Citation Nr: 1318400 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 09-37 547 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida THE ISSUES 1. Entitlement to an initial disability rating greater than 30 percent for an anxiety disorder from January 29, 2004. 2. Entitlement to a disability rating greater than 30 percent for an anxiety disorder, from June 12, 2008. 3. Entitlement to a total disability rating based upon individual unemployability due to service-connected disability (TDIU). REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Heather J. Harter, Counsel INTRODUCTION The Veteran served on active duty from November 1960 to April 1964 and from February 1968 to April 1968. This matter comes before the Board of Veterans' Appeals (Board) from a March 2008 RO decision. In Rice v. Shinseki, the Court held that a TDIU claim cannot be considered separate and apart from an increased rating claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Instead, the Court held that a TDIU claim is an attempt to obtain an appropriate rating for a service-connected disability. The Court also found in Rice that, when entitlement to a TDIU is raised during the adjudicatory process of the underlying disability, it is part of the claim for benefits for the underlying disability. The record in this case indicates that the Veteran has essentially asserted that he is not employable solely by reason of his claimed service-connected disability. However, a review of the claims file does not show that this issue has been adjudicated by the RO. As such, the issue of TDIU has been characterized as an issue on appeal as styled on the title page of this decision and remand. The issues of entitlement to a disability rating greater than 30 percent for an anxiety disorder, from June 12, 2008; and entitlement to a total disability rating based upon individual unemployability due to service-connected disability, 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. [Continued on Next Page] FINDING OF FACT From January 29, 2004 through June 12, 2008, the Veteran's anxiety has caused occupational and social impairment with reduced reliability and productivity with symptoms such as frequent panic attacks, impaired concentration, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. CONCLUSION OF LAW A 50 percent disability rating for anxiety is warranted from January 29, 2004 through June 12, 2008. 38 U.S.C.A. §§ 1155, 5107 West 2002); 38 C.F.R. § 4.130, Diagnostic Code 9413 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran contends that his service-connected anxiety disorder is more severe than presently rated. He specifically asserts that service-connected anxiety disorder should be rated at 100 percent and causes him to be unemployable. Duties to notify and assist When an application for benefits is received, VA has certain notice and assistance requirements under the law. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). First, proper notice must be provided to a claimant before the initial VA decision on a claim for benefits and must: (1) inform the claimant about the information and evidence not of record necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. The VA is also required to inform the Veteran of how the VA assigns disability ratings and effective dates. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Veteran was provided with this information in a May 2008 letter. With regard to the VA examination reports which are of record, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA examination obtained in this case is adequate with regard to the issue decided herein. The examination report relied upon herein was predicated on a review of the claims folder and the relevant medical records contained therein; contains a description of the history of the disability at issue; and documents and considers the Veteran's complaints and symptoms. The examiner considered the available pertinent evidence of record, and provided a rationale for the opinions rendered, relying on and citing to the records reviewed. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issues on appeal has been met. 38 C.F.R. § 3.159(c)(4). Service treatment records, private medical records, Social Security disability records, and VA examination reports have been obtained and reviewed in support of the Veteran's claim. All relevant records and contentions have been carefully reviewed. The Board therefore concludes that the VA's duties to notify and assist have been met with regard to the matters decided herein. Standard of review Once the evidence has been assembled, it is the Board's responsibility to evaluate the record. 38 U.S.C.A. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." 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. The Board must consider all the evidence of record and discuss in its decision all "potentially applicable" provisions of law and regulation. See 38 U.S.C. § 7104(a); Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). The Board is also required to provide a statement of reasons or bases for its determination, adequate to enable an appellant to understand the precise basis for its decision, as well as to facilitate further appellate review. See 38 U.S.C. § 7104(d)(1); Allday v. Brown, 7 Vet. App. 517, 527 (1995); Gilbert, 56 (1990). To comply with this requirement, the Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). Analysis Disability evaluations are assigned to reflect levels of current disability. The appropriate rating is determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. When 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. In evaluating claims for increased ratings, the Board must evaluate the Veteran's condition with a critical eye toward the lack of usefulness of the body or system in question. 38 C.F.R. § 4.10. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.41; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Because he has perfected an appeal as to the assignment of the initial rating for anxiety following the initial award of service connection, the VA is required to evaluate all the evidence of record reflecting the period of time between the effective date of the initial grant of service connection until the present. Fenderson v. West, 12 Vet. App. 119 (1999). Because the level of a veteran's disability may fluctuate over time, the VA is required to consider the level of the veteran's impairment throughout the entire period. In this respect, staged ratings are a sensible mechanism for allowing the assignment of the most precise disability rating-one that accounts for the possible dynamic nature of a disability while the claim works its way through the adjudication process. O'Connell v. Nicholson, 21 Vet. App. 89 (2007). In another relevant precedent, the Court noted that staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Under the governing regulatory rating criteria, anxiety is rated under a "General Rating Formula for Mental Disorders". 38 C.F.R. § 4.130, Diagnostic Code 9400. The pertinent provisions of the General Formula are as follows: 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. [10 percent] 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, mild memory loss (such as forgetting names, directions, recent events). [30 percent] Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. [50 percent] 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. [70 percent] 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. [100 percent] 38 C.F.R. § 4.130. The psychiatric symptoms discussed above are not exclusive; they are examples of typical symptoms for the listed percentage ratings. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Put another way, the severity represented by those examples may not be ignored. Entitlement to a particular disability rating requires sufficient symptoms of the kind listed in the requirements for each disability level, or others of similar severity, frequency or duration, that cause occupational and social impairment with deficiencies in most areas such as those enumerated in the regulation. Vazquez-Claudio v. Shinseki, 2012-7114 (Fed. Cir. Apr. 8, 2013). 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. 38 C.F.R. § 4.126(a). However, 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(b). All diagnoses of mental disorders must conform to the psychiatric standards set forth in the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, Fourth Edition, The American Psychiatric Association (1994), (DSM-IV). 38 C.F.R. § 4.125. Historically, the Veteran was discharged from his second period of naval service on account of a psychiatric disorder which was at that time identified as a passive-aggressive personality disorder. A March 2008 VA medical opinion based upon a clinical interview with the Veteran, review of his service records, and recent treatment records yielded the conclusion that the symptoms in service represented the onset of his currently-shown anxiety disorder. Service connection was therefore granted effective in January 29, 2004. The Veteran has challenged the initial 30 percent disability rating assigned, contending that his service-connected anxiety disorder is more severe than this rating reflects and renders him unable to obtain and retain employment. Review of the Veteran's VA treatment records, which date back to before his claim for service connection, reveal that he has been treated for an anxiety disorder for many years. He has been taking psychotropic medication and undergoing individual therapy for many years. VA treatment records are available for a portion of the time period at issue here, since the grant of service connection for an anxiety disorder, effective in January 29, 2004, through June 12, 2008. The period of time after June 12, 2008, is addressed in the remand below. Treatment records dated in 2004 reflect medication and regular individual therapy. There is an element of agoraphobia with his anxiety, and 2004 records reflect a focus on getting out of the house and being with others. A March 2004 report reflects the assignment of a Global Assessment of Functioning Score of 51. In June 2004, a Global Assessment of Functioning Score of 55 was assigned. A March 2005 treatment note reflects that the Veteran's family was preventing him from having contact with his grandchildren due to his anger symptoms, although he denied physical aggressiveness. A Global Assessment of Functioning Score of 46 was assigned during that visit. A Score of 46 was again assigned in April 2005, and in January 2006. An April 2006 treatment report reflects small gains on getting out of the house and shopping, along with reduced anger outbursts. A Global Assessment of Functioning Score of 48 was assigned. In August 2007, the Veteran reported he had moved into his daughter's home and had been housebound to the point where he had run out of medication. The Global Assessment of Functioning Score of 48 was continued, however. A November 2007 report also reflects the assignment of a Global Assessment of Functioning Score of 48. Reports dated in February, March, and June 2008 reflect that the Veteran's daughter had moved, and he was having increased panic and anger outbursts, although he stated he continued to take his medication. Upon cross-checking his pharmacy records, however, it was discovered that he had not picked up his mediation for several months. He stated he did not realize he was not taking his medication. The focus of these visits was about his reaction to his daughter's move. Global Assessment of Functioning Scores of 44 were assigned during these visits. His treating psychologist described his diagnostic assessment as panic disorder with agoraphobia, severe; and depressive disorder, not otherwise specified. The nurse practitioner who prescribed his psychotropic medication rendered diagnoses of anxiety with agoraphobia and insomnia. Other evidence of record reflects that the Veteran has not worked on a full-time basis since the late 1980s. He has been in receipt of Social Security disability benefits on account of back pain since 1990. The Veteran underwent a VA psychiatric examination in February 2008 for the purpose of identifying a nexus between his anxiety disorder and his active service. Although it was conducted pursuant to his claim for service connection, the report of the examination nevertheless contains information pertaining to his current level of impairment due to anxiety. The report reflects his anxiety with panic attacks, difficulty sleeping, irritable mood, and concentration difficulties. The report also reflects the Veteran's anxiety over his daughter's relocation, and that the Veteran reported having no relationship at all with his two half-brothers. The examiner noted that the Veteran's anxiety caused severe problems with activities such as shopping and driving, but did not interfere with other activities of daily living, such as household chores and sports/exercise. Although the Veteran receives Social Security disability benefits, he reported that he had worked on and off over the years to include a job answering phones. When asked why he stopped working, he stated he did not know. The examiner noted that the Veteran's VA medical records reflected some reliability issues relating to medication consumption, in that the Veteran sometimes forgot to refill his medications. The Veteran was unable to report his symptoms of anxiety, details and the duration of his symptoms, and he was evasive with his work history. The examiner also questioned the Veteran's report that he was unable to leave home to get groceries, yet he was able to come to the examination and was able to attend the American Legion and VFW monthly. In describing the effects of the Veteran's anxiety on his occupational and social functioning, the examiner opined that the Veteran's impairment did not rise to the level of total occupational and social impairment. However, his mental disorder signs and symptoms did result in deficiencies in his thinking and his mood. The examiner rendered a diagnosis of anxiety disorder, not otherwise specified, and assigned a Global Assessment of Functioning Score of 58. The assignment of a Global Assessment of Functioning score between 51 and 60 represents the assessments of mental health professionals that the veteran has "moderate symptoms or moderate difficulty in social, occupational, or school functioning." By contrast, a score between 41 and 50 represents "serious symptoms or any serious impairment in social, occupation, or school functioning, such as having no friends, and being unable to keep a job." After careful review, the Board finds that the evidence of record supports a disability rating of 50 percent, and no higher than 50 percent, from January 2004 through June 2008. In reaching this conclusion, we place greater emphasis upon the Global Assessment of Functioning scores assigned by his treating mental health providers, which are lower than that assigned by the VA examiner. In this case, it would appear that they are more familiar with him and his level of functioning than the VA examiner. Also significant is that the VA examination was performed for the purpose of identifying a nexus to service, rather than for the purpose of identifying his level of impairment, although the report does contain helpful and relevant information in this regard. The medical evidence of record, pertaining to his impairment between January 29, 2004, and June 12, 2008, overall reflects psychiatric symptomatology and impairment more nearly analogous to that represented by the criteria for the assignment of a 50 percent disability rating under the General Rating Formula for Mental Disorders. His social impairment as manifested by his isolation in particular is more significant than reflected by the criteria for a 30 percent disability rating; his reduced family relationships are very significant, together with his impaired concentration and sleep problems all point to a disability rating greater than 30 percent. His industrial functioning is reduced as well, although his status as a retired person renders his industrial impairment less significant. There are some facets of the Veteran's anxiety disorder which would appear to be so severe as to warrant a 70 percent disability rating, such as the agoraphobic component of his disorder, and his explosive anger, which at one point was so severe that he was barred from spending time with his grandchildren. However, there are other factors concerning this case which require a cautious approach in rating. The Veteran's inconsistent reporting of his symptoms, and his forgetfulness with regard to his medications raise questions as to whether he brings complete veracity to his claim for monetary benefits. The fact that the VA examiner noted these points as well, to include some skepticism as to the extent of the Veteran's reported agoraphobia, is significant. Overall, the Veteran's symptomatology, including his descriptions of his daily life and functioning, does not rise to the level of the symptoms provided as examples of occupational and social impairment with deficiencies in most areas, such as to support the assignment of a 70 percent disability rating under the General Rating Formula. Mauerhan; Vazquez-Claudio. It follows that he also does not manifest total occupational and social impairment to support the assignment of a 100 percent disability rating. 38 C.F.R. § 4.130. In summary, the evidence supports a grant of an initial 50 percent disability rating, but no higher, for anxiety, effective from January 2004 through June 2008. The most appropriate disability rating after June 2008 is a subject of the remand which follows. Extra-schedular consideration Generally, evaluating a disability using either the corresponding or analogous Diagnostic Codes contained in the rating schedule is sufficient. See 38 C.F.R. § 4.20, 4.27. For exceptional cases, VA has authorized the assignment of extraschedular ratings and provided the following guidance for awarding such ratings: To accord justice, therefore, to the exceptional case where the schedular evaluations are found to be inadequate, the Under Secretary for Benefits or the Director, [C & P], upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b). As the Court recently explained in Thun, a "determination of whether a claimant is entitled to an extraschedular rating under § 3.321(b) is a three-step inquiry." Thun v. Peake, 22 Vet. App. 111, 115 (2008). If the RO or Board determines that (1) the schedular evaluation does not contemplate the claimant's level of disability and symptomatology, and (2) the disability picture exhibits other related factors such as marked interference with employment or frequent periods of hospitalization, then (3) the case must be referred to an authorized official to determine whether, to accord justice, an extraschedular rating is warranted. Neither the RO nor the Board is permitted to assign an extraschedular rating in the first instance; rather the matter must initially be referred to those officials who possess the delegated authority to assign such a rating. See Floyd v. Brown, 9 Vet. App. 88, 95 (1996). Anderson v. Shinseki, 22 Vet. App. 423 (2009). In this case, the Board has determined that for the period up to June 12, 2008, Veteran's anxiety symptoms and psychiatric impairment are covered in the schedular criteria set forth above and warrant the rating assigned herein. However, in view of the remand below, which includes consideration of whether TDIU may be awarded on an extra-schedular basis under 38 C.F.R. § 4.16(b) under the entire period of this appeal, the Board finds that it would be premature to preclude consideration for referral of an extra-schedular rating . As such, the matter is deferred as inextricably intertwined with the pending remand for TDIU. ORDER An initial disability rating of 50 percent for anxiety from January29, 2004, through June 12, 2008, is granted, subject to the laws and regulations governing the award of monetary benefits. REMAND As indicated above, however, the Board finds that the evidence of record subsequent to June 12, 2008 (the date of the last relevant VA mental health record) is currently inadequate for a fully-informed disability rating to be assigned. In particular, given that the Veteran receives regular VA medical care and has established on-going and productive relationships with his VA caregivers, his VA medical records over the past four years promise to be particularly relevant. In any case, VA medical records are deemed to be constructively of record in proceedings before the VA. Bell v. Derwinski, 2 Vet. App. 611 (1992). Therefore, his VA records should be actually updated for review by adjudicators. The Veteran has submitted several private medical records reflecting mental health evaluation in October 2008 by a private psychologist, who, among other things, assigned a Global Assessment of Functioning Score of 35. He also submitted the report of a brief hospitalization in November 2008. According to this report, he was involuntarily admitted after he was found crawling naked outside his residence; he did not know what year it was or what he was doing. These private records would appear to indicate a possible shift in the Veteran's symptoms and level of impairment between June 2008 and October and November 2008. They contain some inaccurate history, however, such as information provided by the Veteran's girlfriend to the effect that he had been engaged in top-secret missions as a SEAL in Vietnam. This information is simply not corroborated in his service records, and it may have unduly influenced the authors of these records. Prior to further review, the Veteran's VA treatment records and any further private treatment records reflecting his condition after June 12, 2008, must be obtained. Then another VA examination should be conducted to provide a medical opinion as to the Veteran's level of functioning from June 12, 2008 onward. As noted above, a request for TDIU is reasonably raised by the evidence of record. Rice v. Shinseki, 22 Vet. App. 447 (2009). A TDIU rating may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.34l, 4.16(a) (2012). In accordance with the decision above, the Veteran's service-connected anxiety disorder is rated as 50 percent disabling up to June12, 2008. As this is the Veteran's only service-connected disability, the schedular criteria for TDIU as described under 38 C.F.R. § 4.16(a) is not met. However, in cases such as this one, where the Veteran claims unemployability by reason of service-connected disability but does not meet the schedular criteria under 38 C.F.R. § 4.16(a), the rating board is authorized to refer the case to the Director, Compensation and Pension Service, for assignment of an extra-schedular evaluation. 38 C.F.R. § 4.16(b) (2012). Although the Veteran asserts that his service-connected anxiety disorder results in unemployability, the RO has not explicitly considered the question of TDIU under 38 C.F.R. § 4.16(b). Furthermore, the Veteran has not been provided notice regarding the evidence necessary to substantiate such a claim. Bernard v. Brown, 4Vet. App. 384 (1993); Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). In this case, the RO must consider whether the issue of TDIU under 38 C.F.R. § 4.16(b) is warranted up to June 12, 2008; and depending upon the outcome of the RO's adjudication of the increased rating claim for service-connected anxiety subsequent to June 12, 2008, whether TDIU may be assigned under 38 C.F.R. § 4.16(a) or (b). Accordingly, the case is REMANDED for the following action: 1. The RO should develop the issue of entitlement to a total disability rating based upon unemployability due to service-connected disabilities, providing the Veteran with appropriate notice and the opportunity to respond at every point in the process. 2. The RO should obtain complete medical records from the Haley Veterans' Hospital in Tampa, and the Viera Outpatient Clinic, and any other related facilities from July 2008 onward, for inclusion in the claims file. 3. The RO should obtain the names and addresses of all non-VA medical care providers who treated the veteran for anxiety or any other psychiatric disorder since November 2008. After securing the necessary release, the RO should obtain these records for inclusion in the claims file. 4. The veteran should be afforded a VA psychiatric examination to evaluate his level of impairment due to anxiety from June 12, 2008 onward. The claims folder, including all records obtained pursuant to the above requests, must be made available to the examiner for review before the examination. All tests and studies deemed helpful by the examiner should be accomplished in conjunction with the examination. The examiner is requested to review the records, and interview the Veteran to determine his current level of impairment related to his anxiety. The examiner is requested to comment upon the significance of the Veteran's November 2008 hospitalization as related to his anxiety disorder. The examiner is also requested to render an opinion as to the impact of the Veteran's anxiety upon his employability. The complete rationale for all opinions expressed should be fully explained. 5. After the development requested above has been completed, the RO should again review the record and adjudicate the issues of entitlement to a rating in excess of 30 percent subsequent to June 12, 2013; and entitlement to TDIU under 38 C.F.R. § 4.16(a) and (b). If either benefit sought on appeal remains denied, the Veteran and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). [Continued on Next Page] This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board 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). ______________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs