Citation Nr: 20031685 Decision Date: 05/05/20 Archive Date: 05/05/20 DOCKET NO. 19-09 408 DATE: May 5, 2020 ORDER Entitlement to a disability rating in excess of 40 percent for concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body for the period on appeal prior to December 27, 2013 is denied. Entitlement to a disability rating in excess of 90 percent for concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body for the period on appeal from December 27, 2013 to March 5, 2018 is denied. Entitlement to a disability rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for perforated right eardrum is denied. Entitlement to peripheral neuropathy of the left lower extremity, as secondary to service-connected prostate cancer status-post retropubic prostatectomy, is denied. REMANDED Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. FINDINGS OF FACT 1. For the period on appeal prior to December 27, 2013, the Veteran’s service-connected eye disability was manifested by anatomical loss of the right eye and impairment of visual acuity of, at worst, 20/40 or better in left eye. 2. For the period on appeal from December 27, 2013 to March 5, 2018, the Veteran’s service-connected eye disability was manifested by anatomical loss of the right eye and impairment of visual acuity of, at worst, 20/400 in the left eye. 3. Throughout the appellate period, the Veteran’s service-connected PTSD has been manifested by, at worst, occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. 4. The preponderance of the evidence fails to establish that the Veteran has or had a diagnosis of perforated right eardrum at any time during the pendency of the appeal. 5. The preponderance of the evidence fails to establish that the Veteran has or had a diagnosis of peripheral neuropathy of the left lower extremity at any time during the pendency of the appeal. CONCLUSIONS OF LAW 1. For the period on appeal prior to December 27, 2013, the criteria for the assignment of a rating in excess of 40 percent for concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.79, Diagnostic Code 6063 (2019). 2. For the period on appeal from December 27, 2013 to March 5, 2018, the criteria for the assignment of a rating in excess of 90 percent for concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.79, Diagnostic Code 6063 (2019). 2. The criteria for an evaluation in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2019). 3. The criteria for service connection for perforated right eardrum have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2019). 4. The criteria for service connection for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from June 1964 to December 1969. During his period of service, he earned the National Defense Service Medal, Vietnam Campaign Medal (1960-), Vietnam Service Medal with One Star and Purple Heart Medal. Increased Rating Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Consideration must be given to increased evaluations under other potentially applicable Diagnostic Codes. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The Veteran’s entire history is reviewed when assigning disability ratings. See generally 38 C.F.R. § 4.1. If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based upon the facts found. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). But where service connection has already been established, and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The relevant 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. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a higher rating for concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body in excess of 40 percent for the period on appeal prior to December 27, 2013 Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c). The Veteran is assigned a 40 percent rating for his service-connected concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body for the period on appeal prior to December 27, 2013. He contends that a higher rating warranted. The Veteran’s concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body is currently evaluated under DC 6063, applicable to anatomical loss of one eye. Anatomical loss of one eye is evaluated under the criteria for Impairment of Central Visual Acuity. 38 C.F.R. § 4.79. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15,316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. As the Veteran’s claims on appeal pertain to staged ratings that pre-date the May 13, 2018 effective date of the regulatory change, the amended regulations are not for application in the present case. Diagnostic Code 6063 provides ratings where there is anatomical loss of one eye. Where the visual acuity in the other eye is 20/40, a 40 percent rating is warranted. Where vision in the other eye is 20/50, a 50 percent is warranted. Where the visual acuity in the other eye is 20/70 or 20/100, a 60 percent rating is warranted. Where vision in the other eye is 15/200, an 80 percent is warranted. Where vision in the other eye is 10/200, a 90 percent rating is warranted. Where vision in the other eye is 5/200, a 100 percent rating is warranted. Here, the Veteran appeared for a VA eye conditions examination in November 2012. The examiner noted an anatomical loss of the right eye. An ocular prosthesis had been fitted into the right eye socket. The Veteran’s corrected distance visual acuity was 20/40 or better in left eye. Applying these measurements to the table for Impairment of Central Visual Acuity, visual acuity for the period on appeal prior to December 27, 2013 is consistent with a 40 percent rating for the period on appeal. The November 2012 examination of record shows anatomical loss of the right eye and impairment of visual acuity of, at worst, 20/40 or better in the left eye, which warrants a 40 percent rating. See 38 C.F.R. § 4.79, Diagnostic Code 6063. Accordingly, a higher rating is not warranted for the period on appeal prior to December 27, 2013. 2. Entitlement to a higher rating for concussion, residuals enucleation right eye and decreased vision left eye with retained metallic foreign body in excess of 40 percent for the period on appeal from December 27, 2013 to March 5, 2018 A December 2013 private treatment note indicates that the Veteran’s corrected distance visual acuity was 20/200 in left eye. An additional December 2013 private treatment note indicates that the Veteran’s corrected distance visual acuity was 20/400 in left eye. A February 2014 VA ophthalmology treatment note indicates that the Veteran’s corrected distance visual acuity was 20/200 in left eye. An August 2016 visual impairment services team report notes that the Veteran’s corrected distance visual acuity was 5/200 up to and including 20/200 in the left eye. A July 2017 visual impairment services visit note indicates that the Veteran’s corrected distance visual acuity was barely 20/400 in the left eye. Applying these measurements to the table for Impairment of Central Visual Acuity, visual acuity is consistent with a 90 percent rating for the period on appeal from December 27, 2013 to March 5, 2018. Medical evidence of record shows anatomical loss of the right eye and impairment of visual acuity of, at worst, 20/400 in the left eye, during the period on appeal from December 27, 2013 to March 5, 2018, which warrants a 90 percent rating. See 38 C.F.R. § 4.79, Diagnostic Code 6063. Accordingly, the Board has considered the totality of the symptoms of the Veteran’s left eye disability and they have been factored into the Board’s decision to deny a disability rating in excess of 40 percent for the period prior to December 27, 2013, and to deny a disability rating in excess of 90 percent for the period from December 27, 2013 to March 5, 2018. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to an increased rating, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 3. Entitlement to a higher rating for PTSD The Veteran is currently assigned a 50 percent rating for his service-connected PTSD. He contends that a higher rating is warranted. The Veteran’s PTSD is currently evaluated under DC 9411, applicable to posttraumatic stress disorder. See 38 C.F.R. § 4.130. A 50 percent rating is warranted where there is 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is 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 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); inability to establish and maintain effective relationships. A 100 percent rating is warranted where there is 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; memory loss for names of close relatives, own occupation, or own name. The use of the term “such as” in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of the symptoms contemplated for each rating, in addition to permitting consideration of other symptoms particular to each veteran and disorder, and the effect of those symptoms on his/her social and work situation. Id. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that “a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” The Veteran appeared for a VA PTSD examination in November 2012. The examiner diagnosed PTSD. The examiner indicated that the Veteran’s level of occupational and social functioning could be best summarized as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran reported mild symptoms of depression and anxiety primarily related to the deaths of his son and several close friends. The examiner noted symptoms of PTSD, including emotional triggers; avoiding activities, places, or people; anhedonia; sense of foreshortened future; and an exaggerated startle response. The examiner indicated that the Veteran had been prescribed Ambien for the treatment of symptoms. The examiner noted additional symptoms of anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; flattened affect; and disturbances of motivation and mood. The Veteran most recently appeared for a VA PTSD examination in March 2018. The examiner diagnosed PTSD. The examiner indicated that the Veteran’s level of occupational and social functioning could be best summarized as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran reported that he continued to have nightmares and disturbing memories of his experiences in Vietnam. He also reported issues of sleep disturbance and emotional detached at times with mild to moderate symptoms of depression. The examiner noted symptoms of depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work like setting; and impaired impulse control, such as unprovoked irritability with periods of violence. The Veteran further reported symptoms of disturbance in both sleep and appetite. He was easily agitated with some anger issues and anhedonia. He also reported a propensity to isolate. The examiner explained that the Veteran appeared to be functioning at approximately the same level as his last evaluation. Upon review of the medical and lay evidence of record, the Board finds that the evidence does not reflect symptoms that would meet the criteria for a rating in excess of 50 percent for any period of time during the pendency of the claim. There is no evidence of 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 intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; spatial disorientation; neglect of personal appearance and hygiene; inability to establish and maintain effective relationships; or symptoms of similar severity. The Board notes that the presence or absence of certain symptoms is not necessarily determinative. These symptoms must also cause the occupational and social impairment in the referenced areas. See Vazquez-Claudio, supra. The Board’s determination is not based solely on the listed symptoms. Rather, the treatment records and VA examination report were not indicative of occupational and social impairment that approximate the criteria for a 70 percent rating. While the evidence of record demonstrates impairment in occupational and social functioning, it does not show such impairment with deficiencies in most areas to warrant an increased rating of 70 percent. Indeed, although the Veteran’s symptoms have impacted his social relationships, at the time of his March 2018 examination, he reported that he lived with his wife of nine years and described his marriage as stable. He also maintained contact with some of the people he worked with prior to retirement. He attended occasional meetings at the bank where he remained on a committee and also played golf with a friend. The social and occupational impairment symptomatology reported by the Veteran and noted in the VA examination report is contemplated by the current 50 percent evaluation. Without evidence of more serious occupational and social impairment, with deficiencies in most areas, a higher rating of 70 percent is not warranted. The Board notes that the March 2018 examiner documented the Veteran’s difficulty in adapting to stressful circumstances, including work or a work like setting; and impaired impulse control, such as unprovoked irritability with periods of violence. However, the presence of two symptoms of a nature contemplated within those listed as examples under the 70 percent rating criteria does not warrant a higher rating. Rather, in adjudicating the present claim, the Board must consider the totality of the Veteran’s array of symptomatology. Overall, the Veteran has not demonstrated symptoms consistent with or approximating the general level of impairment warranting a 70 percent evaluation or akin to the symptoms as found in the rating criteria. Mauerhan, supra. The Board also finds that the Veteran’s disability does not warrant an even higher 100 percent disability rating for a “total” occupational and social impairment. In particular, although the Veteran clearly has social difficulties because of his PTSD, the Veteran’s stable marriage and relationships with past coworkers and a friend demonstrate that the Veteran is not “totally” socially impaired. Additionally, there is no indication in the medical evidence of record that the Veteran’s symptomatology warranted other than the currently assigned 50 percent disability rating throughout the appeal period. Assignment of staged ratings is not warranted. See Fenderson, supra. Accordingly, the Board finds that the claim of entitlement to a disability rating in excess of 50 percent for PTSD must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to an increased rating, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz, supra. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to prevail on a claim of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a) (2019). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2019); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a Veteran has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. 4. Entitlement to service connection for perforated right eardrum The Veteran contends that he is entitled to service connection for perforated right eardrum that is related to his military service. A review of the medical evidence of record fails to establish that the Veteran has been diagnosed with perforated right eardrum at any time during the appeal period or proximate thereto. The Veteran appeared for a VA ear conditions examination in November 2012. The examiner noted diagnosis of a perforated eardrum in 1969. The Board notes that service treatment records indicate diagnosis of perforation of left tympanic membrane in July 1969. Upon examination, the VA examiner did not diagnose perforated right eardrum. Accordingly, the Board finds that the evidence does not support a finding that the Veteran has a current diagnosis of perforated right eardrum throughout the appeals period. See Brammer, supra; McClain, supra; Romanowsky, supra. Without such evidence, service connection for perforated right eardrum cannot be granted. See Shedden, supra. Accordingly, the first element of Shedden is not met. Although the Board is sympathetic to the Veteran’s claim, the preponderance of the evidence is against the Veteran’s claim of service connection for perforated right eardrum. Accordingly, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz, supra. 5. Entitlement to peripheral neuropathy of the left lower extremity The Veteran contends that he is entitled to service connection for peripheral neuropathy of the left lower extremity that is secondary to service-connected prostate cancer status-post retropubic prostatectomy. A review of the medical evidence of record fails to establish that the Veteran has been diagnosed with peripheral neuropathy of the left lower extremity at any time during the appeal period or proximate thereto. The Veteran appeared for a VA peripheral nerves conditions examination in November 2012. The examiner noted a 1969 diagnosis of traumatic nerve damage of the median cutaneous nerve in the left lateral arm. The examiner further noted paresthesias and/or dysesthesias in the right lower extremity and numbness in the right upper extremity. Upon examination, the VA examiner did not diagnosis peripheral neuropathy of the left lower extremity. The Veteran most recently appeared for a VA peripheral nerves conditions examination in March 2018. The examiner diagnosed traumatic nerve injury, right upper and lower extremities, residuals of shell fragment wound. Upon examination, the VA examiner did not diagnose peripheral neuropathy of the left lower extremity. Accordingly, the Board finds that the evidence does not support a finding that the Veteran has a current diagnosis of peripheral neuropathy of the left lower extremity throughout the appeals period. See Brammer, supra; McClain, supra; Romanowsky, supra. Without such evidence, service connection for peripheral neuropathy of the left lower extremity cannot be granted. See Shedden, supra. Accordingly, the first element of Shedden is not met. Although the Board is sympathetic to the Veteran’s claim, the preponderance of the evidence is against the Veteran’s claim of service connection for peripheral neuropathy of the left lower extremity. Accordingly, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz, supra. REASONS FOR REMAND 1. Entitlement to SMC based on the need for aid and attendance SMC is payable to a veteran, who, as a result of service-connected disability, has suffered the anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less, is permanently bedridden or is so helpless as a result of service-connected disability that he or she is in need of the regular aid and attendance of another person. 38 U.S.C. § 1114(l) (2012); 38 C.F.R. § 3.350(b) (2019). The factors considered to determine whether regular aid and attendance is needed include: inability to dress or undress, or to keep herself ordinarily clean and presentable; frequent need to adjust special prosthetic or orthopedic appliances which by reason of the particular disability requires aid (this does not include adjustment of appliances that persons without any such disability would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect a claimant from the hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a). The Veteran contends that his service-connected eye disability warranted the need of regular aid and attendance of another person. The Board notes that the Veteran has not been afforded a VA aid and attendance examination to assess whether he requires the assistance of another person as a result of his service-connected eye disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). As such, the Board finds that a remand for examination is warranted. The matter is REMANDED for the following action: Schedule the Veteran for an examination with an appropriate VA clinician to ascertain whether his service-connected eye disability renders him in need of regular aid and attendance. Specifically, the examiner is asked to provide an opinion on whether the Veteran’s service-connected disabilities prevent him from protecting himself from the hazards incident to his environment, keeping himself clean and presentable, dressing or undressing himself, feeding himself, attending to the wants of nature, or otherwise require regular aid and attendance by another person. The examiner is reminded that it is not required for all the disabling conditions enumerated above be found to exist before a favorable evaluation may be made. The particular functions which the Veteran is unable to perform must be considered in connection with his condition as a whole. The examiner must observe the Veteran’s abilities to perform these tasks and comment accordingly. The examiner must be mindful that the need for aid and attendance need only be regular, not constant, for an affirmative opinion to be provided. The examiner must provide all findings, along with a complete rationale for any opinions provided. The examiner must also provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Joseph, Associate 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.