Citation Nr: 21029025 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 16-32 928 DATE: May 12, 2021 ORDER Entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the left elbow with limitation of flexion is denied. Entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the right elbow with limitation of flexion is denied. Entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the left elbow with impairment of supination and pronation is denied. Entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the right elbow with impairment of supination and pronation is denied. Entitlement to service connection for bilateral hearing loss is denied. FINDINGS OF FACT 1. The Veteran's left elbow disability has not manifested to flexion limited to 90 degrees or less, extension to 75 degrees or more, radius impairment, ulna impairment, impairment of the flail joint, or favorable or unfavorable ankylosis of the elbow. 2. The Veteran's right elbow disability has not manifested to flexion limited to 90 degrees or less, extension to 75 degrees or more, radius impairment, ulna impairment, impairment of the flail joint, or favorable or unfavorable ankylosis of the elbow. 3. The Veteran's left elbow disability has not manifested to limitation of pronation with motion lost beyond last quarter of arc; or loss of supination and pronation with her hand in a fixed position. 4. The Veteran's right elbow disability has not manifested to limitation of pronation with motion lost beyond last quarter of arc; or loss of supination and pronation with her hand in a fixed position. 5. A bilateral hearing loss disability has not been shown during the pendency of the Veteran's appeal. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the left elbow with limitation of flexion, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Codes (DC) 5205-5213. 2. The criteria for entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the right elbow with limitation of flexion, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5205-5213. 3. The criteria for entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the left elbow with impairment of supination and pronation, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5205-5213. 4. The criteria for entitlement to an initial disability rating in excess of 10 percent for epicondylitis of the right elbow with impairment of supination and pronation, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5205-5213. 5. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.102, 3.303, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army on active duty from August 1983 to August 1994. The issues come before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The issues were previously before the Board in October 2018. The Board remanded for further development, including to provide VA examinations. In a July 2020 rating decision, the RO granted an increased initial rating of 10 percent for the Veteran's bilateral elbow disabilities with limited flexion for the entire period on appeal. Additionally, the RO granted service connection for the Veteran's bilateral elbow disabilities with impairment of supination and pronation, with a 10 percent evaluation for the entire appeal period. As the full benefit was not granted, the claims remain on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Increased Rating VA has adopted the Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally 38 C.F.R. Part IV. The Board determines the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 C.F.R. § 4.10. The degrees of disabilities are based on the average impairment of earning capacity and individual disabilities are assigned diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various percentage ratings for each disability and the criteria for specific ratings. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Where there is a question of which of two ratings should be applied, the higher rating will be assigned if the disability assessment more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Additionally, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In a claim for a greater original rating after an initial award of service connection, all evidence submitted in support of the veteran's claim is to be considered. See Fenderson v. West, 12 Vet. App. 119 (1999); 38 C.F.R. § 4.2. However, consideration must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. See Fenderson v. West, 12 Vet. App. 119 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2019); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. 38 C.F.R. § 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. 1. Entitlement to initial disability ratings in excess of 10 percent for right and left elbow epicondylitis with limitation of flexion 2. Entitlement to initial disability ratings in excess of 10 percent for right and left elbow epicondylitis with impairment of supination and pronation The Veteran contends that her bilateral elbow disabilities are more severe than reflected by her separate 10 percent ratings for impairment with limitation of flexion and impairment of supination and pronation. The Veteran's service-connected bilateral elbow disabilities are currently provided a 10 percent rating prior to DC 5299-5206 for limitation of flexion of the forearm, and under 5299-5213 for impairment of supination and pronation. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number is "built up" with the first two digits being selected from that part of the schedule most closely identifying the part, and the last two digits being "99" for an unlisted condition. Id. The hyphenated disability will be rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, the diagnostic codes for rating the elbow and forearm were not changed. Under these Diagnostic Codes, the disability is rated based on the General Rating Formula for the Elbow and Forearm. 38 C.F.R. § 4.71a, Diagnostic Codes 5205-5213. The General Rating Formula for the Elbow and Forearm is as follows: Under Diagnostic Code 5205, favorable ankylosis of the elbow at an angle between 90 and 70 degrees is rated at 40 percent for the major arm and 30 percent for the minor arm. Intermediate ankylosis of the elbow at an angle of more than 90 degrees or between 70 and 50 degrees is rated at 50 percent for the major arm and 40 percent for the minor arm; and unfavorable ankylosis of the elbow at an angle of less than 50 degrees or with complete loss of supination or pronation is rated at 60 percent for the major arm and 50 percent for the minor arm. 38 C.F.R. § 4.71a. Diagnostic Code 5206 provides that flexion of the forearm limited to 110 degrees is rated as 0 percent disabling; flexion of the forearm limited to 100 degrees is rated 10 percent; flexion of the forearm limited to 90 degrees is rated 20 percent; flexion of the forearm limited to 70 degrees is rated 30 percent for the major arm and 20 percent for the minor arm; flexion of the forearm limited to 55 degrees is rated 40 percent for the major arm and 30 percent for the minor arm; and flexion of the forearm limited to 45 degrees is rated 50 percent for the major arm and 40 percent for the minor arm. 38 C.F.R. § 4.71a. Diagnostic Code 5207 provides that extension of the forearm limited to 45 degrees is rated 10 percent; extension of the forearm limited to 60 degrees is rated 10 percent; extension of the forearm limited to 75 degrees is rated as 20 percent; extension of the forearm limited to 90 degrees is rated 30 percent for the major arm and 20 percent for the minor arm; extension of the forearm limited to 100 degrees is rated 40 percent for the major arm and 30 percent for the minor arm; and extension of the forearm limited to 110 degrees is rated 50 percent for the major arm and 40 percent for the minor arm. 38 C.F.R. § 4.71a. Under Diagnostic Code 5208, flexion of the forearm limited to 100 degrees and extension of the forearm limited to 45 degrees warrants a 20 percent rating. 38 C.F.R. § 4.71a. Under Diagnostic Code 5209, joint fracture of the elbow with marked cubitus varus or cubitus valgus deformity or with ununited fracture of the head of the radius is rated at 20 percent. Flail joint is rated at 60 percent in the major arm and 50 percent in the minor arm. 38 C.F.R. § 4.71a. Under Diagnostic Code 5210, nonunion of the radius and ulna with flail false joint is rated at 50 percent in the major arm and at 40 percent in the nondominant extremity. 38 C.F.R. § 4.71a. Under Diagnostic Code 5211, malunion of the ulna with bad alignment is rated at 10 percent. Nonunion in the lower half of the ulna is rated at 20 percent. Nonunion in the upper half of the ulna with false movement but without loss of bone substance or deformity is rated at 30 percent in the dominant extremity and at 20 percent in the nondominant extremity. Nonunion in the upper half of the ulna with false movement, loss of an inch or more of bone substance, and marked deformity is rated at 40 percent in the dominant extremity and at 30 percent in the nondominant extremity. 38 C.F.R. § 4.71a. Under Diagnostic Code 5212, malunion of the radius with bad alignment is rated at 10 percent. Nonunion in the upper half of the radius is rated at 20 percent. Nonunion in the lower half of the radius with false movement but without loss of bone substance or deformity is rated at 30 percent in the dominant extremity and at 20 percent in the nondominant extremity. Nonunion in the lower half of the radius with false movement, loss of an inch or more of bone substance, and marked deformity is rated at 40 percent in the dominant extremity and at 30 percent in the nondominant extremity. 38 C.F.R. § 4.71a. Lastly, under Diagnostic Code 5213, limitation of supination to 30 degrees or less is rated at 10 percent. Limitation of pronation with motion lost beyond the last quarter of the arc and the hand not approaching full pronation is rated at 20 percent. Limitation of pronation with motion lost beyond the middle of the arc is rated at 30 percent for the major arm and 20 percent for the minor arm. Loss of supination and pronation due to bone fusion with the hand fixed near the middle of the arc or in moderate pronation is rated at 20 percent. Loss of supination and pronation due to bone fusion with the hand fixed in full pronation is rated at 30 percent for the major arm and 20 percent in the minor arm. Loss of supination and pronation due to bone fusion with the hand fixed in supination or hyperpronation is rated at 40 percent for the major arm and 30 percent for the minor arm. 38 C.F.R. § 4.71a. Here, the Veteran is right-handed, and thus, her right elbow disability is rated as the major arm and the left elbow disability is rated as the minor arm. In May 2014, the Veteran underwent a VA examination. The Veteran reported pain started in the elbows and radiated to her forearms and fingers. The VA examiner confirmed the Veteran's diagnoses of bilateral medial and lateral epicondylitis. The Veteran did not report any flare-ups. The Veteran's initial range of motion (ROM) for both the left and right elbow was listed as flexion to 145 degrees or greater, with no objective evidence of painful motion. The Veteran was able to perform repetitive-use testing with 3 repetitions with no changes in ROM measurements. The VA examiner reported that the Veteran had no additional limitation in ROM of the elbow and forearm following repetitive-use testing. Additionally, the Veteran had no functional loss or functional impairment of the elbow and forearm. The VA examiner noted the Veteran had full ROM of the elbow with respect to dorsiflexion, palmar flexion, supination, and pronation before and after repetitive-use testing. Further, the VA examiner noted the Veteran demonstrated full ROM of the wrists with respect to dorsiflexion, palmar flexion, and radial and ulnar deviation before and after repetitive-use testing. The May 2014 VA examiner noted the Veteran exhibited localized tenderness or pain on palpation of the joints and soft tissue of both elbows and forearms. The examination noted normal muscle strength for bilateral elbow flexion and extension. The examiner reported no ankylosis of the elbow. The VA examiner noted the Veteran's bilateral elbow disability did not impact her ability to work. In March 2016, the Veteran received another VA examination. The Veteran reported continued bilateral elbow pain and numbness. The Veteran reported an increase in severity and frequency of her symptoms. The Veteran stated her symptoms were worse with activities. The Veteran reported daily flare-ups of discomfort but with full function. She noted using caution with lifting objects. The Veteran reported function loss as limitation by pain. The Veteran's initial ROM measurements were recorded as normal for both elbows. The Veteran's ROM, for both left and right arms, was flexion to 145 degrees, extension to 0 degrees, forearm supination to 85 degrees, and pronation to 80 degrees. No pain was noted on examination, and no pain with weight bearing. The VA examiner noted subjective evidence of localized tenderness with palpation for both arms over the lateral and medial epicondyles, with medial epicondyle being worse. The VA examiner noted the Veteran was able to perform repetitive use testing with at least 3 repetitions. The examination noted the Veteran demonstrated no additional functional loss or limitation of ROM after 3 repetitions for the left and right elbow. The examiner noted the Veteran's left and right elbows were examined immediately after repetitive use over time, and recorded that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time. The VA examiner noted the examination did not take place during a flare-up. The examiner noted the examination was medically consistent with the Veteran's description of her functional loss during flares. However, the VA examiner was unable to state without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited the Veteran's functional ability during flare-ups. The examination reported the Veteran had full muscle strength. The examiner noted muscle atrophy due to the Veteran's bilateral elbow condition. Bilateral dorsal interossei muscle wasting was noted. The Veteran did not have need for assistive devices. The VA examiner noted the Veteran's bilateral elbow disability negatively impacted her ability to perform occupational tasks. The Veteran noted her condition was one of the reasons she left her job as a secretary. Pursuant to the Board remand, the RO provided a VA examination in August 2019 to address the Veteran's bilateral elbow disabilities. Again, the Veteran reported worsening symptoms of her bilateral epicondylitis. The Veteran reported pain in her elbow and intermittent numbness from her elbow to her fingertips. The Veteran noted she had to roll over multiple times a night, as laying on her arm caused numbness to occur. The Veteran rated her pain during the day as 4 to 5 out of 10. The Veteran noted typing all day will make her hands go numb. The Veteran reported nightly flare-ups consisting of increased pain, rated as 7 to 8 out of 10. The examination noted the Veteran did not report any functional loss or functional impairment of the elbows. The Veteran's initial ROM measurements were recorded as normal for both elbows. The Veteran's ROM, for both left and right arms, was flexion to 145 degrees, extension to 0 degrees, forearm supination to 85 degrees, and pronation to 80 degrees. No pain was noted on examination, and no pain with weight bearing. The VA examiner noted mild wincing of localized tenderness with palpation over lateral and medial epicondyles of the right and left elbow. The Veteran was noted to be able to perform repetitive-use testing with at least 3 repetitions. There was no functional loss following repetitive testing. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time or during flare-ups. The examination was not being conducted immediately after repetitive use over time or during a flare-up. The VA examiner noted examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time or during flare-ups. Following a review of the relevant evidence of record, including the Veteran's physical examinations, reported history and subjective complaints, the VA examiner stated, using medical knowledge and expertise, there remained no basis to offer additional losses of function or motion when it comes to repeated use over time or during flare-ups. The Veteran had full muscle strength. There was no muscle atrophy noted on examination. The Veteran did regularly use a brace for both elbows to assist her epicondylitis. There was no evidence of pain in non-weight-bearing or on passive ROM testing. Finally, the VA examiner noted the Veteran's bilateral elbow disabilities impacted her ability to perform occupational tasks. The Veteran reported she missed up to 1 week of work time in the last 12 months due to her bilateral elbow disabilities. The examination noted the Veteran experienced intermittent pain with gripping heavy objects with one hand. The Board notes there are no other medical records showing treatment for the Veteran's elbow, to include any documents showing ROM or ankylosis of any kind. After review of the evidence of record, the Board finds that an initial rating in excess of 10 percent disabling for the Veteran's bilateral elbow disabilities based on limitation of flexion is not warranted. During the period on appeal, the Veteran's elbow limitation was primarily manifested by flexion greater than 110 degrees and extension less than 45 degrees. 38 C.F.R. § 4.71a, DC 5299-5206. Thus, at no time during the period on appeal did the Veteran's symptoms of her bilateral epicondylitis manifest as symptoms analogous to a limitation of flexion of either elbow of 90 degrees needed for a higher rating under DC 5206. Further, the Board finds that an initial rating in excess of 10 percent disabling for the Veteran's bilateral elbow disabilities based on a limitation of supination and pronation is not warranted. During the period on appeal, the Veteran's elbow limitation was primarily manifested by supination above 30 degrees. Moreover, at no time during the period on appeal did the Veteran's symptoms of her bilateral epicondylitis manifest as symptoms analogous to impairment due to loss of bone fusion or a limitation of pronation with motion lost warranting a higher rating by analogy under DC 5213. 38 C.F.R. § 4.71a. Additionally, the Veteran has not shown any limitation of forearm extension or favorable or unfavorable ankylosis of the elbow. 38 C.F.R. § 4.71a, 5205, 5207-08. Further, at no time has the Veteran had any radius impairment or nonunion, ulna impairment or nonunion, or impairment of flail joint. Thus, the Veteran does not qualify for a rating in excess of 10 percent under DC 5209-5213. See 38 C.F.R. § 4.71a, DC 5209-13. As provided above, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated and those factors are not contemplated in the relevant criteria when evaluating limitation of motion for joint disabilities. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). However, the Board notes in all VA examinations, functional loss due to pain, weakness, excess fatigability, or incoordination was not found. Further, the Veteran has only reported some functional loss due to pain. Additionally, the March 2016 VA examiner noted muscle atrophy and muscle wasting of the Veteran's bilateral dorsal interossei muscles. These noted disabilities have been considered in the Veteran's 10 percent evaluations of the Veteran's bilateral elbow disabilities under DC 5299-5206 and DC 5299-5213. Therefore, consideration under DeLuca for ratings in excess of 10 percent due to the Veteran's limitation of flexion and impairment of supination and pronation is also not warranted. The Board also acknowledges the Veteran's assertions that she is entitled to higher ratings because her symptoms are worse. The Board recognizes that the Veteran is competent to provide opinions on certain subjective medical issues and of observable symptomatology. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Further, the Veteran's training as a medical assistant may provide her additional insight to her bilateral elbow disabilities. However, although the Veteran is competent to report her symptoms, any opinion regarding whether the Veteran's symptoms have worsened to a certain severity requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). Accordingly, ratings in excess of 10 percent for the Veteran's bilateral elbow disabilities under DC 5299-5206 and DC 5299-5213 are not warranted. See 38 C.F.R. § 4.71a. In reaching this conclusion, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against ratings in excess of those currently assigned, the doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be warranted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 3. Entitlement to service connection for bilateral hearing loss The Veteran contends that she suffers from bilateral hearing loss related to harmful noise exposure during her active duty service. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz 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. The Veteran's September 2014 VA primary care treatment records noted the Veteran complained of decreasing hearing in both ears. Pursuant to the October 2018 Board remand, the RO provided a VA hearing examination in August 2019. The Veteran reported experiencing gradually worsening hearing loss for 15 years. The Veteran reported she required the television louder than other family preferred, and her phone volume was at maximum. The Veteran noted she could not understand what was being said if more than one person was talking at the same time. The Veteran reported difficulty listening on the phone with background noise in the room with her. The Veteran's audiological evaluation, with puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 5 5 5 LEFT 10 5 0 10 5 Speech audiometry revealed speech recognition ability of 94 percent in the right ear and of 96 in the left ear. The VA examiner provided the medical opinion that the Veteran's hearing was within normal limits for both ears. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997). Here, the VA hearing examination's findings are not sufficient to establish a current hearing loss disability in either ear for VA purposes. 38 C.F.R. § 3.385. In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board acknowledges the Veteran's statements that her exposure to harmful noise during active duty service caused bilateral hearing loss. Lay persons are competent to provide opinions on certain subjective medical issues and of observable symptomatology. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, since the cause of hearing loss can be a complex medical matter and the onset can occur later in life, the Veteran as a layperson without the appropriate medical training and expertise, is not competent to provide a probative opinion as to an etiological relationship between hearing loss and a prior injury or exposure to noise. She is also not competent to diagnose hearing loss for VA compensation purposes as it is derived from specific audiometric data. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Without competent evidence of a diagnosis of a bilateral hearing loss disability under 38 C.F.R. § 3.385, the Board must deny the Veteran's claim. Thus, the preponderance of the evidence is against the claim, and the benefit-of-the-doubt doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.V. Bona, 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.