Citation Nr: 1323575 Decision Date: 07/24/13 Archive Date: 08/01/13 DOCKET NO. 07-27 096 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to an increased evaluation for Type II diabetes mellitus, currently rated 20 percent disabling. 2. Entitlement to a total rating for individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD Bernard T. DoMinh, Counsel INTRODUCTION The Veteran served on active duty in the United States Army from October 1966 to September 1968. His military records reflect service in the Republic of Vietnam. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2006 rating decision by the Columbia, South Carolina, Regional Office (RO) of the Department of Veterans Affairs (VA) which, inter alia, denied the Veteran's claim for an increased evaluation above 20 percent for Type II diabetes mellitus. At a March 2008 VA Central Office hearing held in Washington, D.C., the Veteran, accompanied by his representative and his spouse, appeared before the undersigned Acting Veterans Law Judge to present evidence and oral testimony in support of his appeal. A transcript of this hearing has been obtained and associated with the Veteran's claims file for the Board's review and consideration. In March 2010 and September 2011, the case was remanded by the Board to the Appeals Management Center (AMC) in Washington, D.C., for additional evidentiary and procedural development. Following the latest remand, the 20 percent rating assigned for Type II diabetes mellitus was confirmed and continued in an April 2012 rating decision/supplemental statement of the case. The case returned to the Board in May 2012, and the Veteran now continues his appeal. The file indicates that the Veteran is also claiming entitlement to service connection for a chronic low back disorder, to include as secondary to his service-connected depression and bilateral peripheral neuropathy of his lower extremities. As this issue has not been adjudicated in the first instance by the Agency of Original Jurisdiction, the Board does not have jurisdiction over it and it is therefore referred to the RO for appropriate action. The Veteran's representative argues, in a June 2013 presentation, that the issue of entitlement to a TDIU has now been reasonably raised by the record and is ancillary to the increased rating claim for Type II diabetes mellitus on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Although the claim for an increased evaluation for diabetes is adjudicated herein, the TDIU claim requires further evidentiary and procedural development before it can be addressed on the merits. Therefore, for the reasons that will be discussed in the REMAND portion of this decision, the TDIU issue is REMANDED to the RO via the AMC for the appropriate development. The Veteran and his representative will be notified by VA if any further action in this regard is required on their part. FINDINGS OF FACT Type II diabetes mellitus is treated and controlled through injected insulin medication, oral hypoglycemic agents, and a restricted diet, but does not require regulation of physical activities as part of its medical management at any time during the pendency of the current claim. CONCLUSION OF LAW The criteria for an evaluation above 20 percent for Type II diabetes mellitus have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.119, Diagnostic Code 7913 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION With respect only to the claim for an increased rating for Type II diabetes mellitus decided herein, the Board notes at the outset that, in accordance with the VCAA, VA has an obligation to notify claimants what information or evidence is needed in order to substantiate a claim, as well as a duty to assist claimants by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A and 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012); see also Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Generally, the notice requirements of a claim have five elements: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must also: (1) inform the claimant about the information and evidence necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; (3) inform the claimant about the information and evidence the claimant is expected to provide; and (4) request that the claimant provide any evidence in his possession that pertains to the claim. See 38 U.S.C. § 5103(a); 38 C.F.R. § 3.159(b); Beverly v. Nicholson, 19 Vet. App. 394, 403 (2005) (outlining VCAA notice requirements). During the course of the appeal, § 3.159(b) was revised and the requirement that VA request that the claimant provide any evidence in his possession that pertains to the claim was removed from the regulation. The current claim for an increased rating for Type II diabetes mellitus was filed on June 5, 2006. A VCAA notice letter was dispatched to the Veteran in July 2006, prior to the August 2006 rating decision now on appeal. This letter addressed the issues on appeal and satisfied the above-described mandates, as well as the requirements that the Veteran be informed of how VA calculates degree of disability and assigns an effective date for the disability, as prescribed in Dingess v. Nicholson, 19 Vet. App. 473 (2006). As fully compliant notice preceded the initial adjudication of the Veteran's claim for a rating increase for diabetes adjudicated herein, there is no timing of notice defect. VA also has a duty to assist the Veteran in obtaining evidence necessary to substantiate a claim. 38 U.S.C.A. § 5103A(a) ("The Secretary shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the . . . claim"). This duty includes assisting the Veteran in obtaining records and providing medical examinations or obtaining medical opinions when such are necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(b), (c), (d) (setting forth Secretary's various duties to claimant). VA informed the Veteran of its duty to assist in obtaining records and supportive evidence. As the increased rating claim addressed herein stems from June 6, 2006, when the Veteran reopened his diabetes claim, the relevant time period and evidence that must be addressed in the adjudication of the claim encompasses the period from June 6, 2005 to the present, in order to allow the Board to consider the applicability of a staged rating. See 38 C.F.R. § 3.400(o)(2) (2012); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board notes at this juncture that prior to this application, in an October 2004 rating decision, the RO had granted the Veteran's original claim for service connection for Type II diabetes mellitus and assigned an initial 20 percent evaluation, effective April 2003. The claims file indicates that the Veteran filed a notice of disagreement with the initial rating assigned for diabetes, was furnished with a statement of the case in February 2005, but did not thereafter file a timely substantive appeal. His appeal of the October 2004 rating decision has therefore lapsed and the October 2004 rating decision is final. 38 C.F.R. § 19.32 (2012). Furthermore, the claims file does not indicate that the Veteran submitted any new and material evidence pertinent to his service-connected diabetes within the one-year appellate period following the October 2004 rating decision that was not already considered by the RO in the February 2005 statement of the case. Thusly, the October 2004 rating decision is final with respect to the initial 20 percent evaluation assigned for diabetes and the current appeal pertains only to the August 2006 rating decision. See 38 C.F.R. § 3.156(b) (2012); Bond v. Shinseki, 659 F.3d 1362 (2011). The Board observes that private, Social Security Administration (SSA), and VA clinical records for the period spanning June 2005 to September 2012, including reports of VA medical examinations and addendum opinions dated in July 2006, June 2010, and December 2011, have been obtained and associated with the claims file, or are otherwise viewable on the Virtual VA electronic information database. The Board has reviewed the examination reports and notes that the Veteran's claims file was reviewed by the VA clinicians who performed them, and that these examiners provided adequate discussion of their clinical observations and rationales to support their individual findings and conclusions within the context of the Veteran's pertinent clinical history as contained within his claims file. The examinations are therefore deemed adequate for rating purposes. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board further finds that the evidentiary and procedural development ordered in its prior remands of March 2010 and September 2011 have been largely carried out by the RO/AMC, including obtaining all outstanding relevant medical records and an addendum opinion in December 2011 that addressed the severity of the Veteran's diabetes within the context of the specific criteria listed in 38 C.F.R. § 4.119, Diagnostic Code 7913. The RO/AMC has substantially complied with the Board's remand instructions and therefore an additional remand for corrective action is not required. Stegall v. West, 11 Vet. App. 268 (1998) (a remand by the Board confers on a veteran or other claimant the right to VA compliance with the remand order and imposes on the Secretary a concomitant duty to ensure compliance with the terms of such an order, but exact compliance with the directives of a Board remand are not necessarily required if the purpose of the remand has been met, such that the RO's post-remand development is in substantial compliance with the Board's remand instructions); see Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Veteran having been provided with adequate opportunity to submit or otherwise identify relevant evidence in support of the claim for an increased rating for diabetes mellitus, the Board finds that the record does not need to be held open any longer, and that no further delay in the adjudication of this appeal with respect only to the issue decided herein is warranted. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. § 3.103(c)(2) (2012) requires that the Decision Review Officer or Veterans Law Judge who chairs a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. See Bryant v. Shinseki, 23 Vet. App. 488 (2010). A review of the transcript shows that during the March 2008 Board hearing, the undersigned Acting Veterans Law Judge's questions and the oral testimonies of the Veteran and his witness focused on the elements necessary to substantiate, inter alia, the Veteran's claim for a higher evaluation for his service-connected Type II diabetes mellitus. The Acting Veterans Law Judge, furthermore, has clarified the issue on appeal, focusing on the propriety of the rating assigned for this disease of the endocrine system. Thus, the Board finds that the Acting Veterans Law Judge presiding over the March 2008 hearing has substantially fulfilled her obligations as required under 38 C.F.R. § 3.103(c)(2). Bryant, supra. Based on the foregoing, the Board finds that the VA fulfilled its VCAA duties to notify and to assist the Veteran in the evidentiary development of the claims decided herein, and thus no additional assistance or notification is required. The Veteran has suffered no prejudice that would warrant a remand, and his procedural rights have not been abridged. See Bernard v. Brown, 4 Vet. App. 384 (1993). The Board will therefore proceed with the adjudication of this appeal. The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the appellant or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The appellant 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 claimant). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2012). 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 (2012). In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2 (2012); Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7 (2012). It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21 (2012). In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staging the ratings." See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). Based on the June 6, 2006 date of VA's receipt of the Veteran's application to reopen his claim for a rating increase for diabetes, the relevant temporal focus for the increased rating claim is from June 6, 2005. See 38 C.F.R. § 3.400(o)(2). The Veteran's service-connected Type II diabetes mellitus is currently rated 20 percent disabling under the criteria contained in 38 C.F.R. § 4.119, Diagnostic Code 7913. A 20 percent evaluation contemplates diabetes mellitus requiring insulin and restricted diet; or oral hypoglycemic agent and restricted diet. The next higher rating of 40 percent requires insulin, restricted diet, and regulation of activities. For the reasons set forth below, the Board finds that the criteria for a rating in excess of 20 percent have not been met in this case. SSA records show that this agency determined that the Veteran was eligible for SSA disability benefits as of April 2004 due primarily to his non-service-connected degenerative joint and discogenic disease of his lumbosacral spine, with his diabetes as a secondary factor contributing to his disabled state for SSA purposes. The Board notes that SSA administrative decisions and regulations are not binding on VA or the Board. Collier v. Derwinski, 1 Vet. App. 413, 417 (1991). The Board finds that the SSA determination that diabetes was a secondary factor in the Veteran's unemployability, but did not cause unemployability, is consistent with the determination that an evaluation in excess of 20 percent is not warranted. In this regard, notwithstanding the Veteran's subjective assertion at his March 2008 Board hearing that he was unable to move much because of his diabetes, even taking into account his superimposed low back disability, VA and private outpatient treatment reports for the period from June 2005 to September 2012, and VA examination reports and addendum opinions specifically addressing the severity of the Veteran's Type II diabetes mellitus in July 2006, June 2010, and December 2011, objectively demonstrate that the Veteran was prescribed daily injections of insulin and orally administered hypoglycemic agents and a restricted diet to control his diabetes mellitus, but that there was no restriction in his ability to perform strenuous physical activities. These findings were definitively established on the record in the December 2011 addendum opinion. In this regard, it appears from the clinical record that the Veteran's primary restrictions on his capacity for physical activity are associated with his non-service-connected orthopedic disability of his lumbosacral spine. From this, the Board finds that medical management of diabetes did not require medically-prescribed regulation of the Veteran's physical activities due solely to diabetes mellitus at any time during the pendency of the claim. The VA clinician who provided a December 2011opinion conclusively determined that there was nothing in the Veteran's clinical history that suggested that he required regulation of his activities as part of medical management of his diabetes mellitus. Furthermore, the examining clinician opined that the Veteran's diabetes was very stable during the time period relevant to this claim, that he experienced no elevations of blood sugar or hypoglycemia for several years, and that he did not require hospitalization for treatment of his diabetes. The VA examiner also indicated that the diabetes mellitus, by itself, did not prevent the Veteran from being able to obtain and maintain gainful employment in a sedentary capacity. The examiner noted that the Veteran's only occupational impairment related to service-connected disability appeared to be balance problems requiring the assistance of a cane for ambulation. That symptom is a functional impact of the Veteran's bilateral peripheral neuropathy of his lower extremities, the examiner opined. The Board notes that the Veteran has been awarded a separate grant of service connection for that disability, and manifestations of that disability may not serve to warrant an increased rating for diabetes mellitus. 38 C.F.R. § 4.14. Applying the facts of the case to the applicable rating schedule, the Board finds that the Veteran's Type II diabetes mellitus is manifested throughout the entire appellate period by impairment that does not meet the criteria for an evaluation greater than 20 percent under Diagnostic Code 7913. Although he requires insulin injections, oral hypoglycemic agents, and a restricted diet to control his diabetes, the objective medical evidence does not demonstrate that he requires regulation of his physical activities as part of medical management of his diabetes mellitus, as contemplated in the criteria for a 40 percent evaluation under Diagnostic Code 7913. His claim for a rating increase above 20 percent for Type II diabetes mellitus must therefore be denied. Because the evidence in this case is not approximately balanced with respect to this issue, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 4.3 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A rating in excess of the assigned schedular evaluations for the Veteran's service-connected disabilities addressed herein on the merits may be granted when it is demonstrated that the particular disability presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1) (2012). To accord justice in an exceptional case where the schedular standards are found to be inadequate, the field station is authorized to refer the case to the Under Secretary for Benefits or the Director, Compensation and Pension Service, for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. 38 C.F.R. § 3.321(b)(1) (2012). The Court has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) (2012) in the first instance; however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. See Floyd v. Brown, 9 Vet. App. 88 (1996). The Court further held that the Board must address referral under 38 C.F.R. § 3.321(b)(1) only where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. See Shipwash v. Brown, 8 Vet. App. 218, 277 (1995). Extraschedular consideration involves a three step analysis. Thun v. Peake, 22 Vet. App. 111 (2008). First, the Board or the RO must determine whether the schedular rating criteria reasonably describe the Veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe the Veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. Id. If the RO or the Board finds that the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology, then either the RO or the Board must determine whether the Veteran's exceptional disability picture includes other related factors such as marked interference with employment and frequent periods of hospitalization. Id. at 116. If this is the case, then the RO or the Board must refer the matter to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for the third step of the analysis, determining whether justice requires assignment of an extraschedular rating. Id. The Board finds that there is no evidence that the Veteran's service-connected Type II diabetes mellitus presents such an unusual or exceptional disability picture at any time between June 6, 2005 to the present, so as to require consideration of an extraschedular evaluation pursuant to the provisions of 38 C.F.R. § 3.321(b) (2012). In this case, the evidence of record does not indicate the Veteran is frequently hospitalized for his service-connected diabetes. The criteria of the applicable rating schedule in Diagnostic Code 7913 are deemed to adequately contemplate the Veteran's present level of impairment due to his diabetes, as individually considered. As such, the Board cannot concede that the Veteran's Type II diabetes mellitus, standing by itself, causes marked interference with his employment capacity. Higher ratings are available for the Veteran's diabetes, but for the reasons described in the above decision, a higher rating was denied. The clinical evidence and medical opinions fail to show that the disability picture created by the Veteran's diabetes, in isolation, is of an exceptional or unusual nature. Having reviewed the record with these mandates in mind, the Board finds that the schedular rating presently assigned to the Veteran's diabetes adequately reflects the state of his impairment due to this disease for the period to which it is applied, and that there is no evidentiary basis for referral of the case for extraschedular consideration with regard to this issue. ORDER An increased evaluation above 20 percent for Type II diabetes mellitus is denied. REMAND As previously noted, a claim for a TDIU has been reasonably raised by the record as the Veteran presents the general assertion that he is unable to work as a result of his service-connected disabilities; the TDIU issue is therefore ancillary to the increased rating claim for Type II diabetes mellitus that was on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). VA will grant a total rating for compensation purposes based on individual unemployability when the evidence shows that a veteran is precluded, by reason of service-connected disability, from obtaining and maintaining any form of gainful employment consistent with his or her education and occupational experience. See 38 C.F.R. §§ 3.340, 3.341, 4.16 (2012). Under the applicable regulations, benefits based on individual unemployability are granted only when it is established that the service-connected disability or disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. While the regulations do not provide a definition of "substantially gainful employment," VA Adjudication Procedure Manual, M21-1 MR, Part IV, Subpart ii, Chapter 2 (Dec. 13, 2005) (previously cited at M21-1, Part IV, paragraph 7.09), defines the term as that "at which non-disabled individuals earn their livelihood with earnings comparable to the particular occupation in the community where the Veteran resides." In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a Veteran is entitled to TDIU is whether his service-connected disabilities alone are of sufficient severity to produce unemployability. Under 38 C.F.R. § 4.16, if there is only one such disability, it must be rated at least 60 percent disabling to qualify for benefits based on individual unemployability. If there are two or more such 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. See 38 C.F.R. § 4.16(a) (2012). In determining whether unemployability exists, consideration may be given to the veteran's level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by non-service-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19 (2012); see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a Veteran's favor. 38 C.F.R. § 4.3 (2012). The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-332 (1991). The Veteran is presently service-connected for peripheral neuropathy of the left lower extremity (rated 40 percent), peripheral neuropathy of the right lower extremity (rated 40 percent), depression (rated 30 percent disabling), Type II diabetes mellitus (rated 20 percent), and erectile dysfunction (rated noncompensable), which produce a combined disability rating of 80 percent under 38 C.F.R. § 4.25 (2012). Therefore, the Veteran has met the rating requirement for eligibility for a TDIU under 38 C.F.R. § 4.16(a). As relevant, the Board notes that the Veteran is presently 66 years old at the time of this writing. His SSA records indicate that he has a 12-year public school education and a high school diploma. His medical records show that, vocationally, he was employed up until 2004 at a flooring company, when he stopped working due to low back pain and associated disabling symptoms associated with his non-service-connected degenerative joint and discogenic disease of his lumbosacral spine. The Board notes that SSA records associated with the Veteran's claims file show that the SSA has determined that the Veteran is disabled for purposes of SSA benefits due primarily to his lumbosacral disability and, to a lesser and secondary extent, to diabetes mellitus as of April 2004. While this evidence is probative, SSA administrative decisions and regulations are nevertheless not binding on VA or the Board, although findings made by the SSA regarding the existence of a total and permanent disability and resulting unemployability are relevant to determining whether TDIU is applicable under VA laws and regulations and thus must be considered. Collier v. Derwinski, 1 Vet. App. 413, 417 (1991). Although the VA examinations presently of record address the individual impact of each of the Veteran's service-connected disabilities on his employability and indicate that, as a separate and individual factor, none of these disabilities render the Veteran unable to work in at least a sedentary capacity, the Board notes that no objective clinical assessment of the collective impact of all of the Veteran's service-connected disabilities on his capacity for employment has been presented in the record. In a June 2013 brief and informal hearing presentation, the Veteran, via his representative, has indicated as much that this evidentiary deficit exists and requested a remand for further evidentiary development of the TDIU aspect of his increased rating claim on appeal. Therefore, the TDIU claim should be remanded to the RO/AMC so that the Veteran may be provided with the appropriate and comprehensive medical examination to objectively assess the collective impact of his service-connected disabilities on his individual capacity for employment, including sedentary employment, in the context of his education and occupational experience. Furthermore, given that there is a pending undeveloped claim for service connection for a chronic low back disability, which is also indicated by SSA to be the primary disabling condition that renders him unable to work, the Board finds that this issue may have a substantial impact on the outcome of the Veteran's pending TDIU claim, especially if he is awarded service connection for a chronic low back disability. Therefore, in the interests of adjudicatory efficiency, the Board respectfully advises the agency of original jurisdiction that it should first adjudicate the claim for VA compensation for a chronic low back disability and then thereafter address the TDIU claim on the merits. Accordingly, the TDIU claim is REMANDED to the RO/AMC for the following action: 1. Obtain the names and addresses of all medical care providers, both VA and non-VA, who treated the Veteran for his service-connected bilateral peripheral neuropathy of his lower extremities, chronic psychiatric disorders (to include depression), Type II diabetes mellitus, and erectile dysfunction since June 6, 2005 (i.e., one year prior to the date on which his application to reopen his claim for a rating increase for his service-connected disabilities was received by VA). After obtaining the appropriate releases, those records not already associated with the evidence should be obtained for inclusion in the evidence. All attempts to procure records should be documented in the file. If records identified as relevant by the Veteran cannot be obtained, a notation to that effect should be made in the file. The Veteran is to be notified of unsuccessful efforts in this regard, to include providing him with the opportunity to obtain and submit those records for VA review. 2. Thereafter, arrange for the Veteran to undergo the appropriate comprehensive medical examination to objectively assess the collective impact of his service-connected disabilities (i.e., bilateral peripheral neuropathy of his lower extremities, chronic psychiatric disorders (to include depression), Type II diabetes mellitus, and erectile dysfunction) on his individual capacity for employment, including sedentary employment, in the context of his education and occupational experience. Any indicated diagnostic tests and studies must be accomplished. The examiner must review the Veteran's claims folder in conjunction with the examination. A notation to the effect that this review has taken place should be made in the evaluation report. The examiner should provide a complete rationale for any opinion provided. If he/she is unable to provide an opinion without resorting to speculation or conjecture, he/she should so state in his/her discussion and explain why. The report prepared must be typed. 3. Notify the Veteran that it is his responsibility to report for the above examination and to cooperate in the development of the TDIU claim being remanded. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for the aforementioned examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. 4. Thereafter, the claims file must be reviewed to ensure that all of the foregoing requested development has been completed. After all appropriate evidentiary development has been completed, adjudicate the Veteran's claim of entitlement to a TDIU. (With respect to the adjudication of the Veteran's TDIU claim, the agency of original jurisdiction is respectfully advised to defer addressing this issue until the Veteran's pending claim for service connection for a chronic low back disorder is first adjudicated, as the outcome of this undeveloped claim may have a material impact on the outcome of the TDIU claim.) If the claim for a TDIU is denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review, if appropriate. The Board intimates no opinion as to the outcome in this case by the action taken herein. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board 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). ______________________________________________ Tresa M. Schlecht Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs