Citation Nr: 21028228 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 14-40 101 DATE: May 10, 2021 ORDER Entitlement to an initial evaluation more than 10 percent for bilateral hearing loss is denied. Entitlement to a rating more than 20 percent for bilateral hearing loss after November 18, 2019 is denied. Entitlement to an initial compensable evaluation for a history of ruptured bladder (bladder disorder) is denied. Entitlement to a rating more than 20 percent for a bladder disorder after November 18, 2019 is denied. Entitlement to an initial evaluation more than 10 percent for degenerative joint disease of the left hip (left hip disorder) is denied. REMANDED Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. For the period prior to November 18, 2019, the objective medical evidence shows that the Veteran's bilateral hearing loss was manifested by hearing acuity of no worse than Level IV, bilaterally. Thus, a 10 percent rating, but no higher is warranted under the rating schedule for this period. 2. For the period after November 18, 2019, the Veteran's bilateral hearing loss has been manifested by hearing acuity of no worse than Level VI for the left ear and Level V for the right ear. A 20 percent rating, but no higher, is warranted under the rating schedule for this period. 3. For the period prior to November 18, 2019, the Veteran's bladder disorder was asymptomatic and did not require the use of absorbent material or an appliance. 4. For the period after November 18, 2019, the Veteran's bladder disorder has not resulted in urinary retention requiring intermittent or continuous catheterization; leakage requiring the wearing of absorbent materials, which must be changed 2 to 4 times per day; or awakening to void three to four times per night. 5. Throughout the period on appeal, the Veteran's left hip disorder has not resulted in limitation of abduction most lost beyond 10 degrees. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial evaluation more than 10 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code 6100 (2019). 2. The criteria for entitlement to a rating more than 20 percent for bilateral hearing loss after November 18, 2019 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code 6100. 3. The criteria for entitlement to an initial compensable evaluation for a history of ruptured bladder (bladder disorder) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.115a, 4.115b, Diagnostic Code 7517 (2019). 4. The criteria for entitlement to a rating more than 20 percent for a bladder disorder after November 18, 2019 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.115a, 4.115b, Diagnostic Code 7517. 5. The criteria for entitlement to an initial evaluation more than 10 percent for degenerative joint disease of the left hip (left hip disorder) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.71a, Diagnostic Codes 5251-5253 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from June 1965 to May 1968. In June 2018, he and his spouse testified before the Board via videoconference; a transcript of the hearing is of record. In January 2019, the Board, dismissed two issues and remanded the remainder of the appeal for evidentiary development. During development, a September 2020 rating decision granted entitlement to service connection for a lumbar spine disorder, left foot peripheral sensory neuropathy, and residual scar of lumbar spine. As this represents a full grant of those issues, they are no longer on appeal. The September 2020 rating decision also increased the Veteran's bilateral hearing loss from 10 percent to 20 percent, effective November 18, 2019 (date of VA examination) and his bladder disorder from noncompensable to 20 percent, effective November 18, 2019 (date of VA examination). In an October 2020 correspondence, the Veteran challenged the effective dates of these increases. Since the appeal now includes staged ratings, the Board will discuss each period separately. The remaining issues, as they have been characterized above, have since been returned to the Board for further consideration. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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 or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14 (2018); Esteban v. Brown, 6 Vet. App. 259, 262 (1994). While it is necessary to consider the complete medical history of the Veteran's condition in order to evaluate the level of disability and any changes in condition, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991); Francisco v. Brown, 7 Vet. App. 55 (1994). In deciding the Veteran's increased evaluation claim, the Board has considered the determinations in Fenderson v. West, 12 Vet. App. 119 (1999) and Hart v. Mansfield, 21 Vet. App. 505 (2007), and whether the Veteran is entitled to an increased evaluation for separate periods based on the facts found during the appeal period. In addition, when assessing the severity of a musculoskeletal disability that, as here, is at least partly rated on the basis of limitation of motion, VA must also consider the extent to which the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent ("flare-ups") due to symptoms such as pain. See also 38 C.F.R. §§ 4.40, 4.45. 1. Entitlement to an initial evaluation more than 10 percent for bilateral hearing loss 2. Entitlement to a rating more than 20 percent for bilateral hearing loss after November 18, 2019 The Veteran seeks entitlement to an initial rating greater than 10 percent for bilateral hearing loss for the period prior to November 18, 2019 and in excess of 20 percent thereafter. As discussed above, during development, a September 2020 rating decision increased his bilateral hearing loss to 20 percent disabling, effective November 18, 2019 (date of VA examination). The Veteran's bilateral hearing loss has been evaluated under the provisions of Diagnostic Code 6100. See 38 C.F.R. § 4.85. In evaluating hearing loss under the schedular criteria, disability ratings are derived by a mechanical application of the ratings schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The ratings schedule provides a table for ratings purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment in both ears. See 38 C.F.R. § 4.85. When the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels (dB) or more, Table VI or Table VIA is to be used, whichever results in the higher numeral. 38 C.F.R. § 4.86(a). When the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, Table VI or Table VIA is to be used, whichever results in the higher numeral. Thereafter, that numeral will be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). In association with his claim, the Veteran was provided a VA audiological examination in September 2011. VA examination findings show the right ear with 84 percent speech discrimination. Decibel (dB) loss at the puretone threshold of 1000 Hertz (Hz) is 20, with a 75 dB loss at 2000 Hz, a 80 dB loss at 3000 Hz, and a 80 dB loss at 4000 Hz. The average decibel loss is 66 in the right ear. The left ear shows 90 percent speech discrimination. Decibel (dB) loss at the puretone threshold of 1000 Hertz (Hz) is 40, with a 75 dB loss at 2000 Hz, a 70 dB loss at 3000 Hz, and a 65 dB loss at 4000 Hz. The average decibel loss is 62 in the left ear. With mechanical application of the rating schedule to the numeric designations assigned based on audiometric test results, the Veteran's average hearing loss and hearing discrimination score results in Level III impairment for the left ear and Level VI impairment for the right ear. A 10 percent evaluation is derived from Table VII of 38 C.F.R. § 4.85 by intersecting row III, the better ear, with column VI, the poorer ear. The Veteran received another VA audiological examination in November 2016. Decibel (dB) loss at the puretone threshold of 500 Hertz (Hz) is 25, with a 35 dB loss at 1000 Hz, a 80 dB loss at 2000 Hz, a 85 dB loss at 3000 Hz, and a 80 dB loss at 4000 Hz for the right ear. The average decibel loss is 61 in the right ear. Decibel (dB) loss at the puretone threshold of 500 Hertz (Hz) is 20, with a 50 dB loss at 1000 Hz, a 75 dB loss at 2000 Hz, a 70 dB loss at 3000 Hz, and a 70 dB loss at 4000 Hz for the left ear. The average decibel loss is 57 in the left ear. It does not appear that hearing discrimination scores were reported. With mechanical application of the rating schedule to the numeric designations assigned based on audiometric test results, the Veteran's average hearing loss and hearing discrimination score results in Level IV, bilaterally. A 10 percent evaluation is derived from Table VII of 38 C.F.R. § 4.85 by intersecting row IV, the better ear, with column IV, the poorer ear. Pursuant to the Board's January 2019 remand, the Veteran was afforded another VA audiological examination on November 18, 2019. VA examination findings show the right ear with 76 percent speech discrimination. Decibel (dB) loss at the puretone threshold of 500 Hertz (Hz) is 15, with a 35 dB loss at 1000 Hz, a 75 dB loss at 2000 Hz, a 95 dB loss at 3000 Hz, and a 95 dB loss at 4000 Hz. The average decibel loss is 75 in the right ear. The left ear shows 72 percent speech discrimination. Decibel (dB) loss at the puretone threshold of 500 Hertz (Hz) is 20, with a 60 dB loss at 1000 Hz, a 75 dB loss at 2000 Hz, a 70 dB loss at 3000 Hz, and a 70 dB loss at 4000 Hz. The average decibel loss is 69 in the left ear. With mechanical application of the rating schedule to the numeric designations assigned based on audiometric test results, the Veteran's average hearing loss and hearing discrimination score results in Level V for the right ear and Level VI impairment for the left ear. A 20 percent evaluation is derived from Table VII of 38 C.F.R. § 4.85 by intersecting row V, the better ear, with column VI, the poorer ear. The Board acknowledges that as a result of this examination, the Veteran's bilateral hearing loss was increased to 20 percent, effective November 18, 2019 (date of VA examination). The Board has considered whether the Agency of Original Jurisdiction (AOJ) correctly and accurately assigned numeric designations for the Veteran's impairments after the audiometric evaluations were performed in this case and properly performed the mechanical application of the designations to assign the Veteran's hearing loss disability evaluation for compensation purposes. 38 U.S.C. §§ 1155; 38 C.F.R. § 4.85, Diagnostic Code 6100. Here, the Board finds that the determinations made by the AOJ as to the speech recognition scores and thresholds are correct for the all periods on appeal. The Board has also considered the evidence of record regarding the functional effects of the Veteran's hearing loss. Although the Board finds his statements to be credible, it finds that these factors do not provide sufficient evidence on which to award a higher rating for hearing loss on any basis. Disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). In this case, as explained above, the numeric designations correlate to the ratings that were assigned at the time. For these reasons and bases, the Board finds that the preponderance of the evidence is against an initial rating more than 10 percent prior to November 18, 2019, and a rating in excess of 20 percent thereafter. The Board has considered the application of other various provisions, including 38 C.F.R. § 3.321(b)(1), for exceptional cases where schedular evaluations are found to be inadequate. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Thun v. Shinseki, 573 F.3d 1366 (Fed. Cir. 2009). Here, the rating criteria reasonably describe the Veteran's disability and symptomatology. He has complained of difficulty hearing and a deteriorated quality of life. Difficulty understanding speech due to hearing loss is contemplated by Diagnostic Code 6100. In this regard, the Board notes that the rating criteria for hearing loss are based, at least partially, on speech recognition scores. Furthermore, Diagnostic Code 6100 provides for higher ratings for more severe impairment of hearing. The Board points out that the decibel loss and speech discrimination ranges designated for each level of hearing impairment in Tables VI and VIA were chosen in relation to clinical findings of the impairment experienced by veterans with certain degrees and types of hearing disability. In support of this finding, the Board points to the regulatory history of 38 C.F.R. §§ 4.85 and 4.86. In this regard, the rating criteria for hearing loss were last revised, effective June 10, 1999. See 64 Fed. Reg. 25206 (May 11, 1999). In forming these revisions, VA sought the assistance of the Veteran's Health Administration (VHA) in developing criteria that contemplated situations in which a veteran's hearing loss was of such a type that speech discrimination tests may not reflect the severity of communicative functioning these veterans experienced or that was otherwise an extreme handicap in the presence of any environmental noise, even with the use of hearing aids. VHA had found, through clinical studies of veterans with hearing loss that, when certain patterns of impairment are present, a speech discrimination test conducted in a quiet room with amplification of the sounds does not always reflect the extent of impairment experienced in the ordinary environment. The decibel threshold requirements for application of Table VIA were based on the findings and recommendations of VHA. The intended effect of the revision was to fairly and accurately assess the hearing disabilities of veterans as reflected in a real life industrial setting. 59 Fed. Reg. 17295 (April 12, 1994). Accordingly, the Board finds that functional impairment due to hearing loss that is compounded by background or environmental noise is a disability picture that is considered in the current schedular rating criteria. Therefore, the Veteran's struggle to comprehend verbal conversations is a factor contemplated in the regulations and rating criteria as defined. Accordingly, the Board finds that the Veteran's complaints of hearing difficulty have been considered under the numerical criteria set forth in the rating schedule. Based on the foregoing, the Board finds that the rating criteria clearly contemplate the Veteran's disability picture. They include symptomatology of the type reported by the Veteran and by medical professionals on clinical evaluation. Therefore, the threshold factor for extraschedular consideration under step one of Thun has not been met. As the disability picture is contemplated by the Rating Schedule, the assigned schedular ratings are adequate. Therefore, referral for extraschedular consideration is not required under 38 C.F.R. § 3.321(b)(1) for the entirety of the appeal period. In conclusion, the preponderance of the evidence is against the Veteran's claim for an initial rating more than 10 percent for bilateral hearing loss prior to November 18, 2019 and in excess of 20 percent thereafter. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against assignment of a higher rating, that doctrine is not applicable. 38 U.S.C. § 5107. 3. Entitlement to an initial compensable evaluation for a history of ruptured bladder (bladder disorder) 4. Entitlement to a rating more than 20 percent for a bladder disorder after November 18, 2019 The Veteran contends that he is entitled to a higher rating for his service-connected status bladder disorder. Initially, the Board notes that during remand development, the Veteran was awarded a 20 percent disability increase effective November 18, 2019. Accordingly, the Board's review of the Veteran's increased rating claim will address both period on appeal. The Veteran's bladder disorder is rated pursuant to 38C.F.R. §4.115a, Diagnostic Code 7517. Diagnostic Code 7517 directs bladder injuries to be rated under the code for voiding dysfunction. Voiding dysfunction is rated based on urine leakage, frequency, and obstructed voiding. Urinary leakage involves ratings ranging from 20 to 60 percent and contemplates continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence. A 20 percent rating contemplates leakage requiring the wearing of absorbent materials, which must be changed less than 2 times per day. When there is leakage requiring the wearing of absorbent materials, which must be changed 2 to 4 times per day, a 40 percent disability rating is warranted. When these factors require the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day, a 60 percent evaluation is warranted. 38 C.F.R. § 4.115a. The criteria for urinary frequency allow for 20 percent rating when there is a daytime voiding interval between one and two hours, or; awakening to void three to four times per night. 38 C.F.R. § 4.115a. A daytime voiding interval of less than one hour, or; awakening to void five times per night warrants a 40 percent rating. Id. The highest available rating for obstructed voiding is a 30 percent rating warranted for urinary retention requiring intermittent or continuous catheterization. Id. The Veteran underwent a VA examination in September 2011. Examination revealed a diagnosis of history of ruptured bladder s/p cystotomy and repair procedure in July 1966, presently asymptomatic. According to the examiner, the Veteran had a normal bladder exam with no urinary symptoms, leakage, obstructed voiding, urinary tract infections, urinary tract stones, abdominal or flank tenderness. As a result of this examination, he was assigned a noncompensable evaluation. Pursuant to the Board's January 2019 remand, the Veteran received another VA examination on November 18, 2019, wherein his previous diagnosis was confirmed. The examiner stated that the Veteran has voiding dysfunction that causes urine leakage of 1-2 drops on his underwear, but does not result in wearing absorbent material or the use of an appliance. The voiding dysfunction causes increased urinary frequency such as daytime voiding interval between 2 and 3 hours and nighttime awakening to void 3 to 4 times. The voiding dysfunction also resulted in symptoms of obstructed voiding such as slow stream, weak stream, and decreased force of stream. No infections or other conditions were reported. The Board observes that this examination resulted in an increased 20 percent rating, effective November 18, 2019 (date of VA examination). For the period prior to November 18, 2019, the evidence is against the claim for a compensable disability rating for the Veteran's bladder disorder. The Veteran was not entitled to a compensable rating under the voiding dysfunction of urinary leakage as he did not require the wearing of absorbent materials. The September 2011 VA examiner reported that the Veteran's condition was asymptomatic. The Board also finds that the Veteran is not entitled to an initial compensable rating for obstructive voiding symptomatology. The evidence does not show, and the Veteran has not alleged, marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of (1) post void residuals greater than 150 cc; (2) uroflowmetry; markedly diminished peak flow rate (less than 10 cc/sec).; (3) recurrent urinary tract infections secondary to obstruction.; (4) stricture disease requiring periodic dilatation every 2 to 3 months. The Veteran's bladder disorder is currently rated at 20 percent for the period beginning November 18, 2019. Again, to warrant a rating of 40 percent, the evidence would need to show daytime voiding interval less than one hour, or; awakening to void five or more times per night. The Board finds that the medical evidence of record does not indicate that the Veteran's disability picture for the period beginning November 18, 2019 more closely approximated the frequency of symptoms associated with a 40 percent rating. The November 2019 VA examiner stated that the voiding dysfunction causes increased urinary frequency such as daytime voiding interval between 2 and 3 hours and nighttime awakening to void 3 to 4 times. The voiding dysfunction also resulted in symptoms of obstructed voiding such as slow stream, weak stream, and decreased force of stream. A rating in excess of 20 percent for the period beginning November 18, 2019 is therefore not warranted. 38 C.F.R. § 4.115(a), 4.115(b), Diagnostic Code 7517. The Board has also considered an alternative rating for the Veteran's voiding dysfunction, but as the medical evidence of record from the period does not indicate that the Veteran experienced urine leakage requiring the wearing of absorbent materials, renal dysfunction or urinary tract infections, an alternative rating is not warranted. 38 C.F.R. § 4.115(a). Therefore, the preponderance of the evidence is against the Veteran's claim for an initial compensable rating for a bladder disorder prior to November 18, 2019 and in excess of 20 percent thereafter. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against assignment of a higher rating, that doctrine is not applicable. 38 U.S.C. § 5107. 5. Entitlement to an initial evaluation more than 10 percent for degenerative joint disease of the left hip (left hip disorder) The Veteran's left hip disorder is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5251 for limitation of extension of the thigh. The Board notes that it actually appears that the Veteran is in receipt of a 10 percent rating for limitation of abduction based upon medical findings that he cannot cross his legs. Other potentially applicable Diagnostic Codes include Diagnostic Code 5252 for limitation of flexion of the thigh and Diagnostic Code 5253 for limitation of abduction of the thigh. Under Diagnostic Code 5251, a maximum 10 percent rating is warranted for extension of the thigh limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5251. Under Diagnostic Code 5252, a 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees. A maximum 40 percent rating is warranted for flexion limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. Under Diagnostic Code 5253, a 10 percent rating is warranted for limitation of rotation of affected leg, cannot toe out more than 15 degrees. A 10 percent rating is also warranted for limitation of adduction, cannot cross legs. A maximum 20 percent rating is warranted for limitation of abduction, motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. Initially, the Board notes that the Veteran has received some VA and private treatment for his left hip disorder, including physical therapy. However, these reports do not contain range of motion findings. The Veteran had a VA examination in September 2011 which showed diagnoses of old healed fracture, left hip and mild degenerative disease of the left hip. There were flare-ups with the left hip being worse. The right hip flexion was 0 to 120 degrees and extension was at 0 degrees with no objective pain. Left hip flexion was 0 to 110 degrees with pain at 90 degrees. Extension was greater than 5 degrees. After repetitions, right hip flexion was 0 to 120 with extension at 5 degrees or greater. Left hip flexion was 0 to 110 and extension 5 degrees or greater. There was no functional loss of the right lower extremity. The left extremity had excessive fatigability, pain on movement and interference with sitting, standing and /or weight-bearing. There was pain at palpation and tenderness of the left hip. There was no ankylosis of either hip joint. Pursuant to the Board's January 2019 remand, the Veteran had another VA examination in November 2019. The Veteran reported experiencing flare-ups. Flexion is 0-110 degrees, extension is 0-30 degrees, abduction is 0-35 degrees, adduction is 0-18degrees, external rotation is 0-45 degrees, and internal rotation is 0-35 degrees. Pain is noted on exam. There is evidence pain with weight bearing. The examiner stated that the Veteran was able to perform repetitive use testing with at least three repetitions; and range of motion was flexion is 0-100 degrees, extension is 0-30 degrees, abduction is 0-35 degrees, adduction is 0-15 degrees, external rotation is 0-45 degrees, and internal rotation is 0-35 degrees. The examination was not conducted immediately after repetitive use over time; pain and lack of endurance cause functional loss and description in terms of range of motion is flexion is 0-100 degrees, extension is 0-25 degrees, abduction is 0-35 degrees, adduction is 0-15 degrees, external rotation is 0-40 degrees, and internal rotation is 0-30 degrees. The VA examiner did not provide additional commentary regarding functional loss during flare-ups. The Veteran underwent a new VA examination in September 2020, wherein he was diagnosed with an old healed fracture of the left hip with degenerative joint disease. Initial range of motion is as follows: flexion of 0-90 degrees, extension of 0-15 degrees, abduction of 0-15 degrees, and adduction of 0-10 degrees. Adduction is limited to such that the Veteran cannot cross his legs. External rotation is 0-30 degrees and internal rotation is 0-20 degrees. Pain is noted on examination. There is evidence of pain with weight bearing, and localized tenderness or pain on palpation of joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions. The examination was not conducted immediately after repetitive use over time; pain, fatigue, weakness, lack of endurance, and incoordination cause functional loss; and the examiner was unable to describe in terms of range of motion. The examiner provided the following remarks: The changes or worsening of the degrees with the range of motion during the three repetitive movement during the exam. There was no report of flare- up during the exam. Based on the veteran's report of his current functionalities related to his left hip, the review of the service treatment records, the physical examination today, I have no basis to offer additional losses of function or motion when it comes to repetitive use or during a flare-up. The examination was not conducted during flare-ups; pain, fatigue, weakness, lack of endurance, and incoordination cause functional loss; and the examiner was unable to describe in terms of range of motion. The VA examiner stated that: The examination was not performed during the flare up nor did the veteran have a flare up during the exam. Veteran reports pain increased with prolonged sitting or standing which occurs at least once a week. I am not able to provide the active and passive range of motion during flare up. I cannot provide an opinion if Veteran is able to cross his legs during a flare up since this exam was not performed during a flare up nor a flareup occurred when the veteran was tested for range of motion today without resorting to speculation. Based on the veteran's report of his current functionalities during flare up related to his left hip, the review of the service treatment records, and the physical examination today, I have no basis to offer additional losses of function or motion when it comes to repetitive use or during a flare-up. The examiner found that muscle strength is 5/5 (normal) and that the hip is not ankylosed. The examiner also found that there is pain with non-weight bearing, passive range of motion, and weight bearing. Relative to the September 2020 VA examiner's findings, the Veteran's left hip does not manifest with: extension limited to 5 degrees as contemplated by the 10 percent rating criteria under Diagnostic Code 5251; flexion limited to 45 degrees as contemplated by the 10 rating criteria under Diagnostic Code 5252; or abduction of motion lost beyond 10 degrees as contemplated by the 20 percent rating criteria under Diagnostic Code 5253. Additionally, the Board does not find there to be any other evidence of record, medical or lay, that would in any way contradict the VA examinations detailed above that would suggest that the Veteran's left hip disorder is more severe that would result in a higher rating or separately compensable rating. While Veteran's left hip was limited in range of motion with extension and flexion, the examinations did not find that the Veteran exhibited pain during that portion of the testing, nor do the Veteran's statements suggest otherwise. As such, the Board does not find that separately compensable ratings for limitation of extension and flexion are warranted pursuant to 38 C.F.R. § 4.59. As a result, the preponderance of the evidence is against the Veteran's claim for a rating more than 10 percent for his left hip disorder. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against assignment of a higher rating, that doctrine is not applicable. 38 U.S.C. § 5107. REASONS FOR REMAND Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. The Veteran seeks entitlement to a TDIU. Essentially, he contends that his service-connected disabilities cause substantial joint pain, fatigue, and problems hearing, which results in an inability to work. Currently, service connection is in effect for the following disabilities: bilateral hearing loss (20 percent); bladder disorder (20 percent); tinnitus (10 percent); lumbar spine disorder (10 percent); left hip disorder (10 percent); left foot peripheral sensory neuropathy (10 percent); residual scar of the lumbar spine (noncompensable); and residual bladder scar (noncompensable). His combined rating is 60 percent. He is thus not eligible for entitlement to a TDIU on a schedular basis because there is no single disability rated 60 percent, and the ratings do not combine to 70 percent. As the Veteran does not meet the schedular criteria, the Board will next consider whether referral for an extraschedular TDIU is warranted. If the schedular TDIU percentages are not met, the Veteran's claim may be referred to the Director of Compensation Service for an extraschedular rating when the evidence of record shows that Veteran is "unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities." 38 C.F.R. § 4.16(b). The Board cannot award TDIU on this basis in the first instance. Here, the Veteran's November 2010 VA 21-8940 indicates that he last worked in the mining/sand industry from January 2002 to March 2010. He stated that primarily his hip disorder caused him to cease working because he could no longer stand or operate heavy machinery. The VA audiological examiners have consistently reported that the Veteran has difficulty hearing and frequently needs to have things repeated to him. Also, the VA orthopedic examiners have indicated that the Veteran suffers from significant pain in his back and hip, which has limited his ability to stand for long periods of time. As such, while the Veteran does not meet the schedular criteria for a TDIU as set out in 38 C.F.R. § 4.16(a), a total rating, on an extraschedular basis, may nonetheless be granted in exceptional cases (and pursuant to specifically prescribed procedures) when a Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. Considering the various treatment reports and VA examinations of record, the Board finds that there is sufficient evidence to suggest that the Veteran may demonstrate pathology that is beyond that contemplated by the schedule and which may interfere with employment opportunities. Considering the above, the Board finds the Veteran's claim of entitlement to a TDIU merits referral to the Director of Compensation Service for consideration of an extraschedular TDIU under 38 C.F.R. § 4.16(b). Finally, the Veteran has received some previous medical treatment for several conditions. However, his most recently available treatment records are from approximately 2020. Therefore, it would be prudent to obtain any outstanding treatment records. The matters are REMANDED for the following action: 1. With the assistance of the Veteran as necessary, identify and obtain any outstanding, relevant treatment records, and associate them with the Veteran's electronic claims file. If the AOJ cannot locate or obtain such records, it must specifically document the attempts that were made to locate or obtain them, and explain in writing why further attempts to locate or obtain any government records would be futile. The AOJ must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. All attempts to obtain records should be documented in the Veteran's electronic claims file. 2. Thereafter, and regardless of whether additional treatment records are located, refer this case to the Director of Compensation Service for consideration of whether the Veteran is entitled to the award of a TDIU on an extraschedular basis pursuant to 38 C.F.R. § 4.16(b). The electronic claims files should be provided to the Director of Compensation Service. If it is determined that an opinion cannot be entered without additional examination, such examination should be scheduled in accordance with applicable provisions. 3. After the development requested has been completed, the AOJ should review any report to ensure that it is in complete compliance with the directives of this remand. If a report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Miller, 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.