Citation Nr: 21032583 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 17-33 780 DATE: May 27, 2021 ORDER Entitlement to a compensable disability rating for bilateral cholesteatoma, status-post mastoidectomy, is denied. Entitlement to a disability rating in excess of 10 percent for bone loss, status-post mastoidectomy, is denied. Entitlement to a compensable disability rating for left ear hearing loss is denied. FINDINGS OF FACT 1. The Veteran's bilateral cholesteatoma, status-post mastoidectomy, is not manifested by aural polyps and there have been no confirmed episodes of suppuration. 2. The Veteran's bone loss status-post mastoidectomy is smaller than the size of a 25-cent piece or 4.619 cm2 and there is no evidence of a brain hernia. 3. The Veteran's left ear hearing loss is manifested by puretone threshold averages no higher than 35 decibels (dB) and speech recognition scores no lower than 100 percent. CONCLUSIONS OF LAW 1. The criteria for a compensable disability rating for bilateral cholesteatoma, status-post mastoidectomy, are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.31, 4.87, Diagnostic Code 6200. 2. The criteria for a disability rating in excess of 10 percent for bone loss, status-post mastoidectomy, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5296. 3. The criteria for a compensable disability rating for left ear hearing loss are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.85, 4.86 Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1986 to August 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision. In November 2019, the Veteran and his spouse testified before the undersigned Veterans Law Judge (VLJ) at a hearing. A transcript of that hearing is of record. The Veteran's claim for an increased rating was remanded by the Board in November 2019 for further development. The Board finds that there has been substantial compliance with the November 2019 remand directives. Of note, while on remand, an August 2020 rating decision granted separate ratings for bone loss status-post mastoidectomy and left ear hearing loss associated with bilateral cholesteatoma, status-post mastoidectomy. The Veteran's bone loss status-post mastoidectomy was assigned a 10 percent disability rating, effective June 3, 2015. The Veteran's left ear hearing loss was assigned a noncompensable disability rating, effective June 3, 2015. 1. Entitlement to a compensable disability rating for bilateral cholesteatoma, status-post mastoidectomy is denied. For the entire rating period on appeal, the date of the claim for an increased rating, the Veteran's service-connected bilateral cholesteatoma, status-post mastoidectomy has been assigned a noncompensable disability rating under Diagnostic Code 6200. 38 C.F.R. § 4.87. The Veteran maintains that his service-connected bilateral cholesteatoma, status-post mastoidectomy, is more disabling than reflected by the current disability rating. For the reasons discussed below, the Board finds that an increased disability rating is not warranted. VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally, 38 C.F.R. § Part IV. The 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. The percentage ratings in the Schedule for Rating Disabilities represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. All reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3; see also 38 C.F.R. § 3.102. Separate ratings for distinct disabilities resulting from the same injury or disease can be assigned so long as the symptomatology for one condition is not "duplicative or overlapping with the symptomatology" of the other condition. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009); Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). However, the evaluation of the same disability or its manifestations under various diagnoses, which is known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim, or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Under Diagnostic Code 6200 (chronic suppurative otitis media, mastoiditis, or cholesteatoma (or any combination thereof)), a single 10 percent rating is assigned during suppuration, or with aural polyps. 38 C.F.R. § 4.87, Diagnostic Code 6200. In every case where the requirements for a compensable rating are not met, a zero percent evaluation may be assigned, even if the diagnostic schedule does not provide for such a noncompensable evaluation. 38 C.F.R. § 4.31. To evaluate the Veteran's bilateral cholesteatoma, status-post mastoidectomy, he has been afforded several examinations. A July 2015 VA Ear Conditions (including Vestibular and Infectious Conditions) Disability Benefits Questionnaire states that the Veteran has a diagnosis of cholesteatoma. The Veteran does not take continuous medication for his disability and he does not have any signs or symptoms attributable to Meniere's syndrome, a peripheral vestibular condition, or another diagnosed condition. The Veteran did not have evidence of active cholesteatoma, his exterior auditory canal was clear, and he had minimal cerumen in his right ear. He did not have a benign neoplasm of the ear that causes impairment of function. On physical examination, the July 2015 examination report states that the Veteran had bilateral postauricular scars, right external auditory canal within normal limits, and left external auditory canal widened surgically, well-healed, with no evidence of active infection. His right tympanic membrane was intact, with no effusion, and somewhat mobile on Valsalva. His left tympanic membrane was scarred, with no effusion appreciated, and he was unable to mobilize on Valsalva. There was no evidence of active cholesteatoma on either side. The Veteran's gait was normal. Regarding functional impairment, because of the Veteran's disability, he lost his water safety qualifications, he has difficulty equalizing his ears when flying, and he endorsed significant pain when exposed to changing pressure. He takes Flonase as medication. A January 2016 Ear Conditions (including vestibular and infectious conditions) Disability Benefits Questionnaire states that the Veteran has a diagnosis of bilateral cholesteatoma, status-post mastoidectomy and chronic suppurative otitis media. The Veteran does not have Meniere's syndrome or endolymphatic hydrops or a peripheral vestibular disorder. The Veteran reported periods of vertigo during his ear infection. The January 2016 examination report states that the Veteran has hearing impairment with vertigo less than once per month that lasts one to 24 hours and he also has hearing impairment and tinnitus. The Veteran has dry and scaly external ear canal, hearing impairment and/or tinnitus, and thickening with sporadic sites of erythema, but he does not have active suppuration or aural polyps. He does not have a benign neoplasm of the ear that causes any impairment of function. He has periodic left ear infections as a result of the surgery he underwent in 2009. On physical examination, the January 2016 examination report provides that the Veteran's external ear is normal, he has thickening with sporadic sites of erythema on the ear canal, and he has evidence of a healed tympanic membrane perforation, bilaterally. His gait was normal, Romberg test normal or negative, Dix Hallpike test (Nylen-Barany test) for vertigo normal, no vertigo or nystagmus during test, and his Limb coordination test (finger-nose-finger) was normal. He does not have a benign or malignant neoplasm or metastases related to any of his diagnoses. The Veteran is limited functionally by all physical activities during an ear infection complicated with vertigo. The Veteran can perform light physical and sedentary activities according to the examination report. An April 2017 Report Clarification Disability Benefits Questionnaire states that the Veteran does not have either Meniere's syndrome or peripheral vestibular disorder as he has had multiple infections status-post mastoidectomy. The examination in November 2016 shows no objective evidence supporting a diagnosis of Meniere's syndrome or peripheral vestibular disorder. Lastly, the Veteran was provided a December 2019 Ear Conditions (Including Vestibular and Infectious Conditions) Disability Benefits Questionnaire. The examination report states that the Veteran has diagnoses of left ear cholesteatoma status-post mastoidectomy with prosthetic bone placement and cholesteatoma, right ear status-post mastoidectomies. The Veteran does not have diagnoses of Meniere's syndrome or endolymphatic hydrops or peripheral vestibular disorder. He reports that he has ringing in his ears and hearing loss, most prominent on the left ear and constant or daily ear discomfort and pressure. The Veteran is limited to desk work as an engineer due to risk of infections when he is out in the field and he loses two days of work a year for debridement of his ear canal. He cannot swim or partake in water-based hobbies or activities and he cannot participate in work that requires him to travel by air. The Veteran uses Flonase nasal spray to help improve inner ear dysfunction and he is given Ciprofloxacin drops for recurrent ear infection. The December 2019 examination report states that the Veteran has tinnitus that occurs more than once weekly that lasts for one to 24 hours and hearing impairment and/or tinnitus. He also has bone loss of skull of an area lost small than an American quarter (4.619 cm2). He does not have active suppuration, aural polyps, or a benign neoplasm of the ear that causes any impairment of function. As a result of surgeries that the Veteran underwent, he has chronic discomfort, pressure, recurrent ear infection, hearing loss, and tinnitus. On physical examination, the December 2019 examination report states that the Veteran has normal external ear, normal ear canal, evidence of a healed tympanic membrane perforation on the right and the left tympanic membrane was not visualized. The Veteran's gait was normal, the Romberg test was normal or negative, and the limb coordination test (finger-nose-finger) was normal. He does not have a benign or malignant neoplasm or metastases related to any of his diagnoses. The Veteran's private treatment records demonstrate several notations indicating that his mastoid cavity on the left side had keratin debris, which was removed under a microscope with surgical instruments and that there were no granulations. The private treatment records show that he has not had drainage, hearing change, or dizziness. Of note, a February 2015 private treatment record states that the Veteran reports left ear aural fullness with no drainage, pain, or vertigo. The Veteran has stable bilateral tinnitus. A July 2015 private treatment record indicates that the Veteran has been experiencing left ear pain over the pinna for the past three weeks. A March 2016 private treatment record provides that the Veteran has had very brief episodes of buzzing that last for a few seconds every 6 months in his left ear. An August 2016 private treatment record states that the Veteran reported that he has been swimming, his left ear is congested, and his hearing is down. He has a cold and his ear became clogged when he tried to clear it the prior night. He also developed yellow drainage yesterday. On physical examination, a right otomicroscopy showed a normal auditory canal, retracted tympanic membrane, and middle ear without effusion. A Left otomicroscopy showed mastoid cavity with moist keratin debris, tympanic membrane intact with hemotympanum. The Veteran had an upper respiratory infection and attempted to clear his left ear and pain and pus developed. He now has ear pain and muffled hearing. The Veteran's left ear has a hemorrhagic appearing tympanic membrane with opacification anteriorly. There is some granulations in the mastoid cavity. The Veteran's hearing is muffled, and Weber is midline. His right ear is normal. A February 2019 private treatment record demonstrates that the Veteran reports experiencing left ear pain in the jaw area. He does not have drainage, vertigo, or change in hearing. His right external auditory canal was cleaned under otomicroscope, and his tympanic membrane was intact. His left external auditory canal/mastoid was cleaned under otomicroscope, and his tympanic membrane was intact. The Veteran did not have granulations or infections and his left temporomandibular joint was non-tender. The Veteran and his spouse also described his bilateral cholesteatoma, status-post mastoidectomy symptoms. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007) (holding that lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The November 2019 hearing transcript demonstrates that the Veteran has recurrent ear infections, pressure, discomfort, pain, hearing loss, tinnitus. Additionally, as a result of the Veteran's disability, he cannot swim, surf, or boat because he will experience vertigo. Id. He cannot fly and he misses two days of work per year for debridement of the mastoid cavity. Id. He does not experience aural polyps. Id. In light of the above evidence, a 10 percent rating is not warranted for his bilateral cholesteatoma, status-post mastoidectomy. The Veteran's claims folder does not contain evidence of aural polyps or active suppuration. The Veteran is competent to report his ear symptoms, including yellow discharge or pus developing in his left ear. Barr, 21 Vet. App. at 307-08; Layno, 6 Vet. App. at 470; see also Jandreau, 492 F.3d 1372. There is no evidence that the Veteran is not credible. Further, while the November 2016 examination report states that the Veteran has a diagnosis of chronic suppurative otitis media, he does not have active suppuration. A 10 percent disability rating is only warranted during suppuration. In the absence of any objective evidence showing suppuration has occurred and the objective findings contained in the examination reports that the Veteran does not have active suppuration, the Board is unable to assign a 10 percent disability rating. The Board has considered whether separate disability ratings are warranted under another Diagnostic Code. Significantly, when rating cholesteatoma under Diagnostic Code 6200, hearing impairment and complications such as labyrinthitis, tinnitus, facial nerve paralysis or bone loss of skull are to be evaluated separately. See 38 C.F.R. § 4.87, Diagnostic Code 6200, NOTE. In this case, the Veteran is already in receipt of separate disability ratings for bone loss status-post mastoidectomy associated with cholesteatoma, status-post mastoidectomy, and left ear hearing loss, status-post mastoidectomy, associated with cholesteatoma, status-post mastoidectomy. These disabilities will be addressed below. Further, the Veteran is in receipt of separate disability ratings for tinnitus and bilateral ear surgery scars, which are not on appeal before the Board at this time. A separate compensable disability rating is not assignable under Diagnostic Codes 6204 or 6205. While a separate 10 percent disability rating may be assigned under Diagnostic Code 6204 for occasional dizziness due to a peripheral vestibular disorder, it requires that objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code. Here, objective findings do not indicate a diagnosis of vestibular disequilibrium and thus do not support a compensable rating under Diagnostic Code 6204 for peripheral vestibular disorders. The Board is mindful that the Veteran reported experiencing vertigo and vertigo with ear infections. However, the record indicates that the Veteran's gait has been normal, there is no diagnosis of Meniere's syndrome, and the record is absent of objective findings of vertigo. Therefore, a compensable disability rating under Diagnostic Code 6205, for Meniere's syndrome is not warranted. A separate disability rating is also not warranted for right ear hearing loss as the Veteran does not have a current hearing loss disability in the right ear. VA compensation purposes, hearing loss is defined as a disability when the auditory puretone threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory puretone thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is from 0 to 20 decibels; higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The auditory thresholds set forth in § 3.385 establish when hearing loss is severe enough to constitute a disability. Hensley, 5 Vet. App. at 159. The evidence from the Veteran's VA examinations during the current appellate periods does not otherwise show puretone thresholds or speech discrimination scores for the right ear satisfying VA's criteria for a hearing loss disability. See 38 C.F.R. § 3.385. In sum, the Board finds that the preponderance of the evidence weighs against entitlement to a 10 percent rating for the Veteran's bilateral cholesteatoma, status-post mastoidectomy. As such, entitlement to a compensable disability rating is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55. 2. Entitlement to a disability rating in excess of 10 percent for bone loss, status-post mastoidectomy, is denied. The Veteran's bone loss status-post mastoidectomy has been rated 10 percent disabling under Diagnostic Code 5296. 38 C.F.R. § 4.71a. Under Diagnostic Code 5296, loss of part of the skull, both inner and outer tables, and without brain hernia warrants a 10 percent rating involving an area smaller than the size of a 25-cent piece or 0.716 in2 (4.619 cm2). A 30 percent rating is warranted when the area is intermediate. A 50 percent rating is warranted when the area is larger than size of a 50-cent piece or 1.140 in2 (7.355 cm2). An 80 percent rating is warranted when there is loss of part of skull with brain hernia. 38 C.F.R. § 4.71a, Diagnostic Code 5296. An April 2016 letter written by J.D., MD, PhD, indicates that the Veteran underwent four ear surgeries for cholesteatomatwo on the right ear in 2005 and 2006 followed by two on the left ear in July 2007 and January 2011. The final surgery on the left was a canal wall down mastoidectomy. It was recommended that the Veteran not swim because cold water exposure causes vertigo because of the extensive surgery of the left ear. This resulted in loss of the Veteran's water safety qualification with the military. The Veteran also has poor Eustachian tube dysfunction, which keeps him from clearing his ear and restricts his ability to dive. While audiogram results show he suffers from mild conductive hearing loss, he is still able to discriminate words well. The Veteran also experiences subjective tinnitus, bilaterally. A May 2017 letter written by J.D., MD, PhD, states that the Veteran has been treated at his office for left ear cholesteatoma that required surgical intervention in 2007 and then again in 2011, with a left canal wall down tympanomastoidectomy and ossicular chain reconstruction placing a 3.2 Dornhoffer PORP with cradle prosthesis. The surgical intervention required minimal skull bone loss without brain herniation. The area of the skull removed is smaller than the size of a 25-cent piece or 0.716 square inches. The Veteran has continued to follow up regularly in the office for routine ear cleanings. The Veteran was provided a December 2019 Ear Conditions (Including Vestibular and Infectious Conditions) Disability Benefits Questionnaire. The examination report states that the Veteran has bone loss of skull of an area lost small than an American quarter (4.619 cm2). Here, the preponderance of the evidence does not show that the Veteran's bone loss status-post mastoidectomy warrants a disability rating in excess of 10 percent. In particular, the evidence does not demonstrate that the area of bone loss is intermediate, larger than size of a 50-cent piece or 1.140 in2 (7.355 cm2), or that he sustained a brain hernia. 38 C.F.R. § 4.71a, Diagnostic Code 5296. Consequently, the benefit-of-the-doubt rule does not apply, and a disability rating in excess of 10 percent for bone loss status-post mastoidectomy is denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55. 3. Entitlement to a compensable disability rating for left ear hearing loss is denied. The Veteran's left ear hearing loss has been evaluated as noncompensable (0 percent disability) under 38 C.F.R. § 4.85, Diagnostic Code 6100. For the reasons discussed below, the Board concludes that an increased disability rating is not warranted for the Veteran's left ear hearing loss. In evaluating hearing loss, disability ratings are derived from a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests using the Maryland CNC word list, in conjunction with the average hearing threshold, measured by puretone audiometric tests in the frequencies 1,000, 2,000, 3,000 and 4,000 cycles per second. 38 C.F.R. § 4.85, Diagnostic Code 6100. The rating schedule establishes eleven auditory acuity levels designated from Level I, for essentially normal hearing acuity, through Level XI for profound deafness. See id. VA audiometric examinations are generally conducted using a controlled speech discrimination test together with the results of a puretone audiometry test. Id. Table VI in 38 C.F.R. § 4.85 is then used to determine the numeric designation of hearing impairment based on the puretone threshold average derived from the audiometry test, and from the results of the speech discrimination test. The horizontal rows in Table VI represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. See id. The vertical columns in Table VI represent nine categories of decibel loss based on the puretone audiometry test. Id. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the horizontal row corresponding to the percentage of discrimination and the vertical column corresponding to the puretone decibel loss. Id. The percentage evaluation is derived from Table VII in 38 C.F.R. § 4.85 by intersecting the vertical column corresponding to the numeric designation for the ear having the better hearing acuity (as determined by Table VI) and the horizontal row corresponding to the numeric designation level for the ear having the poorer hearing acuity (as determined by Table VI). There are alternative criteria for certain exceptional patterns of hearing loss. Specifically, if puretone thresholds in each of the specified frequencies of 1000, 2000, 3000, and 4000 Hertz are 55 dB or more, an evaluation will be based either on Table VI or Table VIA in 38 C.F.R. § 4.85, whichever results in a higher evaluation. 38 C.F.R. § 4.86(a). Each ear will be evaluated separately. Id. When the puretone threshold is 30 dB or less at 1000 Hertz and 70 dB or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be chosen from either Table VI or Table VIA under 38 C.F.R. § 4.85, whichever results in the higher Roman numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). In the instant case, only the hearing loss in the left ear is service-connected. Under 38 C.F.R. § 4.85(f), if impaired hearing is service connected in only one ear, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation of I, subject to the provisions of § 3.383. Therefore, for the purposes of applying 38 C.F.R. § 4.85(f) to Table VII, the Board designates the non-service-connected right ear to have only, at most, Level I hearing loss. The July 2015 VA Ear Conditions (including Vestibular and Infectious Conditions) Disability Benefits Questionnaire references a May 2012 audiogram, prior to the period on appeal. The examination report states that the Veteran's left ear puretone thresholds were recorded as "CNT" (Could Not Test) as the examiner was instructed that conductive thresholds which may be able to be medically treated should be listed on the audiology compensation and pension from as CNT. The Veteran was afforded a January 2017 Hearing Loss and Tinnitus Disability Benefits Questionnaire. The Veteran's left ear hearing loss was manifested by a puretone threshold average of 35 decibels (the highest of record during the pendency of this claim) and a speech discrimination score of 100 percent (the lowest of record). Applying these values to Table VI yields a numeric designation of I for the left ear. Subject to 38 C.F.R. § 4.85(f), the Veteran's non-service-connected right ear is assigned Level I hearing. The point where designations I and I intersect on Table VII yields a 0 percent disability rating. Based on the Veteran's puretone thresholds, the alternative rating criteria are not applicable. 38 C.F.R. § 4.86(a), (b). The Veteran was also provided a January 2020 Hearing Loss and Tinnitus Disability Benefits Questionnaire. The Veteran's left ear hearing loss was manifested by a puretone threshold average of 28 decibels and a speech discrimination score of 100 percent. Applying these values to Table VI yields a numeric designation of I for the left ear. Subject to 38 C.F.R. § 4.85(f), the Veteran's non-service-connected right ear is assigned Level I hearing. The point where designations I and I intersect on Table VII yields a 0 percent disability rating. Based on the Veteran's puretone thresholds, the alternative rating criteria are not applicable. 38 C.F.R. § 4.86(a), (b). During the November 2019 hearing, the Veteran and his spouse advised that he struggles with hearing others while they are speaking. In this regard, the evaluation of hearing loss under the schedular criteria is based on the results of a puretone audiometry test and a controlled speech discrimination test. 38 C.F.R. § 4.85(a). These tests contemplate the functional effects of difficulty hearing and understanding speech in various contexts. Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017) (holding that the "rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are precisely the effects that VA's audiometric tests are designed to measure"). Accordingly, the Veteran's difficulty hearing and understanding speech in various contexts, as well as the effects of this difficulty on his ability to communicate, is adequately contemplated by the schedular criteria. Doucette, 28 Vet. App. at 369 (holding that "when a claimant's hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the schedular rating criteria"). In sum, the preponderance of the evidence weighs against assignment of a compensable disability rating for the Veteran's left ear hearing loss. Consequently, the benefit-of-the-doubt rule does not apply, and a compensable disability rating is for left ear hearing loss is denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sean Mussey, 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.