Citation Nr: 21009204 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 19-23 996 DATE: February 19, 2021 ORDER A rating in excess of 40 percent for bilateral hearing loss from September 1, 1983, to January 18, 1988, is denied. A rating in excess of 60 percent for bilateral hearing loss from January 18, 1988, to January 24, 2005, is denied. A total disability rating based on individual unemployability (TDIU) due to service-connected disability prior to January 24, 2005, is denied. FINDINGS OF FACT 1. The Veteran had active duty from November 1963 to November 1967; he died in February 2012. He had been 100 percent disabled since January 24, 2005. The appellant is his surviving spouse and is a properly substituted claimant. 2. From September 1, 1983, to January 18, 1988, bilateral hearing loss was manifested by pure tone audiometry decibel (dB) loss that corresponded to Literal Designation D in both ears. 3. From January 18, 1988, to January 24, 2005, bilateral hearing loss was manifested by pure tone audiometry dB loss that corresponded to Literal Designation E in the left ear and Literal Designation E in the right ear, or a bilateral combination of Designation E and F. 4. The Veteran’s service-connected hearing loss and tinnitus did not preclude him from securing or following a substantially gainful occupation prior to January 24, 2005. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 40 percent for bilateral hearing loss from September 1, 1983, to January 18, 1988, have not been met. 38 U.S.C. § 355 (1959); 38 U.S.C. § 1155 (1991); 38 C.F.R. § 4.85, former Diagnostic Code (DC) 6277 to 6297 (1968-1987), 6100 (effective Dec.18, 1987); § 4.86 (1968-1999). 2. The criteria for a rating in excess of 60 percent for bilateral hearing loss from January 18, 1988, to January 24, 2005, have not been met. 38 U.S.C. § 355 (1959); 38U.S.C. §1155 (1991); 38 C.F.R. § 4.85, former DC 6277 to 6297 (1968-1987), 6100 (effective Dec. 18, 1987); § 4.86 (1968-1999). 3. The criteria for a TDIU prior to January 24, 2005, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As an initial matter, in May 2016, the Board found clear and unmistakable evidence that the proper effective date for the grant of service connection for the Veteran’s bilateral hearing loss disability was November 16, 1970, the date of the original claim. A June 2016 rating decision effectuated the Board’s determination of the November 16, 1970, effective date and assigned a 40 percent rating from November 16, 1970, to May 21, 2003. In November 2019, the Board denied a rating in excess of 40 percent for bilateral hearing loss prior to January 18, 1988, granted a 60 percent rating from January 18, 1988, to May 21, 2003, denied a rating in excess of 60 percent from May 21, 2003, to January 24, 2005, and denied accrued benefits based on entitlement to an earlier effective date prior to November 16, 1970. The appellant appealed to the Veterans Claims Court. In August 2020, the Court Clerk granted a joint motion for partial remand (JMPR), which vacated the Board’s decision with regard to a rating in excess of 40 percent for bilateral hearing loss from September 1, 1983, to January 18, 1988, and a rating in excess of 60 for bilateral hearing loss from January 18, 1988, to January 24, 2005. The JMPR also found that a TDIU claim was part and parcel of the bilateral hearing loss issues on appeal under Rice v. Shinseki, 22 Vet. App. 447 (2009). The appeals are now again before the Board. Increased Ratings for Hearing Loss 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. 38C.F.R. §4.1. Separate diagnostic codes identify the various disabilities. 38U.S.C. §1155; 38 C.F.R. Part 4. Disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. Lendenman v. Principi,3 Vet. App. 345(1992). The rating schedule establishes auditory hearing acuity levels based on average pure tone thresholds and speech discrimination.38C.F.R. §4.85. Initially, the rating criteria for evaluating hearing loss have undergone a number of revisions prior to and during the period on appeal, which began November 16, 1970. Below, the substantive changes to the rating criteria for each revision during this time are discussed in further detail. There is no indication that any of the revised criteria were intended to have retroactive effect, and accordingly, the claim will be evaluated according to each set of revised criteria beginning only on the effective date of those amended criteria. See VAOPGCPREC 3-2000 and 7-2003. Therefore, the Board will discuss both the pre-amended and amended rating criteria for hearing loss (in essence – the rating criteria both prior to and after December 18, 1987). For evidence dated prior to December 18, 1987, only the pre-amended version will apply but for evidence dated on and after December 18, 1987, whatever version of the rating criteria is most favorable will apply. Historically, the provisions of 38 C.F.R. § 4.85 had been in effect since May 22, 1964, and provided that if the results of controlled speech reception tests were used, the letter A through F, designating the impairment in efficiency of each ear separately, would be ascertained from Table I. Table I indicated six areas of impairment in efficiency. The literal designation of impaired efficiency (A, B, C, D, E, or F) was determined by intersecting the horizonal row appropriate for percentage of discrimination and the vertical column appropriate to the speech reception dB loss. The next subsection described how the rating would be determined from Table II by intersecting the horizontal row appropriate for the literal designation for the ear having the better hearing and the vertical column appropriate to the literal designation for the ear having the poorer hearing. The third subsection applies if the results of pure tone audiometry (either pure tone air conduction or Galvanic Skin Response, PGSR) were used. The equivalent literal designation for each ear, separately, would be ascertained from Table II, and the rating determined in the same manner as for speech reception impairment in paragraph (b) of the section. The revisions to 40 Fed. Reg. 53011were made effective September 9, 1975. Table II was revised by changing the pure tone audiometric average dB loss at the three frequencies of 500, 1000, and 2000 hertz (Hz) at the various levels of hearing in both the better and the poorer ear to conform to the ISO (ANSI) norms in Table I of 38 C.F.R. § 4.87. The revisions of 41 Fed. Reg.11291, effective March 10, 1976, were not substantive and included renumbering Tables I and II to read as Tables IV and V. See 38C.F.R. § 4.85(a), (b), and (c) (1976). Substantive changes were made to 38 C.F.R. § 4.85, effective December 18, 1987, to implement a new method for evaluating the degree of disability attributable to hearing loss and included revisions to Tables IV and V and the addition of Table VIa. See 52 Fed. Reg. 44117. They provide that examinations were to be conducted using the controlled speech discrimination tests together with the results of the pure tone audiometry test. The horizonal lines in Table VI represented nine categories of percent of discrimination based on the controlled speech discrimination test. The vertical columns in Table VI represent nine categories of dB loss based on the pure tone audiometry test. The numeric designation of impaired efficiency (I through XI) were to be determined for each ear by intersection the horizontal row appropriate for the percentage of discrimination and the vertical column appropriate to pure tone dB loss; thus, with percentage discrimination of 70 and average pure tone dB loss of 64, the numeric designation is V for one ear. The same procedure was to be followed for the other ear. See 38 C.F.R. § 4.85(a) (1987). Subsection (b) explained how the percentage evaluation would be found from Table VII by intersecting the horizontal row appropriate for the numeric designation for the ear having the better hearing and the vertical column appropriate to the numeric designation for the ear having the poorer hearing. The language from subsection (c) was eliminated and instead stated that Table VI provided numeric designations based solely on pure tone averages and was for application only when the Chief of the Audiology Clinic certified that language difficulties or inconsistent speech audiometry scores made the use of both pure tone average and speech discrimination inappropriate. Additionally, clarifying amendments to the hearing loss criteria were made, effective June 10, 1999, and under subsection (a) provided that an examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination tests (Maryland CNC) and a pure tone audiometry tests. Examinations were to be conducted without the use of hearing aids. See 64 Fed. Reg. 25202 to 25210 (May 11, 1999). Subsection (d) was also added to explain that the “Pure tone threshold average,” as used in Tables VI and VIa, was the sum of the pure tone threshold at 1000, 2000, 3000 and 4000 Hz divided by four. According to both the December18, 1987, and June 10, 1999, amendments, in evaluating service-connected hearing loss, ratings were derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations were performed. Lendenmann v. Principi,3 Vet. App. 345, 349 (1992). Thus, effective December 18, 1987, evaluations of bilateral hearing loss range from 0 percent to 100 percent based on an organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by pure tone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 Hz. The rating schedule establishes 11 auditory acuity Levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. The percentage evaluation would be found from Table VII by intersecting the ear having the better hearing and the ear having the poorer hearing. 38 C.F.R. §§ 4.85, 4.87, DCs 6100-6110 (1987). The Veteran’s bilateral hearing loss was rated under 38 C.F.R. § 4.85, DC 6100. The rating has already been staged by the RO for different periods of time. Specifically, prior to January 18, 1988, bilateral hearing loss was rated as 40 percent, 60 percent rating from January 18, 1988, to January 24, 2005, and 100 percent rating thereafter.   Rating in Excess of 40 Percent from September 1, 1983, to January 18, 1988 Private medical records include numerous audiograms in graphical format with no numeric interpretation; however, as the audiometric results were conveyed in a straightforward graph, as the finder of fact the Board can interpret the chart to determine the numeric values of the pure tone levels for adjudication purposes. See Kelly v. Brown, 7 Vet. App. 471 (1995). Additionally, the private audiograms do not include the Maryland CNC Word test, and there is some question as to whether all examinations were performed by a state-licensed audiologist, both of which are required by current regulations. However, as the period on appeal began in September 1983, before the Maryland CNC Word test was required, and during which time it was only specified that audiological examinations be conducted by a “regional office or authorized audiology clinic,” it is most advantageous to the Veteran to consider his appeal for the entire period on appeal under the criteria then in effect. Of note, there was not an audiological examination which satisfied the amended criteria until August 2003; however, by considering the claim under the pre-amended criteria, the Board may consider private evidence. Accordingly, the following reflects private audiogram results, interpreted from a graph as follows: • A March 30, 1983, private audiology examination report showed pure tone thresholds, in dB, at 500, 1000, and 2000 Hz were 55, 70, and 85 in the right ear and 30, 60, and 80 in the left ear. The average pure tone threshold was 70 in the right ear, and 57 in the left ear. Application of these scores to Table II resulted in a 40 percent rating. • A December 20, 1984, private audiology examination report showed pure tone thresholds, in dB, at 500, 1000, and 2000 Hz were 50, 70, and 75 in the right ear and 35, 70, and 75 in the left ear. The average pure tone threshold was 65 in the right ear, and 60 in the left ear. Speech audiometry revealed speech reception of 64 dB in the right ear and 56 in the left ear, and speech discrimination of 56 percent in the right ear and 46 percent in the left ear. Application of these scores to Table II resulted in a 40 percent rating. • An April 4, 1985, private audiology examination report showed pure tone thresholds, in dB, at 500, 1000, and 2000 Hz were 50, 65, and 80 in the right ear and 40, 75, and 85 in the left ear. The average pure tone threshold was 65 in the right ear, and 66.6 in the left ear. Application of these scores to Table II resulted in a 40 percent rating. The Veteran was afforded a VA audiology examination in May 1985. In pertinent part, pure tone thresholds as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 45 65 80 NT 100 LEFT 40 70 80 NT 110 The average pure tone threshold was 63 in the right ear, and 63 in the left ear. Speech audiometry revealed speech reception of 58 dB in the right ear and 54 in the left ear, and speech discrimination of 38 percent in the right ear and 58 percent in the left ear. Application of these scores to Table II resulted in a 40 percent rating. According to the criteria in 1968, when the average was not more than 67 and no frequency was more than 80 dB, the literal designation in the right ear and left ear using table II was D. The rating percent was found where the horizonal D row and the vertical D column met and resulted in a 40 percent rating. When the 1985 criteria are applied to the criteria effective September 9, 1975, they also resulted in a 40 percent rating. The average of the three frequencies in the right ear was 63 dB with a high of 80 in one of the frequencies. The average of the three frequencies in the left ear was also 63, with a high of 80 dB in one of the frequencies. When the average was not more than 67 and no frequency was more than 80 dB, the literal designation in the right ear and left ear using table II was D. The rating percent is found where the horizonal D row and the vertical D column met and resulted in a 40 percent rating. The criteria in effect in December 1987 and after cannot be applied to the Veteran’s hearing loss because at this point considering only the audiometric results was not permitted unless the Chief of the Audiology Clinic determined that use of both pure tone average and speech discrimination was inappropriate. Further, the 1985 audiometry evaluation did not test air conduction at 3000 Hz; therefore, the pure tone threshold average cannot be calculated using the criteria. In addition, the speech discrimination was not based on the Maryland CNC, as required by the later criteria. Next, in a January 1987 buddy statement, J.C., indicated that he became impatient and irritated when he had to repeat himself to the Veteran and the Veteran would sometimes incorrectly respond to his questions. In a September 1987, private treatment note, the clinician reported that the Veteran must have two hearing aids in place and that an individual speaking must have his full attention and that he must be looking at you from a distance of about two to three feet due to his hearing problem. Although, the Veteran and his friend were competent to describe hearing difficulty, their description of his service-connected disability must be considered in conjunction with the clinical evidence of record, as well as the pertinent rating criteria. In this regard, ratings are derived by a mechanical application of the rating schedule. Lendenmann, 3 Vet. App. at 349. Thus, the Board must predicate its determinations on the basis of the results of the audiology studies of record. The audiometric results disclosed that the Veteran’s hearing loss warranted a 40 percent rating but no more under the schedular criteria. The evidence was not in equipoise to warrant a higher evaluation. Thus, for the period prior to January 18, 1988, the medical evidence did not support a rating in excess of 40 percent.   Rating in Excess of 60 Percent from January 18, 1988, to January 24, 2005 A January 18, 1988, private audiology examination report showed pure tone thresholds, in dB, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 70 75 90 NT 110 LEFT 70 85 90 NT 110 The average pure tone threshold was 78.3 in the right ear, and 81.6 in the left ear. Speech audiometry revealed speech reception of 70 dB in the right ear and 75 in the left ear, and speech discrimination of 36 percent in the right ear and 28 percent in the left ear. Application of these scores to Table II resulted in a 60 percent rating. According to the criteria in 1968, when the average was not more than 87 and no frequency was more than 95 dB, the literal designation in the right ear and left ear using table II is E. The rating percent is found where the horizonal E row and the vertical E column meet; and resulted in a 60 percent rating. When the 1988 findings are applied to the criteria effective September 9, 1975, they also result in a 60 percent rating. The average of the three frequencies in the right ear was 78.3 dB with a high of 90 in one of the frequencies. The average of the three frequencies in the left ear was 81.6, with a high of 90 dB in one of the frequencies. When the average was not more than 87 and no frequency was more than 95 dB, the literal designation in the right ear and left ear using table II was E. The rating percent is found where the horizonal E row and the vertical E column met and resulted in a 60 percent rating. The criteria in effect in December 1987 and after cannot be applied because at this point considering only the audiometric results was not permitted unless the Chief of the Audiology Clinic determined that use of both pure tone average and speech discrimination was inappropriate. Further, the 1988 audiometry evaluation did not test air conduction at 3000 Hz; therefore, the pure tone threshold average cannot be calculated using the criteria. In addition, the speech discrimination was not based on the Maryland CNC, as required by the later criteria. The audiometric results of the examination thus establish that the Veteran’s hearing loss does not warrant a rating of 60 percent from January 18, 1988, to January 24, 2005, under the schedular criteria. On a February 1988 private treatment note, the clinician reported that the Veteran’s hearing was obviously grossly impaired. with the need for his repeating numerous questions and commands despite the fact that he was wearing a hearing aid. As indicated above, there was no audiological examination which satisfied the rating criteria in effect on or after December 18, 1987, until the August 2003 VA examination. The remaining audiometric tests were performed by private clinicians and were presented in graph form. As the graphical representations in this case were clear, the Board can interpret them and to calculate the averages. The criteria in effect in December 1987 and after cannot be applied because considering only the audiometric results was not permitted unless the Chief of the Audiology Clinic determined that use of both pure tone average and speech discrimination was inappropriate. Private audiograms include speech discrimination not based on the Maryland CNC, as required by the later criteria. Therefore, only the criteria in effect prior to and on September 9, 1975, will be considered and the findings will be converted when considering the criteria in effect in 1968. A December 13, 1988, private audiology examination report showed pure tone thresholds, in dB, as follows:   HERTZ 500 1000 2000 3000 4000 RIGHT 75 95 90 100 110 LEFT 75 95 100 110 110 The average pure tone threshold was 86.6 in the right ear, and 90 in the left ear. Speech audiometry revealed speech reception of 75 dB in the right ear and 75 in the left ear, and speech discrimination (not Maryland CNC word discrimination) of 40 percent in the right ear and 52 percent in the left ear. Application of these scores to Table II resulted in a 60 percent rating. An April 6, 1994, private audiology examination report showed pure tone thresholds, in dB, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 65 80 80 NT 100 LEFT 55 80 80 105 110 The average pure tone threshold was 75 in the right ear, and 71.6 in the left ear. Speech audiometry revealed speech reception of 70 dB in the right ear and 65 in the left ear, and speech discrimination of 58 percent in the right ear and 54 percent in the left ear. Application of these scores to Table II resulted in a 60 percent rating. An April 7, 1995, private audiology examination report showed pure tone thresholds, in dB, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 75 85 80 NT 100 LEFT 65 80 80 110 100 The average pure tone threshold was 80 in the right ear, and 75 in the left ear. Speech audiometry revealed speech reception of 80 dB in the right ear and 80 in the left ear, and speech discrimination of 52 percent in the right ear and 46 percent in the left ear. Application of these scores to Table II resulted in a 60 percent rating. A July 2, 1998 private audiology examination report showed pure tone thresholds, in dB, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 75 85 85 95 100 LEFT 60 80 80 95 110 The average pure tone threshold was 81.6 in the right ear, and 73.3 in the left ear. Speech audiometry revealed speech reception of 75 dB in the right ear and 75 in the left ear, and speech discrimination of 80 percent in the right ear and 72 percent in the left ear. Application of these scores to Table II resulted in a 60 percent rating. A July 6, 2001, private audiology examination report showed pure tone thresholds, in dB, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 70 80 90 NT 95 LEFT 70 80 85 NT 95 The average pure tone threshold was 80 in the right ear, and 78.3 in the left ear. Speech audiometry revealed speech reception of 75 dB in the right ear and 75 in the left ear, and speech discrimination of 76 percent in the right ear and 68 percent in the left ear. Application of these scores to Table II resulted in a 60 percent rating. The July 6, 2001, hearing tests cannot be considered based on any of the rating criteria in effect on or after December 18, 1987, since the criteria required rating the disability based on both speech discrimination and audiometry tests; provisions for rating solely on audiometry were eliminated except under special circumstances that did not apply here. The tests in 2001 did not include word discrimination scores; therefore, only the criteria in effect prior to and on September 9, 1975, will be considered and the findings will be converted when considering the criteria in effect in 1968. The Veteran was afforded another VA audiology examination in August 2003. On examination, his chief complaint was that he missed out on hearing things and that he either lost or did not get jobs because of his hearing. He also reported difficulty hearing in both quiet and noise. The pure tone thresholds, in dB, were reported as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 65 80 85 100 105 LEFT 75 85 95 105 100 The average pure tone threshold was 93 in the right ear, and 96 in the left ear. Speech audiometry revealed speech recognition ability of 58 percent in the right ear and 48 percent in the left ear. Applying these results to Table VI of 38 C.F.R. § 4.85 yielded a finding of Level VIII and Level IX hearing loss in the right and left ears, respectively. Where hearing loss was at Level VIII in the better ear and Level IX in the worse ear, a 60 percent rating was assigned under Table VII. There is no indication that the speech discrimination test was not appropriate, and no examiner certified that speech discrimination testing was not appropriate, so the use of Table VIA, used to evaluate hearing impairment based only on pure tone threshold averages, was not applicable. The audiometric results of the examination disclose that the Veteran’s hearing loss warranted a 60 percent rating but no greater under the schedular criteria. The evidence is not in equipoise to warrant a higher evaluation. Thus, for the period from January 18, 1988, to January 24, 2005, the medical evidence does not support the appeal. In sum, the medical evidence does not support a rating in excess of 40 percent rating prior to January 18, 1988, or a rating in excess of 60 percent from January 18, 1988, to January 24, 2005, under any version of the pre-amended or amended hearing loss regulations. The Board considered the lay statements of the Veteran during his lifetime and of the appellant that his disability was worse. While laypersons are competent to report symptoms experienced or observed because this requires only personal knowledge as it comes through the senses, they are not competent to identify a specific level of disability of a service-connected disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s bilateral hearing loss disability was provided by the medical personnel who examined him during his lifetime and who 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 this disability was evaluated. Moreover, as the examiners had the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disabilities and had sufficient facts and data on which to base the conclusion, 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 and the appellant’s observations. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeal is denied. TDIU Prior to January 24, 2005 It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation due to 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 because 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 were 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). A claim for TDIU is because of subjective factors that the objective rating does not consider. Vittese v. Brown, 7 Vet. App. 31 (1994). The Veteran was assigned a 100 percent schedular rating starting in January 24, 2005, and continued until his death in February 2012. His combined rating prior to January 2005 was 60 percent. The threshold question is whether he was entitled to a TDIU prior to January 24, 2005. Prior to January 24, 2005, the Veteran had been rated at 60 percent for bilateral hearing loss and 10 percent for tinnitus effective January 18, 1988. Prior to January 18, 1988, his combined rating was 40 percent; starting January 1988, it was 60 percent. As such, he met the schedular rating criteria for a TDIU effective January 18, 1988. The Veteran claimed his service-connected bilateral hearing loss specifically resulted in his unemployability prior to January 25, 2005. On the April 2006 VA Form 21-8940, he indicated that he last worked in September 1983 due to his bilateral hearing loss disability. He reported completing one year of college education. Pertinent evidence of record includes VA examination reports, VA treatment records, and records obtained from the Social Security Administration (SSA). On a September 1987, private treatment note, the clinician reported that the Veteran must have two hearing aids in place and that an individual speaking must have his full attention and that he must be looking at you from a distance of about two to three feet due to his hearing problem. In a February 1988 private treatment record, the clinician indicated that Veteran’s hearing was obviously grossly impaired, with the need for his repeating numerous questions and commands despite the fact that he was wearing a hearing aid. In an April 1988 vocational assessment, the clinician found that the Veteran could not return to his previous at least semi-skilled work. The clinician indicated that the Veteran was now limited to light work which did not require good hearing and which did not require him to be in a noisy area. In a January 1989 decision, the SSA found that the Veteran was disabled for purposed of eligibility for SSA benefits as of January 17, 1984. SSA noted that the diagnoses that resulted in the disability included primarily sensorineural hearing loss and secondarily coronary arteriosclerosis with angina. At an August 2003 VA examination, the Veteran’s chief complaint was that he missed out on hearing things and that he either lost or did not get jobs because of his hearing. At an April 2006 VA examination, the clinician opined that although the Veteran had a profound sensorineural hearing loss in both ears, his hearing loss would not preclude him from employment in jobs similar to at least some of those that he had in the past, with reasonable accommodations. In an October 2020 private vocational assessment, after the Veteran’s death as part of the claim development, the clinician found that it was at least as likely as not that the Veteran had been unable to secure and follow substantially gainful employment, to include both skilled and unskilled sedentary work, since at least September 1983 until his death in February 2012. The clinician noted that the Veteran’s service-connected bilateral hearing loss and tinnitus caused severe limitations with interacting with coworkers, supervisors, and the general public, the inability to appropriately hear his surroundings in the work place, inability to work safely in his environment (unable to hear noises from hazards), and distractibility due to tinnitus, which resulted in time off-task. Further, the clinician disagreed with the April 2006 VA examiner’s opinion that the Veteran’s bilateral hearing loss would not preclude him from employment in jobs similar to at least some of those that he had in the past, with reasonable accommodations. He explained much of the Veteran’s past occupations, including construction work and meat slicing, required effective hearing and communication as he often worked around dangerous machinery and equipment; and his previous work as a security guard required the ability to hear and observe incidences as they occurred, ability to communication with patrons, and verbally relaying information to supervisor and authorities when necessary. The clinician opined that the Veteran’s inability to hear others and machinery would impair his ability to work safely around dangerous machinery and equipment due to his hearing loss and tinnitus and he would have been a significant safety risk in these positions. He noted that the Veteran’s risk for ongoing misunderstanding, injury, and errors would not generally be tolerated in a shelter work environment, with expectations and standards inconsistent with gainful employment in the competitive workforce. When looking at the disability picture as a whole, the evidence does not support a finding that, prior to January 24, 2005, the Veteran’s service-connected disabilities rendered him unable to secure and follow a substantially gainful occupation. While the evidence shows that his service-connected bilateral hearing loss and tinnitus affected his ability to work and precluded his work in construction and around machinery, no reviewer determined that he was unable to work in a position that did not require hearing, such as on-line or computer positions. While none of the clinicians offered any specific job for the Veteran, it is reasonable to assume that there were multiple jobs for the hearing-impaired. As noted above, the April 1988 vocational assessment found that that the Veteran was limited to light work which did not require good hearing and which did not require him to be in a noisy area. Further, although the April 2006 VA examiner found that although the Veteran had a profound sensorineural hearing loss in both ears, his hearing loss would not preclude him from employment in jobs similar to at least some of those that he had in the past, with reasonable accommodations. Both of these opinions were undertaken during the Veteran’s lifetime and relied on a physical assessment of the Veteran and a review of the record contemporaneous to his claim. Although the October 2020 private vocational assessment found that the Veteran’s inability to hear others and machinery would impair his ability to work safely around dangerous machinery and equipment due to his hearing loss and he would have been a significant safety risk in these positions, the clinician did not find that the Veteran was precluded from all gainful employment, only that he could not have worked around machinery or in other dangerous areas. Accordingly, the Board places more probative weight on the April 1988 and April 2006 assessments and finds that the Veteran was not unemployable due to his service connected hearing loss and tinnitus. Thus, the appeal is denied. Finally, the appellant 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. Grzeczkowicz 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.