Citation Nr: 1322175 Decision Date: 07/11/13 Archive Date: 07/18/13 DOCKET NO. 11-21 948 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manila, the Republic of the Philippines THE ISSUES 1. Entitlement to service connection for a vision disorder. 2. Entitlement to service connection for osteoarthritis of the hips, knees, hands, and fingers. 3. Entitlement to service connection for low back pain. 4. Whether a reduction in the Veteran's disability rating from 50 percent to 40 percent, effective September 16, 2010, for bilateral hearing loss was proper, to include entitlement to an increased rating for bilateral hearing loss. 5. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities. WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD A. Fagan, Associate Counsel INTRODUCTION The Veteran served on active duty from April 1955 to July 1974. This matter comes before the Board of Veterans' Appeals (Board) from a March 2010 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO) in Manila, the Republic of the Philippines. The Veteran testified before the undersigned Veterans Law Judge in January 2013. A transcript of the hearing is of record. As an introductory matter, the Board observes that the record is somewhat ambiguous as to whether the issue of entitlement to an increased rating for hearing loss is properly on appeal. In this regard, in a June 2010 statement construed by the RO to be a notice of disagreement as to the other issues currently on appeal, the Veteran discussed his 50 percent initial disability rating assigned by the March 2010 rating decision. Additionally, in an August 2010 written statement, the Veteran expressed both a belief that he was entitled to a higher rating and that his hearing loss had worsened. Indeed, in the June 2011 rating decision reducing the Veteran's hearing loss disability rating from 50 percent to 40 percent, the RO explicitly referenced as evidence the Veteran's disagreement notice received on June 10, 2010, and discussed the Veteran's disagreement in the reasons and bases of the decision. Accordingly, the Board finds that the RO interpreted the Veteran's June 2010 statement to be a timely notice of disagreement with the initial disability rating assigned for hearing loss by the March 2010 decision. However, the June 2010 statement of the case issued by the RO does not include the issue of entitlement to an increased rating for hearing loss, and no separate statement of the case relating to that claim was issued by the RO. Notwithstanding that omission, subsequent correspondence from the Veteran, namely his August 2011 substantive appeal, and communications between the Veteran and the undersigned VLJ during the January 2013 indicates that the Veteran considered the hearing loss increased rating claim to be currently on appeal. Percy v. Shinseki, 23 Vet. App. 37 (2009); Gonzalez-Morales v. Principi, 16 Vet. App. 556 (2003). As such, the VLJ expressly agreed during the January 2013 Travel Board hearing to accept jurisdiction of the Veteran's hearing loss increased rating claim, to include the propriety of the RO's rating reduction. The Board recognizes that when an appellant submits a timely notice of disagreement and no statement of the case has been provided, the general remedy is to remand so that one may be issued. Manlincon v. West, 12 Vet. App. 238 (1999). However, that further development would only result in additional delay with no benefit to the Veteran. Sabonis v. Brown, 6 Vet. App. 426 (1994); VAOPGCPREC 5-04 (2004), 69 Fed. Reg. 59,989 (2004). The Board has decided to restore the Veteran's 50 percent disability rating and remand the issue of entitlement to a rating in excess of 50 percent for hearing loss. As that outcome is fully favorable to the Veteran, he is not prejudiced by the Board's consideration of the hearing loss issue on appeal. The issue of entitlement to service connection for a bilateral foot disability was raised by the Veteran in a statement dated in July 2012. However, that issue has not been adjudicated by the Agency of Original Jurisdiction. Accordingly, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. 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 issues of service connection for a vision disorder, low back pain, and osteoarthritis of the hips, knees, hands, and fingers; an increased initial rating for bilateral hearing loss; and entitlement to a TDIU are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. A June 2011 rating decision reduced the evaluation for the Veteran's service-connected hearing loss from 50 percent to 40 percent, effective September 16, 2010. 2. As of September 16, 2010, the 50 percent evaluation for the Veteran's service-connected bilateral hearing loss had been in effect for less than five years. 3. The September 2010 VA examination on which the reduction is based was inadequate for the purposes of reducing the evaluation assigned for service-connected bilateral hearing loss, and the preponderance of the evidence does not support a finding that the Veteran's bilateral hearing loss underwent actual improvement. CONCLUSION OF LAW The reduction of the disability evaluation for service-connected hearing loss from 50 percent disabling to 40 percent was not proper, and the 50 percent rating is restored from September 16, 2010. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2012); 38 C.F.R. §§ 38 C.F.R. §§ 3.105, 3.344, 4.1, 4.2, 4.3, 4.7, 4.10, 4.13, 4.21 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Given the favorable disposition of the claim herein decided, the Board finds that all notification and development actions needed to fairly adjudicate this claim have been accomplished. Analysis Historically, in a March 2010 rating decision, the Veteran was granted service connection and assigned an initial 50 percent rating for bilateral hearing loss, effective December 4, 2009. The 50 percent rating was based on the findings from a March 2010 VA examination. At that examination, the Veteran described difficulty hearing and poor social interactions due to his hearing loss. Audiometric testing revealed profound hearing loss in both ears, with puretone threshold averages of 82.5 decibels in the right ear and 87.5 decibels in the left ear. Speech audiogram revealed poor speech discrimination, with right ear speech recognition of 60 percent and left ear speech recognition of 52 percent. In light of the March 2010 VA examination, the RO assigned an initial 50 percent rating for bilateral hearing loss. A June 2010 statement from the Veteran was construed by the RO as a notice of disagreement with the 50 percent rating, and in an August 2010 written statement, the Veteran asserted that his hearing had worsened. The Veteran was afforded a VA examination on September 16, 2010, in conjunction with this claim. The examiner noted the Veteran's complaints of hearing difficulty and poor social interaction. Audiometric testing revealed puretone threshold averages of 81.25 decibels in the right ear and 88.75 decibels in the left ear. However, speech audiogram was too unreliable to score, as the Veteran was unable to understand or repeat any of the recorded test words. The examiner noted severe to profound hearing loss bilaterally. It was also noted that the Veteran's complaints of worsening hearing were likely due to presbycusis. Based on the September 2010 VA examination, in a June 2011 rating decision, the RO reduced the disability rating for the Veteran's service-connected hearing loss from 50 percent to 40 percent, effective September 16, 2010. Procedurally, where a reduction in an evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance must be prepared setting forth all material facts and reasons. In addition, the RO must notify the Veteran that he has 60 days to present additional evidence showing that compensation should be continued at the present level. The Veteran is also to be informed that he may request a predetermination hearing, provided that the request is received by VA within 30 days from the date of the notice. If no additional evidence is received within the 60 day period and no hearing is requested, a final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the Veteran expires. 38 C.F.R. § 3.105(e). In this case, the reduction in rating of the service-connected hearing loss from 50 percent to 40 percent disabling, effective September 16, 2010, did not result in a reduction in the amount of compensation payable to the Veteran (because the RO simultaneously granted service connection and assigned an initial 10 percent rating for tinnitus, effective September 16, 2010). As such, 38 C.F.R. § 3.105(e) does not apply. See VAOPGCPREC 71-91. See also Stelzel v. Mansfield, 508 F.3d 1345, 1349 (Fed. Cir. 2007); O'Connell v. Nicholson, 21 Vet. App. 89 (2007). Thus, the Board will turn to the question of whether the rating reduction was proper. A veteran's disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. See 38 U.S.C.A. § 1155 (West 2002). When an RO reduces a rating without following the applicable regulations, the reduction is void ab initio. Greyzck v. West, 12 Vet. App. 288, 292 (1999). For reductions in rating to be properly accomplished, specific requirements must be met. See 38 C.F.R. § 3.344; see also Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992). In this case, the 50 percent rating for the Veteran's service-connected bilateral hearing loss was in effect for less than five years at the time of reduction. Accordingly, the provisions of 38 C.F.R. § 3.344(a) and (b) do not apply in this case. Rather, as regards disability ratings in effect for less than five years, adequate reexamination that discloses improvement in the condition will warrant reduction in rating. See 38 C.F.R. § 3.344(c). Nevertheless, prior to reducing a Veteran's disability rating, VA is required to comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13 (2012); see also Brown v. Brown, 5 Vet. App. 413, 420 (1993). These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of the Veteran's disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating reduction case not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 350 (2000). It is essential both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. 38 C.F.R. § 4.1. If an examination report does not contain sufficient detail, or the diagnosis is not supported by the findings on the examination report, it must be returned as inadequate for rating purposes. 38 C.F.R. § 4.2. When any change in evaluation is to be made, the rating agency should assure itself that there has been an actual change in the conditions, for better or worse, and not merely a difference in thoroughness of the examinations or in use of descriptive terms. 38 C.F.R. § 4.13. Finally, it must be considered that the basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The Board further 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 considering the propriety of a reduction, the Board must focus on the evidence of record available to the RO at the time the reduction was effectuated, although post-reduction medical evidence may be considered for the limited purpose of determining whether the condition has demonstrated actual improvement. Cf. Dofflemyer, 2 Vet. App. at 281-82. A claim as to whether a rating reduction was proper must be resolved in the Veteran's favor unless the Board concludes that a fair preponderance of evidence weighs against the claim. Brown, 413 Vet. App. at 421. In the instant case, the Board finds that the September 2010 VA audiological examination provided an inadequate basis for reducing the Veteran's disability evaluation for service-connected bilateral hearing loss. As stated, in a rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but also that the improvement actually reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Brown, 413 Vet. App. at 420-21; Schafrath, 1 Vet. App. at 594. Here, the September 2010 examiner did not offer any opinion on the Veteran's ability to function under the ordinary conditions of life and work. Nor did the examiner adequately discuss the functional effects of the Veteran's hearing loss on his ordinary activity. In this regard, while the examiner found no apparent effects on activities of daily living, and effects on occupational activities to include "poor social interactions" and "difficulty hearing," the Board finds those to be inadequate assessments given the fact that the Veteran was unable to repeat or understand the recorded test words on speech discrimination testing at that time, even in the controlled and presumably quiet setting of the VA audiological examination. The inability to hear in the controlled VA environment in September 2010 clearly supports impairment in the ability to function under the ordinary and arguably less quiet conditions of life and work; however, no discussion of the Veteran's functioning under the ordinary conditions of life and work was set forth. Moreover, the functional effects noted in September 2010, when the Veteran could not perform speech discrimination testing, are identical to those noted on the March 2010 VA examination report, at which time the Veteran was able to produce reliable findings on the speech discrimination testing. Given the change in speech discrimination ability from March 2010 to September 2010, the Board finds that there would likely be a corresponding functional loss, or at the very least, a discussion as to why there is not. However, the VA examination report contains no discussion or rationale for the conclusions offered. Absent a discussion of the Veteran's ability to function under the ordinary conditions of life and work, and absent a full accounting of the functional effects of the Veteran's hearing impairment, the September 2010 VA examination report contains insufficient detail for the RO to make a fully-informed evaluation of the Veteran's hearing loss disability, and is therefore inadequate. Furthermore, the Board notes that, while audiometric findings in September 2010 may have shown slight improvement when compared to the March 2010 VA examination, the Veteran's inability to perform speech discrimination testing in September 2010 weighs against a finding of actual improvement in the Veteran's overall hearing disability. Evidence dated after the September 2010 VA examination also supports that the Veteran's hearing loss did not undergo actual improvement at the time of the June 2011 rating decision reducing the Veteran's disability rating from 50 percent to 40 percent. Specifically, six months after the September 2010 VA examination, the Veteran was unable to participate in the interview portion of a March 2011 VA examination because he could "hardly hear and understand." Instead, his wife provided the VA examiner with the Veteran's medical history. Thus, the Board finds that a preponderance of the evidence was against a finding that the Veteran's service-connected bilateral hearing loss underwent actual improvement at the time of the June 2011 rating decision reducing the disability rating. Considering the above, the Board finds that the September 2010 VA audiological examination report was inadequate for reducing the evaluation assigned for the Veteran's bilateral hearing loss. The September 2010 VA examiner did not offer an opinion on the Veteran's ability to function under the ordinary conditions of life and work as required, nor did it adequately address the functional effects of the Veteran's hearing impairment. Further, the Board finds that the RO did not base the reduction upon review of the entire history of the Veteran's disability. Specifically, the RO did not consider the evidence dated after the September 2010 VA examination suggesting that the Veteran's hearing loss had worsened, or at least not improved, namely the March 2011 VA examination report. Thus, the Board finds that a preponderance of the evidence was against a finding that the Veteran's service-connected bilateral hearing loss underwent actual improvement at the time of the June 2011 rating decision. Accordingly, the Board finds that the reduction in the evaluation for service-connected bilateral hearing loss to a 40 percent disability was improper, and the 50 percent disability evaluation is restored, effective September 16, 2010. ORDER Restoration of the Veteran's 50 percent rating for bilateral hearing loss is granted, effective September 16, 2010. REMAND While further delay is regrettable, the Board finds that additional development is required concerning the Veteran's service connection, increased rating, and TDIU claims. The Veteran asserts that he currently suffers from a vision disorder, a low back disorder, and osteoarthritis of the knees, hips, hands, and fingers, that are related to service, to include his duties as a cook therein. Service treatment records show that the Veteran complained of a stiff neck and back in November 1957. They also show that, in December 1963, he fell on broken glass and sustained lacerations to his left hand. However, those records are otherwise negative for complaints related to low back, hip, knee, hand, finger, or vision problems. The Veteran's vision was routinely shown to be 20/20 in both eyes, and the Veteran's July 1974 separation examination revealed no abnormalities other than hearing loss. Post-service private medical records show that the Veteran began receiving treatment for osteoarthritis of the hands, fingers, knees, and hips in June 2009, and was receiving treatment as recently as March 2011. They also show treatment for presbyopia with astigmatism in January 2009 and August 2010. The Veteran was afforded VA joint and vision examinations in March 2011 during which the Veteran essentially reported an onset of his low back, hand, knee, and vision symptoms in service or soon thereafter. Pursuant to those examinations, he was diagnosed with degenerative disc disease of the lumbar spine, degenerative joint disease of the hands and knees, bilateral cataracts, hyperopia/astigmatism/presbyopia, and dry eyes. Significantly, no etiological opinion was rendered for any diagnosis offered. As such, it remains unclear to the Board whether the Veteran's currently diagnosed low back, knee, hand, and vision disabilities are related to service, to include the Veteran's duties as a cook. Therefore, on remand, the Veteran should be afforded additional VA examinations to address the etiology of the his low back, knee, hand, and vision disorders. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes an examination, even if not required to do so, an adequate one must be produced). Additionally, as the Veteran is to be afforded a VA joints examination on remand, the VA examiner should also address the nature and etiology of the Veteran's claimed hip disability. Next, a new examination is also warranted with respect to the Veteran's bilateral hearing loss. In a claim for increased compensation, the need for a follow-up examination is triggered whenever there is evidence of worsening of the disability at issue. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4) (VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is necessary to make a decision on the claim); see also Weggenmann v. Brown, 5 Vet. App. 281 (1993) (when available evidence is too old for an adequate evaluation of the Veteran's current condition, VA's duty to assist includes providing a new examination). Such is the case here. Specifically, the record reflects that the Veteran's hearing loss was last evaluated during a September 2010 VA audiological examination. The September 2010 VA examination report does not indicate that the Veteran's wife assisted with the examination or that the Veteran was otherwise unable to speak or participate in the examination. However, during a subsequent March 2011 VA examination, the Veteran's wife provided the medical information, as the Veteran "could hardly hear and understand." Similarly, during his January 2013 Board hearing, the Veteran was effectively unable to participate due to the severity of his hearing loss and spoke only one time during the course of the hearing. His wife offered testimony on his behalf. In light of the foregoing, the Board finds that the Veteran should undergo an additional VA examination that addresses whether his overall hearing disability has worsened. The RO should also consider whether the Veteran's hearing disability renders him deaf for purposes of entitlement to special monthly compensation under 38 C.F.R. § 3.350. The Board now turns to the Veteran's claim for a TDIU. Total disability will be considered to exist where there is impairment of mind or body sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (2012). Total disability ratings for compensation may be assigned where the schedular rating is less than total when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, the disability shall be ratable at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a) (2012). If the schedular rating is less than 100 percent, the issue of unemployability must be determined without regard to the advancing age of the Veteran. 38 C.F.R. §§ 3.341(a); 4.19 (2012). Factors to be considered are the Veteran's education, employment history, and vocational attainment. Ferraro v. Derwinski, 1 Vet. App. 326 (1991). The record shows that, in addition to hearing loss, now rated 50 percent, the Veteran is service connected for bilateral tinnitus, rated 10 percent. The Veteran's total combined rating is now 60 percent. 38 C.F.R. § 4.25. He does not meet the percentage criteria for consideration of a TDIU rating. 38 C.F.R. § 4.16(a) (2012). Nevertheless, additional development is needed in order to ascertain whether the Veteran is entitled to an increased initial rating for his hearing loss disability. That additional development could have bearing on whether he meets the criteria in 38 C.F.R. § 4.16(a) and, thus, affect the outcome of his TDIU claim. Accordingly, the Board considers the Veteran's TDIU claim to be inextricably intertwined with the hearing loss issue currently on appeal. Consideration of the Veteran's TDIU claim must be deferred pending adjudication of his claim for an increased rating for hearing loss. Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on a Veteran's claim for another issue). To facilitate the Veteran's TDIU claim, the Board also finds that he should be afforded another VA examination. While the Veteran was afforded VA general medical and vision examinations in March 2011 that addressed the occupational impairment caused by musculoskeletal and vision disabilities, the Veteran is not currently service connected for any vision or musculoskeletal disabilities. Moreover, while the Veteran was afforded a VA examination in September 2010 pertaining to his hearing disability, the examiner did not offer any opinion as to the Veteran's employability. Nor did the examiner adequately address the impact of the Veteran's hearing disability on his occupational functioning, as the examiner simply noted that the Veteran was not employed. Moreover, the record includes evidence that the severity of the Veteran's hearing loss may have worsened since that prior examination and, thus, may be productive of greater occupational impairment. Accordingly, the Board finds that, on remand, the Veteran should be afforded a VA examination and opinion to ascertain the current impact of his service-connected disorders on his ability to obtain and maintain substantially gainful employment. Friscia v. Brown, 7 Vet. App. 294 (1995) (VA has a duty to supplement the record by obtaining an examination that includes an opinion as to the effect of the Veteran's service-connected disabilities on his ability to secure or follow a substantially gainful occupation). Finally, it appears that pertinent medical records may be outstanding. The claims folder contains various medical certificates from the Veteran's private physician certifying that the Veteran has been receiving treatment since June 2009 for osteoarthritis of the knees, hands, and hips. However, ongoing treatment records relating to that treatment have not been associated with the claims file. Accordingly, as the possibility of outstanding private medical records has been raised by the record, efforts to obtain those reports should be undertaken along with the other development requested above. 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. Afford the Veteran an opportunity to identify all healthcare providers who treated him for his low back, hip, knee, hand, finger, and vision disorders. Then, after securing any necessary authorization from the Veteran, obtain all identified treatment records, to include any previously unattained records from the private physician (Mary Ann W. Tomeldan-Balatero, M.D.) who treated the Veteran for osteoarthritis since June 2009. Explain to the Veteran that his previous authorization forms have expired and that he will need to submit a new authorization for the release of any pertinent private records that have yet to be obtained. All reasonable attempts should be made to obtain the requested private treatment records. If any of these records cannot be obtained after reasonable efforts have been exhausted, issue a formal determination that such records do not exist and that further efforts to obtain them would be futile. That formal finding should be documented in the Veteran's claims folder. The Veteran should also be personally notified of that formal finding and allowed the opportunity to provide any pertinent records in his own possession. 38 U.S.C.A. § 5103A(b)(2); 38 C.F.R. § 3.159(e). 2. After the above development has been completed, schedule the Veteran for appropriate VA examinations to assess the nature and etiology of any current knee, hand, finger, hip, and vision disorders. The claims file should be reviewed by the examiners, and the examination reports should reflect that review. The examiners should provide complete rationales for any opinions expressed and reconcile the opinions with all pertinent evidence of record, including the March 2011 VA examination reports. In particular, the joints and/or spine examiner should take into account the Veteran's reports of in-service manifestation of back and hand symptoms, and his post-service treatment for osteoarthritis. The examiners should also expressly consider any evidence suggesting a continuity of symptoms since service. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Finally, the examiners should give careful consideration to any additional lay or clinical evidence obtained pursuant to this remand. Specifically, as appropriate, the examiners should diagnose any current knee, hip, hand, finger, low back, and vision disorders and then, for each diagnosis offered or shown elsewhere in the record, provide an opinion as to whether it is at least as likely as not (50 percent or greater) that any such disorder either began during the Veteran's active service or was otherwise caused or aggravated by his military service, to include his duties as a cook. 3. Then, schedule the Veteran for a VA examination to determine the severity of his service-connected hearing loss and to ascertain the impact of his service-connected disabilities on his employability. The claims folder should be reviewed by the examiner, and the examination report should note that review. The examiner should provide a complete rationale for all conclusions reached and should discuss those findings in relation to the pertinent evidence of record, particularly the Veteran's previous VA examination conducted in September 2010, and the evidence, including the March 2011 VA eye examination report and the January 2013 hearing transcript, suggesting that his overall hearing disability subsequently worsened, resulting in more severe occupational and social impairment. The examiner should describe the overall impact of the Veteran's hearing disability on his occupational and social functioning. Thereafter, the VA examiner should state whether the Veteran's service-connected hearing loss and bilateral tinnitus, either singularly or jointly but without consideration of any nonservice-connected disabilities, render him unable to secure or follow a substantially gainful occupation. 4. Then, readjudicate the claims. If any decision remains adverse to the Veteran, issue a supplemental statement of the case. Allow the appropriate time for response. Afterwards, return the case to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ C. CRAWFORD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs