Citation Nr: 1306155 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 10-22 107 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an initial compensable evaluation for tension headaches. 2. Entitlement to an evaluation in excess of 70 percent for paranoid schizophrenia. 3. Entitlement to a total disability evaluation based on individual unemployability due to service connected disability (TDIU) for the period of April 28, 2009, to November 21, 2009. REPRESENTATION Veteran represented by: Florida Department of Veterans Affairs WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD C.A. Skow, Counsel INTRODUCTION The Veteran served on active duty from August 1955 to October 1956. This case comes before the Board of Veterans' Appeals (Board) on appeal from December 2008, October 2011, and February 2012 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Respectively, the Veteran appeals from the assignment of an initial noncompensable evaluation for tension headaches, the assignment of a 70 percent evaluation for schizophrenia, and the denial of TDIU from April 28, 2009, to November 21, 2009. Historically, in a July 2010 rating decision, the RO granted service connection for schizophrenia at the 50 percent disability level, effective August 28, 2009. No appeal was filed and that decision became final. In August 2011, the Veteran requested an increased evaluation for paranoid schizophrenia. In an October 2011 rating decision, the RO granted a 70 percent disability evaluation for schizophrenia, effective August 24, 2011 (date of claim for increase). Later, in a February 2012 rating decision, the RO determined that an effective date of November 1, 2010 (date of application for a total rating based on individual unemployability due to service-connected disability [TDIU]) for schizophrenia was warranted based on a finding of clear and unmistakeable error. At this time, the RO further granted the claim for TDIU effective from November 1, 2010. As reflected in the November 2012 hearing on appeal, the Board has accepted jurisdiction of the claim for an evaluation in excess of 70 percent for paranoid schizophrenia and for entitlement to TDIU from April 28, 2009, to November 21, 2009. In November 2012, the Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing. A copy of the transcript is associated with the record. In December 2012, VA received from Veteran additional evidence without a waiver of consideration by the agency of original jurisdiction (AOJ). However, this evidence is not pertinent to the issue on appeal and, therefore, referral to the originating agency is not required. 38 C.F.R. § 20.1304(c). Lastly, in addition to the paper claims files, there is a Virtual VA electronic claims file associated with the Veteran's claim. A review of the documents in the electronic file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issues on appeal. The issues of entitlement to an initial compensable evaluation for tension headaches and TDIU for the period of April 28 to November 21, 2009, are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action is required. Please note 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). FINDING OF FACT The impairment from the Veteran's paranoid schizophrenia more nearly approximates deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, but not total occupational and social impairment. CONCLUSION OF LAW The criteria for an evaluation in excess of 70 percent for paranoid schizophrenia are not met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.126, 4.130, Diagnostic Code 9203 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION I. Duties to Notify and Assist The Veterans Claims Assistance Act (VCAA), codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2012), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. They also require VA to notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. Although the regulation previously required VA to request that the claimant provide any evidence in the claimant's possession that pertains to the claim, the regulation has been amended to eliminate that requirement for claims pending before VA on or after May 30, 2008. The Board also notes the United States Court of Appeals for Veterans Claims (Court) has held the plain language of 38 U.S.C.A. § 5103(a) requires notice to a claimant pursuant to the VCAA be provided "at the time" or "immediately after" VA receives a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). VA satisfied its duty to notify. The RO provided the Veteran fully adequate VCAA notice in August 2009 and September 2011 letters prior to the rating decisions on appeal. The United States Supreme Court has held that an error in VCAA notice should not be presumed prejudicial, and that the burden of showing harmful error rests with the party raising the issue, to be determined on a case-by-case basis. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). In this case, the Veteran has not demonstrated any prejudicial or harmful error in the VCAA notice. VA satisfied its duty to assist the Veteran. VA obtained all relevant medical records. VA made reasonable efforts to obtain Social Security Administration (SSA) records, but SSA informed VA that "After exhaustive and comprehensive searches, we were not able to locate medical records. Further efforts would be futile." The RO notified the Veteran that these records were unavailable and afforded him the opportunity to provide copies of these records in his possession. No records from the Veteran were received. Additionally, VA afforded the Veteran medical examinations. The Board has reviewed the examination reports and finds that they describe the psychiatric disability in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Lastly, VA afforded the Veteran a hearing on the appeal before the Board. A transcript of this hearing is associated with the claims files. Accordingly, the Board will address the merits of the claim. II. Claims for Increase The Veteran seeks an increased evaluation for paranoid schizophrenia. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Legal Criteria Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4 (2012). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1 (2012). 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. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be "staged." Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show distinct period where the service- connected disability exhibits symptoms that would warrant different ratings.); see also Fenderson v. West, 12 Vet. App. 119, 126 (2001). A disability may require re-evaluation in accordance with changes in a veteran's condition. It is thus essential, in determining the level of current impairment, that the disability be considered in the context of the entire recorded history. 38 C.F.R. § 4.1. For schizophrenia, paranoid type, the rating schedule provides that a 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; 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); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9203. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. The use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In assessing the evidence of record, it is important to note that the Global Assessment of Functioning (GAF) score is based on a scale reflecting the, "psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness." Richard v. Brown, 9 Vet.App. 266, 267 (citing DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th ed. (DSM-IV) at 32). A score of 41- 50 is assigned where there are, "Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job)." A score of 51-60 is assigned where there are moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflict with peers or co-workers). GAF scores between 61 and 70 reflect some mild symptoms (e.g. depressed mood and mild insomnia), or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. Id. The Board is required to analyze the credibility and probative value of the evidence, account for any evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Daye v. Nicholson, 20 Vet. App. 512, 516 (2006). It is noted that competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In determining whether statements are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). Analysis The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against an increased evaluation for paranoid schizophrenia, paranoid type. Neither the lay nor the medical evidence more nearly reflects the criteria for a 100 percent disability rating based on total occupational and social impairment. 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9203. A VA outpatient psychiatric note dated in April 2010 reflects schizophrenia, chronic, paranoid type. The Veteran received long acting psychotropic injections as scheduled. He reported euthymic mood with good energy, good motivation, stable interests, good attention/concentration, and good appetite. He reported improved sleep. He denied hallucinations, paranoid ideations, or delusions. He denied manic symptoms. He exhibited mild-moderate involuntary movements of the orobuccolingual region. It was noted that the Veteran had a "good support system consisting of many friends in the Miami area as well as his family..." The Veteran reported frequent outings, including going to the library, attending VA appointments, and meeting with friends. He planned to enroll in an advanced computer course at the University of Miami next semester, and stated "I would like to return to work soon." He was independent in his activities of daily living. Thought processes were circumstantial at times, but redirectable. There were no delusions or preoccupations elicited. A GAF score for 62 was assigned. Report of VA examination dated in June 2010 reflects a diagnosis for paranoid schizophrenia with a GAF score for 50. By history, the Veteran was never married and had no children. He reported a good rapport with his siblings and having a few friends whom he sees weekly. He indicated that he went to dinner with friends and had no romantic relationships. He indicated that he spent his time in a "rat infested room" and went for long walks. The Veteran reported that he lived with a friend and that they mutually assisted each other, but that he had several other friends. He denied any activities other than watching television. The examiner noted that the Veteran was prescribed medication for schizophrenia and received outpatient treatment. The examiner further noted that the Veteran had moderate anxiety (feeling over energized) most of the time. Clinical findings reflect anxious mood, attention disturbance, and rambling, circumstantial thought processes. Thought content was preoccupied with one or two topics. Speech was slightly slurred. The Veteran was unable to maintain minimal personal hygiene. He had no difficulty with the activities of daily living except for a slight problem with shopping activities. There was no impairment of affect, orientation, or insight. There were no suicidal or homicidal thoughts. There were no hallucinations or delusions. Impulse control was good with no episodes of violence. Memory (remote, recent, and immediate) was normal. It was noted that the Veteran was retired and on SSA disability since 1978. The examiner stated that there was not total occupational and social impairment due to mental disorder signs and symptoms; but rather, the Veteran had occupational and social impairment with deficiencies in thinking (circumstantial rambling thoughts), work (poor concentration, anxiety, and rambling and circumstantial thinking), and mood (anxiety). A letter dated in August 2011 from a VA physician reflects that the Veteran was unable to work secondary to his psychiatric disorder, he took psychotropic medications for his conditions, and that he experienced some residual symptoms such as sleep disturbance. Report of VA examination dated in September 2011 reflects that a diagnosis for paranoid schizophrenia with a GAF score for 50. The physician evaluated the Veteran and determined that he had occupational and social impairment with deficiencies in most area, such as work, school, family relations, judgment, thinking and/or mood. He did not find total occupational and social impairment. By history, the Veteran lived with a roommate with worsening rapport and periods of mild paranoia around the roommate. The Veteran reported that he was considering having his roommate move out-the roommate does not pay rent but assists the Veteran with household operations. The Veteran reported less contact with friends, but contact and fair rapport with his siblings. He indicated that he spent most his time at home, avoids and mistrusts people, and was experiencing financial problems due to SSA decreasing his benefits. The physician noted that the Veteran was prescribed medication for schizophrenia and received outpatient treatment. His symptoms included anxiety; suspiciousness; chronic sleep impairment; circumstantial, circumlocutory or stereotyped speech; impaired abstract thinking; difficulty in adapting to stressful circumstances, including work or worklike settings; and impaired impulse control, such as unprovoked irritability with periods of violence. Also, the Veteran had symptoms of mild paranoia in crowds, around strangers and around his roommate at times. He was found competent to handle his financial affairs. The Veteran testified in November 2012 that he was extremely paranoid, which warranted a higher disability rating. He reported that he goes to the hospital twice a week and has computer lessons. He stated that he cannot concentrate on the computer and was unable to work at age 73. He complained of irritability and difficulty getting along with people, along with paranoia and fearfulness about his urban and dangerous neighborhood. The Veteran reported that he lives in a townhome with a roommate and that he leaves his home daily. He reported that his roommate helped him. He indicated that he attends to the activities of daily living himself. He indicated that his roommate has lived with him for the past 3 years. He reported monthly psychiatric counseling and taking medication for control of symptoms. He reported sleep impairment, but denied suicidal or homicidal thoughts. Neither the lay nor the medical evidence more nearly reflects total occupational and social impairment. The Veteran has had significantly retained social functioning throughout the appeal period. Both the lay and medical evidence show that the Veteran has friends and family with whom he interacts. The Veteran is not a recluse, but leaves his home daily and interfaces with the community at large when shopping or attending his scheduled VA appointments. His symptoms of anxiety; suspiciousness; chronic sleep impairment; circumstantial, circumlocutory or stereotyped speech; impaired abstract thinking; difficulty in adapting to stressful circumstances; unprovoked irritability; and paranoia are not of the frequency, severity and duration to result in total social occupational impairment. The GAF scores for 50 reflect serious symptoms, but to the extent that the assigned score suggests having no friends, this is not borne out by the Veteran's statements. It is noted that the schedular criteria require both total occupational and social impairment. While the Veteran is competent to report that his disability is worse than presently evaluated, whether a disability has worsened sufficiently to meet the schedular criteria for the assignment of a higher evaluation is a factual determination by the Board based on the Veteran's complaints coupled with the medical evidence. Although the Veteran believes he meets the criteria for a higher disability rating, his complaints and the medical findings do not meet the schedular requirements for an evaluation higher than 70 percent for schizophrenia, paranoid type, as explained and discussed above. Accordingly, the claim is denied and there is no basis to stage the rating. Hart, supra. Because the evidence is not roughly in equipoise, there is no doubt to resolve. Gilbert, supra. The Board has also considered whether the case should be referred to the Director of the VA Compensation and Pension Service for extra-schedular consideration under 38 C.F.R. § 3.321(a). In determining whether a case should be referred for extra-schedular consideration, the Board must compare the level of severity and the symptomatology of the claimant's disability with the established criteria provided in the rating schedule for disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the disability picture is contemplated by the rating schedule, the assigned evaluation is therefore adequate, and no referral for extra-schedular consideration is required. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). In this case, the record reflects that the manifestations of the disability are specifically contemplated by the schedular criteria. Accordingly, the Board has concluded that referral of this case for extra-schedular consideration is not in order. Thun v. Peake, 22 Vet. App. 111, 115 (2008). ORDER An evaluation in excess of 70 percent for paranoid schizophrenia is denied. REMAND Headaches VA treatment records reflect history of headaches. A February 2010 note reflects headache complaint, with pain 10 of 10, lasting 2 hours, and associated with nausea/vomiting and photophobia. He last vomited one month ago. He reported that headaches occur once daily, and even wake him from sleep. MRI performed in September 2009 showed no masses. Headache was not improved with Tylenol, aspirin, or codeine, but improved when he turned off his television and when he took one of his landlady's Percocets. He denied visual/auditory changes, and difficulty walking or speaking. The assessment was several month history of intermittent severe headaches with no organic etiology; he was prescribed sumatriptan for use as needed with onset of headache. An April 2010 VA treatment note reflects that the Veteran made telephone contact in regard to headaches of one month duration. The Veteran was advised to present for evaluation. On presentation, headaches were evaluated and he was prescribed prophylactic medication and sumatriptan as needed for breakthrough headaches. Report of VA examination dated June 2010 reflects complaints of headaches occurring 2 to 3 times weekly, lasting 2 to 3 hours, with phono/photophobia, nausea/vomiting, and photopsias, which the examiner found consistent with migraine headaches. The Veteran testified in November 2012 that he sought a 100 percent evaluation for headaches. He described his headaches as occurring twice daily and lasting for one hour, with pain at a level 8 of 10, associated with vomiting, treated without relief by prescriptive mediation and rest. He reported that his headaches interfere with concentration. He reported treatment with Dr. Franz and at a Miami hospital. Having carefully reviewed the evidence, the Board finds that additional evidentiary development is required. VA's duty to assist includes obtaining records in Federal custody and making reasonable efforts to obtain those outstanding medical records not in Federal custody. 38 C.F.R. § 3.159. Here, the record shows that the treatment records of Dr. Franz and from a Miami hospital have not been request. Also, VA's duty to assist includes obtaining a VA medical examination where necessary to decide the claim. 38 C.F.R. § 3.159. Report of VA examination dated in June 2010 does not address the severity of the Veteran's headache disorder, to include whether the condition is prostrating in nature. Therefore, this examination is not adequate for rating purposes. It is noted that an adequate examination report must described the disability in sufficient detail so that the Board's "evaluation of the claimed disabilities will be a fully informed one." Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991). See also, D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). TDIU The Veteran seeks an award of TDIU for the period of April 28 to November 21, 2009. The Veteran has been service connected for schizophrenia, paranoid type, at 50 percent from August 28, 2009, and at 70 percent from November 1, 2010; and tension headaches at zero percent from September 19, 2008. His combined rating is 50 percent from August 28, 2009, and 70 percent from November 1, 2010. TDIU was awarded effective from November 1, 2010. Because the TDIU claim is inextricably intertwined with the claim for increase for headaches, the Board may not decide this claim presently. It is noted that the Veteran reported on his application for TDIU dated in November 2011 that he was self-employed as a restaurant owner until November 1976. Report of VA examination dated in December 2008 reflects that the Veteran had retired in 1975 from 15 years of work as a restaurant manager due to psychiatric problems. Report of VA examination dated in June 2010 reflects that the Veteran earned a Bachelor of Arts from a university in Miami in the 1970s. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. If there is only one such disability, it must be rated at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. 38 C.F.R. § 4.16(a). For those veterans who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a), total disability ratings for compensation may nevertheless be assigned when it is found that the service-connected disabilities are sufficient to produce unemployability; such cases should be referred to the Director, Compensation and Pension Service, for extra-schedular consideration. 38 C.F.R. § 4.16(b). For a veteran to prevail on a total rating claim, the record must reflect some factor which takes the claimant's case outside the norm. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1996); 38 C.F.R. §§ 4.1, 4.15. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. . . . The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. See Van Hoose, supra. at 363; 38 U.S.C.A. § 4.16(a). On remand, if the Veteran does not meet the schedular requirements under 38 C.F.R. § 4.16(a) following readjudication of the headache claim for increase, then the RO should consider whether referral to the Director, Compensation and Pension Service, for extra-schedular consideration is warranted under 38 C.F.R. § 4.16(b). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2). Expedited handling is requested.) 1. The RO or the AMC should undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claim, to include all records of treatment by Dr. Franz at Fort Pierce and at a Miami hospital (reported by the Veteran at his videoconference hearing). 2. Then, the Veteran should be afforded a VA examination to determine the frequency, duration, and severity of his service-connected headaches. The claims folders must be made available to and reviewed by the examiner along with any pertinent records located in the VA Virtual file. The examiner should indicate whether the headaches are "prostrating in nature." The RO or the AMC should ensure that the examiner provides all information required for rating purposes, including a description of the functional effects of the disability on the Veteran's daily activities and on his ability to obtain or retain substantially gainful employment. A complete rationale for all opinions is required. 3. The RO or the AMC should also undertake any other development it determines to be warranted. 4. Then, the RO or the AMC should readjudicate the Veteran's claims based on a de novo review of the record. If the Veteran does not meet the TDIU schedular requirements under 38 C.F.R. § 4.16(a) following readjudication of the headache claim, then the RO should consider whether referral to the Director, Compensation and Pension Service, for extra-schedular consideration is warranted under 38 C.F.R. § 4.16(b). If the benefits sought on appeal are not granted to the Veteran's satisfaction, a supplemental statement of the case should be issued, and the Veteran and his representative should be afforded the requisite opportunity to respond before the claims folders are returned to the Board for further appellate action. By this remand, the Board intimates no opinion as to any final outcome warranted. The Veteran 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). _________________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs