Citation Nr: 21073305 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-43 427 DATE: December 8, 2021 ORDER Entitlement to service connection for hypertension is granted. Entitlement to an initial disability rating in excess of 10 percent for atopic allergic conjunctivitis with dry eyes is denied. Entitlement to an initial compensable disability rating for bilateral hearing loss prior to December 10, 2020, and in excess of 10 percent thereafter is denied. REMANDED Entitlement to service connection for a psychiatric disorder, to include unspecified depressive disorder is remanded. Entitlement to service connection for COPD is remanded. FINDINGS OF FACT 1. The Veteran has had hypertension since his separation from active service. 2. The Veteran's atopic allergic conjunctivitis with dry eyes is not shown to be productive of defects of visual impairment, incapacitating episodes requiring treatment visits, or disfigurement. 3. Prior to December 10, 2020, the Veteran's right ear hearing loss was manifested, at worst, by a puretone threshold average of 36 decibels, and a speech discrimination score of 96 percent; his left ear hearing loss was manifested, at worst, by a puretone threshold average of 50 decibels and a speech discrimination score of 90 percent. 4. From December 10, 2020, forward, the Veteran's right ear hearing loss was manifested, at worst, by a puretone threshold average of 44 decibels, and a speech discrimination score of 72 percent; his left ear hearing loss was manifested, at worst, by a puretone threshold average of 53 decibels and a speech discrimination score of 72 percent. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for an initial disability rating in excess of 10 percent for atopic allergic conjunctivitis with dry eyes have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 6018. 3. The criteria for an initial compensable disability rating for bilateral hearing loss prior to December 10, 2020, and in excess of 10 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1976 to February 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision and a February 2016 rating decision. The Board notes that the December 2019 Board decision granted service connection for right ear hearing loss. A June 2020 rating decision evaluated the Veteran's bilateral hearing loss as noncompensable and a January 2021 rating decision assigned a 10 percent disability rating, effective December 10, 2020. While the Veteran perfected an appeal for a higher initial compensable disability rating for left ear hearing loss, hearing loss in both ears are rated together under 38 C.F.R. § 4.85. Further, the Agency of Original Jurisdiction has rated the Veteran's bilateral hearing loss as noncompensable beginning August 29, 2013, and 10 percent disabling from December 10, 2020. Thus, the Board has recharacterized the appeal as an increased rating for bilateral hearing loss. Service Connection Service connection means that a Veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when the evidence shows that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical "nexus" requirement). See 38 C.F.R. § 3.303(a); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004)). For the chronic diseases listed in 38 C.F.R. § 3.309(a), including cardiovascular-renal disease, including hypertension, if the chronic disease manifested in service, then service connection will be established for subsequent manifestations of the same chronic disease at any date after service, no matter how remote, without having to show a causal relationship or medical nexus, unless the later manifestations are clearly due to causes unrelated to service ("intercurrent causes"). 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012) (holding that § 3.303(b) only applies to the chronic diseases listed in 38 U.S.C. § 1101; 38 C.F.R. § 3.309(a)). When the condition noted during service is not shown to be chronic, or its chronicity may be legitimately questioned, then a continuity of symptoms after service must be shown to establish service connection under this provision. 38 C.F.R. § 3.303(b); Walker, 708 F.3d at 1338-39. To establish service connection based on a continuity of symptoms, the evidence must show: (1) a condition "noted" during service; (2) post-service continuity of the same symptoms; and (3) a nexus between the present disability and the post-service symptoms. Fountain v. McDonald, 27 Vet. App. 258, 263-64 (2015). In addition, where a Veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, there is a presumption of service connection for certain diseases, such as cardiovascular-renal disease, including hypertension, if the disease manifested to a degree of 10 percent or more within one year from the date of separation from service, even if there is no evidence of the disease during the service period itself. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). This presumption may be rebutted by affirmative evidence to the contrary. 38 C.F.R. § 3.307(d). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to service connection for hypertension is granted. The Veteran maintains that his currently diagnosed hypertension is related to his active service. In particular, the Veteran advised that he was treated for high blood pressure during his active service. See August 2017 VA Form 9, Appeal to the Board of Veterans' Appeals. For the reasons discussed below, the Board finds that service connection is warranted. The Veteran's service treatment records indicate that he had a blood pressure reading in October 1979 of 128/90. He also had blood pressure readings of 142/92 on April 10, 1980; 138/98 on April 11, 1980; 138/90 and 136/96 on May 2, 1980; 134/86 and 138/90 on May 5, 1980; 130/80 and 142/94 on May 6, 1980; 130/80 and 134/90 on May 7, 1980; 126/80 and 120/84 on May 8, 1980; 142/78 and 140/86 on May 9, 1980. The Veteran was afforded a VA Hypertension Disability Benefits Questionnaire in April 2015 that shows that he has a current diagnosis of hypertension. The medical history section of the examination report provides that the Veteran has been on antihypertensive medication for the past 7 to 8 years and that he has been followed by the same physician for the past 20 years. The corresponding April 2015 VA medical opinion provides that it is less likely than not that the Veteran's hypertension is related to his active service. In support, the medical opinion states that the determination was "actually close." While the Veteran had some episodes of elevated blood pressure in service, this was not sustained. His blood pressure was elevated on his separation examination, but several days later, his blood pressure was determined not to be consistent with hypertension. The medical opinion continues that while he has been followed by the same physician for approximately 20 years, he was only placed on antihypertensive medication about 7 to 8 years ago. Thus, it would appear that the diagnosis of hypertension was only made 7 to 8 years ago, which was a little more than 20 years after the Veteran's discharge from active service. The Veteran's claims folder contains a December 2020 Hypertension Disability Benefits Questionnaire. The examination report states that the Veteran has a diagnosis of hypertension. The medical history section of the examination report indicates that the Veteran reported beginning medication for hypertension just prior to his discharge in 1986. Currently, he takes Losartan/Hydrochlorothiazide. The corresponding December 2020 medical opinion states that the Veteran was seen numerous times during his active service for hypertension and had 3-day and 5-day checks. His service treatment records demonstrate that he had diastolic elevation many times. Therefore, it is at least as likely as not that the Veteran's hypertension started during his active service. The Board finds that the April 2015 VA medical opinion is inadequate because it is primarily based on an absence of a diagnosis for hypertension until approximately 20 years after the Veteran's active service. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The mere passage of time is not a reasoned explanation as to why the Veteran's hypertension is not related to his active service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (noting that "a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two"). The Board finds the December 2020 medical opinion to be especially probative as it represents the informed conclusion of a medical professional supported by a review of the Veteran's medical history, the clinical findings made on examination, and the symptomatology reflected in the medical and lay evidence of record. See Nieves-Rodriguez, 22 Vet. App. at 304 (the probative value of a medical opinion comes from its reasoning); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). In sum, the record shows that the Veteran had elevated blood pressure during his active service and currently has a diagnosis of hypertension. While the Veteran's claims folder does not demonstrate continuous treatment for high blood pressure from his active service until present, the December 2020 examination report shows that the Veteran reported beginning medication for hypertension just prior to his discharge in 1986. Therefore, the Board resolves reasonable doubt in the Veteran's favor and finds that his hypertension had its clinical onset during his active service. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Therefore, service connection for hypertension is granted. 38 C.F.R. § 3.303(b). Increased Rating VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally, 38 C.F.R. § Part IV. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule for Rating Disabilities represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. All reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. See 38 C.F.R. § 4.3; see also 38 C.F.R. § 3.102. Separate ratings for distinct disabilities resulting from the same injury or disease can be assigned so long as the symptomatology for one condition is not "duplicative or overlapping with the symptomatology" of the other condition. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009); Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). However, the evaluation of the same disability or its manifestations under various diagnoses, which is known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). In initial-rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson, 12 Vet. App. at 126. 2. Entitlement to an initial disability rating in excess of 10 percent for atopic allergic conjunctivitis with dry eyes is denied. The Veteran's atopic allergic conjunctivitis with dry eyes is rated 10 percent disabling under 38 C.F.R. § 4.79, Diagnostic Code (DC) 6018, for chronic conjunctivitis (nontrachomatous). During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Both the former and revised criteria distinguish active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivae, mucous secretion, etc.) is assigned a 10 percent rating. Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. For an inactive disease process, both the former and revised criteria instruct to evaluate based on residuals, such as visual impairment and disfigurement (Diagnostic Code 7800). With regard to visual impairment, the May 2018 amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. The General Rating Formal for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, Diagnostic Codes 6061-6091. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. Id. § 4.75(b). Examinations of visual field or muscle function will be conducted only when medically indicated. Id. Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c). Based on consideration of all evidence of record, the Board finds that an initial disability rating in excess of 10 percent for atopic allergic conjunctivitis with dry eyes is not warranted. To evaluate the Veteran's eye disability, he was afforded a VA Eye Conditions Disability Benefits Questionnaire in April 2015. The examination report states that the Veteran has diagnoses of dry eye and allergic conjunctivitis. The Veteran had corrected distance vision of 20/40 or better bilaterally. There was not a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran's pupils were measured at three millimeters bilaterally. His pupils were round and reactive to light and there was not an afferent pupillary defect present. The April 2015 VA examination report provides that the Veteran does not have anatomical loss, light perception only, extremely poor vision, or blindness of either eye. He does not have a corneal irregularity that results in severe irregular astigmatism. He does not have diplopia. Tonometry revealed right eye pressure of 17 and left eye pressure of 14. He was noted to have atopic/allergic conjunctivitis changes, bilaterally. His cornea, anterior chamber, and iris were normal, and his lens showed an incipient cataract bilaterally. The internal eye examination was normal. The April 2015 VA examination report demonstrates that visual field testing was not performed. He did not have legal blindness based upon visual field loss. He was shown to have bilateral nontrachomatous and atopic/allergic conjunctivitis changes with no decrease in visual acuity or other visual impairment. The examination report states that the above eye disabilities did not cause scarring or disfigurement. Preoperative cataract was present bilaterally without aphakia or dislocation of the crystalline lens without decrease in visual acuity or other visual impairment. During the past 12 months, he did not have any incapacitating episodes attributable to any eye disability. The Veteran was provided a January 2021 Eye Conditions Disability Benefits Questionnaire. The examination report states that the Veteran has diagnoses of blepharoconjunctivitis, bilateral; dry eye, bilateral; nonexudative age-related macular degeneration, early dry stage, bilateral; cataracts, combined form, bilateral; and optic disc cupping, bilateral. He reported current symptoms of increased burning and itching and some blurring on occasion. He further advised that his eye symptoms make his employment more challenging because he works at a computer for 8-hour shifts. He had corrected distance vision of 20/40 vision bilaterally. There was not a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran's pupils were measured at four millimeters bilaterally. His pupils were round and reactive to light and there was not an afferent pupillary defect present. The January 2021 examination report provides that the Veteran does not have anatomical loss, light perception only, extremely poor vision, or blindness of either eye. He does not have a corneal irregularity that results in severe irregular astigmatism. He does not have diplopia. Tonometry revealed right eye pressure of 15 and left eye pressure of 16. On external eye examination, he was noted to have meibomian gland segmentation, marginal and paramarginal palpebral injection, low tear film layer, and combined nuclear sclerotic and cortical cataract. On internal eye examination, he was noted to have optic disc cupping, fine drusen with one medium-sized druse on the right eye and fine drusen with one large-sized druse on the left eye. He did not have a documented visual field defect. The January 2021 examination report provides that the Veteran has bilateral chronic atopic allergic blepharoconjunctivitis that affects the tear film layer and is associated with chronic redness and itching. He has a disorder of the lacrimal apparatus, to include epiphora, dacryocystitis, etc. This disorder causes an impairment as he is supplementing his tear film layer with artificial tears. The January 2021 examination report provides that the Veteran has dry eye syndrome bilaterally. He has not had an elective procedure performed. He utilizes over-the-counter artificial tears and prescription medication for his dry eye syndrome. The examination report provides that the low tear film layer can affect visual acuity. The January 2021 examination report states that the Veteran has bilateral chronic conjunctivitis that is active and affects the tear film layer and is associated with chronic redness and itching. He has preoperative bilateral cataract. There is no replacement intraocular lens, aphakia or dislocation of the crystalline lens. The examination report provides that the primary reason that the Veteran does not have 20/20 vision is because of his cataracts. He has bilateral maculopathy and disc cupping that does not cause a decrease in visual acuity or other visual impairment. He does not have scarring or disfigurement attributable to any eye disability. During the past 12 months, the Veteran has not had any incapacitating episodes attributable to any eye disability. The January 2021 examination report states that the Veteran's eye disabilities do not impact his ability to work. He spends his time on the telephone and computer as a patient advocate. He can compensate for the atopic allergic conjunctivitis with dry eyes by using multiple eyedrops. With the use of medications to suppress the atopic allergic conjunctivitis and supplemental artificial tears to mitigate the dry eyes, he can function normally. If he were unable to use any eye drops, he would be uncomfortable, but it would most likely not affect his vision or visual function to a greater degree than his cataracts, which are likely to progress in the future. In sum, he is able to function well using his medications and artificial tears. The Veteran's private treatment records describe the severity of his atopic allergic conjunctivitis with dry eyes. A December 2015 report of consultation completed by a licensed chiropractor states that for the Veteran's service-connected eye disability, he has suffered from substantial extension from the disability. He requires more medication to control the dryness and he has developed persistent itching and pain with occasional impairment to his vision. A March 2017 private treatment record from Treasure Coast Optical provides that the Veteran's acuity was 20/20 for his right eye and 20/25 for his left eye. The Veteran's VA treatment records also contain evidence regarding the severity of his atopic allergic conjunctivitis with dry eyes. A June 2018 VA Primary Care Note states that the Veteran reported eye redness, irritation, itch, burn, and slight sensitivity to light. He stated that his eyes are weeping clear. He denied any crusting and his eyes were noticeably red and watery. A July 2018 VA Ophthalmology Technician Note provides that the Veteran complained of bloodshot eyes, tearing, dry eyes, and allergies. Without correction, the Veteran had 20/40 vision on the right eye and 20/25+2 with the left eye. He had full visual field and full extra-ocular motility. A September 2018 VA Optometry Note demonstrates that the Veteran reported blurred distance vision and redness. Without correction, the Veteran had 20/20-1 vision with the right eye and 20/20 vision with the left eye. A December 2018 VA Ophthalmology Technician Note states that his eyes burn at times, even though his eye drops help. He advised that sometimes his eyes feel like they are on fire. Without correction, the Veteran had 20/20-2 vision with the right eye and 20/20-1 vision with the left eye. A June 2019 VA Ophthalmology Technician Note provides that the Veteran is following up due to dry eye symptoms. He had right eye vision of 20/25-2 and left eye vision of 20/25. A December 2019 VA Ophthalmology Technician Note provides that the Veteran reports his distance and reading vision have probably worsened. He has redness, tearing, itching, and burning and has had to increase the font size on his computer. He denied flashes of lights and floaters, and pain. With correction, the Veteran had 20/25 vision with his right eye and 20/25-1+1 with his left eye. He had full visual field and extra-ocular motility. Because the Veteran is not shown to have a medical background or expertise, he is considered a layperson in the field of medicine. Lay testimony is competent as to matters capable of lay observation or within a person's first-hand experience and may be competent evidence with respect to both the diagnosis of a medical condition and its etiology or cause. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). However, lay testimony is not competent with respect to determinations that cannot be made based on lay observation alone due to their medical or scientific complexity. Davidson, 581 F.3d at 1316; Jandreau, 492 F.3d at 1376-77; Barr, 21 Vet. App. at 309; Layno v. Brown, 6 Vet. App. 465, 469 (1994) (holding that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). The Board must determine on a case-by-case basis whether lay testimony is competent on the matter at issue, or whether medical evidence is required. See Davidson, 581 F.3d at 1316 (holding that it was error to reject categorically lay statements on the issue of medical nexus, or to make a categorical finding that a medical opinion was required); Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011) (holding that the Board erred in categorically rejecting lay evidence without assessing its competence). Therefore, the Veteran's statements concerning his eye symptomatology and their related functional impairments are competent. The Board additionally finds these competent assertions concerning his eye symptomatology to be credible, as they have remained generally consistent throughout the pendency of his claim. See Caluza v. Brown, 7 Vet. App. at 711, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table) (holding that, in determining whether statements submitted by or on behalf of a claimant are credible, the Board may consider their internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant). However, the criteria needed to support higher disability ratings require medical findings that are within the province of trained medical professionals as it requires specialized medical expertise in interpreting complex diagnostic information. See Jones v. Brown, 7 Vet. App. 134 (1994). Therefore, the Board finds that when evaluating the Veteran's atopic allergic conjunctivitis with dry eyes as an active disease process, a disability rating in excess of 10 percent disabling is not warranted. The Veteran's corrected distance vision of 20/40 bilaterally corresponds to a noncompensable disability rating based on impairment of visual acuity. Additionally, there is no evidence of incapacitating episodes requiring treatment, as defined by the rating criteria. Thus, under an active disease process, there is no basis for a disability rating higher than 10 percent. The Board has also considered evaluating the Veteran's atopic allergic conjunctivitis with dry eyes as an inactive disease process. However, such would yield a noncompensable rating because the Veteran's eye condition is not productive of visual impairment, disfigurement, or other residuals. Accordingly, an initial disability rating in excess of 10 percent for atopic allergic conjunctivitis with dry eyes is not warranted. 38 C.F.R. § 4.118, Diagnostic Code 6018. A higher evaluation is not warranted unless the evidence were to show worsened visual impairment, incapacitating episodes requiring at least 3 treatment visits, or disfigurement attributed to the conjunctivitis. None of these criteria have been shown throughout the period of appeal. Therefore, entitlement to an initial disability rating in excess of 10 percent is not warranted. The Board has also considered whether it may be appropriate to rate the Veteran's atopic allergic conjunctivitis with dry eyes under other diagnostic codes but finds that no higher or separate ratings are warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim for an initial disability rating in excess of 10 percent for atopic allergic conjunctivitis with dry eyes, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. The Board determines that the Veteran's disability is fully capable of evaluation under the rating schedule. There is no applicable provision that would warrant a higher rating in this case. 3. Entitlement to an initial compensable disability rating for bilateral hearing loss prior to December 10, 2020, and in excess of 10 percent thereafter is denied. The Veteran's service-connected bilateral hearing loss is currently rated as noncompensable prior to December 10, 2020, and 10 percent thereafter, under 38 C.F.R. § 4.85, Diagnostic Code 6100. In evaluating hearing loss, disability ratings are derived from a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests using the Maryland CNC word list, in conjunction with the average hearing threshold, measured by puretone audiometric tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. 38 C.F.R. § 4.85, Diagnostic Code 6100. The rating schedule establishes eleven auditory acuity levels designated from Level I, for essentially normal hearing acuity, through Level XI for profound deafness. See id. VA audiometric examinations are generally conducted using a controlled speech discrimination test together with the results of a puretone audiometry test. Id. Table VI in 38 C.F.R. § 4.85 is then used to determine the numeric designation of hearing impairment based on the puretone threshold average derived from the audiometry test, and from the results of the speech discrimination test. The horizontal rows in Table VI represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. See id. The vertical columns in Table VI represent nine categories of decibel loss based on the puretone audiometry test. Id. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the horizontal row corresponding to the percentage of discrimination and the vertical column corresponding to the puretone decibel loss. Id. The percentage evaluation is derived from Table VII in 38 C.F.R. § 4.85 by intersecting the vertical column corresponding to the numeric designation for the ear having the better hearing acuity (as determined by Table VI) and the horizontal row corresponding to the numeric designation level for the ear having the poorer hearing acuity (as determined by Table VI). There are alternative criteria for certain exceptional patterns of hearing loss. Specifically, if puretone thresholds in each of the specified frequencies of 1000, 2000, 3000, and 4000 Hertz are 55 dB or more, an evaluation will be based either on Table VI or Table VIA in 38 C.F.R. § 4.85, whichever results in a higher evaluation. 38 C.F.R. § 4.86(a). Each ear will be evaluated separately. Id. When the puretone threshold is 30 dB or less at 1000 Hertz and 70 dB or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be chosen from either Table VI or Table VIA under 38 C.F.R. § 4.85, whichever results in the higher Roman numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). In Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the Court of Appeals for Veterans Claims (Court) held that relevant to VA audiological examinations, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Id. The Veteran was afforded a VA Hearing Loss and Tinnitus Disability Benefits Questionnaire in April 2015. He described having a hard time hearing people, asking others to repeat themselves, having difficulties hearing on the telephone, and needing to turn up the volume on his television. The examination report shows that based on audiometric and speech discrimination testing, the Veteran's right ear hearing loss was manifested by a puretone threshold average of 36 decibels, and a speech discrimination score of 96 percent. His left ear hearing loss was manifested by a puretone threshold average of 50 decibels and a speech discrimination score of 90 percent. Applying these values to Table VI yields a numeric designation of I for the right ear and II for the left ear. The point where designations I and II intersect on Table VII yields a 0 percent disability rating. Based on the Veteran's puretone thresholds, the alternative rating criteria are not applicable. 38 C.F.R. § 4.86(a), (b). The Veteran's private treatment records describe the severity of his bilateral hearing loss. A July 2014 Associated Coastal ENT Physicians PA record provides that the Veteran has bilateral hearing loss that is worsening. He has to increase the volume on his television to hear properly. Audiometric testing showed bilateral mild sloping to moderate sensorineural hearing loss slightly worse on the left than the right with normal tympanograms. The Veteran's speech discrimination score was recorded as 96 percent bilaterally. These findings are consistent with noise-induced hearing loss per the private treatment record. A December 2015 private report of consultation completed by a licensed chiropractor provides that a normal conversation across the consultation table was difficult as the Veteran had difficulty hearing and understanding the examiner. The Veteran's hearing was tested in a very quiet room and in a room with normal day-to-day noise. Testing revealed hearing loss under normal conditions of 40 percent bilaterally. Further, the Veteran's VA treatment records demonstrate that he has hearing loss and uses hearing aids. A June 2016 VA Audiology Note states that the Veteran is always increasing volume on his hearing aids. An otoscopy revealed clear canals bilaterally. A June 2018 VA Primary Care Note states that the Veteran reported his hearing has become worse. His hearing aides have been adjusted twice and he is still not hearing well. The Veteran had mild to moderately severe sloping sensorineural hearing loss in the right ear and mild to moderately severe sloping sensorineural hearing loss in the left ear. The Veteran's hearing loss was described as stable, and all thresholds were within 5 to 10 decibels of his previous results. Word recognition scores were excellent for the right ear and good for the left ear on a standard test presented via CD recorded material through insert earphones at a suprathreshold level. His previous results were excellent for each ear. The Veteran was also afforded an air conduction audiology evaluation. The Veteran was afforded a Hearing Loss and Tinnitus Disability Benefits Questionnaire in December 2020. He stated that he had to ask people to repeat themselves often and he still had trouble understanding. The examination report shows that based on audiometric and speech discrimination testing, the Veteran's right ear hearing loss was manifested by a puretone threshold average of 44 decibels, and a speech discrimination score of 72 percent. His left ear hearing loss was manifested by a puretone threshold average of 53 decibels and a speech discrimination score of 72 percent. Applying these values to Table VI yields a numeric designation of IV for the right ear and V for the left ear. The point where designations IV and V intersect on Table VII yields a 10 percent disability rating. Based on the Veteran's puretone thresholds, the alternative rating criteria are not applicable. 38 C.F.R. § 4.86(a), (b). Regarding the above hearing tests demonstrated in the Veteran's private treatment records and VA treatment records, 38 C.F.R. § 4.85 specifically requires examinations used for VA purposes to have a controlled speech discrimination test using the Maryland CNC word list and a puretone audiometry test. Thus, the private hearing tests and the June 2018 VA air conduction audiology evaluation cannot be used to support an increased rating because these tests are conducted differently than VA examinations and not in accordance with the regulations. The Board notes that the Veteran's representative has argued that an initial 10 percent disability rating for his bilateral hearing loss is warranted from the date of his claim, rather than the December 10, 2020, examination. The Veteran's representative contends the December 2020 examination merely confirmed the level of disability from the time he filed his claim. However, as noted above, disability ratings are derived from a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann, 3 Vet. App. at 349. The evidence contained in the Veteran's claims folder from audiometric evaluations does not support a higher disability rating prior to December 10, 2020, based on such a mechanical application. Therefore, an initial 10 percent disability rating for bilateral hearing loss is not warranted prior to December 10, 2020. According to the April 2015 VA examination report, the Veteran advised that he has difficulty hearing others speak while at work and while using the telephone and he has to increase the volume on his television to hear. The December 2020 examination report provides that the Veteran's hearing loss forces him to ask others to repeat themselves often when speaking and he has difficulty understanding speech. When a claimant's hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the schedular rating criteria. Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017). In sum, the preponderance of the evidence weighs against assignment of an initial compensable disability rating for his service-connected bilateral hearing loss prior to December 10, 2020, and in excess of 10 percent thereafter. Consequently, the benefit-of-the-doubt rule does not apply and increased disability ratings for bilateral hearing loss are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. The Board determines that the Veteran's disability is fully capable of evaluation under the rating schedule. There is no applicable provision that would warrant a higher rating in this case. REASONS FOR REMAND The below claims for service connection were remanded by the Board in December 2019 for evidentiary development. Unfortunately, the Veteran's claims must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claims, so he is afforded every possible consideration. 1. Entitlement to service connection for a psychiatric disorder, to include unspecified depressive disorder is remanded. The Veteran's claim for service connection was remanded by the Board in December 2019 to obtain an examination and an adequate medical opinion concerning the nature and etiology of his unspecified depressive disorder. Pursuant to the Board's December 2019 remand, the Veteran was afforded a December 2020 Mental Disorders (Other than PTSD and Eating Disorders) Disability Benefits Questionnaire. The examination report states that the Veteran has a diagnosis of unspecified depressive disorder. The corresponding December 2020 medical opinion provides that the Veteran's unspecified depressive disorder is less likely than not incurred in or caused by his military service. Further, there is no evidence of a psychiatric disability occurring within one year following his separation from military service. While recognizing the occurrence of a significant loss in service, the death of the Veteran's friend, his depressive symptoms, for which he received related treatment several years ago, to include psychotropic medication, have been described as primarily related to various life stressors (i.e., familial, financial, housing) in recent years. The medical opinion provides that his symptoms and treatment are not connected to his military service that occurred decades earlier. Lastly, there are no current or recent indications of significant functional impairment associated with the Veteran's depressive symptoms according to the medical opinion. In February 2016, the Veteran submitted a Review of Posttraumatic Stress Disorder (PTSD) Disability Benefits Questionnaire completed by a private psychologist. The examination report indicates that the Veteran does not have a diagnosis of PTSD. However, he has diagnoses of other specified trauma and stressor related disorder and other specified depressive disorder that is inseparable from trauma-related symptomatology and bereavement with anxious distress. He has subclinical symptoms of PTSD according to the examination report. While the Veteran's claims folder contains a medical opinion addressing the etiology of his unspecified depressive disorder, it does not contain a medical opinion regarding the etiology of his other specified trauma and stressor related disorder. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that the "current disability" requirement is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim' and reversing Board's denial of service connection where disability resolved during pendency of appeal); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, a remand is necessary to obtain such a medical opinion. 2. Entitlement to service connection for COPD is remanded. The Veteran's claim for service connection was remanded by the Board in December 2019 to obtain authorizations for private treatment records and to obtain an examination and medical opinion concerning the nature and etiology of any respiratory disability, including COPD. Thereafter, the Veteran was afforded a December 2020 Respiratory Conditions (Other than Tuberculosis and Sleep Apnea) Disability Benefits Questionnaire. The examination report provides that the Veteran has a diagnosis of COPD. The medical history section of the examination report states that in the late 1970s, the Veteran developed problems with shortness of breath. He did not seek medical treatment for his symptoms. He smoked 2.5 packs of cigarettes for 14 years and quit in 1984. Concerning current treatment, he uses Symbicort and ProAir. The corresponding December 2020 medical opinion states that the Veteran's January 1986 separation examination demonstrates that he had shortness of breath and a cough. He was a heavy smoker at the time. Therefore, it is at least as likely as not that that the Veteran's COPD is related to his period of heavy smoking during his active service. The Board finds that the above medical opinion cannot support a grant for service connection for COPD as it is inadequate. See Barr, 21 Vet. App. at 312. Service connection for a disability attributable to tobacco usage during service is prohibited. 38 U.S.C. § 1103; 38 C.F.R. § 3.300. Even if the Veteran began smoking while in service, service connection cannot be awarded for a disability on the grounds that it was caused by such smoking. Service connection is expressly precluded for any disability related to chronic tobacco use (smoking) for claims received by VA after June 9, 1998, which is the case here. See 38 U.S.C. § 1103; 38 C.F.R. § 3.300; Internal Revenue Service Restructuring and Reform Act of 1998, Pub. L. No. 105-206, 112 Stat. 685, 865-66 (1998). Therefore, an addendum medical opinion is necessary to determine the nature and etiology of his COPD. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from December 2020 to the present and associate them with the claims file. 2. After the above development is completed, obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's other specified trauma and stressor related disorder. The examiner must review the Veteran's claims folder. The examiner must: (a.) Opine whether the Veteran's other specified trauma and stressor disorder is at least as likely as not (50 percent probability or greater) related to his active service. In providing the above medical opinion the examiner should consider: The Veteran's reported in-service stressors of (1) being shocked while aboard a ship; (2) being near a pinhole leak while aboard a ship that could have resulted in injury or death if he were closer; and (3) having a shipmate washed overboard that resulted in his death while aboard a ship. A complete rationale must be provided for all opinions and conclusions reached. 3. Obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's COPD. The examiner must review the Veteran's claims folder. The examiner must: (a.) Opine whether the Veteran's COPD is at least as likely as not (50 percent probability or greater) related to his active service, including possible asbestos exposure. In providing the above medical opinion the examiner should consider: The Veteran's service treatment records demonstrate that he had potential asbestos exposure while decommissioning ships and he reported respiratory symptoms of cough, muscle aches, shortness of breath, stuffy nose, eyes burning or watering, and throat sore or burning. See March 1985 Medical Surveillance Questionnaire. Additionally, a chest x-ray conducted in January 1986 indicated left lower lobe atelectasis vs. pleural thickening. See January 1986 Radiologic Consultation Request. A May 2016 chest CT scan states that there are no calcified pleural plaques seen to indicate prior asbestos exposure. There is no evidence for pleural thickening or pericardial fluid. There are no pleural effusions seen. There are small mediastinal and hilar lymph nodes that are not enlarged by CT criteria. The lungs are clear. There appears to be subpleural deposition of fat and hazy atelectasis is seen at the right lung base. There is no evidence of septal thickening to suggest interstitial lung disease. There is no evidence of thoracic aortic aneurysm. A suspicious osseous abnormality is not observed. Diagnostic testing from December 2020 revealed no gross pleural effusions or consolidations and mild bibasilar atelectasis. A complete rationale must be provided for all opinions and conclusions reached. 4. Ensure that the requested opinions are associated with the claims file. After completing the above, and any additionally indicated development, readjudicate the claims. RACHEL E. JENSEN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mussey, Sean 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.