Citation Nr: 21025697 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 17-10 213 DATE: April 28, 2021 ORDER Entitlement to a higher rating for left elbow chronic strain and tendinitis, rated as compensable prior to July 30, 2015 and in excess of 10 percent thereafter, is denied. Entitlement to a rating in excess of 10 percent for left elbow impairment of supination/pronation is denied. Entitlement to a compensable rating for right ear hearing loss is denied. FINDINGS OF FACT 1. For the appeal period prior to July 30, 2015, the Veteran’s left elbow chronic strain and tendinitis manifested as extension to zero degrees without pain, at worst, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; without ankylosis, limitation of motion, flail joint, joint fracture, nonunion of the radius and ulna, or nonunion of the radius 2. For the appeal period beginning on July 30, 2015, the Veteran’s left elbow chronic strain and tendinitis manifested as painful joint motion with extension to zero degrees, at worst, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; without ankylosis, limitation of motion, flail joint, joint fracture, nonunion of the radius and ulna, or nonunion of the radius. 3. Throughout the period on appeal, the Veteran’s left elbow impairment of supination and pronation has manifested as painful joint motion with supination up to 60 degrees and pronation up to 65 degrees, at worst, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without ankylosis, limitation of motion, flail joint, joint fracture, nonunion of the radius and ulna, nonunion of the radius or was it limited to motion lost beyond last quarter of arc. 4. Throughout the period on appeal, the Veteran’s right ear hearing loss has been manifested by hearing acuity of no worse than Level VI in the right ear. CONCLUSIONS OF LAW 1. The criteria for a compensable rating prior to July 30, 2015, and a rating in excess of 10 percent thereafter, for left elbow chronic strain and tendinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.59, 4.71a, Diagnostic Codes 5024, 5207. 2. The criteria for a rating in excess of 10 percent for left elbow impairment of supination/pronation have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.59, 4.71a, Diagnostic Code 5213. 3. The criteria for a compensable rating for right ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.85, 4.86, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from June 1976 to December 1976 and from March 2003 to August 2004. These matters come before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified before the undersigned Veterans Law Judge. A hearing transcript has been associated with the record. In a March 2020 decision, the Board remanded these matters to the agency of original jurisdiction (AOJ) for further development. More specifically, the Board directed the AOJ to schedule the Veteran for a new examination to address the Veteran’s statements in the October 2019 Board hearing about the flareups of his left elbow pain and any additional functional loss suffered during his flareups, as well as, provide another examination to evaluate the severity of the Veteran’s right ear hearing loss. The Board also directed that updated VA treatment records be obtained and the Veteran be afforded the opportunity to identify any outstanding private treatment records. Updated VA treatment records have been associated with the record and the Veteran was asked to complete appropriate authorization forms to allow VA to obtain private treatment records in a July 2020 letter. VA examinations were conducted in October 2020 and November 2020. In November 2020, the RO issued a Supplemental Statement of the Case again denying increased rating for the Veteran’s claimed left elbow tendinitis, left elbow impairment of supination/pronation and right ear hearing loss. The Board determines that there has been substantial compliance with its previous remand. The matters now return to the Board. A September 2019 rating decision awarded a total rating based upon individual unemployability (TDIU) as a result of his posttraumatic stress disorder (PTSD), effective February 27, 2015, the date the claim for a TDIU was filed. The Veteran has not alleged, and the record does not establish, that he is unable to obtain and maintain employment due to his left elbow chronic strain and tendinitis, left elbow impairment of supination/pronation and/or right ear hearing loss. As such, the Board finds that a claim for a TDIU is not raised in connection with the instant appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered because of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods based on the facts found, a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to a compensable rating prior to July 30, 2015, and in excess of 10 percent thereafter for left elbow tendinitis is denied. 2. Entitlement to a rating in excess of 10 percent for left elbow impairment of supination/pronation is denied. The Veteran generally contends that his left elbow tendinitis and impairment of supination/pronation is more severe than contemplated by the currently assigned rating. Specific argument in support of this appeal has not been provided. The Veteran’s service-connected left elbow tendinitis and impairment of supination/pronation is currently rated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Codes 5207 and 5213, respectively. The record reflects that the Veteran’s left arm is dominant. See September 2020 VA examination. Under Diagnostic Code 5207, for a dominant elbow (major), a 10 percent rating is warranted for forearm limitation of extension to 45 degrees and also limited to 60 degrees; a 20 percent rating is warranted for extension limited to 75 degrees; a 30 percent rating is warranted for extension limited to 90 degrees; a 40 percent rating is warranted for extension limited to 100 degrees; a schedular maximum 50 percent rating is warranted for extension limited to 110 degrees. Id. Under Diagnostic Code 5213, for a dominant elbow (major), a 10 percent rating is warranted for limitation of supination to 30 degrees or less; a 20 percent rating is warranted for limitation of pronation if motion lost beyond last quarter of arc, the hand does not approach full pronation; a 30 percent rating is warranted for limitation of pronation if motion lost beyond middle of arc. The Veteran did not allege, and the record does not show that the Veteran has experience loss of bone fusion, so that will not be addressed. The Board also notes that under the Rating Schedule, a rating higher than 10 percent is warranted for a dominant elbow (the Veteran’s left elbow) disability where there is ankylosis, limitation of motion, flail joint, joint fracture, nonunion of the radius and ulna, and nonunion of the radius. See 38 C.F.R. §§ 4.71a, Diagnostic Codes 5205-5212. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary 93 (30th ed. 2003). In this case the evidence does not reflect, and the Veteran does not allege, that he has tibia or fibula impairment, genu recurvatum, or ankylosis of his left elbow. As such, those diagnostic codes are not for application. The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). In the instant case, the claims file is absent any medical evidence submitted or associated with the claims file subsequent to the revised rating effective date of February 7, 2021. Therefore, the February 2021 musculoskeletal criteria do not apply to the Veteran’s claims on appeal; and the appropriate criteria is discussed below. Turning to the medical evidence, the Veteran was afforded a VA examination in March 2014. At that time, he complained of functional loss due to less movement than normal and pain in his left arm. He denied flare-ups of his left elbow. Upon physical examination, range of motion measurements showed left elbow range of motion was abnormal and were as follows: extension was to zero degrees. After repetitive use testing, the Veteran’s range of motion was the same and his supination was to 90 degrees and pronation was to 65 degrees. There was no additional loss of function or range of motion after three repetitions. There was localized tenderness or pain on palpation of his left elbow. However, there was no objective evidence of crepitus, no muscle atrophy, no ankylosis, no flail joint, no joint fracture, no ununited fracture and no malaligned fracture. There were significant diagnostic test findings that showed that there was essentially a normal left elbow. The Veteran was afforded another VA examination in July 2015. At that time, the Veteran did not report flareups in his left elbow. Upon physical examination, range of motion measurements showed left elbow range of motion was abnormal and were as follows: extension was 130 to zero degrees; his supination was to 75 degrees and pronation was to 70 degrees. The range of motion after repetitive use testing were as follows: extension was 130 to zero degrees; his supination was to 70 degrees and pronation was to 65 degrees. It was noted that pain, weakness, fatigability or incoordination significantly limited the Veteran’s functional ability with repeated use over a period of time. There was objective evidence of localized tenderness or pain on palpation over the medial epicondyle and olecranon consistent with his diagnosed tendonitis and chronic elbow strain. There was no evidence of pain with weight bearing. There was no crepitus, no ankylosis, muscle atrophy, no flail joint, joint fracture, no ununited fracture, and no malaligned fracture of the left elbow. There were no other pertinent physical findings related to his condition. The Veteran was afforded another VA examination in September 2020. At that time, the Veteran reported flareups where the pain comes randomly. The Veteran also reported functional loss due to limited bending and lifting. Upon physical examination, range of motion measurements showed left elbow range of motion was abnormal and were as follows: extension was 115 to zero degrees; his supination was to 60 degrees and pronation was to 70 degrees. The range of motion after repetitive use testing did not change and there was no additional loss of function. It was noted that pain, weakness, fatigability or incoordination significantly limited the Veteran’s functional ability with repeated use over a period of time. There was objective evidence of localized tenderness or pain on palpation consistent with his diagnosed tendonitis. However, there was no pain with weight bearing and non-weight bearing. There was no crepitus, muscle atrophy, no flail joint, joint fracture, no ununited fracture, and no malaligned fracture of the left elbow. There were no other pertinent physical findings related to his condition. Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported left elbow symptoms that are worse than those noted above. For the appeal period prior to July 30, 2015, a 10 percent rating for left elbow chronic strain and tendinitis is warranted where the forearm limitation of extension was to 45 degrees and or to 60 degrees. The Veteran’s left elbow chronic strain and tendinitis manifested as extension to zero degrees with no pain in the March 2014 VA examination. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned zero percent rating. 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, supra. Thus, a higher rating is not warranted for the Veteran's left elbow chronic strain and tendinitis even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Therefore, a compensable rating is not warranted for the appeal period prior to July 30, 2015 is not warranted. For the appeal period beginning on July 30, 2015, a rating in excess of 10 percent is warranted where the forearm limitation of extension was to 75 degrees. The Veteran’s left elbow chronic strain and tendinitis manifested as extension was 130 to zero degrees in the July 2015 VA examination with pain and extension was 115 to zero degrees in the October 2020 VA examination with pain. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned zero percent rating. 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, supra. Thus, a higher rating is not warranted for the Veteran's left elbow chronic strain and tendinitis even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Therefore, a rating in excess of 10 percent for the appeal period beginning on July 30, 2015 is not warranted. Throughout the appeal period, a rating in excess of 10 percent for the Veteran’s left elbow impairment of supination/pronation is warranted if limitation of pronation if motion lost beyond last quarter of arc and the hand does not approach full pronation. The March 2014 and July 2015 VA examinations found pronation to be to 65 degrees and a September 2020 VA examination found pronation to be to 70 degrees. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned zero percent rating. 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, supra. Thus, a higher rating is not warranted for the Veteran's left elbow impairment of supination/pronation even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Therefore, a rating in excess of 10 percent rating is not warranted. Furthermore, the Board finds the evidence, to include the Veteran’s reported symptoms as considered in the VA examination reports and treatment records, does not demonstrate symptoms that rise to the level as required for a higher rating under the diagnostic criteria. While the Veteran has essentially stated that he has pain in his left elbow, he has not described a range of motion less than that found on examinations. In this regard, he reported that he experienced symptoms that included pain and weakness. The Veteran’s statements do not show the requisite limitation of motion necessary for higher or separate ratings. Treatment records do not show greater limitations of motion than the above examination findings. Specifically, the Veteran was not shown to have range of motion that was limited to 45 degrees of extension in the left elbow, nor limited supination to 30 degrees or pronation noted to be limited to motion lost beyond last quarter of arc after July 30, 2015. Given the above, even when considering the impact of left elbow pain on physical activities, higher or separate ratings are not warranted based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5207 and 5213. The Board has considered the applicability of other potential diagnostic codes. The record does not establish, and the Veteran has not alleged, ankylosis, crepitus, flail joint, joint fracture, nonunion of the radius and ulna, and nonunion of the radius. A higher or separate rating under 5205, 5209, 5210, 5211 and 5212 is not warranted. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court’s holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). In this case, the March 2014 and July 2015 VA examinations were conducted prior to Correia and Sharp and provides only partial information as described above. No pain was noted on examination in the July 2014 VA examination report. Pain was noted on examination in the July 2015 VA examination report and the effect of pain on range of motion is described above. Regarding repeated use over time, the Board notes that July 2015 examiner conducted repetitive-use testing and concluded that there was additional limitation in range of motion while the July 2014 VA examiner concluded that there was no additional limitation of motion. The Veteran denied flare-ups in the March 2014 and July 2015 VA examinations. The September 2020 VA examiner noted that pain, weakness, and lack of endurance significantly limit functional ability with repeated use over a period of time, and functional ability could be described in terms of range of motion after repetitive use or with pain of extension from 115 to zero degrees, full supination to 60 degrees, and full pronation to 70 degrees, with flareups, pain on non-weight and weight bearing considered. The Board finds the March 2014, July 2015 and September 2020 examinations to be adequate for rating purposes. See Correia v. McDonald, 28 Vet. App. 158 (2016); see also Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board acknowledges the Veteran's belief that his left elbow tendinitis and impairment of supination/pronation symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. The Board has considered whether a staged rating under Hart, supra, are warranted, however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning staged ratings is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Accordingly, the Board finds that the preponderance of the evidence is against the assignment of an initial rating higher for left elbow tendinitis and impairment of supination/pronation. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 3. Entitlement to a compensable rating for right ear hearing loss is denied. The Veteran generally contends that his right ear hearing loss is worse than currently rated. Specific argument in support of this appeal has not been provided. In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. 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 in conjunction with the average hearing threshold and as measured by pure tone audiometric tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. 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 (Maryland CNC) together with the results of a pure tone audiometry test. The vertical columns in Table VI (38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The horizontal rows 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 (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 thresholds 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 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. If impaired hearing is service connected in only one ear, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I in order to determine the percentage evaluation from Table VII, subject to the provisions of 38 C.F.R. § 3.383. See 38 C.F.R. § 4.85(f). In the present case, the Veteran's non service-connected left ear hearing does not meet the provisions of 38 C.F.R. § 3.385 so as to be considered a disability. Thus, left ear hearing is assigned Roman numeral I. During his examinations, the Veteran reported functional impairments due to his right hearing loss. He reported having difficulty hearing conversations in crowds and hearing the television in his March 2014 and November 2020 VA examination reports. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Board acknowledges that the Veteran believes that his right ear hearing acuity is worse than evaluated because it is difficult for him to hear and understand when people are speaking to him. However, far more probative of the degree of the disability are the results of testing prepared by a skilled professional since the schedular criteria are predicated on audiological findings rather than subjective reports of severity of hearing loss. In essence, lay statements are of limited probative value. As a layperson, the Veteran is competent to report difficulty with his hearing; however, he is not competent to assign particular speech recognition scores or pure tone decibel readings to his current acuity problems. As indicated above, ratings of hearing loss disability involve mechanical application of the rating criteria to the findings on official audiometry. See Lendenmann v. Principi, supra. In a March 2014 VA examination, the Veteran’s audiometric testing results, in decibels and Maryland CNC Word List speech recognition score were as follows: HERTZ 1000 2000 3000 4000 AVG CNC RIGHT 45 5 5 65 30 86% Applying the March 2014 results to Table VI, the findings yield a numeric designation of Level II in the right ear and Level I for his non-service-connected left ear which equates to a noncompensable rating under Diagnostic Code 6100. The Veteran underwent another audiometric testing in November 2020. Audiometric testing results in decibels and Maryland CNC Word List speech recognition scores were as follows: HERTZ 1000 2000 3000 4000 AVG CNC RIGHT 45 50 70 90 63.75 64% Applying the March 2014 results to Table VI, the findings yield a numeric designation of Level VI in the right ear and Level I for his non-service-connected left ear which equates to a noncompensable rating under Diagnostic Code 6100. The pure tone thresholds of record do not reflect an exceptional pattern of hearing loss as contemplated by 38 C.F.R. § 4.86(a) because the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is not 55 decibels or more; and, as such, that provision is inapplicable. Additionally, an exceptional pattern of hearing loss as contemplated by 38 C.F.R. § 4.86(b) is not shown as the documented pure tone thresholds for the Veteran are not 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, thus Table VIA is not applicable. 38 C.F.R. § 4.86(b). In Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the Court held that, relevant to VA audiological examinations, and in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. In the March 2014 audiology evaluation report, the VA audiologist noted the Veteran's reports that it was harder to hear in crowds. A VA audiologist, in a November 2020 VA evaluation report, indicated cannot hear conversations going on around him and has to raise the volume up on the television. Therefore, the Board finds that the VA examinations of record fully described the functional effects caused by the Veteran's hearing loss disability in accordance with Martinak. As such, the Board finds that the examinations of record are adequate to adjudicate the Veteran's increased rating claim and no further examination is necessary. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran’s contentions of difficulty hearing. 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, supra. The functional impact that the Veteran describes, is contemplated by the rating criteria. Doucette v. Shulkin, supra. The Veteran’s main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Ross v. Shulkin, 29 Vet. App. 142, 145 (2017). The Board has considered whether a staged rating under Hart, supra, are warranted, however, the Board finds that his symptomatology has been stable throughout period on appeal. Therefore, assigning staged ratings is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra. (Continued on the next page)   Thus, the Board concludes that the preponderance of the evidence is against finding that the Veteran meets the criteria for a compensable rating for right hearing loss. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Adeyemi, 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.