Citation Nr: 22048312 Decision Date: 08/24/22 Archive Date: 08/24/22 DOCKET NO. 16-54 488 DATE: August 24, 2022 ORDER Entitlement to a compensable rating prior to January 21, 2022 for bilateral hearing loss is denied. Entitlement to a rating in excess of 10 percent from January 21, 2022 to the present for bilateral hearing loss is denied. Entitlement to a rating in excess of 20 percent for painful scars of the left elbow, humerus, and shoulder associated with left bicep, brachialis, brachioradialis, is denied. Effective July 1, 2021, entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is granted. REMANDED Entitlement to a compensable rating for a groin condition is remanded. FINDINGS OF FACT 1. Prior to January 21, 2022, the Veteran's hearing was manifested by hearing acuity of no worse than Level I in the right ear and no worse than Level V in the left ear. 2. Since January 21, 2022, the Veteran's hearing has been manifested by hearing acuity of no worse than Level III in the right ear and no worse than Level IV in the left ear. 3. The Veteran has three scars that are unstable or painful. 4. The evidence is at the very least in equipoise that the Veteran's service-connected disabilities prevented him from gainful employment as of July 1, 2021. CONCLUSIONS OF LAW 1. Prior to January 21, 2022, the criteria for a compensable rating for left ear hearing loss are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 2. From January 21, 2022, the criteria for a rating in excess of 10 percent for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 3. The criteria for a rating in excess of 20 percent for three painful scars of the left arm have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. 4. Effective July 1, 2021, the criteria for entitlement to a TDIU are met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.18. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1976 to July 1977, November 2002 to July 2003, January 2005 to April 2006, and February 2012 to January 2013, with additional periods of service in the Reserves. This appeal was previously before the Board in September 2019 and again in September 2021. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, 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. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). 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). Thus, although the Board has thoroughly reviewed all evidence of record, the more critical evidence consists of the evidence generated during the appeal period. Further, the Board must evaluate the medical evidence of record since the filing of the claim for increased rating and consider the appropriateness of a "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts). See Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Bilateral Hearing Loss The Veteran contends that he is entitled to higher ratings for his service-connected bilateral hearing loss. By way of history, a November 2013 rating decision granted service connection for left ear hearing loss and assigned a noncompensable rating effective January 31, 2013. An August 2020 rating decision granted service connection for right ear hearing loss and continued the noncompensable rating for bilateral hearing loss. A February 2022 rating decision increased the rating to 10 percent disabling effective January 21, 2022. Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100. To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII. An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). If impaired hearing is service-connected in only one ear, the law allows for compensation for hearing loss as if both ears were service-connected if the service-connected hearing loss is ratable as at least 10 percent disabling and the non-service-connected hearing loss meets the standard for a hearing loss disability for VA purposes under 38 C.F.R. § 3.385, unless the non-service-connected hearing loss is the result of the Veteran's willful misconduct. See 38 C.F.R. § 3.383. To determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I, subject to the provisions of 38 C.F.R. § 3.383. 38 C.F.R. § 4.85(f). An August 2013 VA examination reveals that the Veteran reported a gradual hearing loss. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 15 20 15 35 21 96 LEFT 10 45 60 65 45 96 Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level I in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level I for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 0 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. In his June 2014 Notice of Disagreement, the Veteran contended that his left ear hearing loss was worse than reflected by the noncompensable rating assigned. An August 2016 VA examination reveals that the Veteran reported difficulty hearing out of his left ear in particular. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 25 30 20 35 28 96 LEFT 25 55 70 65 54 68 Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level V in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level V for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 0 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. At his January 2019 Hearing, the Veteran testified that he struggled with hearing in both ears and needed hearing aids and often had to read lips to understand people speaking. The Veteran underwent a VA audiological examination in February 2019 but the examiner was unable to test the Veteran because despite repeated attempts and reinstruction, the test results were not reliable and not suitable for rating purposes. The examiner noted that the use of the word recognition score was not appropriate for the Veteran because of language difficulties, cognitive problems, inconsistent word recognition scores, etc., that made combined use of pure tone averages and word recognition scores inappropriate. In a July 2019 statement, the Veteran submitted a letter indicating that he requested and underwent another hearing examination in July 2019. A copy of the private report was submitted in October 2019. As an initial matter, the Board notes that the October 2019 private audiogram was performed by a state licensed audiologist and includes a controlled speech discrimination test (Maryland CNC), per the requirements of 38 C.F.R. § 4.85(a); therefore, this examination is deemed adequate for rating purposes. At that time, the Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 20 25 20 50 29 98 LEFT 15 55 60 60 48 90 Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level II in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level II for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 0 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. A January 2020 VA examination reveals that the Veteran reported difficulty using the telephone and difficulty hearing people speak. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 15 25 25 40 26 96 LEFT 15 55 65 65 50 92 Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level I in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level I for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 0 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. An October 2020 VA examination reveals that the Veteran reported having to turn the television up high and having to speak loudly. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 35 45 40 55 44 100 LEFT 45 70 70 70 64 96 Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level II in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level II for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 0 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. The Veteran's family members submitted lay statements in April 2021 attesting to the Veteran's difficulty with hearing. A January 2022 VA examination reveals that the Veteran reported significant difficulty understanding every day speech. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). The Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 25 30 30 35 30 82 LEFT 25 65 70 65 56 80 Applying the results to Table VI, the findings yield a numeric designation of Level III in the right ear and Level IV in the left ear. Entering the resulting bilateral numeric designation of Level III for the right ear and Level IV for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 10 percent disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. The Veteran submitted Correspondence in April 2022 stating that he wore hearing aids and that his poor hearing affected every aspect of his life. He said that he struggled to hear people even when they were near him. Based on the evidence above, a compensable rating is not warranted prior to January 21, 2022, and a rating in excess of 10 percent is not warranted thereafter for the Veteran's bilateral hearing loss. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the statements from the Veteran and various family members that the Veteran has significant difficulty hearing people speak and hearing the television. The Veteran is competent to report difficulty with his hearing, and the Board does not call this into question. However, the rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes, is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). While the Veteran expressed a belief that his VA examinations did not accurately reflect the severity of his hearing loss, there is nothing of record to suggest the test results discussed above were incorrect or otherwise invalid. In rating hearing loss disabilities, the Board is constrained by the rating criteria and the ratings assigned are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to a compensable rating prior to January 21, 2022, and a rating in excess of 10 percent thereafter for hearing loss. As the most probative evidence of record persuasively weighs against higher ratings, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 999 F.3d 1391 (2021). 2. Left Arm Scars The Veteran seeks higher ratings for his service-connected painful scars. By way of history, a January 2015 rating decision granted entitlement to service connection for a scar on the left arm associated with left bicep, brachialis, brachioradialis, and assigned a noncompensable rating effective August 11, 2014, pursuant to Diagnostic Code 7805. The Veteran filed an increased rating claim in April 2016, and the September 2016 rating decision on appeal continued the noncompensable rating. Diagnostic Codes 7800 to 7805 pertain to scars. 38 C.F.R. § 4.118. The Schedule of ratings for the skin were amended effective August 13, 2018. See 38 Fed. Reg. 32,592 (July 13, 2018). Prior to August 13, 2018, the Board will consider the old version of the diagnostic codes only (old code); however, for the period beginning August 13, 2018 the Board will consider both the old and amended version (amended code) of the diagnostic codes and rate based on whichever is most favorable to the Veteran. Diagnostic Code 7800 (both old code and amended code) pertains to scars of the head, face, or neck, and is inapplicable in this case, as the scars to be rated are on the left arm. Diagnostic Code 7801 provides for a 10 percent rating for a scar that is not of the head, face, or neck, that is deep and nonlinear (old code) or associated with underlying soft tissue damage (amended code), and that has an area of at least 6 square inches (39 sq. cm.). Higher ratings are available if larger areas are affected. Under the old code, a "deep scar" is defined as one associated with underlying soft tissue damage. The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar. Diagnostic Code 7802 provides for a 10 percent rating for a scar not of the head, face, or neck, that is superficial and nonlinear (old code) or not associated with underlying soft tissue damage (amended code) and which covers an area of at least 144 square inches (929 sq. cm.) or more. No higher ratings are available under either version of this code. Under the old code, a "superficial scar" is defined as one not associated with underlying soft tissue damage. The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar. Diagnostic Code 7804 provides for a 10 percent disability evaluation for one or two scars that are unstable or painful. A 20 percent disability evaluation is assigned where there are three or four scars that are unstable or painful. A 30 percent disability evaluation is assigned where there are five or more scars that are unstable or painful. An unstable scar is one where there is frequent loss of skin covering over the scar. If one or more scars are both unstable and painful 10 percent is added to the evaluation. Under the new and amended codes, pursuant to Diagnostic Code 7805, a scar may be rated on any disabling effect(s) not considered as part of Diagnostic Codes 7800 to 7804. In connection with his April 2016 increased rating claim, the Veteran submitted a statement indicating that he had three painful scars on his left arm. He underwent a VA scars examination in September 2016. The examiner identified three scars. Two scars were located over the anterior aspect of the left elbow. The first scar was linear and measured 5 centimeters (cm) by 0.2 cm. It was superficial and non-tender. The second scar was located below the left anterior elbow and measured 4 cm by 0.2 cm. It was linear and non-tender. The third scar was located over the lateral aspect of the left forearm and measured 6 cm by 0.2 cm. It was linear, well-healed, and non-tender. The scars were not noted as being painful and the examiner stated that the scars were quiescent. In his September 2016 NOD and December 2016 substantive appeal, the Veteran stated that all three scars were painful and warranted a higher rating. At his January 2019 Hearing, the Veteran testified that his scars were painful to the touch. He underwent another VA scars examination in March 2021. The Veteran told the examiner that the scars on his left arm were painful and itchy. The scars were not unstable. The same three scars as identified at the September 2016 examination were again identified with the same measurements. The total area was noted to be 15 cm by 0.2 cm. A March 2021 rating decision increased the rating assigned for the three scars to 20 percent disabling under Diagnostic Code 7804, based on three painful scars, effective March 17, 2021. In April 2021 Correspondence, the Veteran expressed that the 20 percent rating assigned as of March 17, 2021, should have been made effective throughout the entire appeal period, as the scar symptoms had remained consistent since the filing of his claim. The Veteran underwent another VA scars examination in May 2021. The examiner noted three scars on the left arm and shoulder; the first measured 5 cm by 0.3 cm, the second measured 4.5 cm by 0.5 cm, and the third measured 7 cm by 0.4 cm. The Veteran reported that all three scars were painful. The scars were not unstable. They were noted as being tender to palpation and having underlying soft tissue damage. A May 2021 rating decision continued the 20 percent rating. A September 2021 Board decision found that as of April 5, 2016, it became factually ascertainable that the Veteran had three, painful left arm scars. Thus, the 20 percent was made effective as of April 5, 2016. Whether a rating higher than 20 percent was warranted was remanded for additional examination. Accordingly, the Veteran underwent a VA scars examination in January 2022. The examiner identified three painful scars measuring 6 cm by 0.2 cm, 5 cm by 0.2 cm, and 6 cm by 0.2 cm. They were tender to palpation. A February 2022 rating decision separately granted service connection for scars of the left elbow, humerus, and shoulder, and assigned a noncompensable rating effective August 11, 2014. The rating decision noted that the rating was separate from the 20 percent rating under Diagnostic Code 7804. The separate rating was based on the total area of the scars under Diagnostic Code 7802. The Veteran did not indicate any disagreement with that rating; however, as it is part and parcel of the overall rating for the Veteran's scars, the Board will also address whether a higher rating is warranted under Diagnostic Code 7802. The Board concludes that a rating in excess of 20 percent under Diagnostic Code 7804 is not warranted. In this regard, to obtain the next highest rating of 30 percent, the evidence would have to show the presence of five or more scars that are unstable or painful. The evidence does not show, and the Veteran has never contended, that he has five or more painful scars. Thus, a rating over 20 percent under Diagnostic Code 7804 is not warranted, both prior to and from August 13, 2018. With respect to the noncompensable rating assigned under Diagnostic Code 7802, to obtain the maximum 10 percent rating under that Code, the evidence would need to show that the scars have an area of 929 square centimeters or greater. As the three identified scars do not have such an area, a higher rating under Diagnostic Code 7802 is also not warranted. The Board has considered whether higher ratings may be warranted under any other Diagnostic Codes pertaining to scars. As the scars are not of the head, face, or neck, Diagnostic Code 7800 is inapplicable. As the May 2021 VA examiner indicated that the scars had underlying soft tissue damage, the Board has considered Diagnostic Code 7801. However, the May 2021 examiner indicated that the total area of the three scars was 7.55 square centimeters, which does not equate to a compensable rating under Diagnostic Code 7801. Finally, with respect to Diagnostic Code 7805, there are no other disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804, based on the findings of the VA examinations. In light of the foregoing, a rating in excess of 20 percent for three painful scars of the left arm is denied. 3. Entitlement to a TDIU The Veteran raised the issue of entitlement to a TDIU in April 2021 correspondence. He indicated that his service-connected disabilities forced him to announce his resignation from his employment. In September 2021, the Board remanded the claim for additional development. Subsequently, the Veteran submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, in March 2022. Therein, he indicated that due to the constant pain in his left arm, shoulder, and wrist, groin pain, and anxiety and sleep apnea, he lost the ability to concentrate at work. He said that the pain caused his depression and anxiety and he subsequently resigned from his employment on July 1, 2021. A VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, completed by the Veteran's employer in April 2022, confirms that the Veteran separated from his position on July 1, 2021. A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id. An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). For the time period from July 1, 2021 to the present, the Veteran is eligible for a TDIU on a schedular basis. 38 C.F.R. § 4.16(a). For the reasons that follow, the Board finds that a TDIU is warranted from July 1, 2021. The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the physical effects of his hearing loss, shoulder, neck, wrist, low back, and groin. In addition to the Veteran's subjective complaints of pain, VA examiners have expressed various functional limitations caused by the disabilities, including difficulty lifting his left arm or carrying any objects, difficulty with wrist action due to left wrist weakness and pain, and difficulties with clearly hearing speech. The Veteran's ability to secure and follow a substantially gainful occupation is also impacted by the mental effects of his service-connected anxiety. Specifically, it was noted at his May 2022 VA examination that he retired from his work due to anxiety, depressed mood, and concentration problems. He noted anxiety, irritability and decreased motivation secondary to his painful shoulder. He said he had nightly insomnia. Given the forgoing, and after resolving all doubt in the Veteran's favor, the Board concludes that the Veteran's service-connected disabilities preclude him from the ability to secure and follow a substantially gainful occupation consistent with his education, skills, training, and work history. Although the Veteran last worked in a sedentary, skilled, environment, the Board nevertheless finds that his service-connected disabilities precluded even sedentary work at the time he stopped working. He noted difficulties with concentration, sleeping trouble that caused daytime sleepiness, extreme difficulty with hearing, which was highly challenging in a legal position, and physical impairments that made any sort of prolonged sitting or walking difficult. Accordingly, a TDIU is warranted and is granted effective July 1, 2021, the day the Veteran stopped full-time employment. REASONS FOR REMAND Entitlement to a compensable rating for a groin condition is remanded. The Veteran's service-connected groin disability has been rated by VA under the diagnostic criteria governing muscle injuries. His last examination took place in January 2022, at which time the examiner noted disability of muscle group XV, pertaining to the medial thigh muscle, right side. The examiner then reported the Veteran's complaints of pain on both sides now, present when going up stairs, getting out of bed and turning over in bed. Indeed, the Veteran has consistently reported symptoms of pain related to his groin disability throughout the appeal period. In connection with his April 2016 increased rating claim, the Veteran submitted correspondence stating that he had persistent pain in his groin area that limited his ability to stretch and jog. VA treatment records show that the Veteran began a course of physical therapy for his groin pain in April 2016. At his initial evaluation, he explained that the left groin area was sore all the time and was aggravated by prolonged sitting. Although the January 2022 examiner noted the Veteran's complains of pain and reviewed the record, the examiner indicated no impairment of function as due to the muscle disability. When asked if the Veteran experienced, among other things, fatigue and/or pain associated with his muscle injury, the examiner simply indicated "No," without further explanation. Given the Veteran's observed symptoms and functional limitations, and the incomplete findings of the last examiner, the Board believes updated muscle and hip examinations must be completed before an informed decision can be made as to whether higher or separate ratings may be warranted for this condition. The matters are REMANDED for the following action: 1. Schedule the Veteran for (1) muscle and (2) right and left hip examinations to assess the nature and severity of his service-connected groin disability. The examiners should discuss the Veteran's complaints of groin pain due to his service-connected groin condition, and indicate to what extent, if at all, such impairs function of the muscle or hip joints. All manifestations of the Veteran's service-connected groin condition must be identified, to include impact on range of motion of the hips, loss of power, weakness and fatigue. If the Veteran's service-connected groin condition causes no impairment of function of the hips, this should be made clear. Reports should be created and associated with the claims file. (Continued on Next Page) 2. Then, readjudicate the issue on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Polly Johnson, 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.