Citation Nr: 1304603 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 11-31 940 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to an initial rating in excess of 30 percent for bilateral hearing loss from November 26, 2007. 2. Entitlement to an initial rating in excess of 60 percent for bilateral hearing loss from August 3, 2009. 3. Entitlement to a total rating based on individual unemployability (TDIU). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL The Veteran and his wife ATTORNEY FOR THE BOARD N. T. Werner, Counsel INTRODUCTION The Veteran served on active duty from May 1966 to May 1969, including combat service in the Republic of Vietnam, and his decorations include the Purple Heart Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In December 2012, the Veteran and his wife testified at a video hearing before the undersigned. A transcript of that hearing has been attached to the virtual VA claims file. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The Board finds that the testimony at the hearing raises a claim for a TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (per curiam) (holding that claims for higher evaluations also include a claim for a total rating based on TDIU the appellant claims he is unable to work due to a service connected disability). The claim for a rating in excess of 60 percent for bilateral hearing loss from August 3, 2009, and the claim for a TDIU are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. From November 26, 2007, to May 21, 2008, the audiometric test results obtained during examination by a VA audiologist correspond to a numeric designation of no greater than IX in the right ear and IX in the left ear. 2. From May 22, 2008, to August 2, 2009, the audiometric test results obtained during examination by a VA audiologist correspond to a numeric designation of no greater than VI in the right ear and VI in the left ear. 3. From August 3, 2009, the audiometric test results obtained during examination by a VA audiologist correspond to a numeric designation of no greater than VIII in the right ear and X in the left ear. CONCLUSIONS OF LAW 1. From November 26, 2007, to May 21, 2008, the criteria for a 60 percent rating, but no more, for bilateral hearing loss, were met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.159, 4.85, 4.86, Diagnostic Code 6100 (2012). 2. From May 22, 2008, to August 2, 2009, the criteria for a 60 percent rating, but no more, for bilateral hearing loss, were met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.159, 4.85, 4.86, Diagnostic Code 6100 (2012). 3. From August 3, 2009, the Veteran met the criteria for a 60 percent rating, but no more, for bilateral hearing loss. the criteria for a 60 percent rating, but no more, for bilateral hearing loss, were met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.159, 4.85, 4.86, Diagnostic Code 6100 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under 38 U.S.C.A. § 5102 VA first has a duty to provide an appropriate claim form, instructions for completing it, and notice of information necessary to complete the claim if it is incomplete. Second, under 38 U.S.C.A. § 5103(a), VA has a duty to notify the claimant of the information and evidence needed to substantiate and complete a claim, i.e., existence of a current disability, the degree of disability, and the effective date of any disability benefits. The appellant must also be notified of what specific evidence he is to provide and what evidence VA will attempt to obtain. Third, VA has a duty to assist claimants in obtaining evidence needed to substantiate a claim. This includes obtaining all relevant evidence adequately identified in the record and, in some cases, affording VA examinations. 38 U.S.C.A. § 5103A. In Dingess v. Nicholson, 19 Vet. App. 473, 490 (2006), the United States Court of Appeals for Veterans Claims (Court) observed that a claim of entitlement to service connection consists of five elements, of which notice must be provided prior to the initial adjudication: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date. See 38 U.S.C. § 5103(a). The Board notes that the Veteran is challenging the initial evaluation assigned following the grant of service connection for bilateral hearing loss. In Dingess, supra, the Court also held that in cases where service connection has been granted and initial disability evaluation has been assigned, the service connection claim has been more than substantiated, it has been proven, thereby rendering § 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id, at 490-91; See also Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) requires that the Veterans Law Judge (VLJ) who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, during the Board personal hearing, the VLJ noted the elements of the claims that were lacking to substantiate the claim for a higher evaluation. The Veteran was assisted at the hearing by his wife and an accredited representative and his representative and the VLJ asked questions to draw out the current severity of the appellant's hearing loss. No pertinent evidence that might have been overlooked and that might substantiate the claim was identified by the Veteran, his wife, or the representative. The hearing focused on the elements necessary to substantiate the claim, and the Veteran through his wife's testimony, demonstrated that they had actual knowledge of the elements necessary to substantiate the claim. Therefore, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). As to the duty to assist, the Board finds that VA has secured all available and identified pertinent in-service and post-service evidence including the Veteran's service treatment records as well as his post-service records from the Southeast Louisiana Healthcare System. The Veteran was also provided VA examinations in January 2008, May 2008, August 2009, and January 2012. Moreover, the Board finds that the examinations are adequate for rating purposes because after comprehensive examinations of the claimant as well as after a review of the record on appeal the examiners provided opinions as to the severity of his hearing loss that allow the Board to rate it under all relevant Diagnostic Codes. See 38 U.S.C.A. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007). The examiners also opined on the functional impact the Veteran's hearing was having on his daily activities and employment. See Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In summary, the facts relevant to this appeal have been properly developed and there is no further action to be undertaken to comply with the provisions of 38 U.S.C.A. §§ 5103(a), 5103A or 38 C.F.R. § 3.159. Therefore, the Veteran will not be prejudiced as a result of the Board proceeding to the merits of the appeal. See Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). In adjudicating the claim below, the Board has reviewed all of the evidence in the Veteran's claims file including those found in virtual VA. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that all the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims files shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Claim The Veteran asserts that his hearing loss meets the criteria for higher evaluations. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Court has held that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998). The July 2008 rating decision granted service connection for bilateral hearing loss and assigned it a 30 percent rating effective from November 26, 2007, under the provisions of 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. Under the law and regulations that have been in effect since before the Veteran filed his claim for service connection in May 2007, the rating assigned for hearing loss is determined by a mechanical application of the rating schedule, which is grounded on numeric designations assigned to audiometric examination results. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Specifically, evaluations of hearing impairment range from 0 to 100 percent based on organic impairment of hearing acuity. Auditory acuity is gauged by examining the results of controlled speech discrimination tests, together with the results of puretone audiometric tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hz). To evaluate the degree of disability, the rating schedule establishes 11 auditory acuity levels ranging from level I, for essentially normal acuity, through level XI, for profound deafness. 38 C.F.R. § 4.85 et. seq. Tables VI and VII as set forth following 38 C.F.R. § 4.85 are used to calculate the rating to be assigned. 38 C.F.R. § 4.85. Under 38 C.F.R. § 4.86, when the puretone threshold at each of the four specified frequencies (1,000, 2,000, 3,000, and 4,000 Hertz) is 55 decibels or more, Table VI or Table VIa is to be used, whichever results in the higher numeral. 38 C.F.R. § 4.86(a). Additionally, when the puretone threshold is 30 decibels or less at 1,000 Hertz, and 70 decibels or more at 2,000 Hertz, Table VI or Table VIa is to be used, whichever results in the higher numeral. Thereafter, that numeral will be elevated to the next higher Roman numeral. 38 C.F.R. § 4.86(b). 38 C.F.R. § 4.85(c) also provides, in substance, that Table VIa will be used to determine a Roman numeral designation (I through XI) for hearing impairment based only on the puretone threshold average when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc.. From November 26, 2007, to May 21, 2008 As to the time period from November 26, 2007, to May 21, 2008, the audiometric testing found in the record is the testing conducted at the January 2008 VA examination. At that time, the examination showed puretone thresholds of 90, 90, 100, and 105 decibels in the right ear and puretone thresholds of 90, 100, 100, and 100 decibels in the left ear, at 1000, 2000, 3000, and 4000 Hertz, respectively. The averages were 96.25 decibels in the right ear and 97.5 decibels in the left ear. Speech recognition ability was 20 percent in the right ear and 24 percent in the left ear. Initially, the Board notes that the January 2008 VA examiner opined, in substance, that the Veteran's speech recognition scores were not credible given communication problems caused by the appellant's dementia. Therefore, the Board will rate the severity of his bilateral hearing loss, without regard to his speech recognition scores, using his puretone threshold averages only under Table VIa. 38 C.F.R. § 4.86(c). With application of the above test results to 38 C.F.R. § 4.85, Table VIa, the Veteran's right ear hearing loss is assigned a numeric designation of IX and the left ear hearing loss is assigned a numeric designation of IX. These test scores results show that the Veteran met the criteria for a 60 percent rating for his bilateral hearing loss under Table VII. See 38 C.F.R. § 4.85, Diagnostic Code 6100. This is true from November 26, 2007, to May 21, 2008, and therefore staged ratings are warranted. Fenderson, supra. From May 22, 2008, to August 2, 2009 As to the time period from May 22, 2008, to August 2, 2009, the only audiometric testing found in the record is the testing conducted at the May 22, 2008, VA examination. At that time, testing showed puretone thresholds of 55, 70, 75, and 90 decibels in the right ear and puretone thresholds of 60, 75, 80, and 80 decibels in the left ear, at 1000, 2000, 3000, and 4000 Hertz, respectively. The averages were 70 decibels in the right ear and 73.75 decibels in the left ear. Speech recognition ability was 92 percent in the right ear and 92 percent in the left ear. With application of the above test results to 38 C.F.R. § 4.85, Table VI, Table VII, the Veteran's right ear hearing loss is assigned a numeric designation of II and the left ear hearing loss is assigned a numeric designation of II. These test scores results do not show that the Veteran met the criteria for even a compensable rating his bilateral hearing loss under Table VII. See 38 C.F.R. § 4.85, Diagnostic Code 6100. This is true from May 22, 2008, to August 2, 2009, and therefore further consideration of staged ratings is not warranted. Fenderson, supra. As to 38 C.F.R. § 4.86(a), when examined on May 22, 2008, the Veteran had thresholds of 55 decibels or more at each of the four specified frequencies (1,000, 2,000, 3,000, and 4,000 Hz). Consequently, 38 C.F.R. § 4.86(a) is for application. With the application of 38 C.F.R. § 4.86(a), the Veteran has a numeric designation of VI for the right ear under Table VIA and a numeric designation of VI for the left ear under Table VIA. These test scores result in the appellant's bilateral hearing loss being rated as 30 percent disabling under Diagnostic Code 6100. See 38 C.F.R. § 4.85, Table VII. Therefore, even with the application of 38 C.F.R. § 4.86(a) he did not meet the criteria for a rating in excess of 30 percent for his service-connected bilateral hearing loss. This is true from May 22, 2008, to August 2, 2009, and therefore further consideration of staged ratings is not warranted. Fenderson, supra. As to 38 C.F.R. § 4.86(b), when examined on May 22, 2008, the Veteran did not have thresholds of 30 decibels or less at 1,000 Hz (i.e., it was 55 decibels in the right ear and 60 decibels in the left ear at 1,000 Hz) and 70 decibels or more at 2,000 Hz (i.e., it was 70 decibels in the right ear and 75 decibels in the left ear). Consequently, 38 C.F.R. § 4.86(b) is not for application. This is true from May 22, 2008, to August 2, 2009, and therefore further consideration of staged ratings is not warranted. Fenderson, supra. From August 3, 2009 As to the time period from August 3, 2009, the only usable audiometric testing found in the record is the testing conducted at the August 3, 2009, VA examination. In this regard, the Board notes that while the Veteran provided VA with a graph of private audiological testing conducted in November 2011 this testing did not include his speech discrimination scores. Likewise, while the Veteran was afforded a VA examination in January 2012 no audiometric findings were reported by that examiner because the Veteran's dementia made obtaining credible test scores impossible. Therefore, the Board finds that these tests cannot not be used to evaluate whether the Veteran is entitled to a rating in excess of 60 percent for his bilateral hearing loss from August 3, 2009. At the August 3, 2009, VA examination, the Veteran had puretone thresholds of 80, 90, 100, and 100 decibels in the right ear and puretone thresholds of 100, 100, 100, and 100 decibels in the left ear, at 1000, 2000, 3000, and 4000 Hertz, respectively. The averages were 92.5 decibels in the right ear and 100 decibels in the left ear. Speech recognition ability was 0 percent in the right ear and 0 percent in the left ear. Initially, the Board notes that the August 3, 2009, VA examiner also opined, in substance, that the Veteran's speech recognition scores were not credible given communication problems caused by the appellant's dementia. Therefore, the Board will rate the severity of his bilateral hearing loss, without regard to his speech recognition scores, using his puretone threshold averages only under Table VIa. 38 C.F.R. § 4.86(c). With application of the above test results to 38 C.F.R. § 4.85, Table VIa, the Veteran's right ear hearing loss is assigned a numeric designation of VIII and the left ear hearing loss is assigned a numeric designation of X. These test scores results show that the Veteran met the criteria for a 60 percent rating for his bilateral hearing loss under Table VII. See 38 C.F.R. § 4.85, Diagnostic Code 6100. This is true from August 3, 2009, and therefore staged ratings are warranted. Fenderson, supra. Conclusion Based on the Veteran's and his representative's claims that the appellant's hearing loss is worse than rated, the Board will consider the application of 38 C.F.R. § 3.321(b)(1) (2012). Under Thun v. Peake, 22 Vet App 111 (2008), there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. First, the Board must first determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether the Veteran's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular evaluations for the service-connected bilateral hearing loss is inadequate. A comparison between the level of severity and symptomatology of the Veteran's condition with the established criteria shows that the rating criteria reasonably describe the Veteran's disability level and symptomatology. The Board further observes that, even if the available schedular evaluation for the disability is inadequate (which it manifestly is not), the Veteran does not exhibit other related factors such as those provided by the regulation as "governing norms." Specifically, there simply is no objective evidence that his hearing loss, acting alone, has resulted in frequent periods of hospitalization or in marked interference with employment. See Bagwell v. Brown, 9 Vet. App. 337 (1996). Therefore, the Board finds that the evidence does not demonstrate an exceptional or unusual clinical picture beyond that contemplated by the rating criteria. In short, there is nothing in the record to indicate that this service-connected disability causes impairment with employment over and above that which is contemplated in the assigned schedular ratings. The Board, therefore, has determined that referral of this case for extra-schedular consideration pursuant to 38 C.F.R. 3.321(b)(1) is not warranted at all times prior to August 3, 2009. In reaching the above conclusions, the Board has not overlooked the various lay statements found in the record. In this regard, the Veteran is credible to report on what he sees and feels and his wife and representative are credible to report on what they can see. See Davidson, supra. However, the Board finds more competent and credible the medical opinions as to the severity of his disability provided by the experts at the Veteran's VA examinations than these lay assertions. See Black v. Brown, 10 Vet. App. 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data); Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators. . ."). ORDER Subject to the law and regulations governing payment of monetary benefits, a 60 percent rating, for bilateral hearing loss is granted at all times from November 26, 2007, to May 21, 2008, A rating in excess of 30 percent for bilateral hearing loss is denied at all times from May 22, 2008, to August 2, 2009. Subject to the law and regulations governing payment of monetary benefits, a 60 percent rating for bilateral hearing loss is granted at all times from August 3, 2009. REMAND As to the claim for a rating in excess of 60 percent for bilateral hearing loss from August 3, 2009, in November 2011 the RO received a private audiological examination dated earlier in November 2011 that reported the Veteran's results in a graphic form. However, the graph does not contain an opinion by the examiner as to the Veteran's speech discrimination scores as well as whether such scores were based on the Maryland CNC test. Therefore, a remand to obtain this information is required. See Savage v. Shinseki, 24 Vet. App. 259 (2011) (holding that it was error for VA not to seek clarification from a private doctor as to whether an audiological hearing report was based on the Maryland CNC test, or explain why such clarification was not needed or was unreasonable). As noted above, the record raises a claim for a TDIU. See Rice, supra. However, the TDIU issue has not been developed for appellate review. Specifically, the Board finds that a remand is needed for the Veteran to be provided with notice of the laws and regulations governing a TDIU. 38 U.S.C.A. § 5103(a). When adjudicating the TDIU claim, the RO/AMC should be mindful of the fact that the Court has recently noted that VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); See also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement special monthly compensation (SMC) under 38 U.S.C.A § 1114 (West 2002). See Bradley, 22 Vet. App. 280, 294 (2008) (finding that SMC "benefits are to be accorded when a Veteran becomes eligible without need for a separate claim"). Indeed, as noted in Bradley, VA must consider a TDIU claim despite the existence of a schedular total rating and award SMC under 38 U.S.C.A. § 1114(s) if VA finds the separate disability supports a TDIU rating independent of the other 100 percent disability rating. See Bradley, 22 Vet. App. 280, 294 (2008); See also DVA Sum. Op. Gen. Counsel Prec., 75 Fed. Reg. 11229-04 (March 10, 2010) (withdrawing VAOPGCPREC 6-99, 64 Fed. Reg. 52375 (1999) (the logic of Bradley suggests that if a Veteran has a schedular total rating for a particular service-connected disability and subsequently claims TDIU for a separate disability, VA must consider the TDIU claim despite the existence of the schedular total rating and award SMC under section 1114(s) if VA finds the separate disability(ies) support a TDIU rating independent of the other 100 percent disability rating). The Veteran's service-connected psychiatric disability is rated as 70 percent disabling and it appears that the RO has determined that he is totally disabled due to this condition, separate and apart from any other service-connected or nonservice-connected disability. See August 2009 rating decision. Further, his service-connected bilateral hearing loss is rated as 60 percent disabling. As such, the RO must determine whether the Veteran is entitled to special monthly compensation at the housebound rate based on a service-connected disability rated as "total" and other combined service-connected disabilities rated as 60 percent disabling. Buie The record shows that the Veteran receives ongoing treatment from the Southeast Louisiana Healthcare System. However, his post-April 2012 treatment records from this facility do not appear in the claims file. Therefore, while the appeal is in remand status, an attempt should be made to obtain and associate with the record these outstanding medical records. See 38 U.S.C.A. § 5103A(b); Bell v. Derwinski, 2 Vet. App. 611 (1992) (holding that VA adjudicators are deemed to have constructive notice of VA treatment records). Accordingly, these issues are REMANDED to the RO/AMC for the following actions: 1. Associate, physically or electronically the Veteran's post-April 2012 treatment records from the Southeast Louisiana Healthcare System. All actions to obtain the requested records should be documented fully in the claims file. 2. Provide the Veteran with notice of the laws and regulations governing entitlement to a TDIU in accordance with 38 U.S.C.A. § 5103A (West 2002) and Dingess v. Nicholson, 19 Vet. App. 473 (2006). 3. Contact the private audiologist that conducted the November 2011 audiological examination and request the Veteran's speech discrimination scores at the time of the testing as well as a statement as to whether this testing was based on the Maryland CNC test. All actions to obtain this information should be documented fully in the claims file. 4. After undertaking any other needed development, readjudicate the claim for rating in excess of 60 percent for bilateral hearing loss from August 3, 2009, as well as the claim for a TDIU. When adjudicating the TDIU claim, the RO must adjudicate whether the Veteran is entitled to special monthly compensation at the housebound rate, i.e., having a service-connected disability rated as total and separate combined service-connected disability rated as 60 percent disabling. In doing so, the RO must determine whether the Veteran is unable to secure or follow a substantially gainful occupation due solely to his service-connected psychiatric disability, bilateral hearing loss, and/or diabetes mellitus and its independently rated manifestations. 5. If any benefit sought on appeal remains denied, the Veteran and his representative should be provided a supplemental statement of the case (SSOC). The SSOC must contain notice of all relevant actions taken on the claims for benefits to include a summary of the evidence received, and any evidence not received, and all applicable laws and regulations considered pertinent to the issues currently on appeal including those governing a TDIU. A reasonable period of time should be allowed for response before the appeal is returned to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ STEVEN D. REISS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs