Citation Nr: 1323833 Decision Date: 07/26/13 Archive Date: 08/06/13 DOCKET NO. 09-35 692 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an increased rating in excess of 20 percent for right shoulder impingement syndrome. 2. Entitlement to an increased rating for posttraumatic stress disorder (PTSD), adjustment disorder with anxiety, and depression, in excess of 10 percent prior to February 23, 2011, and in excess of 30 percent from February 23, 2011. 3. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU). 4. Entitlement to service connection for a right knee disability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Christine C. Kung, Counsel INTRODUCTION The Veteran, who is the appellant in this case, served on active duty from April 1986 to July 2006. This matter comes on appeal before the Board of Veterans' Appeals (Board) from August 2007 and March 2008 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In September 2009, the RO granted an increased 20 percent rating for right shoulder impingement syndrome effective September 5, 2007, the date of the claim for an increase. In February 2010, the RO added PTSD to the Veteran's service-connected psychiatric diagnoses and granted an increased 30 percent evaluation for PTSD, adjustment disorder with anxiety, and depression effective February 23, 2011. The Veteran was scheduled for an April 2013 Travel Board hearing, but he withdrew his hearing request in an April 2013 statement, indicating that he did not wish to reschedule the hearing. Accordingly, the hearing request has been withdrawn. The issue of entitlement to 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. For the entire rating period, right shoulder impingement syndrome has been manifested by at least 90 degrees flexion and 90 degrees abduction in the right (major) shoulder with objective evidence of pain with active motion. 2. For the entire rating period, PTSD, adjustment disorder with anxiety, and depression are manifested by occupational and social impairment with reduced reliability and productivity due to symptoms which include depression, anxiety, panic symptoms occurring daily, blunted affect, sleep disturbance, disturbances in motivation in mood, and poor concentration and short term memory. 3. The Veteran did not exhibit right knee symptoms in service. 4. The Veteran does not have a currently diagnosed right knee disability that is etiologically related to service. CONCLUSIONS OF LAW 1. For the entire rating period, the criteria for an evaluation in excess of 20 percent for right shoulder impingement syndrome have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. § 4.71a, Diagnostic Codes 5201 (2012). 2. Resolving the benefit of the doubt in favor of the Veteran, for the entire rating period, the criteria for an increased 50 percent rating for PTSD, adjustment disorder with anxiety, and depression have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411-9440 (2012). 3. The criteria for service connection for a right knee disability have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.326(a) (2012). The notice requirements of VCAA require VA to notify the claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. Id. The United States Court of Appeals for Veterans Claims (Court) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service-connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Id. In a claim for increase, the VCAA requirement is generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). In an October 2007 letter, the RO provided preadjudicatory notice to the Veteran regarding what information and evidence is needed to substantiate the Veteran's claims, as well as what information and evidence must be submitted by the Veteran, and what evidence VA would obtain. This notice letters included information regarding how disability ratings and effective dates are assigned. The Veteran was afforded VA examinations in October 2007 to address his right shoulder disability, and in January 2008, December 2009, and February 2011 to address his psychiatric disorder. 38 C.F.R. § 3.159(c)(4) (2012). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA examinations obtained are adequate for rating purposes because they were performed by a medical professional, and were based on a review of the record and history and symptomatology from the Veteran and a thorough examination of the Veteran. The Board finds that the examiners reported findings pertinent to the rating criteria and adequately addressed the occupational and social effects of the Veteran's disabilities. Nieves-Rodriguez v. Peake, 22 Vet. App 295 (2008); see Barr v. Nicholson, 21 Vet. App. 303 (2007) (holding that VA must provide an examination that is adequate for rating purposes). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). The Veteran was not afforded a VA examination to address service-connection for claimed a right knee disability. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the United States Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the Board finds that a VA examination is not necessary. As the Board will discuss below, service treatment records do not reflect a chronic right knee injury, symptoms, or complaints in service, and there is no indication that the Veteran has a currently diagnosed right knee disability related to service. Absent evidence that indicates that the Veteran has a current claimed disability related to symptoms in service, the Board finds that a VA examination is not necessary for disposition of the claim. The Board is also satisfied that VA has made reasonable efforts to obtain relevant records and evidence. Specifically, the information and evidence that has been associated with the claims file includes service treatment records, Social Security Administration (SSA) medical records, private treatment records, VA examinations, and the Veteran's statements. In light of the foregoing, the Board finds that VA has provided the Veteran with every opportunity to submit evidence and arguments in support of his claims, and to respond to VA notices. The Veteran and representative have not identified any outstanding evidence that needs to be obtained. For these reasons, the Board finds that VA has fulfilled the duties to notify and assist the Veteran. Disability Rating Laws and Regulations Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2012). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. VA must assess the level of disability from the date of initial application for service connection and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim, a practice known as a "staged rating." See Fenderson v. West, 12 Vet. App 119 (1999). The Court has also held that staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Id. The Board finds that the Veteran's right shoulder disability has not increased during the course of the appeal to warrant a staged rating. While the Veteran was assigned a staged rating for his psychiatric disability based on findings from a February 2011 VA examination, as the Board will discuss in more detail below, the Board finds that for the entire rating period, a higher rating is warranted for PTSD, adjustment disorder with anxiety, and depression. In rendering a decision on appeal the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Increased Rating for Right Shoulder Impingement Syndrome The Veteran is service-connected for disability of his right (major) shoulder. Limitation of motion for the shoulder may be rated under Diagnostic Code 5201. Diagnostic Code 5201 assigns a 20 percent evaluation for limitation of motion of the major arm at shoulder level; a 30 percent evaluation for limitation of motion of the major arm midway between the side and shoulder level; and a 40 percent evaluation for limitation of the major arm to 25 degrees to the side. 38 C.F.R. § 4.71a; see also 38 C.F.R. § 4.71a Plate I. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40 (2012). Pain on movement, swelling, deformity, or atrophy of disuse are relevant factors in regard to joint disability. 38 C.F.R. § 4.45 (2012). Painful, unstable, or malaligned joints, due to a healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59 (2012). Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a veteran's service-connected disability. 38 C.F.R. § 4.14 (2012). However, it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; the critical element in permitting the assignment of several evaluations under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). The Veteran was afforded a VA rating examination in October 2007. The examiner noted that the Veteran is right hand dominant. The Veteran had complaints of pain with overhead activities and was unable to perform push-ups. A physical examination reflects 90 degrees abduction and 90 degrees flexion in the right shoulder with pain noted throughout range of motion. The only additional limitation following repetitive use was increased pain. There were no flare-ups, incoordination, fatigue, weakness, or lack of endurance on joint function. The Veteran had tenderness over the right acromioclavicular joint (AC) joint which was prominent, and over the insertion of the rotator cuff on the lateral aspect of the humerus. He had a positive drop arm test on the right. Private treatment records dated in 2007 reflect treatment for chronic right shoulder pain. A July 2007 x-ray shows that the right shoulder was intact without evidence of fracture or dislocation and was otherwise unremarkable. The Veteran was found to have degenerative change at the AC, but the shoulder was stated to be otherwise intact. VA treatment records dated in 2012 continue to reflect right shoulder pain. Based on the foregoing, the Board finds that for the entire rating period, right shoulder impingement syndrome has been manifested by at least 90 degrees flexion and 90 degrees abduction in the right (major) shoulder with objective evidence of pain with active motion, approximating a rating based on limitation of motion of the major arm at shoulder level. Limitation of motion of the major arm is not limited to midway between the side and shoulder level, even with consideration of the Veteran's painful motion. There was no additional limitation to motion noted on repetitive use on testing in October 2007. For these reasons, the Board finds that the Veteran's disability does not more nearly approximate a 30 percent rating under Diagnostic Code 5201. In light of the forgoing, the Board finds that for the entire rating period, an evaluation in excess of 20 percent evaluation is not warranted for right shoulder impingement syndrome. In making this determination, the Board has considered, along with the schedular criteria, the Veteran's functional loss due to pain and painful motion. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. at 206-7. The Board has considered whether an evaluation is warranted under other potentially applicable provisions of the Diagnostic Code. The Board finds, however, that the evidence of record does not reflect ankylosis or malunion, non-union, or dislocation of the humerus or clavical at any time during the rating period to warrant a rating under Diagnostic Code 5200 (ankylosis of scaplohumeal articulation), 5202 (other impairment of the humerus) or 5203 (impairment of the clavical or scapula). For these reasons, the Board finds that for the entire rating period the preponderance of the evidence is against finding that right shoulder impingement syndrome warrants a higher rating evaluation. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b) regarding benefit of the doubt. Increased Rating for a Psychiatric Disability Prior to February 23, 2011, the Veteran was in receipt of a 10 percent disability rating for a service-connected adjustment disorder with anxiety and depression under Diagnostic Code 9440. Effective February 23, 2011, PTSD was added to the Veteran's service-connected psychiatric diagnoses and his rating was increased to 30 percent. For the entire rating period, the Board has considered all of the Veteran's psychiatric symptoms and diagnoses in rating his service-connected psychiatric disability. See Mittleider v. West, 11 Vet. App. 181 (1998) citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996) (the Board is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence which does so, but may not disregard such evidence of differentiation in the record). Under both Diagnostic Codes 9411 (PTSD) and 9440 (chronic adjustment disorder), a 30 percent rating is assigned for 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 mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130. A 50 percent rating is assigned for 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 difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130. A 70 percent disability rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech that is intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. 38 C.F.R. § 4.130. A 100 percent disability rating is assigned total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, or for the veteran's own occupation or name. 38 C.F.R. § 4.130. In applying the above criteria, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected disability, such signs and symptoms shall be attributed to the service-connected disability. See 38 C.F.R. § 3.102 (2012); Mittleider, 11 Vet. App. at 181. In determining the level of impairment under 38 C.F.R. § 4.130, a rating specialist is not restricted to the symptoms provided under the diagnostic code, and should consider all symptoms which affect occupational and social impairment, including those identified in the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (4th ed. 1994) (hereinafter DSM- IV). See Mauerhan v. Principi, 16 Vet. App. 436 (2002). If the evidence demonstrates that a claimant suffers symptoms or effects that cause an occupational or social impairment equivalent to those listed in that diagnostic code, the appropriate, equivalent rating is assigned. Id. Within the DSM-IV, Global Assessment Functioning (GAF) scale scores ranging from 1 to 100, reflect "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996). GAF scores from 71 to 80 reflect transient symptoms, if present, and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family arguments); resulting in no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind school work). GAF scores from 61 to 70 reflect 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, with some meaningful interpersonal relationships. GAF scores ranging from 51 to 60 reflect 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). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsession rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends, inability to keep a job). GAF scores ranging from 31 to 40 reflect some impairment in reality testing or communication (e.g., speech which is at times illogical, obscure, or irrelevant) or major impairment in several areas such as work or school, family relations, judgment, thinking, or mood (e.g., a depressed patient who avoids friends, neglects family, and is unable to do work). DSM-IV at 46-47. After a review of all the evidence, lay and medical, the Board finds that for the entire rating period, the severity of the Veteran's psychiatric symptoms more nearly approximate a rating based on occupational and social impairment with reduced reliability and productivity as described for a higher 50 percent rating. See 38 C.F.R. § 4.130, Diagnostic Code 9411-9440. Private treatment records dated in 2007 show that the Veteran had chronic anxiety and received medication management for anxiety through his primary care physician. During a January 2008 VA examination, the Veteran reported that he was divorced and was living alone in his father's old home. The Veteran reported having panic attack-like symptoms daily but reported that these attacks were not bad. He reported depressed mood, little interest in activities, and he did not clean his house. The Veteran reported that he was doing temporary work at a power plant on a contract basis since his last examination, but reported that he would likely be laid off in March because they had hired full time employees to start at that time. The Veteran denied current problems on-the-job and was able to follow detailed checklists to keep on tract at work. He reported some anxiety at work, but was still able to do his job. He stated that he worked about 40 hours a week, but when the plant shuts down, he did not work at all. A mental status examination shows that the Veteran was casually dressed and groomed. Verbal and social skills were estimated as fair. Thought processes were logical, coherent, and relevant. Affect was blunted. Reasoning and judgment were fair. Concentration and short term memory were poor and the examiner stated that this appeared to relate to his depression and lack of interest in things. Long term memory was fair. The VA examiner also identified symptoms of anxiety, panic symptoms, mild depressive symptoms, fatigue, and mild sleep disturbance. The January 2008 VA examiner stated that the Veteran's mental and emotional problems had a very mild impact on occupational functioning. The examiner stated that his main problem with work was that he was doing temporary work which was not secured long-term. The Veteran was not showing signs of significant social dysfunction and had a number of friends in the area and talked to family members on a frequent basis. He was diagnosed with depressive disorder, NOS, and panic disorder without agoraphobia, and was assessed with a GAF score of 65. A SSA Psychiatric Residual Functional Capacity Assessment dated in June 2008 identified diagnoses of mild depressive disorder and panic disorder without agoraphobia. Limitations to daily living were stated to be mild. The Veteran had no difficulties in maintaining social functioning, and he had mild difficulties in maintaining concentration, persistence, or pace. He had no episodes of decomposition due to his psychiatric disorders. It was noted that the Veteran was working at a power plant, making well over what would be considered for substantial gainful activity at $20 per hour. The SSA examiner made reference to the January 2008 VA examination, noting findings from the mental status examination. The SSA examiner stated that the Veteran's symptoms marginally impacted his ability to function independently, appropriately, and effectively on a sustained bases and stated that his limitations were non-severe. The Veteran was referred for a psychiatric clinical evaluation in association with his SSA claim on October 2008, and a second SSA Psychiatric Residual Functional Capacity Assessment was completed in October 2008. The October 2008 private evaluation shows that the Veteran last worked in May 2008 because his job, which was a temporary one, ended at that time. The Veteran was taking medication for treatment of his psychiatric disability. He lived alone, but reported that his brother and mother lived in close proximity. The Veteran did not require assistance in grooming, but did not shop for groceries and reported that he ate out for every meal. He stated that prior to 1998, when he lost custody of his daughter, he kept his home neat and tidy, but admitted that he did not clean his home and that it was filthy. The Veteran reported that he tried to get out of the house as much as he could and would visit his brother and mother. He communicated with his friends on the computer. A mental status examination shows that the Veteran was casually dressed, groomed, and was socially appropriate. The Veteran spoke profusely and would go off on verbal tangents. His speech was organized and coherent. He admitted that he often heard his deceased father taking to him, telling him to do the right thing. He reported that his mood was depressed, but denied suicidal thoughts. He had sleep apnea and had difficulty with sleep and nightmares. Insight was fair and judgment was assessed as poor. The Veteran was diagnosed with psychotic disorder NOS and PTSD and was assessed with a GAF score of 45. A SSA Psychiatric Residual Functional Capacity Assessment dated in October 2008 reflects moderate limitations in ability to understand detailed instructions, to maintain attention and concentration for extended periods, to perform activities within a schedule and maintain regular attendance, and to work in coordination with or in proximity to others without being distracted by them. He had some moderate limitations in social interactions, and had moderate limitation to responding appropriately to changes in a work setting. The SSA examiner stated that the Veteran was unable to sustain an eight-hour work day due to the severity of his depression and anxiety. The Veteran was stated to have moderate restriction in activities of daily living, moderate difficulties in maintaining social function, and moderate difficulties in maintaining concentration, persistence and pace. The SSA examiner made reference to findings from the October 2008 private psychiatric evaluation and stated that the Veteran's disability appears to have worsened as alleged. He concluded that the Veteran's anxiety and depressive symptoms compromised his ability to sustain a work week on a reliable basis over time. A December 2009 VA examination shows that the Veteran continued to report frequent panic attacks which were not severe. The Veteran was able to function on the job and visit places such as Wal-Mart but felt uncomfortable in such situations. He reported symptoms of depressed mood, anhedonia, fatigue, hypervigilance, and anxiety, and reported that these symptoms occurred every day and were moderate in degree. The Veteran was unemployed at the time of the examination. He had a history of experiencing anxiety at work, but generally was able to perform his work duties. The Veteran had frequent contact with his mother, half-sister, and some other siblings, but reported that he avoided most other social interaction. A mental status examination shows that the Veteran had adequate hygiene and grooming. Psychomotor activity was low. Speech and communication were normal. Thought processes were clear, logical, linear, coherent, and goal-directed. Affect was restricted. Judgment was intact. The Veteran reported depression, anxiety, and panic attacks, but denied suicidal or homicidal ideation. Memory, attention, and concentration were stated to be fair. The Veteran was diagnosed with panic disorder without agoraphobia and depressive disorder, NOS. He was assigned a GAF score of 65. The VA examiner stated that the Veteran's symptomatology had not significantly changed since his last VA examination. He stated that the Veteran's occupational functioning was mildly impaired and social functioning was mildly to moderately impaired by his psychiatric symptomatology. During a February 2011 VA examination, the Veteran reported having a good relationship with his brothers, sister, and mother. A mental status examination reflects no impairment of thought processes or communication. The Veteran denied suicidal or homicidal thoughts. He was able to maintain minimal hygiene and other basic activities of daily living were intact. The Veteran reported depressed mood, anxiety, and panic attacks occurring a few times a week, and indicated some sleep impairment. The Veteran was diagnosed with chronic, mild PTSD and was assessed with a GAF score of 55. The examiner stated that the Veteran's social functioning appeared to be mildly to moderately impaired due to nervousness in unfamiliar social situations. The Veteran did have contact with his family members and had some social support. The VA examiner stated that the Veteran had occupational decrease in work efficiency or intermittent periods of inability to perform occupational tasks due to his psychiatric symptoms but was generally functioning satisfactorily. He stated that the Veteran was mostly unable to work due to his medical problems. Based on the lay and medical evidence of record discussed above, the Board finds that for the entire rating period, the Veteran's psychiatric disorder has resulted in occupational and social impairment with reduced reliability and productivity due to symptoms which include depression, anxiety, panic symptoms occurring daily, blunted affect, sleep disturbance, nightmares, disturbances of motivation and mood, diminished interest in activities, and poor concentration and short term memory. The Board finds that the Veteran has exhibited symptoms over the course of the rating period ranging from mild to moderate in degree. In that regard, while a January 2008 VA examination shows the Veteran's disability had a mild impact on occupational functioning, and no impact on social functioning and a June 2008 SSA evaluation noted that the Veteran was able to function independently, appropriately, and effectively and that his disability was non-severe, an October 2008 SSA psychiatric evaluation reflects an increase in symptoms and the associated Residual Functional Capacity Assessment indicates moderate impairment in activities of daily living, in maintaining social function, and in maintaining concentration, persistence and pace such that it impaired his ability to complete a eight-hour work week. More recent December 2009 and February 2011 VA examinations both reflect mild to moderate social and occupational impairment due to the Veteran's psychiatric symptoms. Based on the forgoing, for the entire rating period, the Board finds that the Veteran's symptoms and the severity of his symptoms are consistent with the criteria for both a 30 percent and 50 percent rating under Diagnostic Code 9411-9440. See 38 C.F.R. § 4.130. The Veteran was assigned GAF scores of 65 in January 2008, June 2008, and December 2009 indicating mild symptoms, mild impact on occupational functioning, and no social impairment, but had higher GAF scores of 45 to 55 respectively in October 2008 and more recently in February 2011, indicating severe or moderate symptomatology. See DSM-IV at 46-47. The Board finds that the Veteran's GAF scores are largely consistent with the medial evidence of record which reflects mild to moderate occupational and social impairment to due to his psychiatric symptoms. For these reasons, and resolving doubt in favor of the Veteran, the Board finds that for the entire rating period, the severity of the Veteran's occupational and social impairment and symptoms due to service-connected PTSD, adjustment disorder with anxiety, and depression more nearly approximates the criteria a higher 50 percent disability rating. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. The Board has reviewed all the evidence of record, lay and medical, and finds that for the entire rating period, the Veteran has not met or more nearly approximated the criteria for a higher 70 percent disability rating. See 38 C.F.R. § 4.130. For the entire rating period, the record does not indicate occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood due his psychiatric disability. Although the Veteran was shown to have deficiencies in mood, as evidenced by his anxiety and depression as well as some moderate deficiencies in work, he was not shown to have deficiencies in most areas to include family relations, judgment, or thinking. SSA and VA psychiatric evaluations show that the Veteran maintained regular contact with family members, and frequently visited his siblings and his mother. Mental status did not reflect impairment in judgment or thinking. While judgment was indicated as poor in an October 2008 SSA evaluation, mental status examinations dated in January 2008, December 2009, and February 2011 do not reflect such impairment. Additionally, the Board finds that the Veteran has not exhibited symptoms of a severity as described for a higher 70 percent evaluation. While there is evidence of reported panic attacks and depression, the weight of the evidence does not demonstrate near-continuous panic or depression affecting the ability to function independently, appropriately and effectively. The Board finds that the Veteran's GAF score of 55 and 65 and his assessment of mild to moderate PTSD symptoms and mild to moderate social and occupational impairment are not consistent with a higher 70 percent rating. The Board finds that the GAF score rendered during the October 2008 SSA psychiatric evaluation indicates symptoms of a greater severity than described during the course of examination, and is not indicative of symptomatology and impairment, which was identified as moderate, at most, during a October 2008 Psychiatric Residual Functional Capacity Assessment. Moreover, the SSA examiner did not provide reasoning or a discussion for his assessment as to the severity of the Veteran's psychiatric disability. This isolated GAF score of 45, indicating more severe symptomatology, is also inconsistent with findings from later December 2009 and February 2011, which reflect mild to moderate psychiatric symptoms, or mild to moderate occupational and social impairment. While the Board finds that both SSA and VA evaluations are probative in this case, the Board finds that weight of the evidence does not reflect a severity of psychiatric symptomatology to warrant a higher 70 percent rating under Diagnostic Code 9411-9440. The Board finds, based on all of the evidence of record, the Veteran's psychiatric symptoms and associated occupational and social impairment are shown to be mild to moderate in degree. The Board finds that this is consistent with symptoms and level of impairment, social and occupational, identified in both VA and SSA psychiatric evaluations of record. For these reasons, the Board finds that the Veteran's overall psychiatric presentation is not of a severity as described for a 70 percent rating. The Board finds that for the entire rating period, the Veteran's service-connected psychiatric disability does not more nearly approximate the rating criteria for a 70 percent evaluation under Diagnostic Code 9411-9440, but more closely approximates a 50 percent rating. Extraschedular Consideration The Board has considered whether referral for an extraschedular evaluation is warranted. In exceptional cases an extraschedular rating may be provided. 38 C.F.R. § 3.321 (2012). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. In the second step of the inquiry, however, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." 38 C.F.R. 3.321(b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). When the rating schedule is inadequate to evaluate a claimant'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 for completion of the third step-a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. 38 C.F.R. 3.321(b)(1). Turning to the first step of the extraschedular analysis, the Board finds that the symptomatology and impairment caused by the Veteran's right shoulder impingement syndrome and by his psychiatric disorder is specifically contemplated by the schedular rating criteria, and no referral for extraschedular consideration is required. The schedular rating criteria, Diagnostic Code 5201 specifically provides for disability ratings based on limitation of motion, including due to pain and other orthopedic factors. See 38 C.F.R. §§ 4.21, 4.40, 4.45, 4.59 (2012); see also DeLuca. In this case, considering the lay and medical evidence, right shoulder impingement syndrome is manifested by 90 degrees flexion and abduction with painful motion. These symptoms are part of or similar to symptoms listed under the applicable schedular rating criteria. Diagnostic Code 9411-9400 provides for disability ratings based on a combination of clinical psychiatric symptoms and findings. The Veteran's psychiatric disorder is manifested by symptoms of depression, anxiety, panic symptoms occurring daily, blunted affect, sleep disturbance, nightmares, deficiencies in mood, diminished interest in activities, and poor concentration and short term memory. The schedular rating criteria specifically include ratings based on occupational and social impairment with reduced reliability and productivity due psychiatric symptoms. The schedular rating criteria also include ratings based on analogous symptoms that are "like or similar to" listed schedular rating criteria. Mauerhan, 16 Vet. App at 442; see also 38 C.F.R. § 4.21 (2012). Additionally, the Board has considered probative GAF scores, which are incorporated through the DSM-IV as part of the schedular rating criteria, in determining the degree of severity of psychiatric symptoms or overall functional impairment caused by the Veteran's PTSD, anxiety, and depression. While the Veteran has reported his service-connected disabilities, to include his psychiatric disorder, have limited his pursuit of proper gainful employment as evidenced by SSA records, the Board finds that this is adequately addressed by the separate claim for a TDIU which is being remanded by the Board. For these reasons, the Board finds that the schedular rating criteria is adequate to the Veteran's disabilities and referral for consideration of an extraschedular evaluation is not warranted. The schedule is intended to compensate for average impairments in earning capacity resulting from service-connected disability in civil occupations. 38 U.S.C.A. § 1155. "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." 38 C.F.R. § 4.1. In this case, the problems reported by the Veteran are specifically contemplated by the criteria discussed above, including the effect on his occupational and daily life. In the absence of exceptional factors associated with right shoulder impingement syndrome or a service-connected psychiatric disorder, the Board finds that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). Service Connection Law and Analysis Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The evidence does not establish a current diagnosis of right knee arthritis; therefore, 38 C.F.R. § 3.303(b) does not apply in this case. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In rendering a decision on appeal the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the veteran's claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). At the outset, it is noted that the Board has reviewed all of 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 extensive evidence of record. Indeed, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate. After reviewing all the lay and medical evidence, the Board finds that the weight of the evidence demonstrates that the Veteran does not have a currently diagnosed right knee disability that is related to service. The Veteran did not exhibit right knee symptoms in service. Service treatment records do not reflect any right knee complaints or treatment in service, nor were any knee complaints noted around the time of the Veteran's separation from service. A July 2006 VA authorized general medical examination, completed prior to separation, does not reflect any right knee complaints, treatment, or diagnoses at the time of the Veteran's separation. The Board finds that the evidence of record does not establish a current right knee diagnosis. Private treatment records, dated in 2006 and 2007 do not reflect any complaints or treatment for a right knee disability. VA medical records dated from February 2012 to January 2013 identify "knee arthralgia" on the Veteran's problem list, but no treatment for the right knee is shown or identified in the record. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See 38 U.S.C.A. § 1110, 1131; Degmetich v. Brown, 104 F. 3d 1328 (1997). Although the Veteran was assessed with knee pain, or arthralgia, the record does not reflect a diagnosed chronic disability related to such. The Court has held that pain alone, without a diagnosed or identifiable underlying malady or condition does not in and of itself constitute a disability for which service connection may be granted. See Sanchez- Benitez v. West, 13 Vet. App. 282, 285 (1999). Further, there is no competent, credible, and probative evidence of record which relates a claimed right knee disability to a disease, injury or event in service During the course of a February 2011 VA psychiatric examination, the Veteran noted that in early August 2005, he was assaulted by police officers prior to his deployment to Iraq. He reported that they beat him up and he sustained injuries to both knees, bruises, and contusions. While the Board finds that the Veteran is competent to report a physical assault which occurred while he was in service; the Board finds that he is not competent or credible in identifying a chronic right knee injury or disability in service. In that regard, the Veteran was not treated for any right knee complaints in service. The Board has reviewed service treatment records, to include service treatment records dated in August 2005. The Veteran sought treatment of right shoulder pain, requesting an MRI, in late August 2005, shortly after the alleged assault, but made no mention of any right knee problems. Clinical treatment records reflect treatment for the shoulder and back in September 2005 and in 2006 but do not reflect any right knee complaints. Additionally, no knee problems were indicated on a July 2006 post-deployment evaluation or on a July 2006 VA authorized general medical examination, completed just prior to the Veteran's separation from service. Despite the Veteran's allegations, service treatment records made no mention of any injury or complaints relating to the right knee. Moreover, post-service private treatment records dated in 2006 and 2007 do not identify any right knee complaints or pathology. The absence of any in-service complaints, findings, diagnosis, or treatment for right knee symptoms around the time of the Veteran's report of injury, to include the absence of such findings around the time of his separation, is one factor which weighs against the Veteran's claim. See Buchanan, 451 F.3d at 1337 (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence). Additionally, the Board finds it unlikely that the Veteran would fail to report symptoms relating to the right knee if such symptoms were present in service, as service treatment records appear to be complete, and the Veteran actively reported problems related to other orthopedic disabilities, to include disabilities of the shoulders and back in service. See Kahana v. Shinseki, No. 24 Vet. App. 428, 439 (2011) (citing Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (VA may use silence in the service treatment records as evidence contradictory to a veteran's assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred). For these reasons, the Board finds that the weight of the evidence shows that the Veteran did not sustain a chronic injury to the right knee in service, nor did he exhibit right knee symptoms. The Board finds that competent, credible, and probative evidence of record shows that Veteran did not exhibit right knee symptoms in service or shortly after service separation, the evidence does not establish currently diagnosed right knee disability, and Veteran has not established any nexus between his claimed right knee disability and service. Accordingly, the Board finds that service connection for a right knee disability is not warranted. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b) regarding benefit of the doubt, but there is not such a state of equipoise of positive and negative evidence to otherwise grant the Veteran's claim. ORDER An increased rating for right shoulder impingement syndrome in excess of 20 percent is denied. For the entire rating period, a 50 percent disability rating, but no more, is granted for PTSD, adjustment disorder with anxiety, and depression subject to the law and regulations governing the payment of monetary benefits. Service connection for a right knee disability is denied. REMAND Pursuant to VA's duty to assist, VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4)(i) (2012). TDIU ratings may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For the purpose of one 60 percent or one 40 percent disability in combination, disabilities resulting from a common etiology or a single accident will be considered as one disability. 38 C.F.R. § 4.16(a). The Veteran is service connected for sleep apnea, PTSD, adjustment disorder with anxiety, depression, left shoulder strain, right shoulder impingement syndrome, degenerative disc disease of the thoracolumbar spine, tinnitus, gastroesophageal reflux disease, a scar on the right pinna, temporomandibular joint dysfunction, and cervical spine degenerative disc disease, and he has a number of service-connected disabilities rated as noncompensable, to include a status post left thumb fracture, left plantar fasciitis with a status post second digit fracture of the left foot, bilateral hearing loss, calcified granuloma, hypertension, a scar to the left hand, herpes simplex type 2, and tinea pedis with plantar warts. The Board finds that for the entire rating period, the Veteran's service-connected disabilities met the combined rating threshold criteria for the assignment of a TDIU. Therefore, application of a TDIU is appropriate so long as the severity of the Veteran's service-connected disabilities warrant such a rating. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The Veteran was afforded VA examinations in October 2007, and these examinations included a discussion of the occupational impairment caused by his service-connected shoulders, spine, feet, left thumb, sleep apnea, temporomandibular joint dysfunction, hearing loss, and tinnitus. VA psychiatric examinations address the effect of the Veteran's PTSD, adjustment disorder with anxiety, and depression on his employability. However, the Veteran has not been afforded an examination to address the effect the Veteran's occupational impairment due to the combination of his service-connected disabilities. The Court has held that a TDIU claim may not be denied without producing evidence, as distinguished from mere conjecture, that a veteran's disability does not prevent him from performing work that would produce sufficient income to be other than marginal. Friscia v. Brown, 7 Vet. App. 294 (1995), citing Beaty v. Brown, 6 Vet. App. 532, 537 (1994). In Friscia, the Court specifically stated that VA has a duty to supplement the record by obtaining an examination which includes an opinion on what effect the appellant's service-connected disability has on the ability to work. Friscia, at 297, citing 38 U.S.C.A. § 5107(a) (West 2002); 38 C.F.R. §§ 3.103(a), 3.326, 3.327, 4.16(a) (2012); Beaty, 6 Vet. App. at 537; and Obert v. Brown, 5 Vet. App. 30, 33 (1993). For these reasons, the Board finds that a remand for a VA examination is necessary to clearly address whether the combination of the Veteran's service-connected disabilities render him unable to obtain and maintain substantially gainful employment. Accordingly, the case is REMANDED for the following action: 1. The Veteran should be scheduled for the appropriate examination(s) to determine the current effect of his service-connected disabilities on his employability. The record must be made available to the examiner(s) for review. The examiner should offer the following opinion: Without regard to the Veteran's age or the impact of any nonservice-connected disabilities, but with regard to his education level, state whether it is at least as likely as not that the Veteran's service-connected disabilities, in combination (sleep apnea, PTSD, adjustment disorder with anxiety, depression, left shoulder strain, right shoulder impingement syndrome, degenerative disc disease of the thoracolumbar spine, tinnitus, gastroesophageal reflux disease, a scar on the right pinna, temporomandibular joint dysfunction, cervical spine degenerative disc disease, a status post left thumb fracture, left plantar fasciitis with a status post second digit fracture of the left foot, bilateral hearing loss, calcified granuloma, hypertension, a scar to the left hand, herpes simplex type 2, and tinea pedis with plantar warts) preclude him from engaging in substantially-gainful employment. The examiner must review all pertinent records associated with the claims file and to comment on the combined effect of the Veteran's service-connected disabilities on his ability to engage in any type of full-time employment and whether, in the examiner's opinion, the service-connected disabilities alone are of such severity to result in unemployability. The examiner should provide a rationale for his or her opinion with reference to the evidence of record and should provide a discussion of the facts and medical principles involved. 2. The RO/AMC must review the VA opinion to ensure that they are in complete compliance with this remand. If it is deficient in any manner, the RO/AMC should implement corrective procedures at once. 3. After all development has been completed, the RO/AMC should readjudicate the issue of entitlement to a TDIU. If the benefits sought remain denied, the Veteran and his representative should be furnished a supplemental statement of the case, and be given an opportunity to submit written or other argument in response before the claims file is returned to the Board for further appellate consideration. The Veteran is advised to appear and participate in any scheduled VA examination, as failure to do so may result in denial of this claim. See 38 C.F.R. § 3.655 (2012). 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). 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). ______________________________________________ K. J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs