Citation Nr: 21006542 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 18-36 157 DATE: February 4, 2021 ORDER Service connection for right hip and leg condition, diagnosed as right hip osteoarthritis and degenerative joint disease, is granted. Entitlement to a 20 percent, but no higher, initial rating prior to February 5, 2009 for bilateral hearing loss is granted, subject to the regulations governing the payment of monetary awards. Entitlement to a 50 percent, but no higher, initial rating from February 5, 2009 to June 21, 2010 for bilateral hearing loss is granted, subject to the regulations governing the payment of monetary awards. Entitlement to a 20 percent, but no higher, initial rating from June 22, 2010 to July 24, 2011 for bilateral hearing loss is granted, subject to the regulations governing the payment of monetary awards. Entitlement to a 10 percent, but no higher, initial rating from July 25, 2011 to February 25, 2013 for bilateral hearing loss is granted, subject to the regulations governing the payment of monetary awards. From February 26, 2013, entitlement to an initial compensable rating for bilateral hearing loss is denied.   REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The evidence is at least in equipoise that the Veteran’s right hip and leg condition, diagnosed as right hip osteoarthritis and degenerative joint disease, is related to service. 2. Prior to February 5, 2009, the Veteran’s bilateral hearing loss was shown at worst with Level VI hearing acuity in the right ear and Level V hearing acuity in the left ear. 3. From February 5, 2009 to June 21, 2010, the Veteran’s bilateral hearing loss was shown at worst with Level VIII hearing acuity in the right ear and Level IX hearing acuity in the left ear. 4. From June 22, 2010 to July 24, 2011, the Veteran’s bilateral hearing loss was shown at worst with Level V hearing acuity in the right ear and Level VI hearing acuity in the left ear. 5. From July 25, 2011 to February 25, 2013, the Veteran’s bilateral hearing loss was shown at worst with Level IV hearing acuity bilaterally. 6. From February 26, 2013 the Veteran’s bilateral hearing loss was shown at worst with Level I hearing acuity bilaterally. CONCLUSIONS OF LAW 1. The criteria for service connection for right hip and leg condition, diagnosed as right hip osteoarthritis and degenerative joint disease, are met. 38 U.S.C. §§ 101(24), 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.307, 3.309 (2020). 2. Prior to February 5, 2009, the criteria for a 20 percent, but no higher, rating for bilateral hearing loss are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.85, 4.86, Diagnostic Code 6100 (2020). 3. From February 5, 2009 to June 21, 2010, the criteria for a 50 percent, but no higher, rating for bilateral hearing loss are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.85, 4.86, Diagnostic Code 6100 (2020). 4. From June 22, 2010 to July 24, 2011, the criteria for a 20 percent, but no higher, rating for bilateral hearing loss are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.85, 4.86, Diagnostic Code 6100 (2020). 5. From July 25, 2011 to February 25, 2013, the criteria for a 10 percent, but no higher, rating for bilateral hearing loss are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.85, 4.86, Diagnostic Code 6100 (2020). 6. From February 26, 2013, the criteria for a compensable rating for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.85, 4.86, Diagnostic Code 6100 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served with the Army National Guard and had verified periods of active duty for training (ACDUTRA) from February 1980 to May 1980 and from July 1994 to August 1994. These matters are before the Board of Veterans’ Appeals (Board) on appeal from February 2006 and January 2018 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In a January 2010 decision, the Board awarded service connection for left ear hearing loss and denied the Veteran’s claims of entitlement to service connection for right hip and leg condition and right ear hearing loss. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In August 2010, the Court partially vacated the Board’s January 2010 decision and remanded the issues seeking service connection for right hip and leg condition and right ear hearing loss to the Board for further consideration pursuant to a Joint Motion for Partial Remand (Joint Motion) dated in August 2010. The Board remanded the claims for additional development pursuant to the Joint Motion in May 2011. Subsequently, the Board remanded the claims in April 2014 for further development. Thereafter, in an October 2017 decision, the Board awarded service connection for right ear hearing loss and remanded the claim for service connection for right hip and leg condition. In a