Citation Nr: 18142809 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 11-05 022A DATE: October 17, 2018 ORDER New and material evidence having been submitted, the claim for service connection for residuals of a head injury is reopened. REMANDED Entitlement to service connection for residuals of a head injury, to include a cognitive disorder, not otherwise specified (NOS), is remanded. Entitlement to an initial evaluation in excess of 30 percent for mood disorder, NOS, with anxious, depressive, and intermittent hypomanic symptoms prior to November 29, 2012, is remanded. Entitlement to an initial evaluation in excess of 50 percent for mood disorder, NOS, with anxious, depressive, and intermittent hypomanic symptoms for the period from November 29, 2012, to March 2, 2016, is remanded. Entitlement to an initial evaluation in excess of 70 percent for mood disorder, NOS, with anxious, depressive, and intermittent hypomanic symptoms on or after March 2, 2016, is remanded. Entitlement to an evaluation in excess of 20 percent for multi-level degenerative disc disease and degenerative joint disease of the lumbar spine, post-operative, with spinal stenosis and spondylosis prior to March 8, 2016, is remanded. Entitlement to an evaluation in excess of 10 percent for multi-level degenerative disc disease and degenerative joint disease of the lumbar spine, post-operative, with spinal stenosis and spondylosis on or after March 8, 2016, is remanded. Entitlement to an evaluation in excess of 50 percent for hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia prior to December 24, 2008, is remanded. Entitlement to an evaluation in excess of 70 percent for hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia for the period from December 24, 2008, to January 6, 2012, is remanded. Entitlement to an evaluation in excess of 100 percent for hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia on or after January 6, 2012, to include whether separate evaluations are warranted, is remanded. Entitlement to an effective date earlier than April 10, 2008, for the award of a 50 percent evaluation for hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia, is remanded. Entitlement to an initial evaluation in excess of 10 percent for radiculopathy of the right lower extremity prior to March 2, 2016, is remanded. Entitlement to an initial evaluation in excess of 20 percent for radiculopathy of the right lower extremity on or after March 2, 2016, is remanded. Entitlement to an initial rating in excess of 20 percent for radiculopathy of the left lower extremity is remanded. Entitlement to a total rating based upon individual unemployability due to service-connected disabilities (TDIU) prior to January 6, 2012, is remanded. FINDINGS OF FACT 1. In a June 2003 rating decision, the Regional Office (RO) denied a claim for service connection for a head injury with post-concussion syndrome. The Veteran was notified of that decision and of his appellate rights, but he did not appeal or submit new and material evidence within the one-year period thereafter. 2. The evidence received since the June 2003 rating decision relates to an unestablished fact and raises the reasonable possibility of substantiating the claim for service connection for residuals of a head injury. CONCLUSIONS OF LAW 1. The June 2003 rating decision that denied the Veteran’s claim for service connection for residuals of a head injury is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2003). 2. The evidence received since the June 2003 rating decision is new and material, and the claim for service connection for residuals of a head injury is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1969 to February 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from July 2010, January 2011, January 2013, and March 2014 rating decisions. In a July 2010 rating decision, the RO denied an evaluation in excess of 20 percent for multilevel degenerative disc disease of the lumbar spine and TDIU. In a January 2011 rating decision, the RO granted service connection for mood disorder NOS, with anxious, depressive, and intermittent hypomanic symptoms and assigned an initial 30 percent evaluation effective from January 6, 2009. In a January 2013 rating decision, the RO increased the evaluation assigned for the Veteran’s service-connected hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia to 50 percent effective from April 10, 2008; to 70 percent, effective from December 24, 2008; and to 100 percent effective from January 6, 2012. In a May 2013 rating decision, the RO increased the evaluation for the Veteran’s service-connected mood disorder to 50 percent effective from November 29, 2012. Nevertheless, the issues remain in appellate status, as the maximum schedular ratings have not been assigned. AB v. Brown, 6 Vet. App. 35, 38 (1993). In a March 2014 rating decision, the RO granted service connection for radiculopathy of the right lower extremity and assigned an initial 10 percent evaluation effective from December 12, 2013; granted service connection for radiculopathy of the left lower extremity and assigned an initial 10 percent evaluation effective from February 9, 2011; and determined that new and material evidence had not been submitted to reopen a previously denied claim of service connection for residuals of a head injury. In a July 2014 rating decision, the RO increased the initial evaluation assigned for the Veteran’s service-connected radiculopathy of the left lower extremity to 20 percent effective from February 9, 2011. Nevertheless, the issue remains in appellate status, as the maximum schedular rating has not been assigned. AB, 6 Vet. App. at 38. In September 2014, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that proceeding is associated with the record. In March 2015, the Board denied entitlement to increased evaluations for vascular headaches; denied entitlement to an earlier effective date for the award of a 30 percent evaluation for vascular headaches; and dismissed the issue of entitlement to a temporary total rating for multi-level degenerative disc and degenerative joint disease of the lumbar spine. In addition, the Board remanded the issues of entitlement to increased evaluations and an earlier effective date for hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia; increased evaluations for mood disorder, NOS; increased evaluations for a lumbar spine disability; increased evaluations for radiculopathy of the right and left lower extremities; and TDIU. The Board also remanded the issue of whether new and material evidence has been submitted to reopen a claim for service connection for residuals of a head injury to afford the Veteran a hearing. The Veteran was scheduled for a hearing before the Board on April 26, 2018, but he failed to report for that proceeding. The Veteran’s representative requested to reschedule the hearing. However, she did not show good cause. Indeed, the Veteran’s representative herself acknowledged that she did not have good cause to reschedule. Therefore, the Board deems the hearing request withdrawn. In a March 2016 rating decision, the RO increased the evaluation assigned for mood disorder, NOS, to 70 percent effective from March 2, 2016. The RO also increased the evaluation assigned for right lower extremity radiculopathy to 20 percent effective from March 2, 2016. Nevertheless, the issues remain in appellate status, as the maximum schedular ratings have not been assigned. AB, 6 Vet. App. at 38. In addition, the RO decreased the evaluation assigned for the Veteran’s service-connected multilevel degenerative disc disease and degenerative joint disease of the lumbar spine, post-operative, with spinal stenosis and spondylosis from 20 percent to 10 percent effective from March 8, 2016. The Veteran did not appeal that decision. See Dofflemeyer v. Derwinski, 2 Vet. App. 277 (1992). Thus, the issue of the propriety of the rating reduction is not on appeal. The Board notes that a private agent submitted a statement in November 2016 indicating that he was withdrawing as the Veteran’s representative. However, as previously noted by the Board in the March 2015 remand, the Veteran already revoked the power of attorney for the agent and appointed the American Legion as his representative. Therefore, the Veteran is currently represented by the American Legion in this appeal. Law and Analysis In order to reopen a claim which has been denied by a final decision, a claimant must present new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); see also Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001) (regardless of action taken by RO, Board must determine whether new and material evidence has been received subsequent to an unappealed RO denial). In a June 1972 rating decision, the RO denied service connection for a head injury with post-concussion syndrome and granted service connection for vascular headaches. In so doing, the RO stated that residuals of a head injury were not found during a May 1972 VA examination. Rather, the RO noted the VA examiner determined that the most accurate diagnosis was vascular headaches due to post concussion and encephalalgia. The Veteran was notified of the decision and of his appellate rights; however, he did not file a notice of disagreement or submit new and material evidence within one year of receiving notice of the decision. Therefore, the June 1972 rating decision became final. See 38 U.S.C. § 4005(c) (1970); 38 C.F.R. §§ 3.104, 19.118, 19.153 (1972). In making this determination, the Board notes that, prior to expiration of the appeal period, a VA medical record was associated with the claims file in June 1972. However, a review of that evidence reveals that it was cumulative of evidence already of record. Indeed, the June 1972 rating decision specifically referenced findings from the November 1971 hospital report. Therefore, the Board finds that 38 C.F.R. § 3.156(b) does not apply. In an August 1975 rating decision, the RO considered the Veteran’s claim for service connection for residuals of a head injury and granted service connection for a seizure disorder. The RO assigned a combined the evaluation for the Veteran’s seizure disorder with his service-connected vascular headaches. In so doing, the RO noted that the medical evidence showed that the Veteran’s symptoms, including dizziness and syncope, were felt to represent a seizure disorder possibly originating in the temporal lobe. The Veteran was notified of the August 1975 rating decision and of his appellate rights; however, he did not file a notice of disagreement or submit new and material evidence within one year of receiving notice of the decision. Therefore, the August 1975 rating decision became final. See 38 U.S.C. § 4005(c) (1970); 38 C.F.R. §§ 3.104, 19.118, 19.153 (1975). In August 1994, the Veteran stated that he was assigned a 10 percent evaluation for service connection for a head injury and wished to file for an increased evaluation. In November 2002, the Veteran’s representative submitted a claim for entitlement to service connection for a concussion secondary to an in-service parachute accident. His representative also submitted a claim for an increased evaluation for a service-connected condition of the nervous system. In December 2002, the Veteran filed a motion to revise the June 1972 rating decision, alleging that the failure to assign separate ratings for a seizure disorder and headaches was a clear and unmistakable error. In so doing, the Veteran reported that he suffered a concussion with unconsciousness and a major seizure in March 1970. He also reported having headaches, dizziness, tinnitus, multiple syncopal episodes, and paresthesias. In a January 2003 rating decision, the RO concluded that revision of the June 1972 rating decision was warranted. The RO assigned an initial 10 percent evaluation for vascular headaches and separate evaluations for a seizure disorder. In a June 2003 rating decision, the RO denied service connection for head injury residuals (claimed as concussion or syncope) finding that there was no evidence of a clinically diagnosed disability. In so doing, the RO stated that a VA examination showed that the Veteran’s parachute accident caused residual headaches, a seizure disorder, and lumbar spine degenerative disc disease. It was also noted that the Veteran’s current complaints of disorientation and dizziness were considered as part of his seizure disorder. The Veteran was notified of the January 2003 and June 2003 rating decisions and of his appellate rights. In a July 2003 notice of disagreement, the Veteran disagreed with the January 2003 and June 2003 rating decisions as to the evaluations and effective dates assigned for his lumbar spine disability, vascular headaches, and seizure disorder. However, he did not appeal the denial of service connection for residuals of a head injury or submit new and material evidence within the one-year appeal period. Therefore, the June 2003 rating decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. In making this determination, the Board notes that, prior to expiration of the appeal period, VA medical records were associated with the claims file. However, a review of this evidence reveals that the records were cumulative or not relevant to the Veteran’s claim for service connection for residuals of a head injury. In this regard, the records showed ongoing treatment for complaints headaches, dizziness, and behavioral issues. Therefore, the Board finds that 38 C.F.R. § 3.156(b) does not apply. In a May 2012 deferred rating decision, the RO stated that it appeared that a new claim was received on March 11, 2013, but it was not associated with the claims file. In a February 2014 report of general information, the Veteran’s representative stated that he had no record that a claim to reopen service connection for residuals of a head injury had been submitted. However, a February 2014 VA email noted that VA records showed that a statement in support of claim requesting to reopen a claim for service connection for a head injury was received in March 11, 2013, and that an “EP 020” had been established. Therefore, the RO decided to develop the claim. In a March 2014 rating decision, the RO determined that new and material evidence had not been received to reopen a claim for service connection for residuals of a head injury finding that there was no evidence of a current diagnosis or in-service event. The Veteran appealed that decision. In March 2015, the Board remanded the case to afford the Veteran a hearing in connection with his claim to reopen service connection for residuals of a head injury. In so doing, the Board advised the Veteran that it would be to his benefit to clarify the nature of the disability sought in connection with his application to reopen the claim of service connection for residuals of a head injury, to include whether he believed he suffered from any sequelae of a head injury not already compensated. To date, no response has been received from the Veteran. The evidence received since the June 2003 rating decision includes VA medical records, VA examinations, and lay statements. The Board notes that December 2010 and December 2013 VA examinations show diagnoses of cognitive disorder, NOS. In addition, in an October 2012 VA examination, the examiner stated that there were multiple reasons for the Veteran’s cognitive deficits, to include a head injury from a parachute fall in 1970 and hepatitis. This evidence relates to a previously unestablished fact and could reasonably substantiate the claim were it to be reopened by triggering VA’s duty to assist. See Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010). Thus, the Board finds that the evidence is both new and material, and the claim for service connection for residuals of a head injury is reopened. However, as will be explained in the remand section below, the Board is of the opinion that further development is necessary before the merits of the Veteran’s claim can be addressed. REASONS FOR REMAND Entitlement to service connection for residuals of a head injury, to include cognitive disorder, NOS. Entitlement to increased evaluations for a mood disorder, NOS. The Veteran has been diagnosed with a mood disorder, NOS, and cognitive disorder, NOS. However, where the record does not separate the effects of a service-connected disability from the effects of a non-service-connected disability, the effects must be attributed to the service-connected disability or a medical determination must be obtained. Mittleider v. West, 11 Vet. App. 181, 182 (1998). In this case, a December 2013 VA examiner opined that it was not possible to differentiate the symptoms attributable to the Veteran’s mental disorders. Thereafter, a March 2016 VA stated that the complicated nature of the Veteran’s mental health problems “resulted in an inability to state what is service connected and what is not service connected without resorting to mere speculation.” The examiner also indicated that the Veteran had significant cognitive problems due to health issues. However, he stated that the Veteran’s cognitive functioning was not formally assessed. Therefore, the Board finds that an additional VA examination is needed to ascertain the current severity and manifestations of his service-connected mood disorder. In addition, the Board notes that there are conflicting medical opinions of record regarding the etiology of the Veteran’s cognitive disorder, NOS. In this regard, a December 2010 VA examiner opined that the Veteran’s cognitive disorder, NOS, was less likely as not associated with situations first experienced during his military service. A December 2013 VA examiner opined that it was reasonable to conclude that the Veteran’s observed impairments were, at least in part, related to his history of a myocardial infarction with anoxic brain injury. He further opined that the Veteran’s impairments may be related, in part, to vascular changes in brain functioning. An October 2012 VA examiner opined that there were multiple reasons for the Veteran’s cognitive deficits, to include an in-service head injury, hepatitis, an ischemic cerebrovascular accident, and a myocardial infarction with anoxic brain injury. However, the examiner provided no supporting rationale for her determination. Thereafter, a March 2016 VA examiner stated that the Veteran had significant cognitive problems due to health issues. Given the conflicting evidence of record regarding the etiology of the Veteran’s cognitive disorder, NOS, as well as the extent to which any residuals of a head injury exist, an additional VA examination and medical opinion are needed. Entitlement to increased evaluations for hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia. Entitlement to an effective date earlier than April 10, 2008, for the award of a 50 percent rating for hepatitis C with cirrhosis of the liver, anemia, and thrombocytopenia. In a March 8, 2016, VA medical opinion, the examiner opined that it was not possible to determine what symptoms were caused by the Veteran’s hepatitis C, cirrhosis of the liver, thrombocytopenia, and anemia without resorting to mere speculation because there was no conceptual or empirical basis for making such a determination. In so finding, he stated that as all of the Veteran’s conditions can cause fatigue, anorexia, nausea, and any abdominal symptoms. However, he also stated that abdominal discomfort was strictly and reliably a result of cirrhosis of the liver. Moreover, he did not provide a retrospective opinion regarding the severity of the Veteran’s disorder prior to January 6, 2012, as directed by the Board in the March 2015 remand. In a March 31, 2016, VA medical opinion, the examiner stated the Veteran had no symptoms or symptomatology from his chronic hepatitis C, compensated liver cirrhosis, anemia, or thrombocytopenia prior to January 6, 2012. In so finding, the examiner distinguished between “symptoms,” “signs,” and “sequela” of the conditions. For example, the examiner stated that cirrhosis, in and of itself, has no symptomatology. However, the examiner also opined that the Veteran had mild to moderate hepatitis with sequalae of moderate compensated cirrhosis of the liver, mild anemia, and moderate thrombocytopenia. In addition, the examiner noted that the Board requested delineation of all pathology and symptomatology attributable to the Veteran’s hepatitis C, cirrhosis of the liver, anemia, and thrombocytopenia for the period prior to January 6, 2010. He also noted that the Board cited decisions issued by the United States Court of Appeals for Veterans Claims (Court) in the cases of Esteban v. brown, 6 Vet. App. 259 (1994) and Murray v. Shinseki¸24 Vet. App. 420, 423 (2011). However, the examiner opined that “only symptoms may be used to ascertain distinct and separate.” He further stated that it should have been understood that a medical examiner’s January 2013 statement that “all of these symptoms are inter-related to each other” meets the conditions of Esteban and Murray. The March 31, 2016, VA examiner did not provide a description of the manifestations of the “sequelae” of the Veteran’s service-connected hepatitis C, cirrhosis, anemia, or thrombocytopenia. Moreover, the examiner’s opinion included numerous legal conclusions. It is not the responsibility of the examiner to render an opinion regarding the adequacy of the rating schedule or to provide an analysis regarding the rating schedule. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007) (“The medical examiner provides a disability evaluation and the rating specialist interprets medical reports in order to match the rating with the disability.”), rev’d on other grounds sub nom. Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). For these reasons, the Board finds that a remand is necessary to obtain an additional VA medical opinion that clearly identifies the signs, symptoms, and/or sequelae necessary for rating the Veteran’s service-connected disability. The Board also finds that the issue of entitlement to an effective date earlier than April 10, 2008, for the award of a 50 percent rating for the Veteran’s service-connected hepatitis C disability is inextricably intertwined with the increased rating claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two issues are inextricably intertwined when the adjudication of one issue could have significant impact on the other issue). Entitlement to increased evaluations for multi-level degenerative disc disease and degenerative joint disease of the lumbar spine, post-operative, with spinal stenosis and spondylosis. Regarding the issue of entitlement to increased evaluations for the Veteran’s lumbar spine disability, the Veteran was afforded a VA examination in March 2016. However, in light of a decision issued by the United States Court of Appeals for Veterans Claims (Court), a remand is required. In Correia v. McDonald, 28 Vet. App. 158, 169 (2016), the Court held that 38 C.F.R. § 4.59 requires VA examinations to include joint testing for pain on both active and passive range of motion, as well as with weight-bearing and nonweight-bearing. Correia v. McDonald, 25 Vet. App. 158 (2016). In this case, the March 2016 VA examination report did not include all of these findings. Therefore, the Board finds that a VA examination is needed to ascertain the current severity and manifestations of the Veteran’s service-connected lumbar spine disability. The examiner will also be able to determine whether it is possible to provide a retrospective medical opinion for the VA examinations conducted during the appeal period. See Chotta v. Peake, 22 Vet. App. 80 (2008) (when there is an absence of medical evidence during a certain period of time, a retroactive medical evaluation may be warranted). Entitlement to increased evaluations for radiculopathy of the right and left lower extremities. Entitlement to a total rating based upon individual unemployability due to service-connected disabilities (TDIU) prior to January 6, 2012, is remanded. As resolution of the claims discussed above may have an impact on the Veteran’s claims for increased evaluation for radiculopathy of the lower extremities and TDIU prior to January 6, 2012, the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Lastly, in a March 2016 VA medical opinion, the examiner stated that he reviewed medical records dated from January 1995, to include records located in the Computerized Patient Record System (CPRS) and Vista Imaging System. Therefore, on remand, the Agency of Original Jurisdiction (AOJ) should obtain any outstanding treatment records. The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for the disorders on appeal. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. The AOJ should also associate with the claims file any records located in the Vista Imaging System or CPRS that pertain to the disorders on appeal. 2. After completing the above development, the AOJ should refer the Veteran’s claims file to a suitably qualified VA examiner for a clarifying opinion as to the severity and manifestations of the Veteran’s service-connected hepatitis C with cirrhosis of the liver, thrombocytopenia, and anemia prior to January 6, 2012. An additional examination of the Veteran should be performed only if deemed necessary by the individual providing the opinion. The examiner is requested to review all pertinent records associated with the claims file. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should report all signs and symptoms necessary for evaluating the Veteran’s hepatitis C disability under the rating criteria, including any sequelae such as cirrhosis, anemia, thrombocytopenia, and malignancy of the liver. In particular, the examiner should indicate whether there is daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication. He or she should also state the total duration of any incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) over the past 12 months. It should be noted that an “incapacitating episode” means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. The examiner should indicate whether the Veteran has cirrhosis, and if so, to delineate all pathology and symptomatology attributable to the cirrhosis of the liver for the period prior to January 6, 2012, to include whether the symptomatology associated with the Veteran’s cirrhosis is distinct and separate from any symptomatology associated with his hepatitis C. The examiner should also assess the severity of the signs or symptoms. He or she should specifically state whether the Veteran experienced portal hypertension, splenomegaly, episodes of ascites, hepatic encephalopathy, or hemorrhage from varices or portal gastropathy (erosive gastritis). The examiner should also delineate all pathology and symptomatology attributable to the Veteran’s anemia and thrombocytopenia for the period prior to January 6, 2012. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After any additional records are associated with the claims file, the Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected lumbar spine disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the disability. In particular, the examiner should provide the range of motion in degrees for the Veteran’s thoracolumbar spine. In so doing, the examiner should test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain so in the report. The examiner should also indicate whether there is any form of ankylosis. In addition, he or she should state the total duration of incapacitating episodes during the past 12 months and identify all associated neurologic abnormalities, including whether the Veteran has any bowel or bladder impairment resulting from his service-connected lumbar spine disability. The presence of objective evidence of pain, excess fatigability, incoordination and weakness should also be noted, as should any additional disability (including additional limitation of motion) due to these factors. Further, the VA examiner should indicate whether range of motion measurements for active motion, passive motion, weight-bearing, and/or nonweight-bearing can be estimated for the other VA examinations conducted during the appeal period. See, e.g., June 2010, March 2013, March 2016 VA examinations. If the examiner is unable to provide a retrospective opinion as to these specific range of motion findings, he or she should clearly explain so in the report. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. After any additional records are associated with the claims file, the Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected mood disorder, NOS, and the nature and etiology of any residuals of a head injury that may be present. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. Regarding the service-connected mood disorder, NOS, the examiner should report all signs and symptoms necessary for evaluating the disability under the rating criteria. The findings of the examiner should address the level of social and occupational impairment attributable to the Veteran’s mood disorder, NOS. If the examiner is unable to distinguish between the symptoms associated with the mood disorder, NOS, and any symptoms associated with the separately service-connected disability or a non-service connected disability, he or she should state so in the report and provide an explanation Regarding the claimed residuals of a head injury, the examiner should identify all current residuals of a head injury, other than vascular headaches, a seizure disorder with disorientation and dizziness, and a lumbar spine disorder. He or she should specifically state whether the Veteran has cognitive disorder, NOS. For each disorder identified, the examiner should state whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to the Veteran’s military service, to include a parachuting accident and head injury therein. The examiner should also state whether it is at least as likely as not that the cognitive disorder was either caused by or aggravated by a service-connected disability, to include hepatitis C with cirrhosis of the liver and vascular headaches. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 5. The AOJ should review the examination reports to ensure compliance with this remand. If the reports are deficient in any manner, the AOJ should implement corrective procedures. 6. After completing the above actions, the AOJ should conduct any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Wulff, Associate Counsel