Citation Nr: 22017746 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 16-36 680 DATE: March 26, 2022 ORDER Entitlement to an increased disability evaluation for sinusitis of 50 percent, but no higher, prior to December 13, 2021, is granted. Entitlement to an increased disability evaluation for PTSD of 50 percent, but no higher, is granted. Entitlement to service connection for rhinitis is granted. Entitlement to service connection for bilateral hearing loss disability is denied. FINDINGS OF FACT 1. The competent and probative medical evidence of record supports that the Veteran had sinus related headaches, constant drainage, and underwent sinus surgery prior to December 13, 2021. 2. For the entire initial rating period, the Veteran's PTSD has been manifested by symptoms including anxiety, chronic sleep impairment, depressed mood, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships with suicidal ideation that did not result in occupational and social impairment with deficiencies in most areas. 3. The Veteran has a diagnosis of rhinitis that is secondary to the service-connected disability of sinusitis. 4. The competent and probative medical evidence persuasively weighs against a finding that the Veteran has current left ear hearing loss disability for VA compensation and pension purposes. 5. The Veteran has a current right ear hearing loss condition that meets the VA guidelines, preexisted active service but was not aggravated thereby. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased disability evaluation for sinusitis to 50 percent, but no higher, prior to December 13, 2021, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.97, DC 6513. 2. The criteria for entitlement to an increased disability evaluation for PTSD to 50 percent, but no higher, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.130, DC 9411. 3. The criteria for entitlement to service connection for rhinitis have been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.310. 4. The criteria for entitlement to service connection for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1110, 1111, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 1983 to July 1988, from December 2001 to July 2003, and from January 2004 to December 2004, with additional periods of active duty for training (ACDUTRA) in the Army National Guard. These issues were previously before the Board which issued a decision in March 2019 denying an increased disability rating for PTSD and sinusitis and denied entitlement to service connection for bilateral hearing loss. The Veteran appealed the decision to the Court of Appeals for Veterans Claims (Court) and in a March 2021 memorandum decision, the Court set aside the Board's determinations and remanded the issues for further development and readjudication. The Board remanded the issues in a November 2021 decision directing the RO to obtain records presented at the CAVC hearing, as well as VA examinations for sinusitis, PTSD, and hearing loss, and send the Veteran a notice informing him of the requirements under 38 C.F.R. § 3.385 for hearing impairment. Additional medical records are in the claims file, the Veteran underwent the requested VA examinations and the examiners provided opinions as directed, and the RO mailed the Veteran the hearing loss notice. Therefore, the Board considers the remand development as substantially complete and no further action to ensure compliance with the remand directive is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating 1. Entitlement to an increased disability evaluation for sinusitis to 50 percent, but no higher, prior to December 13, 2021 The Veteran contends that his sinusitis disability was worse than the assigned noncompensable evaluation assigned prior to December 13, 2021. The Board notes that the RO issued a decision grating an increase to 50 percent for sinusitis from December 13, 2021. The RO then issued a supplemental statement of the case (SSOC) in January 2022 which did not include the issue of an increased rating in excess of 50 percent prior to December 13, 2021. A veteran is presumed to be seeking the maximum possible evaluation. AB v. Brown, 6 Vet. App. 35 (1993). Accordingly, this issue should have been included in the statement of the case. However, under Diagnostic Code 6513 for sinusitis, the maximum rating evaluation is 50 percent. The Board herein is granting entitlement to the maximum schedular evaluation prior to December 13, 2021, and the Veteran was already granted the maximum from that date, accordingly, the Veteran is not prejudiced by the omission of this issue in the SSOC. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. If there is a question as to which evaluation to apply to the Veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Given the nature of the present claim for a higher initial evaluation, the Board has considered all evidence of severity since the effective date for the award of service connection. Fenderson v. West, 12 Vet. App. 119 (1999). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings are sufficiently characteristic to identify the disease and the resulting disability and coordination of rating with impairment of function. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of his disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). The Veteran is currently rated at a noncompensable evaluation for sinusitis prior to December 13, 2021, and at 50 percent from that date under DC 6513. Under DC 6513, sinusitis is noncompensable when detected by x-ray only, with no compensable symptoms. A 10 percent rating is warranted if the condition is manifested by one or two incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment; or by three to six non-incapacitating episodes per year characterized by headaches, pain, and purulent discharge or crusting. Id. A 30 percent rating is warranted if the condition is manifested by three or more incapacitating episodes per year requiring prolonged antibiotic treatment; or by more than six non-incapacitating episodes per year characterized by headaches, pain, and purulent discharge or crusting. A maximum 50 percent rating is warranted if there is chronic osteomyelitis following radical surgery; or near constant sinusitis characterized by headaches, pain, and tenderness of an affected sinus, and purulent discharge or crusting after repeated surgeries. The Veteran had sinus surgery in 2002. In a December 2013 VA examination, the Veteran reported constant drainage and sore throat. The examiner confirmed sinusitis diagnosis. The Veteran reported no incapacitating episodes in the prior year. A CT scan noted mild chronic sinus disease. The examiner did not mark headaches as a symptom. In the November 2017 VA examination, the examiner noted symptoms included episodes of sinusitis, tenderness of affected sinus, and purulent discharge, but did not mark headaches. The examiner recorded that, "veteran has not had a flare of sinusitis requiring antibiotics for about 3 years; has periodic tenderness over the maxillary sinus; has nighttime postnasal drip leading to sore throat, as a result of surgery and fee [sic] flowing secretions." The Veteran reported no incapacitating episodes in the prior year. A new CT scan noted no substantial change as compared to prior study. In a December 2021 VA examination report, the examiner explained, in response to the Board's prior remand directive inquiring about the presence of headaches, "The veteran has frequent sinus related headaches. He states he has pain more days than not. Pain is in front of head, with pressure. The veteran does not indicate any headache symptoms that are indicative of migraines or tension headaches. He has not been noted to have complained of headaches to providers. It was as if the veteran is so accustomed to having them that he fails to mention it. He listed his symptoms, and headache was not one of the symptoms he listed. When asked about headaches specifically, he said he has them 'all the time.'" The examiner further explained, "The veteran has pain related to sinus pressure. His description of the pain and its location, with the absence of symptoms that would indicate migraine or tension headaches lead to the conclusion that his headaches are related to sinusitis." Based on the December 2021 medical opinion, the Board finds that the Veteran's sinusitis has manifested throughout the appeal period in near constant sinusitis, with occasional sinus infections, constant drainage, purulent discharge, to include headaches associated with sinusitis. The Veteran has had sinus surgery. Accordingly, the Board finds that the Veteran's sinusitis most closely approximates the 50 percent evaluation rating under the associated Diagnostic Code and grants the appeal of an increased rating during the appeal period prior to December 13, 2021. 2. Entitlement to an increased disability evaluation for PTSD The Veteran contends that the symptoms of his posttraumatic stress disorder (PTSD) are worse than the currently assigned initial 30 percent disability evaluation. After a thorough review of the evidence, the Board finds that a 50 percent evaluation, but no higher, is warranted for the Veteran's PTSD. Under the General Formula for Rating Mental Disorders, a 30 percent rating is assigned when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactory, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; or mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130. The next-higher 50 percent rating is warranted where the disorder is manifested by 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 a week); difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where there is 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 ideations; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when there is 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; memory loss for names of close relatives, own occupation, or own name. Id. Evaluation under 38 C.F.R. § 4.130 is symptom-driven, meaning that symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The nomenclature employed in the portion of VA's rating schedule that addresses service-connected psychiatric disabilities is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV). See 38 C.F.R. § 4.130. The Board notes VA implemented usage of the DSM-5, effective August 4, 2014. When evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126(a). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). When evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board remanded this issue previously in order to obtain a medical opinion that parsed out some of the previously mentioned behaviors in VA examinations that did not seem to be accounted for in the symptomatology assigned, as discussed in the Court's decision. VA conducted this examination in December 2021. The Veteran was afforded a VA psychiatric examination in September 2014. The examiner noted that the Veteran reported difficulty sleeping, being easily irritated and angry but not aggressive, avoided social situations, and had recurrent thoughts about incidents that formed the basis of the PTSD diagnosis. The Veteran reported no trouble with concentration. The Veteran described his home life as "always been bad." The examiner recorded that the Veteran's home life has significant personality conflicts and frequent arguments with the Veteran reporting that there are not any family members with whom he relates well but does have a couple friends with whom he had infrequent contact. The examiner evaluated the Veteran's PTSD as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, which equates to a 10 percent disability rating. The symptoms included depressed mood, anxiety, and sleep impairment. The Veteran was afforded a VA psychiatric examination in March 2016. The examiner noted that the Veteran reported staying at home in lieu of attending social activities, difficulty sleeping, being impatient and irritable with suspiciousness, and being easily angered. The examiner evaluated the Veteran's PTSD as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, which equates to a 10 percent disability rating. The symptoms included depressed mood, anxiety, suspiciousness, and sleep impairment. The Veteran reported that he had not sought mental health treatment since the prior VA examination. The Veteran had been on Trazodone to help him sleep, but he had since stopped taking it due to the side effects. The Veteran reported drinking alcohol regularly, six out of seven days per week. The Veteran reported that he lived with his wife and adult son but did not have a positive relationship with them. Additionally, his marriage has deteriorated due to his prostate cancer. The Veteran has sisters that he sees about once per year. The Veteran has a couple friends with whom he talks occasionally but one of his best friends had recently died. The Veteran reported doing remodeling projects, watching television, and generally spending time at home when he is not at his full-time employment. The Veteran reported not enjoying socializing in public settings. At a July 2016 medical appointment, the Veteran had a negative depression screen and reported no suicidal or homicidal ideations. At a February 2018 VA appointment, the Veteran had a negative depression screen. At the September 2018 Board hearing, the Veteran reported that his main symptom of PTSD was trouble sleeping. He wanders the house at night. The Veteran reported being irritable and having difficulty getting along with people and being easily angered. The Veteran reported "hating" being in crowds and not liking loud noises and unexpected loud noises. The Veteran reported that he had at some time in the past had suicidal thoughts. The Veteran testified that he was undergoing no mental health treatment related to PTSD. At the December 2021 VA examination, the examiner reported no current suicidal ideation by the Veteran. The examiner evaluated the Veteran's PTSD as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation, which equates to an overall 30 percent disability evaluation. The Veteran reported sleeping problems and that his wife considers him "emotionally distant, socially withdrawn, and short-tempered," and that the couple had been separated at some point. The Veteran mentioned he has friends with whom he sometimes plays cards. The Veteran does upholstery and carpentry projects. The Veteran also explained that he avoids crowded venues and has few friends, has a generally solitary lifestyle and "is not very fun to be around." The Veteran is currently employed at the same position in a part-time capacity for the past seven years and has been disciplined at work in the past for his "harsh" approach with others. The symptoms included depressed mood, anxiety, chronic sleep impairment, and disturbances of motivation and mood. As requested by previous Board remand, the examiner commented that the Veteran's previous suicidal ideation was considered "fleeting and transient" and did not cause occupational impairment with deficiencies in most areas. As requested by previous Board remand, the examiner also affirmed that various behaviors support a symptomatology of difficulty in establishing and maintaining effective work and social relationships, commenting that, "the Veteran reported that his PTSD symptoms have negatively impacted his marriage as well as his relationship with his son. His wife expressed concern that he is emotionally distant, socially withdrawn and easily angered. In the workplace, [the Veteran] has been addressed about his direct and somewhat 'harsh' approach to others. He shared that the fatigue associated with his sleep disturbance sometimes negatively impacts his productivity and performance. Finally, [the Veteran] shared that the PTSD has negatively impacted his social functioning. He avoids crowded venues. He maintains a solitary lifestyle." The Board acknowledges analysis of suicidal ideation as applied to the rating schedule in Bankhead, where the Court wrote, "...there are no descriptors, modifiers, or indicators as to suicidal ideation in the 70% criteria (including no specific mention of "active" suicidal ideation, "passive" suicidal ideation, suicidal "intent," suicidal "plan," suicidal "preparatory behavior," hospitalization, or past suicide attempts). Thus, the language of the regulation indicates that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas." Bankhead v. Shulkin, 29 Vet. App. 10, 20-21 (2017). The Board notes the use of "may," and that the Court further stated, "...the Board was obligated to consider the actual effects of Mr. Bankhead's suicidal ideation on his occupational and social situation to determine the severity of that symptom." Id at 23. In the present case, the Veteran has been employed for at least seven years, although he reported disciplinary action at work, and although he reported a generally isolated lifestyle, he also reported some socializing with friends. The Board obtained a medical opinion specifically regarding the level of impairment of the Veteran's previously noted suicidal ideation and that provider opined that previous suicidal ideation did not result in occupational impairment with deficiencies in most areas. The Board also notes that in Bankhead, the Court criticized the Board's use of descriptors of suicidal ideation where the rating schedule does not include them, as noted above. Although the examiner in the present appeal used the words "fleeting and transient" as applied to the Veteran's historical suicidal ideation, and the Board herein is reporting the opinion of the examiner using their words, the Board acknowledges that the rating schedule does not include such descriptors. However, "fleeting and transient" are helpful descriptions, here provided by a medical provider pertaining to suicidal ideation, to evaluate the severity, frequency, and duration of the signs and symptoms of the veteran's service-connected mental disorder as discussed in Bankhead, referencing Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). Id at 25. The Board finds, after a thorough review of the evidence, that the Veteran's service-connected PTSD has been manifested by occupational and social impairment with reduced reliability and productivity that would equate to a 50 percent rating. As discussed above, the Veteran's psychiatric disability has been manifested by irritability, chronic sleep impairment, discomfort in crowds, anxiety, depressed mood, and suspiciousness, with disturbances of motivation and mood, and difficulty in establishing and maintaining effective relationships. While the Veteran reported previous suicidal ideation, per the December 2021 VA examiner, such ideations did not result in occupational impairment with deficiencies in most areas. The overall symptoms more nearly approximate the 50 percent disability rating. The evidence does not demonstrate that the Veteran has occupational and social impairment, with deficiencies in most areas, due to suicidal ideations; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Accordingly, an initial rating in excess of 50 percent is not warranted at any time during the appeal period. See 38 C.F.R. § 4.130, DC 9411. The Board is aware that the symptoms listed under the next-higher ratings of 70 and 100 percent are essentially examples of the type and degree of symptoms for that rating, and that the Veteran need not demonstrate those exact symptoms to warrant a higher rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Moreover, entitlement to such an evaluation requires sufficient symptoms of the requirements, or others of similar severity, frequency, or duration, that cause the specific type of occupational and social impairment. See Vazquez-Claudio, 713 F.3d at 117-18. In this case, the Board has considered these higher ratings for the entire appeal period but finds that it is rated appropriately herein. The signs and symptoms manifested are contemplated by the disability rating of 50 percent assigned herein, as they do not manifest with the severity, frequency, or duration indicative of a higher rating. The Board has considered the Veteran's reported history of symptomatology related to the service-connected PTSD. He is competent to report such symptoms and observations because this requires only personal knowledge as it comes through one's senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). His credible descriptions of his observable symptoms are not more closely described by the 70 or 100 percent criteria. Lastly, the Board has considered the possibility of staged ratings and finds that the increased schedular rating assigned herein for the service-connected disability on appeal is appropriate for the entire appeal period. Accordingly, staged ratings are inapplicable. See Hart, 21 Vet. App. at 505. Service Connection 3. Entitlement to service connection for rhinitis During the course of this appeal, the Veteran underwent a VA examination for sinus conditions in December 2021. The medical provider added an opinion as follows, "The veteran has references to rhinitis as far back as 2012 in his records. A progress note from family practice notes diagnosis of rhinitis in 2012. This examiner's opinion is that the rhinitis is a progression of the sinusitis that has been present for nearly 10 years now. It should have been noted on previous DBQs. His rhinitis diagnosis is due to chronic nasal turbinate hypertrophy, which happens when the lining of the mucous membranes over the turbinate bone become enlarged, blocking nasal passages. This is due to inflammation in the sinuses and nasal passages, caused by URIs, sinusitis or even the common cold. The veteran's claimed rhinitis is a progression of his sinusitis." Secondary service connection under § 3.310 entails "any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition." Allen v. Brown, 7 Vet. App. 439, 448 (1995). Accordingly, in order to establish entitlement to service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id. Under the anti-pyramiding provision of 38 C.F.R. § 4.14, the evaluation of the "same disability" or the "same manifestation" under various diagnoses is to be avoided. For purposes of determining whether a veteran is entitled to separate ratings for different problems or residuals of an injury, such that separate evaluations do not violate the prohibition against pyramiding, the critical element is that none of the symptomatology for any one of the conditions is duplicative of, or overlapping with, the symptomatology of the other conditions. Esteban v. Brown, 6 Vet. App. 259 (1994). Based on the December 2021 VA medical opinion, the Board finds that the Veteran has an additional diagnosed condition of rhinitis with its own symptomatology manifestation as chronic nasal turbinate hypertrophy, separate and secondary to the service-connected sinusitis. Accordingly, the Board finds that entitlement to service connection is warranted for rhinitis. 4. Entitlement to service connection for bilateral hearing loss The Veteran contends that he has bilateral hearing loss due to hazardous noise exposure during active service. After a thorough review of the evidence, the Board finds that entitlement to service connection for bilateral hearing loss is not warranted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C. § 1112; 38 C.F.R. § 3.304. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board concludes that the Veteran does not have a current diagnosis of hearing loss disability in the left ear and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Board notes that some of the Veteran's service treatment records (STRs) are not available in the present case and that there has been a formal finding of unavailability in June 2014. As for the right ear hearing loss, the Board finds that the Veteran has a current diagnosed right ear hearing loss that meets VA regulations but it preexisted service and was not aggravated thereby. Every Veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). If a condition is not noted upon entrance into service, then to rebut the presumption of soundness at service entrance VA must show by clear and unmistakable evidence both that there was a pre-existing condition and that it was not aggravated during or by the Veteran's service. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-2003 (July 16, 2003). To satisfy this second-prong requirement for rebutting the presumption of soundness, the government must show by clear and unmistakable evidence either that there was no increase in disability during service or that any increase in disability was "due to the natural progression" of the condition. Joyce v. Nicholson, 443 F.3d 845, 847 (Fed. Cir. 2006). If a pre-existing disability is noted upon entry into service, then the Veteran cannot bring a claim for service connection for that disability, only a claim for service-connected aggravation of that disability. In that case, 38 U.S.C. § 1153 applies and the burden falls on him, not VA to establish aggravation. Wagner, 370 F.3d at 1096; Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). If VA fails to show by clear and unmistakable evidence that the pre-existing condition was not aggravated by active service, then the presumption of soundness has not been rebutted and the claim will be considered as a normal claim for service connection. See Wagner, 370 F.3d at 1094 (observing that Congress intended to "convert aggravation claims to ones for service connection when the government fails to overcome the presumption of soundness under section 1111"). If service connection is granted, no deduction for the degree of disability existing at the time of entrance will be made. Id. at 1096 (citing 38 C.F.R. § 3.322). In short, the claim may not be denied, nor benefits deducted, on the basis of a finding that the disability in question pre-existed active service, if VA does not also meet its evidentiary burden of showing that the disability was not aggravated during service. See id. The clear-and-unmistakable-evidence standard is a formidable evidentiary burden. It is an "onerous" and "very demanding" evidentiary standard, requiring that the evidence be "undebatable." See Cotant v. West, 17 Vet. App. 116, 131 (2003) (citing Laposky v. Brown, 4 Vet. App. 331, 334 (1993)). The determination of whether a veteran has a ratable hearing loss "disability" is governed by 38 C.F.R. § 3.385, which states that hearing loss will be considered to be a disability (for VA purposes) when the threshold level in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz (Hz) is 40 decibels or greater; or the thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores utilizing recorded Maryland CNC word lists are less than 94 percent. 38 C.F.R. § 3.385. The Court has indicated that, "when audiometric test results at a veteran's separation from service do not meet the regulatory requirements for establishing a 'disability' at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service." Hensley v. Brown, 5 Vet. App. 155, 160 (1993). The Court held that the threshold for normal hearing is from 0 to 20 decibels and that higher threshold levels indicate some degree of hearing loss. Hensley, 5 Vet. App. at 157. The Court further held that 38 C.F.R. § 3.385 operates only to establish when a hearing loss can be service connected. Hensley at 159. It was also found that, regardless of when the criteria of 38 C.F.R. § 3.385 are met, a determination must be made as to whether the hearing loss was incurred in or aggravated by service. On the authorized audiological evaluation in January 2014, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 0 10 30 30 LEFT 15 0 5 15 10 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and of 98 percent in the left ear. On the authorized audiological evaluation in December 2014, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 5 10 25 35 LEFT 15 5 0 20 20 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 100 percent in the left ear. On the authorized audiological evaluation in December 2021, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 20 20 35 40 LEFT 25 20 15 30 25 Speech audiometry revealed speech recognition ability of 92 percent in the right ear and of 98 percent in the left ear. The December 2021 examiner commented, "The Veteran's MOS was Infantryman, which had a high probability for hazardous noise exposure. The Veteran's enlistment audiological evaluation on April 28, 1983, revealed hearing within normal limits in the left ear and hearing within normal limits from 500 through 2000 Hz sloping to a mild hearing loss from 3000 through 6000 Hz in the right ear. The Veteran's initial separation audiological evaluation on May 17, 1989, revealed hearing within normal limits in the left ear and hearing within normal limits from 500 through 4000 Hz sloping to a mild hearing loss of 40 dB HL at 6000 Hz in the right ear. No STS were seen. A final separation audiological evaluation in December 2004 was not available. A retention audiological evaluation after active duty on July 14, 2007, revealed hearing within normal limits from 500 through 4000 Hz sloping to a mild hearing loss of 45 dB HL, bilaterally. The results in the right ear show no STS when compared to the enlistment evaluation on April 28, 1983. The results in the left ear show a STS at 6000 Hz when compared to the enlistment evaluation on April 28, 1983." The examiner opined that the Veteran's left ear hearing loss was at least as likely as not related to hazardous noise exposure during active service. As the Board notes however, the Veteran's left ear hearing loss does not currently meet the regulatory guidelines for hearing loss disability. As for the right ear hearing loss, the examiner stated that it preexisted active service and that based on later examinations, it was not aggravated during active service. As reference for discussion of STS (significant threshold shift) and aggravation, the Veteran's service treatment records contain a hearing loss testing report done in conjunction with the medical entrance examination in December 1982. On the December 1982 entrance examination (with April 1983 for certain specialties) audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 10 20 30 30 LEFT 5 0 5 15 10 The Board notes that the reading at the 6000 range was 40 in the right ear and 25 in the left ear. On the medical examination in May 1988, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 25 10 15 LEFT 5 0 0 15 10 The Board notes that the reading at the 6000 range was 40 in the right ear and 20 in the left ear. While the Veteran believes he has difficulty hearing, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997). As the medical evidence of record does not demonstrate that the Veteran has a current left ear hearing loss that meets the regulatory requirements for a hearing loss disability under 38 C.F.R. § 3.385, the Board must deny the claim for entitlement to service connection. To the extent that the Veteran contends that he has a hearing loss disability, the record does not show that he is competent to state that he meets the audiometric requirements under 38 C.F.R. § 3.385 for the left ear. As the evidence does not show that he had met the regulatory requirements for establishing a hearing loss disability for VA purposes, the appeal for entitlement to service connection for left ear hearing loss is denied. As for the right ear, the Veteran's most recent VA audiological examination demonstrates that his right ear hearing loss measurements meet VA regulatory requirements for a hearing loss disability. However, the VA examiner also opined that the Veteran's right ear hearing loss preexisted active service and was not aggravated thereby. Accordingly, the presumption of soundness is rebutted and the appeal for entitlement to service connection for right ear hearing loss is denied. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Miller, 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.