Citation Nr: 1323349 Decision Date: 07/23/13 Archive Date: 08/01/13 DOCKET NO. 09-03 755 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an increased rating for dysthymic disorder with depressed mood, initially evaluated as 30 percent disabling prior to August 12, 2010, and as 50 percent disabling thereafter. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The Veteran served on active duty from May 1983 to April 1988. This case comes before the Board of Veterans' Appeals (Board) on appeal of March 2008 and December 2011 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. For reasons which will become apparent, the appeal as to the issue of a current evaluation in excess of 50 percent for service-connected dysthymic disorder with depressed mood is being REMANDED to the RO via the Appeals Management Center (AMC) in Washington, D.C. VA will notify you if further action is required on your part. FINDING OF FACT Prior to August 12, 2010, the Veteran's service-connected dysthymic disorder with depressed mood was productive of no more than occupational and social impairment, with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and/or mild memory loss (such as forgetting names, directions, or recent events). CONCLUSION OF LAW The criteria for an initial evaluation in excess of 30 percent for dysthymic disorder with depressed mood prior to August 12, 2010 have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. § 4.130 and Part 4, Diagnostic Code 9433 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Veterans Claims Assistance Act of 2000 (VCAA) In the case at hand, inasmuch as service connection, an initial rating, and an effective date have been assigned, the notice requirements of 38 U.S.C.A. § 5103(a) (West 2002) have been met. Moreover, VA has fulfilled its duty to assist the Veteran in obtaining identified and available evidence needed to substantiate his claim, and, as warranted by law, affording VA examinations. Currently, there is no evidence that additional records have yet to be requested, or that additional examinations are in order. Moreover, there is currently no error or issue which precludes the Board from addressing the merits of the Veteran's appeal for the time period herein considered. Increased Rating In reaching this determination, the Board has reviewed all the evidence in the Veteran's claims file, which includes his multiple contentions, and those of his spouse, as well as both VA (including Virtual VA) and private treatment records and examination reports. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the Veteran's claim, and what the evidence in the claims file shows, or fails to show, with respect to that claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran in this case seeks an increased evaluation for service-connected dysthymic disorder with depressed mood. In pertinent part, it is contended that manifestations of that disability are more severe than now evaluated, and productive of a greater degree of impairment than is reflected by the 30 percent schedular evaluation assigned prior to August 12, 2010. More specifically, it is contended that, as of March 8, 2008, the date of a VA examination, the Veteran was, in fact, entitled to a 50 percent schedular evaluation for his service-connected psychiatric disorder. In that regard, disability evaluations, in general, are intended to compensate for the average impairment of earning capacity resulting from a service-connected disability. They are primarily determined by comparing objective clinical findings with the criteria set forth in the Rating Schedule. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § Part 4, (2012). Where there is a question as to which of two evaluations apply, the higher evaluation will be assigned where the disability picture more nearly approximates the criteria for the next higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). While the Board must consider the Veteran's medical history as required by various provisions under 38 C.F.R. § Part 4, including 38 C.F.R. § 4.2 [see Schafrath v. Derwinski, 1 Vet. App. 589 (1991)], the degree of impairment resulting from a service-connected disability is a factual determination, with the Board's primary focus in such cases being upon the current severity of the service-connected disability. See Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). However, in Fenderson v. West, 12 Vet. app. 119 (1999), it was held that the Francisco rule does not apply where the appellant has expressed dissatisfaction with the assignment of an initial rating following an award of service connection for the disability in question. Rather, at the time of the initial rating, separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 126 (1999). Accordingly, the analysis in this decision is undertaken with consideration of the possibility that different ratings may be warranted for different time periods. See also Hart v. Mansfield, 21 Vet. App. 505 (2007). Ratings are to be based as far as practicable upon the average impairment of earning capacity, with the additional proviso that the Secretary shall, from time to time, readjust the Schedule of Ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular evaluations are found to be inadequate, the Under Secretary for Veterans Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in 38 C.F.R. § 3.321 (2012) an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is the finding that the case presents such an exceptional or unusual disability picture, with such related factors as a marked interference with employment or frequent periods of hospitalization, as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (2012). In the case at hand, at the time of the aforementioned rating decision in March 2008, the RO granted service connection (and a 30 percent evaluation) for dysthymic disorder with depressed mood, effective from August 7, 2007, the date of receipt of the Veteran's initial claim. The Veteran voiced his disagreement with that assignment of benefits, with the result that, in a subsequent rating decision of December 2011, the RO awarded a 50 percent evaluation for service-connected dysthymic disorder with depressed mood, effective from August 12, 2010, the date of a VA psychiatric examination. The current appeal ensued. During the course of VA outpatient psychiatric treatment in July 2007, the Veteran indicated that his psychotropic medication was working well. However, he still felt somewhat down and depressed. According to the Veteran, he currently worked for the United States Postal Service, where he had been working for almost 17 years. Reportedly, while the Veteran had asked his employer to give him a lighter job due to his physical limitations, without a good attendance record, he could not move laterally to other positions with the Postal Service. Significantly, the Veteran denied both manic and obsessive-compulsive symptomatology, as well as sleep troubles, appetite problems, difficulties with concentration, anhedonia, and/or self guilt. On mental status examination, the Veteran displayed fair grooming and hygiene, and was both pleasant and cooperative. Eye contact was described as fair, and speech was normal in rate, rhythm, and tone. At the time of examination, the Veteran's mood was described as "not bad." His affect, while slightly restricted, was appropriate, and his thought content displayed no evidence of paranoia or delusions. The Veteran denied suicidal and homicidal ideation, as well as auditory and visual hallucinations, and his thought processes were linear and goal-directed. At the time of examination, the Veteran was alert and well oriented, with no apparent deficits. Insight was full, and judgment was described as fair. The pertinent diagnosis noted was dysthymic disorder, rule out pain disorder associated with both psychological factors and a general medical condition, with a Global Assessment of Functioning Score of 65. During the course of subsequent VA outpatient treatment in September 2007, the Veteran indicated that an increase in his medication had helped with his mood and anxiety. According to the Veteran, both his sleep and appetite were "getting better." On mental status examination, the Veteran once again displayed fair grooming and hygiene, and was both pleasant and cooperative. The Veteran's affect was slightly restricted but appropriate, and his speech was normal in rate, rhythm, and tone. Noted at the time of examination was that the Veteran's mood was now "better," and that his thought processes were linear and goal-oriented. Insight was described as full, and judgment as fair. The pertinent diagnosis noted was dysthymic disorder, with a Global Assessment of Functioning Score of 65. At the time of a subsequent VA psychological examination on March 8, 2008, it was noted that the Veteran's claims folder and medical records were available, and had been reviewed. When questioned, the Veteran indicated that he had been treated for depression with medication for several years. However, he had never been hospitalized for treatment of his psychiatric symptomatology. According to the Veteran, he experienced difficulty with motivation, and was chronically in pain, suffering from fatigue, irritability, and difficulty concentrating. On mental status examination, the Veteran was alert and well-oriented, and cooperative. He maintained adequate eye contact, with thought processes which were goal-directed, and thought content devoid of auditory or visual hallucinations, and either suicidal or homicidal ideation. Noted at the time of examination was that the Veteran presented with a depressed mood and flat affect. However, during the course of the psychiatric interview, he responded in a logical manner, with no evidence of any impairment of thought processes or communication, and no delusions, hallucinations, or inappropriate behavior. The Veteran denied both suicidality and homicidality, and was well oriented. However, he did apparently experience some difficulty with short-term memory. Impulse control was described as adequate, and there was no evidence of either obsessive or ritualistic behavior. Speech patterns were described as "OK," and the Veteran denied any history of panic attacks. Regarding his depression, the Veteran reported problems with being tired, a lack of motivation, and a depressed mood. Reportedly, the Veteran experienced difficulty with "feeling energized," and remaining interested in daily activities. Additionally noted were symptoms of depression, including difficulty concentrating, irritability, and a decreased interest in previously enjoyed activities. When questioned regarding his sleep, the Veteran indicated that he typically got from 3 to 4 hours of sleep per night, given that he was awakened several times during the night due to pain. As a result, the Veteran was reportedly tired, fatigued, and irritable, and experienced difficulty concentrating. When further questioned, the Veteran denied any history of suicide attempts. Reportedly, while he had experienced suicidal ideation, there was no plan or intent, and he denied any current suicidal thoughts. At the time of examination, impulse control was described as "OK." The pertinent diagnosis noted was dysthymic disorder related to service-connected medical conditions, with a Global Assessment of Functioning Score of 55. When seen later that same month, the Veteran complained of significant low mood. Additionally noted were complaints of "a lot of worry," and difficulty getting out of the house, due to worry. On mental status examination, the Veteran displayed fair grooming and hygiene, and was both pleasant and cooperative. Eye contact was described as fair, and speech was of a normal rate, rhythm, and tone. The Veteran's mood was described as "down," and his affect, while slightly restricted, was appropriate. At the time of examination, there was no evidence of either paranoia or delusions, and the Veteran denied both suicidal and homicidal ideation, as well as auditory and visual hallucinations. Thought processes were linear and goal-oriented, and the Veteran was alert and well oriented, with no apparent deficits. Insight was described as full, and judgment as fair. The pertinent diagnosis noted was dysthymic disorder; rule out agoraphobia without a history of panic disorder, rule out pain disorder associated with mostly psychological factors and a general medical condition, with a Global Assessment of Functioning Score of 65. During the course of VA outpatient psychiatric treatment in June 2008, the Veteran indicated that he was "doing better," and had been able to work more. Additionally noted was that the Veteran had taken up the hobby of raising chickens. On mental status examination, the Veteran displayed fair grooming and hygiene, and was both pleasant and cooperative. His eye contact was fair, and his speech of a normal rate, rhythm, and tone. The Veteran's mood was described as "OK," and his affect was appropriate. At the time of evaluation, there was no evidence of paranoia or delusions, and the Veteran denied both suicidal and homicidal ideation, as well as auditory and visual hallucinations. Thought processes were linear and goal-directed, and the Veteran was alert and well-oriented with no apparent deficits. Once again, insight was full, and judgment fair. The pertinent diagnosis noted was dysthymic disorder, with a Global Assessment of Functioning Score of 65. During the course of subsequent VA outpatient treatment in November 2008, the Veteran reported that he was "functioning OK," though he felt tired "all the time." According to the Veteran, although he ate a normal amount of food, he had been gaining weight, although slowly. When questioned, the Veteran indicated that his concentration was "OK." Moreover, while he still experienced some anxiety about work, he had not had any panic attacks. Reportedly, the Veteran's sleep hadn't been better since increasing his medication. Nonetheless, he sometimes found himself humming and in a better mood. On mental status examination, the Veteran displayed casual appropriate dress. Grooming and hygiene were described as fair, and he was both calm and cooperative, with fair eye contact. The volume and rate of the Veteran's speech were within normal limits, and he denied both suicidal and homicidal ideation, as well as auditory and visual hallucinations. Thought processes were linear and logical, and the Veteran's mood was "feeling OK." His affect was congruent, though restricted, and he displayed partial, fair insight. At the time of evaluation, the Veteran's judgment was good, and he was alert and well-oriented. The pertinent diagnosis noted was dysthymic disorder, with a Global Assessment of Functioning Score of 60. On subsequent VA outpatient psychiatric treatment in January 2009, the Veteran described his mood as "OK," but wished it could be better. According to the Veteran, he had been unable to sleep well due to pain. Additionally noted were problems with decreased energy, though with no feelings of worthlessness and/or hopelessness. The Veteran denied suicidal ideation, but felt that inadequate control of his pain had been contributing to his decreased mood, given that he was not able to do the things he usually could do. On mental status examination, the Veteran was cooperative, and displayed both fair eye contact and good grooming, with no evidence of any psychomotor abnormality. Speech was normal in tone and volume, and the Veteran's mood was described as "OK." At the time of evaluation, the Veteran's affect was somewhat constricted. However, he denied any suicidal or homicidal ideation, and similarly denied any delusions or preoccupations. The Veteran was alert and well-oriented, with good judgment and fair insight. The pertinent diagnoses noted were dysthymic disorder; possible agoraphobia without a history of panic disorder; and possible mood disorder, secondary to chronic pain/medical conditions, with a Global Assessment of Functioning Score of 65. During the course of subsequent VA outpatient psychiatric treatment in early June 2009, the Veteran indicated that his medications were working, and that his mood was "better." According to the Veteran, he was not as tired anymore, and his "energy was better." Further noted was that the Veteran had been sleeping better with medication, though he continued to have occasional nightmares. When questioned, the Veteran indicated that his appetite was "too good," and that he had gained 20 pounds. The Veteran denied any changes in concentration, and similarly denied thoughts of self-harm or injury to others. However, he continued to dislike being in a crowd, though he denied any episodes of panic attacks. On mental status examination, the Veteran was cooperative, and displayed both good eye contact and fair grooming. His speech was slightly decreased in volume and rate, though his mood was better, and his affect congruent. Once again, the Veteran denied both suicidal and homicidal ideation, and similarly denied any problems with delusions or preoccupations. At the time of evaluation, there was no evidence of any problem with auditory, visual, or tactile hallucinations. Judgment was described as good, and insight fair. The pertinent diagnoses noted were dysthymic disorder; agoraphobia without a history of panic disorder; and mood disorder secondary to chronic pain/medical conditions, with a Global Assessment of Functioning Score of 50. On subsequent VA outpatient psychiatric treatment in October 2009, the Veteran reported good mood management, as well as a good relationship with his wife since his last outpatient visit. Reportedly, the Veteran had been feeling better overall, and was in less stress than when he was working. Moreover, he was stable financially, and in general, had experienced no major stressors. Under the circumstances, it was decided to reduce the Veteran's outpatient visits to every 60 days, with a view to termination were he to maintain his gains. The pertinent diagnosis noted was dysthymic disorder. At the time of VA outpatient psychiatric treatment in March 2010, the Veteran indicated that his anxiety was "somewhat better," though his main complaint continued to be insomnia, which made him more anxious and tired during the daytime. When questioned, the Veteran reported compliance with his medication, as well as a fair response to that medication. Moreover, he denied any major changes in his social life, and similarly denied any thoughts of self-harm, as well as homicidal ideation. On mental status examination, the Veteran was alert and cooperative, with poor to fair grooming/hygiene. His speech was fluent and nonpressured, and of a normal volume and tone. The Veteran displayed normal psychomotor activity, though he was slightly jittery and anxious. Eye contact was described as fair, with mood which was "OK." The Veteran's affect was dysthymic, and his thought processes were linear and coherent. The Veteran denied suicidal and homicidal ideation, and similarly denied any auditory or visual hallucinations. At the time of evaluation, insight was partial, and judgment fair. The pertinent diagnoses noted were dysthymic disorder; agoraphobia without a history of panic disorder; and mood disorder secondary to chronic pain/medical conditions. The Global Assessment of Functioning Score assigned was 60. During the course of VA outpatient treatment the following month, the Veteran reported that his present psychiatric medications were "helpful and satisfactory" in the management of his mood problems. Accordingly, the Veteran did not wish to change his medications or medication dosages. The Veteran was described as alert and cooperative, and affectively appropriate. The pertinent diagnosis noted was mood disorder, under control. Pursuant to applicable law and regulation, the 30 percent evaluation in effect prior to August 12, 2010 for the Veteran's service-connected dysthymic disorder with depressed mood contemplates the presence of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment and/or mild memory loss (such as forgetting names, directions, or recent events). A 50 percent evaluation, under those same regulations, requires demonstrated evidence of occupational and social impairment, with reduced reliability and productivity, due to such symptoms as: flattened affect, circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and/or difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130 and Part 4, Diagnostic Code 9433 (2012). Global Assessment of Functioning Scores are a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) [citing the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Page 32]. A Global Assessment of Functioning Score of between 51 and 60 is defined as "moderate symptoms (e.g. flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g. few friends, conflicts with peers or co-workers)." In contrast, a Global Assessment of Functioning Score of between 61 and 70 is defined as "some mild symptoms (e.g. depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g. occasional truancy or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships." While the Rating Schedule does indicate that the rating agency must be familiar with the Diagnostic and Statistical Manual of Mental Disorders, it does not assign disability percentages based solely on Global Assessment of Functioning Scores. See 38 C.F.R. § 4.130 (2012). Rather, Global Assessment of Functioning Scores are but one factor to be considered in conjunction with all other pertinent evidence of record. In light of the evidence, it is clear that, prior to August 12, 2010, at which time a 50 percent evaluation was assigned, no more than a 30 percent evaluation was warranted for the Veteran's service-connected dysthymic disorder with depressed mood. Significantly, at no time during that period did the Veteran exhibit symptomatology consistent with a 50 percent evaluation, such as circumstantial, circumlocutory or stereotyped speech, panic attacks more than once a week, or difficulty in understanding complex commands. Rather, for the period in question, the Veteran was most often described as alert and well oriented, with an affect which was congruent with his mood. In fact, as recently as June 2010, the Veteran was described as alert and cooperative, and "affectively appropriate." Significantly, at that time, the Veteran's mood disorder was described as "under control." While it is true that, during the period in question, the Veteran's insight and judgment were at times somewhat impaired, at no time was his predominant symptomatology consistent with that required for a 50 percent evaluation. In fact, during the period in question, the Veteran's Global Assessment of Functioning Scores for the most part ranged between 60 and 65, consistent with only mild psychiatric symptomatology. Under the circumstances, the 30 percent evaluation in effect for the Veteran's service-connected dysthymic disorder with depressed mood during the period prior to August 12, 2010 is appropriate, and an increased rating is not warranted. Accordingly, the Veteran's claim for an increased evaluation must be denied. Moreover, based on a review of the entire evidence of record, the Board is of the opinion that, for the period in question, the disability picture presented by the Veteran's service-connected dysthymic disorder with depressed mood was appropriately contemplated by the Rating Schedule, and that referral for consideration of an extraschedular evaluation is, therefore, not warranted. See Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). ORDER Entitlement to an initial evaluation in excess of 30 percent for dysthymic disorder with depressed mood for the period prior to August 12, 2010 is denied. REMAND In addition to the above, the Veteran in this case seeks a current evaluation in excess of 50 percent for service-connected dysthymic disorder with depressed mood. However, a review of the record raises some question as to the current severity of that particular disability. It is noted that a total rating based on individual unemployability has been assigned since May 6, 2010. In that regard, at the time of a VA psychological examination on August 12, 2010, the majority of the Veteran's psychiatric symptomatology appeared to be consistent with the currently assigned 50 percent evaluation. However, during the course of that examination, it was noted that the Veteran's wife complained about his personal hygiene, and that the Veteran had "no motivation to take care of himself." Significantly, the Global Assessment of Functioning Score assigned at the time was 50, representing a depressed mood, low motivation, low energy, anhedonia, and suicidal thoughts resulting in significant social and occupational problems. As of the time of a more recent VA psychological examination in December 2011, the majority of the Veteran's psychiatric symptomatology appeared to be consistent with the 50 percent evaluation now assigned. However, it was additionally noted at that time that the Veteran suffered from suicidal ideation, and that his major depressive disorder was productive of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. Significantly, the Global Assessment of Functioning Score assigned at the time was 45, consistent with serious symptomatology and/or serious impairment in social and occupational functioning. Finally, based on a review of the Veteran's file, it would appear that he last underwent a VA psychological examination for compensation purposes in December 2011, slightly more than 1 1/2 years ago. Under the circumstances, and given the ambiguity inherent in the aforementioned clinical findings, the Board is of the opinion that an additional, more contemporaneous VA examination would be appropriate to a final adjudication of the Veteran's claim for increase. See Snuffer v. Gober, 10 Vet. App. 400 (1997); see also Caffrey v. Brown, 6 Vet. App. 377, 381 (1994). Accordingly, in light of the aforementioned, the case is REMANDED to the RO/AMC for the following actions: 1. Any pertinent VA or other inpatient or outpatient treatment records, subsequent to December 2011, the date of the most recent VA examination of record, should be obtained and incorporated in the claims folder. The Veteran should be requested to sign the necessary authorization for release of any private medical records to the VA. All attempts to procure such records should be documented in the file. If the RO/AMC cannot obtain records identified by the Veteran, a notation to that effect should be included in the claims file. In addition, the Veteran and his representative should be informed of any such problem. 2. The Veteran should then be afforded an additional VA psychiatric examination in order to more accurately determine the current severity of his service-connected dysthymic disorder with depressed mood. The aforementioned examination should be conducted by a VA psychiatrist who has not heretofore seen or examined the Veteran. The Veteran is hereby notified that it is his responsibility to report for the examination, and to cooperate in the development of his claim. The Veteran is further advised that the consequences for failure to report for a VA examination without good cause may include denial of his claim. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for the aforementioned examination, documentation should be obtained which shows that notice scheduling the examination was sent to his last known address. It should also be indicated whether any notice sent was returned as undeliverable. Following completion of the psychiatric examination, and in accordance with the latest worksheets for evaluating service-connected psychiatric disabilities, the examiner is to prove a detailed review of the Veteran's pertinent medical history and current complaints, as well as the nature and extent of his service-connected dysthymic disorder with depressed mood. In particular, the examiner should specifically comment regarding current symptomatology directly attributable to the Veteran's service-connected psychiatric disability and the impact of that symptomatology on the Veteran's occupational and social functioning A complete rationale must be provided for any opinion offered, and all information and opinions, once obtained, must be made a part of the Veteran's claims folder. The claims folder must be made available to and reviewed by the examiner prior to completion of the examination. In addition, the examiner must specify in his report that the claims file and Virtual VA records have been reviewed. 3. The RO/AMC should then review the examination report to ensure that it is in complete compliance with the directives of this REMAND, and that the examiner has documented his consideration of all records contained in Virtual VA. If the report is deficient in any manner, the RO/AMC must implement corrective procedures. 4. The RO/AMC should then readjucate the Veteran's claim for a current evaluation in excess of 50 percent for service-connected dysthymic disorder with depressed mood. Should the benefit sought on appeal remain denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case (SSOC). The SSOC must contain notice of all relevant action taken on the claim for benefits since the issuance of the most recent SSOC in January 2012. An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome in this case. The Veteran need take no action unless otherwise notified. 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). ______________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs