Citation Nr: 21031885 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-16 076 DATE: May 24, 2021 ORDER Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. Entitlement to service connection for neuropathy of the right upper extremity (claimed as numbness of the right hand) is denied. Entitlement to service connection for neuropathy of the left upper extremity (claimed as numbness of the left hand) is denied. Entitlement to an initial rating greater than 20 percent for bilateral hearing loss is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a cervical spine disability had its onset during active service; resulted from a disease or injury incurred or aggravated during active duty; or that cervical spine arthritis manifested within one year of service discharge. 2. The preponderance of the evidence is against finding that a low back disability had its onset during active service; resulted from a disease or injury incurred or aggravated during active duty; or that lumbar spine arthritis manifested within one year of service discharge. 3. The preponderance of the evidence is against finding that a right knee disability had its onset during active service; resulted from a disease or injury incurred or aggravated during active duty; or that right knee arthritis manifested within one year of service discharge. 4. The preponderance of the evidence is against finding that COPD had its onset during active service; or resulted from a disease or injury incurred or aggravated during active duty. 5. The preponderance of the evidence is against finding that neuropathy of the right upper extremity (claimed as numbness of the right hand) had its onset during active service; resulted from a disease or injury incurred or aggravated during active duty. 6. The preponderance of the evidence is against finding that neuropathy of the left upper extremity (claimed as numbness of the left hand) had its onset during active service; resulted from a disease or injury incurred or aggravated during active duty. 7. The Veteran's bilateral hearing loss has been manifested by hearing acuity of no worse than Level IV in the right ear and Level VIII in the left ear. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a lower back disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for COPD have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for neuropathy of the right upper extremity (claimed as numbness of the right hand) have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for neuropathy of the left upper extremity (claimed as numbness of the left hand) have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for an initial rating greater than 20 percent for bilateral hearing loss have not been met. 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 duty service from May 1966 to November 1986. This appeal before the Board of Veterans' Appeals (Board) arose from a March 2015 rating decision in which a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for the issues currently before the Board, as well as service connection for tinnitus; and granted service connection for bilateral hearing loss, assigning a noncompensable disability rating, effective December 2014. The Veteran was notified by a May 2017 letter of a rating decision that month which denied service connection for diabetes mellitus, a thyroid condition, a right hip tumor, and a left knee condition. He did not appeal that decision. In July 2019, the Board remanded the appeal for further development. Thereafter, an April 2020 rating decision granted service connection for tinnitus which was assigned the highest possible evaluation of 10 percent, effective December 2014, date of receipt of claim. The Veteran did not appeal either the rating assigned or the effective date. Thus, this represented a complete grant of that benefit and it is no longer before the Board. That rating decision also retroactively granted an increase from the noncompensable rating for bilateral hearing loss to 20 percent, effective December 2014 (the date of receipt of original claim for service connection). As this is not the highest possible rating assignable, this matter remains in appellate status. Service Connection Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in- service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden, 381 F.3d at 1167; see Caluza, 7 Vet. App. at 506, aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Holton, 557 F.3d at 1366; 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). Reasonable doubt will be favorably resolved. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Arthritis shall be considered to have been incurred in or aggravated by service although not otherwise established during the period of service if manifested to a compensable degree within one year following service in a period of war or following peacetime service on or after January 1, 1947. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Certain diseases have been determined to be associated with the use of herbicide agents and VA regulations identify those disease that are presumptively associated with herbicide agent exposure. 38 C.F.R. § 3.309(e). Early-onset peripheral neuropathy is a disease identified as presumptively associated with herbicide agent exposure. 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e). However, 38 C.F.R. § 3.307(a)(6)(ii) requires that early-onset peripheral neuropathy must have become manifest to a degree of ten percent or more within one year after the veteran's last in-service exposure to an herbicide agent in order to qualify for the herbicide presumption of service connection. Service connection will be granted on a secondary basis for disability that is proximately due to or the result of, or permanently aggravated by, an already service-connected condition. 38 C.F.R. § 3.310(a) and (b). This requires (1) evidence of a current disability; (2) a service-connected disability; and (3) evidence establishing a nexus between the service-connected disability and the claimed disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Initial Considerations With respect to the Veteran's service connection claim for COPD, he contends that this was incurred during service as a result of exposure to exhaust fumes from aircraft. See the Veteran's original claim in December 2014 for VA compensation, VA Form 21-526EZ, and June 2015 Notice of Disagreement (NOD). As to the claims for low back, cervical spine, right knee disabilities, and for neuropathy into the right and left upper extremities, he described in his June 2015 notice of disagreement (NOD) his belief that these developed due to his strenuous military duties as an aircraft armament systems technician, as reflected on his DD Form 214. Personnel records show that his military occupational specialty was a weapons mechanic. Also, while the Veteran has alleged that some of his claimed disabilities are due to or aggravated by other claimed disabilities, inasmuch as the Board finds that service connection is not warranted for any of the claimed disorders, there is no legal basis for granting service connection on the basis of either causation or aggravation. 1. Entitlement to service connection for a cervical spine disability The Board finds that the preponderance of the evidence is against finding that a cervical spine disability was of onset during active duty; resulted from a disease or injury during active duty; and finds that arthritis did not manifest until many years after service. The Veteran's service treatment records (STRs) are negative for disability of the cervical spine. A February 2015 VA outpatient treatment (VAOPT) record noted that after service he worked heavy equipment in construction at a cement plant. Private treatment records from 1996 to 2020 from the reflect that a February 2010 office visit note shows that the Veteran was hit in the head in December 2009 with a bale of hay and he complained of neck pain. X-rays and an MRI revealed multilevel degenerative changes throughout the cervical spine. A June 2001 MRI revealed disc space narrowing at C6-7. In January 2014, it was noted that his occupation was in heavy duty construction. In 2011 and 2013 the Veteran's medical problems included degenerative disc disease of the cervical spine. On VA Neck (Cervical Spine) Conditions Disability Benefits Questionnaire (DBQ) of January 2020, the Veteran was examined, and his VA electronic records were reviewed. The diagnosis was cervical intervertebral disc degeneration, having been diagnosed in 2008. Currently, he had no signs or symptoms of radiculopathy. The examiner opined that it was less likely than not that the current cervical spine disability had its onset in service or is otherwise medically related to service, to include as a result of the Veteran's duties as an aircraft armament systems technician. The rationale was that there was no documented medical evidence in the STRs of an injury to the Veteran's neck while experiencing any military activities. Specifically, the STRs were negative for evidence that his military duties as an aircraft armament systems technician caused a neck injury, that he had problems/symptoms, sought evaluation, was placed on profile, and/or was treated for any neck issues. Moreover, there were no documented neck symptoms, evaluations, or treatments until after an injury in about 2010; and during the associated evaluation it was incidentally noted that an MRI of his cervical spine revealed a mild degree of intervertebral disc degeneration. The examiner opined that the Veteran's job activities related to his post-service jobs, along with the normal aging changes in the spine, most likely accounted for any current cervical spine findings and subjective symptoms of neck pain. It was stated that the Veteran's cervical spine disability was most consistent with his high intensity activities after leaving miliary service. Also, the number of years of in-service physical stress was greatly outweigh by the number of years of post-service physical stress. Aligned against this medical opinion is the Veteran's belief that his current cervical spine disorder is due to years of strenuous in-service work. The Veteran is competent to describe observable symptomology (e.g. pain), but his belief that his current cervical spine disability stems from extensive and prolonged inservice physical exertion, is a medical opinion of etiology as to which he is not competent to opine, particularly since he had no in-service symptoms. He lacks the medical expertise to formulate such a medical opinion, which involves a complex matter beyond the competence of a layperson and requires specialized medical education and knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Such a medical opinion was rendered, as stated above, by a competent medical professional who examined the Veteran, reviewed the record, and applied expert knowledge to the facts of this case. Unfortunately, the opinion not only weighs against the claim but is unrebutted by any other competent medical opinion and is of far greater probative value than the lay opinion of the Veteran, for the reasons explained by the recent examiner. Specifically, the absence of contemporaneous signs or symptoms in the many years of post-service private clinical records, the lapse of many years before the occurrence of the earliest symptoms, and the fallibility of memory after the passage of many years. See generally Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) and Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Thus, the Board finds that the preponderance of the evidence is against finding that the Veteran's cervical spine disability had an onset during active duty; resulted from a disease during active duty; or that arthritis manifested within one year after service discharge. 2. Entitlement to service connection for a lower back disability In the Veteran's June 2015 Notice of Disagreement (NOD) he reported that he had seen a chiropractor at his own expense from 1975 to the present. However, pursuant to the Board remand, in November 2019 he was requested to execute and return the appropriate authorization form but failed to do so. STRs reflect that in February1973 the Veteran had a lipoma, i.e., a fatty mass, excised from his back. Other than this skin problem, the STRs are negative for disability of the low back. An April 1996 private clinical record reflects that the Veteran complained of having cold symptoms for 2 weeks with some low back pain for the past 24 hours. In January 2014 it was noted that his occupation was in heavy duty construction. This was again noted in a February 2015 VAOPT record which noted that after service he had worked heavy equipment in construction at a cement plant. Private records show that X-rays and a MRI were taken in September 2016 for complaints of right hip and low back pain, which disclosed a lesion in the right femoral shaft; disc protrusion at L4-5 and L5-S1, greater at L4-5; and lumbar degenerative disc disease. On VA Back (Thoracolumbar Spine) Conditions DBQ of January 2020, the Veteran was examined, and his VA electronic records were reviewed. The diagnoses were: lumbosacral intervertebral disc degeneration; facet arthropathy; and lumbago, mechanical low back pain syndrome, with each having been diagnosed in about 2016. It was noted that in a report of a military examination in 1974 he denied having had recurrent back pain. He had no pain or other radicular symptoms. The examiner opined that the Veteran's disabilities of the lumbar spine were less likely than not incurred in or caused by any inservice injury, event, or illness. The rationale was that there was no documented medical evidence in the STRs of an injury to the Veteran's low back while experiencing any military activities. Specifically, the STRs were negative for evidence that his military duties as an aircraft armament systems technician caused a low back injury, that he had problems/symptoms, sought evaluation, was placed on profile, and/or was treated for any low back issues. Moreover, there were no documented chronic low back symptoms, evaluations, or treatments until 2016, when imaging studies revealed intervertebral disc degeneration. The examiner opined that the Veteran's job activities related to his post-service jobs, along with the normal aging changes in the spine, most likely accounted for any current low back findings and subjective symptoms of low back pain. It was opined that the current lumbar spine disability was most consistent with his high intensity activities after leaving miliary service. Also, the number of years of in-service physical stress was greatly outweighed by the number of years of post-service physical stress. As noted, the Veteran is competent to describe observable symptoms (e.g. pain), but his belief that his current low back disability stems from extensive and prolonged in-service physical exertion, is a medical opinion of etiology as to which he is not competent to opine, particularly since he had no in-service symptoms. He lacks the medical expertise to formulate such a medical opinion. See Jandreau, Id. and Davidson, Id. Such a medical opinion was rendered, as stated above, by a competent medical professional who examined the Veteran, reviewed the record, and applied expert knowledge to the facts of this case. Unfortunately, the opinion not only weighs against the claim but is unrebutted by any other competent medical opinion and is of far greater probative value than the lay opinion of the Veteran, for the reasons explained by the recent examiner. Specifically, the absence of contemporaneous signs or symptoms in the many years of post-service private clinical records, the lapse of many years before the occurrence of the earliest symptoms, and the fallibility of memory after the passage of many years. Thus, the Board finds that the preponderance of the evidence is against finding that the Veteran's low back disability had an onset during active duty; resulted from a disease during active duty; or that arthritis manifested within one year after service discharge. 3. Entitlement to service connection for a right knee disability The STRs are negative for disability of the right knee. A November 2010 letter from Dr. R. stated that the Veteran sustained a left knee injury three weeks earlier and imaging studies revealed moderate left knee osteoarthritis and a tear of the left medial meniscus. Private records show that X-rays and an MRI were taken in September 2016 for complaints of right hip and low back pain, which disclosed a lesion in the right femoral shaft. A January 2020 private clinical record reflects that the Veteran had a total thyroidectomy in December 2016 but because of metastatic thyroid cancer, he had a tumor removed from his right femur in October 2016. Private records in March 2017 show that the Veteran's problem list included thyroid cancer, right femur pain, bone lesion of the right femur, and closed fracture of the distal end of the femur. On VA Knee and Lower Legs Conditions DBQ of January 2020, the Veteran was examined, and his VA electronic records were reviewed. The diagnoses were a left knee meniscal tear, having been diagnosed in about 2010, and bilateral patellofemoral pain syndrome. It was noted that military records indicated that in 1974 the Veteran denied having issues or symptoms of his knees. A clinical record in March 2017 stated that he had osteoarthritis in both knees. It was also noted that due to metastasis from thyroid cancer he had a pathologic fracture of the distal right femur in 2016, which had been surgically treated. The examiner opined that the claimed right knee condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there was no evidence in the STRs that the Veteran experienced any injury or significant knee symptoms, problems, injuries, evaluations, or treatment during service. It was not until a clinic procedure in 2017, when both knees were injected with a viscous supplement due to subjective knee pain symptoms, that there was a clinical assessment of bilateral knee arthritis, although otherwise there was no documented assessment of right knee arthritis nor any objective findings of right knee arthritis or patella chondromalacia. The examiner indicated that the Veteran's job activities related to his post-service work, along with the normal aging changes of the right knee tissues, most likely accounted for the current right knee subjective symptom of pain, which was consistent with patellofemoral pain syndrome. Also, the number of years of in-service physical stress was greatly outweighed by the number of years of post-service physical stress. The examiner further noted that passage of many years without supporting clinical evidence of relevant signs or symptoms in the many years of post-service private clinical records and the worsening fallibility of human memory with the concomitant passage of time. It was additionally stated that the right knee patellofemoral pain syndrome was not likely to have been caused by or aggravated by the lower back and/or cervical spine conditions. Rather, in the Veteran's case, it was as likely as not due to or caused by the history of the right femur malignant lesion, resection, hardware placement, and "re-do" procedure. Also, the patellofemoral pain syndrome was less likely than not due to or secondary to the current lumbar or cervical spine conditions because the latter were not of the nature nor of the extent to pathophysiologically be the cause of the patellofemoral condition. The Veteran is competent to describe observable symptomology (e.g. pain), but his belief that his current right knee disability stems from extensive and prolonged in-service physical exertion, is a medical opinion in the guise of lay evidence and, so, he is not competent to render such an opinion, particularly since he had no in-service symptoms. Such a medical opinion was rendered, as stated above, by a competent medical professional who examined the Veteran, reviewed the record, and applied expert knowledge to the facts of this case. Unfortunately, the opinion not only weighs against the claim but is unrebutted by any other competent medical opinion and is of far greater probative value than the lay opinion of the Veteran, for the reasons explained by the recent examiner. Specifically, the absence of contemporaneous signs or symptoms in the many years of post-service private clinical records, the lapse of many years before the occurrence of the earliest symptoms, and the fallibility of memory after the passage of many years. Thus, the Board finds that the preponderance of the evidence is against finding that the Veteran's right knee disability had an onset during active duty; resulted from a disease during active duty; or that arthritis manifested within one year after service discharge. 4. Entitlement to service connection for COPD The STRs are negative for a chronic respiratory disability. A February 2015 VAOPT record noted that the Veteran quit smoking in 2000, and after service he worked heavy equipment in construction at a cement plant. Private clinical records reflect that the Veteran was treated since 2010 for respiratory symptoms. A May 2014 treatment record shows that now being retired, he was out of the dusty work environment, specifically concrete dust, and was now breathing better. A November 2014 treatment record reflects a diagnosis of COPD. A January 2020 clinical record noted that he had had lots of exposures, to include cement, having worked in a sawmill, and possible asbestos exposure. On VA Respiratory Conditions DBQ of January 2020, the Veteran was examined, and his VA electronic records were reviewed. The diagnosis was COPD, having been diagnosed in about 2012. The examiner opined that the Veteran's COPD was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there was no evidence in the STRs that the Veteran experienced any significant respiratory/COPD symptoms, problems, injuries, evaluations, or treatments, during service. This was inconsistent with any current respiratory condition, e.g., COPD, being related to service military activities or experiences. There was no apparent nexus to in-service documented events, and the record was silent as to any documented toxic level exposures jet fuel, jet fuel exhaust, and other chemicals. Any significant exposure of a hazardous nature to the lungs more likely than not would have caused immediate, severe pulmonary symptoms requiring physician level evaluations and management, none of which was documented in the STRs. The examiner noted the passage of many years without supporting clinical evidence of relevant signs or symptoms in the many years of post-service private clinical records, and the worsening fallibility of human memory with the concomitant passage of time. The Veteran's COPD was most consistent with his life activities since leaving the service; also, the number of years of in-service exposures to toxins was greatly outweighed by the number of years of post-service exposures to toxins. Again, the Veteran lacks the medical expertise to formulate such a medical opinion as to the etiology of his COPD. Such a medical opinion was rendered, as stated above, by a competent medical professional who examined the Veteran, reviewed the record, and applied expert knowledge to the facts of this case. Unfortunately, the opinion not only weighs against the claim but is unrebutted by any other competent medical opinion and is of far greater probative value than the lay opinion of the Veteran, for the reasons explained by the recent examiner. Specifically, the absence of contemporaneous signs or symptoms in the many years of post-service private clinical records, the lapse of many years before the occurrence of the earliest symptoms, and the fallibility of memory after the passage of many years. Thus, the Board finds that the preponderance of the evidence is against finding that the Veteran's COPD had an onset during active duty or resulted from a disease during active duty. 5. Entitlement to service connection for neuropathy of the right upper extremity (claimed as numbness of the right hand) 6. Entitlement to service connection for neuropathy of the left upper extremity (claimed as numbness of the left hand) STRs are negative for signs or symptoms of neuropathy of the upper extremities, including numbness of the hands. Private treatment records from 1996 to 2020 show that he had had a left finger laceration in 1992 which required sutures. Treatment records in 2011 and 2013 reflect his medical problems included degenerative disc disease of the cervical spine. In August and November 2014, he was noted to have a medical history of right-hand surgery as a child for excision of a Baker's cyst. Significantly, repeated examinations throughout 2013 and 2014, including of the neurological system, were negative for neurologic complaints or findings of the upper extremities. On VA Peripheral Nerve Conditions DBQ of January 2020, the Veteran was examined, and his VA electronic records were reviewed. The diagnoses were carpal tunnel syndrome (CTS), by personal history and self-report of the Veteran, with the date of diagnosis being about 2018; and bilateral mild ulnar neuritis of the hand, currently diagnosed. The Veteran reported a history of a right CTS diagnosis and surgical repair of approximately 2 years ago. Currently, he described some intermittent decreased sensation of the 3rd,4th, and 5th digits of each hand. He described having some decreased fine motor control/coordination, due to numbness, during grasping/holding but denied having any symptoms in the first and second digits of either hand. The examiner reported that the Veteran had mild incomplete paralysis of the median of the right hand; mild incomplete paralysis of the ulnar nerves of both hands; and mild incomplete paralysis of the lower radicular group of nerves of the right and the left hands. The examiner opined that the neuropathies of the upper extremities were less likely than not incurred in or caused by in-service injury, event, or illness. The rationale was that there was no evidence in the STRs that the Veteran experienced any significant neuropathic symptoms, problems, injuries, evaluations, or treatment during service. This was inconsistent with any current neurologic condition of the upper extremities being related to service military activities or experiences. The examiner once again noted the passage of many years without supporting clinical evidence of relevant signs or symptoms in the many years of post-service private clinical records and the worsening fallibility of human memory with the concomitant passage of time. It was opined that post-service work-related activities, along with non-occupational use of the upper extremities, most likely accounted for the development of the neurologic disorders of the upper extremities. Further, the examiner opined that with respect to whether any upper extremity neuropathy, claimed as numbness, and including bilateral ulnar neuritis and right CTS, they were less likely than not caused or aggravated by the claimed spinal conditions. The rationale was that the spinal conditions would not cause or effect, nor aggravate, the conditions of right CTS and bilateral ulnar neuritis of the hand because this was not anatomically or pathologically even remotely likely. There were no nerves from the low back that would cause or contribute to pathologic etiology of these neuropathic hand conditions. These neuropathic hand conditions were due to nerve pathology which was located solely at the level of the distal upper limbs. Although the Veteran had a Baker's cyst removed from his right hand prior to service, no residual disability was found at entrance into active service or, for that matter, at any time during active service, and it is not contended that it was aggravated during service. The only competent medical opinion as to this claim was rendered, as stated above, by a competent medical professional who examined the Veteran, reviewed the record, and applied expert knowledge to the facts of this case. Unfortunately, the opinion not only weighs against the claim but is unrebutted by any other competent medical opinion and is of far greater probative value than the lay opinion of the Veteran, for the reasons explained by the recent examiner. Specifically, the absence of contemporaneous signs or symptoms in the many years of post-service private clinical records, the lapse of many years before the occurrence of the earliest symptoms, and the fallibility of memory after the passage of many years. Thus, the Board finds that the preponderance of the evidence is against finding that the Veteran's neuropathy of the upper extremities, claimed as numbness of the hands, had their onset during active duty or resulted from a disease or injury during active duty. Lastly, although the Veteran served in Vietnam and is presumed to have been exposed to herbicides, e.g., Agent Orange, there is no evidence, lay or medical, that he had any peripheral neuropathy within one year of his last in-service exposure, as required by 38 C.F.R. § 3.307(a)(6)(ii). 7. Entitlement to an initial rating greater than 20 percent for bilateral hearing loss The Veteran contends that he is entitled to a higher rating because he has poor hearing acuity of both ears and requires the use of amplification. 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). A March 2015 VA examination reveals that the Veteran reported he had a hearing loss in both ears, with the left ear being worse. He stated he noticed about a year and half ago that the words in the left ear sounded muffled. He had to look at people to understand what they said. 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: March 2015 HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 25 35 75 70 53.75 92% LEFT 35 100 100 100 83.75 72% Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level VII in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level VII for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a noncompensable disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86(a) and (b) was not shown. A February 2017 VAOPT record noted that the Veteran was followed up for a left sided acoustic neuroma. He continued to have left sided hearing loss but denied having otalgia, otorrhea, and vertigo. Also, in that month it was noted that he used hearing aids. A January 2020 VA examination reveals that the Veteran reported he could not hear wildlife, such as birds, and that he often had to ask others to repeat what they said. However, the examiner commented that the Veteran's bilateral hearing loss should result in little to no difficulty in a quiet, face-to-face work setting, and mild to moderate difficulties in a nonface-to-face or noisy working environment, but that with the use of state of the art amplification, assistive devices, and/or vocational rehabilitation, he would be successful in any work environment. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). (Continued on the next page) The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: January 2020 HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 30 60 70 80 60 76% LEFT 50 105 105 105 91.25 52% Applying the results to Table VI, the findings yield a numeric designation of Level IV in the right ear and Level VIII in the left ear. Entering the resulting bilateral numeric designation of Level IV for the right ear and Level VIII for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 20 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86(a) and (b) was not shown. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including his difficulty hearing others and the need for amplification. 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. Doucette v. Shulkin, 28 Vet. App. 366 (2017). 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 evidence is against finding that an initial rating greater than 20 percent for bilateral hearing loss is warranted at any time during the appeal period. In reaching this conclusion, 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 v. Derwinski, 1 Vet. App. 49 (1990). L. ANDERSEN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Fussell, 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.