Citation Nr: 21030740 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 15-13 026 DATE: May 19, 2021 ORDER Entitlement to service connection for allergies is denied. Entitlement to service connection for bronchitis is denied. Entitlement to service connection for pneumonia is denied. Entitlement to service connection for sinusitis is denied. Entitlement to service connection for rhinitis is denied. Entitlement to service connection for asthma, including a claim for chronic obstructive pulmonary disease (COPD), is denied. Entitlement to service connection for urinary retention, to include as secondary to the service-connected prostate cancer, is denied. Entitlement to an initial compensable rating prior to March 17, 2020, for bilateral sensorineural hearing loss is denied. Entitlement to a rating in excess of 10 percent from March 17, 2020, for bilateral sensorineural hearing loss is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that allergies began during active service, or are otherwise related to an in-service injury or disease. 2. The preponderance of the evidence of record is against finding that the Veteran has had bronchitis, or any residuals, at any time during or approximate to the pendency of the claim. 3. The preponderance of the evidence of record is against finding that the Veteran has had pneumonia, or any residuals, at any time during or approximate to the pendency of the claim. 4. The preponderance of the evidence of record is against finding that the Veteran has had sinusitis, or any residuals, at any time during or approximate to the pendency of the claim. 5. The preponderance of the evidence is against finding that rhinitis began during active service, or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence is against finding that asthma began during active service, or is otherwise related to an in-service injury or disease. 7. The Veteran's urinary retention is not secondary to service-connected prostate cancer, and is not otherwise related to an in-service injury or disease. 8. Prior to March 17, 2020, the Veteran's bilateral sensorineural hearing was manifested by hearing acuity of no worse than Level I in the right ear and no worse than Level I in the left ear. 9. From March 17, 2020, the Veteran's bilateral sensorineural hearing is manifested by hearing acuity of no worse than Level III in the right ear and no worse than Level VI in the left ear. CONCLUSIONS OF LAW 1. The criteria for service connection for allergies are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for bronchitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for pneumonia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for sinusitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for rhinitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for asthma, including a claim for COPD, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for urinary retention due to service or service-connected prostate cancer are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 8. The criteria for an initial compensable rating for bilateral sensorineural hearing loss are not met prior to March 17, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 9. The criteria for a rating in excess of 10 percent for bilateral sensorineural hearing loss are not met from March 17, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from January 1971 to December 1972. He testified before the undersigned Veterans Law Judge during a September 2018 hearing. This matter is on appeal from a September 2012 rating decision and was previously remanded by the Board of Veterans' Appeals (Board) in May 2019. The Board also remanded the issue of service connection for a prostate disorder. That issue is no longer on appeal since service connection was granted for prostate cancer in a March 2020 rating decision. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 1. Entitlement to service connection for allergies The Veteran contends that he has allergies due to exposure to jet fuels during service. September 2018 Hearing Transcript at 4. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of allergies, and evidence shows that in-service exposure to jet fuels occurred, the preponderance of the evidence weighs against finding that the Veteran's allergies began during service or are otherwise related to an in-service injury, event, or disease. Private treatment records show that the Veteran was not seen for an allergy consultation until July 1976, while the first diagnosis of chronic allergies is in July 1994, years after his separation from service in 1972. While the Veteran is competent to report having experienced respiratory symptoms since service, he does not have the training or credentials to provide a diagnosis in this case or determine that these symptoms were manifestations of his current allergies. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the December 2020 VA examiner opined that the Veteran's claimed allergies were not at least as likely as not related to an in-service injury, event, or disease, including exposure to jet fuels. The rationale was that the temporal relationship was weak. The examiner reported that research on the topic revealed no strong association between jet fuel and respiratory conditions. They referred to a research paper discussing military personnel occupationally exposed to jet fuels. The examiner reported that the paper showed that the numbers of medical visits related to respiratory problems were not markedly different between the exposed and unexposed groups. The paper also showed that specific diseases, including respiratory illnesses, were examined, but no marked differences were found between the groups. The examiner also discussed the paper's research on the effects of jet fuels on rats and mice. The examiner concluded that given the information in the research paper, it was less likely than not that the Veteran's exposure to jet fuels resulted in his current pulmonary conditions. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his allergies are related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the December 2020 VA examiner's opinion in denying this claim. 2. Entitlement to service connection for bronchitis The Veteran contends that he has bronchitis due to exposure to jet fuels during service. September 2018 Hearing Transcript at 4. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of bronchitis, or any residuals, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The December 2020 VA examiner evaluated the Veteran and determined that, while he experienced respiratory symptoms, there was no objective evidence to support a diagnosis of bronchitis. Further, despite consistent treatment during this appeal through January 2021, VA and private treatment records do not contain a diagnosis of bronchitis or any residuals. In finding no current diagnosis, the Board acknowledges that an October 2010 private record, prior to the filing of the claim in June 2011, shows a diagnosis of acute bronchitis. There are no further treatment records documenting active bronchitis, or that the Veteran had any residuals from the acute bronchitis in 2010. The December 2020 VA examiner specifically found that there was no objective evidence of bronchitis. Consequently, the Board concludes that a chronic disability, or residuals of any acute bronchitis prior to the claim, have not been shown. While the Veteran believes he has a current diagnosis of bronchitis, he does not have the training or credentials to provide a diagnosis in this case. Jandreau, 492 F.3d at 1377 n.4. Moreover, there is insufficient lay or medical evidence to suggest that any respiratory symptoms, other than those associated with the diagnosed rhinitis, reaches the level of functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In the absence of proof of a present disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, the Board gives more probative weight to the competent medical evidence failing to show a current diagnosis. 3. Entitlement to service connection for pneumonia The Veteran contends that he has pneumonia due to exposure to jet fuels during service. September 2018 Hearing Transcript at 4. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of pneumonia, or any residuals, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. The December 2020 VA examiner evaluated the Veteran and determined that, while he experienced respiratory symptoms, there was no objective evidence to support a diagnosis of pneumonia. Further, despite consistent treatment during this appeal through January 2021, VA and private treatment records do not contain a diagnosis of pneumonia or any residuals. While the Veteran believes he has a current diagnosis of pneumonia, he does not have the training or credentials to provide a diagnosis in this case. Jandreau, 492 F.3d at 1377 n.4. Moreover, there is insufficient lay or medical evidence to suggest that any respiratory symptoms, other than those associated with the diagnosed rhinitis, reaches the level of functional impairment of earning capacity. In the absence of proof of a present disability, there can be no valid claim for service connection. Brammer, 3 Vet. App. at 225. Consequently, the Board gives more probative weight to the competent medical evidence failing to show a current diagnosis. 4. Entitlement to service connection for sinusitis The Veteran contends that he has sinusitis due to exposure to jet fuels during service. September 2018 Hearing Transcript at 4. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of sinusitis, or any residuals, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. The December 2020 VA examiner evaluated the Veteran and determined that, while he experienced respiratory symptoms, there was no objective evidence to support a diagnosis of sinusitis. The examiner opined that the Veteran's claimed sinusitis was related to chronic rhinitis. Further, despite consistent treatment during this appeal through January 2021, VA and private treatment records do not contain a diagnosis of sinusitis or any residuals. While the Veteran believes he has a current diagnosis of sinusitis, he does not have the training or credentials to provide a diagnosis in this case. Jandreau, 492 F.3d at 1377 n.4. Moreover, there is insufficient lay or medical evidence to suggest that any respiratory symptoms, other than those associated with the diagnosed rhinitis, reaches the level of functional impairment of earning capacity. In the absence of proof of a present disability, there can be no valid claim for service connection. Brammer, 3 Vet. App. at 225. Consequently, the Board gives more probative weight to the competent medical evidence failing to show a current diagnosis. 5. Entitlement to service connection for rhinitis The Veteran contends that he has rhinitis due to exposure to jet fuels during service. September 2018 Hearing Transcript at 4. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of chronic rhinitis, and evidence shows that in-service exposure to jet fuels occurred, the preponderance of the evidence weighs against finding that the Veteran's rhinitis began during service or is otherwise related to an in-service injury, event, or disease. Private treatment records show the Veteran was not diagnosed with rhinitis until May 1987, years after his separation from service. A June 1988 private record reveals that the Veteran had a history of allergic rhinitis treated in 1976, and had intermittent rhinitis, which he attributed to allergies. While the Veteran is competent to report having experienced respiratory symptoms since service, he does not have the training or credentials to provide a diagnosis in this case or determine that these symptoms were manifestations of his current chronic rhinitis. Jandreau, 492 F.3d at 1377 n.4. Further, the December 2020 VA examiner opined that the Veteran's claimed chronic rhinitis was not at least as likely as not related to an in-service injury, event, or disease, including exposure to jet fuels. The rationale is the same discussed above in denying service connection for allergies, and will not be repeated. The examiner's opinion is again probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his rhinitis is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24 Vet. App. 428. Consequently, the Board gives more probative weight to the December 2020 VA examiner's opinion in denying this claim. 6. Entitlement to service connection for asthma, including a claim for COPD The Veteran contends that he has asthma, including a claim for COPD, due to exposure to jet fuels during service. September 2018 Hearing Transcript at 4. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of asthma, and evidence shows that in-service exposure to jet fuels occurred, the preponderance of the evidence weighs against finding that the Veteran's asthma began during service or is otherwise related to an in-service injury, event, or disease. Regarding the Veteran's claimed COPD, the December 2020 VA examiner opined that there was no objective evidence to support a diagnosis. VA and private treatment records during this appeal also do not show a diagnosis of COPD. Private treatment records show the Veteran was not diagnosed with asthma until 1976, years after his separation from service. While the Veteran is competent to report having experienced symptoms of difficulty breathing since service, he does not have the training or credentials to provide a diagnosis in this case or determine that these symptoms were manifestations of his current asthma. Jandreau, 492 F.3d at 1377 n.4. Further, the December 2020 VA examiner opined that the Veteran's asthma was not at least as likely as not related to an in-service injury, event, or disease, including exposure to jet fuels. The rationale is the same discussed above in denying service connection for allergies, and will not be repeated. The examiner's opinion is again probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his asthma is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24 Vet. App. 428. Consequently, the Board gives more probative weight to the December 2020 VA examiner's opinion in denying this claim. 7. Entitlement to service connection for urinary retention, to include as secondary to the service-connected prostate cancer The Veteran contends that he has urinary retention due to exposure to herbicide agents during service or that is secondary to his service-connected prostate cancer. September 2018 Hearing Transcript at 4. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Regarding service connection on a direct basis, the question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. As for service connection on a secondary basis, the question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected prostate cancer. The Board concludes that, while the Veteran has a current diagnosis of voiding dysfunction, and evidence shows that in-service exposure to herbicide agents occurred, the preponderance of the evidence weighs against finding that the Veteran's urinary retention began during service or is otherwise related to an in-service injury, event, or disease. The preponderance of the evidence also weighs against finding that it is proximately due to or the result of, or aggravated beyond its natural progression by service-connected prostate cancer. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The December 2020 VA examination treatment records show that the Veteran was not diagnosed with voiding dysfunction until 2011, decades after his separation from service. The Veteran has not reported experiencing urinary problems since service. Even if he had, the Veteran does not have the training or credentials to provide a diagnosis in this case or determine that any symptoms were manifestations of his current voiding dysfunction. Jandreau, 492 F.3d at 1377 n.4. Further, the December 2020 VA examiner opined that the Veteran's voiding dysfunction was due to benign prostatic hypertrophy. They further opined that it was not proximately due to or aggravated by the service-connected prostate cancer. The rationale was that the Veteran's only symptoms pertaining to his benign prostatic hypertrophy was obstructive urination. The examiner opined that the Veteran's benign prostatic hypertrophy was a benign condition, separate and distinct from his prostate cancer, and not caused by prostate cancer. The Veteran was receiving anti-androgen therapy for his prostate cancer, and treatment discussed by his VA urologist for obstructive urination were directed at treating benign prostatic hypertrophy, and not prostate cancer. They reported that there was no evidence in the medical record or the medical literature that benign prostatic hypertrophy was proximately due to prostate cancer. They noted that the prostate cancer was a malignancy, and not benign. Regarding aggravation, the examiner described the baseline level of severity, and opined that the current severity was not aggravated beyond its natural progression by prostate cancer. The examiner again noted that the Veteran's only real symptoms pertaining to his benign prostatic hypertrophy was obstructive urination. They reported that the Veteran had received maximal medical therapy for benign prostatic hypertrophy. The examiner again noted that it was a benign condition, and not caused by prostate cancer. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes his voiding dysfunction is related to an in-service injury, event, or disease. He also believes that it is proximately due to or the result of/aggravated beyond its natural progression by service-connected prostate cancer. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24 Vet. App. 428. Consequently, the Board gives more probative weight to the December 2020 VA examiner's opinion in denying this claim. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100. To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII. An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). In making the below determinations, the Board notes that neither the Veteran nor his representative has raised any other issues, or has the record reasonably raised any other issues. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Moreover, as the Veteran has not contended, nor does the evidence show, that this disability renders him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). 8. Entitlement to a compensable rating prior to March 17, 2020, for bilateral sensorineural hearing loss An August 2011 VA examination reveals that the Veteran did not report any functional impairment. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 15 15 35 55 30 100 LEFT 25 30 50 60 41 96 Applying the results to Table VI, the findings yield a numeric designation of Level I in both ears. Entering the resulting bilateral numeric designation of Level I for both ears to 38 C.F.R. § 4.85, Table VII, equates to a zero percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. Private treatment records received in September 2011 contain undated audiological reports. The records show that speech discrimination tests did not use the Maryland CNC Word List. Therefore, the reports cannot be used to evaluate the Veteran's hearing loss disability for VA purposes. Based on the evidence above, an initial compensable rating for the Veteran's bilateral sensorineural hearing loss is not warranted. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran's testimony that even with hearing aids, he is unable to hear clearly. The Veteran is competent to report difficulty with his hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes, is contemplated by the rating criteria. The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). Accordingly, the preponderance of the most probative evidence is against the claim of entitlement to an initial compensable rating for bilateral sensorineural hearing loss. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against the claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 9. Entitlement to a rating in excess of 10 percent from March 17, 2020, for bilateral sensorineural hearing loss A March 2020 VA examination reveals that the Veteran reported that he could hear people talking, but could not understand what they were saying. 38 C.F.R. § 4.10; Martinak, supra. The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 35 40 50 60 46 82 LEFT 40 55 55 75 56 66 Applying the results to Table VI, the findings yield a numeric designation of Level III in the right ear and Level VI in the left ear. Entering the resulting bilateral numeric designation of Level III for the right ear and Level VI for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 10 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. Based on the evidence above, a rating in excess of 10 percent for the Veteran's bilateral sensorineural hearing loss is not warranted. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran's report of not being able to understand what people are saying. The Veteran is competent to report difficulty with his hearing. However, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann, supra. The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes is contemplated by the rating criteria. The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy, 29 Vet. App. at 145. Accordingly, the preponderance of the most probative evidence is against the claim of entitlement to a rating in excess of 10 percent for bilateral sensorineural hearing loss. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert, 1 Vet. App. at 55. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Barstow, 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.