Citation Nr: 21029603 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 16-44 819 DATE: May 14, 2021 ORDER Entitlement to a rating of 50 percent, but no higher, for posttraumatic stress disorder (PTSD) is granted, subject to the laws and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 40 percent for bilateral hearing loss is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran's PTSD was manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms as depressed mood; blunted affect; anxiety; irritability; intrusive memories; chronic sleep impairment; mild memory loss; disturbances of motivation and mood; mild difficulty in establishing and maintaining effective work and social relationships; and intermittent suicidal ideations without plan or intent, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 2. The Veteran's bilateral hearing loss has been manifested by pure tone threshold averages and speech recognition scores corresponding to no more than Level VI hearing loss in the right ear and Level VII hearing loss in the left ear. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for a 50 percent disability rating, but no higher, for PTSD have been met or approximated. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.129, 4.130, Diagnostic Code 9411 (2019). 2. The criteria for a rating in excess of 40 percent for bilateral hearing loss are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.85, 4.86 Diagnostic Code 6100 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1969 to December 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, which, in pertinent part, continued a 30 percent rating for PTSD and increased the rating for bilateral hearing loss to 30 percent. The Veteran timely perfected an appeal. See March 2015 Notice of Disagreement; August 2016 Statement of the Case; September 2016 VA Form 9. In February 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been prepared and associated with the record. In April 2020, the Board remanded this matter for additional development. Thereafter, in a January 2021 rating decision, the RO increased the rating for the Veteran's bilateral hearing loss to 40 percent, effective from March 18, 2014, i.e., the date of his increased rating claim. As the January 2021 rating decision did not represent a total grant of benefits sought on appeal the claim for a rating in excess of 40 percent remains before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Increased Ratings Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. 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. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where, as here, entitlement to compensation already has been established and 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). Here, the relevant evidentiary window begins one year before the Veteran filed his claim for an increased rating and continues to the present time. The Board will also consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). In making all determinations, the Board must fully consider the lay assertions of record. A Veteran is competent to report on that of which he or she has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. A. PTSD The Veteran contends that he is entitled to a higher disability rating for his PTSD, which is currently assigned a 30 percent rating. Legal Criteria The Veteran's PTSD has been evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula For Mental Disorders, a 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent evaluation is assignable where there is total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126(a). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b). It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. Factual Background Turning to the evidence of record, a March 2013 VA PTSD group therapy note shows that the Veteran was very active during a group discussion and that he reported recently accompanying his grandson on a school trip. An April 2013 VA psychiatry note shows that the Veteran denied severe depressive symptoms. He reported periodic nightmares. On mental status examination, the Veteran was reasonably dressed and groomed, and he was attentive and cooperative. His speech was fluent and of regular rate and rhythm. His mood was euthymic, and his affect was calm and appropriate. His thought processes were logical and goal directed. There was no evidence of delusions, hallucinations, or suicidal/homicidal ideation, plan, or intent. The Veteran was oriented, and his recent and remote memory were intact. His insight and judgment were fair. A May 2013 VA PTSD group therapy note shows that the Veteran "shared examples of positive activities he has found since his retirement and learning to structure his time without dwelling on the past." VA mental health treatment records through September 2014 reflect similar findings as above. See, e.g., July 2013 Psychiatry Note (denying depressive symptoms; reporting nightmares); September 2013 Group Therapy Note ("The [V]eteran is a leader in the discussion encouraging others to participate."); March 2014 Psychiatry Note (reporting increased insomnia; denying depressive symptoms). During a February 2014 SSA examination, the Veteran was neatly and appropriately dressed and groomed. His mood appeared sad, but he was alert, polite, pleasant, and cooperative. The Veteran was oriented to time, place, person, and situation. His recent and remote memory appeared intact. No psychotic symptoms were noted such as hallucinations, delusions, ideas of reference, or grandiosity. His mood was sad, but conversation appeared logical and goal directed. He admitted feeling depressed for over twenty years, and he reported frequent nightmares and flashbacks, usually as much as twice weekly. He complained of sadness, worry, poor memory and concentration, social withdrawal, anhedonia, and variable sleep, energy, and appetite. He denied any current suicidal thoughts or suicide attempts. His insight and judgment appeared adequate. The examiner indicated that the Veteran's "[a]bility to function in his previous work appeared moderately to severely impaired due to chronic physical and emotional difficulties." The Veteran was afforded a VA examination in September 2014. He reported that he lived with his wife, and he denied significant marital problems. He reported good relationships with his children and four grandchildren. He indicated that he had several friendships and that he was involved in a hunting club. He also reported that he and his wife attend church weekly and occasionally go out to eat with others. The Veteran reported that he recently retired from his job. He reported that he enjoyed working with some of the people there but that on at least on occasion he got into a verbal altercation with a coworker. The Veteran described his customary mood as "fair," and he reported occasional "bad days," often triggered by thoughts of his Vietnam experiences. He also reported variable sleep and frequent nightmares, as well as intrusive thoughts and avoidance. On mental status examination, the Veteran was casually dressed with adequate grooming and hygiene. His psychomotor activity was unremarkable, his speech was clear and coherent, and his thought process/content was unremarkable. His attitude was pleasant and cooperative, and his affect was appropriate. The examiner noted the following symptoms: depressed mood; anxiety; chronic sleep impairment; and mild memory loss. The examiner diagnosed the Veteran with PTSD, which results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The examiner also noted that the Veteran's PTSD symptoms were mild. VA treatment records through November 2016 show that the Veteran continued group and individual therapy, and they show similar findings to those discussed above. See, e.g., February 2015 Psychiatry Note (reporting irritability when around people; reporting that PTSD caused him difficulty when he was working; denying severe depressive symptoms; denying suicidal/homicidal ideations); November 2015 Psychiatry Note (reporting no severe nightmares; denying anxiety and depressive symptoms; denying suicidal/homicidal ideations); June 2016 Psychiatry Note (reporting that he was doing fair, with increased insomnia; denying depressive symptoms; denying suicidal/homicidal ideations). A November 2016 VA mental health note shows that the Veteran reported increased isolation, irritability, and depression. On mental status examination, his grooming was appropriate, and his eye contact was direct. His speech was normal, his attitude was cooperative, and his behavior was appropriate. His mood was detached, and his affect was sad. His attention span was limited, and there were deficits in attention and concentration. He was oriented to person, place, time, and situation. His thought process was relevant and ruminating. He denied suicidal ideations or intent. His insight and judgment were fair. An October 2017 VA mental health note shows that the Veteran reported sadness, anxiety, and sleep disturbances. He denied suicidal/homicidal ideation. The Veteran was afforded a VA examination in May 2018. He reported a good relationship with his wife of 47 years. He indicated that he visits his grandchildren twice weekly and that if the children make too much noise, he goes outside. He reported that he has friends with whom he hunts deer. He also reported that he goes to church weekly. The Veteran reported passive suicidal ideation, which he described as getting "in a mood" every two to three days where he wishes he were dead. The Veteran indicated that he would not act on these thoughts because of his grandchildren. On mental status examination, the Veteran was oriented and appropriately dressed and groomed. His mood was fair, and his affect was mildly dysphoric. His speech was relevant and coherent, and there were no symptoms of a thought disorder. His insight and judgment were fair. The examiner noted the following symptoms: depressed mood; anxiety; chronic sleep impairment; mild memory loss; and suicidal ideation. The examiner diagnosed the Veteran with PTSD, which results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. A June 2018 VA psychiatry note shows that the Veteran had no specific complaints. He reported mild sleep disturbance, and he denied depressive symptoms. He also denied suicidal/homicidal ideation. A June 2018 VA group therapy note shows that the Veteran participated openly and actively in the discussion. He reported symptoms of depression, anxiety, excessive and/or unnecessary anger, and hypervigilance. His PTSD was noted to caused moderate impairment. Subsequent VA treatment records show that the Veteran continued individual and group therapy, with occasional exacerbations of PTSD symptoms, but with overall similar functioning as described above. During the February 2020 Board hearing, the Veteran reported panic attacks more than once per week. He also reported memory impairment, impaired judgment, and issues with motivation and depression. He indicated that he often had anger issues and that he got into arguments with co-workers. He also reported suicidal thoughts, but he indicated that he would not "go through with it." The Veteran was afforded a VA examination in October 2020. He reported that he and his wife were doing well. He indicated that he had contact with his children and grandchildren two to three times per week. He reported that during family gatherings, he will sometimes have to withdraw to a quiet place when it is too noisy. The Veteran reported that he retired in 2012 and that his bosses were very supportive, even when he was irritable, easily angered, or troubled by distressing memories of Vietnam. The Veteran indicated that he often wakes up several times per night and that he sometimes roams the house at night checking locks and looking for intruders. He denied any suicidal or homicidal ideation. On mental status examination, the Veteran was cooperative and appropriately dressed. He was oriented, and he displayed no symptoms of a thought disorder. He denied hallucinations or delusions. His range of affect was full, except when he talked about Vietnam, when it became blunted. His speech was normal, and his memory systems appeared to be intact. He denied any recent suicidal or homicidal ideation. The examiner noted the following symptoms: depressed mood; anxiety; chronic sleep impairment; and mild memory loss. The examiner diagnosed the Veteran with PTSD, which results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The examiner also indicated that the Veteran's "reported frequent irritability, occasional temper outbursts, distress regarding loud noises, and anxiety would likely be a problem in a job without such understanding bosses." The examiner further indicated that the Veteran's "disturbing memories of his time in Viet Nam and his frequent problems with disturbed sleep is likely to interruptions in his work efficiency and work attendance." The October 2020 VA examiner also completed a separate Individual Unemployability Statement. The examiner indicated that the Veteran had (1) intrusive thoughts which interfere with the ability to stay focused on the task at hand and (2) significant difficulty functioning around other people, has difficulty functioning as a team member, and feels uncomfortable around others. The examiner also noted that the Veteran's "irritability has increased making it more difficulty for him to manage his anger/this has caused him difficulties at work in the past and would continue to cause him problems particularly if he did not get along with a boss." Finally, the examiner indicated that the Veteran's sleep impairment "might cause him to miss work sometimes or might interfere with his memory and concentration at work." Analysis Taking all factors into consideration with application of the approximating principles of 38 C.F.R. § 4.7, and the benefit-of-the-doubt doctrine, the Board finds that the Veteran's PTSD most nearly approximates occupational and social impairment with reduced reliability and productivity. The above-cited evidence reflects that the Veteran's PTSD has primarily been manifested by depressed mood; blunted affect; anxiety; irritability; intrusive memories; chronic sleep impairment; mild memory loss; disturbances of motivation and mood; mild difficulty in establishing and maintaining effective work and social relationships; and intermittent suicidal ideations without plan or intent. Collectively, these symptoms are of the type, extent, severity and/or frequency to result in occupational and social impairment with reduced reliability and productivity. Accordingly, a 50 percent rating for the Veteran's PTSD is granted. Nonetheless, the overall disability picture demonstrated by the evidence is not consistent a 70 percent or 100 percent rating. As noted above, a 70 percent evaluation is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, while a 100 percent rating requires total occupational and social impairment. With respect to the 70 percent criteria, the Court has held that "the regulation also requires an ultimate factual conclusion as to the veteran's level of impairment in 'most areas.'" Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). With respect to the areas of impairment listed in the 70 percent criteria, the Board finds that the evidence does not demonstrate deficiency in work as contemplated by the applicable rating criteria. The Board notes that the criteria for a 50 percent rating expressly contemplate some level of occupational impairment, such as the impairment shown by the evidence in this case, while the 70 percent rating contemplates difficulty in adapting to stressful circumstances, including work or a work like setting. This degree of occupational impairment is not suggested by the evidence of record, which reflects that the Veteran has generally credited his physical disabilities for his inability to work and indicates that his occupational functioning was not significantly impacted by his psychiatric symptoms. Furthermore, even though the Veteran did not work during the appeal period, he frequently discussed developing a schedule of activities to structure his time during retirement. Thus, while the evidence reflects some level of impairment in occupational functioning, the Veteran is clearly able to work around those stressors, further indicating his ability to adapt to stressful circumstances. Nor does the evidence demonstrate a deficiency in family relations as contemplated by the 70 percent criteria. As with occupational impairment, a degree of social impairment is contemplated by the 50 percent rating criteria. The 70 percent rating elaborates on the concept of deficiency in family relations in that it notes an inability, not merely a difficulty, in establishing and maintaining effective social relationships. In this case, the evidence shows that the Veteran was able to maintain social interactions with family members, including his wife, children, and grandchildren, and some friends. Although the Veteran infrequently reported being socially isolated, he also maintained a long-term relationship with his wife, visited friends and family regularly, and interacted with members of his community. Thus, even if the Veteran has difficulty in maintaining relationships, it cannot be said that the Veteran is completely unable to establish and maintain effective relationships. Therefore, the Board finds that the evidence does not depict a deficiency in family relations for purposes of satisfying the 70 percent rating criteria. The Board also finds that the evidence does not demonstrate deficiencies in judgment, thinking, and mood as contemplated by the 70 percent criteria. In this regard, there is no evidence of symptoms such as intermittently illogical, obscure, or irrelevant speech; obsessional rituals which interfere with routine activities; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; or neglect of personal appearance and hygiene. VA treatment records and VA examination reports show that the Veteran did not exhibit intermittently illogical, obscure, or irrelevant speech; or spatial disorientation; or neglect of personal hygiene. In fact, the evidence of record shows that the Veteran was consistently noted as well-groomed with good hygiene and oriented to person, time, and place. His speech was within normal limits with regular rate and rhythm during individual and group therapy and during VA examinations. VA mental health treatment records repeatedly and consistently describe the Veteran as having fair judgment, with appropriate thought content and processes. Further, the September 2014, May 2018, and October 2020 VA examiners specifically noted no observable impairments in communication or thought disorders. The Board notes that the Veteran regularly endorsed depression and anxiety; however, the evidence does not reflect that these symptoms are near-continuous, nor do they affect the Veteran's ability to function independently, appropriately, and effectively. The record reveals more moderate anxiety and depression symptoms, with the Veteran reporting decreased symptomatology on several occasions. This evidence indicates that although the Veteran experiences disturbances of motivation and mood, which is a symptom enumerated in the criteria for a 50 percent rating, he clearly does not exhibit an inability to function independently, appropriately and effectively, as contemplated by the criteria for a 70 percent rating. The Board also notes that the record reflects occasional suicidal ideation, primarily during the May 2018 VA examination and during the February 2020 Board hearing. Although this is a symptom contemplated by the by the 70 percent criteria, the Veteran consistently denied any plan or intent to harm himself, and he more often than not denied any suicidal thoughts or ideation. Thus, this symptom is not of the severity contemplated in a 70 percent rating, and this finding could not credibly form the sole basis for such a rating. The Board notes that it is not the type of symptoms, in this case, suicidal ideation, that is determinative of whether the criteria for the next higher rating have been met. It is the effect of the symptoms that is determinative. In other words, deficiencies in most areas must be "due to" the symptoms listed for that rating level, "or others of similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). That is, simply because this Veteran has some symptoms contemplated by the 70 percent rating criteria; it does not mean that disability rises to that level. The Board must instead look to the frequency, severity, and duration of the impairment. Id. Here, the evidence of record does not support a finding that this symptom caused social and occupational impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Ultimately, the record reveals that the Veteran's thinking and judgment were good; he had no history of legal or behavioral problems, violence, or arrests; he maintained relationships with his spouse, children, and friends; and he engaged in several leisure activities, such as traveling and hunting. Considering the overall effect of suicidal ideation on the Veteran's occupational and social impairment, the disability picture presented does not more nearly approximate or equate to occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood. Taken together, the preponderance of the record evidence indicates that the Veteran's symptoms were, at worst, moderate, which is consistent with a 50 percent rating. The Board's finding that the Veteran's disability does not meet the criteria for a 70 percent rating entails a finding that he does not meet the criteria for a 100 percent rating. The maximum schedular rating of 100 percent is not warranted in this case because there is not total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name. In this regard, there is no documentation of symptoms such as gross impairment in thought processes or communication; in fact, the Veteran has been consistently able to actively communicate during individual and group therapy and at examinations. Similarly, his symptoms have not been manifested by persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform daily living activities, disorientation to time or place, or memory loss of names of close relatives, own occupation, or own name. In this regard, the record shows that the Veteran did not exhibit intermittently illogical, obscure, or irrelevant speech or spatial disorientation. In fact, the evidence of record shows that the Veteran was consistently noted as oriented to person, time, and place. His speech was within normal limits with regular rate and rhythm. His judgment and insight were noted as fair to good. The Veteran's communication skills were good, and his understanding was intact. Additionally, the Veteran consistently denied delusions or hallucinations; grossly inappropriate behavior has not been documented; there has not been persistent danger of hurting self or others noted; and memory loss for names of close relatives, own occupation, or own name or similar symptoms has not been shown. Further, total occupational and social impairment has not been shown. As stated, the Veteran maintained social relationships with family and friends. The Board emphasizes that, in analyzing this claim, the symptoms identified in the Rating Formula have been considered not as an exhaustive list of symptoms, but as examples of the type and degree of the symptoms, or effects, that would justify a particular rating. The Board has not required the presence of a specified quantity of symptoms in the rating schedule to warrant a higher rating. See Mauerhan, supra. The Board has considered a staged rating but finds that the totality of the evidence shows a rating of 70 or 100 percent is not warranted at any point during the period on appeal. At times the Veteran's VA treatment records indicate improved symptoms, which may, in fact, warrant a lower rating than 50 percent. However, giving the Veteran the benefit of the doubt, the Board finds that a 50 percent rating for PTSD is warranted for the entirety of the period on appeal. B. Bilateral Hearing Loss The Veteran contends that he is entitled to a higher disability rating for his bilateral hearing loss, which is currently assigned a 40 percent rating. Legal Criteria In evaluating the extent of hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss ratings range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with average hearing thresholds determined by puretone audiometric testing at frequencies of 1000, 2000, 3000 and 4000 cycles per second. "Puretone threshold average" is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz divided by four. This average is used in all cases (including those in §4.86) to determine the Roman numeral designation for hearing impairment from Table VI or VIa. 38 C.F.R. § 4.85, Diagnostic Code 6100. The rating schedule establishes eleven auditory acuity levels, designated from Level I for essentially normal hearing acuity, through Level XI for profound deafness. 38 C.F.R. § 4.85. The horizontal rows in Table VI (in 38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The vertical columns in Table VI represent nine categories of decibel loss based on the puretone audiometry test. The Roman numeral designation is located at the point where the percentage of speech discrimination and puretone threshold average intersect. See 38 C.F.R. §§ 4.85, 4.86. The Roman numeral designation for each ear is then used to determine the current level of disability based upon a pre-designated schedule. Table VII in 38 C.F.R. § 4.85. If impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation, from Table VII, the nonservice-connected ear will be assigned a Roman numeral designation of I. 38 C.F.R. § 4.85 (f). The regulations also provide that in cases of exceptional hearing loss, i.e. when the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the Roman numeral designation will be determined for hearing impairment, separately, from either Table VI or Table VIa, whichever results in the higher numeral. 38 C.F.R. § 4.86. A Roman numeral designation will also be determined from either Table VI or Table VIa, whichever results in the higher numeral, when the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz. That numeral will then be elevated to the next higher Roman numeral. Facts and Analysis The Veteran underwent a VA examination in September 2014. The Veteran reported difficulty hearing. The resulting examination report shows puretone thresholds, in decibels, and speech discrimination scores as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 35 60 95 95 71 72% LEFT 40 65 80 80 66 72% The above audiological findings translate to a Level VI hearing acuity for the right ear and a Level VII hearing acuity for the left ear under Table VI. Applying these results to Table VII, a 30 percent disability rating is warranted. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. The Veteran underwent a VA examination in January 2021. The Veteran reported difficulty understanding conversations in noisy environments. The resulting examination report shows puretone thresholds, in decibels, and speech discrimination scores as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 45 70 90 90 74 62% LEFT 45 75 90 85 74 64% The above audiological findings translate to a Level V hearing acuity for the right ear and a Level V hearing acuity for the left ear under Table VI. Applying these results to Table VII, a 20 percent disability rating is warranted. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. VA treatment records have also been reviewed. These medical records, however, do not contain any audiological findings or complaints that would entitle the Veteran to a higher rating for his hearing loss under 38 C.F.R. § 4.85 or 38 C.F.R. § 4.86. Based on the evidence above, the Board finds that the audiometric testing fails to reflect that the Veteran's hearing loss disability meets the criteria to warrant a rating in excess of 40 percent at any time during the appeal period. To the extent that the Veteran contends that his hearing loss is even more severe than currently evaluated, the Board observes that the Veteran, while competent to report symptoms such as difficulty understanding conversation, is not competent to report that his hearing acuity is of sufficient severity to warrant a higher evaluation under VA's tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007); Charles v. Principi, 16 Vet. App. 370 (2002). Moreover, as noted above, disability ratings for hearing impairment are to be derived by the mechanical application of the Rating Schedule to the numeric designations assigned based on objective audiometric test results. See Lendenmann, supra (explaining that the assignment of 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). Thus, even after considering such contentions as to the functional effects of the Veteran's hearing loss disability, without medical evidence of hearing loss which merits higher evaluations, the Veteran's condition is properly rated as discussed above. Accordingly, based on the Veteran's audiological examinations, the Board is compelled to conclude that the preponderance of the evidence is against entitlement to a rating in excess of 40 percent for bilateral hearing loss. In addition, the assignment of staged ratings has been considered and is not for application. See Hart v. Mansfield, 21 Vet. App. 505 (2007). B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Kipper, 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.