January 2018 rating decision, the Agency of Original Jurisdiction (AOJ) assigned the Veteran’s bilateral hearing loss a noncompensable rating effective June 15, 2005. The Veteran subsequently completed an appeal of the rating assigned by this decision. The matter seeking an increased rating for a service-connected lumbar spine disability is addressed in a separate Board decision as the Veteran has a different representative for that claim. Service Connection – Right Hip and Leg Condition The Veteran and his attorney contend that the Veteran’s right hip and leg condition is related to an in-service injury to his right leg. In addition, they contend the Veteran’s right hip and leg condition are secondary to his service-connected lumbar spine disability. See Attorney Statement, July 2017. The Board acknowledges that the Veteran’s right hip and leg condition is a chronic disease and that there is competent and credible evidence in the record that the Veteran’s right hip and leg condition may be secondary to his service-connected lumbar spine disability; however, the Board will not address entitlement to service connection on a presumptive or secondary basis since service connection is being granted on a direct basis. The Board concludes that the Veteran has a current right hip and leg disability that is related to an injury incurred during a period of ACDUTRA. 38 U.S.C. §§ 101(24), 1110, 1131, 5107(b); 38 C.F.R. §§ 3.6, 3.303(a); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). VA examinations in the record show the Veteran has current diagnoses of right hip osteoarthritis and degenerative joint disease. In addition, a May 1980 service treatment record during the Veteran’s period of active duty for training from February 1980 to May 1980 reflects that the Veteran was seen for right hip and mid knee pain. Furthermore, the treatment note indicates he was to undergo a bone scan. In addition, the Veteran has submitted multiple buddy statements attesting to the Veteran injuring his right hip and leg in May 1980. See VA 21-4138, Statements in Support of Claim, December 2011, January 2012, November 2014. The Veteran’s fellow servicemembers are competent to report what they observed during the time they served with the Veteran. Furthermore, the Board finds them to be credible in reporting the in-service right hip injury. As such, the Board finds the evidence is at least in equipoise that the Veteran injured his right hip and leg during a period of ACDUTRA. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6. Thus, the question becomes whether the current disability is related to the injury in ACDUTRA. On this question, there are multiple probative opinions in favor of and against the claim. In an April 2018 VA opinion, the VA clinician opined that the Veteran’s right hip and leg condition is less likely as not related to his military service. In support of the opinion, the VA clinician noted that a review of the Veteran’s service treatment records shows no complaints or treatment for a right hip condition. The examiner also noted that the periodic examinations for the Veteran’s National Guard service contain no right hip diagnosis and the examinations are normal regarding the right hip. The examiner then noted the buddy statements and the private medical opinions in the record and concluded that the statements and opinions seem to be formed on the basis of the Veteran’s 21 years of National Guard service and not just his ACDUTRA periods. The evidence in favor of the claim regarding direct service connection includes July 2013 and January 2015 opinions from Dr. D.P., a private physician, and July 2013 and January 2015 opinions from C.H., a nurse practitioner. The July 2013 and January 2015 letters from Dr. D.P. opine that it is likely as not that the Veteran’s right hip pain with osteoarthritis and right leg pain is directly related to his injuries in service. In support of the opinions, Dr. D.P. noted that the Veteran had a period of disability involving his right hip in May 1980. Furthermore, Dr. D.P. noted that he reviewed the Veteran’s medical records. In C.H.’s July 2013 and January 2015 opinions, he opined that it is at least as likely as not that the Veteran’s right hip and leg condition is related to his service. In support of the opinions, C.H. noted the Veteran’s May 1980 in-service right hip injury. Furthermore, C.H. noted that he reviewed the Veteran’s service treatment records. The Board places equal weight of probative value on the private and VA opinions as they reflect full knowledge of the Veteran’s history and reasoned consideration of the evidence. Although the April 2018 VA opinion indicated that Dr. D.P. and C.H.’s opinions seemed to be based on consideration of the Veteran’s entire period of National Guard service, the letters specifically reference the right hip injury and treatment received in May 1980 and clearly reflect consideration of what occurred during that period of ACDUTRA in determining that the Veteran’s right hip and leg disability is related to his service. In conclusion, the Board finds the probative evidence of record to at least be in equipoise as to whether the Veteran’s current right hip and leg condition is related to an injury during his period of ACDUTRA in 1980. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for right hip and leg condition, diagnosed as right hip osteoarthritis and degenerative joint disease, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Rating – Bilateral Hearing Loss The Veteran and his attorney contend the Veteran’s bilateral hearing loss disability is severe enough to warrant a 20 percent rating from June 2005 to February 2009 and a 10 percent rating from February 2009 to September 2014. See VA Form 21-0958, Notice of Disagreement (NOD), April 2018; VA Form 9, Appeal to Board of Veterans’ Appeals (Form 9), October 2018; Correspondence, July 2019. The Veteran’s bilateral hearing loss has been rated as noncompensable under Diagnostic 6100 throughout the appeal period. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Additionally, a request for an increased rating must be viewed in light of the entire relevant medical history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282, 287 (1991). In evaluating service-connected hearing loss, disability ratings for hearing impairment are derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 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 (Maryland CNC) in conjunction with the average hearing threshold, as measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz cycles per second (Hertz or Hz). The Rating Schedule establishes 11 auditory acuity levels designated from Level I, for essentially normal hearing acuity, through Level XI, for profound deafness. VA audiometric examinations are conducted using a controlled speech discrimination test together with the results of a pure tone audiometry test. The vertical lines in Table VI (in 38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The horizontal columns in Table VI represent nine categories of decibel loss based on the pure tone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the pure tone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85) by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate to the numeric designation level for the ear having the poorer hearing acuity. For example, if the better ear has a numeric designation Level of “V” and the poorer ear has a numeric designation Level of “VII,” the percentage evaluation is 30 percent. See 38 C.F.R. § 4.85. The provisions of 38 C.F.R. § 4.86(a) provide that when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Each ear will be evaluated separately. The provisions of 38 C.F.R. § 4.86(b) provide that when the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for the hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. Prior to February 5, 2009 The AOJ has assigned a noncompensable rating prior to February 5, 2009. Based on a review of the relevant evidence and the applicable law and regulations, it is the Board’s conclusion that a 20 percent, but no higher, rating for the Veteran’s bilateral hearing loss is warranted prior to February 5, 2009. The Board notes that the Veteran’s claim for an increased rating for bilateral hearing loss currently before the Board stems from a June 2005 claim for entitlement to service connection for bilateral hearing loss and his award of service connection for hearing loss is effective June 15, 2005. For an increased rating claim, “the present level of disability is of primary concern.” Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Prior to February 5, 2009, there is no relevant evidence during the period for the Veteran’s claim. However, the Veteran underwent a private audiogram in May 2002. Although outside of the period at issue, the Board has considered the evidence in assigning the rating prior to February 5, 2009 given the absence of any pertinent evidence during this period.   The May 2002 private audiogram revealed the following puretone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 75 70 80 80 76 N/A LEFT 55 65 60 70 63 N/A The average puretone threshold was 76 decibels in the right ear and 63 decibels in the left ear. No speech recognition testing was conducted with the May 2002 audiogram. However, given that the puretone thresholds were 55 decibels or more at all of the frequencies in the right and left ears, the Veteran had an exceptional pattern of hearing impairment in both ears according to 38 C.F.R. § 4.86(a). As such, Table VIA will be used for rating purposes for both ears. For the right ear, using Table VIA, the Rating Schedule shows Level VI hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. For the left ear, using Table VIA, the Rating Schedule shows Level V hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule results in a 20 percent evaluation for bilateral hearing loss under Diagnostic Code 6100. The Board has considered whether a rating in excess of 20 percent is warranted prior to February 5, 2009; however, there are no audiometric findings during this time period that reflect a greater level of hearing impairment. The Board has considered any lay evidence provided by the Veteran. The Veteran is competent to report difficulty with his hearing; 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 v. Principi, 3 Vet. App. 345 (1992).   Accordingly, the evidence most nearly approximates a rating of 20 percent, but no higher, prior to February 5, 2009. February 5, 2009 to June 21, 2010 Based on a review of the relevant evidence and the applicable law and regulations, it is the Board’s conclusion that a 50 percent, but no higher, rating for the Veteran’s bilateral hearing loss is warranted from February 5, 2009 to June 21, 2010. There are two audiograms of record during this period. A February 5, 2009 private audiogram revealed the following puretone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 80 85 90 90 86 N/A LEFT 90 95 95 95 94 N/A The average puretone threshold was 86 decibels in the right ear and 94 decibels in the left ear. No speech recognition testing was conducted with the February 2009 audiogram. However, given that the puretone thresholds were 55 decibels or more at all of the frequencies in the right and left ears, the Veteran had an exceptional pattern of hearing impairment in both ears according to 38 C.F.R. § 4.86(a). As such, Table VIA will be used for rating purposes for both ears. For the right ear, using Table VIA, the Rating Schedule shows Level VIII hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. For the left ear, using Table VIA, the Rating Schedule shows Level IV hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule results in a 50 percent evaluation for bilateral hearing loss under Diagnostic Code 6100. The Veteran also attended a VA audiological examination on February 5, 2009. The VA audiogram revealed the following puretone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 40 35 40 40 39 82 LEFT 45 45 40 50 45 60 The average puretone threshold at 1000, 2000, 3000, and 4000 Hertz was 39 decibels in the right ear and 45 decibels in the left ear. Using the Maryland CNC word list, the speech recognition score was 82 percent in the right ear and 60 percent in the left ear. The VA examiner, however, noted that the audiogram and speech recognition testing were not reliable, as the Veteran did not give his best effort during the testing. Applying the results from the February 2009 VA audiological examination to the Rating Schedule shows Level III hearing acuity in the right ear and Level V hearing acuity in the left ear using Table VI. See 38 C.F.R. § 4.85, Table VI, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule, would result in a 10 percent rating for bilateral hearing loss under Diagnostic Code 6100. However, the VA examination report reflects that the puretone and speech recognition scores were not reliable as the examiner felt that the Veteran was not giving his best effort during testing. As such, given the unreliable nature of the VA audiological testing, the Board has used the private audiogram dated February 5, 2009 for rating purposes during this period. The Board acknowledges the Veteran’s attorney’s April 2018, October 2018, and July 2019 written statements in which the attorney contested that VA erroneously considered the February 2009 VA audiological testing to be invalid, and that the Veteran is entitled to a 10 percent rating based on the February 2009 VA audiological testing. However, the Board places great weight of probative value on the VA examiner’s conclusion that the test results were not valid, as the VA examiner personally conducted the testing. Irrespective of the VA examiner’s conclusion, the February 5, 2009 private audiological testing is more beneficial to the Veteran and results in a higher rating than the VA audiological testing would, had it been deemed valid. Although it appears the private testing was done on the same day as the VA audiological testing, the private audiologist did not indicate any concerns regarding the validity of the testing; hence, the Board has no supported reason to doubt the reliability of those results. As such, further discussion of the validity of the February 2009 VA audiological testing is unnecessary. The Board has considered whether a rating in excess of 50 percent is warranted from February 5, 2009 to June 21, 2010; however, there are no audiometric findings during this time period that reflect a greater level of hearing impairment. The Board has considered any lay evidence provided by the Veteran. The Veteran is competent to report difficulty with his hearing; 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. App. 345. Accordingly, the evidence most nearly approximates a rating of 50 percent, but no higher, during this period. June 22, 2010 to July 24, 2011 Based on a review of the relevant evidence and the applicable law and regulations, it is the Board’s conclusion that a 20 percent, but no higher, rating for the Veteran’s bilateral hearing loss is warranted from June 22, 2010 to July 24, 2011. There are two audiograms of record during this period.   A June 22, 2010 private audiogram revealed the following puretone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 55 65 65 75 65 N/A LEFT 70 75 75 80 75 N/A The average puretone threshold was 65 decibels in the right ear and 75 decibels in the left ear. No speech recognition testing was conducted with the June 2010 audiogram. However, given that the puretone thresholds were 55 decibels or more at all of the frequencies in the right and left ears, the Veteran had an exceptional pattern of hearing impairment in both ears according to 38 C.F.R. § 4.86(a). As such, Table VIA will be used for rating purposes for both ears. For the right ear, using Table VIA, the Rating Schedule shows Level V hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. For the left ear, using Table VIA, the Rating Schedule shows Level VI hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule results in a 20 percent evaluation for bilateral hearing loss under Diagnostic Code 6100. The Veteran attended a VA audiological examination on July 19, 2010. The VA audiogram revealed the following puretone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 40 40 40 40 40 54 LEFT 45 45 45 50 46 30 The average puretone threshold at 1000, 2000, 3000, and 4000 Hertz was 40 decibels in the right ear and 46 decibels in the left ear. Using the Maryland CNC word list, the speech recognition score was 54 percent in the right ear and 30 percent in the left ear. Applying the results from the July 2010 VA audiological examination to the Rating Schedule shows Level VI hearing acuity in the right ear and Level X hearing acuity in the left ear using Table VI. See 38 C.F.R. § 4.85, Table VI, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule, would result in a 50 percent rating for bilateral hearing loss under Diagnostic Code 6100. However, the VA examiner noted that puretone testing did not represent the Veteran’s best effort, and that the reliability is “fair” at best. Regarding the speech recognition scores, the VA examiner stated that the scores should not be used for rating purposes as the scores are inconsistent with the puretones to which the Veteran admitted. The examiner noted that subjectively, the Veteran appeared to have minimal, if any difficulty, with conversational speech. The Board places great weight of probative value on the VA examiner’s conclusion that the test results were not valid, as the VA examiner personally conducted the testing and is qualified to opine as to the validity of such test results. As such, given the unreliable nature of the July 2010 VA audiological testing, the Board has used the private audiogram dated June 22, 2010 for rating purposes during this period. Notwithstanding the above, given that the VA July 2010 VA noted that the reliability of the puretone testing was fair at best, if Table VIA was used per 38 C.F.R. § 4.85(c) based on the inconsistent speech scores, the Rating Schedule shows Level I hearing acuity in the right ear and Level II in the left ear. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule would result in a noncompensable rating for bilateral hearing loss under Diagnostic Code 6100. As such, the June 2010 private testing is more beneficial to the Veteran during this period. The Board has considered whether a rating in excess of 20 percent is warranted from June 22, 2010 to July 24, 2011; however, there are no other reliable audiometric findings during this time period that reflect a greater level of hearing impairment. The Board has considered any lay evidence provided by the Veteran. The Veteran is competent to report difficulty with his hearing; 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. App. 345. Accordingly, the evidence most nearly approximates a rating of 20 percent, but no higher, during this period. July 25, 2011 to February 25, 2013 Based on a review of the relevant evidence and the applicable law and regulations, it is the Board’s conclusion that a 10 percent, but no higher, rating for the Veteran’s bilateral hearing loss is warranted from July 25, 2011 to February 25, 2013. There are two audiograms of record during this period. A July 25, 2011 private audiogram revealed the following puretone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 55 55 60 65 59 N/A LEFT 60 60 55 65 60 N/A The average puretone threshold was 59 decibels in the right ear and 60 decibels in the left ear. No speech recognition testing was conducted with the July 2011 audiogram. However, given that the puretone thresholds were 55 decibels or more at all of the frequencies in the right and left ears, the Veteran had an exceptional pattern of hearing impairment in both ears according to 38 C.F.R. § 4.86(a). As such, Table VIA will be used for rating purposes for both ears. For the right ear, using Table VIA, the Rating Schedule shows Level IV hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. For the left ear, using Table VIA, the Rating Schedule shows Level IV hearing acuity. See 38 C.F.R. § 4.85, Table VIA, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule results in a 10 percent evaluation for bilateral hearing loss under Diagnostic Code 6100. The Veteran attended a VA audiological examination in August 2011. The VA audiogram revealed the following puretone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 25 35 35 35 33 96 LEFT 30 40 40 35 36 88 The average puretone threshold was 33 decibels in the right ear and 36 decibels in the left ear. Using the Maryland CNC word list, the speech recognition score was 96 percent in the right ear and 88 percent in the left ear. Applying the results from the August 2011 VA audiological examination to the Rating Schedule shows Level I hearing acuity in the right ear and Level II hearing acuity in the left ear using Table VI. See 38 C.F.R. § 4.85, Table VI, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule, would result in a noncompensable rating for bilateral hearing loss under Diagnostic Code 6100. However, the VA examiner noted that reliability of the puretone testing was “fair” at best, as the Veteran was difficult to test and was elevating his responses. Regarding the speech recognition scores, the VA examiner noted that the Veteran responded with nonsensical words. The Board places great weight of probative value on the VA examiner’s conclusion that the test results were not valid, as the VA examiner personally conducted the testing. As such, given the unreliable nature of the VA audiological testing, the Board has used the private audiogram dated July 25, 2011 for rating purposes during this period. Although the private testing was done contemporaneously to the VA audiological testing, the private audiologist did not indicate any concerns regarding the validity of the testing; as such, the Board has no supported reason to doubt the reliability of that testing. Notably, the July 25, 2011 private audiological testing is more beneficial to the Veteran and results in a higher rating than the VA audiological testing would, had it been deemed valid. As such, further discussion of the validity of the August 2011 VA audiological testing is unnecessary. The Board has considered whether a rating in excess of 10 percent is warranted from July 25, 2011 to February 25, 2013; however, there are no other reliable audiometric findings during this time period that reflect a greater level of hearing impairment. The Board has considered any lay evidence provided by the Veteran. The Veteran is competent to report difficulty with his hearing; 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. App. 345. Accordingly, the evidence most nearly approximates a rating of 10 percent, but no higher, during this period. From February 26, 2013 Based on a review of the relevant evidence and the applicable law and regulations, a preponderance of the evidence is against a finding that a compensable is rating is warranted from February 26, 2013. The Veteran attended three VA audiological examinations during this period, and the VA examiners considered the audiological testing to be valid at all three examinations.   A February 26, 2013 VA examination revealed the following pure tone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 25 30 35 35 31 100 LEFT 25 40 35 25 31 96 The average pure tone threshold was 31 decibels in the right and left ears. Using the Maryland CNC word list, the speech recognition score was 100 percent in the right ear and 96 percent in the left ear. The examiner noted the functional impact of the Veteran’s bilateral hearing loss is that the Veteran has minimal difficulty, only in noise. Applying the results from the February 2013 audiological examination to the Rating Schedule shows Level I hearing acuity in each ear using Table VI. See 38 C.F.R. § 4.85, Table VI, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule, results in a noncompensable evaluation for bilateral hearing loss under Diagnostic Code 6100. These results do not reflect an exceptional pattern of hearing impairment, as such Table VIA is not applicable. A September 2014 VA examination revealed the following pure tone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 20 30 30 35 29 94 LEFT 25 30 35 30 30 96 The average pure tone threshold was 29 decibels in the right ear and 30 decibels in the left ear. Using the Maryland CNC word list, the speech recognition score was 94 percent in the right ear and 96 percent in the left ear. The examiner noted the Veteran’s bilateral hearing loss caused no functional impact. Applying the results from the February 2014 audiological examination to the Rating Schedule shows Level I hearing acuity bilaterally using Table VI. See 38 C.F.R. § 4.85, Table VI, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule, results in a noncompensable evaluation for bilateral hearing loss under Diagnostic Code 6100. These results do not reflect an exceptional pattern of hearing impairment, as such Table VIA is not applicable. A January 2017 VA examination revealed the following pure tone thresholds, in decibels: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 30 35 35 30 33 100 LEFT 25 35 30 30 30 100 The average pure tone threshold was 33 decibels in the right ear and 30 decibels in the left ear. Using the Maryland CNC word list, the speech recognition score was 100 percent bilaterally. The examiner noted the functional impact of the Veteran’s bilateral hearing loss is that the Veteran would have minimal difficulty if noise is present. Applying the results from the January 2017 audiological examination to the Rating Schedule shows Level I hearing acuity bilaterally using Table VI. See 38 C.F.R. § 4.85, Table VI, Diagnostic Code 6100. Applying these findings to 38 C.F.R. § 4.85, Table VII of the Rating Schedule, results in a noncompensable evaluation for bilateral hearing loss under Diagnostic Code 6100. These results do not reflect an exceptional pattern of hearing impairment, as such Table VIA is not applicable. Further, regarding all three of the VA audiological examinations during this period, there is no medical certification of situations such as language difficulties or inconsistent speech discrimination scores, and there is no indication the Veteran’s bilateral hearing loss disability met the criteria of an exceptional pattern of hearing loss. Therefore, evaluation under the alternate criteria in Table VIA, based only on pure tone thresholds is not appropriate. 38 C.F.R. §§ 4.85(c), 4.86. There are no other audiometric findings during this time period that reflect hearing impairment that would warrant a compensable evaluation. The Board has considered any lay evidence provided by the Veteran. The Veteran is competent to report difficulty with his hearing; 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. App. 345. Hence, the preponderance of the evidence is against a finding that the Veteran is entitled to a compensable rating from February 26, 2013. In summary, the Board finds that the Veteran is entitled to a 20 percent rating prior to February 5, 2009, a 50 percent rating from February 5, 2009 to June 21, 2010, a 20 percent rating from June 22, 2010 to July 24, 2011, a 10 percent rating from July 25, 2011 to February 25, 2013, and a noncompensable rating from February 26, 2013.   REASONS FOR REMAND Entitlement to TDIU is remanded. The AOJ must be afforded the opportunity to adjudicate the claim of entitlement to TDIU after implementation of the Board’s grant in the decision above of service connection for right hip and leg condition and increased rating awards. Therefore, the AOJ should take appropriate steps to develop and adjudicate the claim for TDIU in light of the above. If the Veteran does not meet the schedular requirements for TDIU after implementation of the above awards at any time for the period under consideration for the claim seeking TDIU, the RO should consider whether referral to the Director of Compensation Service for consideration of an extraschedular TDIU rating under 38 C.F.R. § 4.16(b) is appropriate. The matter is REMANDED for the following action: After implementing the above award of service connection for right hip and leg condition and increased ratings for bilateral hearing loss, readjudicate the issue of entitlement to TDIU. If the Veteran does not meet the requirements for TDIU at any time during the period under consideration, consider and address whether referral of the claim to the Director of Compensation   Service for consideration of an extraschedular TDIU rating under 38 C.F.R. § 4.16(b) is appropriate. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Breitbach, 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.