Citation Nr: 20021555 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 16-11 493A DATE: March 26, 2020 ORDER A 50 percent disability rating for service-connected migraine headaches is granted, subject to the legal authority governing the payment of compensation. REMANDED The claim of entitlement to service connection for a right shoulder condition is remanded. The claim of entitlement to service connection for a bowel disorder, claimed as secondary to service-connected status post-laparoscopic cholecystectomy, is remanded. The claim of entitlement to service connection for decreased libido, claimed as secondary to service-connected cervical spine disability, is remanded. The claim of entitlement to a disability rating higher than 10 percent for status post-laparoscopic cholecystectomy is remanded. The claim of entitlement to a compensable disability rating for esophagitis with gastritis is remanded. FINDING OF FACT Throughout the appeal period, the Veteran’s service-connected migraine headaches have been manifested by very frequent and severe headaches which have required him to lie down in a dark, quiet place for up to several hours, have required the use of ongoing prescription medications, and have resulted in his frequent missing of college courses and loss of his job; and thus, have constituted very frequent, completely prostrating and prolonged headache attacks, productive of severe economic inadaptability. CONCLUSION OF LAW Resolving all reasonable doubt in the Veteran’s favor, the criteria for a 50 percent, but no higher, disability rating for service-connected migraine headaches are met, 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code (DC) 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 2007 to October 2009. He had a period of active duty for training from February to June 2006. This appeal before the Board of Veterans’ Appeals (Board) arose from a March 2014 rating decision in which the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, inter alia, denied higher disability ratings for migraine headaches, status-post laparoscopic cholecystectomy, and esophagitis with gastritis; as well as denied service connection for a bowel disorder, a right shoulder condition, and decreased libido. The Veteran filed a notice of disagreement (NOD) in September 2014, the RO issued a statement of the case (SOC) in February 2016, and the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans’ Appeals) in March 2016. While the Veteran also appealed a claim of entitlement to service connection for a psychiatric disorder, service connection for an acquired psychiatric disorder was granted in a March 2017 rating decision. As such, that service connection claim has been resolved. In May 2016, the Veteran withdrew a prior request to testify at a Board hearing. See 38 C.F.R. § 20.603(e). Evaluation of Migraine Headaches Disability evaluations are determined by comparing a veteran’s present symptomatology with criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. A veteran’s s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is sought, generally, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, in evaluating a claim for a higher initial rating or increased rating, staged rating is appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007) (for increased rating claims); Fenderson v. West, 12 Vet. App. 119, 126 (1999) (for initial rating claims). The Veteran is currently assigned a 30 percent rating for his service-connected migraine headaches under 38 C.F.R. § 4.124a, DC 8100. He contends that a higher rating is warranted for his migraine headaches. Under DC 8100, migraines are rated as follows: a noncompensable rating is warranted with less frequent attacks; a 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in two months over the last several months; a 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once a month over the last several months; and a 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100. The rating criteria do not define “prostrating.” Dorland’s Illustrated Medical Dictionary defines “prostration” as “extreme exhaustion or powerlessness.” Dorland’s Illustrated Medical Dictionary 1554 (31st ed. 2007). Turning to the pertinent evidence of record, the Veteran described the severity of his headaches in a December 2012 statement, noting that medications were not very effective and the he had migraines sometimes lasting several hours and some lasting all night. He maintained that some headaches occurred in the morning, and some kept him from sleeping. He reported that he had migraines several times a week, which were made worse by lighting, and noise or commotion. He noted that the migraines sometimes caused confusion, an inability to think, and affected his memory. He maintained that the migraines were most persistent, and that sometimes the migraines would only get better when he got into a dark, quiet place to relax. The Veteran reiterated many of his contentions in a statement received in March 2013, noting that sometimes his migraine pain was so intense that he could not focus, and he would become slightly nauseous. He noted that he could not be around light when this happened and that the attacks would last several hours. he reported that his headaches occurred five to seven times per week, sometimes as often as 10 times per week. He further reported that when he would have a migraine at school, he would become unfocused and have scattered thoughts, usually requiring him to leave the classroom because of the fluorescent lighting, which would also make him nauseous and irritable. During VA examination in November 2013, the Veteran reported having headaches 12 to 15 times per week, lasting from two hours to two days. The examiner noted that the Veteran’s treatment plan included taking medication, including Topamax daily and Maxalt as needed. The Veteran noted that when he would get a headache, he would take a breath and relax. If the headache did not improve after one-half hour, he would lie down in a dark room. He reported that although he had been taking college courses, he dropped out due to medical issues. He maintained that he was missing three to five classes a week because of migraines. The examiner noted that the Veteran’s headache symptoms included pulsating or throbbing head pain that worsened with physical activity, in the back of the head and neck, behind the ears, and in the top of the head. Additional symptoms included nausea, vomiting, sensitivity to light and sound, changes in vision, and dizziness. The examiner noted that the Veteran had characteristic prostrating attacks of migraine headache pain more than once per month. The examiner did not clearly indicate whether the Veteran had very frequent, prostrating and prolonged attacks of migraine headache pain. In a June 2015 statement, the Veteran noted that he had very severe migraines, which caused him to not be able to see properly, or to be able to focus or concentrate. He indicated that his medications took time to work, and that he would experience headache pain for two to three hours or more, that would cause him to not be able speak, and to forget where he was at times. He also noted that he would get dizzy and lose his balance. He further noted that he would get migraine headaches 12 to 15 times per week, lasting from hours to days. He reported that he would take Topamax and Maxalt but that at times the medications did not work, and that he would have to go to a quiet and dark place. In support of his claim, the Veteran provided an August 2015 private Headaches Disability Benefits Questionnaire (DBQ). In the DBQ, the Veteran’s physician noted that the Veteran used Topamax, Maxalt, and Oxycodone. The Veteran experienced pulsating or throbbing head pain on both sides of the head that worsened with physical activity. Additional symptoms included sensitivity to light and sound. His headaches typically lasted one to two days and occurred more frequently than once per month. The physician noted that the Veteran experienced very frequent, prostrating and prolonged attacks of migraine headache pain. He additionally had non-migraine headache pain, with very frequent, prostrating and prolonged attacks of non-migraine headache pain, and non-migraine headaches occurring more than one time per month. In his March 2016 VA Form 9, the Veteran reported that he was released from his last job due to the severe effects of his headaches, including on his concentration and memory. He maintained that the headaches occurred two to three times per week, and were completely prostrating, even with the use of his prescription medication. He noted that only being in a dark room helped. Based on the evidence presented, and affording the Veteran the benefit of the doubt, the Board finds that a 50 percent rating for the Veteran’s headaches is warranted for the entire appeal period. In this regard, the Veteran’s statements and the examination reports of record clearly demonstrate that he has had very frequent and very severe migraine headaches that have had a significant detriment on his daily functioning throughout the entire appeal period. From the time of the December 2012 statement, the Veteran noted the very frequent nature of his headaches, occurring as frequently as 10 times per week, and that the headaches sometimes lasted all night, affecting his sleep and requiring that he lay in a dark, quiet place. Although the March 2013 VA examination report did not clearly state whether the Veteran’s migraine headache attacks were completely prostrating, the report did note that his headaches were very frequent, and that he forced him to lie down in a quiet, dark place, indicating that his headaches were completely prostrating. Moreover, the Veteran reported that his headaches caused him to miss his college classes three to five times per week. The examiner further noted that the Veteran’s headaches worsened with physical activity, thus further demonstrating that the headaches were productive of severe economic inadaptability. The Board further finds that the severity of the Veteran’s headaches has remained fairly constant throughout the period under consideration int his appeal. In reaching these conclusions, the Board notes that the Veteran is competent to report the severity of his headache symptomatology, including frequency and severity. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). Moreover, his reports are consistent with the examination reports of record, to include the November 2012 VA examination report and the August 2015 private DBQ, which describe migraine headaches of a very frequent and severe nature, significantly inhibiting the Veteran’s daily activities. Further, there is no evidence of record indicating that the Veteran’s headaches are of a lesser severity than he contends. While a 50 percent rating is warranted for the Veteran’s service-connected headache disability for the entirety of the appeal period, no higher rating is assignable at any other time pertinent to the appeal as the assigned 50 percent rating is the highest schedular rating available under DC 8100. The Veteran’s headache disability also has not been shown to involve any other factor(s) warranting any higher rating under any other provision(s) of VA’s rating schedule at any pertinent point. For all the foregoing reasons, the Board finds that with resolution of all reasonable doubt in the Veteran’s favor, the criteria for a 50 percent rating for the Veteran’s migraine headaches are met for the entire appellate period. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53; 38 C.F.R. §§ 3.102, 4.3. As a final point, the Board notes that the claim on appeal has been decided based on the evidence of record, and that no other issues have been raised by the Veteran or the evidence of record with respect to the claim herein decided. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND The Board’s review of the claims file reveals that further agency of original jurisdiction (AOJ) action on the remaining claims on appeal, prior to appellate consideration, is warranted. With respect to the higher rating claims for the Veteran’s gallbladder removal and esophagitis, it appears that the medical evidence of record does not provide a full description of the severity of these disabilities. Notably, the Veteran’s disabilities have been rated under the criteria for gall bladder removal and for hiatal hernia. In the prior August 2015 VA examination report, with respect to his esophageal condition, the Veteran was noted to have reflux, substernal pain, and four or more vomiting episodes per year. The report indicated that the Veteran did not have any other pertinent physical findings, complication, conditions, signs and/or symptoms related to his esophagitis condition. The report did not indicate the severity of the Veteran’s noted symptoms or the overall impact of these symptoms on his health. See 38 C.F.R. § 4.2; see also 38 C.F.R. § 4.114, DC 7346. Additionally, with respect to intestinal conditions, the VA examination report noted that the Veteran symptoms included diarrhea, which, per the report, the Veteran had attributed to his gallbladder removal. The report further noted that the Veteran experienced vomiting two to three times per week, but that he also attributed the vomiting to his migraines. The report did not clearly indicate whether the Veteran had symptoms that were attributable to his gallbladder removal and the severity of any present symptoms. See id. In his March 2016 VA Form 9, the Veteran argued that his intestinal conditions had also caused ulcers. The August 2015 examination report indicated negative findings for ulcers; thus, it appears that the examination findings may also not reflect the current severity of the Veteran’s service-connected gastrointestinal disabilities. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). Based on the above considerations, remand is warranted to afford the Veteran new VA examination to fully describe and to assess the current severity of his service-connected gastrointestinal disabilities. With respect to the Veteran’s claimed bowel disorder, in the August 2015 VA examination report, the examiner indicated that claimed irritable bowel syndrome was less likely than not proximately due to or the result of the Veteran’s service-connected condition. The examiner reportedly based this opinion on review of the medical record and interview with the Veteran, and indicated that his symptoms were more likely than not related to gastroesophageal reflux disease (GERD)/esophagitis and residuals of gallbladder removal than to IBS. Notably, in a prior November 2013 VA examination report, a VA examiner additionally opined that IBS was not cause by or a result of service-connected gallbladder removal. The examiner based this on a lack of literature supporting the association. The examiner indicated that IBS was a clinical diagnosis not based on tests or examinations, and that IBS was caused by a dysmotility disorder of the intestines. The examiner did not provide a clear opinion as to whether IBS was aggravated by the Veteran’s service-connected gall bladder removal. Based on the foregoing, it is unclear whether the Veteran has a current, identifiable bowel disorder, to include IBS, and whether such disorder is at least as likely as not caused by or aggravated by service-connected gall bladder removal. Thus, remand of this claim is warranted to afford the Veteran a new VA examination to obtain an adequate etiology opinion for all appropriately diagnosed bowel disorders. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79 (2006); cf. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). With respect to the claimed right shoulder condition, the medical evidence has clearly noted that the Veteran has suffered right shoulder pain, which appears to have originated from his in-service motor vehicle accident. Imaging studies of the Veteran’s right shoulder, however, have consistently revealed normal results. Additionally, the November 2013 VA examination report indicated that the Veteran’s shoulder was normal on examination. Sensory examination of the Veteran’s shoulder during August 2015 VA examination revealed normal findings. Notably, however, the Veteran reported in a May 2016 statement that he had been diagnosed with bursitis. This diagnosis was no considered by VA examiners. Further, in spite of normal examination findings, the Veteran has consistently reported having chronic right shoulder pain. In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the United States Court of Appeals for the Federal Circuit found that the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” Although specific right shoulder disability has not been diagnosed, the Veteran has reported having pain and the examinations of record have not adequately evaluated/discussed whether such pain resulted in functional impairment. Thus, the Board finds that remand of this claim for new VA examination is warranted, to obtain information as to the nature and etiology of any right shoulder condition, to include any condition resulting in impairment of earning capacity. See 38 U.S.C. § 5103A(d); McLendon, 20 Vet. App. 79; 38 C.F.R. § 3.159; see also See Saunders, 886 F.3d at 1361. With respect to the Veteran’s service connection claim for decreased libido, he has contended that the disability was the result of medications that he took, and as a result of chronic pain. In the November 2013 VA examination report, the examiner diagnosed decreased libido, and opined that the condition was not caused by or a result of narcotic mediations taken for cervical disc disease. The examiner based this opinion on an apparent lack of medical literature. In his March 2016 VA Form 9, the Veteran asserted that his physicians had told him that oxycodone affected libido, and was a listed side effect of the medication. Regardless, the Board notes that the examiner did not consider the effects of the Veteran’s other medications, to include medications for headaches, or the effects of his chronic pain on his libido, per the Veteran’s contentions. Moreover, the examiner did not address whether the Veteran’s decreased libido was aggravated by medications taken for service-connected disabilities or chronic pain. See id. Thus, remand of this claim is warranted to obtain a new opinion as to the nature and etiology of the Veteran’s decreased libido. Prior to scheduling the Veteran for new VA examinations, to ensure that all due process requirements are met, and the record is complete, the AOJ should undertake appropriate action to obtain and associate with the claims file all outstanding, pertinent records. As for VA records, the claims file currently includes VA outpatient treatment records dated through December 2015. Accordingly, the AOJ should obtain all outstanding records of VA evaluation and/or treatment of the Veteran dated since December 2015. The AOJ should also give the Veteran another opportunity to provide additional information and/or evidence pertinent to any remaining claim(s) on appeal (particularly, regarding private (non-VA) treatment), explaining that he has a full one-year period for response. See 38 U.S.C. § § 5103(b)(1); but see also 38 U.S.C. § § 5103(b)(3) (clarifying that VA may decide a claim before the expiration of the one-year notice period). Thereafter, the AOJ should attempt to obtain any additional evidence for which the Veteran provides sufficient information and, if necessary, authorization, following the procedures prescribed in 38 C.F.R. § 3.159. The actions identified herein are consistent with the duties imposed by the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 3.159. However, identification of specific actions requested on remand does not relieve the AOJ of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the AOJ should also undertake any other development and/or notification action deemed warranted prior to adjudicating the remaining claims on appeal. Adjudication of each higher rating claim should include consideration of whether staged rating of the disability is appropriate. These matters are hereby REMANDED for the following action: 1. Obtain complete copies of all outstanding records of VA evaluation and/or treatment of the Veteran, dated since December 2015. Follow the procedures set forth in 38 C.F.R. § 3.159(c) regarding requesting records from Federal facilities. All records and/or responses received should be associated with the claims file. 2. Send to the Veteran and his representative a letter requesting that the Veteran provide sufficient information concerning, and, if necessary, authorization to enable VA to obtain, any additional evidence pertinent to any remaining claim(s) on appeal that is not currently of record, to include any private (non-VA) records. Clearly explain to the Veteran that he has a full one-year period to respond (although VA may decide a claim within the one-year period). 3. If the Veteran responds, assist him in obtaining any additional evidence identified, following the current procedures set forth in 38 C.F.R. § 3.159. All records/responses received should be associated with the claims file. If any records sought are not obtained, notify the Veteran of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo VA gastrointestinal examination, by an appropriate medical professional, for evaluation of his service-connected esophagitis and gallbladder removal. The contents of the entire, electronic claims file, to include a complete copy of this REMAND, must be made available to the designated examiner, and each examination report should reflect consideration of the Veteran’s documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner should clearly identify and comment on the existence and extent (or frequency, as appropriate) of all symptoms of rhe Veteran’s service-connected esophagitis, to include any symptoms of vomiting, material weight loss, hematemesis, melena, anemia, recurrent epigastric distress, dysphagia, pyrosis, regurgitation, and substernal or arm or shoulder pain, and/or any other symptoms productive of severe or considerable impairment of health. The examiner should specifically describe the impact of the Veteran’s symptoms on his overall health. The examiner should also clearly identify and comment on the existence and extent (or frequency, as appropriate) of all symptoms of the Veteran’s service-connected gallbladder removal, and indicate whether such symptoms are mild or severe. All examination findings/testing results, along with complete, clearly stated rationale for the conclusions reached, must be provided. 4. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a VA examination, by an appropriate physician ,for his claimed bowel disorder. The contents of the entire electronic claims file, to include a complete copy of this REMAND, must be made available to the designated physician, and the examination report should reflect consideration of the Veteran’s documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The physician should clearly identify all bowel disorders, to include any IBS, currently present or present at any point pertinent to the current claim (even if now asymptomatic or resolved). Then, for each such identified bowel disorder, the physician should provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability), that such disability (a) was caused OR (b) is, or has been, aggravated (worsened beyond the natural progression) by the Veteran’s service-connected gastrointestinal disabilities, to specifically include gallbladder removal. Both causation and aggravation should be addressed. If aggravation is found, the physician should attempt to quantify the extent of additional disability resulting from aggravation, to include by identifying (to the extent possible), the baseline level of disability prior to aggravation. In addressing the above, the physician must consider and discuss all relevant medical evidence, and all lay assertions as to the nature, onset, and continuity of symptoms, to specifically include the Veteran’s reports that he has suffered chronic diarrhea as a result of his gallbladder removal. In this regard, the physician is advised that the Veteran is competent to report his symptoms and history, and that his assertions in this regard must be considered and discussed in formulating the requested opinions. If lay assertions in any regard are discounted, the physician should clearly so state, and explain why. All examination findings/testing results, along with complete, clearly stated rationale for the conclusions reached, must be provided. 5. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a VA examination of his right shoulder by an appropriate physician. The contents of the entire electronic claims file, to include a complete copy of this REMAND, must be made available to the designated physician, and the examination report should reflect consideration of the Veteran’s documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The physician should clearly identify all right shoulder disabilities/conditions, to include bursitis, neurological impairment, and/or any condition manifested by pain and resulting in functional impairment (such impairment must be identified), currently present or present at any point pertinent to the current claim (even if now asymptomatic or resolved). Then, for each such identified right shoulder disability/condition, the physician should provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability), that such disability: (a) had its onset in service, or is otherwise medically related to service, to include the Veteran’s in-service motor vehicle accident; or, if not, (b) was caused OR is, or has been, aggravated (worsened beyond the natural progression) by the Veteran’s service-connected cervical spine disability. Both causation and aggravation should be addressed. If aggravation is found, the physician should attempt to quantify the extent of additional disability resulting from aggravation, to include by identifying (to the extent possible), the baseline level of disability prior to the aggravation. In addressing the above, the physician must consider and discuss all pertinent medical and lay evidence of record, to include assertions as to the nature, onset, and continuity of symptoms. If lay assertions in any regard are discounted, the physician should clearly so state, and explain why. All examination findings/testing results, along with complete, clearly stated rationale for the conclusions reached, must be provided. 6. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo a VA examination for decreased libido, by an appropriate physician. The contents of the entire electronic claims file, to include a complete copy of this REMAND, must be made available to the designated physician, and the examination report should reflect consideration of the Veteran’s documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the physician prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner is asked to provide an opinion, consistent with sound medical principles, as to whether it is at least as likely as not (i.e., a 50 percent or greater probability), that the Veteran’s decreased libido disability (a) was caused OR (b) is, or has been, aggravated (worsened beyond the natural progression) by service-connected musculoskeletal and neurological disabilities, to include as a result of medication (including oxycodone) to treat such disabilities, and/or chronic pain associated with the disabilities. Both causation and aggravation should be addressed. If aggravation is found, the physician should attempt to quantify the extent of additional disability resulting from aggravation, to include by identifying (to the extent possible), the baseline level of disability prior to aggravation. In addressing the above, the physician must consider and discuss all relevant medical evidence, and all lay assertions as to the nature, onset, and continuity of symptoms, to specifically include the Veteran’s reports of being told that his medications, to include oxycodone, resulted in his decreased libido. In this regard, the physician is advised that the Veteran is competent to report his symptoms and history, and that his assertions in this regard must be considered and discussed in formulating the requested opinions. If lay assertions in any regard are discounted, the physician should clearly so state, and explain why. All examination findings/testing results, along with complete, clearly stated rationale for the conclusions reached, must be provided. 7. To help avoid future remand, ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 8. After completing the requested actions, and any additional notification and/or development deemed warranted adjudicate the remaining claims on appeal, considering all pertinent evidence (to include all evidence added to the electronic claims file since the last adjudication) and legal authority (to include, for each higher rating claim, consideration of whether staged rating of the disability is appropriate). JACQUELINE E. MONROE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael Wilson, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.