Citation Nr: 1319442 Decision Date: 06/14/13 Archive Date: 06/21/13 DOCKET NO. 05-26 127 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Newark, New Jersey THE ISSUES 1. Entitlement to service connection for hypertension, including as secondary to service-connected anxiety disorder. 2. Entitlement to an increased rating for right ear hearing loss, currently evaluated as noncompensably disabling. 3. Entitlement to an increased rating for residuals of right ankle injury, currently evaluated as 10 percent disabling. 4. Entitlement to an increased rating for an anxiety disorder, evaluated as 30 percent disabling from January 9, 2002, as 50 percent disabling from February 5, 2004, and as 70 percent disabling from April 9, 2010. 5. Entitlement to an increased rating for myositis of the cervical, dorsal, and lumbar spine, currently evaluated as 10 percent disabling. 6. Entitlement to a total disability rating based on unemployability due to service-connected disability (TDIU). REPRESENTATION Appellant represented by: National Association of County Veterans Service Officers WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD C. Fleming, Counsel INTRODUCTION The Veteran had active military service from January 1967 to January 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2002, July 2003, and February 2008 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey. In the January 2002 decision, the RO denied the Veteran's claim for service connection for hypertension. In the July 2003 decision, the RO awarded the Veteran an increased rating of 10 percent for his service-connected residuals of right ankle disability. In that decision, the RO also denied the Veteran's other claims for increased ratings. However, in a January 2005 rating decision, the RO granted the Veteran an increased rating of 30 percent for anxiety disorder, effective January 9, 2002, and of 50 percent, effective February 5, 2004. The RO further increased the Veteran's disability rating for anxiety disorder to 70 percent, effective April 9, 2010, in a June 2011 rating decision. By the February 2008 rating decision, the RO denied the Veteran's claim for TDIU. The Board remanded the Veteran's case in June 2012 for further evidentiary development and adjudication. In the remand, the Board instructed the agency of original jurisdiction (AOJ) to obtain records from the Veteran's private treatment providers, provide the Veteran with VA examination, and then re-adjudicate the claims. The AOJ obtained the identified records and scheduled the Veteran for VA examination, which were conducted in November 2012. The AOJ then issued the Veteran a supplemental statement of the case in April 2013 in which it again denied the claims. Thus, as to the issues decided herein, there has been compliance with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in January 2012. A transcript of the hearing has been associated with the Veteran's claims file. The decision below addresses the Veteran's claim for entitlement to service connection for hypertension, as well as his claims for increased ratings for his service-connected right ankle disorder, right ear hearing loss, and anxiety disorder. Adjudication of the remaining claims on appeal is deferred pending completion of the development sought in the remand that follows the decision. FINDINGS OF FACT 1. The Veteran does not have hypertension that is related to military service; his hypertension has not been caused or made worse by service-connected anxiety disorder. 2. The Veteran's right ear hearing loss has been manifested by hearing impairment corresponding to auditory acuity no worse than Level I in the right ear. 3. The Veteran's service-connected residuals of right ankle injury is manifested by a disability equating to no worse than moderate limitation of motion. 4. For the period from January 9, 2002, to April 9, 2010, the Veteran's anxiety disorder was manifested by flattened affect, disturbances of motivation and mood, nightmares, irritability, isolation, and difficulty in establishing and maintaining effective relationships that approximate occupational and social impairment with reduced reliability and productivity. 5. From the period from April 9, 2010, the Veteran's anxiety disorder has been manifested by occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, and mood. Total occupational and social impairment has not been shown. CONCLUSIONS OF LAW 1. The Veteran does not have hypertension that is the result of disease or injury incurred in or aggravated during active military service, nor may hypertension be presumed to have been incurred therein; his hypertension is not proximately due to or the result of service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.310 (2006); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 2. The criteria for a compensable disability rating for service-connected right ear hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100 (2012). 3. The criteria for a rating higher than 10 percent for residuals of right ankle injury have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code 5271 (2012). 4. The criteria for a disability rating of 50 percent for the Veteran's service-connected anxiety disorder were met for the period from January 9, 2002, to February 5, 2004. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9400 (2012). 5. The criteria for a disability rating higher than 50 percent for the Veteran's service-connected anxiety disorder were not met for the period from February 5, 2004, to April 9, 2010. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9400 (2012). 6. The criteria for a disability rating higher than 70 percent for the Veteran's service-connected anxiety disorder have not been met for the period since April 9, 2010. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9400 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist At the outset, the Board notes the enactment of the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), in November 2000. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, and 5107 (West 2002 & Supp. 2012). To implement the provisions of the law, VA promulgated regulations codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The VCAA and its implementing regulations include, upon the submission of a substantially complete application for benefits, an enhanced duty on the part of VA to notify a claimant of the information and evidence needed to substantiate a claim, as well as the duty to notify the claimant of what evidence will be obtained by whom. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In addition, they define the obligation of VA with respect to its duty to assist a claimant in obtaining evidence. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). In this case, the Board finds that all notification and development action needed to arrive at a decision as to the claims decided herein has been accomplished. In this respect, through May 2003, March 2005, April 2010, April 2011, and October 2012 notice letters, the Veteran received notice of the information and evidence needed to substantiate his claims. Thereafter, the Veteran was afforded the opportunity to respond. Hence, the Board finds that the Veteran has been afforded ample opportunity to submit information and/or evidence needed to substantiate his claims. The Board also finds that the May 2003, March 2005, April 2010, April 2011, and October 2012 notice letters satisfy the statutory and regulatory requirement that VA notify a claimant what evidence, if any, will be obtained by the claimant and which evidence, if any, will be retrieved by VA. See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). In the letters, the RO also notified the Veteran that VA was required to make reasonable efforts to obtain medical records, employment records, or records from other Federal agencies. The RO also requested that the Veteran identify any medical providers from whom he wanted the RO to obtain and consider evidence. Proper VCAA notice 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. See Pelegrini v. Principi, 18 Vet. App. 112, 121 (2004). See also Notice and Assistance Requirements and Technical Correction, 73 Fed. Reg. 23,353 (Apr. 30, 2008) (codified at 38 C.F.R. § 3.159) (removing the prior requirement that VA specifically ask the claimant to provide any pertinent evidence in his possession). These requirements were met by the aforementioned May 2003, March 2005, April 2010, April 2011, and October 2012 letters. Further, the Veteran was provided notice regarding awards of effective dates and ratings in the April 2010, April 2011, and October 2012 letters. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Nothing about the evidence or any response to the RO's notification suggests that the case must be re-adjudicated ab initio to satisfy the requirements of the VCAA. The Board also points out that there is no indication that any additional action is needed to comply with the duty to assist in connection with the claims decided herein. The Veteran's service treatment records, as well as records of his post-service treatment with VA and private treatment providers, have been associated with the claims file. Otherwise, the Veteran has not alleged that there are any outstanding medical records probative of the claims that need to be obtained. The Veteran also underwent VA examination in January 2002, February 2003, February 2004, December 2004, March 2005, July 2007, May 2011, and November 2012, reports of which are of record. To that end, 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). Here, the Board finds that the VA examinations obtained in this case are collectively adequate, as they are predicated on full physical, audiological, and psychiatric examination as well as consideration of the medical records in the claims file and the Veteran's reported history. The examinations consider all of the pertinent evidence of record, to include statements given by the Veteran at the time of the examinations, and provide a complete rationale for the opinions stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the claims decided herein has been met. 38 C.F.R. § 3.159(c)(4). Additionally, the Veteran and his representative have both submitted written argument, and the Veteran testified before the undersigned Veterans Law Judge at a hearing in January 2012. Neither the Veteran nor his representative has alleged that there are any outstanding records probative of the claims decided herein that need to be obtained. Under these circumstances, the Board finds that VA has complied with all duties to notify and assist required under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159. II. Analysis A. Claim for Service Connection Regarding his service connection claim, the Veteran has contended that he has hypertension as a result of his time on active duty or, in the alternative, as secondary to his service-connected anxiety disorder. The RO denied the Veteran's claim on the basis that the medical evidence of record weighed against a finding of a link both between his current hypertension disability and his service-connected anxiety disorder, and between his hypertension and service. Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires: (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of an injury or disease; and (3) evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999). Further, it is not enough that an injury or disease occurred in service; there must be chronic disability resulting from that injury or disease. 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). When hypertension is manifested to a compensable degree within a year of separation from qualifying service, it may be presumed to have been incurred in or aggravated by active military service. 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for a disability that is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310 (2006). This includes a disability made chronically worse by service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The Board notes that there has been an amendment 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 non-service-connected disability by a service-connected one is judged. Although VA has indicated that the purpose of the regulation was merely to apply the Court's ruling in Allen, 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 non-service-connected disability before an award of service connection based on aggravation may be made. This had not previously been VA's practice, which strongly suggests that the change amounts to a substantive change in the regulation. Given what appear to be substantive changes, and because the Veteran's claim for service connection for hypertension was pending before the regulatory change was made, the Board will consider the version of 38 C.F.R. § 3.310 in effect before the change, which version favors the claimant. Relevant medical evidence consists of the Veteran's service treatment records, as well as his post-service treatment at private and VA facilities and VA examinations conducted in January 2002, December 2004, and May 2011, and November 2012. Service treatment records are silent as to any complaints of or treatment for high blood pressure or any heart problems while the Veteran served on active duty; he was not treated for hypertension for many years after his separation from service. A review of the Veteran's post-service private and VA treatment records reflects that he was first treated for heart problems in approximately 1998 and has continued to receive treatment since that time. He has undergone multiple VA examinations in relation to this claim. In that connection, report of the January 2002 examination reflects the examiner's conclusion that the Veteran's hypertension was not caused by the anxiety disorder, "but preexisting hypertension could be aggravated by anxiety." However, the examiner failed to offer a rationale for this opinion. In a clarification opinion following the December 2004 VA examination, the examiner stated that the Veteran's hypertension is less likely than not to have been aggravated by anxiety disorder. However, this examiner also failed to explain the opinion. In addition, the May 2011 VA examiner diagnosed the Veteran with essential hypertension but failed to offer an opinion as to its etiology. Similarly, his private physicians have offered opinions dated in July 2005, November 2008, and October 2009 indicating their findings that the Veteran's hypertension is related to his anxiety disorder, but none of the physicians has provided a rationale for the opinion. The Veteran has also submitted multiple statements to VA in which he emphasizes his belief that his service-connected anxiety disorder has caused or aggravated his hypertension. Pursuant to the Board's June 2012 remand, and to address the lack of rationale for the positive and negative opinions contained in the file, the Veteran again underwent VA examination in November 2012. In the report of the November 2012 examination, the VA examiner examined the Veteran, reviewed his claims file, including his entire medical history, and concluded that the Veteran's hypertension was not directly linked to service or caused or aggravated by his anxiety disorder. In so finding, the examiner noted that the Veteran had not been diagnosed with essential hypertension until eighteen years after his separation from service and pointed out that anxiety could cause short-term "spikes" in blood pressure but was not known to cause or aggravate a long-standing diagnosis of hypertension. Upon consideration of the above evidence, the Board first finds that the preponderance of the evidence is against the Veteran's claim of service connection for hypertension on a direct basis. The Board concedes that VA examination confirms that the Veteran currently suffers from hypertension. The Board concludes, however, that the greater weight of the evidence is against the claim. Here, the Veteran's service treatment records are silent as to any complaints of or treatment for high blood pressure or hypertension. Further, the November 2012 VA examiner considered the in-service findings but nevertheless found no link between any current disability and military service. In addition, records of the Veteran's treatment from VA treatment providers reflects that he was not diagnosed with hypertension until approximately eighteen years after his separation from service. Furthermore, the Board finds persuasive the absence of medical evidence to support a finding of a nexus between the Veteran's service and his current hypertension. In that connection, the Board notes that the medical opinion submitted by the November 2012 VA examiner did not attribute the Veteran's current hypertension to his time on active duty. In so finding, the examiner noted the 30-year period between the Veteran's separation from active duty and his first diagnosis of hypertension, as well as the lack of any in-service diagnosis of or treatment for high blood pressure. This evidence is uncontradicted by any medical evidence of record; there is simply no medical evidence in the record supporting a finding of an etiological relationship between the Veteran's time in service and his current hypertension. The Board thus finds that the preponderance of the evidence is against the Veteran's claim of service connection for hypertension on a direct basis. The Board concedes that the Veteran has a current diagnosis of hypertension. However, there is no credible evidence indicating that his hypertension began during service or that he has experienced a continuity of symptomatology since service. Thus, in order for the Veteran's claim to be granted, the record would have to contain competent evidence of a link between the present disorder and military service. Here, there is no such evidence; indeed, as noted above, the only medical opinion of record that speaks to the relationship between any current disability and service is unfavorable. Relevant law and regulations do not provide for the grant of service connection on a direct basis in the absence of evidence linking the current disability to service. The Board is satisfied that the VA examiner's opinions are adequate for deciding this appeal. In this case, the November 2012 VA examiner's medical opinion, which is based on the entire record, including the Veteran's own history, is that the Veteran's hypertension is not at least as likely as not related to military service. Because this opinion is not controverted by any other medical evidence of record, and in light of the foregoing analysis and the underlying facts, the Veteran's service connection claim for hypertension on a direct basis must be denied. As noted above, the Veteran has contended that his currently diagnosed hypertension is related to service. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (i.e., experiencing symptoms either in service or after service). See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). However, he is not competent to say that any such symptoms experienced in service were a result of or worsened by any incident in service or were of a chronic nature to which any current disability is attributable. Although the Veteran has contended otherwise, the evidence, viewed in its totality, does not support a finding that the Veteran first developed hypertension in service that has continued to the present. More importantly, however, the record contains no medical evidence whatsoever to show that the Veteran's current hypertension can be attributed to service. In November 2012, the VA examiner considered the entirety of the record, to include the Veteran's contentions and his service treatment records, and nevertheless opined that it was less likely than not that the Veteran's hypertension was linked to military service. None of this evidence, or any of the other competent evidence of record, in any way relates the Veteran's current hypertension to service. Absent such evidence, the claim for service connection on a direct basis must be denied. Turning to the Veteran's claim of secondary service connection, because the question of whether a disability such as hypertension is related to another disorder, such as anxiety disorder, is a medical question requiring expertise, the Board relies upon the November 2012 VA examiner's opinions. The examination report reflects that the examiner reviewed the Veteran's claims file and understood the medical questions asked by the originating agency. Additionally, the November 2012 VA examiner offered a clear rationale for his opinion that the Veteran's hypertension was less likely than not related to or aggravated by service-connected anxiety disorder, relying on both the Veteran's medical records and reported history and the examiner's own medical expertise. Specifically, the November 2012 VA examiner opined that the Veteran's hypertension was not likely linked to his service-connected anxiety disorder, reasoning that although anxiety can cause short-term "spikes" in blood pressure, there is no known medical association between anxiety disorder and a long-term diagnosis of hypertension. Thus, the Board finds persuasive the absence of competent medical evidence to support a finding of a nexus between the Veteran's service-connected anxiety disorder and hypertension. In so finding, the Board acknowledges that there are opinions in the file that purport to offer an etiological link between the Veteran's current hypertension and his service-connected anxiety disorder. However, an evaluation of the probative value of medical opinion evidence is based on the medical expert's knowledge and skill in analyzing the data, and the medical conclusion reached. The weight to be attached to such opinions is within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Greater weight may be placed on one physician's opinion over another depending on factors such as reasoning employed by the physicians and whether or not, and the extent to which, they considered prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. See Sklar v. Brown, 5 Vet. App. 140 (1993). For the reasons set forth below, the Board is thus satisfied that the November 2012 VA examiner's opinions are adequate for deciding this appeal and are of greater weight than the opinions offered by the Veteran's private physicians, who have submitted multiple letters attributing the Veteran's diagnosed hypertension to his service-connected anxiety disorder. In so finding, the Board notes that the private physicians have failed to offer any explanation or rationale for their conclusions that the Veteran's hypertension is linked to anxiety disorder. To the contrary, as noted above, the private treatment providers have merely stated that the Veteran's hypertension is "due to anxiety" or "is definitely attributed to his anxiety disorder" but have not provide any reasoning in any of the multiple letters they have submitted as to why the diagnosis was characterized in that manner. Given this failure, and in light of the reasoned opinions offered by the VA examiner in November 2012, which relied on consideration of the Veteran's entire medical history as well as the examiner's medical knowledge and expertise, the Board finds the private physicians' statements concerning the etiology of the Veteran's hypertension to be of less probative value. See Gabrielson, 7 Vet. App. at 40. The November 2012 VA reviewer, by contrast, provided a report that considered the Veteran's history, set out findings in detail, and contained fully articulated reasons for the conclusions. Importantly, the November 2012 VA examiner considered the Veteran's complete medical history, including the onset of his hypertension and his history of psychiatric problems, in arriving at the conclusion that the Veteran's hypertension was not etiologically linked to or aggravated by his service-connected anxiety disorder. For these reasons, the Board concludes that the November 2012 VA examiner's opinion is of greater weight. The Board has considered the Veteran's contentions that his hypertension is related to his service, or to his service-connected anxiety disorder. The Veteran, however, has not demonstrated that he has any medical expertise to make such an opinion or render a diagnosis for a complex etiological question such as this, which requires testing and medical expertise to diagnose and ascertain etiology. The Board notes that although the Veteran is competent to report symptoms, he does not have medical expertise and therefore cannot provide a competent opinion regarding diagnosis or causation of his claimed hypertension on a direct or a secondary basis. As a layperson without the appropriate medical training and expertise, the Veteran is simply not competent to provide a probative opinion on a medical matter such as the etiology of hypertension in relation to an additional disability. See Bostain v. West, 11 Vet. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). In reaching its conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim of service connection for hypertension, that doctrine is not helpful to the Veteran in this instance. See 38 U.S.C.A § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). B. Claims for Increase The Veteran contends that his service-connected right ear hearing loss is more disabling than reflected by the noncompensable disability rating currently assigned. He claims that his residuals of right ankle injury are more disabling than reflected by the 10 percent rating currently assigned. The Veteran additionally contends that his service-connected anxiety disorder is more disabling than reflected by the 30 percent rating assigned from January 9, 2002, the 50 percent rating assigned from February 5, 2004, and the 70 percent rating assigned from April 9, 2010. Disability evaluations are determined by comparing a Veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher of the two evaluations is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2012). The Veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). 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). Where entitlement to compensation has already been established, the United States Court of Appeals for Veterans Claims has held that consideration of the appropriateness of a staged rating is required. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When evaluating musculoskeletal disabilities, VA must consider granting a higher rating in cases in which the Veteran experiences functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination (to include during flare-ups or with repeated use). See 38 C.F.R. §§ 4.40, 4.45 (2012); DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In VA Fast Letter 06-25 (November 29, 2006), VA's Compensation and Pension Service noted that to properly evaluate any functional loss due to pain, examiners, at the very least, should undertake repetitive testing (to include at least three repetitions) of the joint's range of motion, if feasible. It was determined that such testing should yield sufficient information on any functional loss due to an orthopedic disability. Regarding the Veteran's hearing loss claim, relevant evidence of record consists of report of VA audiological examinations provided to the Veteran in February 2003, February 2004, July 2007, May 2011, and November 2012. The Veteran has also submitted written argument in support of his claim and has testified before the undersigned Veterans Law Judge. Report of the February 2003 examination reflects that the puretone threshold average was 18.75 for the right ear, and the Maryland CNC speech recognition score was 96 percent. Based on those results with the utilization of Table VI, the Veteran had level I hearing impairment in the right ear. Applying the results of the Veteran's February 2003 VA audiogram reveals no worse than Level I hearing acuity in both ears under 38 C.F.R. § 4.85. (The Veteran's left ear hearing impairment is presumed to be level I for the sole purpose of determining the percentage evaluation from Table VII, as that ear is not service connected. See 38 C.F.R. § 4.85(f); 38 C.F.R. § 3.383 (2012) (a non-service-connected ear may be treated as service connected for rating purposes, but only when hearing impairment in the service-connected ear is compensable to a degree of 10 percent or more and hearing impairment in the non-service-connected ear meets the provisions of 38 C.F.R. § 3.385).) Report of the February 2004 examination reflects that the puretone threshold average was 25 for the right ear, and the Maryland CNC speech recognition score was 100 percent. Based on those results with the utilization of Table VI, the Veteran had level I hearing impairment in the right ear. Applying the results of the Veteran's February 2004 VA audiogram reveals no worse than Level I hearing acuity in both ears under 38 C.F.R. § 4.85. Similarly, report of the July 2007 examination reflects that the puretone threshold average was 21.25 for the right ear, and the Maryland CNC speech recognition score was 100 percent. Based on those results with the utilization of Table VI, the Veteran had level I hearing impairment in the right ear. Applying the results of the Veteran's July 2007 VA audiogram reveals no worse than Level I hearing acuity in both ears under 38 C.F.R. § 4.85. The Veteran also underwent VA audiological examination in May 2011. Report of that examination reflects that that the puretone threshold average was 20 for the right ear, and the Maryland CNC speech recognition score was 98 percent. Based on those results with the utilization of Table VI, the Veteran had level I hearing impairment in the right ear. Applying the results of the Veteran's April 2007 VA audiogram reveals no worse than Level I hearing acuity in both ears under 38 C.F.R. § 4.85. Additionally, report of the November 2012 examination reflects that the puretone threshold average was 21.25 for the right ear, and the Maryland CNC speech recognition score was 94 percent. Based on those results with the utilization of Table VI, the Veteran had level I hearing impairment in the right ear. Applying the results of the Veteran's November 2012 VA audiogram reveals no worse than Level I hearing acuity in both ears under 38 C.F.R. § 4.85. In addition, the Veteran has contended on multiple occasions, including to his November 2012 VA examiner, that he has a great deal of difficulty hearing voices, particularly when background noise is present. The Veteran's right ear hearing loss has been evaluated under Diagnostic Code 6100 for hearing loss. The assigned evaluation for hearing loss is determined by mechanically applying the rating criteria to certified test results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Under Diagnostic Code 6100, ratings for hearing loss are determined in accordance with the findings obtained on audiometric examination. Evaluations of hearing impairment range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by puretone audiometry tests in the frequencies 1,000; 2,000; 3,000; and 4,000 Hertz (cycles per second). To evaluate the degree of disability from hearing impairment, the rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal acuity through Level XI for profound deafness. As set forth in the regulations, Tables VI, VIa, and VII are used to calculate the rating to be assigned. See 38 C.F.R. § 4.85, Diagnostic Code 6100 (2012). Hearing tests will be conducted without hearing aids, and the results of above-described testing are charted on Table VI and Table VII. See 38 C.F.R. § 4.85. Alternatively, VA regulations provide that in cases of exceptional hearing loss, when the puretone thresholds at each of the four specified frequencies (1,000; 2,000; 3,000; and 4,000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(a). The provisions of 38 C.F.R. § 4.86(b) further provide that, when the puretone threshold is 30 decibels or less at 1,000 Hertz, and 70 decibels or more at 2,000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever would result in the higher numeral. In view of the examination results detailed below, these provisions are not applicable during any period of the claims process. Applying the results of the Veteran's February 223, February 2004, July 2007, May 2011, and November 2012 VA audiograms thus reveals no worse than Level I hearing acuity in the right ear Application of the above-noted findings to Table VII results in a noncompensable disability rating under 38 C.F.R. § 4.85, Diagnostic Code 6100. Thus, none of the VA examination reports support the assignment of a compensable disability rating for the Veteran's right ear hearing loss. The Board in no way discounts the difficulties that the Veteran experiences as a result of his right ear hearing loss. However, it must be emphasized, as previously noted, that the disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. Hence, the Board must base its determination on the results of the pertinent VA and private audiology studies. See Lendenmann, 3 Vet. App. at 345. In other words, the Board is bound by law to apply VA's rating schedule based on the Veteran's audiometry results. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Under these circumstances, the Board finds that the record presents no basis for assignment of a disability rating higher than the noncompensable disability rating currently assigned for the Veteran's service-connected right ear hearing loss. Regarding the Veteran's right ankle claim, the Veteran contends that his service-connected residuals of right ankle injury are more disabling than reflected by the 10 percent rating currently assigned. In its July 2003 rating decision, the RO evaluated the Veteran's residuals of right ankle injury in accordance with the criteria set forth in Diagnostic Code 5271, governing limited motion of the ankle. The Board notes at the outset that "residuals of right ankle injury" do not have a specified Diagnostic Code under the rating schedule. 38 C.F.R. Part 4. Nevertheless, when an unlisted condition is encountered, it is permissible to rate it under a closely related disease or injury to which not only the functions affected, but also the anatomical location and symptomatology are closely analogous. 38 C.F.R. § 4.20 (2012). In that connection, the Board notes that diagnostic criteria analogous to the Veteran's disability are found in Diagnostic Code 5271, which covers limitation of motion of the ankle. Under Diagnostic Code 5271, a 10 percent rating is warranted for moderate limitation of motion. A 20 percent rating is warranted for marked limitation of motion. The Board notes that a 20 percent rating is the highest rating available for limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5271 (2009). A higher rating is warranted only for ankylosis. 38 C.F.R. § 4.71a, Diagnostic Code 5270 (2009). In an October 2009 decision, the RO awarded a higher initial disability rating of 10 percent. Relevant medical evidence consists of VA examinations conducted in February 2003, February 2004, July 2007, May 2011, and November 2012, as well as records of treatment the Veteran has received from both private and VA treatment providers. Report of the February 2003 VA examination reflects that he complained of mild pain in his right ankle with walking. Physical examination revealed pain on tarsal motion, but no instability or tenderness to palpation. Range of dorsiflexion was to 15 degrees and plantar flexion was to 30 degrees without pain. Radiological study of the ankle was normal, and the examiner diagnosed the Veteran with status post right ankle contusion. Similarly, report of the February 2004 VA examination reflects that the Veteran complained of chronic swelling in the right ankle and intermittent pain. Physical examination found swelling in the right ankle but full range of motion without tenderness. Radiological evaluation was normal, and the examiner diagnosed the Veteran with right ankle pain. Report of the July 2007 VA examination of the Veteran's right ankle reflects the Veteran's complaints of chronic swelling in the ankle. The Veteran reported giving way, instability, stiffness, weakness, and pain in the ankle. On physical examination, no ankylosis was noted. The examiner noted mild swelling and tenderness, as well as slight instability of the ankle. The Veteran's range of motion was dorsiflexion to 10 degrees, with pain beginning at 5 degrees, and plantar flexion to 30 degrees, with pain beginning at 20 degrees and no additional functional limitations or pain on repetitive motion. The examiner opined that the Veteran had no significant orthopedic or functional limitations due to his right ankle disorder, which was diagnosed as chronic right ankle strain. Similarly, report of the May 2011 VA examination reflects the Veteran's complaints of pain and swelling in the right ankle that "comes and goes with standing or walking." No locking or instability was reported. Physical examination revealed some swelling and edema, with dorsiflexion to 20 degrees and plantar flexion to 45 degrees, with complaints of pain throughout but no objective signs of pain or instability. The examiner found the Veteran's right ankle to be normal. Report of the November 2012 VA examination of the Veteran's right ankle reflects the Veteran's complaints of worsening pain and swelling in the ankle. On physical examination, no instability, tenderness, or ankylosis was noted. The Veteran's range of motion was dorsiflexion to 20 degrees and plantar flexion to 45 degrees, with no additional functional limitations or pain on repetitive motion. No functional limitation was found in the right ankle. Radiological examination revealed mild degenerative joint disease in the right ankle. The examiner diagnosed the Veteran with right ankle contusion and mild degenerative joint disease. Treatment records from the Veteran's private treatment provider reflect that he was seen in July 2005 for complaints of pain in the right ankle that increased on walking. Physical examination revealed dorsiflexion to 6 degrees and plantar flexion to 25 degrees. Pain to palpation was noted, as was edema. On examination conducted pursuant to the Veteran's application for SSA benefits, the Veteran complained of pain and swelling in his right ankle. He was found to have dorsiflexion to 15 degrees and plantar flexion to 30 degrees with some soreness. No tenderness was noted. Here, following its review of the medical evidence of record, the Board finds that, for the entirety of the appeal period, the Veteran's service-connected residuals of right ankle injury warrant no more than the 10 percent disability rating already assigned. As the 10 percent rating has been assigned for the entire period of the claim, a higher schedular rating is not warranted for limited motion. In so finding, the Board notes that the most recent examination, in November 2012, revealed a full range of motion without pain or limitation on repetition and no swelling, instability, or tenderness. Significantly, at that examination no limitations on standing or walking were noted. Further, each VA examiner has found the Veteran's right ankle disability to cause no occupational or functional limitation. Range-of-motion testing has revealed, at worst, dorsiflexion to 5 degrees and plantar flexion 20 degrees without pain. As there is no medical evidence of record suggesting that the symptoms caused by residuals of right ankle injury equate to worse than moderate limitation of motion, a higher rating is not warranted, and has not been at any time from the inception of the claim. In sum, the evidence of record shows that, for the entirety of the claim period, a rating higher than the currently assigned 10 percent for the Veteran's residuals of right ankle injury is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5271. The Board has considered the Veteran's contentions with regard to his claim for a higher rating for his right ankle disability. While the Board does not doubt the sincerity of the Veteran's belief that his disability is more severely disabling than reflected in the current rating, as a lay person without the appropriate medical training or expertise, he simply is not competent to provide a probative opinion on a medical matter, such as the severity of a current disability as evaluated in the context of the rating criteria. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). The statements from the Veteran clearly articulate the symptoms and troubles he experiences; however, even with consideration of those problems, a higher rating is not warranted under the pertinent criteria, and as noted above, his disability has not reached the level of ankylosis. Regarding the Veteran's claim for increase for his service-connected anxiety disorder, the Board notes that in July 2003, January 2005, and June 2011 rating decisions, the Veteran's anxiety disorder was evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9400 (2012). Under the General Rating Formula For Mental Disorders, to include anxiety disorder, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation), 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). Id. A 50 percent rating is assigned for 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; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is 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; intermittently illogical, obscure, or irrelevant speech; 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 work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent evaluation is assignable where there is 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); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, 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. See 38 C.F.R. § 4.126(a). Furthermore, when evaluating the level of disability arising 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). It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2 (2012). The relevant medical evidence of record consists of the Veteran's ongoing treatment with both private and VA treatment providers, as well as report of VA psychological examinations conducted in January 2002, February 2003, February 2004, July 2007, May 2011, and November 2012. Report of the January 2002 examination reflects the examiner's observation that the Veteran had a history of suicidality and anxiety. The Veteran complained of feeling anxious and getting upset and irritable over small things. He reported having very little contact with his son and relationship problems with his wife. However, the Veteran reported that he had several friends. Psychiatric examination revealed a neutral mood and appropriate affect, with no abnormalities of thought processes or content. The examiner noted that the Veteran had a "very demanding work schedule" with a great deal of stress at work and diagnosed him with generalized anxiety disorder. The examiner assigned a Global Assessment of Functioning (GAF) score of 50 and opined that the Veteran experienced moderate psychiatric symptoms. Similarly, report of the February 2003 VA examination reflects that the Veteran complained of anxiety with occasional shortness of breath and muscle tenseness. He stated that his relationship with his wife was normal but reported being estranged from other family members. He reported having "a few" friends. Psychiatric examination revealed neutral mood with an appropriate affect, with no problems with perception or thought. The examiner found the Veteran to have a supportive social network and diagnosed him with anxiety disorder. A GAF score of 70 was assigned; the examiner found the Veteran's symptoms to be mild in severity. Report of the February 2004 VA examination reflects that the Veteran complained of experiencing severe anxiety and regular panic attacks, with trouble breathing and chest pain. The Veteran also reported recurring nightmares and stated that he has an "explosive" temper. He stated that he felt "intense[ly] angry and anxious most of the time" and reported some passive suicidal thoughts. Some short-term memory loss was noted, and the Veteran reported some ritualistic and obsessive behavior. His speech was pressured, and his mood was anxious. The examiner found the Veteran to have intact impulse control but noted that he was fighting with his wife frequently and also getting into conflicts at work. He diagnosed the Veteran with generalized anxiety disorder and assigned a GAF score of 50, noting that the Veteran experienced "severe-to-moderate symptoms" that caused serious impairment in social and occupational functioning. Similarly, report of the July 2007 VA examination reflects that Veteran reported a history of one suicide attempt and stated that he often got into "fights and altercations." He complained of anxiety, depression, and panic attacks, as well as problems sleeping, difficulty getting along with others, and poor energy and concentration. The examiner found the Veteran's symptoms to be "moderately severe in nature." He reported having frequent arguments with his wife and stated that he frequently isolated himself because he had trouble getting along with others. The examiner noted a depressed mood with blunted affect, although no abnormalities with thoughts were noted. The examiner diagnosed the Veteran with generalized anxiety disorder and assigned a GAF of 40. The Veteran again underwent VA examination in May 2011. At that time, he complained of chronic anxiety and social avoidance as well as insomnia and worry about his and his family members' health. He reported experiencing panic attacks and stated that he had "angry conflicts" with his friends and wife. He stated that he did not have a relationship with his mother or sister or with his adult son and reported that his relationship with his wife was characterized by frequent arguments. Mental status found the Veteran to be high-strung, with normal speech and no delusions or hallucinations. Orientation and memory were noted to be normal. The Veteran reported depression and occasional panic attacks, as well as "rage outbursts." The examiner diagnosed the Veteran with generalized anxiety disorder and assigned a GAF score of 43. He noted the Veteran to experience markedly reduced reliability and productivity. Pursuant to the Board's June 2012 remand, the Veteran underwent another VA examination in November 2012. At that time, the Veteran complained of anxiety. The examiner found him to display disturbances of motivation and mood, difficulty establishing and maintaining effective relationships, and difficulty adapting to stressful circumstances, as well as an inability to establish and maintain effective relationships. Psychiatric evaluation revealed a constricted and initially irritable mood. His attention and orientation were normal, as were thought process and content, and no delusions or hallucinations were noted. The examiner similarly found no suicidal or homicidal ideation, and no obsessive or ritualistic behavior was noted. The Veteran denied experiencing panic attacks but stated that he hyperventilated occasionally. The examiner diagnosed the Veteran with anxiety disorder and assigned a GAF score of 50. She specifically found the Veteran not to experience total occupational and social impairment but did find him to experience deficiencies in the areas of family relations, work, and mood, as well as reduced reliability and productivity due to his mental disorder. Report of the Veteran's ongoing treatment with both private and VA treatment providers reflects that he has been seen by mental health treatment providers on a regular basis since at least 2002. Report of a Vet Center evaluation reflects complaints of anxiety and anger, as well as some depression. The Veteran reported that he was continuing to work but that he experienced increasing on-the-job-conflict, increasing his anxiety and anger. He also reported problems with sleep and an increasingly stressful relationship with his wife. At an October 2006 SSA psychiatric evaluation, the Veteran reported that he had stopped working due primarily to physical problems. He reported increasing anxiety and panic attacks, particularly when driving. He also complained of nightmares. He reported being estranged from his mother and sister and stated that his relationship with his wife was strained, but he stated that he and his wife had friends with whom they socialized. He also reported enjoying music, computers, and movies. Mental status evaluation revealed anxious mood and affect, with normal speech and thoughts. Orientation and memory were within normal limits. The examiner diagnosed the Veteran with obsessive compulsive disorder and posttraumatic stress disorder. No GAF score was assigned. Report of the Veteran's VA treatment reflects that he was seen in May 2002 for complaints of panic attacks and nightmares, as well as anger that was causing problems at work. His mood was euthymic at that time, with a mildly histrionic and anxious affect. He was diagnosed with mild generalized anxiety disorder at that time. At August 2005 treatment visits, the Veteran was found to have anxiety, emotional instability, and irritability. He reported having "considerable conflict" with his supervisor and his wife and complained of anxiety, panic attacks, and irritability. He stated that he enjoyed going to the beach and the pool but also reported that he liked to "start fights." He was diagnosed with generalized anxiety disorder and depressive disorder, with a GAF score of 65. His mood was noted to be mildly depressed and anxious, with no mania or psychosis. Similarly, a March 2007 VA treatment visit reflects complaints of anxiety and frustration. The treating psychiatrist found the Veteran to display a "down and anxious mood" and assigned a GAF score of 60 for the diagnosis of generalized anxiety disorder and depressive disorder. In addition, the Veteran and his wife have submitted statements attesting to the Veteran's "vicious temper" that has cost him friends. The Veteran's wife also stated that they had few friends due to the Veteran's anger and irritability. For the period from January 9, 2002, to April 9, 2010, upon review of the evidence of record, the Board finds that a rating of 50 percent for the Veteran's service-connected anxiety disorder is warranted for the entirety of this time period. This is so because the evidence from the VA examinations and the Veteran's VAMC treatment reflects that his acquired psychiatric disability more nearly approximates a 50 percent rating for occupational and social impairment with reduced reliability and productivity due to flattened affect, disturbances of motivation and mood, nightmares, irritability, isolation, and difficulty in establishing and maintaining effective relationships that approximate occupational and social impairment with reduced reliability and productivity. See Mauerhan v. Principi, 16 Vet. App. 436 (2002) (symptoms recited in the rating schedule for mental disorders are to serve as examples of the type and degree of the symptoms and not an exhaustive list). In so concluding, the Board finds particularly persuasive the VA examiner's findings at the January 9, 2002, VA examination, as well as VA examinations conducted in February 2004 and July 2007, that the Veteran experiences symptoms of isolation, recurrent panic attacks, and detachment from others, as well as nightmares, irritability, and difficulty in establishing and maintaining effective relationships. In particular, the Veteran has been found to have severe anxiety, as well as panic attacks and anger that has caused problems in his relationships with his wife and others. These findings have been echoed by the Veteran's VAMC treatment providers, who have noted on multiple occasions, including at treatment visits in May 2002, August 2005, and March 2007, that the Veteran experienced nightmares, panic attacks, and pervasive anxiety, as well as an anxious and depressed mood. Further, although his relationship with his wife was noted to be strained during the period at issue, he reported socializing with his wife and friends during that time. The Board finds that these symptoms more closely approximate occupational and social impairment with reduced reliability and productivity to warrant a 50 percent rating for the entirety of the period from January 9, 2002, to April 9, 2010. Hence, in light of the findings of the Veteran's treatment providers and VA examiners, the Board finds that, for the period from January 9, 2002, to April 9, 2010, the Veteran's service-connected anxiety disorder more nearly approximates a 50 percent rating for occupational and social impairment with reduced reliability and productivity due to panic attacks, irritability, nightmares, isolation, anger, and difficulty establishing and maintaining effective relationships. See Mauerhan, 16 Vet. App. 436. In so concluding, the Board finds particularly persuasive the Veteran's ongoing depression and panic attacks, as well as nightmares, irritability, isolation, and difficulty in establishing and maintaining effective relationships as recorded by his treating psychiatrists and VA examiners. Nevertheless, the Board does not find that a rating greater than 50 percent for anxiety disorder is warranted for the period from January 9, 2002, to April 9, 2010. Here, the medical evidence from this period does not reflect deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as obsessional rituals that interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 work like setting); or an inability to establish and maintain effective relationships. To the contrary, none of these symptoms has been noted at any time during the period from January 9, 2002, to April 9, 2010. Further, from April 9, 2010, the Board finds that a rating higher than 70 percent is not warranted for the Veteran's anxiety disorder. This is so because the evidence from the Veteran's VA psychiatric treatment and examinations reflects that his PTSD more nearly approximates a 70 percent rating for occupational and social impairment with deficiencies in most areas, due to symptoms such as near-continuous depression affecting the ability to function independently, appropriately and effectively; difficulty in adapting to stressful circumstances; and the inability to establish and maintain effective relationships. See Mauerhan v. Principi, 16 Vet. App. 436 (2002) (holding that symptoms recited in the rating schedule for mental disorders are to serve as examples of the type and degree of the symptoms and not an exhaustive list). In so concluding, the Board acknowledges that the Veteran's May 2011 and November 2012 VA examiners have described his symptoms as "severe" and have pointed out his ongoing isolation and estrangement, leading to problems with effective relationships. The Veteran has also been found to have problems with concentration and memory and to have occasional fleeting suicidal thoughts, although no sustained suicidal or homicidal ideation has been noted. Importantly, however, while the Veteran has been repeatedly found to have significant impairment in his ability to function, his November 2012 examiner specifically did not find him to suffer from total occupational or social impairment. The Board has also has considered but does not find that, at any time during the appeal period, the Veteran's anxiety disorder has caused total social and occupational impairment; thus, it does not more nearly approximate a 100 percent disability rating under 38 C.F.R. § 4.130. In that connection, the Board acknowledges that the Veteran has occasionally reported passive suicidal thoughts. However, the Board finds that these symptoms are no more than fleeting and are not chronic in nature; in so finding, the Board looks to the Veteran's consistent denials of any suicidal intent or plan to each of his VA examiners as well as his VAMC treatment providers. Further, at no time during the appellate period has the Veteran displayed symptoms such 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); or disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Thus, a 100 percent disability rating is not warranted for the Veteran's anxiety disorder at any time during the appellate period. In its analysis, the Board has considered the GAF scores assigned to the Veteran. According to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the GAF is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." It does not otherwise include impairment in functioning due to physical (or environmental) limitations. There is no question that the GAF score and the interpretations of the score are important considerations in rating a psychiatric disability. See, e.g., Richard v. Brown, 9 Vet. App. 266, 267 (1996); Carpenter v. Brown, 8 Vet. App. 240 (1995). Regardless, the GAF score assigned in a case, like an examiner's assessment of the severity of a condition, is not dispositive of the evaluation issue; rather, they must be considered in light of the actual symptoms of the Veteran's disorder (which provide the primary basis for the rating assigned). See 38 C.F.R. § 4.126(a). The DSM-IV identifies scores in the ranges of 41-50 as "serious symptoms," which include suicidal ideation, severe obsessional rituals, frequent shoplifting, or any serious impairment in social, occupation, or school functioning, such as no friends or being unable to keep a job. Scores in the range of 51-60 are identified as "moderate symptoms" such as flat affect and circumstantial speech or moderate difficulty in social or occupational functioning. The Board notes here that the Veteran has not at any time displayed suicidal ideation or severe obsessional rituals, nor has he been noted to engage in activities such as shoplifting. Further, although the Veteran has been noted to have difficulty maintaining social relationships, he has had some degree of success; he continues to maintain relationships with his wife, as well as a few friends. Nothing about the Veteran's assigned GAF scores, when considered in light of the other evidence of record-in particular the Veteran's assessed level of occupational and social impairment-leads the Board to conclude that ratings higher than those assigned herein are warranted. In so finding, the Board reiterates that the Veteran's assigned GAF scores are not dispositive of the evaluation and must be considered in light of the actual symptoms of his disorder. In this case, the Board has found that the Veteran's symptomatology, as discussed above, is appropriately compensated by the 50 and 70 percent ratings assigned herein. C. Extra-Schedular Evaluation The above determinations are based upon consideration of applicable rating provisions. Regarding the Veteran's right ear hearing loss, the November 2012 VA examination report describes the effects of the Veteran's hearing impairment on his daily life. See Martinak v. Nicholson, 21 Vet. App. 447 (2007). It was noted by the November 2012 VA examiner that the Veteran complained of difficulty understanding speech, particularly with background noise. However, such effects-as well as those described in the Veteran's multiple other VA examinations and treatment records-do not take the Veteran's case outside the norm as to warrant consideration of any higher evaluation on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1) (2012). The symptoms of each of his disabilities analyzed above have been addressed by the schedular criteria. Without sufficient evidence reflecting that the Veteran's disability picture is not contemplated by the rating schedule, referral for a determination of whether the Veteran's disabilities require the assignment of an extra-schedular rating is not warranted. See Thun v. Peake, 22 Vet. App. 111, 115-16 (2008). For all the foregoing reasons, the Board finds that the claim for an initial compensable disability rating for the Veteran's service-connected right ear hearing loss must be denied. 38 C.F.R. §§ 4.3, 4.7, 4.85, Diagnostic Code 6100. The Board further finds that the Veteran's residuals of right ankle injury warrant a rating of no more than 10 percent. 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code 5271 (2012). This is so for the entirety of the appeal period. The Board finds that the Veteran's service-connected anxiety disorder warrants a disability rating of 50 percent, but no higher, for the period from January 9, 2002, to April 9, 2010, and no higher than 70 percent thereafter. 38 C.F.R. §§ 4.3, 4.7, 4.22, 4.130, Diagnostic Code 9400 (2012). In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims for ratings higher than those assigned herein, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Entitlement to service connection for hypertension is denied. Entitlement to a compensable disability rating for right ear hearing loss is denied. Entitlement to a disability rating higher than 10 percent for residuals of right ankle injury is denied. Entitlement to a disability rating of 50 percent for anxiety disorder for the period from January 9, 2002, to February 5, 2004, is granted, subject to the laws and regulations governing the award of monetary benefits. Entitlement to a disability rating higher than 50 percent for anxiety disorder for the period from February 5, 2004, to April 9, 2010, is denied. Entitlement to a disability rating higher than 70 percent for anxiety disorder from April 9, 2010, is denied. REMAND The Board finds that further evidentiary development is necessary before a decision can be reached on the merits of the Veteran's claim for increase for his service-connected myositis of the cervical, thoracic, and lumbar spine, as well as for his claim of entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU). As an initial matter, the Board notes that the VCAA and its implementing regulations include, upon the submission of a substantially complete application for benefits, an enhanced duty on the part of VA to notify a claimant of the information and evidence needed to substantiate a claim, as well as the duty to notify the claimant of what evidence will be obtained by whom. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In addition, they define the obligation of VA with respect to its duty to assist a claimant in obtaining evidence. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). Regarding his claim for an increased rating for his service-connected myositis of the cervical, thoracic, and lumbar spine, the Veteran contends that his symptoms are worse than is recognized by the assigned 10 percent disability rating. A review of the Veteran's claims file reflects that he has been provided multiple VA examinations, most recently in November 2012, to assess the severity of his myositis of the spine. In addition, the Veteran has sought ongoing treatment with VA and private treatment providers for complaints of pain in his neck and back. Report of a March 2005 VA examination reflects that the examiner found specifically that the Veteran's degenerative disc disease of the cervical and thoracolumbar spine was not related to his service-connected myositis and was instead due to his advancing age. However, the Veteran has also submitted private physicians' statements, dated in July 2003 and June 2005, which indicate that his current back problems, including sacroiliac syndrome and sciatica, are linked to his service-connected myositis. Private records reflect treatment in 2005 for a diagnosis of sacroiliac syndrome with sciatica. In addition, a private EMG study conducted in May 2007 found the Veteran to have left S1 radiculopathy. He similarly complained of decreased sensation to the lower extremities bilaterally, as well as pain radiating into his right leg, at a July 2007 VA examination. At a January 2010 private treatment visit, the Veteran was diagnosed with osteomyelitis, a diagnosis that was confirmed at a May 2011 VA examination. At that time, the Veteran was also diagnosed with degenerative disc disease of the cervical, thoracic, and lumbar spine. Report of the most recent November 2012 examination reflects that the examiner diagnosed the Veteran with lumbosacral strain, herniated discs in the lumbosacral spine, and degenerative joint disease of the lumbosacral spine. The Veteran complained of low back pain that radiated to his right leg and ankle. The examiner conducted range-of-motion testing of the Veteran's thoracolumbar spine and found him to have tenderness to palpation and guarding and muscle spasm that did not cause abnormal gait or spinal contour. The examiner also found the Veteran to display normal sensory testing but reduced muscle strength and deep tendon reflexes in the lower extremities, as well as positive straight-leg raising test on the right and mild numbness in the lower extremities bilaterally The examiner diagnosed the Veteran with moderate radiculopathy involving the sciatic nerve on the right. The Veteran's myositis of the cervical, thoracic, and lumbar spine has been rated by the RO under 38 C.F.R. § 4.71a, Diagnostic Code 5021 for myositis. That Diagnostic Code provides that myositis is to be rated on limitation of motion of affected parts as degenerative arthritis. 38 C.F.R. § 4.71a (2012). Limitation of motion of the cervical and thoracolumbar spines are rated under the General Rating Formula for Diseases and Injuries of the Spine. That rating formula provides separate rating criteria for the cervical and thoracolumbar spine. In particular, regarding the cervical spine, under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Additionally, regarding the thoracolumbar spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, a combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis or the entire thoracolumbar spine warrants a 40 percent rating. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating. Unfavorable ankylosis of the entire spine warrants a 100 percent rating. Id. Following the criteria, Note (1) provides: evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2) provides that, for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. The normal combined range of motion of the cervical spine is 340 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3) provides that in exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4) requires that each range of motion measurement be rounded to the nearest five degrees. Note (5) provides that for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6) provides that disabilities of the thoracolumbar and cervical spine segments must be separately evaluated, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The Board notes that when evaluating musculoskeletal disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination is demonstrated. See 38 C.F.R. §§ 4.40, 4.45 (2012); DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); Johnson v. Brown, 9 Vet. App. 7 (1996). In VA Fast Letter 06-25 (November 29, 2006), VA's Compensation & Pension (C&P) Service noted that to properly evaluate any functional loss due to pain, examiners, at the very least, should undertake repetitive testing (to include at least three repetitions) of the joint's or spine's range of motion, if feasible. It was determined that such testing should yield sufficient information on any functional loss due to an orthopedic disability. Additionally, where the record does not adequately reveal the current state of the claimant's disability, the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination. See Allday v. Brown, 7 Vet. App. 517, 526 (1995); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (where the appellant complained of increased hearing loss two years after his last audiology examination, VA should have scheduled the appellant for another examination). In this case, the Board notes that the examiner properly conducted an evaluation of the condition of the Veteran's thoracolumbar spine at the time of the November 2012 VA examination but notes that no evaluation of the Veteran's cervical spine was done at that examination, despite a clear directive in the June 2012 Board remand to do so. Further, the Board notes that once VA undertakes the effort to provide an examination when developing a claim for service connection, even if not statutorily obligated to do so, it must provide an adequate one. See Woehlaert v. Nicholson, 21 Vet. App. 456, 464 (2007), citing Barr, 21 Vet. App. at 311; see also Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence . . . is essential for a proper appellate decision"). Although it appears that the VA examiners attempted to conduct evaluation of the Veteran's physical condition at the time, the Board notes that no evaluation of the Veteran's cervical spine was performed. In addition, the evidence of record is not clear as to the extent to which the Veteran's current cervical and thoracolumbar spine problems are due to his service-connected myositis of the cervical, thoracic, and lumbar spine. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (establishing that, where an examiner is unable to distinguish the symptoms of a service connected disability from non-service-connected manifestations, all the manifestations will be considered part of the service-connected disability). The Board further notes that the Veteran has complained on multiple occasions, including at the November 2012 VA examination, that his back disability causes radiating pain in his lower extremities. At that time, he was diagnosed with radiculopathy of the right lower extremity. In addition, the Veteran was diagnosed with left lower extremity radiculopathy at a May 2007 EMG study. The Board acknowledges that the General Rating Formula for Diseases and Injuries of the Spine contemplates rating disabilities of the spine with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. The rating criteria, however, also allow for separate ratings for neurological abnormalities related to or caused by the spine disability. In this case, the Veteran has been noted to complain of radiating pain into his legs and has been diagnosed with, variously, radiculopathy of the right and left lower extremity. However, no VA examiner has addressed whether any such problem is due to his service-connected myositis. The Board thus finds that in light of the above findings, another VA examination is needed to provide current findings with respect to the Veteran's service-connected myositis of the cervical, thoracic, and lumbar spine. In light of this evidence, therefore, a remand is required to have an examiner supplement the record with a report regarding the current severity of the Veteran's disability. Under these circumstances, the Veteran should be scheduled for examination at an appropriate VA medical facility. See 38 U.S.C.A. § 5103A. Regarding the Veteran's claim for entitlement to a TDIU, the Board acknowledges that under applicable criteria, a TDIU may be awarded where the schedular rating is less than total and when it is determined that the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16 (2012). Under § 4.16(a), if there is only one service-connected disability, it must be rated at 60 percent or more. If there are two or more disabilities, at least one of those disabilities must be rated at 40 percent or more, and the total combined rating must be 70 percent or more. Disabilities resulting from common etiology or a single accident, disabilities of one or both of the upper extremities or of the lower extremities, disabilities affecting a single body system, multiple injuries incurred in action, or multiple disabilities incurred as a prisoner of war may be considered as one disability in applying the provisions of § 4.16(a). Despite these requirements, it is the established policy of VA that all Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). The Board notes that the Veteran is service connected for anxiety disorder, currently rated as 70 percent disabling; myositis of the cervical, dorsal, and lumbar spine, rated as 10 percent disabling; residuals of right ankle injury, rated as 10 percent disabling; tinnitus, rated as 10 percent disabling; and right ear hearing loss, rated as noncompensably disabling. The current combined evaluation for the Veteran's service-connected disabilities is 80 percent. See 38 C.F.R. § 4.25 (2012). The United States Court of Appeals for Veterans Claims (Court) has stated that in order for a Veteran to prevail on a claim for a TDIU, the record must reflect some factor that takes his case outside of the norm. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In adjudicating a claim for TDIU, the Board may not reject the Veteran's claim without producing evidence, as distinguished from mere conjecture. See Friscia v. Brown, 7 Vet. App. 294 (1995). In Friscia, the Court stated that VA has a duty to supplement the record by obtaining an examination which includes an opinion on what effect the appellant's service-connected disabilities have on his ability to work. Here, the Board notes that the relevant evidence includes the Veteran's treatment records from both VA and private treatment providers, as well as VA examinations provided to the Veteran in July 2007, May 2011, and November 2012. At those examinations, the examiners conducted evaluation of the Veteran's ability to work as impacted by each of his service-connected disabilities separately; however, the examiners failed to make a determination as to whether the Veteran's service-connected disabilities, when considered together, render him unable to seek or maintain gainful employment. This so despite a directive in the Board's June 2012 remand to consider the Veteran's service-connected disabilities collectively when addressing his employability. Similarly, multiple statements from private physicians, including statements dated in July 2007, September 2008, March 2010, and September 2012, note that the Veteran is "totally and permanently disabled." However, in their statements, the Veteran's private physicians attribute his unemployability not only to service-connected disabilities, but also to non-service-connected disorders such as coronary artery disease, venous stasis, and diabetes mellitus. In addition, the Veteran has stated to VA on multiple occasions, including at his January 2012 hearing, that he is unable to work due to his service-connected disabilities. The Board notes further that no adequate VA examination has been conducted to assess the Veteran's current employability based on both a thorough assessment of all his service-connected disabilities and his educational and occupational history and experience. Upon review of the record, the Board finds that a medical examination and opinion are needed to decide the Veteran's claim for a TDIU. Thus, following the development identified above, the Veteran must be scheduled for a VA examination, and the examiner requested to conduct thorough examination of the Veteran and review of the medical evidence and provide a medical opinion addressing the question of whether the Veteran's service-connected disabilities, when considered together but without consideration of the Veteran's age or any non-service-connected disabilities, combine to make him unemployable. See 38 U.S.C.A. § 5103A(d); Friscia v. Brown, 7 Vet. App. 294 (1995). Such opinion must be based upon consideration of the Veteran's current medical condition as well as his documented history and assertions, to include employment history and education, and medical evidence associated with the record. 38 U.S.C.A. § 5103A. In view of the foregoing, the case is REMANDED for the following action: 1. The Veteran must be scheduled for VA examination and notified that failure to report to any scheduled examination, without good cause, could result in a denial of his claims. See 38 C.F.R. § 3.655(b) (2012). Myositis examination-The entire claims file, to include a complete copy of this remand, must be made available to the examiner designated to examine the Veteran. All appropriate tests and studies must be accomplished, and all clinical findings must be reported in detail. Clinical findings must include whether, during the examination, there is objective evidence of pain on motion of the Veteran's cervical or thoracolumbar spine (if pain on motion is present, the examiner must indicate at which point pain begins); weakness, excess fatigability, and/or incoordination associated with the Veteran's cervical or thoracolumbar spine; and whether, and to what extent, the Veteran experiences functional loss due to pain and/or any of the other symptoms noted above during flare-ups or with repeated use. The examiner must equate such functional losses to additional degrees of limited motion (beyond that shown clinically). Note: To properly evaluate any functional loss due to pain, C&P examiners, as per C&P Service policy, must at the very least undertake repetitive testing (to include at least three repetitions) of the cervical and thoracolumbar spine's range of motion. See VA Fast Letter 06-25 (Nov. 29, 2006). Loss of motion, whether clinically shown, or estimated based on functional impairment, must be described for the entire range of motion of the cervical and thoracolumbar spine. The examiner must provide a detailed account of all manifestations of the service-connected myositis of the cervical, thoracic, and lumbar spine found to be present. The examiner must distinguish between any symptomatology associated with the service-connected myositis of the cervical, thoracic, and lumbar spine and that associated with any non-service-connected cervical or thoracolumbar spine disability. If no such differentiation is possible, the examiner must so state and provide an explanation for this conclusion. The examiner must also identify any neurological impairment associated with the Veteran's cervical, thoracic, and lumbar myositis, addressing in particular the Veteran's complaints of pain radiating into his legs and the findings of left lower extremity radiculopathy at the May 2007 EMG study and right lower extremity radiculopathy at the November 2012 VA examination. Any necessary diagnostic testing must be accomplished. If neurological impairment is identified, the level of impairment and the particular peripheral nerve(s) affected, or seemingly affected, must be reported. The level of nerve impairment for each such nerve must be equated with "mild," "moderate," "moderately severe," or "severe" disability. (If additional examination is required by a specialist to address any question, such examination should be scheduled.) If no neurologic impairment is found, or if any diagnosed neurologic disorder is found not to be related to service-connected disability, the examiner should explain the Veteran's previous history of radiating pain and whether any previous clinical findings suggested radiculopathy due to myositis. The examiner(s) must set forth all examination findings, along with the complete rationale for the opinions expressed. TDIU examination-(This examination should be conducted after a report of the myositis examination is made a part of the record.) The entire claims file, to include a complete copy of this remand, must be made available to the examiner designated to examine the Veteran. The examiner must consider the current severity of each of the Veteran's service-connected disabilities. Report of the examination must include discussion of the Veteran's documented medical history and assertions. In addition, the examiner must elicit from the Veteran and record for evaluation purposes a full work and educational history. Following the above-requested examination of the Veteran and review of the claims file, the examiner must offer an opinion as to whether it is at least as likely as not (i.e., there is at least a 50 percent probability) that the Veteran's service-connected anxiety disorder; myositis of the cervical, dorsal, and lumbar spine; residuals of right ankle injury; tinnitus; and right ear hearing loss combine to preclude substantially gainful employment that is consistent with the Veteran's education and occupational experience. A thorough explanation for the opinion must be provided. The examiners must thoroughly review the Veteran's claims file, to include a copy of this remand. Well-reasoned opinions must be provided with a detailed explanation for all conclusions reached by the reviewers. Citations to the record or relevant medical principles should be included as necessary to explain the opinions, and a complete rationale should be given for all opinions and conclusions expressed. 2. The adjudicator must ensure that all examination reports comply with this remand and the questions presented in the examination request. If any report is insufficient, it must be returned to the examiner for necessary corrective action, as appropriate. 3. After completing the requested actions and any additional notification and/or development deemed warranted, the claims remaining on appeal must be adjudicated in light of all pertinent evidence and legal authority. If any benefit sought is not granted, the Veteran must be furnished a supplemental statement of the case (SSOC) and afforded the appropriate time period for response before the claims file is returned to the Board. 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). This case 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). ______________________________ MARK F. HALSEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs