Citation Nr: 1321986 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 09-32 298A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD). 2. Entitlement to a compensable rating for right ear hearing loss. 3. Entitlement to service connection for a traumatic brain injury (TBI). REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Kristy L. Zadora, Counsel INTRODUCTION The Veteran had active duty service from July 1949 to July 1976. He is the recipient of the Purple Heart Medal. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2008 rating decision decided by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania and issued by the RO in St. Petersburg, Florida, which, in pertinent part, denied the Veteran's claim for an increased rating for right ear hearing loss as well as his claim for service connection for a TBI. In addition, the Veteran appeals from a February 2009 rating decision issued by the St. Petersburg, Florida, RO which, in pertinent part, denied his claim for an increased rating for PTSD. The Veteran also perfected an appeal as to the denial of service connection for prostate cancer, diabetes mellitus type II, and residuals of lung cancer. However, in a December 2010 rating decision, service connection for such disabilities was granted. As such was a full grant of the benefits sought on appeal, these issues are no longer properly before the Board. The Board notes that, in addition to the paper claims file, there is a paperless, electronic (Virtual VA) claims file associated with the Veteran's claims. A review of the Virtual VA claims processing system reveals VA treatment records dated through November 2011, which were considered by the agency of original jurisdiction (AOJ) in the December 2011 supplemental statement of the case (SSOC). In a January 2012 statement, the Veteran indicated that the claim for service connection for a TBI was mischaracterized, as he actually intended for the claim to be for cervical spondylitis. However, an appeal arising from the June 2008 claim for service connection for a TBI has been perfected. In addition, the Veteran's claim for service connection for cervical spondylitis was denied by the RO in an unappealed March 2010 rating decision. The Veteran is advised to file a request to reopen the claim for service connection for cervical spondylitis at the RO should he desire to further pursue the matter. In connection with his September 2009 substantive appeal, the Veteran requested a Board hearing before a Veterans Law Judge sitting at the RO. In March 2013, he was advised that his hearing had been scheduled for April 2013. However, prior to his hearing, in April 2013, the Veteran withdrew his request for a Board hearing. 38 C.F.R. § 20.704(e) (2012). Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issue of entitlement to service connection for a TBI is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C. FINDINGS OF FACT 1. For the entire appeal period, the Veteran's PTSD is manifested by occupational and social impairment with reduced reliability and productivity as a result of episodic suicidal ideation, episodic auditory hallucinations, periods of depression, difficulty sleeping, irritability or outbursts of anger, flashbacks and intermittent impairment of remote, recent, and immediate memory, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 2. For the entire appeal period, the Veteran's nonservice-connected left ear is assigned Level I hearing, and he has no worse than Level VIII hearing in the right ear. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.7, 4.130, Diagnostic Code 9411 (2012). 2. For the entire appeal period, the criteria for a compensable rating for right ear hearing loss have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.321, 3.383, 4.3, 4.7, 4.85, Diagnostic Code 6100 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VA's Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). 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. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). In Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (Court) held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) Veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the Court held that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable AOJ decision on the claim for VA benefits. In the instant case, the Board finds that VA has satisfied its duty to notify under the VCAA. Specifically, a letter dated in June 2008, sent prior to the rating decision issued in September 2008, advised the Veteran of the evidence and information necessary to substantiate his claim for an increased rating for his hearing loss. In addition, a letter dated in December 2008, sent prior to the rating decision issued in February 2009, provided such notice with regard to his claim for an increased rating for PTSD. Such letters advised him of his and VA's respective responsibilities in obtaining such evidence and information. Additionally, these letters advised him of the information and evidence necessary to establish an effective date in accordance with Dingess/Hartman, supra. Relevant to the duty to assist, the Veteran's service treatment records, service personnel records, private treatment records, and VA treatment records have been obtained and considered. Responses from Healthport dated in August 2009 and September 2009 indicated that they were unable to locate records related to the Veteran. A November 2009 RO memorandum made a formal finding as to the unavailability of records from Patrick Air Force Base. In this regard, the Board notes that in subsequent statements, he has indicated that he was never stationed at such base. Finally, the Veteran has not identified any additional, outstanding records that have not been requested or obtained. The Veteran was afforded multiple VA examinations in conjunction with the claims decided herein, including VA examinations conducted in January 2009, November 2009 and March 2011 to determine the severity of his PTSD and in February 2007, August 2008 and March 2011 to determine the severity of his right ear hearing loss. Neither the Veteran nor his representative has alleged that these VA psychological examinations and/or audiology examinations are inadequate for rating purposes. Moreover, the Board finds that the examinations are adequate in order to evaluate the Veteran's service-connected PTSD and right ear hearing loss as they include interviews with the Veteran, a review of the record, and full examinations, addressing the relevant rating criteria. Moreover, neither the Veteran nor his representative have alleged that his PTSD and/or right ear hearing loss has worsened in severity since the March 2011 VA examinations. Rather, with respect to such claims, they argue that the evidence reveals that these disabilities have has been more severe than the currently assigned ratings for the duration of the appeal period. Palczewski v. Nicholson, 21 Vet. App. 174 (2007) (the passage of time alone, without an allegation of worsening, does not warrant a new examination). Therefore, the Board finds that the examinations of record are adequate to adjudicate the Veteran's claims for an increased rating and no further examination is necessary. Pertinent to the Veteran's claim for a compensable rating for his right ear hearing loss, the Board notes that, in Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the Court held that, relevant to VA audiological examinations, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. In the instant case, the February 2007 examiner noted that the Veteran experienced the greatest difficulty hearing in any place with background noise. The August 2008 VA examiner specifically noted the Veteran's complaints that his greatest difficulty was understanding speech, particularly in a noisy environment. Additionally, the March 2011 VA examiner noted the Veteran's complaints of significant difficulties hearing and understanding conversation. Therefore, as the August 2008 and March 2011 VA examiners addressed the functional effects of the Veteran's right ear hearing loss, the Board finds that such examinations comply with the Court's holding in Martinak, and no further examination is necessary. Thus, the Board finds that VA has fully satisfied the duty to assist. In the circumstances of this case, additional efforts to assist or notify the Veteran in accordance with the VCAA would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements of the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the appellant); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the appellant are to be avoided). VA has satisfied its duty to inform and assist the Veteran at every stage in this case, at least insofar as any errors committed were not harmful to the essential fairness of the proceeding. Therefore, he will not be prejudiced as a result of the Board proceeding to the merits of his claims. II. Increased Rating Claims Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the Veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, are expected in all instances. 38 C.F.R. § 4.21. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). A. PTSD The Veteran filed his claim for an increased rating for PTSD in October 2008. He contends that he is entitled to a 100 percent rating for PTSD. PTSD is evaluated under VA's General Rating Formula for Mental Disorders. Under the formula, a 50 percent rating is warranted when there is 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 understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment, impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent rating 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; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when 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), disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the evaluation, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific evaluation. Mauerhan v. Principi, 16 Vet App 436, 442-3 (2002). On the other hand, if the evidence shows that a Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Id. at 443. The United States Court of Appeals for the Federal Circuit has embraced the Mauerhan Court's interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). Ultimately in Mauerhan, the Court upheld the Board's decision noting that the Board had considered all of the Veteran's psychiatric symptoms, whether listed in the rating criteria or not, and had assigned a rating based on the level of occupational and social impairment. Mauerhan, supra at 444. The Global Assessment of Functioning (GAF) scale is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV). A GAF score of 71 to 80 indicates that, if symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). A GAF score of 61 to 70 reflects some mild symptoms, or some difficulty in social, occupational, or school functioning, but generally functioning pretty well, with some meaningful interpersonal relationships. A GAF score of 51 to 60 indicates moderate symptoms, or moderate difficulty in social, occupational, or school functioning. DSM-IV; 38 C.F.R. §§ 4.125, 4.130. See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995). Although GAF scores are important in evaluating mental disorders, the Board must consider all the pertinent evidence of record and set forth a decision based on the totality of the evidence in accordance with all applicable legal criteria. Carpenter, supra. An assigned GAF score, like an examiner's assessment of the severity of a condition, is not dispositive of the percentage rating issue; rather, it must be considered in light of the actual symptoms of a psychiatric disorder (which provide the primary basis for the rating assigned). See 38 C.F.R. § 4.126(a). Accordingly, an examiner's classification of the level of psychiatric impairment, by word or by a GAF score, is to be considered but is not determinative of the percentage VA disability rating to be assigned; the percentage evaluation is to be based on all the evidence that bears on occupational and social impairment. Id.; see also 38 C.F.R. § 4.126, VAOPGCPREC 10-95, 60 Fed. Reg. 43186 (1995). A March 2008 VA treatment note reflects the Veteran reports of overriding anger and anxiety, including anger over even simple things; his wife confirmed these symptoms to the examiner. The Veteran indicated that he had been married to his current wife for 10 years, that he was divorced and that he had four adult children who he did not see. Mental status examination found the Veteran to be alert and oriented, his thoughts organized and his speech goal-directed. Judgment and insight appeared to be fair to good while psychosis, gross cognitive or memory deficits were not found. Mood was a bit dysphonic with no suicidal or homicidal ideas expressed. Affect was somewhat intense and he appeared to be anxious. A GAF of 57 was assigned. A May 2008 VA treatment note indicates that the Veteran was alert and oriented, that he was cooperative and that he actively participated in discussions and groups activities. A GAF of 55 was assigned. A July 2008 VA treatment note reflects the Veteran's reports of improved sleep, better controlled anger and no depression with his medication. Mental status examination found him to be alert and oriented with a high energy, a loud voice and goal-directed and well-expressed thoughts. Suicidal ideations were not found. In an October 2008 statement, the Veteran's wife wrote that she had known the Veteran in grammar and high school but that they had gone their separate ways after graduation. They reunited in 1997 and had been together since that time. His symptoms included severe mood changes, anger and depression for no reason, and combativeness. He has also spoken of suicide. A December 2008 VA treatment note reflects the Veteran's complaints of memory difficulties, including not remembering what he has read or recalling names, including the names of family members as well as where he was while driving. He reported that he had lived with his current wife for nine years before they married, that he had four adult children, that three of his children did not speak to him, that he regularly attended church and that he had been active in a community organization. Mental status examination noted that the Veteran's personal hygiene was good and that his speech was found to be goal-directed. Behavior was found to be appropriate, judgment and insight were found to be fair and a memory assessment was found to be "mild." The examiner noted that a screening for dementia was negative and that lapses of concentration, which may be related to symptoms of PTSD or other medical problems, were suspected. A GAF of 55 was assigned. A January 2009 VA examination report reflects the Veteran's reports that his symptoms were generally stable and that he continued to have difficulty fitting in socially with other people due to irritability. Other symptoms included anger, intrusive memories, disrupted sleep, a chronically low energy level, frequent nightmares, an exaggerated startle response, hypervigilance and a generalized suspiciousness of others. He reported that his concentration had been good as he has been doing crosswords and reading, that he was currently married to his fifth wife, who he described as his "perfect wife," and that his irritability put a strain on his marriage. He further reported that his children did not call him, that he attended church regularly and that he was active in a community organization. Mental status examination conducted by the January 2009 VA examiner found the Veteran to be alert and fully oriented, neatly-groomed and casually dressed, his behavior to be polite and appropriate and his speech to be of normal rate, rhythm and volume. Mood was described as angry, affect was found to be euthymic and appropriate and thought processes were logical, linear and goal-directed. Thought content was found to be appropriate, insight was found to be good and judgment was found to be functional. Hypnagogic hallucinations in which people cry for help were reported. Delusions were denied but a baseline of suspiciousness of others was endorsed. Memory was intact for immediate, recent and remote recall of events and factual information. Current suicidal ideations were denied but he endorsed passive thoughts approximately once per week. Following this examination and a review of the Veteran's claims file, a GAF of 52 was assigned. The examiner opined that the Veteran's symptoms were moderate in severity and appeared to affect his social functioning in that he was irritable but was able to successfully participate in extracurricular activities and maintained his activities of daily living. A June 2009 VA treatment note indicates that the Veteran's irritability had improved with medication but that his depression remained. Fleeting suicidal ideations without intent or plan were noted. Mental status examination found the Veteran to be oriented times three and his mood to be depressed, although he was quite affable, laughed, smiled and initiated appropriate social conversation. Judgment and insight appeared to be intact and there was no evident overt psychosis. Memory was reported to be poor but neuropsychiatric testing revealed no dementia and suggested poor concentration. A GAF of 51 was assigned. A July 2009 VA treatment note reflects the Veteran's complaints of depression but the examiner noted that the Veteran appeared "quite good" and was able to joke and laugh. Mental status examination found the Veteran to be oriented to person, time, place and situation and to be appropriately dressed and groomed with a pleasant and friendly attitude. Speech was found to be of normal rate, volume and tone while affect was found to be reactive and mood to be dysthymic. Thought processes were found to be logical and goal-directed, memory/concentration was found to be grossly intact, judgment was found to be intact and insight was found to be fair. Suicidal ideations, homicidal ideations, delusions, ideas of reference, hallucinations or illusions were not found. A GAF of 58 was assigned. In a September 2009 substantive appeal, the Veteran's wife wrote that the Veteran no longer used a computer or drove due to his memory difficulties. A November 2009 VA examination report reflects the Veteran's reports that he experienced his PTSD symptoms weekly to daily in frequency and that they were severe. He reported having few or no acquaintances and that he loved to cook and bake. Mental status examination found the Veteran to be fully oriented, well-groomed, friendly and cooperative. Mood was found to be mildly anxious with a constricted affect. Attention and judgment appeared to be within normal limits. While the Veteran complained of mild memory loss, attention, concentration or executive functions impairments, there was no objective evidence of such on examination. Suicidal intent or planning, homicidal ideations, hallucinations or delusions were denied. The examiner determined that there were no impairments to his activities of daily living due to symptoms of his mental disorder. A GAF of 75 was assigned. The examiner noted that the Veteran's PTSD symptoms appeared to be controlled by continuous medication and that there were no significant impairments in occupational and social functioning. VA mental status examination conducted in June 2010 found the Veteran to be appropriately dressed and groomed and to be oriented to person, time, place and situation. Speech was found to be normal in rate, volume and tone without psychomotor agitation or retardation. Affect was found to be reactive, mood to be euthymic, thought processes to be logical and goal-directed and memory and concentration to be intact. Judgment was found to be intact and insight to be fair. There were no suicidal ideations, homicidal ideations, delusions, ideas of reference, hallucinations, or illusions found. A GAF of 59 was assigned. A July 2010 VA neurology treatment note indicated that the Veteran's mild cognitive impairments were related to untreated sleep apnea, poor sleeping and a mood disorder. A March 2011 VA examination report reflects the Veteran's complaints of flashbacks, sleep difficulties, a "short-fuse" and being "antisocial" except for people at his church. He described his current marriage as excellent and reported that they had dinner with church friends once per week and went out to lunch. No impairments to activities of daily living due to PTSD were noted by the examiner. Mental status examination found the Veteran to be fully-oriented and well-groomed with a moderately anxious mood and a somewhat restricted affect. Attention, memory and judgment appeared to be within normal limits. Suicidal intent or planning, homicidal ideations, hallucinations or delusions were denied. A GAF of 65 was assigned. A May 2011 VA treatment note reflects the Veteran's reports that he did not have contact with his children from his third marriage of 28 years. Mental status examination found the Veteran to be appropriately dressed and groomed and that he was alert to person, place and time. Speech was found to be normal rate and volume and tone while affect was full and euthymic. Thought content was found to be logical and goal-directed with tendency to become circumstantial. Memory, concentration and judgment were found to be grossly intact and insight was found to be fair. Suicidal ideations, homicidal ideations, delusions, ideas of reference, hallucinations or delusions were not found. A GAF of 58 was assigned. In a December 2011 statement, the Veteran wrote that he experienced severe depression with recluse habits, unprovoked irritability with periods of violence and anti-social behavior. In a December 2012 statement, the Veteran's wife wrote that the Veteran experienced persistent delusions and was anti-social. They had lost many friends due to his inappropriate behavior and he becomes disoriented and stopped conversations. He was in constant danger of hurting himself and other due to falling. He did not bathe unless reminded, did not shave regularly and preferred to dress in old military clothes. Following a review of the relevant evidence of record, which includes VA treatment records dated through November 2011, the Veteran's own statements, statements from the Veteran's wife and the VA examination reports dated in January 2009, November 2009 and March 2011, the Board concludes that the Veteran is not entitled to a rating in excess of 50 percent for his PTSD. Specifically, the Board finds that, for the entire appeal period, such disability is manifested by occupational and social impairment with reduced reliability and productivity as a result of episodic suicidal ideation, episodic auditory hallucinations, periods of anxiety and depression, nightmares and difficulty sleeping, irritability and periods of anger, poor motivation, flashbacks and poor concentration, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. In this regard, the Board finds that such symptomatology, to specifically include the Veteran's depressed and anxious mood, his episodic suicidal ideations and intermittent impairment of memory, are contemplated in his current 50 percent rating. As indicated previously, a 70 percent rating 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; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Based on the evidence of record, the Board finds that the Veteran's PTSD does not result in occupational and social impairment with deficiencies in most areas. With respect to the symptoms noted to be indicative of a 70 percent rating, the Board notes that, at his January 2009 VA examination, the Veteran had episodic passive suicidal thoughts and that he reported fleeting suicidal ideations without intent or plan. Likewise, a June 2009 treatment record reflects that the Veteran experienced fleeting suicidal ideation. However, he subsequently denied suicidal ideations in subsequent VA treatment and examinations, including in November 2009, June 2010 and March 2011. In addition, the Veteran's wife reported that he had spoke of suicide in October 2008 but did not indicate the frequency of such statements. Therefore, at most, the Veteran has only occasional or episodic suicidal ideation. However, as discussed below, the Board finds that, despite his episodic suicidal ideation, the Veteran's PTSD symptomatology on the whole does not more nearly approximate a 70 percent rating. In this regard, there is no evidence that the Veteran has obsessional rituals which interfere with routine activities. Pertaining to the Veteran's speech, it has been consistently found to be of normal rate, volume and tone without psychomotor agitation or retardation. His speech has never been described as illogical, obscure, or irrelevant. There is also no evidence of near-continuous panic or depression affecting the Veteran's ability to function independently, appropriately, and effectively. In this regard, the January 2009 VA examiner found that the Veteran was able to maintain his activities of daily living. In addition, the November 2009 VA examiner found that there were no impairments in the Veteran's activities of daily living attributable to his mental disorder. Panic attacks were not reported during the appellate period. Moreover, the Veteran's reported periods of depression do not rise to the level of near-continuous and such have not been shown to affect his ability to function independently, appropriately, and effectively. Additionally, there is no evidence that the Veteran suffers from impaired impulse control during the current appeal period. In this regard, he has reported having a short-fuse and that he had periods of violence. However, no assaultive behavior was reported and objective examination did not reveal impaired impulse control. In July 2008, the Veteran reported that his anger was better controlled with medication. Furthermore, the Veteran has never been noted to have spatial disorientation. In this regard, VA treatment records dated during the course of the appeal reflect that the Veteran was consistently alert and oriented. Likewise, at his January 2009, November 2009 and March 2011 VA examinations, he was noted to be fully oriented. The Board further finds that the evidence fails to demonstrate that the Veteran neglects his personal appearance and hygiene. In this regard, VA treatment records and examination reports dated during the appeal period consistently show that he has been clean and casually dressed and well-groomed. Although the Veteran's wife asserted that he bathed only when reminded and that he did not shave regularly, he was consistently found to be well-groomed on objective examination. Pertaining to whether the Veteran has difficulty in adapting to stressful circumstances, the Board finds that, while the Veteran was unemployed, the evidence fails to demonstrate that such is due solely to his PTSD. In this regard, he reported in June 2009 that he retired in 1992 after working as a letter carrier and a real estate agent, as well as operating his own dive shop. The November 2009 VA examiner found that the Veteran's PTSD symptoms were controlled by medication and caused no significant occupational impairment. In addition, a January 2009 VA examiner noted that the Veteran was retired and had successfully participated in extracurricular activities. Regarding the Veteran's ability to establish and maintain effective relationships, the Board notes that he had been a relationship with his current wife since 1997 and that he reported that his irritability had put a strain on their relationship. The Veteran reported that he attended church regularly and was active in a community organization in January 2009. However, he did report that he no contact with his adult children. In addition, although the Veteran's wife reported that they had lost friends due to his inappropriate behavior, the Veteran reported that they went out to dinner with church friends once per week in March 2011. Therefore, although the Veteran reported having no relationship with his children the course of this appeal, he maintained a relationship with his wife and maintained friendships with individuals from his church. As such, the Board finds that the Veteran is able to establish and maintain effective relationships. The Board further notes that the evidence of record reflects that the Veteran has additional symptomatology that is not enumerated in the rating criteria, to include flashbacks, difficulty sleeping and difficulty concentrating. See Mauerhan, supra. However, the Board finds that such symptoms do not more nearly approximate a rating in excess of 50 percent under the General Rating Formula as they are not of such a severity or frequency to result in occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. In reaching this decision, the Board observes that, the November 2009 VA examiner found that the Veteran's PTSD symptoms appeared to be controlled by medications and that there were no significant impairments in occupational and social functioning. The January 2009 VA examiner found that the Veteran's PTSD symptoms were moderately severe and impacted his social functioning but he was still able to successfully participate in extracurricular activities. Moreover, the Board finds that the evidence of record, as discussed in detail above, supports the conclusion that the Veteran's PTSD results in moderate symptomatology, rather than moderately severe or severe symptomatology. The Board has also considered the Veteran's GAF scores assigned during the course of the appeal. In this regard, the January 2009 VA examiner assigned a score of 52, indicating moderate symptoms. The November 2009 VA examiner assigned a GAF score of 75 while the March 2011 VA examiner assigned a GAF score of 65, indicating mild symptoms. VA treatment records document GAF scores ranging between 51 and 59. A GAF score is highly probative as it relates directly to the Veteran's level of impairment of social and industrial adaptability, as contemplated by the rating criteria for mental disorders. See Massey v. Brown, 7 Vet. App. 204, 207 (1994). As the Veteran has predominantly been assigned GAF scores reflecting mild to moderate symptoms and the evidence of record, as detailed previously, supports such a score, the Board finds that the Veteran is not entitled to a rating in excess of 50 percent for PTSD. Therefore, as the Veteran's PTSD symptoms, as detailed previously, are contemplated by his 50 percent rating and, absent more severe symptoms, a higher rating is not warranted. Moreover, the Board finds that the criteria for a 100 percent rating under the General Rating Formula are not met. In this regard, the evidence does not show that the Veteran has total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. In this regard, although the Veteran reported hypnagogic hallucinations, which were not persistent, at the January 2009 VA examination, there was no evidence of hallucinations, delusions, or significant cognitive impairment found on mental status examination. Mental status examinations conducted in July 2009 and June 2010 found the Veteran's thought process and content to be logical and goal-directed with no delusions. Likewise, VA treatment records showed no perceptual disturbance such as delusions or hallucinations, mania or psychosis. Moreover, while the Veteran's wife asserted in a December 2012 statement that the Veteran was in constant danger of hurting himself and others, she attributed such dangers to falling rather than his PTSD. Furthermore, as indicated previously, the evidence reflects that, while the Veteran is unemployable, such is not due to his PTSD. Additionally, the evidence reflects that he was active in a community organization, attended church and has social relationships with church friends. Furthermore, there is no evidence of gross impairment in thought processes or communication, grossly inappropriate behavior, persistent danger to himself or others, an inability to perform activities of daily living, disorientation to time or place, or memory loss for names of close relatives, occupation, or own name. The Board notes that, while the Veteran and his wife have reported memory difficulties, his memory was consistently found to be intact on objective examination and his reported difficulties were attributed to lapses of concentration in December 2008. In addition, a July 2010 VA neurologist attributed the Veteran's memory difficulties to his mood disorder, untreated sleep apnea and poor sleeping. Therefore, the Veteran is not entitled to a 100 percent rating under the General Rating Formula. The Board has considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected PTSD; however, the Board finds that his symptomatology has been stable throughout the appeal. Therefore, assigning staged ratings for such disability is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to a rating in excess of 50 percent for PTSD. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. B. Right Ear Hearing Loss The Veteran's service-connected right ear hearing loss is currently assigned a noncompensable rating under 38 C.F.R. § 4.85, Diagnostic Code 6100. He filed a claim for an increased rating in October 2006. The Veteran contends that his hearing disability is worse than the currently assigned evaluation. Therefore, he alleges that he is entitled to an initial compensable rating for such disability. Ratings of hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from level I, for essentially normal acuity, through level XI, for profound deafness. 38 C.F.R. § 4.85(h), Table VI. In order to establish entitlement to a compensable rating for hearing loss, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The criteria for rating hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, Table VIA in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. The Board initially notes that the Veteran is only service-connected for right ear hearing loss. Pursuant to 38 C.F.R. § 4.85(f), if impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the nonservice-connected ear will be assigned a Roman Numeral designation for hearing impairment of I. However, if impaired hearing is service-connected in only one ear, the impairment in both ears will be considered in rating the disability if the impairment in the service-connected ear is to a degree of 10 percent or more and the impairment in the nonservice-connected ear qualifies as a disability under 38 C.F.R. § 3.385. 38 C.F.R. § 3.383. In this regard, in order for the right ear hearing loss to be considered 10 percent disabling, it must reach Level X or XI (which are the Roman Numeral designations for hearing loss of a severity that it would equate to a 10 percent rating when the nonservice-connected ear is assigned Level I hearing impairment). However, as will be discussed below, the Veteran's right ear hearing loss results in no worse than Level VIII hearing impairment. As such, for the entire appeal period, the Veteran's nonservice-connected left ear is assigned Level I hearing. A February 2007 VA audiological examination revealed the following pure tone thresholds, measured in decibels: Hertz 1,000 2,000 3,000 4,000 Avg. Right 45 50 90 95 70 Word recognition testing revealed speech recognition ability of 80 percent. No exceptional pattern of hearing loss was demonstrated. These audiometry test results equate to Level IV hearing in the right ear using Table V. 38 C.F.R. § 4.85. Applying the percentage ratings for hearing impairment found in Table VII, Level IV hearing in the right ear and Level I hearing in the left ear results in a noncompensable rating. 38 C.F.R. § 4.85. An August 2008 VA audiological examination revealed the following pure tone thresholds, measured in decibels: Hertz 1,000 2,000 3,000 4,000 Avg. Right 55 60 105 100 80 Word recognition testing revealed speech recognition ability of 72 percent. No exceptional pattern of hearing loss was demonstrated. These audiometry test results equate to Level VI hearing in the right ear using Table V. 38 C.F.R. § 4.85. Applying the percentage ratings for hearing impairment found in Table VII, Level VI hearing in the right ear and Level I hearing in the left ear results in a noncompensable rating. 38 C.F.R. § 4.85. A November 2009 VA audiological examination revealed the following pure tone thresholds, measured in decibels: Hertz 1,000 2,000 3,000 4,000 Avg. Right 45 65 95 90 73.75 Word recognition testing was found to be too unreliable to score due to inconsistent responses during both pure tone and speech testing. No exceptional pattern of hearing loss was demonstrated. These audiometry test results equate to Level VI hearing in the right ear using Table VI. 38 C.F.R. § 4.85. Applying the percentage ratings for hearing impairment found in Table VII, Level VI hearing in the right ear and Level I hearing in the left ear results in a noncompensable rating. 38 C.F.R. § 4.85. A March 1, 2011 VA audiological examination revealed the following pure tone thresholds, measured in decibels: Hertz 1,000 2,000 3,000 4,000 Avg. Right 60 75 100 95 82.50 Word recognition testing was found to be 60 percent. No exceptional pattern of hearing loss was demonstrated. These audiometry test results equate to Level VIII hearing in the right ear using Table VI. 38 C.F.R. § 4.85. Applying the percentage ratings for hearing impairment found in Table VII, Level VIII hearing in the right ear and Level I hearing in the left ear results in a noncompensable rating. 38 C.F.R. § 4.85. The Board further finds that the evidence of record reflects no certification of language difficulties, inconsistent speech audiometry scores, or pure tone threshold findings of 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz as to warrant consideration as an exceptional pattern of hearing impairment. See 38 C.F.R. § 4.86(b). Therefore, the Board finds that, for the entire appeal period, the Veteran's nonservice-connected left ear is assigned Level I hearing, and as he has no worse than Level VIII hearing in the right ear, he is not entitled to a compensable rating for his right ear hearing loss. To the extent that the Veteran contends that his hearing loss is more severe than currently evaluated, the Board observes that the Veteran, while competent to report symptoms such as difficulty understanding speech, particularly in noisy environments, he is not competent to report that his hearing acuity is of sufficient severity to warrant a higher evaluation under VA's tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Despite the foregoing, the Board acknowledges the Veteran's reports of the difficulty he has in understanding speech, particularly in noisy environments. Even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a compensable rating are not met. See Lendenmann, supra (assignment of disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered). The Board has considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected right ear hearing loss; however, the Board finds that his symptomatology has been stable throughout the appeal. Therefore, assigning staged ratings for such disability is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to a compensable rating for right ear hearing loss. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. C. Other Considerations Additionally, the Board has contemplated whether the case should be referred for extra-schedular consideration. An extra-schedular disability rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1). In Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), the Court explained how the provisions of 38 C.F.R. § 3.321 are applied. Specifically, the Court stated that the determination of whether a claimant is entitled to an extra-schedular rating under § 3.321 is a three-step inquiry. First, it must be determined whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. In this regard, the Court indicated that there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as "marked interference with employment" and "frequent periods of hospitalization." Third, when an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating. Id. The Board has carefully compared the level of severity and symptomatology of the Veteran's service-connected PTSD and right ear hearing loss with the established criteria found in the rating schedule. The Board finds that the Veteran's PTSD and right ear hearing loss symptomatology is fully addressed by the rating criteria under which such disabilities are rated. In this regard, all of the Veteran's psychiatric symptomatology is contemplated by the rating criteria, to include those symptoms which are not specifically enumerated. See Mauerhan, supra. Moreover, the rating criteria pertinent to hearing loss contemplates the difficulty the Veteran has hearing in all situations. There are no additional symptoms of his PTSD and right ear hearing loss that are not addressed by the rating schedule. Therefore, the Board finds that the rating criteria reasonably describe the Veteran's disability level and symptomatology of his service-connected disabilities. As such, the Board finds that the rating schedule is adequate to evaluate the Veteran's disability picture. Therefore, the Board need not proceed to consider the second factor, viz., whether there are attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization. Consequently, the Board concludes that referral of this case for consideration of an extra-schedular rating is not warranted. Id.; Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim for a TDIU is part of an increased rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. The Board notes that the Court has noted that VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C.A § 1114. See Bradley, 22 Vet. App. 280, 294 (2008) (finding that SMC "benefits are to be accorded when a Veteran becomes eligible without need for a separate claim"). Subsection 1114(s) requires that a disabled Veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for the special monthly compensation provided by that statute. Under the law, subsection 1114(s) benefits are not available to a Veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. The record reflects that the Veteran is currently in receipt of a 100 percent schedular rating for prostate cancer as of May 25, 2001, and SMC pursuant to 38 U.S.C.A § 1114(s) based on such 100 percent rating and additional disabilities independently ratable at 60 percent or more as of October 23, 2006, the date his claim for an increased rating for right ear hearing loss was received by VA. His claim for an increased rating for PTSD was not received until October 2008. Therefore, he is in receipt of the maximum benefit allowable under the law for the entire appeal period. As such, a claim for TDIU is rendered moot and need not be addressed further. ORDER A rating in excess of 50 percent for PTSD is denied. A compensable rating for right ear hearing loss is denied. REMAND Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim for service connection for a TBI so that he is afforded every possible consideration. Once the Secretary undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, he must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). VA regulations provide that where an examination report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes. 38 C.F.R. §§ 4.2, 19.9. Where the Board makes a decision based on an examination report which does not contain sufficient detail, remand is required "for compliance with the duty to assist by conducting a thorough and contemporaneous medical examination." Goss v. Brown, 9 Vet. App 109, 114 (1996); Stanton v. Brown, 5 Vet. App. 563, 569 (1993). The Veteran contends that he suffered multiple head injuries during service as a result of various explosions during combat operations, and that such head injuries caused a TBI. Service personnel records confirm that the Veteran was responsible for controlling and directing all aircraft maintenance at the Korat Royal Thai Air Force Base (RTAFB) in support of combat operations in Southeast Asia and that he had been awarded the Purple Heart medal. In addition, several lay statements from the Veteran's former commanders detail his head injuries during enemy attacks. VA obtained an etiological opinion as to the Veteran's claimed TBI in October 2009. The VA examiner opined that it was less likely than not that the Veteran's subjective complaints were related to a TBI and that such complaints were not consistent with a mild TBI. The examiner explained that the Veteran had multiple medical issues, including diabetes and peripheral neuropathy, which significantly overlapped into complaints he attributed to a TBI. The examiner also appeared to suggest that the Veteran's mild in-service TBI had resolved without residuals. In addition, the examiner referred to a head injury sustained in March 1975 after the Veteran was knocked down by artillery fire and struck his head on an aircraft tire. However, a November 2008 VA treatment note detailed three separate in-service head injuries, including two in March 1975 and one in April 1975. In this regard, the Court has held that a medical opinion based on an inaccurate or incomplete factual premise is not probative. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The VA examiner's opinion was based on an incomplete or inaccurate factual premise, namely, that the Veteran sustained only one head injury during service, and is therefore inadequate under Barr and Reonal. In addition, it is not clear whether the Veteran currently suffers from a TBI or residuals of a TBI, as the examiner indicated that the Veteran's mild TBI had "resolved without residuals." In light of these deficiencies, a remand is necessary in order to obtain another opinion regarding the etiology of the Veteran's claimed TBI. Finally, due to the length of time which will elapse on remand, updated VA treatment records dated from November 2011 to the present from the Community Based Outpatient Clinics (CBOCs) located in Eglin and Pensacola that are not already associated with the claims file should be obtained for consideration in the Veteran's appeal. In this regard, while VA treatment records dated through November 2011 were associated with the Veteran's Virtual VA file. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Obtain all treatment records from the Eglin and Pensacola VA CBOCs dated from November 2011 to the present. All reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C.A. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. After obtaining all outstanding treatment records, the claims file should be forwarded to a medical professional to offer an opinion regarding the etiology of the Veteran's claimed TBI. An examination of the Veteran is not required unless deemed necessary by the medical professional selected to offer the opinion. The examiner should review the entire claims file, including the Veteran's service and personnel records, and lay statements, including the December 2010 statements from the Veteran's former commanders, as well as the October 2009 VA examination report. The examiner is asked to furnish an opinion with respect to the following questions: a) Does the Veteran currently suffer from a TBI or residuals of a TBI? The examiner should identify all such disorders that have been present at any time since June 2008. (b) If it is determined that the Veteran currently suffers from a TBI or residuals of a TBI, the examiner should offer an opinion as to whether it is at least as likely as not (50 percent or greater probability) that such disorder is related to the Veteran's military service, to include his in-service head injuries. In offering the foregoing opinions, the examiner should specifically consider the Veteran's contention that he sustained three separate head injuries during service. In addition, the examiner should specifically address the October 2009 VA examination report suggesting that the Veteran's mild TBI had resolved without residuals and that his subjective complaints overlapped with other nonservice-connected physical disabilities. The rationale for any opinion offered should be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claim should be readjudicated based on the entirety of the evidence. If the claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. The Board intimates no opinion as to the outcome of this case. The Veteran need take no action until so informed. The purpose of this REMAND is to ensure compliance with due process considerations. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board 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). ______________________________________________ A. JAEGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs