Citation Nr: 21075997 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 18-53 448 DATE: December 22, 2021 ORDER Entitlement to a compensable evaluation for bilateral hearing loss from October 26, 2001 through September 7, 2010 is denied. Entitlement to a 10 percent evaluation, but no higher, for bilateral hearing loss from September 8, 2010 through December 7, 2014 is granted, subject to the applicable laws and regulations governing the payment of monetary benefits. Entitlement to a total disability rating based on individual unemployability (TDIU) from October 26, 2001 through December 14, 2014 is denied. FINDINGS OF FACT 1. Throughout the rating period from October 26, 2001 through September 7, 2010, the most probative evidence of record does not reflect Veteran's service-connected bilateral hearing loss manifested with hearing impairment in either ear to warrant a compensable rating. 2. Resolving reasonable doubt in the Veteran's favor, throughout the rating period from September 8, 2010 through December 7, 2014, the most probative evidence of record reflects the Veteran's service-connected bilateral hearing loss approximated, at worst, level VI hearing impairment in the right ear and level II hearing impairment in the left ear. 3. Throughout the appeal period from October 26, 2001 through December 14, 2014, the preponderance evidence of record is against a finding that the Veteran was unable to secure or follow a substantially gainful occupation due solely to his service-connected disability/ies. CONCLUSIONS OF LAW 1. The criteria for a compensable evaluation for bilateral hearing loss, from October 26, 2001 through September 7, 2010, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.21, 4.85, 4.86, Diagnostic Code 6100. 2. The criteria for a 10 percent evaluation, but no higher, for bilateral hearing loss, from September 8, 2010 through December 7, 2014, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.21, 4.85, 4.86, Diagnostic Code 6100. 3. The criteria for a TDIU, from October 26, 2001 through December 14, 2014, due to service-connected disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321(b)(1), 4.16(a), (b). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1965 to September 1967, with service in the Republic of Vietnam from August 1966 to September 1967. The Board thanks the Veteran for his service to our country. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2018 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). The March 2018 rating decision found clear and unmistakable error in a prior rating decision and granted service connection for bilateral hearing loss and assigned a noncompensable evaluation from October 26, 2001. These matters, entitlement to a compensable evaluation for bilateral hearing loss from October 26, 2001 through December 7, 2014, and entitlement to a TDIU due to service-connected disability from October 26, 2001 through December 14, 2014, were remanded by the Board in November 2020 and August 2021. These remanded matters now return for appellate review. In August 2020, the Veteran presented testimony at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is associated with the claims file. 1. Entitlement to a compensable evaluation for bilateral hearing loss from October 26, 2001 through December 7, 2014 Disability evaluations are determined by comparing a veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The rating period for consideration on appeal is from the date service connection has been established for bilateral hearing loss, which is October 26, 2001. The assigned evaluation for hearing loss is determined by mechanically applying the rating criteria to certified test results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Under the applicable criteria, ratings for hearing loss are determined in accordance with the findings obtained on audiometric examinations. Evaluations of hearing impairment range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests (Maryland CNC), together with the average hearing threshold level as measured by puretone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz. The rating criteria establish eleven auditory acuity levels designated from I to XI. As set forth in the regulations, Tables VI, VIa, and VII are used to calculate the rating to be assigned. See 38 C.F.R. § 4.85, Diagnostic Code 6100. Additionally, the regulations allow for evaluating exceptional patterns of hearing impairment. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, Table VI or Table VIa is to be used, whichever results in the higher numeral. Each ear will be evaluated separately. 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, Table VI or Table VIa is to be used, whichever results in the higher numeral. Thereafter, that numeral will be elevated to the next higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86 (b). Here, as discussed above, the March 2018 rating decision found clear and unmistakable error in a prior rating decision and granted service connection for bilateral hearing loss and assigned a noncompensable evaluation from October 26, 2001. Thus, as service connection for bilateral hearing loss was retroactively established, during the appeal period at issue, from October 26, 2001 through December 7, 2014, there is a single June 2002 VA fee-based examination report with audiometric testing. The June 2002 fee based examination report documented a rounded puretone threshold average of 54 decibels for the Veteran's right ear and a rounded puretone threshold average of 58 decibels for his left ear, at the relevant frequencies of 1000, 2000, 3000 and 4000 Hertz. The June 2002 fee based examination results revealed Maryland CNC speech recognition scores of 98 percent, bilaterally. Based on these results with the utilization of Table VI, the Veteran had level I hearing impairment in the right ear, and level II hearing impairment in the left ear. Applying the results to Table VII, a zero percent rating is warranted for bilateral hearing loss based on the June 2002 audiological examination results. See 38 C.F.R. § 4.85, Diagnostic Code 6100. Also, as relevant to the appeal period, a January 2015 private medical record noted, in part, that in August 2011, the Veteran had a chief complaint of hearing loss after chemotherapy and radiation therapy. Similarly, August 2015 and December 2015 VA opinions also found, in part, that the Veteran was diagnosed with non-Hodgkin's lymphoma in November 2009, and he was given six months of chemotherapy and radiation therapies, and months following the chemotherapy, he informed his private physicians about a decrease in his bilateral hearing. Additionally, the Veteran submitted private audiometric testing dated during the appeal period at issue; however, the private audiometric testing does not contain Maryland CNC speech recognition scores, which are required to utilize Table VI. In this regard, the private audiometric testing dated in April 2012, November 2014, May 2015 explicitly noted use of Northwestern University Auditory Test Number Six (NU-6) live voice. Further, in a September 2020 statement, the Veteran confirmed his private medical provider used NU-6 live voice. Further, although private audiometric testing dated in May 2011, August 2011, April 2012, and November 2014 showed an exceptional patterns of hearing impairment under Table VIa, with respect to puretone thresholds, for the Veteran's right ear, at the relevant frequencies of 1000, 2000, and 4000 Hertz; the relevant of frequency of 3000 Hertz was not specifically noted in the August 2011 and April 2012 testing. Further, as to all private audiometric testing, utilization of Table VI for the Veteran's left ear is still required to achieve an accurate rating as his left ear did not demonstrate an exceptional patterns of hearing impairment. Further, use of Table VIa as to the May 2011 and November 2014 private audiometric testing of the Veteran's right ear, which provided puretone thresholds for all four frequencies, and assigment of a level I for the Veteran's left ear, still results in a noncompensable evaluation under Table VII. 38 C.F.R. § 4.85 (f). Thus, due to lack audiometric testing with the required Maryland CNC speech recognition scores during the appeal period, a VA examiner provided a retrospective opinions in March 2021 and April 2021. See Savage v. Shinseki, 24 Vet. App. 259 (2011). In the April 2021 opinion, the VA examiner found the Veteran's hearing remained mostly stable from October 26, 2001 to September 8, 2010. Further, in both the March 2021 and April 2021 opinions, the VA examiner found the Veteran's hearing loss in the right ear began progressing somewhere between September 8, 2010 and April 24, 2012. Both the March 2021 and April 2021 opinions specifically noted on September 8, 2010 the Veteran's right ear presented with a puretone average of 40 decibels and by April 24, 2012, the hearing loss indicated a puretone average of 63.8 decibels. However, both opinions also explained during the period of time at issue, there were several privately obtained audiograms that showed the right ear fluctuating. The VA examiner explained, in both opinions, in other words, sometimes the right ear appeared to hear better than previous records and sometimes it seemed to hear worse than previous records. However, the VA examiner found, in both opinions, by April 24, 2012, the fluctuations appeared to have settled in to a permanent progressive hearing loss. Both the March 2021 and April 2021 opinions further explained the progression seen in the left ear was minimal when compared to the right ear, specifically on September 8, 2010, the puretone average in the left ear was 35 decibels as compared to 50 decibels on April 24, 2012. In this regard, generally consistent with the March 2021 and April 2021 VA opinions, September 8, 2010 private audiometric testing demonstrated a rounded puretone threshold average of 49 decibels for the Veteran's right ear and a rounded puretone threshold average of 46 decibels for his left ear, at the relevant frequencies of 1000, 2000, 3000 and 4000 Hertz. In contrast, prior private audiometric testing dated in March 2009 demonstrated a rounded puretone threshold average of 56 decibels for the Veteran's right ear and a rounded puretone threshold average of 53 decibels for his left ear, at the relevant frequencies of 1000, 2000, 3000 and 4000 Hertz. Further, comparison of word recognition scores reflect a decrease from March 2009 to September 2010. Specifically, in March 2009 the Veteran had a right ear word recognition score of 80 percent, characterized as good, and a right ear word recognition score of 92 percent, characterized as excellent. However, in September 2010, he had a right ear word recognition score which had decreased to 76 percent and a left ear word recognition score which had decreased to 84 percent. Further, consistent with the March 2021 and April 2021 VA opinions, other evidence dated prior to September 8, 2010 does not demonstrate a 10 percent rating is warranted. Specifically, proximate to the appeal period, October 2000 private medical records noted, in part, the Veteran had bilateral ear congestion with prescription for bilateral ear irrigation and a hearing related complaint. During the appeal period, a June 2002 private medical record, documented, in part, the Veteran complained of being hard of hearing and wanted an ear lavage. Similarly another June 2002 private medical record of the same date, documented, in part, the Veteran needed cleaning and was having a hearing test. Also, a March 2010 private medical record noted, in part, the Veteran had been medically evaluated and may be considered a candidate for a hearing aid. The Board recognizes some of the March 2021 and April 2021 VA opinions' findings are inconsistent with evidence of record. For example, the finding that on September 8, 2010, the Veteran's right ear presented with a puretone average of 40 decibels, and by April 24, 2012, the hearing loss indicated a puretone average of 63.8 decibels, is inconsistent with evidence of record. In this regard, on September 8, 2010 private audiometric testing demonstrated a rounded puretone threshold average of 49 decibels for the Veteran's right ear, rather than 40 decibels. Also, April 2012 private audiometric testing does not contain a puretone threshold at the relevant frequency of 3000 Hertz necessary to calculate an average. However, these inaccuracies do not change March 2021 and April 2021 VA opinions in any meaningful way as the main premise of the opinions, that the Veteran's hearing loss declined, at the earliest, beginning on September 8, 2010, remains unchanged as evidence, as discussed above, does reflect his hearing worsened on September 8, 2010. Thus, the March 2021 and April 2021 VA opinions, taken in combination, are entitled to substantial probative weight. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). Following the June 2002 fee based examination report, the next audiometric testing with the required Maryland CNC speech recognition scores, is dated in July 2015, which is proximate to the appeal period. The July 2015 VA examination report documented a rounded puretone threshold average of 61 for the Veteran's right ear and a rounded puretone threshold average of 58 for his left ear, at the relevant frequencies of 1000, 2000, 3000 and 4000 Hertz. The July 2015 VA examination results revealed Maryland CNC speech recognition scores of 64 percent, in the Veteran's right ear, and 96 percent in his left ear. Based on those results with the utilization of Table VI, the Veteran had level VI hearing impairment in the right ear, and level II hearing impairment in the left ear. Thus, applying the results to Table VII, a 10 percent rating is warranted for bilateral hearing loss based on the July 2015 VA audiological examination results following application of Table VI. See 38 C.F.R. § 4.85, Diagnostic Code 6100 In addition, the July 2015 VA examination results demonstrated an exceptional pattern of hearing impairment in the Veteran's right ear, and thus, with the utilization of Table VIa, such provides a lesser finding of level IV hearing impairment in the right ear. 38 C.F.R. § 4.86 (a). Thus, applying the results to Table VII, a noncompensable rating is warranted for bilateral hearing loss based on the July 2015 VA audiological examination results following application Table VIa. Id. Thus, as the VA examiner in the March 2021 and April 2021 opinions found the Veteran's hearing loss in the right ear began progressing somewhere between September 8, 2010 and April 24, 2012, which is consistent with other evidence of record, the Board will resolve reasonable doubt in the Veteran's favor and find his hearing loss began progressing as of September 8, 2010. Further, as the Veteran's hearing loss began progressing as of September 8, 2010, the Board will apply the next audiometric testing results of record, with the required Maryland CNC speech recognition scores, which is the audiometric testing results dated in July 2015. Given the puretone threshold averages and speech recognition scores as set forth in the July 2015 VA audiological examination, in mechanically applying the rating criteria, the Veteran's bilateral hearing loss has been shown to warrant a 10 percent rating but no higher. The demonstrated July 2015 audiometric test results simply do not call for a rating in excess of 10 percent for this level of hearing impairment pursuant to the rating criteria. See 38 C.F.R. § 4.85, Diagnostic Code 6100. For these reasons, the Board finds that, from September 8, 2010, but no earlier, the Veteran is entitled to a 10 percent rating, but no higher, for bilateral hearing loss. Furthermore, the Board recognizes the Veteran's assertions that he has experienced reduced hearing acuity and clarity for many decades. Specifically, in an October 2001 application for hearing loss, the Veteran reported he had a loss of partial hearing, specifically 80 percent, in both ears, which began in basic training and continued thereafter. In a December 2017 statement, the Veteran reported, in part, that his initial claim was filed in 2001, that he was a combat Vietnam Veteran and his hearing loss had been problematic to him throughout his life since he was discharged. In August 2020 testimony, the Veteran reported as to his right ear, he was completely deaf, and he never passed a hearing examination in 53 years, including his separation examination. Also, in a September 2020 statement, the Veteran reported he had never passed a hearing examination in 53 years, which includes his separation examination. Most recently, in a November 2021 statement, the Veteran argued the noncompensable evaluation assigned from 2001 to 2014 was unjust. The Board expressly acknowledges its consideration of the Veteran's statements and acknowledges he is competent to report difficulty with his hearing. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, 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, 3 Vet. at 349. Further, the Veteran has not been shown to have the requisite medical knowledge or training to be deemed competent to identify a specific level of disability of his bilateral hearing loss according to the rating criteria. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Such competent evidence concerning the nature and extent of the Veteran's bilateral hearing loss has been provided by the June 2002 fee based examination report, the July 2015 examination report, retroactively applied, and March 2021 and April 2021 VA opinions, and these reported medical findings directly address the rating criteria under which the Veteran's hearing loss disability is evaluated. The Board finds the June 2002 fee based examination report, the July 2015 examination report, retroactively applied, and March 2021 and April 2021 VA opinions to be competent, objective, and probative evidence of record, and are therefore accorded greater weight than the Veteran's subjective complaints of increased symptomatology for his bilateral hearing loss. Further, in August 2020 testimony and a September 2020 statement, the Veteran also reported, due his hearing loss, in his workplace he was ridiculed, taunted, and isolated, and his mental trauma was so great that he had to retire early. Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran's disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant's symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. In regard to the first element, comparison of the Veteran's symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. 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. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). In this case, the rating criteria for hearing loss contemplate the functional effects of the Veteran's reported reduced hearing acuity and clarity. Further, mental trauma can adequately be evaluated under VA's General Rating Formula for Mental Disorders, and therefore, is not considered exceptional. See Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). Additionally, during the appeal period prior to December 7, 2014, there is no indication the Veteran had a psychiatric condition, with valid DSM-5 diagnosis, related to mental trauma, and thus it is not considered a compensable condition. See Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 404 (2020). While a May 2014 private medical record, in part, noted the Veteran's health problems reviewed included anxiety, the record did not indicate the Veteran had a diagnosis of anxiety in accordance with the DSM-5. Further, the evidence does not show or indicate a nexus between any mental trauma and the Veteran's hearing loss warranting the need for further development. Additionally, proximate to the appeal period, a June 2015 VA examiner endorsed diagnoses of posttraumatic stress disorder (PTSD) and major depressive disorder. However, from December 15, 2014, service connection for PTSD and major depressive disorder was awarded, on a direct incurrence basis, in a July 2015 rating decision. Again, the evidence does not show a nexus between any mental trauma and the Veteran's hearing loss. The threshold issue under Thun is thus is not met, and further consideration of an extraschedular rating is not warranted. Long v. Wilkie, 33 Vet. App. 167 (2020). Additionally, in August 2020 testimony, the Veteran reported that the VA examination conducted in 2002 was biased and invalid and he spent approximately five minutes with the physician. He also testified it was conducted in a hearing aid shop, separate from the physician's office, and it was his sincere opinion that the purpose was only to sell hearing aids to VA for profit. He also stated he never viewed any of his paperwork or saw the physician again. In this regard, the Veteran's recollection is consistent with the record in that it reflects the June 2002 examination was a fee-based examination. However, the question of whether an examiner is competent and whether he or she has rendered an adequate opinion are two separate inquiries. See Francway v. Wilkie, 930 F.3d 1377, 1381 (Fed. Cir. 2019). Absent some challenge to the expertise of a VA expert, there is no requirement that VA present affirmative evidence of a medical professional's qualifications in every case as a precondition for the Board's reliance upon that person's opinion, and the Board is entitled to assume the competence of a VA examiner unless the competence is challenged. Sickels v. Shinseki, 643 F.3d 1362, 1365-66 (Fed. Cir. 2011); Rizzo v. Shinseki, 580 F.3d 1288 (Fed. Cir. 2009). This presumption is rebutted when the Veteran raises the issue of competency. See Francway, 930 F.3d at 1380. After the Veteran challenges the competency of a medical examiner, the Board must then make factual findings regarding the qualifications and provide reasons and bases for concluding whether or not the medical examiner was competent to provide the opinion. Id. at 1381. Rather than challenging the competency of the June 2002 fee based examiner in this case, the Veteran's objections are generally based the length of the examination, the lack of follow-up with the examiner and the paperwork, and that he believed the examiner's motivation was to sell hearing aids to the VA for profit. However, there is no evidence to support the Veteran's contentions of any material irregularity nor is the Board able to discern any material irregularities in the June 2002 fee based examination report. Indeed, as discussed above, the June 2002 fee based examiner documented objective audiometric testing. Further, the June 2002 fee based examiner provided a positive nexus opinion in support of the Veteran's claim, which would not seemingly support a finding of bias against the Veteran. Thus, the June 2002 fee based examination report is adequate. Accordingly, the Board finds that, from September 8, 2010, but no earlier, the Veteran is entitled to a 10 percent rating, but no higher, for bilateral hearing loss. In reaching this decision, the Board considered the doctrine of reasonable doubt, however, to the extent the preponderance of the evidence is against a rating higher than or separate from that already granted herein, the doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a total disability rating based on TDIU from October 26, 2001 through December 14, 2014 The Veteran contents entitlement to a TDIU is warranted from October 26, 2001 through December 14, 2014. In an October 2001 statement, the Veteran reported, in part, that during his civilian career, he applied a job at a sheriff's department but was denied admittance due to his loss of hearing, and he was only able to get custodial jobs to support his family. In August 2020 testimony, the Veteran reported he tried to get career jobs after discharge but could not because of his hearing loss. Most recently, in a November 2021 statement, the Veteran reported he was employed by a school district for many years as a custodian, and there was constant noise on the school campuses, specifically from children running and yelling, bells ringing, loud talking, phones ringing, loud intercoms and the beeping from walkie talkies. He further described, when he was in his office, the administrative staff communicated using walkie talkies and it was difficult to hear when he was summoned. He also reported that there were times he did not hear the telephone ring and that he acted like he heard the conversation or instruction when in reality he did not. A total disability rating may be assigned, where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as the result of service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.16. Consideration may be given to a veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or the impairment caused by any nonservice-connected disabilities. See 38 C.F.R. §§ 4.16, 4.19. To meet the schedular requirements, there must be one disability ratable at 60 percent or more, or, if more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent. 38 C.F.R. § 4.16(a). Nevertheless, it is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Rating boards are to refer to the Director of the Compensation Service for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage requirements of 38 C.F.R. § 4.16(a). 38 C.F.R. § 4.16(b). In determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to both an economic component and a non-economic component. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the Veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. The rating period for consideration on appeal from October 26, 2001 through December 14, 2014. During the appeal period from October 26, 2001 through December 7, 2014, service connection was established for bilateral hearing loss, rated as noncompensable from October 26, 2001 through September 7, 2010, and based on the above grant, as 10 percent disabling, from September 8, 2010 through December 7, 2014. The Veteran's combined evaluation for compensation from October 26, 2001 through December 7, 2014 mirrors his bilateral hearing loss rating. Therefore, the Veteran does not meet the schedular criteria for a TDIU from October 26, 2001 through December 7, 2014. 38 C.F.R. § 4.16(a). After careful consideration, the Board finds there is insufficient evidence to substantiate a reasonable possibly that a Veteran is unemployable because of service-connected bilateral hearing loss from October 26, 2001 through December 7, 2014 to warrant referral, on extraschedular basis to the Director of Compensation, under 38 C.F.R. § 4.16(b). Snider v. McDonough, 2021 U.S. App. Vet. Claims LEXIS 2050 (Nov. 19, 2021). Specifically, two September 2021 VA opinions, each found, in part, the Veteran's hearing loss alone from 2001 to 2014, should not be a barrier to a wide range of employment settings with the use of hearing aids. Further, the September 2021 VA opinions were specifically obtained to address the functional effects of the Veteran's bilateral hearing loss on his occupational and daily functioning from October 26, 2001 through December 7, 2014 and, as such, provide the most probative evidence against a finding that there is sufficient evidence to substantiate a reasonable possibly that a Veteran is unemployable because of service-connected bilateral hearing loss. Moreover, the September 2021 VA opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. As such, referral for consideration of entitlement to a TDIU on an extraschedular basis is not warranted under 38 C.F.R. § 4.16(b). Further, TDIU benefits are not warranted because the veteran is not unemployable due to service-connected disability/ies. During the appeal period from December 8, 2014 through December 14, 2014, service connection was established for Meniere's syndrome (claimed as vertigo, hearing loss, and tinnitus) associated with non-Hodgkin's lymphoma, in remission, with surgical scar on the left side of the neck, rated as 100 percent disabling effective from December 8, 2014. Here, if the criteria for TDIU were met based on a single service-connected disability in addition to, and independent of, the total schedular rating for Meniere's syndrome, the Veteran would be entitled to a category of special monthly compensation pursuant to 38 U.S.C. § 1114 (s) which would result in a rate of compensation above the rate provided for 100 percent disability. See Bradley, 22 Vet. App. at 280. Specifically, in addition to Meniere's syndrome, the Veteran is service-connected non-Hodgkin's lymphoma, in remission, with surgical scar on the left side of the neck, rated as noncompensable effective from December 8, 2014. In regard to the Veteran's employment history, an October 1984 private medical record documented, in part, that the Veteran was a custodian for a school district. Similarly, a May 1986, private medical record documented the Veteran was employed, at a school district, as a custodian and plant manager from 1969 through the present. More recently, VA treatment records dated from April 2018 through June 2021 noted the Veteran was a retired custodial worker. Also of record is a May 2021 VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, from a former employer of the Veteran, a school district, which reflected he was last employed in December 2000. The May 2021 VA Form 21-4192 also documented the Veteran worked as a plant manager, and was employed from October 1969 to December 2000. The May 2021 VA Forms 21-4192 documented the Veteran was not allowed any concessions during his employment and he was not working due to retirement. In addition, on his August 2015, VA Form 21-8940, the Veteran reported he engaged in custodial work, that he last worked full-time in December 2000, and that he became too disabled to work in November 2009. In a May 2021 VA Form 21-8940, the Veteran reported he was a custodial plant manager, that he last worked full-time in December 2000 and became too disabled to work in January 2010. However, he also reported he worked 20 hours a week for a school district as a custodian from September 1994 to March 2008, with highest gross monthly earnings of $1440.00, and 15 hours a week at a convention center from September 2008 to December 2009, with highest gross monthly earnings of $780.00. In August 2020 testimony, the Veteran reported he worked two janitorial jobs, 16 hours a day for 33 years, and then he worked part-time the last 10 years. The poverty threshold for two persons (as the Veteran was married during this period) over 65 years in 2008 was $13,030.00, and in 2009 was $12,982.00. U.S. Department of Commerce, Bureau of the Census, Poverty Thresholds, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html. Thus, for the Veteran's part-time work history from September 2008 to December 2009, he earned less than the poverty threshold for two persons based on his reported highest gross monthly earnings of $780.00. 38 C.F.R. § 4.16 (a). Additionally, as to the Veteran's part-time work history from September 1994 to March 2008, although he earned more than the poverty threshold for two persons based on his reported highest gross monthly earnings of $1440.00, as noted, this is the highest gross monthly earnings, not actual earnings. Thus, rather than remand to obtain any actual earnings from September 1994 to March 2008, the Board will resolve reasonable doubt in the Veteran's favor and find any employment after December 2000 was marginal employment. In terms of the Veteran's education, in his August 2015 and May 2021 VA Forms 21-8940, he reported two years of college education. In his August 2015, VA Form 21-8940, he also reported continuous custodial training from 1967 to 1988. Similarly, December 2015 and March 2016 VA treatment records noted the Veteran had two years of college education. As discussed above, during the appeal period from October 26, 2001 through December 7, 2014, the Veteran was service-connected solely for bilateral hearing loss. In terms of the Veteran's service-connected bilateral hearing loss, proximate to the appeal period, a June 2015 VA examiner found the Veteran's hearing loss did not impact the ordinary conditions of daily life, including his ability to work. Also, proximate to the appeal period, an October 2015 VA examiner found the Veteran had significant functional hearing loss that caused marked functional impairment, and noted he was unable to hear at all without hearing aids. Thus, the June 2015 and October 2015 VA examiners provided conflicted opinions within a short window of time. Thus, a September 2021 VA examiner found, in part, the Veteran's hearing loss alone from 2001 to 2014, as shown on the June 2015 VA examination report, should not be a barrier to a wide range of employment settings with the use of hearing aids. The September 2021 VA examiner explained that any individuals with the Veteran's degree of hearing loss, function well in many occupational settings with hearing aids, but this was not to say that the Veteran's hearing loss would cause some problems depending on the vocation. Specifically, the September 2021 VA examiner noted the Veteran may have trouble working well in very noisy environments, and in environments which required him to often use non face-to-face communications equipment (such as intercoms, phone, etc.), or in jobs which required a great deal of attention to high pitched sounds (such as monitoring medical equipment or other "beeps and pings"). A September 2021 addendum opinion, from the September 2021 VA examiner, also noted communication would be more difficult without the use of hearing aids or in work environments when hearing aids were not allowed, and Veteran's hearing loss would cause difficulty hearing conversation in certain noisy environments. The September 2021 addendum opinion noted the Veteran would do well one-on-one in a quiet room with visual cues and the more noise introduced to the environment, the more difficult this individual would have with daily communication. The September 2021 addendum opinion also noted hearing loss alone did not affect the physical or sedentary abilities of an individual. Here, the Board finds the term "sedentary" as used by the September 2021 VA addendum opinion to have the common meaning of a non-physical job, primarily involving sitting and usually performed in an indoor, office-type environment. See Withers v. Wilkie, 30 Vet. App. 139, 147-48 (2018). The VA examiner's September 2021 addendum opinions, taken in combination, are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Board gives these opinions significant probative value and finds the preponderance of the evidence of record is against the claim for TDIU. As discussed above, during the appeal period from December 8, 2014 through December 14, 2014, only the Veteran's service-connected non-Hodgkin's lymphoma, in remission, with surgical scar on the left side of the neck, is for consideration. In this regard, proximate to the appeal period, July 2014, September 2014, and November 2014 private medical records documented, in part, the Veteran had a history of non-Hodgins's lymphoma, but these records did not document any specific symptoms or complaints related to non-Hodgins's lymphoma. Also, proximate to the appeal period, a March 2015 VA examiner found the Veteran's primary hematologic or lymphatic disorder, diagnosed as non-Hodgkin's lymphoma, was in remission. The March 2015 VA examiner also found the Veteran's hematologic or lymphatic disorder, diagnosed as non-Hodgkin's lymphoma, did not require continuous medication, and that he was not currently undergoing any treatment, but instead, the status was watchful waiting. The March 2015 VA examiner also found Veteran did not currently have any findings, signs and symptoms due to a hematologic or lymphatic disorder or to treatment for a hematologic or lymphatic disorder. Specifically, the March 2015 VA examiner did not endorse findings of weakness, easy fatigability, light-headedness, shortness of breath, headaches, tachycardia, syncope, cardiomegaly, high output congestive heart failure, or other symptoms. The March 2015 VA examiner also found that Veteran's hematologic or lymphatic condition did not impact his ability to work. Therefore, the Board concludes that the criteria for a TDIU were not met for the purposes of special monthly compensation at the housebound rate. Other Considerations The Board also recognizes, a December 2015 VA treatment record noted the Veteran was retired, that he had been a janitor and he stated that this was all he could do because of Meniere's Syndrome. Another December 2015 VA treatment record noted the Veteran reported that he was employed as a custodian until 2009 and had to retire because of problems related to his hearing and/or vertigo. A July 2017 VA treatment record documented, in part, the Veteran had been struggling with hearing loss since his service, which affected his employment. Also, as noted above, in August 2020 testimony and a September 2020 statement, the Veteran also reported, due his hearing loss, in his workplace he was ridiculed, taunted, and isolated, and his mental trauma was so great that he had to retire early. Similarly, in his August 2015 VA Form 21-8940, the Veteran reported non-Hodgkins lymphoma, anxiety, hearing loss, and vertigo, prevented him from securing or following a substantially gainful occupation. In his May 2021 VA Form 21-8940, the Veteran reported non-Hodgkins lymphoma and Meniere's syndrome (vertigo, hearing loss, tinnitus) prevented him from securing or following a substantially gainful occupation. However, as to the Veteran's psychiatric disability, service connection was established during the appeal at issue prior to December 14, 2014, and thus, is not for consideration. Also, as discussed above, Meniere's syndrome is not for consideration. Further, although not dated proximate to the appeal period, the Veteran's private medical records, dated contemporaneous to his employment, do not reflect he was limited in his employment duties due to his bilateral hearing loss or non-Hodgkin's lymphoma. For example, an October 1980 private medical record noted, in part, that the Veteran injured his left knee while at work about a week ago. Also, a May 1983 private medical record documented, in part, the Veteran had anxiety secondary to work stress, and a June 1983 private medical record documented, in part, the Veteran was seeking disability from work secondary to increased stress and/or anxiety on the job. Thereafter, an August 1983 private medical record noted, in part, the Veteran was on part-time work and had obtained disability from workers compensation. A November 1983 private medical record noted, in part, a specific physician did not does not consider the Veteran permanently disabled. Also, a February 1986 private medical record noted the Veteran had been followed in the clinic since 1982, that he was currently treated for hypertension, which was controlled on medication, and in the interim, he had had numerous somatic complaints, which had been a function of the stress he has experienced while at his job with the sheriff's department. An April 1986 private medical record noted the Veteran had been retired since September 1984, and was applying for medical disability but a decision was still pending. More recently, a July 2001 private medical record documented, in part, that the Veteran had a problem with his foot and required another week off from work. Further, as discussed above the May 2021 VA Form 21-4192, documented the Veteran was not allowed any concessions during his employment ending in December 2000, and he was not working due retirement. Having considered the medical and lay evidence of record, the Board finds the Veteran's service-connected bilateral hearing loss, from October 26, 2001 through December 7, 2014, and his service-connected non-Hodgkin's lymphoma, from December 8, 2014 through December 14, 2014, did not preclude him from securing or following a substantially gainful occupation consistent with his education and vocational background. In terms of the occupational economic component, as discussed above, the Veteran was unemployed as of December 2000, and resolving reasonable doubt in the Veteran's favor, any employment following December 2000 is considered marginal employment. However, in terms of the non-economic component, as discussed above, the limitations documented as resulting from the Veteran's service-connected bilateral hearing loss, from October 26, 2001 through December 7, 2014, or his service-connected non-Hodgkin's lymphoma, from December 8, 2014 through December 14, 2014, are not reflective of limitations that would preclude him from securing or following a substantially gainful occupation consistent with his education and vocational background, in particular, with his prior usual occupation of a custodial plant manager and/or custodian. While the Veteran may believe he was unable to secure and follow a substantially gainful occupation due to his service-connected disability/ies, he has not been shown to have the requisite medical knowledge to be deemed competent to provide an opinion in this case. The issue is medically complex, as it requires specialized medical education. Jandreau, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent medical evidence, to include March 2015 and September 2021 VA opinions. Thus, in consideration of the evidence, the Board finds that the Veteran's disability/ies did not preclude him from securing or following a substantially gainful occupation, consistent with his educational and vocational history at any point during the appeal period. 38 C.F.R. § 4.16 (b). As the preponderance of the evidence is against the entitlement to a TDIU, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102 , 4.3, 4.7; Gilbert, 1 Vet. App. at 53-56. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Espinoza, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.