Citation Nr: 1322239 Decision Date: 07/11/13 Archive Date: 07/18/13 DOCKET NO. 09-46 318 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Entitlement to service connection for bilateral incipient senile cataracts, to include as secondary to service-connected diabetes mellitus. 2. Entitlement to an initial compensable evaluation for hypertension. 3. Entitlement to a total disability rating based on individual unemployability (TDIU). ATTORNEY FOR THE BOARD H. Bunker, Associate Counsel INTRODUCTION The Veteran served on active duty from August 1969 to August 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). A December 2008 rating decision granted service connection for hypertension and assigned a noncompensable rating, rated as part of the Veteran's service-connected diabetes mellitus. The Veteran wants a separate, compensable rating for his hypertension. An August 2009 rating decision denied entitlement to service connection for bilateral cataracts. The case was brought before the Board in February 2012 at which time the claims were remanded to allow the Agency of Original Jurisdiction (AOJ) to further assist the Veteran in the development of his appeal, to include obtaining VA and private treatment records, records from the Social Security Administration (SSA), and affording the Veteran new VA examinations. The Veteran's most recent VA and private treatment records were obtained and associated with the claims file. Records from the SSA were also associated with the file. The Veteran was afforded VA examinations in March 2012 for his hypertension and cataracts claims. Therefore, the Board finds that there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). In the February 2012 Board remand, the issue of entitlement to a total disability rating based on individual unemployability was referred to the RO for appropriate action. However, in Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court of Appeals for Veterans Claims (Court) determined that claim for a TDIU is considered part and parcel of a claim for benefits for the underlying disability. Therefore, in this case, the Veteran's claim for a TDIU is part and parcel of his claim for increase for hypertension, and as such, this issue is properly before the Board. Accordingly, the issues on appeal are as stated on the cover page. The claim for a TDIU is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran's bilateral cataracts are related to service or were caused or aggravated by a service-connected disability. 2. The Veteran's hypertension is manifested by diastolic pressure which is under 100 and systolic pressure under 160; there is no history of diastolic pressure which is predominantly over 100. CONCLUSIONS OF LAW 1. The criteria for the award of service connection for bilateral cataracts have not been met. 38 U.S.C.A. §§ 1110, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2012). 2. The criteria for a separate, compensable evaluation for hypertension have not been met at any point during the appeal period. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.104, Diagnostic Code 7101 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has thoroughly reviewed all the evidence in the Veteran's claims folder. Although the Board has an obligation to review the entire record, the Board does not have to discuss each piece of evidence reviewed. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran). It is VA's defined and consistently applied policy to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim. Reasonable doubt is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2012). The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). The notice requirements were met in this case by letters sent to the Veteran in October 2008, February 2009, and February 2012. These letters advised the Veteran of the information necessary to substantiate his claims and of his and VA's respective obligations for obtaining specified types of evidence. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); 38 C.F.R. § 3.159(b). These letters also advised the Veteran of how disability ratings and effective dates are determined. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); see also Goodwin v. Peake, 22 Vet. App. 128, 136 (2008) (holding that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service- connection claim has been proven and thus section 5103(a) notice is no longer required because the purpose that the notice is intended to serve has been fulfilled). The Veteran has not alleged that VA failed to comply with the notice requirements of the VCAA, and he was afforded a meaningful opportunity to participate effectively in the processing of his claim, and has in fact provided additional arguments at every stage. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005). The notice required by 38 U.S.C.A. § 5103(a) should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005). That was done in this case by means of the October 2008 and February 2009 letters. The Veteran's service treatment records, SSA records, and VA treatment records are in the file. VA has also obtained private treatment records and associated them with the claims file. The Veteran has not indicated that there are any additional outstanding records to be obtained. The duty to assist with obtaining medical records has been satisfied. The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. The case of McLendon v. Nicholson, 20 Vet. App. 79 (2006), held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. The Veteran was afforded multiple VA medical examinations for his cataracts claim. These opinions were rendered by medical professionals following a thorough examination and interview of the Veteran and review of the claims file. The examiners obtained an accurate history. The examiners provided a detailed conclusion for the conclusions that were reached. Therefore, the Board finds that the examinations are adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The duty to assist includes, when appropriate, the duty to conduct a thorough and contemporaneous examination of the Veteran. Green v. Derwinski, 1 Vet. App. 121 (1991). In addition, where the evidence of record does not reflect the current state of the Veteran's disability, a VA examination must be conducted. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 3.327(a). The Veteran was afforded a VA medical examination in March 2012 to determine the severity of his hypertension. This opinion was rendered by a medical professional following a thorough examination and interview of the Veteran and review of the claims file. The examiner obtained an accurate history. The examiner provided a detailed explanation for the opinions that were reached. There is no objective evidence indicating that there has been a material change in the severity of the Veteran's service-connected disorder since he was last examined. 38 C.F.R. § 3.327(a). The duty to assist does not require that a claim be remanded solely because of the passage of time since an otherwise adequate VA examination was conducted. VAOPGCPREC 11-95. Therefore, the Board finds that the examination is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In light of the foregoing, all relevant facts have been adequately developed to the extent possible; no further assistance to the appellant in developing the facts pertinent to the issue on appeal is required to comply with the duty to assist. 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. § 1110. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disorder on a direct basis, generally there must be probative evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). For secondary service connection, it must be shown that the disability for which the claim is made is proximately due to or the result of service-connected disease or injury or that service-connected disease or injury has chronically worsened the disability for which service connection is sought. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Direct and Secondary Service Connection Analysis The Veteran contends that his bilateral cataracts are related to his service-connected diabetes. The Board will also consider whether direct service connection is warranted. For the reasons discussed below, the Board finds that service connection is not warranted. The Veteran was afforded a medical examination at entrance to, and separation from, service in August 1969 and August 1971, respectively. At his entrance examination, there is no evidence of cataracts and the Veteran was found to be qualified for entrance to service. There are also no complaints in the service treatment records of vision defects. At the Veteran's separation examination, again there is no record of vision defects or cataracts. Ultimately, the Veteran was found qualified for separation. In short, the service treatment records are devoid of any complaints, diagnoses, or treatment consistent with cataracts. Even if a chronic condition was not shown during service, service connection may be established under 38 C.F.R. § 3.303(d) if the evidence shows a disease first diagnosed after service was incurred in service. The Board has reviewed the Veteran's post-service treatment records, however there is no competent and credible evidence linking his cataracts to service. Following separation from service the Veteran has been diagnosed with various eye disabilities. He has a refractive error, mild dry eyes, bilateral cataracts, and left eye macular pucker. See e.g., March 2009 VA examination report. These disabilities were addressed and denied separately in the August 2009 rating decision, and the Veteran limited his appeal to the condition of cataracts. Thus, the other eye disabilities are not at issue here. There is no medical opinion linking the Veteran's cataracts to service, nor has the Veteran alleged that the condition began in service. To the contrary, the examiners have found that the Veteran's eye conditions are related to the normal aging process. See March 2009 and March 2012 VA examination reports. The Board finds that the preponderance of the evidence is against the Veteran's claim for direct service connection. Bilateral cataracts were not diagnosed during service or for many years thereafter, and there is no competent and credible evidence of record showing that the condition began in service. With respect to secondary service connection, the Veteran contends that his cataracts were proximately caused by his service-connected diabetes. In a May 2008 VA treatment record, the Veteran had no evidence of diabetic changes in his eyes. The Veteran was also afforded a VA examination in July 2008 for diabetes. He did report visual impairment, to include refractive error, but the examiner opined that there was no evidence of diabetic retinal changes. There was also no evidence that the Veteran's diabetes worsened or increased his eye condition. The March 2009 VA examiner noted that there was no diabetic retinopathy observed on examination. The March 2009 VA examiner also opined that the Veteran's cataracts were not caused by his diabetes. The examiner did not discuss whether the cataracts were aggravated by his diabetes. A July 2010 VA examiner also found the Veteran did not have diabetic retinopathy. See also June 2012 VA treatment record. Most recently at his March 2012 VA examination, the Veteran reported he had a history of blurring of vision which improved with blinking. He also reported using eye drops from the VA Medical Center. He was diagnosed with preoperative cataracts of both eyes. The examiner reviewed the claims file and performed a full visual examination. She opined the Veteran's cataracts were not caused or aggravated by his diabetes. Her rationale was that the mild yellowish discoloration of the ocular lens was compatible with the aging process. She also noted that the Veteran's cataracts were found in 2009 and nuclear sclerosis had not progressed. His best corrected visual acuity was still 20/20 and the Veteran did not complain of the usual visual symptoms commonly associated with cataracts. In sum, a preponderance of the probative evidence of record weighs against the Veteran's assertion that his service-connected diabetes is the proximate cause of, or has aggravated, his bilateral cataracts. Specifically, VA physicians have opined that it is less likely than not that the Veteran's bilateral cataracts are related to, or aggravated by, his service-connected diabetes. These opinions were rendered following an interview and evaluation of the Veteran as well as a review of historical records. The Board finds credible the Veteran's report that he has cataracts which were diagnosed post-service. The Veteran has also provided numerous statements indicating that he believes his cataracts are due to his service or his service-connected diabetes. However, the most credible evidence of record shows that the Veteran's cataracts are not related to service or to his service-connected diabetes. The Board acknowledges that the Veteran believes he has cataracts as a result of his service-connected diabetes. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, diagnosing the etiology of cataracts, this falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In this case, given the Veteran's lack of medical expertise, his assertions that he currently has cataracts that are related to service-connected diabetes are beyond his competence. These statements are greatly outweighed by the VA examiners' negative opinions. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for bilateral cataracts on a direct and secondary basis and the benefit of the doubt rule does not apply. See 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Increased Rating Disability evaluations are determined by comparing a Veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. See generally, 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In Fenderson v. West, 12 Vet. App. 119 (1999), the Court held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. In Fenderson, the Court also discussed the concept of the "staging" of ratings, finding that in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a Veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. Fenderson at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran's hypertension is rated as zero percent disabling. Under 38 C.F.R. § 4.104, Diagnostic Code 7101, a 10 percent rating is warranted when the diastolic pressure is predominantly 100 or more; the systolic pressure is predominantly 160 or more; or the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent is warranted for diastolic pressure predominately 110 or more, or; systolic pressure predominately 200 or more. A 40 percent rating is awarded where diastolic pressure is predominantly 120 or more. A 60 percent rating is awarded where diastolic pressure is predominantly 130 or more. Id. There is no evidence that he meets the requirements for a higher rating under Diagnostic Code 7101. In this regard, the Veteran's diastolic pressure is never predominantly 100 or more, and his systolic pressure is never predominantly 160 or more. The VA has obtained numerous post-service treatment records which recorded the Veteran's blood pressure. In April 2008, the Veteran was diagnosed with hypertension and his blood pressure was recorded as 150/99. At a July 2008 VA examination the Veteran's hypertension was related to his diabetes. His blood pressure was recorded as 131/86, 135/81, and 138/88. In a February 2009 VA examination, the Veteran's blood pressure was recorded as 124/80 in the right arm and 137/92 in the left arm. VA treatment records show that the Veteran's blood pressure was recorded as 138/85 in March 2009 and as 132/82 in September 2009. The Veteran was afforded a VA examination in October 2009 for his hypertension. It was noted he used medication to control his hypertension which had recently been increased in dosage. His blood pressure was stable on examination. His blood pressure was measured as 145/83, 145/85, and 151/86. The examiner could not determine a baseline for his hypertension without resorting to mere speculation. Her rationale was that there were no private or VA treatment record available prior to April 2008 when he was diagnosed with hypertension. In an August 2011 VA treatment record the Veteran's blood pressure was recorded as 128/85. In November 2011, it was 132/86. At his most recent VA examination in March 2012, the Veteran reported that he used medication to control his hypertension. His blood pressure was measured as 148/95, 148/93, and 146/93. The examiner noted no objective findings prior to April 2008 which could help to establish a baseline for aggravation by his diabetes. The evidence suggested that since July 2008 microalbuminuria was present, which meant renal involvement was secondary to diabetes. The Veteran's prescription was increased in March 2008 for better control of his high blood pressure. The examination in March 2012 was normal and there was no evidence of hypertrophy. VA treatment records shows blood pressure readings of 121/74 in March 2012; 150/84 and 127/82 in July 2012; 120/64 in August 2012; and 109/77 in October 2012. In a January 2013 VA treatment note, the Veteran reported that his blood pressure at home was 105/85. The Board has considered the requirement of 38 C.F.R. § 4.3 to resolve any reasonable doubt regarding the level of the Veteran's disability in his favor. However, as has been discussed the Veteran has not, at any time, met the requirements for a 10 percent evaluation under Diagnostic Code 7101. The Board concludes that the objective medical evidence and the Veteran's statements regarding his symptomatology show disability that more nearly approximates that which warrants the assignment of a noncompensable rating. See 38 C.F.R. § 4.7. The VA treatment records indicate the Veteran's blood pressure has been taken on numerous occasions; however, his diastolic pressure is never predominantly 100 or more, and his systolic pressure is never predominantly 160 or more. See e.g., VA treatment records: August 2011, 128/85 and July 2012, 127/82. As there is no evidence to indicate that at any time during the appeal period the Veteran's diastolic pressure was predominantly 100 or more, or that his systolic pressure was predominantly 160 or more, a higher rating of 10 percent is not warranted under Diagnostic Code 7101. The March 2012 VA examination report indicated that the Veteran did need medication for his hypertension, however under Diagnostic Code 7101 the requirement for a 10 percent evaluation is continuous medication and a history of diastolic pressure predominantly 100 or more. There is no competent medical evidence that the Veteran had a history of diastolic pressure of 100 or more. In addition to the medical evidence, the Board has considered the Veteran's statements and testimony in support of his claim. The Veteran, as a layman, is competent to report matters of which he has personal knowledge, such as the requirement that he take medication to control his symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 310 (2007); 38 C.F.R. § 3.159(a)(2). However, as a layman without the appropriate medical training and expertise, the Veteran is not further competent to provide a probative opinion on the severity of his hypertension in relation to the applicable rating criteria. Medical examiners, including the VA compensation examiners, have measured the objective range of blood pressure findings and reported the Veteran's necessity for prescribed medications. This determination is multi-factorial, not just predicated on lay statements and other testimony, rather, all of the relevant medical and other evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). As discussed above, the Board finds that the Veteran is not entitled to an initial compensable (separate) evaluation for his hypertension. The Board has considered whether the benefit of the doubt rule applies the Veteran's appeal. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). However, a preponderance of the evidence is against a higher evaluation; thus, this rule does not apply and the claim for an increased evaluation must be denied. Extra-Schedular Consideration There is no evidence of exceptional or unusual circumstances to warrant referring this claim for extra-schedular consideration. 38 C.F.R. § 3.321(b)(1). The Court has clarified the analytical steps necessary to determine whether referral for extra-schedular consideration is warranted. See Thun v. Peake, 22 Vet. App. 111 (2008). First, there must be a determination of whether the evidence presents such an exceptional disability picture that the available schedular evaluation for the service-connected disability is inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, there must be a determination of whether the Veteran's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has 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 under 38 C.F.R. § 3.321(b)(1). The Veteran's service-connected hypertension is appropriately evaluated. His primary symptoms are that he requires medication to control his blood pressure. All of his symptoms are accounted for in the regular schedular rating criteria. According to 38 C.F.R. § 4.1, generally, the degrees of disability specified in the Rating Schedule are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. Indeed, in Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993), the Court reiterated this, noting the disability rating, itself, is recognition that industrial capabilities are impaired. As the assigned schedular evaluation for the service-connected hypertension is adequate, referral for an extra-schedular rating is unnecessary. Thun, supra. Furthermore, there is no evidence of any exceptional or unusual circumstances, such as frequent hospitalizations, suggesting he is not adequately compensated for this disability by the regular Rating Schedule. Extra-schedular referral is not warranted under the circumstances presented. See Bagwell v. Brown, 9 Vet. App. 237, 238-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995); and VAOPGCPREC 6-96 (August 16, 1996). ORDER Entitlement to service connection for bilateral cataracts is denied. Entitlement to an initial compensable evaluation for hypertension is denied. REMAND Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. In April 2010, the Veteran submitted a claim of entitlement to a TDIU. As noted above, the United States Court of Appeals for Veterans Claims (Court) has held that there is no freestanding claim for a TDIU. The matter is a component of the appeal for a higher initial rating regarding the service-connected hypertension. As such, it is necessary for the Board to remand the issue. On remand, the agency of original jurisdiction (AOJ) will have the opportunity to include the issue in a new notice letter, ask a VA examiner to address the matter, obtain any recent VA treatment records, and adjudicate the issue in the first instance. Also, the Board notes that in a March 2009 VA Form 21-4138, the Veteran stated that the symptomatology associated with his service-connected conditions presented a greater degree of impairment than the currently assigned evaluations. Any claims for an increased rating are inextricably intertwined with the claim for a TDIU. Therefore, additional action is required, as set forth below. Accordingly, the case is REMANDED for the following action: 1. Send the Veteran a VCAA letter for his TDIU claim. He should also be provided with a formal application for a TDIU and asked to complete and return the form. 2. In a VA form 21-4138 dated March 3, 2009, the Veteran stated that the symptomatology associated with his service-connected conditions presented a greater degree of impairment than the currently assigned evaluations. He should be asked to clarify if he is claiming an increased rating for any of his service-connected disabilities, and if so, which ones. Then, after complying with the duty to notify and assist, the RO/AMC should adjudicate the Veteran's claims for increased ratings (if any). 3. Make arrangements to obtain the Veteran's VA treatment records, dated since January 2013. 4. After the treatment records have been obtained, schedule the Veteran for an appropriate VA examination. The claims file and a complete copy of this REMAND should be reviewed in association with the examination. The VA examination report should indicate that this has been accomplished. All necessary studies and tests should be conducted. The examiner is requested to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's service-connected disabilities (i.e., depressive disorder, diabetes mellitus with hypertension, peripheral neuropathy of the upper and lower extremities, and erectile dysfunction) render him unable to secure or follow substantially gainful employment consistent with his education and occupational experience. The examiner should provide a comprehensive report including complete rationale for all opinions expressed and conclusions reached. 5. Finally, after undertaking any other development deemed appropriate, readjudicate the claim for a TDIU. If any benefit sought is not granted, furnish the Veteran and his representative, if any, with a supplemental statement of the case (SSOC) and afford them an opportunity to respond before the record is returned to the Board for further review. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the Veteran until further notice. However, the Board takes this opportunity to advise the Veteran that his cooperation in VA's efforts to develop his claim, including reporting for any scheduled VA examination, is both critical and appreciated. Failure to report for any scheduled examination may result in the denial of a claim. 38 C.F.R. § 3.655 (2012). 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). ____________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs