An initial rating in excess of 30 percent for PTSD. The Veteran contends that his PTSD should be rated higher than 30 percent. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, VA will assign the higher evaluation if the disability picture more nearly approximates the criteria required for that rating. Otherwise, it will assign the lower rating. 38 C.F.R. § 4.7. VA resolves any reasonable doubt regarding the degree of disability in favor of the Veteran. 38 C.F.R. § 4.3. In the case of an initial rating, the entire evidentiary record from the time of a veteran's claim for service connection to the present is of importance in determining the proper evaluation of the disability. Fenderson v. West, 12 Vet. App. 119 (1999). In evaluating a disability, the current examination reports are considered in light of the whole recorded history to ensure that the current rating accurately reflects the disorder's severity. The medical and industrial history are 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. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent or higher. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to require continuous medication or interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events) cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 worklike setting); or the inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for 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; or memory loss for names of close relatives, own occupation or own name. Veterans are competent to report observable symptoms in the realm of their personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information, including lay and medical evidence of record, in a case before the Secretary concerning benefits under laws the Secretary administers. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 50 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a 30 percent rating and resulted in a level of impairment that most closely resembled the level of impairment associated with a 30 percent rating. The record demonstrates the Veteran has attended VA mental health group sessions bi-weekly and individual sessions every 2-4 weeks since May 2014. In the June 2014 intake assessment, the Veteran reported being easily frustrated, irritable, and having sleep disturbances but denied aggression with little or no provocation, anxiety, depression, apathy, or suicidal or homicidal ideations. The June 2014 intake assessment mental status examination demonstrated the Veteran was friendly, cooperative, and oriented to time, place, and person; he had appropriate speech, relaxed and at ease motor activity, good judgment, and no thought disorder. Subsequent session notes through September 2017 show work on finding what stressors lead to feelings of anxiety or anger, but the notes did not indicate any other symptoms. In September 2014, the Veteran was provided with a VA examination. The examiner determined the Veteran did not have a mental disorder that conformed with the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (5th ed. 2013) (DSM-5) criteria. Nevertheless, the examiner observed the following symptoms: minor difficulty with short-term memory and concrete thinking, depressed mood, and chronic sleep impairment. However, the Veteran's mental status examination and evaluation were otherwise normal for cognitive functioning, affect, speech, eye contact, thought process, judgment, and appearance. The Veteran denied experiencing active memories of traumatic events, flashbacks, nightmares, active thoughts of suicidal or homicidal ideation, or difficulty with family or work relationships during the examination. The Veteran did report having a "short fuse." In a November 2014 Correspondence, the Veteran's wife stated the Veteran's PTSD has become worse in the past 2 to 3 years, he feels worthless, and she is afraid he might hit her. A July 2016 VA examiner diagnosed the Veteran as having Unspecified Depressive Disorder (depression) under the DSM-5 criteria, more likely than not related to his declining health. The examiner determined that depression resulted in depressed mood, chronic sleep impairment, and mild memory loss. The depression caused occupational and social impairment due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. The examiner noted normal behavioral observations. During the examination, the Veteran denied suicidal ideation, anxiety, or worry since having retired two weeks ago (he previously worried about whether he completed tasks correctly at work). He vaguely reported occasional intrusive thoughts about Vietnam at night, occasional feeling of worthlessness (lasting 30 to 60 minutes), not laughing easily, irritability that can lead him to "fly off the handle" for 15 to 20 minutes, mediocre appetite, sleeping no more than 5 to 6 hours nightly, occasionally not feeling rested during the day, awakening 1 to 5 times nightly to urinate, having trouble falling back to sleep, and difficulty remembering people's names on occasion. The Veteran also reported feelings of sadness during the past ten years, lasting 1 to several hours for 2 to 4 days, 4 to 5 times monthly, and he acknowledged that health issues may have played a part in some of his sadness. A September 2016 VA examiner determined the Veteran met the DSM-5 criteria for a diagnosis of PTSD and that the symptom of depression was attributed to his PTSD, along with symptoms of anxiety, chronic sleep impairment, and mild memory loss, such as forgetting names, directions, or recent events. The examiner determined PTSD resulted in occupational and social impairment due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. In a January 2017 Statement in Support of Claim, the Veteran reported he has problems "blowing up," poor sleep, in the past has thought of killing himself, has poor appearance, trust issues, and lack of confidence. The Veteran was provided with a new VA examination in May 2017. The examiner found the Veteran's PTSD caused symptoms of chronic sleep impairment, mild memory loss, and disturbances of motivation and mood, resulting in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. The examiner observed the Veteran walked stiffly but at a normal pace and ambulated without gross motor impairment; his affect was constricted and tense, and he displayed no range of emotional expression; he answered questions without much elaboration or detail but was inclined to talk at some length about topics he appeared interested in (such as the training of diesel mechanics); his overall mood and presentation were one of moderate irritation; and he appeared alert, oriented and engaged with surroundings. An October 2017 VA examiner determined the Veteran had PTSD in partial remission, and symptoms were not severe enough to interfere with occupational and social functioning or require continuous medication. The examiner determined the Veteran's only symptom was chronic sleep impairment. Behavioral observations of the Veteran were all regular: he was calm, pleasant, appropriately dressed; he had a euthymic mood, full affective range, easily elicited and fluent speech, logical and goal-directed thought processes, reality-based thought content, good insight and judgment, recent and remote memory within normal limits, no grooming or hygiene deficits, no psychomotor abnormalities, no hallucinations, no active suicidal or homicidal ideation. The Veteran's performance on cognitive screening was within normal limits. The examiner remarked that symptoms did not appear to substantially impact the Veteran's daily functioning, noting that the Veteran was employed as a diesel mechanic for 45 years until his retirement two years ago. He described having functioned well in this job, getting along well with others, performing well with his job duties, and being in a stable marriage for over 40 years. Additionally, the Veteran has never had a psychiatric hospitalization, and he has never been prescribed psychotropic medication. The Veteran underwent a private examination in December 2017. The examiner's behavioral observations of the Veteran were that he was dressed appropriately with good grooming hygiene and oriented to person, place, time, and situation; he had logical, coherent, and goal-directed thought process; he spoke with a quick rate of speech, normal volume and tone, and occasional stutter that did not impair his ability to communicate. He was willing to engage in any assessment, reporting he knew the process existed to help him. He expressed his frustration with the wording of certain items. The Veteran reports experiencing suicidal ideation years ago, but group therapy was tremendously helpful. During the December 2017 private examination, the Veteran took a Minnesota Multiphasic Personality Inventory diagnostic test (MMPI-2), and reported significant depression, somatic complaints, and social discomfort. The examiner noted that people with that MMPI-2 profile are likely to experience emotional fluctuations between anxiety, moodiness, depression, agitation, and irritability. This emotional turbulence may present as disturbed sleep or restlessness. The examiner found it likely that some of those symptoms emanate from the Veteran's concerns for his health and ability to work. When depression is present, it is experienced as anhedonia and possibly pessimism. The examiner noted that while the Veteran endorsed having unpleasant dreams about the event, suddenly feeling as if the event were happening again, avoiding thoughts or feelings about the event, feeling less interested in activities, difficulty experiencing positive feelings, irritability or anger, and sleep disturbances, the Veteran failed to meet the frequency or intensity required for a diagnosis of PTSD under the DSM-5. The Veteran did not meet the threshold of clinically significant impairment under the Trauma Symptom Inventory self-report. The examiner found that the Veteran's responses in the Detailed Assessment of Posttraumatic Stress (a self-report measure that assesses exposure, posttraumatic response, PTSD symptoms, dissociation, substance abuse, and suicidal thoughts) showed that he either endorsed some statistically unusual phenomena or generally overreported symptoms. The December 2017 private examiner concluded that while the Veteran does have symptoms of PTSD, he does not reach the level of meeting the full diagnostic criteria at this time. The Veteran reported that his sub-threshold PTSD-related symptoms include distressing dreams about the event, some avoidant behavior such as trying not to think about the event, irritability, sleep disturbance, and diminished interest in activities. The examiner found that his trauma-related symptoms impair his functioning and quality of life. The results indicate depressive symptoms such as depressed mood, irritability, decreased pleasure in engaging activities he used to enjoy, disturbed sleep, passive suicidal ideation, and occasional feelings of inappropriate guilt or worthlessness. The Veteran did not provide clarity regarding a timeframe or whether symptoms increased or decreased as subthreshold PTSD symptoms increased, which, the examiner noted, made it difficult to specify if the Veteran met the criteria for a more specific depressive disorder. The examiner concluded the Veteran does seem to struggle with depression; however, he also expressed hope for the future and the desire to reconnect to his wife. In December 2017, the Veteran also underwent a VA examination to determine the severity of his PTSD. The examiner determined the Veteran has PTSD, in partial remission, and symptoms cause occupational and social impairment due to mild or transient symptoms, decreasing work efficiency and ability to perform occupational tasks only during periods of significant stress. The examiner determined the Veteran's only symptom was chronic sleep impairment. The examiner observed that the Veteran was appropriately dressed, irritable but cooperative, had a congruent affect, and exhibited adequate concentration, abstract reasoning, and continuity of thought. The Veteran denied symptoms consistent with obsessive-compulsive or bipolar disorder, auditory or visual hallucinations, delusional thought content, regular panic attacks (stating he has not had one in a year), problems with memory, or current homicidal or suicidal ideation. The Veteran endorsed variable concentration based on his level of interest in a task. The Veteran scored 24 out of 30 on the Saint Louis University Mental Status. (SLUMS) examination, which was lower than expected. In February 2018, the Veteran's wife provided a Buddy/Lay Statement reporting that the Veteran has sleep issues, depression, and becomes easily depressed. During a June 2018 VA Mental Health Medication Initial Visit, the Veteran reported never feeling good about himself, and he has an interest in doing some things but little financial resources. He stated that his energy, concentration, and appetite are good, and he denied guilt about anything in particular. The psychiatrist observed that the Veteran was anxious with chronic dysphoria, but he had no psychomotor agitation, retardation, clear panic, suicidal ideation, or psychosis. The psychiatrist prescribed the Veteran sertraline. A July 2018 VA Mental Health Medication Management follow-up note shows the Veteran reported feeling better and worrying less. During the September 2018 visit, he was in grief due to the sudden passing of his wife. January 2019, April 2019, July 2019, and October 2019 VA Mental Health Medication Management visits show the Veteran had normal mental status examinations, but his affect was neutral, non-labile, narrow range. During the October 2019 visit, he reported his mood was okay, he does not have excessive irritability, his sleep is okay, and his sleep is somewhat more variable than his mood. The psychiatrist, in October 2019, found the Veteran to be euthymic and forward-thinking. During a January 2020 VA Mental Health Medication Management visit for routine follow-up, the psychiatrist noted the Veteran's mood is stable, but he went through a couple of weeks a month ago with trouble sleeping. His mental status examination was normal, and he appeared euthymic. During the October 2021 Board hearing, the Veteran reported experiencing panic attacks at least twice a week, waking up in the middle of the night, night sweats, nightmares, night terrors, waking up screaming, restlessness, anxiety, memory issues, concentration issues, some hypervigilance, and anger issues. VA and private treatment records, the Veteran and his wife's lay statements, the private December 2017 examination, and September 2014, July 2016, September 2016, May 2017, October 2017, and December 2017 VA examinations show that the Veteran's PTSD was manifested by symptoms associated with a 30 percent rating (e.g., depressed mood, anxiety, chronic sleep impairment, and mild memory loss), and the symptom of panic attacks more than once a week associated with a 50 percent rating. He also had symptoms not listed with a specific rating, such as a mediocre appetite, hypervigilance, and occasionally feeling worthlessness. The Board finds the severity, frequency, and duration of the Veteran's mediocre appetite, hypervigilance, and occasionally feeling worthlessness symptoms more closely approximate the symptoms contemplated by a 30 percent rating, which are less severe, less frequent, and shorter in duration than those associated with a 50 percent rating. See 38 C.F.R. § 4.126. Further, mediocre appetite, hypervigilance, and occasionally feeling worthlessness are similar to depressed mood and suspiciousness, which is contemplated by the assigned 30 percent rating. The Board notes that the Veteran expressed suicidal ideation, which is contemplated by the 70 percent criteria and is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, all reports of suicidal ideation were retrospective, and the Veteran denied any suicidal ideation during the period on appeal. The Board also finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 30 percent rating. The Veteran experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks but was generally functioning satisfactorily, with routine behavior, self-care, and normal conversation. Mental status examinations were typically normal in all VA and private treatment records and the VA examinations, with anxious, irritable, or depressed mood and a constricted or neutral affect noted on some examinations. While during the October 2021 Board hearing, the Veteran reported experiencing panic attacks more than once a week, a symptom contemplated by a 50 percent rating, the evidence overall does not demonstrate the level of impairment associated with a 50 percent rating. The extensive medical evidence of the record does not show any evidence of panic attacks, let alone multiple weekly. However, the medical evidence does show the Veteran's symptoms include anxiety, which is contemplated by the 30 percent rating. Regardless, as noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 30 percent rating. Further, VA and private treatment records contain reports that the Veteran was generally performing well at work before he retired. In fact, during the October 2017 VA examination, the Veteran reported functioning well at his job, getting along well with others, and performing well with his job duties. There is no basis for a rating in excess of 30 percent for PTSD under the applicable criteria. In reaching this decision, the Board notes the Veteran's last VA examination was in December 2017. However, in this case, the Board finds that the December 2017 VA examination and testing is adequate and provides an accurate picture of the Veteran's disability from his service-connected PTSD and enables the Board to rate the disability. In this regard, the Board notes that VA treatment records dating through February 2020 have been reviewed, but these do not show any complaints or treatment relating to PTSD other than to monitor his condition approximately every three months; indeed, these records demonstrate an improvement of symptoms. Therefore, the Board finds a new examination is not warranted at this time. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 50 percent rating. The criteria for a rating in excess of 30 percent are not met, and the appeal must be denied. 2. Whether the reduction from 70 percent to 30 percent for bilateral hearing loss was proper, effective May 1, 2018. The Veteran contends that his hearing loss has not improved and that restoring the prior 70 percent rating is appropriate. An October 2013 rating decision assigned a 70 percent disability rating for hearing loss, effective September 16, 2013. After that, a November 2017 rating decision proposed to reduce the hearing loss rating to 30 percent, and a February 2018 rating decision reduced the rating to 30 percent effective May 1, 2018. A rating is not reduced unless an improvement in a veteran's disability is shown to have occurred. 38 U.S.C. § 1155. Reductions include due process provisions. See 38 C.F.R. § 3.105(e). There are greater protections when the rating has been in effect for five or more years. 38 C.F.R. § 3.344(a). However, these requirements do not apply to ratings that have not continued for long periods at the same level (five years or more) or to disabilities that have not become stabilized and are likely to improve. Rather, in such cases, reexaminations disclosing improvement, physical or mental, in these disabilities will warrant a rating reduction. 38 C.F.R. § 3.344(c); See Simon v. Wilkie, 30 Vet. App. 403, 409-411 (2018). Under 38 C.F.R. § 3.105(e), where a reduction in the evaluation of a service-connected disability is considered warranted, and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. Beneficiaries will be notified at their latest address of record of the contemplated action, furnished detailed explanations, and given 60 days to present additional evidence to show that that VA should continue compensation payments at their present level. Final rating action will reduce or discontinue the compensation effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(e). Here, the RO issued a rating decision in November 2017 proposing to reduce the Veteran's hearing loss rating from 70 percent to 30 percent. In the proposed rating notice, the RO advised the Veteran that he had 60 days to present additional evidence to show that compensation payments should be continued at the 70 percent level and that he had 30 days to request a predetermination hearing. The RO also notified the Veteran that this reduction would reduce his overall disability rating, for his combined service-connected disabilities, from 80 percent to 30 percent. Next, the RO issued the rating decision in February 2018, reducing the rating to 30 percent effective May 1, 2018, which is greater than 60 days after the last day of the month in which a 60-day period from the date of the February 2018 notice to the Veteran of the final action expired. Thus, the RO's actions satisfied all procedural requirements under 38 C.F.R. § 3.105. The Veteran contends that his hearing loss rating should remain at 70 percent. In a November 2017 VA 21-4138 Statement in Support of Claim, the Veteran argued the August 2017 VA examination should be invalid because he was wearing hearing aids during the hearing examination. During the October 2021 Board hearing, the Veteran's representative argued the audiologist conducted the VA examination incorrectly; however, the representative did not specify which examination was incorrect. During the October 2021 Board hearing, the Veteran reported requiring others to repeat what they have said and problems hearing what's happening behind him. 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 Consonant-Vowel-Nucleus-Consonant (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. The schedule establishes 11 auditory hearing acuity levels to evaluate the degree of disability from bilateral service-connected hearing loss, designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII. An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, 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. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, 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, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). In the September 2013 VA examination, the Veteran reported thinking he may need hearing aids. See Martinak v. Nicholson, 21 Vet. App. 447, 54-55 (2007) (reaffirming the need for VA audiologists to describe the effect of a hearing disability on a claimant's occupational functioning and daily activities); 38 C.F.R. § 4.10. The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: Sept. 2013 HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 60 75 75 75 71 30% LEFT 35 65 80 90 68 44% Applying the results to Table VI yields a numeric designation of Level XI in the right ear and Level VIII in the left year. Entering the resulting numeric designations of Levels XI and VIII to 38 C.F.R. § 4.85, Table VII equates to a 70 percent disability rating under Diagnostic Code 6100. The September 2013 examination showed an exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 in the right ear. Therefore, if more favorable, Table VIA could have been applied for the numeric designation of the right ear. However, Table VIA yields the numeric designation of Level VI in the right ear, which is less favorable than the numeric designations under Table VI. In an August 2017 VA examination, the Veteran reported difficulty understanding speech in areas with background noise. The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: Aug. 2017 HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 60 75 75 75 71 68% LEFT 35 65 80 90 68 66% Applying the results to Table VI, the findings yield a numeric designation of Level VI in the right ear and Level VII in the left ear. Entering the resulting numeric designations of Level VI and VII to 38 C.F.R. § 4.85, Table VII equates to a 30 percent disability rating under Diagnostic Code 6100. The August 2017 examination showed an exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 in the right ear. Applying the results to Table VIA, the findings yield a numeric designation of Level VI in the right ear, the same as the numeric designation under Table VI. An October 2017 VA audiology note showed excellent or good word recognition ability. The audiologist noted that the October 2017 evaluation results were essentially stable when compared to previous test results from the August 2017 VA examination. In November 2017, the Veteran underwent a private audiological examination. Unfortunately, the examination does not comply with 38 C.F.R. § 4.85 as the Maryland CNC Word List speech recognition test was not conducted; thus, the word recognition testing conducted in the November 2017 private examination is not valid for VA rating purposes. The Veteran's pure tone thresholds, in decibels, were as follows: Nov. 2017 HERTZ 1000 2000 3000 4000 Avg RIGHT 65 90 95 100 87.5 LEFT 55 85 90 100 83.75 The November 2017 examination showed an exceptional pattern of hearing impairment under 38 C.F.R. § 4.86. Applying the results to Table VIA, the findings yield a numeric designation of Level VIII bilaterally. Entering the resulting bilateral numeric designation of Level VIII to 38 C.F.R. § 4.85, Table VII equates to a 50 percent disability rating under Diagnostic Code 6100. In a January 2018 VA examination, the Veteran reported difficulty on the phone, hearing women's voices, and hearing things correctly, and he said things sound "distorted." The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: Jan. 2018 HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 65 80 85 90 80 70% LEFT 45 75 85 100 76 80% Applying the results to Table VI, the findings yield a numeric designation of Level VI in the right ear and Level V in the left ear. Entering the resulting numeric designations of Levels VI and V to 38 C.F.R. § 4.85, Table VII equates to a 20 percent disability rating under Diagnostic Code 6100. The January 2018 examination showed an exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 in the right ear. Applying the results to Table VIA, the findings yield a numeric designation of Level VII in the right ear. Entering the resulting numeric designations of Levels VII in the right ear and V in the left ear to 38 C.F.R. § 4.85, Table VII equates to a 30 percent disability rating under Diagnostic Code 6100. The Board finds all the examinations discussed above competent and probative as they were all conducted by state-licensed audiologists, and no further examination is needed. The Veteran's representative argued the examination was conducted incorrectly but did not cite his expertise or other probative evidence. See Francway v. Wilkie, 940 F.3d 1304 (Fed. Cir. 2019). The Veteran's representative's argument, without further support, is not sufficient to warrant remand for a new examination. The Board finds that the reduction from 70 percent to 30 percent effective May 2018 for the Veteran's hearing loss was proper. The evidence shows the Veteran's hearing loss has had actual improvement, which is reasonably certain to be maintained under the ordinary conditions of life. August 2017, October 2017, November 2017, and January 2018 hearing evaluations demonstrated improvement from the September 2013 VA examination. The Board acknowledges the Veteran's assertion of worsening hearing and that he wore his hearing aids during the August 2017 examination; however, October 2017, November 2017, and January 2018 hearing evaluations all confirm improved hearing, and the January 2018 VA examination demonstrates that the disorder is correctly rated presently. The rating criteria consider the functional impact that the Veteran describes. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's main complaint is reduced hearing acuity and clarity, which the rating assigned contemplates. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). Further, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). This evidence of record demonstrates an actual improvement in disability. See 38 C.F.R. § 4.13. Therefore, the reduction in rating to 30 percent was proper, and restoration of the 70 percent rating is not warranted. REASONS FOR REMAND 1. Entitlement to a TDIU. A remand is required for referral of the claim for a TDIU to the Director, Compensation Service, for extraschedular consideration. The February 2018 rating decision discontinued the Veteran's entitlement to a TDIU effective May 1, 2018, because he no longer met the schedular criteria. The Veteran maintains that his service-connected disabilities prevent him from performing substantially gainful employment. During the October 2021 Board hearing, the Veteran's representative argued that the Veteran could not complete the tasks being asked of him because he did not fully understand what was being asked. During the hearing, the Veteran reported currently working as a diesel mechanic 8 to 12 hours per week. The Veteran has the following service-connected disabilities: PTSD (rated 30 percent from July 2014 to present); bilateral hearing loss (noncompensable from October 6, 2010, to September 15, 2013, and 70 percent from September 16, 2013, to June 30, 2018, and 30 percent as of May 1, 2018); left inguinal hernia (noncompensable as of August 5, 1969); diffuse large B-cell lymphoma (noncompensable as of October 6, 2010); and left groin scar (noncompensable as of January 17, 2017). Based on the foregoing, the Veteran does not meet the percentage standards set forth in § 4.16(a) as of May 1, 2018. Therefore, the Board may not consider his claim for a TDIU in the first instance but will refer it to the Director, Compensation Service; there is a reasonable possibility that he is unemployable because of his service-connected disabilities. 38 C.F.R. § 4.16(b); see also Ray v. Wilkie, 31 Vet. App. 58, 66 (2019). A remand is required to refer the claim for a TDIU to the Director, Compensation Service, for extraschedular consideration. The matters are REMANDED for the following action: (Continued on the next page) 1. Refer the Veteran's claim for TDIU to VA's Director of Compensation Service for extraschedular consideration. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Costa, Stephanie D. 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.