Citation Nr: 21023832 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 15-21 804 DATE: April 21, 2021 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to an initial rating in excess of 30 percent prior to January 8, 2020, and in excess of 60 percent thereafter for service-connected asthma is denied. FINDINGS OF FACT 1. The Veteran does not have a hearing loss disability as defined by VA regulations at any time since the claim has been filed. 2. From May 23, 2012 to January 8, 2020, the Veteran’s asthma required daily bronchodilator and anti-inflammatory medication; however, there is no evidence of higher-level disability symptoms. 3. From January 8, 2020 onward, the Veteran’s asthma required intermittent course of systemic corticosteroids; however, there is no evidence of higher-level disability symptoms. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1131, 5107 (b)(2012); 38 C.F.R. §§ 3.102, 3.303 (a), 3.307, 3.309 (2019). 2. The criteria for a rating in excess of 30 percent prior to January 8, 2020, and in excess of 60 percent thereafter for service connected asthma are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.14, 4.97, Diagnostic Code (DC) 6602. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Navy from March 1983 to October 1987. These issues come before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. These claims were recently remanded in May 2019 for additional development, which was accomplished in February 2020. A review of the record shows substantial compliance with the Board’s prior remand; therefore, additional development is not needed. Stegall v. West, 11 Vet. App. 268 (1998). The Board notes that the Veteran’s claim for entitlement to service connection for a left knee disorder was granted in a May 2020 rating decision. Thus, this claim is no longer on appeal and the Board does not have jurisdiction at this time. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second NOD must thereafter be timely filed to initiate appellate review of the claim concerning “downstream” issues, such as the compensation level assigned for the disability and the effective date); see also 38 C.F.R. § 20.200 (2019). 1. Entitlement to service connection for bilateral hearing loss The Veteran contends that his bilateral hearing loss is the result of in-service acoustic trauma. His claim of compensation was received by VA in May 2012. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: “(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 or aggravated during service.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain diseases, to include sensorineural hearing loss may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2018). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden for certain chronic disabilities such as sensorineural hearing loss is through a demonstration of continuity of symptomatology. In relevant part, 38 U.S.C. § 1154(a) requires that the VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Service connection for impaired hearing shall only be established when hearing status as determined by audiometric testing meets specified pure tone and speech recognition criteria. Audiometric testing measures threshold hearing levels (in decibels) over a range of frequencies (in Hertz). Hensley v. Brown, 5 Vet. App. 155, 158 (1993). A veteran will be found to have hearing loss for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. For service connection, in-service noise exposure need not be the only source of acoustic trauma; it must only be a contributing source. The absence of in-service evidence of hearing loss disability during a veteran’s period of active duty is not fatal to a claim for service connection. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Competent evidence of a current hearing loss disability (i.e., one meeting the requirements of section 3.385, as noted above), and a medically sound basis for attributing such disability to service, may serve as a basis for a grant of service connection for hearing loss disability. Hensley, 5 Vet. App. at 159. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. at 54). The Veteran contends that he currently has hearing loss as a result of his military service. However, the Board finds that the preponderance of the competent probative evidence demonstrates that the Veteran does not have a current hearing loss disability as defined for VA purposes at any time since this claim has been submitted. As such, the Veteran’s claim of entitlement to service connection must be denied as there is no current disability. The Veteran’s service treatment records (STRs) are entirely negative for complaints of, diagnosis of, or treatment for hearing problems. The enlistment examination is silent as to any hearing loss problems and clinical examination of the ears was normal. The October 1982 audiometric examination showed puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 05 00 00 00 LEFT 10 05 00 00 00 An October 1985 examination showed puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 05 00 05 00 LEFT 15 10 00 00 00 An April 1987 examination showed puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 05 10 00 00 00 LEFT 10 10 00 00 00 An October 1987 examination showed puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 00 00 00 00 LEFT 10 10 00 00 00 Medical evaluation before discharge from service did not reveal the presence of any chronic hearing disability. Clinical examination of the ears was normal, and the Veteran did not report any hearing related problems. The Board finds no evidence of hearing loss during active duty. The audiometric testing conducted during active duty documented normal hearing. See Hensley v. Brown, 5 Vet. App. 155 (1993) (the threshold for normal hearing is from 0 to 20 decibels). There is no evidence of hearing loss for VA purposes in the contemporaneous medical evidence from active duty and shortly thereafter. The record contains no medical evidence dated between October 1987 and October 1988 - within the first year of discharge from service - indicating hearing problems or that audiological testing was conducted. The first complaint of hearing loss is dated years after the Veteran’s discharge. There is no competent evidence of the presence of hearing loss to a compensable degree within one year of discharge. Service connection for hearing loss on a presumptive basis is not warranted. A review of the post service VA and private treatment records note complaints of hearing difficulties during the appeal period. However, none of the Veteran’s treating physicians have given a positive opinion that the hearing loss was due to military service. The Veteran underwent a VA examination in January 2020. He underwent audiometric testing, which revealed normal hearing for VA purposes. His puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 30 15 25 35 LEFT 15 20 20 20 35 The examiner reported speech discrimination test results of 96 percent for the right ear and 100 percent for the left ear. Bilateral hearing loss was not shown to have risen to the level required to be considered disabling for VA purposes. The post-service evidence demonstrates that the Veteran does not have a current bilateral hearing loss disability as defined by 38 C.F.R. § 3.385, as the auditory thresholds obtained during the pendency of this claim were not 40 decibels or greater at any of the frequencies, the auditory thresholds at the minimum three of the frequencies were not 26 decibels or greater, and the Maryland CNC speech recognition score was not less than 94 percent. See 38 C.F.R. § 3.385. Notably, the January 2020 VA examination does not show a bilateral hearing loss disability by VA standards. Thus, there is no competent evidence reflective of a bilateral hearing loss disability as defined by 38 C.F.R. § 3.85 at any time during the pendency of this appeal. The Board appreciates the Veteran’s contentions and statements related to his claimed bilateral hearing loss. However, even conceding that the Veteran was exposed to significant noise in service and noting the VA examiner’s positive nexus opinion that the hearing difficulties are the result of military service, the evidence does not show a bilateral hearing loss disability by VA standards. Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1110. Thus, where, as here, competent and persuasive medical evidence establishes that the Veteran does not have a bilateral hearing loss disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, the claim for service connection for bilateral hearing loss must be denied because the first essential criterion for a grant of service connection-competent evidence of the currently-claimed disability-has not been met. With respect to the Veteran’s contention that he currently has bilateral hearing loss disability, a layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). As a layperson, the Veteran is competent to report that he experiences difficulty hearing. However, he is not competent to render a diagnosis of a bilateral hearing loss disability that satisfies the regulatory criteria set forth in 38 C.F.R. § 3.385. Absent evidence of a current hearing loss disability diagnosis, the Board concludes that the claim of entitlement to service connection for a bilateral hearing loss disability must be denied. The preponderance of the evidence is against the Veteran’s claim and the doctrine of reasonable doubt is not applicable in the instant appeal. Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990); 38 C.F.R. § 3.102. 2. Entitlement to an initial rating in excess of 30 percent prior to January 8, 2020, and in excess of 60 percent thereafter for asthma. The Veteran contends that his asthma is worse than the rating currently assigned. His claim for compensation was received by VA in May 2012. The September 2013 rating decision on appeal granted service connection for asthma and awarded a 30 percent rating effective May 23, 2012. The Veteran timely appealed this determination to the Board. During the pendency of this appeal, a May 2020 rating decision increased the rating to 60 percent effective January 8, 2020 based on his symptomology. Law and Regulations Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a “staged” rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The United States Court of Appeals for Veterans Claims (the Court) has extended this practice even to established ratings, not just initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Under DC 6602, chronic asthma is rated at 30 percent for Forced Expiratory Volume in one second (FEV-1) of 56- to 70- percent predicted, or; FEV-1/FVC (Forced Vial Capacity) of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or inhalational antiinflammatory medication. Assignment of a 60 percent evaluation is warranted where there is FEV-1 of 40 to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations or; intermittent (at least three per year) course of systemic (oral or parenteral) corticosteroids. For the assignment of a 100 percent evaluation, there must be FEV-1 of less than 40 percent of predicted value, or; FEV-1/FVC of less than 40 percent, or more than one attack per week with episodes of respiratory failure, or; required daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medications. 38 C.F.R. § 4.97. In addition, under the General Rating Formula for Interstitial Lung Diseases (e.g., DC 6833), a 30 percent rating is warranted for Forced Vial Capacity (FVC) of 65 to 74 percent predicted; or for Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) of 56 to 65 percent predicted. 38 C.F.R. § 4.97. A 60 percent rating is warranted for FVC of 50 to 64 percent predicted; or DLCO (SB) of 40 to 55 percent predicted; or maximum exercise capacity of 15 to 20 ml/kg in oxygen consumption with cardiorespiratory limitation. Id. A 100 percent rating is warranted for FVC of less than 50 percent predicted; or DLCO (SB) of less than 40 percent predicted; or maximum exercise capacity of less than 15 ml/kg in oxygen consumption with cardiorespiratory limitation; or cor pulmonale or pulmonary hypertension; or requires outpatient oxygen therapy. Id. Under the Rating Schedule, pulmonary function testing (PFTs) are required for evaluation and assignment of ratings under DCs 6600, 6603, 6604, 6825-6833, and 6840-6845. 38 C.F.R. § 4.96 (d). For PFTs to be valid for rating purposes, post-bronchodilator studies are required to be conducted except when the results of pre-bronchodilator PFTs are normal or when the examiner determines that post-bronchodilator studies should not be done and states why. Id. These post-bronchodilators results are used in applying the evaluation criteria under the rating schedule. 38 C.F.R. § 4.96 (d)(5). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. at 54 ). The Board will address the following appeal periods: (1) From May 23, 2012, 2015 to January 8, 2020, and (2) from January 8, 2020 onward. May 23, 2012 to January 8, 2020 Factual History A review of the Veteran’s post service VA treatment records shows a history of asthma. PFT results post-bronchodilator in May 2012 revealed the following results: FVC of 77 percent predicted; FEV-1 of 73 percent predicted; and FEV-1/FVC of 93 percent predicted. Pre-bronchodilator results revealed the following results: DLCO of 58 percent predicted. The Veteran underwent a VA examination in July 2013. He was diagnosed with asthma and reported shortness of breath, wheezing, light headedness, and a tight chest that began during service. The examiner found that the Veteran’s asthma did not require the use of oral or parenteral corticosteroid medications. The examiner also found that the asthma required daily inhalational bronchodilatory therapy and anti-inflammatory medication; however, the Veteran did not require the use of oral bronchodilators or outpatient therapy for the asthma. The examiner noted the Veteran experiencing asthma attacks or exacerbations over the past 12 months that required physician visits that occurred less frequently than monthly for required care. In addition, the examiner noted that the Veteran did not have any episodes of respiratory failure. PFT testing results pre-bronchodilator revealed the following: FVC of 80 percent predicted; FEV-1 of 75 percent predicted, and FEV-1/FVC of 93 percent predicted. The examiner found that FEV-1/FVC test results most accurately reflected the Veteran’s disability level, stating that pre-bronchodilator results were normal and results were not needed post-bronchodilator. The examiner also found no evidence of multiple respiratory conditions or that the asthma impacted the Veteran’s ability to work. The Board finds that the VA examination is adequate, as it was based upon clinical examination and testing of the Veteran. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). It is also probative because it provided a clear conclusion based on the supporting clinical data and was consistent with the other evidence of record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A December 2012 VA treatment record noted the Veteran’s use of nebulizers as needed for asthma treatment. A January 2014 VA treatment record noted the Veteran’s on/off use of inhalers for 30 years. A September 2015 VA treatment record noted nebulizer treatment for the Veteran’s asthma. A June 2017 VA treatment record noted shortness of breath from wheezing/asthma. VA treatment records in January 2018 and April 2018 note the Veteran’s asthma to be controlled. The Board notes that no PFTs were conducted during these examinations. The Veteran testified at the November 2018 Board hearing that he has been placed on different inhalers and breathing medications since the last VA examination. In addition, he testified that his inhaler medication usage had increased to four times a day. Also, he testified that he uses two different types of nebulizers at least twice a day for his symptoms. Analysis Based on the evidence of record, the Board finds that a rating of 30 percent is warranted for this appeal period. While the PFT results during this period do not show FEV-1 of 56- to 70- percent predicted, or FEV-1/FVC of 56 to 70 percent, the evidence of record demonstrates that the Veteran underwent daily inhalational or oral bronchodilator therapy. However, the pertinent evidence is against a finding the symptomology present for a 60 percent rating or greater. There is no objective evidence indicating that the Veteran’s asthma was productive of FEV-1 of 40 to 55-percent predicted, or FEV-1/FVC of 40 to 55 percent. In addition, there is no evidence that the Veteran required at least monthly visits to a physician for required care of exacerbations or intermittent course of systemic corticosteroids. Based on this evidence, a 60 percent rating is unwarranted. The Board has also considered other diagnostic codes applicable to the Veteran’s asthma. However, higher ratings are not warranted under any alternative diagnostic code. The Board notes that there is no objective medical evidence that shows that the Veteran’s asthma was productive of FVC of 50 to 64 percent predicted; or DLCO (SB) of 40 to 55 percent predicted; or maximum exercise capacity of 15 to 20 ml/kg in oxygen consumption with cardiorespiratory limitation. Therefore, a 60 percent rating under the General Rating Formula for Interstitial Lung Diseases cannot be assigned to the Veteran. In adjudicating this claim, the competence and credibility of lay statements must be considered by the Board. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Veteran contends that his lung disability is entitled to a higher rating. The Board notes the Veteran’s Board testimony regarding worsening asthma symptomology. While the Veteran may be credible to describe the symptoms which he experiences, determining the exact extent of his disability and pulmonary function restriction requires specialized testing and medical knowledge or training which he is not shown to have. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In addition, the rating schedule contemplates the Veteran’s breathing complaints and difficulties in the rating criteria listed under both the General Rating Formula and DC 6002. Although the Veteran may believe that he meets the criteria for the next higher disability rating, his complaints along with the medical findings do not meet the schedular requirements for a rating in excess of 30 percent. From January 8, 2020 onward Factual History The Veteran underwent a second VA examination in January 2020. He was diagnosed with asthma and reported shortness of breath, wheezing, light headedness that began during service. He also reported using inhalers and needed asthma treatment. The examiner found that the asthma required the use of chronic low dose corticosteroids and intermittent courses of oral or parenteral corticosteroid medications. The examiner also found that the asthma required daily inhalational bronchodilatory therapy and anti-inflammatory medication and that the Veteran required require the use of oral bronchodilators. However, the examiner found that outpatient therapy was not needed for the asthma. The examiner noted the Veteran experiencing two asthma attacks or exacerbations over the past 12 months that required physician visits that occurred less frequently than monthly for required care. In addition, the examiner noted that the Veteran did not have any episodes of respiratory failure. The examiner did not conduct any PFTs, deferring to the Veteran’s previous PFT results due to him developing a heart attack. The examiner also found no evidence of multiple respiratory conditions or that the asthma impacted the Veteran’s ability to work. The Board finds that the VA examination is adequate, as it was based upon clinical examination and testing of the Veteran. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). It is also probative because it provided a clear conclusion based on the supporting clinical data and was consistent with the other evidence of record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A review of the post-service VA treatment record do not note any complaints or treatment for the Veteran’s asthma during this appeal period. Analysis Based on the evidence of record, the Board finds that a rating of 60 percent but no higher is warranted for this appeal period. While there is no objective medical evidence demonstrating FEV-1 of 40 to 55-percent predicted, or FEV-1/FVC of 40 to 55 percent, the evidence of record shows that the Veteran underwent intermittent course of systemic corticosteroids. The pertinent evidence is against a finding of 100 percent rating is warranted. For the assignment of a 100 percent rating, there must be FEV-1 of less than 40 percent of predicted value, or FEV-1/FVC of less than 40 percent, or more than one attack per week with episodes of respiratory failure, or required daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medications. 38 C.F.R. § 4.97. A review of the evidence of record does not demonstrate that the Veteran’s asthma manifested with asthma attacks of more than one per week with episodes of respiratory failure. In addition, there is no objective findings that the asthma was productive of FEV-1 of less than 40 percent of predicted value or FEV-1/FVC of less than 40 percent. In addition, there is no evidence that the Veteran required daily use of systemic high dose corticosteroids or immunosuppressive medications. As such, a 100 percent rating is unwarranted. The Board has also considered other diagnostic codes applicable to the Veteran’s asthma. However, higher ratings are not warranted under any alternative diagnostic code. Specifically, the Board notes that there is no objective medical evidence that shows that the Veteran’s asthma was productive of FVC of 50 to 64 percent predicted; or DLCO (SB) of 40 to 55 percent predicted; or maximum exercise capacity of 15 to 20 ml/kg in oxygen consumption with cardiorespiratory limitation. Therefore, a 100 percent rating under the General Rating Formula for Interstitial Lung Diseases cannot be assigned to the Veteran. In adjudicating this claim, the competence and credibility of lay statements must be considered by the Board. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Veteran contends that his lung disability is entitled to a higher rating. While the Veteran may be credible to describe the symptoms which he experiences, determining the exact extent of disability and pulmonary function restriction requires specialized testing and medical knowledge or training which he is not shown to have. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In addition, the rating schedule contemplates the Veteran’s breathing complaints and difficulties in the rating criteria listed under the General Rating Formula and DC 6002. Although the Veteran may believe that he meets the criteria for the next higher disability rating, his complaints along with the medical findings do not meet the schedular requirements for a rating in excess of 60 percent. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.T. Massey, 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.