Citation Nr: 22017201 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 15-14 894A DATE: March 24, 2022 ORDER Entitlement to a 60 percent rating, but no higher, for coronary artery disease (CAD) for the period from October 19, 2012 to December 10, 2015, for accrued benefits purposes (substituted), is granted. Entitlement to a 100 percent rating for CAD for the period from December 11, 2015, for accrued benefits purposes (substituted), is granted. Entitlement to an initial rating in excess of 10 percent for CAD for the period prior to October 19, 2012, for accrued benefits purposes (substituted) is denied. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD), for accrued benefits purposes (substituted), is denied. Entitlement to an initial compensable rating for the period prior to March 25, 2015, and a rating in excess of 10 percent thereafter, for bilateral hearing loss, for accrued benefits purposes (substituted), is denied. Entitlement to an extraschedular total disability rating based on individual unemployability (TDIU) award for the period from August 31, 2010 to May 1, 2011, for accrued benefits purposes (substituted), is denied. FINDINGS OF FACT 1. For the period from October 19, 2012 to December 11, 2015, the Veteran's CAD resulted in left ventricular dysfunction with an ejection fraction of 49 percent. 2. For the period from December 11, 2015 to the Veteran's death, his CAD resulted in heart failure symptoms at a workload of one to three metabolic equivalents (METs). 3. For the period prior to October 19, 2012, the Veteran's CAD caused a left ventricular ejection fraction (LVEF) of no worse than 52 percent and a maximum workload of no less than 7.1 METs. 4. Throughout the rating period on appeal, the Veteran's PTSD was productive of no worse than occupational and social impairment with reduced reliability and productivity to such symptoms as flattened affect, impaired judgment, disturbances of motivation and mood, mild memory loss, depressed mood, anxiety, and suicidal ideation. 5. For the period prior to March 25, 2015, the Veteran had no worse than Level I hearing loss in the right and left ears. 6. For the period from March 25, 2015 until the Veteran's death, he had no worse than Level III hearing loss in the right ear and Level VI hearing loss in the left ear. 7. For the period from August 31, 2010 to May 1, 2011, the Veteran's CAD has not been shown to have caused marked interference with employment or render the Veteran unable to secure and maintain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a 60 percent rating, but no higher, for CAD for the period from October 19, 2012 to December 10, 2015, for accrued benefits purposes, have been met. 38 U.S.C. §§ 1100, 5107; 38 C.F.R. §§ 4.1, 4.104, Diagnostic Code 7005. 2. The criteria for a 100 percent rating for coronary artery disease (CAD) for the period from December 11, 2015, for accrued benefits purposes, have been met. 38 U.S.C. §§ 1100, 5107; 38 C.F.R. §§ 4.1, 4.104, Diagnostic Code 7005. 3. The criteria for an initial rating in excess of 10 percent for the period prior to October 19, 2012, for CAD, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1100, 5107; 38 C.F.R. §§ 4.1, 4.104, Diagnostic Code 7005. 4. The criteria for an initial rating in excess of 50 percent for PTSD, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411. 5. The criteria for an initial compensable rating, and a rating in excess of 10 percent for the period from March 25, 2015, for bilateral hearing loss, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1155, 5100, 5102, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.10, 4.85, Diagnostic Code 6100, 4.86. 6. The criteria for an extraschedular TDIU award for the period from August 31, 2010 to May 1, 2011, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from June 1960 to June 1986. The Veteran died in October 2019. The Appellant is his surviving spouse. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO) in February 2012 and October 2012. In the February 2012 rating decision, the RO granted service connection for PTSD, depressive disorder, and cognitive disorder and assigned an initial disability rating of 50 percent, effective May 2, 2011, and granted service connection for bilateral hearing loss and assigned a noncompensable rating, effective May 2, 2011. In the October 2012 rating decision, the RO ranted service connection for CAD status post coronary artery bypass graft and assigned a 10 percent disability rating, effective August 31, 2010. In a January 2013 rating decision, the RO assigned a 30 percent rating for the Veteran's CAD, effective November 15, 2012. In a May 2015 rating decision, the RO granted a 10 percent rating for hearing loss, effective March 25, 2015, and granted entitlement to a TDIU, effective November 15, 2012. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at an October 2018 hearing. A copy of the hearing transcript has been reviewed and associated with the claims file. The Appellant filed a VA Form 21-534EZ, Application for DIC, Survivors Pension, and/or Accrued Benefits in October 2019. In April 2020, the Appellant was informed that she has been substituted as the claimant in this appeal for the purpose of accrued benefits. In a May 2020 rating decision, the RO granted an effective date of May 2, 2011 for the Veteran's TDIU award. Increased Ratings for Accrued Benefits Purposes When a Veteran dies with an outstanding claim for VA benefits that was awaiting a decision, a claim for accrued benefits may be filed. 38 U.S.C. § 5121. Accrued benefits are the monetary sums which the Veteran was legally entitled to receive from VA at the time of his death but were unpaid. Upon the death of the Veteran, all benefits which are properly payable shall be paid to the Veteran's spouse, if living. 38 U.S.C. § 5121(a); 38 C.F.R. § 3.1000(a). Disability evaluations are determined by the application of the Schedule for Rating Disabilities (Rating Schedule), which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of life, including employment, by comparing his symptomatology with the criteria set forth in the Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In the case of an initial rating, the entire evidentiary record from the time of a Veteran's claim of service connection to the present is of importance in determining the proper evaluation of disability, and staged ratings are to be considered in order to reflect the changing level of severity of a disability during this period. Fenderson v. West, 12 Vet. App. 119 (1999). However, where entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Additionally, the Board must consider whether the disability has undergone varying and distinct levels of severity while the claim has been pending and provide staged ratings during those periods. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or if there is an approximate balance of positive and negative evidence, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Lynch v. McDonough, 999 F.3d 1391, 1394-95 (Fed. Cir. 2021). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. §§ 4.7, 4.21. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the appellant. 38 C.F.R. § 4.3. 1. Entitlement to a rating in excess of 10 percent for the period from October 19, 2012 to November 14, 2012 and in excess of 30 percent for the period from November 15, 2012 for CAD, for accrued benefits purposes Prior to his death, the Veteran's CAD was assigned an initial disability rating of 10 percent and a rating of 30 percent effective November 15, 2012, pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7005. VA recently amended the rating criteria for cardiovascular disabilities, effective November 14, 2021. The General Counsel of VA has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the appellant. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. As such, VA must generally consider the claim pursuant to both versions during the course of an appeal. See VAOPGCPREC 3-2000; 65 Fed. Reg. 33422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Under the pre-November 14, 2021 rating criteria, Diagnostic Code 7005 assigned a 10 percent disability rating if a workload of greater than 7 metabolic equivalents (METs) results in dyspnea, fatigue, angina, dizziness, or syncope; or if continuous medication is required. A 30 percent rating was assigned if a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or for evidence of cardiac hypertrophy or dilatation shown on an electrocardiogram, echocardiogram, or x-ray. A 60 percent rating was awarded for more than one episode of acute congestive heart failure in the past year; or if a workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or for left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating was assigned for chronic congestive heart failure; or if a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; or for left ventricular dysfunction with an ejection fraction of less than 30 percent. Under the current criteria of 38 C.F.R. § 4.104, Diagnostic Code 7005 is rated under the General Rating Formula for Diseases of the Heart. The formula assigns a 10 percent rating if a workload of 7.1 to 10.0 METs results in heart failure symptoms; or if continuous medication is required for control of CAD. A 30 percent rating is awarded if a workload of 5.1 to 7.0 METs results in heart failure symptoms; or if there is evidence of cardiac hypertrophy or dilatation confirmed by an echocardiogram or equivalent. A 60 percent rating is assigned if a workload of 3.1 to 5.0 METs results in heart failure symptoms. Finally, a 100 percent rating is awarded if a workload of 3.0 METs or less results in heart failure symptoms. Note (3) to 38 C.F.R. § 4.104 stipulates that "heart failure symptoms" include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrythmia, palpitations, or syncope. The Veteran's private treatment records indicate that a stress test was performed on October 19, 2012, which resulted in a LVEF of 49 percent. The Veteran underwent a VA cardiovascular examination in November 2012. The examiner conducted an interview-based METs test and found that a workload of greater than 5 METs but not greater than 7 METs resulted in dyspnea. He had a LVEF of 55 to 60 percent. The examiner noted the presence of cardiac hypertrophy or dilatation. No congestive heart failure was noted. The Veteran underwent another VA examination in March 2015. The examiner noted the presence of cardiac hypertrophy as shown on an echocardiogram. The Veteran's LVEF was 58 percent. An interview-based METs test revealed that a workload of greater than 5 METs but not greater than 7 METs resulted in dyspnea, fatigue, and dizziness. No congestive heart failure was noted. The Veteran's private treatment notes indicate that he underwent a catheterization procedure on December 11, 2015 after he reported that his dyspnea on exertion had worsened. The treating physician indicated that the Veteran had severe triple-vessel CAD. He underwent a percutaneous coronary intervention (PCI) procedure in August 2018 and had additional stents placed in September 2018. The Veteran underwent another VA examination in April 2019. He had a LVEF of 55 percent, and an interview-based METs test indicated that he experienced dyspnea at a workload of 1 to 3 METs. Based on the relevant evidence of record, the Board finds that the Veteran's CAD warranted a 60 percent rating, effective October 19, 2012, and a 100 percent rating, effective December 11, 2015. A 60 percent rating is assigned from October 19, 2012, the date that a non-VA stress test produced a LVEF of 49 percent. The pre-November 14, 2021 rating criteria for Diagnostic Code 7005 provide that a 60 percent rating is warranted for a LVEF of 30 to 50 percent. 38 C.F.R. § 4.104. Prior to December 11, 2015, a 100 percent rating is not warranted under either the pre-November 14, 2021 rating criteria or the current General Formula for Diseases of the Heart. In this regard, the Veteran has not been shown to have had chronic congestive heart failure at any time during that period and there are no VA or private medical records indicating that a workload of 3 METs resulted in dyspnea, fatigue, angina, dizziness, syncope, or any other heart failure symptoms. Further, there are no medical records indicating that he had a LVEF of less than 30 percent at any time during the rating period. Therefore, a 60 percent rating, but no higher, granted for accrued benefits purposes for the period from October 19, 2012 to December 10, 2015. A 100 percent rating is warranted for the Veteran's CAD for the period beginning December 11, 2015. At the April 2019 VA examination, the examiner indicated that a workload of 1 to 3 METs resulted in dyspnea. This finding warrants a 100 percent rating under both the current and pre-November 14, 2021 rating criteria for CAD. 38 C.F.R. § 4.104. The effective date of December 11, 2015 is assigned for this award because that is the earliest date at which a worsening of symptomatology is shown to have occurred. The private treatment record on that date indicates that the Veteran reported worsening dyspnea with exertion and underwent a catheterization procedure, which resulted in a finding of severe CAD. This worsening is further indicated by the August 2018 PCI procedure and September 2018 stent placement. A review of the claims file did not show any VA cardiovascular examinations or stress tests performed between December 11, 2015 and the April 2019 examination. Therefore, the Board resolves any reasonable doubt in the Appellant's favor and finds that a 100 percent rating is warranted for accrued benefits purposes for the period beginning December 11, 2015. 38 C.F.R. §§ 3.1000, 4.3, 4.104, Diagnostic Code 7005. 2. Entitlement to an initial rating in excess of 10 percent for the period prior to October 19, 2012 for CAD, for accrued benefits purposes As indicated above, the Veteran's service-connected CAD was assigned an initial rating of 10 percent, effective from August 31, 2010, pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7005. The Veteran's private treatment records indicate that he underwent stress tests in December 2004, March 2006, March 2007, April 2009, and November 2011. His LVEF was 52 percent in 2004, 64 percent in 2006, 55 percent in 2007, 59 percent in April 2009, and 54 percent in November 2011. METs testing conducted in March 2007, April 2009, and November revealed a maximum workload of 10.1, 10.2, and 7.1 METs, respectively. As indicated in the preceding section of this decision, an October 19, 2012 stress test resulted in a LVEF of 49 percent, and a November 2012 VA examination noted that a workload of greater than 5 METs but not greater than 7 METs resulted in dyspnea. The Board finds that an initial CAD disability rating in excess of 10 percent is not warranted for the period prior to October 19, 2012. In this regard, while no VA examination was performed until November 2012, the Veteran's medical records throughout the period prior to October 19, 2012 (including those dated prior to the date of service connection on August 31, 2010) do not indicate that his CAD had progressed to the severity reflected in the October 2012 stress test and November 2012 VA examination. Prior to October 19, 2012, the Veteran's LVEF was no lower than 52 percent, and his maximum workload was no lower than 7.1 METs. These medical findings are consistent with a 10 percent rating under both the current and pre-November 14, 2021 rating criteria for Diagnostic Code 7005. 38 C.F.R. § 4.104. A higher rating of 30 percent is not warranted for the period prior to October 19, 2012 because the evidence fails to demonstrate that a workload of 7 METs or less resulted in dyspnea, fatigue, angina, dizziness, syncope, or other heart failure symptoms, and there is no evidence of cardiac hypertrophy or dilatation during this period. Additionally, 60 and 100 percent ratings are not warranted for this period because there is no evidence of congestive heart failure or a LVEF of 50 percent or less. Therefore, under both the previous and current rating criteria for 38 C.F.R. § 4.104, Diagnostic Code 7005, an initial disability rating in excess of 10 percent is not warranted for the Veteran's CAD for the period prior to October 19, 2012. In denying the claim, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence persuasively weighs against the claim, that doctrine is not applicable. 38 U.S.C. § 5107; see Lynch v. McDonough, 999 F.3d 1391, 1394-95 (Fed. Cir. 2021). 3. Entitlement to an initial rating in excess of 50 percent for PTSD for accrued benefits purposes Throughout the rating period on appeal, or from May 2, 2011 until his death in October 2019, the Veteran was in receipt of a 50 percent rating for his service-connected PTSD pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. Diagnostic Code 9411 applies the General Rating Formula for Mental Disorders. Under the General Rating Formula, a 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once per week; difficulty in understanding complex commands; impairment of short- and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a worklike setting; and inability to establish and maintain effective relationships. Finally, a 100 percent rating is awarded for total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. The nomenclature employed in the General Rating Formula is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, of the American Psychiatric Association (DSM-5). 38 C.F.R. § 4.130. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b). Also, the factors listed in the rating criteria are simply examples of the type and degree of symptoms, or their effects, that would justify a particular rating; analysis should not be limited solely to whether a Veteran exhibited the symptoms listed in the rating scheme. Rather, the determination should be based on all of a Veteran's symptoms affecting his level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002); see also 38 C.F.R. § 4.126(a). "[A] veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). A private medical record dated in February 2011 indicates that the Veteran and the Appellant reported that he was having memory problems. The treating physician indicated that the Veteran had pseudodementia causing some memory loss, secondary to anxiety and depression. The Veteran underwent a VA psychiatric examination in October 2011. The examiner recorded the following symptoms: depressed mood, anxiety, suspiciousness, panic attacks weekly or less often, mild memory loss, impaired judgment, and suicidal ideation. He opined that these symptoms were mild or transient, or that they were controlled by medication. The Veteran reported that he talked to his wife and adult children every day. He also indicated that he talked to and visited with neighbors and church members, but that he often preferred being alone. Another VA examination was conducted in March 2015. The examiner opined that the Veteran's symptoms of depressed mood, anxiety, mild memory loss, and flattened affect were mild or transient, or that they were controlled by medication. The Veteran was noted as being friendly and having good hygiene and grooming, adequate concentration, with no perceptual disturbances or thought disorders. He had indicated feeling a little more depressed lately. The Veteran underwent a final VA psychiatric examination in April 2019. The examiner opined that his symptoms of depressed mood, anxiety, impairment of short- and long-term memory, and disturbances of motivation and mood were productive of occupational and social impairment with reduced reliability and productivity. The Veteran reported that he lived with his wife and had frequent contact with his three adult children, two grandchildren, and friends. He had adequate grooming, hygiene, speech, and thought process, though the examiner reported that a score of 22 out of 30 on the Montreal Cognitive Assessment (MoCA) indicated at least mild cognitive impairment. The Board finds that the severity, frequency, and duration of the Veteran's PTSD symptoms most closely approximated the criteria for a 50 percent rating. During the rating period on appeal, he was shown to have depression, anxiety, memory problems, flattened affect, panic attacks, impaired judgment, suicidal ideation, and disturbances of motivation and mood. VA examiners in October 2011, March 2015, and April 2019 opined that these symptoms were productive of no worse than occupational and social impairment with reduced reliability and productivity. A higher rating of 70 percent or 100 percent is not warranted because the type, severity, frequency, and duration of the Veteran's symptoms do not rise to the levels contemplated by those ratings. Although the October 2011 examination notes suicidal ideation, the examiner stated that the Veteran's symptoms were controlled by his medication and/or were mild or transient, not causing occupational or social impairment. He was noted at each examination to have good hygiene and grooming, and he reported frequent contact with family, friends, and neighbors. The Veteran's PTSD disability picture did not closely approximate the criteria for a 70 or 100 percent rating because it has not been shown to produce any worse than occupational and social impairment with reduced reliability and productivity. Further, his noted symptoms, other than suicidal ideation, are not similar to those contemplated by the 70 or 100 percent disability rating criteria. Therefore, the Board finds that a rating higher than 50 percent for PTSD is not warranted for accrued benefits purposes. 38 C.F.R. § 4.130, Diagnostic Code 9411. In denying the claim, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence persuasively weighs against the claim, that doctrine is not applicable. 38 U.S.C. § 5107; see Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307, at *10 (Fed. Cir. Dec. 17, 2021); 38 C.F.R. § 3.102. 4. Entitlement to an initial compensable rating, and a rating in excess of 10 percent for the period from March 25, 2015, for bilateral hearing loss, for accrued benefits purposes The Veteran's hearing loss was assigned an initial noncompensable rating, and a 10 percent rating effective March 25, 2015, pursuant to Diagnostic Code 6100. Under Diagnostic Code 6100, evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairments of hearing acuity as measured by the results of controlled speech discrimination tests (Maryland CNC) 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). To evaluate the degree of disability from bilateral service-connected defective hearing, the Rating 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, Diagnostic Code 6100. 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, 349 (1992). 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. 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. 38 C.F.R. § 4.86(a). 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. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b). Table VIA will be used when the examiner certifies that the use of the Maryland CNC is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of 30 C.F.R. §§ 4.85(c), 4.86. The Veteran underwent a VA examination in October 2011. His hearing thresholds were as follows: HERTZ 1000 2000 3000 4000 RIGHT 10 20 25 40 LEFT 15 25 60 65 The pure tone average was 24 (23.75) decibels in the right ear and 41 (41.25) decibels in the left ear. Speech discrimination scores were 96 percent in the right ear and 94 percent in the left ear. These findings translate to Level I hearing loss bilaterally. 38 C.F.R. § 4.85, Table VI. Applying Table VII, this equates to a noncompensable disability rating. Based on the above evidence, the exceptional patterns of hearing impairment under 38 C.F.R. § 4.86 are not for application. The Veteran underwent another VA audiological examination in March 2015. His hearing thresholds were as follows: HERTZ 1000 2000 3000 4000 RIGHT 20 30 35 70 LEFT 35 60 60 70 The pure tone average was 39 (38.75) decibels in the right ear and 56 (56.25) decibels in the left ear. Speech discrimination scores were 80 percent in the right ear and 72 percent in the left ear. These findings translate to Level III hearing loss in the right ear and Level V hearing loss in the left ear. 38 C.F.R. § 4.85, Table VI. Applying Table VII, this equates to a 10 percent disability rating. Based on the above evidence, the exceptional patterns of hearing impairment under 38 C.F.R. § 4.86 are not for application. The claims file contains a non-VA audiological evaluation conducted in May 2017. His hearing thresholds were as follows: HERTZ 1000 2000 3000 4000 RIGHT 20 25 40 60 LEFT 20 45 60 75 The pure tone average was 36 (36.25) decibels in the right ear and 50 decibels in the left ear. The evaluation also contains speech audiometry percentages, with 88 percent in the right ear and 84 percent in the left ear. However, the report does not specify whether the Maryland CNC test was used, as is required under 38 C.F.R. § 4.85(a). Accordingly, the Board is unable to utilize these evaluation results in its assessment of hearing impairment for VA purposes. However, even if the Board were to assume that the Maryland CNC was used, the findings would not result in a higher evaluation. Applying Table VI, the findings would equate to Level II hearing loss in both ears. Under Table VII, this equates to a noncompensable rating. The Veteran underwent a final VA examination in April 2019. His hearing thresholds were as follows: HERTZ 1000 2000 3000 4000 RIGHT 25 50 65 80 LEFT 30 70 80 80 The pure tone average was 55 decibels in the right ear and 65 decibels in the left ear. Speech discrimination scores were 94 percent in the both ears. Applying Table VI, these findings translate to Level I hearing loss in the right ear and Level II hearing loss in the left ear. However, the left ear presents an exceptional pattern of hearing impairment, as the pure tone threshold was 30 decibels at 1000 Hertz and 70 decibels at 2000 Hertz. 38 C.F.R. § 4.86(b). Under Table VIa, the Veteran's left ear presented Level V hearing loss. 38 C.F.R. § 4.86(b) prescribes that the next highest numeral will be used for this exceptional pattern of hearing loss; therefore, his left ear presented Level VI hearing loss. Applying Table VII, this equates to a noncompensable disability rating. In sum, the audiological examinations of record do not support a compensable disability rating for hearing loss prior to March 25, 2015 or a rating in excess of 10 percent for the period from that date until the Veteran's death. The Board acknowledges the impact that the Veteran's hearing loss had on his daily activities and VA's obligation to resolve all reasonable doubt in the Appellant's favor. However, given that the assignment of disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometry evaluations are rendered, there is no doubt as to the proper evaluation to assign. Lendenmann, 3 Vet. App. at 349; 38 C.F.R. § 4.85, Tables VI, VIA, and VII, Diagnostic Code 6100. Applying the audiological test results most favorable to the Veteran to the regulatory criteria, the Board is compelled to conclude that an initial compensable rating and a rating in excess of 10 percent from March 25, 2015 are not warranted for the Veteran's bilateral hearing loss for accrued benefits purposes. 5. Entitlement to an extraschedular TDIU award for the period from August 31, 2010 to May 1, 2011, for accrued benefits purposes A total disability rating due to individual unemployability (TDIU) may be granted where the schedular rating is less than 100 percent if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16(a), 4.19, 4.25. Generally, to be eligible for a TDIU, a schedular percentage threshold must be met. If there is only one service-connected disability for TDIU purposes, it must be rated at least 60 percent disabling. If there are two or more service-connected disabilities, there must be at least one disability rated at 40 percent or more and enough additional disabilities to bring the combined overall rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In determining employability for VA purposes, consideration is given to the level of education, special training, and work experience, but not to age or non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16(a), 4.19; see also Faust v. West, 13 Vet. App. 342 (2000). The question is whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). The Veteran does not have to be 100 percent unemployable in order to be entitled to a TDIU. Robertson v. Principi, 251 F. 3d 1378, 1385 (Fed. Cir. 2001). Where there is an approximate balance of positive and negative evidence as to any issue, all reasonable doubt will be resolved in favor of the Veteran. 38 U.S.C. § 5107. An extraschedular TDIU may be assigned in exceptional cases to a veteran who is found to be unemployable because of service-connected disabilities but does not meet the percentage standards set forth in § 4.16(a). In such cases, the rating authority must refer the matter to the Director, Compensation Service for extraschedular TDIU consideration. 38 C.F.R. § 4.16(b). The Board notes that the RO granted a TDIU, effective May 2, 2011, in a May 2020 rating decision. However, this does not constitute a full grant of the benefit sought on appeal, as the rating period on appeal began on August 31, 2010 with respect to the Veteran's CAD rating. Prior to May 2, 2011, the Veteran was service-connected for CAD only, and he was assigned an initial rating of 10 percent. Therefore, he did not meet the schedular criteria for a TDIU award. 38 C.F.R. § 4.16(a). The Veteran submitted an undated Disability Benefits Questionnaire (DBQ), in which the examiner opined that his CAD did not impact his ability to work. The earliest VA examination for CAD was conducted in November 2012. The examiner opined that the Veteran's CAD impacted his ability to work by restricting him from lifting more than 40 pounds and walking for more than three to four miles per day. However, the examiner stated that his heart disease did not prevent him from maintaining gainful employment, as he was capable of light duty and desk job obligations. The examination report indicates that the Veteran had last worked approximately six to eight years earlier. The issue of entitlement to a TDIU award was sent to the Director for extraschedular consideration. In April 2020, the Director stated that an extraschedular TDIU award was warranted, effective May 2, 2011. The RO granted an extraschedular TDIU effective from that date in May 2020. (Continued on the next page) After considering the relevant evidence, the Board finds that an extraschedular TDIU award is not warranted for the period prior to May 2, 2011. In this regard, there is no evidence that his CAD, alone, caused marked interference with his employment prior to May 2, 2011. Further, the November 2012 examiner indicated that he was capable of light duty or sedentary work, and the undated DBQ indicates that the Veteran's CAD did not affect his ability to work. Therefore, the evidence persuasively weighs against a finding that the Veteran's CAD caused marked interference with employability or rendered the Veteran unemployable prior to May 2, 2011. Therefore, an extraschedular TDIU prior to that date is denied for accrued benefits purposes. 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19, 4.25. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Pratt 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.