Citation Nr: 21077609 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 17-26 930 DATE: December 30, 2021 ORDER A rating in excess of 10 percent for tinnitus is denied. A compensable rating for bilateral hearing loss is denied. Service connection for a right knee disorder is denied. Service connection for a left knee disorder is denied. Service connection for a low back disorder is denied. Service connection for a respiratory disorder is denied. Service connection for an acquired psychiatric disorder is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is denied. FINDINGS OF FACT 1. The Veteran served on active duty from September 1975 to August 1978. 2. The current rating for tinnitus is the maximum allowed by the law. 3. Bilateral hearing loss has been manifested by no worse than Level II hearing acuity in the right ear and Level II hearing acuity in the left ear. 4. A right knee disorder has not been shown. 5. A left knee injury was incurred in service but symptoms were not shown to be chronic; a current left knee disorder, diagnosed as degenerative joint disease (DJD) and medial meniscal tear, was not shown to a compensable degree within one year of service and symptoms were not continuous since service; a current left knee disorder is not causally or etiologically related to service. 6. A low back disorder was not shown in service, was not shown to a compensable degree within one year of service, and symptoms were not continuous since service; a current low back disorder, diagnosed as osteoarthritis and degenerative disc disease (DDD), is not casually or etiologically related to service, and has not been medically associated with a service-connected disability. 7. A respiratory disorder, diagnosed as chronic obstructive pulmonary disease (COPD), was not shown in service and is not causally or etiologically related to service. 8. An acquired psychiatric disorder, diagnosed as unspecified anxiety disorder and depressive disorder, was not shown in service, is not causally or etiologically related to service, and has not been medically associated with a service-connected disability. 9. The Veteran's only service-connected disabilities are tinnitus, rated at 10 percent, and bilateral hearing loss, rated as noncompensable; he does not meet the minimum schedular criteria for TDIU and his service-connected disabilities do not render him unable to secure or follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for tinnitus have not been met. 38 C.F.R. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.21, 4.87, Diagnostic Code (DC) 6260 (2020). 2. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A (2012); 38 C.F.R. §§ 4.1, 4.3, 4.85, 4.86, DC 6100 (2020). 3. A right knee disorder was not incurred in service. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 4. A left knee disorder was not incurred in service and is not presumed to have been incurred in service. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). 5. A low back disorder was not incurred in service, is not presumed to have been incurred in service, and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2020). 6. A respiratory disorder was not incurred in service. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 7. An acquired psychiatric disorder was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2020). 8. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a procedural matter, the Board previously remanded the claims for entitlement to an increased rating for tinnitus and bilateral hearing loss and the claims for service connection for a low back disorder, a bilateral knee disorder, a respiratory disorder, and an acquired psychiatric disorder. Further, the Veteran has raised the issue of entitlement to a TDIU associated with the pending increased rating claims. The claims are now ready for adjudication. Increased Rating Claims Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Tinnitus The Veteran is currently rated at 10 percent for tinnitus and contends that he is entitled to a higher rating but offered no theory of entitlement and a higher rating is contrary to law. Specifically, in Smith v. Nicholson, 19 Vet. App. 63, 78 (2005), the Veterans Claims Court held that the pre-1999 and pre-June 13, 2003 versions of DC 6260 required the assignment of dual ratings for bilateral tinnitus. VA appealed this decision to the U.S. Court of Appeals for the Federal Circuit (Federal Circuit), which concluded that the Veterans Court erred in not deferring to VA's interpretation of its own regulations, 38 C.F.R. § 4.25 and DC 6260, which limited a veteran to a single 10 percent rating for tinnitus, regardless of whether the tinnitus is unilateral or bilateral. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). The Veteran's service-connected tinnitus is evaluated as 10 percent disabling, which is the maximum schedular rating available for such disability. To the extent that he has claimed entitlement to a higher rating due to manifestations of severe, debilitating ringing of the ears, there is no legal basis upon which to award a higher rating for these symptoms. Further, an extraschedular rating has been considered. In December 2020, the Director determined that the claim for extraschedular consideration was denied because the evidence of record did not show that the currently assigned schedular rating was inadequate due to exceptional or unusual circumstances. While the medical evidence and lay statements shows complaints of irritation, frustration, and difficulty sleeping due to tinnitus, these symptoms are already contemplated by the current 10 percent rating and do not represent exceptional or unusual circumstances. Hearing Loss Ratings for hearing loss disability are based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination testing together with the average hearing threshold level, in decibels (dB) as measured by pure tone audiometric tests in frequencies 1000, 2000, 3000, and 4000 Hertz (Hz). 38 C.F.R. § 4.85, DC 6100. An examination for hearing impairment for VA purposes must include a controlled speech discrimination test (Maryland CNC). To evaluate the degree of disability from defective hearing, the rating schedule requires assignment of a Roman numeral designation, ranging from I to XI. Other than exceptional cases, VA arrives at the proper designation by mechanical application of Table VI, which determines the designation based on results of standard test parameters. Table VII is then applied to arrive at a rating based upon the respective Roman numeral designations for each ear. Exceptional patterns of hearing impairment allow for assignment of the Roman numeral designation using Table VI or an alternate table, Table VIA, whichever is more beneficial to the Veteran. 38 C.F.R. § 4.86. This applies to two patterns. In both patterns each ear will be evaluated separately. The first pattern is where the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hz) is 55 dB or more. 38C.F.R. § 4.86(a). The second pattern is where the pure tone threshold is 30 decibels or less at 1000 Hz and 70 dB or more at 2000 Hz. If the second pattern exists, the Roman numeral will be elevated to the next higher numeral. Turning to the medical evidence, in an October 2013 VA examination, the pure tone thresholds, in decibels, were reported as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 20 30 75 70 LEFT 25 30 30 75 70 The average pure tone threshold was 49 in the right ear, and 51 in the left ear. Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 96 percent in the left ear. Applying these values to the rating criteria results in a numeric designation of Level I in the right ear and Level I in the left ear. As such, this equates to a noncompensable rating for bilateral hearing loss under Table VII. 38 C.F.R. §§ 3.383, 4.85. Next, in a February 2020 VA examination, the pure tone thresholds, in decibels, were reported as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 35 35 45 95 95 LEFT 35 35 45 80 80 The average pure tone threshold was 68 in the right ear, and 60 in the left ear. Speech audiometry revealed speech recognition ability of 94 percent in the right ear and 94 percent in the left ear. Applying these values to the rating criteria results in a numeric designation of Level II in the right ear and Level II in the left ear. As such, this equates to a noncompensable rating for bilateral hearing loss. Accordingly, the medical evidence obtained from the VA examinations does not support a compensable rating for bilateral hearing loss. Further, the clinical treatment records do not show bilateral hearing loss severe enough to receive a compensable rating. As such, the medical evidence does not support the claim. With respect to the claims for higher ratings, the Board has considered the Veteran's lay statements that his disabilities are worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of these disorders according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's hearing loss and tinnitus has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disabilities are evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disabilities and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeals are denied. Service Connection Claims Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Right Knee Disorder Turning to the medical evidence, an October 2013 VA examiner found that there was no pathology found to support a current diagnosis of a right knee disorder. Further, while the clinical treatment records reflect some complaints of bilateral knee pain, no diagnosis of a right knee disorder has been made. Pain alone is not a disability unless it causes functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Absent evidence of current diagnosed disability of the right knee, there is no disability for which service connection may be granted. See Degmetich v. Brown, 104 F.3d 1328, 1333 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The October 2013 VA examination and clinical treatment records does not show knee pain resulting in functional impairment. As the medical evidence does not show a current diagnosis or right knee pain which results in functional impairment, the first element of service connection has not been met and service connection is not warranted. Left Knee Disorder Turning to the medical evidence, an October 2013 VA examiner noted that the Veteran has been diagnosed with mild DJD of the left knee and a left medial meniscal tear. As such, a current left knee disorder has been shown and the first element of service connection has been met. As to in-service incurrence, the Veteran contends that he hyperextended his knee during active duty. The service treatment records (STRs) show multiple complaints of left knee pain and instability throughout service; however, the August 1978 separation examination reflected a normal clinical evaluation of the lower extremities and musculoskeletal system. Nonetheless, complaints of left knee pain were shown during service and the second element of service connection has been met. As to medical nexus, an October 2013 VA examiner found that the current left knee disorder was less likely than not incurred in or caused by service. After a review of the STRs and medical records, the examiner noted that DJD was a disease of wear and tear that was often due to aging, occupation, trauma, and repetitive small impacts. Further, he noted additional risk factors such as age, sex, obesity, muscle weakness, and genetics. The examiner also indicated that the Veteran did not seek treatment for his knee until nearly 30 years after separation from service. As such, he concluded it was most likely that DJD of the left knee developed slowly over 30 years and less likely that it was related to a few isolated complaints of knee pain during service. There are no contradictory medical opinions of record. As such, the medical evidence weighs against direct service connection. Turning to presumptive service connection, the Veteran has been diagnosed with DJD of the left knee. a disease associated with presumptive service connection under 38 C.F.R. § 3.309. Therefore, the presumptive service connection provisions for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable. The available STRs do not show a chronic left knee injury which began during service. Of note, the separation examination reflected a normal clinical evaluation of the left knee. As such, while complaints related to the left knee were shown during service, a chronic left knee injury was not shown. Next, the medical evidence does not support presumptive service connection based on continuity of symptomatology since service. The August 1978 separation examination reflected that clinical evaluation of his left knee was normal. The record next indicates the Veteran first sought treatment in April 2007 for complaints of left knee pain with swelling. Therefore, this evidence does not support the claim that symptoms of left knee pain were continuous since separation from service in 1978. As such, the medical evidence does not support service connection on a "continuity of symptomatology" basis. Further, the disorder did not manifest to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1978 but did not note symptoms until 2007 at the earliest. This evidence does not support presumptive service connection on a "manifest within one-year from separation" basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. Low Back Disorder Turning to the medical evidence, an October 2013 VA examiner indicated a diagnosis of mild DDD of the lumbosacral spine since approximately 2007. Further, the clinical records reflect a diagnosis of mild osteoarthritis of the spine since February 2020. Accordingly, a current low back disorder has been shown and the first element of service connection has been met. As to in-service incurrence, the STRs do not reflect complaints of, treatment for, or a diagnosis of a back disorder. Further, the August 1978 separation examination indicated a normal clinical evaluation of the spine. As such, the medical evidence does not support the in-service incurrence of a low back disorder. Further, there are no medical opinions of record which establish a direct link between a current back disorder and service. Accordingly, the medical evidence does not support service connection on a direct basis. Turning to presumptive service connection, the Veteran has been diagnosed with degenerative arthritis of the spine. a disease associated with presumptive service connection under 38 C.F.R. § 3.309. Therefore, the presumptive service connection provisions for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable. Nonetheless, the STRs do not show any complaints of or treatment for degenerative arthritis of the lumbar spine in service. Of note, the separation examination reflected a normal clinical evaluation of the spine. As such, a chronic lumbar spine disorder was not shown in service. Next, the medical evidence does not support presumptive service connection based on continuity of symptomatology since service. The August 1978 separation examination reflected that clinical evaluation of his back was normal. The record next indicates the Veteran first sought treatment in June 2007 for complaints of low back pain after he fell off a ladder. Further, he noted that he had had chronic back pain for approximately 15 years, dating the onset to the early 1990s. Therefore, this evidence does not support the claim that symptoms of back pain were continuous since separation from service in 1978. As such, the medical evidence does not support service connection on a "continuity of symptomatology" basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1978 but did not note symptoms until 2007 at the earliest. Even considering his statements that he experienced back pain since the 1990s, this is more than a decade after discharge. Thus, this evidence does not support service connection on a "manifest within one-year from separation" basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. In addition, the Veteran contends that a low back disorder is secondary to a bilateral knee disorder; however, he is not currently service-connected for a bilateral knee disorder. Further, an October 2013 VA examiner opined that a current low back disorder was less likely than not the result of a bilateral knee condition. Rather, the examiner indicated that lumbosacral DDD was more likely related to age or some other incident that occurred in the 35 years after separation from service. As such, the medical evidence does not support service connection on a secondary basis. Respiratory Disorder Turning to the medical evidence, a February 2020 VA examiner noted a diagnosis of COPD since approximately 2013. As such, a respiratory disorder has been shown and the first element of service connection has been met. As to in-service incurrence, the Veteran contends that he was working in shipyards where he was exposed to rust, dust, smoke, and insulation. The STRs reflect several complaints of congestion, coughing, and wheezing in 1978; however, no diagnosis of a chronic respiratory disorder was made and the August 1978 separation examination indicated a normal clinical evaluation of the lungs. As such, the medical evidence does not support the in-service incurrence of a chronic respiratory disorder. Further weighing against the claim, a February 2020 VA examiner opined that COPD was less likely than not incurred in or caused by service. The examiner explained that the multiple treatments for upper respiratory tract infections during service were acute, transient episodes which were unrelated to the current diagnosis of COPD. Further, he noted that the Veteran would have been exposed to dusty, dirty environments in his civilian jobs after separation and also smoked for approximately 10 years after service. While the Veteran has also complained of asbestos exposure, the VA examiner indicated that there was no evidence of asbestosis. Accordingly, the medical evidence does not support service connection for a respiratory disorder. Acquired Psychiatric Disorder Turning to the medical evidence, an October 2013 VA examiner diagnosed the Veteran with dysthymic disorder and unspecified anxiety disorder. Further, subsequent examinations have shown a diagnosis of unspecified depressive disorder. Accordingly, the medical evidence shows a current psychiatric disorder, and the first element of service connection has been met. As to in-service incurrence, the STRs do not reflect complaints of, treatment for, or a diagnosis of a psychiatric disorder during service. Importantly, the August 1978 separation examination showed a normal clinical psychiatric evaluation. As such, the medical evidence does not support the in-service incurrence of an acquired psychiatric disorder. Further, the medical evidence of record does not support a nexus between a current psychiatric disorder and service. An October 2013 VA examiner opined that the records did not support a nexus between a current mental health disorder and active duty. Rather, the Veteran reported extensive childhood trauma and current symptoms due to chronic pain, financial stress, legal problems related to conviction of drug possession and intent to distribute pain medication, and being under house arrest and the stress from regular check-ins and concerns that the alarm may go off. The examiner noted that there was no diagnosis or record of treatment during service. On the other hand, a May 2021 private psychologist concluded that depressive and anxiety disorders more likely than not began in service; however, did not provide a rationale behind this opinion. As such, this opinion is afforded lesser probative value. The Board finds that the VA examination was adequate for evaluation purposes. Specifically, the examiner reviewed the claims file, interviewed the Veteran, and conducted a mental status examination. There is no indication that the VA examiner was not fully aware of the Veteran's past medical history or that he misstated any relevant fact. Moreover, the examiner has the requisite medical expertise to render a medical opinion regarding the etiology of the disorder and had sufficient facts and data on which to base the conclusion. Therefore, the Board finds the VA examiner's opinion to be of great probative value. Accordingly, the weight of the medical evidence does not support service connection on a direct basis due to lack of an in-service incurrence and a medical nexus. The Veteran contends that a current psychiatric disorder is secondary to service-connected tinnitus and hearing loss. In support of the claim, a September 2016 private psychologist opined that depressive disorder was more likely than not caused by his medical conditions and that a psychiatric disorder, along with bilateral hearing loss and tinnitus, rendered the Veteran unemployable. The psychologist pointed to a research study which showed an association between tinnitus, hearing problems, and mental illnesses. The September 2016 concluded that a depressive disorder was more likely than not aggravated by service-connected tinnitus and hearing loss. In May 2021, a separate private psychologist opined that depressive disorder more likely than not aggravated by service-connected disabilities. While the examiner provided a detailed opinion as to the Veteran's psychiatric disorder, she did not explain how service-connected tinnitus and hearing loss aggravated a psychiatric disorder. As such, this opinion is afforded lesser probative value because it did not offer a thorough rationale. Weighing against the claim, a November 2017 VA examiner found it less likely than not that depressive disorder was proximately due to or the result of tinnitus or bilateral hearing loss. He explained that the Veteran had a 10 percent rating for tinnitus and noncompensable rating for hearing loss and that the objective severity of these conditions was less likely the principal factor in a mental health condition. The examiner also noted that the medical records showed a long-standing pattern of psychosocial problems which were more likely the foundation of depression. In addition, the December 2017 VA examiner concluded that a psychiatric disorder was less likely than not proximately due to or the result of a service-connected disability. He explained that the Veteran's hearing loss and tinnitus were manifested by very low levels of symptoms and impairments which were unlikely to cause, or significantly aggravate, anxiety and depression. Next, the examiner indicated that numerous psychosocial stressors, such as childhood abuse, a significant work injury, chronic pain, inability to work, and a history of legal problems, were more likely responsible for depression and anxiety. In addition, the December 2017 examiner found that the September 2016 private examiner's opinion was likely inaccurate and was likely not impartial as it based on exaggerated symptoms reported by the Veteran which were not noted in the VA treatment records. As such, the Board affords the September 2016 psychologist's opinion lesser probative value. Accordingly, the weight of the medical evidence weighs against service connection on a secondary basis. The Board has considered the Veteran's lay statements that his disorders were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. Entitlement to a TDIU A claim for TDIU under Rice v. Shinseki, 22 Vet. App. 447 (2009) has been raised based on the evidence of record. Specifically, the evidence suggests that service-connected disabilities, including bilateral hearing loss and tinnitus, may result in an inability to secure (obtain) or follow (maintain) substantially gainful employment. For these reasons, the issue of TDIU has been reasonably raised by the record. 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 as totally disabled. 38 C.F.R. § 4.16. Substantially gainful employment is that employment that is ordinarily followed by the nondisabled to earn their livelihoods with earnings common to the particular occupation in the community where the veteran resides. Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment will not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). A TDIU may be assigned, if the scheduler rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability it is ratable at 60 percent or more, and that if there are two or more such disabilities at least one is ratable at 40 percent or more and the combined rating is 70 percent or more. 38 C.F.R. § 4.16(a). The central inquiry is whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The Veteran's service-connected disabilities include tinnitus at a rating of 10 percent and bilateral hearing loss at a noncompensable rating. His combined disability rating is 10 percent. Therefore, the schedular criteria for TDIU have not been met at any time pertinent to the appeal. The Board does not have authority to assign a TDIU rating on an extraschedular basis under 38 C.F.R. § 4.16 (b). Bowling v. Principi, 15 Vet. App. 1 (2001). Moreover, in the instant case, referral of the case to the appropriate VA official for consideration of a TDIU rating on an extraschedular basis is not warranted. In this regard, the evidence does not demonstrate that the Veteran's service-connected disabilities render him unable to secure and follow a substantially gainful occupation. The Veteran is not employed and has not been employed full time since approximately 2007 when he injured his back because of a fall off a roof. In support of the claim, two private psychologists have opined that the Veteran's mental health symptoms were severe enough to prevent him from sustaining gainful employment. Further, a May 2021 psychologist submitted a residual functional capacity assessment which detailed the occupational impairment due to a mental disorder; however, service connection for a psychiatric disorder has not been established. Accordingly, symptoms of a psychiatric disorder cannot be considered for the purposes of TDIU. As noted above, the Veteran is only service connected for hearing loss and tinnitus. The VA examinations of record do not show that these disabilities render him unemployable. In October 2013, a VA examiner noted that functional impact included difficulty sleeping and concentrating. In February 2020, an additional VA examiner found that hearing loss and tinnitus had no functional impact on the Veteran's ability to work. Next, private opinions of record also do not support the claim that hearing loss and tinnitus alone render the Veteran unemployable. The September 2016 psychologist found that hearing loss and tinnitus caused sleep interruptions, difficulty concentrating and focusing, and irritability. A May 2021 psychologist noted that these disabilities would further his social isolation and be a cause for frustration. However, the examiners did not opine that these disabilities alone would render him unemployable. In sum, the medical evidence shows that the Veteran's service-connected disabilities do not preclude him from securing and maintaining substantially gainful employment. Rather, the evidence shows that hearing and tinnitus, at a combined rating of 10 percent, result in a low level of functional impairment. As such, referral of the claim to the Director, Compensation Service, for extraschedular consideration is not warranted. The Board has considered the lay statements and testimony of the Veteran regarding his capacity to work throughout the entire period on appeal. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of symptomatology sufficient to satisfy the requirements of 38 C.F.R. § 4.16(a). Such competent evidence concerning the nature and extent of the Veteran's employability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which his employability is evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the impact of the Veteran's service-connected disabilities on his capacity to work and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective evidence of unemployability, and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.