Citation Nr: 21031410 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 17-40 390 DATE: May 21, 2021 ORDER The application to reopen the previously denied claim of entitlement to service connection for bilateral hearing loss is granted. The application to reopen the previously denied claim of entitlement to service connection for right ankle strain is granted. The application to reopen the previously denied claim of entitlement to service connection for left ankle strain is granted. Entitlement to service connection for adjustment disorder is granted. Entitlement to service connection for left ankle disability manifested by pain is granted. Entitlement to service connection for right ankle disability manifested by pain is granted. Entitlement to service connection for obstructive sleep apnea (OSA) is granted. Entitlement to an initial compensable rating for service connected asthma is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDINGS OF FACT 1. In a December 2013 rating decision, the Regional Office (RO), inter alia, denied the Veteran's claim for entitlement to service connection for bilateral hearing loss, and right and left ankle strain; the Veteran did not timely initiate an appeal of that decision or submit new and material evidence within one year of notification. 2. Evidence added to the record since the December 2013 rating decision relates to an unestablished fact necessary to substantiate the claims, and raises a reasonable possibility of substantiating the claims. 3. The evidence is at least evenly balanced as to whether the Veteran's adjustment disorder is related to service. 4. The evidence is at least evenly balanced as to whether the Veteran's left ankle disability had its onset in service. 5. The evidence is at least evenly balanced as to whether the Veteran's right ankle disability had its onset in service. 6. The evidence is at least evenly balanced as to whether the Veteran's OSA had its onset in service. 7. The Veteran's service connected asthma symptomatology does not more nearly approximate bronchial asthma with forced expiratory volume for the first second (FEV-1) of 71 to 80 percent predicted; or, FEV-1/forced vital capacity (FVC) of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy. CONCLUSIONS OF LAW 1. The December 2013 RO decision that denied service connection for bilateral hearing loss, and right and left ankle strain is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 3.156(b), 20.1103. 2. The criteria for reopening the claims of entitlement to service connection for bilateral hearing loss, and right and left ankle strain have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 3. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for adjustment disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for left ankle disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right ankle disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 6. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for OSA have been met. 38 U.S.C. §§ 1110, 5107(b); 38 U.S.C. §§ 3.102, 3.303. 7. The criteria for an initial compensable rating for the Veteran's service connected asthma have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.97, Diagnostic Code (DC) 6602. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 2006 to December 2012. This matter comes to the Board of Veterans' Appeals (Board) on appeal from February 2014, January 2017, and January 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) which, inter alia and respectively, denied service connection for borderline personality disorder; denied reopening claims of service connection for bilateral hearing loss, left and right ankle strain; denied service connection for OSA, and continued a noncompensable rating for service connected asthma. The Veteran filed his notice of disagreement with, among other things, the denial of service connection for borderline personality disorder in July 2014, the denial of reopening the claims for service connection for his right and left ankle disabilities in February 2017, the denial of reopening the claim for service connection for bilateral hearing loss in August 2017, the denial of service connection for OSA and the noncompensable rating assigned for asthma in July 2018. The Veteran was issued statements of the case in July 2017, September 2017, and February 2020, and perfected his appeals to the Board in August 2017, October 2017, and April 2020. In April 2021, the Veteran testified at virtual Board hearing before the undersigned Veterans Law Judge. A copy of the transcript is of record. The Board has recharacterized and granted service connection for the psychiatric disorder for the reasons indicated below. New and Material In a December 2013 rating decision, the RO denied, inter alia, the Veteran's claims of entitlement to service connection for bilateral hearing loss, and right and left ankle strain. The Veteran did not file a timely appeal or submit new and material evidence within a year of the rating decision as to the claims, thus, the December 2013 rating decision as to these claims became final. Generally, a claim which has been denied in an unappealed Agency of Original Jurisdiction (AOJ) decision is final and may not thereafter be reopened and allowed. 38 U.S.C.§ 7105 (c); 38 C.F.R. § 20.1100. One exception to this rule is that a previously denied claim may be reopened by submission of new and material evidence. 38 U.S.C. § 5108; 38 C.F.R.§ 3.156. New and material evidence cannot be cumulative or redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary's duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. At the time of the December 2013 rating decision, evidence relevant to the service connection claims included the Veteran's post service private treatment records from August 3, 2012 through September 26, 2012, September 16, 2013 through September 30, 2013, service treatment records from March 7, 2006 through January 18, 2013, and VA treatment records from March 13, 2013 through November 26, 2013. Evidence received since includes VA treatment records from July 8, 2015 through January 11, 2017, and April 2021 virtual Board hearing testimony. The evidence regarding the claims for service connection for bilateral hearing loss, and right and left ankle disabilities is not redundant of the record and raises a reasonable possibility of substantiating the claims as the Veteran's statements provide evidence regarding the onset, and etiology of his right and left ankle disabilities, and bilateral hearing loss. The evidence is thus new and material, and the service connection claims for bilateral hearing loss, and right and left ankle strain are reopened. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Adjustment disorder The Veteran reported wrapping a cord around his neck during high school due to his girlfriend breaking up with him. He spoke to his guidance counselor about the incident, but never was diagnosed with any mental disability, sent to a mental facility, or prescribed medication. He stated that during service, he began having issues with his marriage, and started hurting himself. He also reported having difficulty with his finances, his superior officers, and his knee disability which led to him having to drop out of college because he felt as if he was being watched. The Veteran stated that he is on medication for his anxiety, but still cannot be in large crowded areas. The Veteran's attorney also noted that the Veteran was hospitalized while in service for mental health issues, which have been ongoing since service. The Veteran's March 2006 medical examination report upon entry is normal, with no indication that the Veteran suffers from a psychiatric disability. The Veteran's September 2012 service treatment records reflect that the Veteran reported previous treatment for "unsafe feelings", and a history of passing suicidal ideation, depression, and anxiety. The Veteran's September 2012 VA examination report upon discharge indicates that he was not provided a psychiatric evaluation, but he was provided with a physical profile which reflected, among other things, a diagnosis of depression, and anxiety. In a June 2013 VA examination report, the examining psychologist opined that the Veteran's borderline personality disorder was less likely than not (less than a 50 percent probability) caused by, or related to his military service, noting that the Veteran was a victim of physical and emotional abuse as a child, and that the Veteran admitted to an impulsive suicidal gesture in high school. The psychologist reported that the Veteran's borderline personality disorder is as likely as not caused by, and related to his childhood history of physical and emotional abuse. In a February 2014 VA examination report, the psychologist reported the existence of an unspecified personality disorder which likely had its onset secondary to childhood issues. The psychologist also noted that the records clearly and unmistakably show at least one suicide attempt prior to service, but it is unclear if this was a component of the personality disorder or a separate stand-alone depressive disorder. The psychologist reported that the Veteran was clearly and unmistakably accepted into the military and was sound at the time of entry. He also stated that the Veteran's adjustment disorder associated with the stressors he experienced in the military have resolved and the current depressive disorder is related to current situational stressors. The psychologist opined that the Veteran's personality disorder is a pre-existing condition and there is no evidence to suggest the condition was permanently aggravated by military service. In a November 2017 mental status examination, a private psychologist, Dr. Atkinson, noted personality disorder which was diagnosed in service, and a suicidal gesture prior to service. Noting that personality disorders cannot be service connected, he diagnosed adjustment disorder. Dr. Atkinson reported clear exacerbation of deep seated pervasive and widespread psychopathology in the military which continues to the present, and will continue for the foreseeable future. Dr. Atkinson opined that in as much as the Veteran's acute disorder was incurred while in service, it is at least as likely as not (at least a 50 percent probability) that the mistreatment he actually had in the military set off an acute process that became chronic, thus it is service connected. The evidence is at least evenly balanced as to whether the Veteran's adjustment disorder is related to service. The June 2013 and February 2014 psychologists focused their analyses on the Veteran's personality disorder. Dr. Atkinson explained why the adjustment disorder was related to service based on an accurate characterization of the evidence of record. Therefore, his opinion is afforded significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). The evidence is thus at least evenly balanced as to whether the Veteran's adjustment disorder is related to service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for adjustment disorder is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. Right and left ankle disabilities The Veteran stated that during a "ruck march" in service, he rolled his ankles and heard "loud pops" every time he took steps forward. He stated as time went on, he started getting severe pain shooting up his leg and did not know what it was. The Veteran reported that since the initial incident, his ankles pop and become very stiff. He stated that there was no pain, just discomfort. The Veteran stated that the pain was consistent during service, including while deployed, and reported using ibuprofen for the pain. He testified that he did not have ankle issues prior to service, and has not been involved in any accident or anything where he suffered from an ankle injury. The Veteran said he has had consistent pain, discomfort, and popping that cause impairment since his initial ankle injuries during service. September 2006 service treatment records reflect that the Veteran reported feeling right ankle pain while walking and stepping on a curb. A June 2013 VA examination report indicated that the Veteran had right and left ankle strain, and the Veteran reported he had the strains in service. The Veteran stated his ankles often "pop" really loud with certain motion, but denied pain. The examination reflected resolved bilateral ankle strains. March 2014 post-service treatment records reflect the Veteran reported left ankle pain. While the June 2013 examination report reflects that the Veteran's bilateral ankle strains had resolved, the Veteran has provided lay evidence that he continues to suffer from discomfort, pain, and "popping" in his ankles since service. The Veteran is competent to describe observable symptomatology regarding his right and left ankle disabilities, and there is no indication in the evidence of record that he lacks credibility, therefore his reports of right ankle disability symptomatology are afforded significant probative weight. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377, n.4 (Fed. Cir. 2007). Additionally, the Veteran has testified that he initially "rolled" his ankles during service. Thus, his lay statements regarding the cause of his pain satisfy the in-service injury requirements, and the dispositive issue is whether there is a nexus between the Veteran's current right and left ankle disabilities and his in-service injury. The Veteran has consistently and competently provided evidence that his right and left ankle pain has persisted since his in-service injury. There is no indication that the Veteran's statements lack credibility, thus they are afforded significant probative weight. See Buchanan v. Nicholson, 451 F. 3d 1331 at 1337 (Fed. Cir. 2006). ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). With regard to whether the current disability requirement has been met, while the June 2013 examination report indicated that the Veteran's bilateral ankle strain had resolved, the Federal Circuit held that pain alone can constitute disability if it causes impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). In this case, the Veteran has testified that his right and left ankle pain and discomfort require that he take over-the-counter medications, and that the pain has caused impairment since the initial injury. Thus, the Veteran's right and left ankle pain and discomfort due to his in-service injury has caused impairment such that the symptoms would constitute disability, to include impairment in earning capacity. See also Wait v. Wilkie, 33 Vet. App. 8 (2020) (indicating that the Board must make the factual determination as to whether manifestations rise to a level of functional impairment in earning capacity with consideration of the Rating Schedule, but the presence of a symptoms or manifestation in the Rating Schedule is not dispositive). Although the Board could remand the claim for a medical opinion, there is sufficient evidence to decide the claim, and a remand could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c). ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Gardner-Dickson v. Wilkie, No. 19-4765, 2020 U.S. App. Vet. Claims LEXIS 1927 (Panel Order), at *20 (denying petition for a writ of mandamus challenging a remand for additional development, but agreeing "with the petitioner that it 'would not be permissible for VA to undertake... additional development if a purpose was to obtain evidence against an appellant's case'" (citing Mariano v. Principi, 17 Vet. App. 305, 312 (2003) and Hart v. Mansfield, 21 Vet. App. 505, 508 (2007)). Moreover, to the extent that the grant of service connection in this case is based primarily on lay evidence, "nothing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself." Buchanan, 451 F.3d at 1335. The evidence is thus at least evenly balanced as to whether the Veteran's right and left ankle disabilities are related to his in-service injury. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for right and left ankle disabilities manifested by pain is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 3. Obstructive Sleep Apnea The Veteran testified that he first noticed difficulty with his sleep when he was in the military, stating that he would have a hard time falling and staying asleep. He stated that during service when he was married, his wife mentioned that he did snore for a couple of days. He reported that there were many times he would wake up and feel exhausted as if he had not slept at all during service. The Veteran stated that since his sleep study and use of a continuous positive airway pressure (CPAP) machine, he no longer has issues with not feeling rested after a good night's sleep. He testified that the same symptoms that he noticed in service were the basis for his later diagnosis of sleep apnea. In a February 2020 VA examination report, the examiner opined that the Veteran's OSA was less likely than not (less than a 50 percent probability) incurred in or caused by the impaired sleep, and fatigue related sleep symptoms described during service. The examiner stated that there is no indication of classical OSA syndrome in service, and reported that OSA is a specific disorder and does not correlate with the Veteran's impaired sleep, and fatigue related sleep symptoms described/noted during service. The Veteran testified that his ex-wife noticed that the symptoms upon which the sleep apnea diagnosis was made were apparent during the Veteran's service, and he also indicated that no such issues existed prior to service. See Jandreau, 492 F. 3d at 1377. The Board finds these statements to be competent and credible. Additionally, February 2020 VA examiner noted a diagnosis of sleep apnea. Thus, both the current disability and the in-service incurrence elements for service connection have been satisfied. The evidence is thus at least evenly balanced as to whether the Veteran's OSA had its onset in service. While the February 2020 examiner opined that the Veteran's OSA was less likely than not (less than a 50 percent probability) incurred in service, the examiner discounted the Veteran's described symptomatology despite the fact that the Veteran's in-service symptoms were a factor in the Veteran's diagnosis of OSA. Therefore, the February 2020 examiner's opinion is afforded little probative value as he based his opinion on an inaccurate factual premise. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). Additionally, the Veteran has attested to a continuity of sleep apnea symptomatology since service until he was prescribed a CPAP machine. To the extent that the grant of service connection in this case is based primarily on lay evidence, "nothing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself." Buchanan, 451 F.3d at 1335. See also Maples v. Wilkie, No. 18-2016 (mem dec. Feb. 11, 2019) (vacating the Board's denial of a claim for service connection for sleep apnea and finding that the Veteran's "lay statements could be evidence sufficient to support his claim, and the mere fact that there is no medical evidence about his snoring does not, by itself, render his lay statements insufficient"); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran's OSA had its onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for OSA is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Ratings Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). 4. Asthma The Veteran testified that his asthma feels "more or less just weather or seasonal reactive", stating that he suffers from some difficulty breathing with drastic weather changes. He reported not using an inhaler, but stated his allergies are heightened by changes in the weather and his surroundings. The Veteran stated that after discharge, he became acclimated to Florida weather, but any strenuous activity such as walking up stairs required that he take a little time to catch his breath. He did state that he used an inhaler while stationed in Korea when he became very ill with an upper respiratory infection and could not catch his breath during a physical training test, but reported that his medical records reflecting this occurrence were lost when he came back from Korea. The Veteran stated that he has not done any sort of physical activity to the extent that he did during his time in service, so he has not had a recurrence of the illness he had in Korea. The Board notes that during the Veteran's virtual Board hearing, the Veteran's attorney indicated that the Veteran's most recent examination was in June 2013, thus the results may not be accurate due to the amount of time which had passed. However, the record reflects a December 2017 VA examination report with pulmonary function test results, which the Board finds are sufficient to adjudicate the Veteran's claim. The Veteran's asthma is currently rated noncompensable under 38 C.F.R. § 4.97, DC 6602 for asthma. Pursuant to 38 C.F.R. § 4.97, DC 6602, a 10 percent disability rating is warranted for bronchial asthma with FEV-1 of 71 to 80 percent predicted; or FEV-1/FVC of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy. A 30 percent disability rating is warranted for bronchial asthma FEV-1 of 56 to 70 percent predicted, or the ratio of FEV-1/FVC of 56 to 70 percent; or, daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication. A 60 percent disability rating is warranted for bronchial asthma with FEV-1 of 40 to 55 percent predicted, or FEV-1/FVC of 40 to 55 percent, or at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent rating is warranted for FEV-1 less than 40 percent of predicted value, or FEV-1/FVC less than 40 percent, or diffusing capacity of the lungs for carbon monoxide (DLCO) (SB) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or cor pulmonale (right heart failure), or; right ventricular hypertrophy, or pulmonary hypertension (shown by Echo or cardiac catheterization), or episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. 38 C.F.R. § 4.96 (d)(4) provides that post-bronchodilator studies are required when pulmonary function test scores (PFTs) are done for disability evaluation purposes except when the results of pre-bronchodilator PFTs are normal or when the examiner determines that post-bronchodilator studies should not be done and states why. Moreover, VA has indicated that post-bronchodilator findings for PFTs are the standard in pulmonary assessment and are the values reported in this decision. See 61 Fed. Reg. 46720, 46723 (Sept. 5, 1996) (VA assesses pulmonary function after bronchodilation; test results after optimum therapy reflect the best possible functioning of an individual). A June 2013 VA examination report reflects that the Veteran reported being placed on an Albuterol inhaler during service, but denied use of any medication currently for asthma. The Veteran's asthma did not require use of oral or parenteral corticosteroid medications, inhaled medications, oral bronchodilators, antibiotics, or oxygen therapy. The Veteran did not report any asthma attacks with episodes of respiratory failure in the past 12 months, or physician visits for required care of exacerbations. Pulmonary function testing was not performed, the examiner noted that the Veteran's asthma is primarily exercise or illness induced, and that the Veteran was currently unmedicated and denied symptoms. In a December 2017 VA examination report, the examiner noted that the Veteran reported that dramatic weather affects his asthma, but now that he is in Florida, it is not as bad. The Veteran stated that he feels if he does strenuous work, it would be difficult to breath and he will have to stop for 10 to 15 minutes, but reported that he does not use inhalers. The examination report reflected that the Veteran's asthma did not require use of inhaled medications, oral bronchodilators, antibiotics, or require outpatient oxygen therapy. The examiner noted that the Veteran had not had any asthma attacks with episodes of respiratory failure in the past 12 months, and had not had any physician visits for required care of exacerbations. Pulmonary function testing noted pre-bronchodilator results as follows: FVC of 90 percent predicted, FEV-1 of 88 percent predicted, FEV-1/FVC of 80 percent, and DLCO of 61 percent predicted; and post-bronchodilator results of: FVC of 90 percent predicted, FEV-1 of 92 percent predicted, and FEV-1/FVC of 83 percent predicted. The evidence of record reflects that a compensable rating for the Veteran's service connected asthma is not warranted. The evidence does not show post-bronchodilator results of FEV-1 of 71 to 80 percent predicted; or, FEV-1/ FVC of 71 to 80 percent, as the December 2017 VA examination report reflects post-bronchodilator results of FEV-1 of 92 percent and an FEV-1/FVC of 83 percent. Additionally, while the Veteran described requiring time to catch his breath with strenuous activity, he stated that he does not require use of inhaled medications, or oral bronchodilators. Therefore, there is no evidence that the Veteran's symptoms require use of intermittent inhalational or oral bronchodilator therapy. Accordingly, the Veteran's service connected asthma symptomatology does not more nearly approximate the criteria for a compensable disability rating under DC 6602. The Board acknowledges the Veteran's contentions that his asthma warrants a compensable rating. While veterans are competent to opine on some medical matters, the degree of disability of the Veteran's asthma is a complex, non-observable process that is of the type that the courts have found to be beyond the competence of lay witnesses. Compare Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis). While the Veteran may feel that his asthma is worse than reflected by the schedular rating, he is not competent as to issues relating to PFT test scores. The above determinations are based on consideration of the applicable provisions of VA's rating schedule. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with respect to this claim. See Doucette v. Shulkin, 28 Vet. App. at 369-70 (2017). For the foregoing reasons, the preponderance of the evidence is against a compensable rating at any time throughout the appeal period. The benefit of the doubt doctrine is therefore not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Reasons for Remand 5. Bilateral Hearing Loss A hearing loss disability is defined for VA compensation purposes with regard to audiological testing involving puretone frequency thresholds and speech discrimination criteria. 38 C.F.R. § 3.385. For 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 of 500, 1,000, 2,000, 3,000, or 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. Id. The Veteran's attorney stated during the virtual Board hearing that the Veteran's hearing loss began in service, noting that the Veteran's 2013 VA examination report indicated that the Veteran had a significant hearing shift in service. The Veteran's attorney stated that the Veteran was exposed to loud noises, and that his military occupational specialty had a high probability of noise exposure. The Veteran stated that during his deployment, he used 3M ear plugs which he reported are currently under investigation for being faulty. The Veteran described instances when he was exposed to acoustic noise during service, and explained that he worked on industrial sized AC units generators, and loud fans. He testified that during on incident during boot camp training, his ear plug fell out, he was exposed to noise from life-like fire sessions, and his hearing was deafened throughout that time. He stated that he notified his drill sergeant who stated it was the Veteran's fault as his ear plug was not properly secured. October 2012 service treatment records reflect the Veteran reported noticing hearing loss 8 years prior while in basic training which has since progressed. On the authorized audiological evaluation in July 2013, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 5 10 5 5 LEFT 15 15 15 10 20 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and of 96 percent in the left ear. The Veteran's audiologist opined that his hearing loss was at least as likely as not (at least a 50 percent probability) caused by or a result of an injury in service, noting that the Veteran had normal hearing upon enlistment, but hearing loss was noted upon examination several months prior to separation from service. The audiologist stated that this change in the Veteran's hearing from enlistment supports a claim for hearing loss as individuals exposed to high intensity noise will report hearing loss. Acoustic trauma due to combat has been accepted as satisfying the in-service disease or injury element of claims for service-connected hearing loss. See Reeves v. Shinseki, 682 F.3d 988, 999 (Fed. Cir. 2012); Hensley v. Brown, 5 Vet. App. 155, 160 (1993). The Veteran has competently and credibly testified, and the Veteran's audiological evaluation reflects, that he was exposed to acoustic trauma and noise during service, consistent with his circumstances of service considering his military occupational specialty. Jandreau, 492 F. 3d at 1376-1377. The July 2013 audiological examination indicates that the Veteran does not meet the criteria for a hearing loss disability for VA compensation purposes as the examination shows the Veteran does not have an auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hz of 40 dB or greater; or 26 dB or greater in at least three of the frequencies; or a speech recognition score of less than 94 percent in the right ear. The Veteran and his attorney indicated that the Veteran's hearing loss has worsened since his July 2013 examination, thus a remand for a new examination is warranted to determine the current severity of the Veteran's bilateral hearing loss, and if it now meets the criteria for hearing loss under 38 C.F.R. § 3.385. The matter is thus REMANDED for the following action: Schedule the Veteran for an examination by an audiologist to determine the current severity and etiology of the Veteran's bilateral hearing loss, in accordance with the current disability benefits questionnaire. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Maddox, 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.