Citation Nr: 1305210 Decision Date: 02/13/13 Archive Date: 02/21/13 DOCKET NO. 10-03 082 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUES 1. Entitlement to service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for rectal bleeding, claimed as secondary to service-connected prostate cancer. 3. Entitlement to a disability rating in excess of 10 percent for mood disorder for the period prior to March 1, 2010. 4. Entitlement to a disability rating in excess of 30 percent for mood disorder for the period since March 1, 2010. 5. Whether the reduction of the disability rating for service-connected prostate cancer from 100 to 20 percent, effective on July 1, 2008, was proper. 6. Entitlement to a disability rating in excess of 20 percent for prostate cancer for the period from July 1, 2008, to March 18, 2010. 7. Entitlement to a disability rating in excess of 40 percent for prostate cancer for the period since March 19, 2010. 8. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Anthony M. Flamini, Counsel INTRODUCTION The Veteran served on active duty from March 1965 to March 1967. This case comes before the Board of Veterans' Appeals (Board) on appeal from April 2008 and July 2012 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Des Moines, Iowa. In September 2012, the Veteran testified at a Board videoconference hearing before the undersigned. A transcript of this hearing is associated with the claims folder. The issues of entitlement to an increased rating for mood disorder and entitlement to 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. In August 2012, prior to any Board decision, the Veteran's representative notified VA in writing that the Veteran desired to withdraw his appeal for entitlement to service connection for PTSD. 2. Resolving doubt in the Veteran's favor, the competent and credible evidence demonstrates that the Veteran's rectal bleeding was caused or aggravated by his service-connected prostate cancer. 3. The Veteran was notified of the reasons for the proposed reduction to 20 percent for his prostate cancer, and a period of 60 days expired prior to the implementation of that reduction; the Veteran's residuals were manifested by no worse than awakening approximately 3 to 4 times per night to void prior to March 19, 2010, and voiding at hourly intervals throughout the day and night with the use of 3 to 4 absorbent pads per day since March 19, 2010, with no indication of renal dysfunction, obstructed voiding, or urinary tract infections. . CONCLUSIONS OF LAW 1. The Veteran's appeal as to the issue of entitlement to service connection for PTSD has been withdrawn. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.204 (2012). 2. Rectal bleeding is proximately due to or aggravated by service-connected prostate cancer. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2009); 38 C.F.R. § 3.303, 3.310 (2012). 3. The assignment of a 20 percent evaluation for the service-connected residuals of prostate cancer effective on July 1, 2008, was proper, and the criteria for the assignment of a rating higher than 20 percent prior to March 19, 2010, or a rating higher than 40 percent since March 19, 2010, are not otherwise met. 38 U.S.C.A. §§ 1155, 5112, (West 2002); 38 C.F.R. §§ 3.105, 3.344, 4.3, 4.7, 4.115a, 4.115b including Diagnostic Codes 7528 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. The Duty to Notify and the Duty to Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide in accordance with 38 C.F.R. § 3.159. This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In a claim for an increased evaluation, the VCAA requirement is generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the U.S. Court of Appeals for Veterans Claims (Court) held that, upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Here, the VCAA duty to notify was satisfied by way of letters sent to the appellant in May 2007, August 2007, and December 2007 that fully addressed all notice elements and were sent prior to the initial AOJ decisions in these matters. The letters informed the appellant of what evidence was required to substantiate the claims and of the appellant's and VA's respective duties for obtaining evidence. VA also has a duty to assist the Veteran in the development of the claim. This duty includes assisting the Veteran in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained service treatment records, service personnel records, VA treatment records, and private treatment records. The Veteran was afforded adequate VA medical examinations in December 2005, April 2007, February 2008, April 2008, March 2010, and May 2012. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Significantly, neither the appellant nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). The Veteran was also afforded a Decision Review Officer (DRO) hearing in December 2008. The Court held in Bryant v. Shinseki, 23 Vet. App. 488, 493-94 (2010), that there are two duties imposed by 38 C.F.R. 3.103(c)(2), (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked, that are not impacted by the Veteran's receipt of a VCAA-compliant notice letter. Here, during the hearing, although the DRO did not explicitly note the elements that were lacking to substantiate the Veteran's claims, the Veteran's representative demonstrated actual knowledge of this information. The representative's questions specifically elicited responses designed to show that the Veteran's claimed service-connected disabilities were related to service and/or currently service-connected disabilities, and that his prostate cancer residuals were more severe than currently rated. See Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007) (explaining that actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what was necessary to substantiate his or her claim.) Accordingly, the Veteran is not shown to be prejudiced on this basis. Moreover, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. 3.103(c)(2), nor has he identified any prejudice in the conduct of the Board hearing. By contrast, the hearing focused on the elements necessary to substantiate the claims, and the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claims. As such, the Board finds that, consistent with Bryant, the DRO complied with the duties set forth in 38 C.F.R. 3.103(c)(2). II. Service Connection for PTSD An appeal may be withdrawn as to any or all issues at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2012). An appeal may be withdrawn by an appellant or by his representative. 38 C.F.R. § 20.204(a) (2012). Except when made on the record at a hearing, appeal withdrawals must be in writing. An appeal withdrawal is effective when received by the RO prior to the appeal being transferred to the Board or when received by the Board before it issues a decision. 38 C.F.R. § 20.204(b). Withdrawal of an appeal will be deemed a withdrawal of the notice of disagreement and, if filed, the substantive appeal, as to all issues to which the withdrawal applies. 38 C.F.R. § 20.204(c). Here, the Veteran was seeking entitlement to service connection for PTSD. He perfected his appeal of that issue in January 2010. In August 2012, after the claim was certified to the Board but prior to the issuance of a decision, the Veteran's representative indicated that the Veteran no longer wished to pursue his appeal as to the issue of service connection for PTSD. The Board finds that the Veteran has expressed his desire to withdraw his appeal as to the issue of service connection for PTSD currently before the Board. Thus, there is effectively no longer any remaining allegation of error of fact or law concerning the issue of entitlement to service connection for PTSD. See 38 U.S.C.A. § 7105(d)(5) (West 2002). Accordingly, the Board will dismiss the appeal of that issue. III. Entitlement to Service Connection for Rectal Bleeding Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2011). As a general matter, service connection for a disability on the basis of the merits of such a claim requires (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Caluza v. Brown, 1 Vet. App. 498 (1995). That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b) (2012). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). Service connection may be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310(a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). An increase in severity of a nonservice-connected disorder that is proximately due to or the result of a service-connected disability, and not due to the natural progress of the nonservice-connected condition, will be service connected. Aggravation will be established by determining the baseline level of severity of the nonservice-connected condition and deducting that baseline level, as well as any increase due to the natural progress of the disease, from the current level. 38 C.F.R. § 3.310(b). Prior to the Veteran's claim and appeal for entitlement to service connection for rectal bleeding, an amendment was made to the provisions of 38 C.F.R. § 3.310. See 71 Fed. Reg. 52,744-47 (Sept. 7, 2006). The amendment sets a standard by which a claim based on aggravation of a nonservice-connected disability by a service-connected one is judged. Although VA indicated that the purpose of the regulation was merely to apply the Court's ruling in Allen, supra, it was made clear in the comments to the regulation that the changes were intended to place a burden on the claimant to establish a pre-aggravation baseline level of disability for the nonservice-connected disability before an award of secondary service connection may be made. This had not been the previous practice, which suggests that the recent change amounts to a substantive change. The Court has also held that medical evidence is required to demonstrate a relationship between a present disability and the continuity of symptomatology demonstrated if the condition is not one where a lay person's observations would be competent. See Clyburn v. West, 12 Vet. App. 296 (1999). Lay evidence is competent to establish observable symptomatology; however, VA may make credibility determinations as to whether the evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007), the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that whether lay evidence is competent and sufficient in a particular case is an issue of fact and that lay evidence can be competent and sufficient to establish a diagnosis when (1) a layperson is competent to identify the medical condition (noting that sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. In Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006), the Federal Circuit held that the lay evidence presented by a Veteran concerning his continuity of symptoms after service may generally be considered credible and ultimately competent, regardless of a lack of contemporaneous medical evidence. The Federal Circuit has also recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). VA is free to favor one medical opinion over another provided it offers an adequate basis for doing so. See Owens v. Brown, 1 Vet. App. 429 (1995). The Veteran contends that his rectal bleeding is related to his service-connected prostate cancer and, as such, should be service-connected secondary to his prostate cancer. The Board notes that the Veteran is currently diagnosed with rectal bleeding as noted in the February 2008 and April 2008 VA examinations. As such, the Board finds that the Veteran has a current disability as required by 38 C.F.R. § 3.303. As noted above, the Veteran was afforded a VA examination in February 2008, at which time the examiner opined that the Veteran suffered from rectal bleeding "secondary to radiation treatments" for his service-connected adenocarcinoma of the prostate. However, the Veteran was subsequently afforded a VA rectum and anus examination in April 2008, at which time the examiner opined that the Veteran's rectal bleeding was the result of episodically exacerbated internal hemorrhoids rather than the result of radiation treatment for prostate cancer. The examiner based this conclusion on the result of a February 2006 colonoscopy report which indicated that there were no findings of radiation proctitis, polyps, mucosal abnormalities, diverticula, or other findings. Rather, the only pertinent findings were very small internal hemorrhoids. As such, the evidence is at least in equipoise with regard to whether the Veteran's rectal bleeding is caused or aggravated by his service-connected prostate cancer. Accordingly, the Board finds that the Veteran's claim for service connection for rectal bleeding must be granted. In light of the February 2008 VA examiner's indication that the Veteran's rectal bleeding was caused by radiation treatments for his service-connected prostate cancer, there exists an approximate balance of evidence for and against the claim. When the evidence for and against the claim is in relative equipoise, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2012). Accordingly, with resolution of doubt in the Veteran's favor, the Board concludes service connection for rectal bleeding must be granted. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). IV. Evaluation of Prostate Cancer The Veteran seeks a higher evaluation for his service-connected prostate cancer. In a January 2005 rating decision, the RO granted service connection for prostate cancer and assigned an evaluation of 100 percent effective February 5, 2004. In a May 2007 rating decision, the RO recharacterized the disability as "residuals of prostate cancer" and proposed to reduce the disability evaluation to 20 percent because his hormonal therapy treatment ended and there was no evidence of local recurrence or metastasis. In an April 2008 rating decision, the RO reduced the Veteran's evaluation for residuals of prostate cancer to 20 percent effective July 1, 2008. However, following a March 2010 VA examination which showed increased voiding intervals, the RO recharacterized his disorder as "adenocarcinoma of the prostate, post treatment" and increased his rating to 40 percent effective March 17, 2010, in a July 2012 rating decision. The Board notes that there are three issues involved. First, whether the reduction from 100 percent to 20 percent was proper. Second, whether an evaluation higher than 20 percent was warranted prior to March 19, 2010. Third, whether an evaluation higher than 40 percent is warranted since March 19, 2010. As to the first issue, the Board finds that the reduction was proper. According to 38 C.F.R. § 4.115b, Diagnostic Code (DC) 7528, malignant neoplasms of the genitourinary system, such as the Veteran's prostate cancer, are evaluated as 100 percent disabling. The 100 percent rating shall continue following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, but there will be a mandatory VA examination at the expiration of six months. 38 C.F.R. § 4.115b, Note. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e), which set forth procedural requirements for reductions in disability compensation ratings. When a reduction in compensation payments is anticipated, the beneficiary must be notified of the proposed reduction, with notice of the reasons for the proposed reduction. Further, the beneficiary must be allowed a period of at least 60 days to submit additional evidence to show that the rating should not be reduced. After the allotted period, if no additional evidence has been submitted, final rating action will be taken and the rating will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating expires. 38 C.F.R. § 3.105(e). Here, the RO granted service connection for prostate cancer in the January 2005 rating decision, and assigned a disability rating of 100 percent. In May 2007, the RO prepared a rating decision proposing the reduction from 100 percent to 20 percent, as indicated in 38 C.F.R. § 3.105(e), and sent such notice, with notice of the reasons for the proposed reduction, to the Veteran on May 10, 2007. This notice was received by the Veteran in May 2007, as evidenced by the correspondence dated by the Veteran on May 14, 2007, in which he disagreed with the proposed reduction. In an April 2008 rating decision, approximately 11 months after the Veteran first received notice of the reduction, the RO reduced his evaluation for residuals of prostate cancer effective July 1, 2008. As such, the Board finds that the provisions of 38 C.F.R. § 3.105(e) were complied with, and that the reduction was proper. The next questions concern whether VA has met its burden of proving that the assignment of a 20 percent rating from July 1, 2008, to March 18, 2010, and a 40 percent rating since March 19, 2010, for the Veteran's prostate cancer was warranted. The 100 percent rating for prostate cancer was made effective on September 30, 2004, and continued in effect until July 1, 2008. Because the evaluation was not in effect for five years or more, compliance with the provisions of 38 C.F.R. § 3.344(a) and (b) is not required. See 38 C.F.R. § 3.344(c). These provisions also do not apply to disabilities that have not become stabilized and are likely to improve. Rather, a reduction is warranted upon reexamination reflecting improvement, physical or mental. 38 C.F.R. § 3.344(c). In this regard, disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which assigns ratings based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. 4.1, et. al. 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 required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In Fenderson v. West, 12 Vet App 119, 125-26 (1999), however, the U.S. Court of Appeals for Veterans Claims (Court) distinguished appeals involving a veteran's disagreement with the initial rating assigned at the time a disability is service-connected. Accordingly, where the question for consideration is the propriety of the initial rating assigned, evaluation of the medical evidence since the effective date of the grant of service connection, and consideration of the appropriateness of "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts found) is required. See id. at 126-27. Moreover, the Board notes, the Court held that in claims for increased rating VA must consider that a claimant may experience multiple distinct degrees of disability, resulting in different levels of compensation, from the time the increased rating claim is filed to the time a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, following the Veteran's initial prostate cancer diagnosis in August 2004, he was treated with radiation therapy until April 2005 and with hormone therapy (Zoladex) until July 2006. The disability is currently in remission and not productive of malignancy. Accordingly, a 100 percent evaluation is no longer assignable, and the Board must consider the rating criteria of the predominant disability as voiding dysfunction, renal dysfunction, or urinary tract infection, to determine if a rating higher than 10 percent is warranted. 38 C.F.R. § 4.115b, DC 7528. According to the provisions of 38 C.F.R. § 4.115a, diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following sections provide descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Because the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis. Evaluations of renal dysfunction are assigned under 38 C.F.R. § 4.115b, which provides that a noncompensable (no percent) rating is assigned for albumin and casts with history of acute nephritis; or, hypertension. A 30 percent evaluation is assigned for albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under Diagnostic Code 7101. A 60 percent evaluation is assigned for constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101. An 80 percent evaluation is assigned for persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. The highest evaluation, 100 percent, is assigned in situations requiring regular dialysis or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. 38 C.F.R. § 4.115a. Voiding dysfunction is rated as either urine leakage, frequency, or obstructed voiding. 38 C.F.R. § 4.115a. With continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, a 20 percent evaluation is assigned for a disability requiring the wearing of absorbent materials which must be changed less than two times per day. A 40 percent evaluation is assigned for a disability requiring the wearing of absorbent materials which must be changed two to four times per day. A 60 percent evaluation is assigned for the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day. In cases of urinary frequency, a 10 percent evaluation is assigned for a daytime voiding interval between two and three hours, or awakening to void two times per night. A 20 percent evaluation is assigned for a daytime voiding interval between one and two hours, or awakening to void three to four times per night. A 40 percent evaluation is assigned in cases of a daytime voiding interval less than one hour, or awakening to void five or more times per night. In cases of obstructed voiding, a noncompensable (zero percent) evaluation is assigned for obstructive symptomatology with or without stricture disease requiring dilatation one to two times per year. A 10 percent evaluation is assigned for marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of the following: post-void residuals greater than 150 cc, urometry with a markedly diminished peak flow rate (less than 10 cc/sec), recurrent urinary tract infections secondary to obstruction, and stricture disease requiring periodic dilation every two to three months. A 30 percent evaluation is assigned for urinary retention requiring intermittent or continuous catheterization. Finally, in cases of urinary tract infections, a 10 percent evaluation is warranted for long-term drug therapy, with one to two hospitalizations per year and/or requiring intermittent intensive management. A 30 percent evaluation contemplates recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management. In cases of poor renal function, the urinary tract infection is to be rated as renal dysfunction. See 38 C.F.R. § 4.115a. Upon review, the Board finds that in comparing the Veteran's symptoms during the applicable appellate period to the rating criteria, his symptomatology does not warrant an evaluation in excess of the currently assigned 20 percent from July 1, 2008, to March 18, 2010. In particular, there was no indication of renal dysfunction or urinary tract infections. Furthermore, the Veteran was not shown to wear absorbent materials; have a daytime voiding interval less than one hour, or awaken to void five or more times per night; or have urinary retention requiring intermittent or continuous catheterization. The Veteran was afforded a VA genitourinary examination in April 2007, at which time the examiner diagnosed him as having adenocarcinoma of the prostate, status post radiation and Zoladex therapy, with mild-to-moderate impact on functional ability. Subjectively, the Veteran reported continual lethargy, fatigue, and a weight increase of approximately 20 pounds in the past year. He reported frequency and urgency of urination, although he denied any hesitancy, poor stream quality, or pain upon urination. He indicated that he awoke approximately 3 to 4 times per night to urinate. He also alleged urinary incontinence due to urgency and reported urinating 2 to 3 times daily, although he denied the use of absorbent pads. There was no history of hepatitis, jaundice, hematemesis, melena, hematuria, dysuria, nephrolithiasis, recurrent urinary tract infections, or flank pain. The Veteran was also afforded a VA examination in February 2008, at which time the examiner diagnosed him as having adenocarcinoma of the prostate, status post treatment. Although the Veteran reported a weight gain of 40 pounds since his treatment discontinued, there was no mention of lethargy or fatigue. It was noted that the Veteran currently had problems with urinary urgency, but not incontinence, and was prescribed Hytrin and Ditropan, which improved his urinary function. The Veteran reported problems with urinary frequency when away from home and not near a bathroom, as he could not empty his bladder all the way, but denied wearing absorbent materials. He explicitly denied any incontinence or any history of genitourinary disease. There was no history of hepatitis, jaundice, hematemesis, melena, hematuria, dysuria, nephrolithiasis, recurrent urinary tract infections, or flank pain. In summary, voiding dysfunction was shown to be the Veteran's predominant disability between July 1, 2008, and March 18, 2010. The evidence, however, demonstrates no more than daytime voiding of up to 3 times and nighttime voiding of up to 4 times. This symptomatology is consistent with a 20 percent evaluation. As shown by the treatment notes and VA examinations, the Veteran did not have urine leakage requiring him to wear absorbent materials, urinary retention requiring intermittent or continuous catheterization, urinary tract infections, or renal dysfunction. Accordingly, higher evaluations are not warranted on this basis. See 38 C.F.R. § 4.115a. With respect to the propriety of the 40 percent evaluation assigned since March 19, 2010, as noted above, the RO increased the rating in response to the results of a VA genitourinary examination conducted on that date. At that time, the Veteran was diagnosed as having prostate cancer, in remission. Subjectively, the Veteran reported nighttime voiding of once per hour and daytime voiding of once per hour with urgency. However, he denied any incontinence. The Veteran was afforded his most recent VA genitourinary examination in May 2012, at which time he was diagnosed as having prostate cancer in remission. Subjectively, he reported daytime voiding at intervals of 2 to 3 hours, as well as awakening to void 2 times per night. He reported using absorbent pads 3 to 4 times per day whenever he left the home for more than several hours. He also reported using one absorbent pad per night. In addition, the voiding dysfunction caused hesitancy, a markedly slow or weak stream, and a markedly decreased force of stream. However, the Veteran denied any recurrent symptomatic urinary tract or kidney infections. Again, voiding dysfunction was shown to be the Veteran's predominant disability since March 19, 2010. The evidence during this period demonstrates no more than voiding once per hour throughout the day and night, as well as the use of absorbent pads 3 to 4 times per day. This symptomatology is consistent with the maximum schedular 40 percent evaluation for urinary frequency, as well as the 40 percent evaluation for voiding dysfunction. As shown by the treatment notes and VA examinations, the Veteran does not have urinary retention requiring intermittent or continuous catheterization, urinary tract infections, or renal dysfunction. Accordingly, higher evaluations are not warranted on this basis. See 38 C.F.R. § 4.115a. In conclusion, the Board finds that the RO's assignment of a 40 percent evaluation effective March 19, 2010, was proper. "Staged ratings" are not otherwise warranted because the schedular criteria for a higher rating were not met at any time during the period under appellate review. See Hart, 21 Vet. App. at 505; Fenderson, 12 Vet. App. at 126-27. The Board's findings above are based on schedular evaluation. To afford justice in exceptional situations, an extraschedular rating may also be provided. 38 C.F.R. § 3.321(b). Here, however, referral for extraschedular consideration is not warranted. First, the applicable rating criteria reasonably describe the Veteran's disability level and symptomatology. Further, the evidence does not show marked interference with employment due to residuals of prostate cancer in excess of that contemplated by the rating schedule. To the contrary, the May 2012 VA examiner specifically opined that the Veteran's prostate cancer residuals did not impact his ability to work. Nor is there any indication of frequent periods of hospitalization due to residuals of prostate cancer or other evidence that would render impractical the application of the regular schedular standards. Therefore, the Board is not required to remand the Veteran's claim for consideration of extraschedular ratings under 38 C.F.R. § 3.321(b)(1). See Thun v. Peake, 22 Vet. App. 111, 115 (2008); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER The appeal as to the issue of entitlement to service connection for pulmonary asbestosis dismissed. Entitlement to service connection for rectal bleeding, to include as secondary to service-connected prostate cancer, is granted. A disability rating in excess of 20 percent for prostate cancer for the period from July 1, 2008, to March 18, 2010, is denied. A disability rating in excess of 40 percent for prostate cancer for the period since March 19, 2010, is denied. REMAND The Veteran also seeks entitlement to an increased rating for his service-connected mood disorder, which is currently rated as 10 percent disabling prior to March 1, 2010, and as 30 percent disabling since March 1, 2010. The Board notes that the Veteran was most recently afforded a VA mental disorders examination in March 2010. Although he was afforded a VA PTSD examination in May 2012, the purpose of this examination was to obtain an etiological opinion as to any PTSD diagnosis rather than to assess the current severity of the Veteran's service-connected mood disorder. Regardless, in light the Veteran's recent allegations at his September 2012 Board videoconference hearing that his psychiatric symptomatology had worsened since his last examination, the Board finds that another VA mental disorders examination is necessary to evaluate the current level of severity of the service-connected mood disorder. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159; Snuffer v. Gober, 10 Vet. App. 400(1997); Caffrey v. Brown, 6 Vet. App. 377, 381(1995); Green v. Derwinski, 1 Vet. App. 121, 124(1991) (VA's statutory duty to assist the Veteran includes the duty to conduct a thorough and contemporaneous examination so that the evaluation of the claimed disability will be a fully informed one). The Veteran also seeks entitlement to a TDIU. The law provides that when a determination on one issue could have a significant impact on the outcome of another issue, such issues are considered inextricably intertwined and VA is required to decide those issues together. Harris v. Derwinski, 1 Vet. App. 180 (1991). In the present case, as the Veteran has a claim for an increased evaluation pending, the Board cannot proceed with the TDIU claim until there has been final adjudication of the Veteran's increased rating claim. Thus, adjudication of the TDIU claim will be held in abeyance pending further development and adjudication of the Veteran's claim of entitlement to an increased evaluation. Accordingly, the case is REMANDED for the following action: 1. The RO must contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of his claim of entitlement to an increased initial disability rating for the service-connected mood disorder. Based on his response and after obtaining any appropriate release from the Veteran, the RO must attempt to procure copies of all records which have not previously been obtained from identified treatment sources. All attempts to secure this evidence must be documented in the claims folder by the RO. If, after making reasonable efforts to obtain named records the RO is unable to secure same, the RO must notify the Veteran and (a) identify the specific records the RO is unable to obtain; (b) briefly explain the efforts that the RO made to obtain those records; and (c) describe any further action to be taken by the RO with respect to the claim. The Veteran must then be given an opportunity to respond. 2. The Veteran must be afforded a VA mental disorders examination for the purpose of determining the current severity of his service-connected mood disorder. The claims folder must be made available to the examiner and reviewed in conjunction with the examination; such review must be noted in the examination report The examiner should describe in detail all current manifestations of the Veteran's mood disorder. Additionally, the examiner must state whether the Veteran's service-connected mood disorder more nearly approximates a disability characterized by: a. A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication; or b. 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, or; symptoms controlled by continuous medication; or c. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, 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, and mild memory loss (such as forgetting names, directions, recent events); or d. 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; or difficulty in establishing and maintaining effective work and social relationships; or e. Occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech that is 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 worklike setting); or an inability to establish and maintain effective relationships; or f. 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; or memory loss for names of one's close relatives, occupation, or own name. The examiner must also enter a complete multiaxial evaluation, and assign a Global Assessment of Functioning score, together with an explanation of what the score represents in terms of his psychological, social, and occupational functioning. The examiner should also comment on whether the Veteran's mood disorder, in and of itself, precludes him from obtaining or maintaining gainful employment. A complete rationale for all opinions must be provided. Any report prepared must be typed. 4. The Veteran must also be advised of the importance of reporting to the scheduled VA examination and of the possible adverse consequences, to include the denial of the claim, of failing, without good cause, to so report. See 38 C.F.R. § 3.655 (2012). The notification letter advising the Veteran of the time, date, and location of the examination must be included in the claims folder, and must reflect that it was sent to the Veteran's last known address of record. If the notification letter is returned as undeliverable, this must also be included in the claims folder. 5. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claims must be readjudicated. If any claim remains denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. 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). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims 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). ______________________________________________ L. M. BARNARD Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs