Citation Nr: 21064747 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-27 113 DATE: October 21, 2021 ORDER The claim of entitlement to service connection for osteoarthritis of the left first metatarsophalangeal (MTP) joint is granted. The claim of entitlement to an initial disability rating in excess of 10 percent for the left fifth toe scar is denied. The claim of entitlement to an effective date prior to August 5, 2016, for the grant of service connection for left fifth toe scar is denied. REMANDED The claim of entitlement to a disability rating in excess of 10 percent for hammertoe of the left fifth toe is remanded. The claim of entitlement to a disability rating in excess of 10 percent for hammertoe of the right fifth toe is remanded. Entitlement to an effective date earlier than August 5, 2016, for the grant of a 100 percent rating for hammertoe left fifth toe is remanded. The claim of entitlement to service connection for a psychiatric disorder is remanded. The claim of entitlement to service connection for a left knee disorder is remanded. The claim of entitlement to service connection for a right knee disorder is remanded. The claim of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The probative, competent evidence is at least in relative equipoise as to whether the Veteran's osteoarthritis of the left first MTP joint was caused or aggravated by his service-connected hammertoe of the left fifth toe. 2. The Veteran's left fifth toe scar is approximately 2 centimeters long and painful; it is not unstable and it is not associated with underlying soft tissue damage with an area greater than 39 square centimeters. 3. On July 12, 2016, the Veteran filed a claim for an increased rating for his service-connected hammertoe of the left fifth toe. 4. The Veteran was granted service connection for left fifth toe scar, effective August 5, 2016. 5. For the left fifth toe scar, the increase in disability occurred after July 12, 2016. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for osteoarthritis of the left first MTP joint have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for an initial disability rating in excess of 10 percent for left fifth toe scar have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.118, Diagnostic Codes 7801, 7802, 7804, 7805. 3. The criteria for entitlement to an effective date prior to August 5, 2016, for the award of service connection for left fifth toe scar have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service in the United States Army from October 1975 to October 1979. In Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that the scope of a mental health disability claim includes any mental health disability that could reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. In compliance with this case law, the Board considers the Veteran's claim of entitlement to service connection for posttraumatic stress disorder (PTSD) as one that encompasses any psychiatric disorder. The Veteran requested a Board hearing by way of his substantive appeal. In September 2021, the Veteran's representative withdrew the hearing request. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310 (b). See Allen v. Brown, 7 Vet. App. 439, 448 (1995). 1. Entitlement to service connection for osteoarthritis of the left first MTP joint. The Veteran asserts that his osteoarthritis of the left first MTP joint is secondary to his service-connected hammertoe of the left fifth toe. A January 2020 left foot x-ray revealed severe degenerative changes at the left first MTP joint. The claims file contains conflicting medical opinions regarding the etiology of the Veteran's osteoarthritis of the left first MTP joint. An April 2014 VA examiner opined that the Veteran's osteoarthritis of the left first MTP joint was less likely than not proximately due to or the result of his service-connected hammertoe of the left fifth toe. The VA examiner provided the following rationale: Hallux valgus or bunion is a result of excessive calcium deposit at the first MTP joint of the foot due to excessive friction placed over the joint with walking and standing in tight footwear. The calcium deposits is the body's attempt to self-heal the damage done by the excess friction placed on the articular surface of the joint and also resulted in osteoarthritis. Hammertoes result from excessive flexion of the toes with prolonged walking. A hammertoe does not result in the development of hallux valgus or osteoarthritis. Based on this, the patient's left first toe condition is not a result of his left fifth hammertoe. In August 2021, the Veteran submitted a private medical opinion from B.K., DPM. Dr. K. found that that the Veteran's osteoarthritis of the left first MTP joint was related to his service-connected hammertoe of the left fifth toe. The following rationale was provided: It is my opinion that that [the Veteran] has developed significant arthritis in this joint as a result of change in gait caused by the condition of his fifth toe. I base this opinion on my experience and training. When one area of the foot works abnormally because of pain or structural problems, other areas of the foot take on additional stress and are more readily [subjected] to early arthritic formations. I believe that this is the etiology of the injury to the first MTP on the left foot. Upon review of the record, and resolving doubt in favor of the Veteran, the Board finds that service connection is warranted for the Veteran's osteoarthritis of the left first MTP joint. After reviewing the conflicting medical opinions of record, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's osteoarthritis of the left first MTP joint is secondary to his service-connected hammertoe of the left fifth toe. The August 2021 medical opinion is probative as it was based on a review of the Veteran's medical records and was supported by well-reasoned rationale. Accordingly, resolving the benefit of the doubt in the Veteran's favor, the Board finds that the Veteran's osteoarthritis of the left first MTP joint is related to his service-connected hammertoe of the left fifth toe. Therefore, service connection for osteoarthritis of the left first MTP joint is warranted. Gilbert v. Derwinski, 1 Vet. App. 49, 53-56. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41, 4.42 and Schafrath v. Derwinski, 1 Vet. App. at 589, the Board has reviewed all evidence of record pertaining to the history of the service-connected disability under appeal. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability under review. In addition, the Board notes that it has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although there is an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). As such, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran's claim. 2. Entitlement to an initial disability rating in excess of 10 percent for left fifth toe scar. The Veteran is assigned a 10 percent disability rating for his service-connected left fifth toe scar pursuant to Diagnostic Code 7804. The left fifth toe scar is associated with his service-connected hammertoe of the left fifth toe. Diagnostic Code 7801 indicates that for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear in an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.), a 10 percent rating is warranted. 38 C.F.R. § 4.118, Diagnostic Code 7801. Note (1) provides that a deep scar is one associated with underlying soft tissue damage. Under Diagnostic Code 7802, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear in an area or areas of 144 square inches (929 sq. cm.) or greater warrant a 10 percent evaluation. Id. Note (1) provides that a superficial scar is one not associated with underlying soft tissue damage. Pursuant to Diagnostic Code 7804, a 10 percent rating is warranted for one or two scars that are unstable or painful. Id. A 20 percent rating is warranted for three to four scars that are unstable or painful, and a 30 percent rating is warranted for five or more scars that are unstable or painful. Id. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id., Note (1). If one or more scars are both unstable and painful, 10 percent is to be added to the evaluation that is based on the total number of unstable or painful scars. Id., Note (2). Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an additional rating under Diagnostic Code 7804, when applicable. Id., Note (3). Under Diagnostic Code 7805, other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate diagnostic code. Id. The Board notes that amendments were made to the criteria for rating the skin, effective August 13, 2018. See 83 Fed. Reg. 32, 592 (July 13, 2018). The amendments did not change the criteria for rating scars under Diagnostic Codes 7800 and 7804. With regard to Diagnostic Codes 7801 and 7802, the terms deep, nonlinear, and superficial, were replaced with "underlying soft tissue damage." The revisions also divided the previously referenced body parts into various zones of the body and indicated that separate evaluations may be assigned for each affected zone. The August 2016 VA examination report indicated that the Veteran's left fifth toe scar measured 2 centimeters by 0.1 centimeter. The examiner found that the scar was not unstable or painful and did not exceed an area of greater than 39 square centimeters. A May 2017 VA treatment record noted surgical scars from prior surgeries that were hypertrophic and painful. The podiatrist noted that there were hyperpigmented skin changes of the left fifth toe. A May 2018 VA scars examination report described a linear scar located on the left fifth toe that measured 2 centimeters. The scar was not painful or unstable. The examiner determined that the left fifth toe scar did not result in functional impairment. An April 2019 VA examination report indicated that the Veteran had only one scar associated with the left fifth hammertoe, but in the same document the examiner identified two left fifth toe scars associated with the left fifth hammertoe. The first scar measured 2 centimeters and the other scar measured 0.1 centimeter. The scars were not painful or unstable and they did not exceed an area of greater than 39 centimeters. The examiner identified several scars located on the Veteran's feet, including two scars associated with the Veteran's service-connected hammertoe of the left fifth toe. The other scars were either on the right toe or were the result of his non service-connected left hallux vagus. Based on a review of the evidence, the Board finds that a disability rating in excess of 10 percent is not warranted for the Veteran's left fifth toe scar. See 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805. The evidence does not show that the scar associated with the left fifth hammertoe was greater than 39 square centimeters with associated underlying soft tissue damage, thus, a rating under Diagnostic Code 7801 is not appropriate. There is also no evidence that the scar was greater than 929 square centimeters, thus, a rating under Diagnostic Code 7802 is not appropriate. The medical evidence does not show that the Veteran had more than two painful left fifth toe scars associated with this left fifth hammertoe. Thus, a higher rating under Diagnostic Code 7804 is not warranted. There is no indication that he has a left foot scar that is both painful and unstable, thus, the Veteran is not entitled to an additional 10 percent rating under Diagnostic Code 7804. With regard to Diagnostic Code 7805, the evidence of record does not indicate, and the Veteran does not contend, that there are any other disabling effects resulting from the left fifth toe scar. Accordingly, the left fifth toe scar is appropriately rated as noncompensable under Diagnostic Code 7805 and 10 percent disabling under Diagnostic Code 7804. See 38 C.F.R. § 4.118, Diagnostic Codes 7801-7805. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The claim of entitlement to an increased rating for the Veteran's left fifth toe scar must be denied. Earlier Effective Date Generally, the effective date of an award based on an original claim for compensation benefits, if received more than one year after the claimant's discharge from service, shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (b)(2)(i). The effective date, "shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefore." 38 U.S.C. § 5110 (a). The general rule with respect to the effective date of an award of increased compensation is that the effective date of the award "shall not be earlier than the date of receipt of the application thereof." 38 U.S.C. § 5110 (a). This statutory provision is implemented by regulation that provides that the effective date for an award of increased compensation will be the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (o)(1). An exception to that rule applies, however, under circumstances where the evidence demonstrates that a factually ascertainable increase in disability occurred within the one-year period preceding the date of receipt of a claim for increased compensation. If an increase in disability occurred within one year prior to the claim, the increase is effective as of the date the increase was "factually ascertainable." 38 U.S.C. § 5110 (b)(2); Harper v. Brown, 10 Vet. App. 125 (1997); 38 C.F.R. § 3.400 (o)(1)(2); VAOPGCPREC 12-98 (1998). If the increase occurred more than one year prior to date of receipt of the claim, the increase is effective the date of receipt of the claim. If the increase occurred after the date of receipt of the claim, the effective date is the date of increase. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(1)(2). Effective March 24, 2015, a specific claim in the form prescribed by VA must be filed in order for benefits to be paid or furnished to any individual under laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). Prior to March 24, 2015, a "claim" was defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). The essential elements for any claim, whether formal or informal, are: (1) an intent to apply for benefits; (2) an identification of the benefits sought; and (3) a communication in writing. Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); see also MacPhee v. Nicholson, 459 F.3d 1323, 1326-27 (Fed. Cir. 2006) (holding that the plain language of the regulations requires a claimant to have intent to file a claim for VA benefits). 3. Entitlement to an effective date earlier than August 5, 2016, for the grant of service connection for the left fifth toe scar. On July 12, 2016, the Veteran filed a claim for an increased rating for his service-connected hammertoe of the left toe. In October 2016, the AOJ granted service-connection for a left fifth toe scar and assigned an effective date of August 5, 2016, the date of the Veteran's left toe surgery. Service connection for the left fifth toe scar was granted as secondary to the hammertoe of the left fifth toe and in connection with his increased rating claim, which was received on July 12, 2016. The Board notes that the grant of service connection for the left fifth toe scar is considered a component of the Veteran's July 2016 claim for an increased rating for the left fifth hammertoe. Accordingly, July 12, 2016, is the appropriate "date of claim". Additionally, the Board finds that there was no pending claim for left fifth hammertoe prior to the July 12, 2016, increased rating claim. As noted above, the effective date for an award of increased compensation will be the date of receipt of claim or the date entitlement arose, whichever is later. The evidence shows that the increase occurred after the date of receipt of the claim. Specifically, the Veteran's service-connected left fifth toe scar was the result of his August 5, 2016, left foot surgery. Accordingly, the appropriate effective date is August 5, 2016, the date entitlement arose. In sum, the evidence demonstrates the service-connected left fifth scar was factually ascertainable after August 5, 2016. Accordingly, an earlier effective date is not warranted. REASONS FOR REMAND 1. The claim of entitlement to a disability rating in excess of 10 percent for hammertoe of the left fifth toe is remanded. Please see discussion in paragraph 2. 2. The claim of entitlement to a disability rating in excess of 10 percent for hammertoe of the right fifth toe is remanded. The Veteran asserts that he is entitled to disability ratings in excess of 10 percent for his bilateral hammertoe of the fifth toes. In August 2021, the Veteran submitted a private medical opinion from his treating physician, B.K., DPM. Dr. K. opined that the Veteran's left fifth toe condition was severe since at least 2018, and that his right fifth toe condition was moderate to severe since at least 2017. Dr. K. based the opinion on the multiple left toe surgeries, as well as the pain and altered gait caused by the Veteran's fifth toes. A review of the VA examination reports do not reflect the level of severity described by Dr. K. Notably, a May 2018 VA foot examination noted that the Veteran underwent a left foot hammertoe procedure and that there were no residual signs or symptoms due to the foot surgery. The May 2018 VA examination report showed that the Veteran denied foot pain, flare-ups, and functional loss. The Board notes that the other VA foot examinations that were conducted during the appeal period in April 2014, August 2016, April 2019, and April 2021 also did not reflect the level of severity described by Dr. K. In light of the above, the Board finds that a remand is required to reconcile the findings. In addition, evidence was added to the claims file since the April 2017 and April 2020 statements of the case (SOC). Accordingly, a remand is also required to furnish the Veteran with an SSOC addressing the additional evidence. See 38 C.F.R. § 19.31. 3. Entitlement to an effective date earlier than August 5, 2016, for the grant of a 100 percent rating for hammertoe left fifth toe is remanded. The issue of entitlement to an effective date earlier than August 5, 2016, for the grant of a 100 percent rating for hammertoe left fifth toe is intertwined with the claim of entitlement to an increased rating for the hammertoe of left fifth toe. Harris v. Derwinski, 1 Vet. App. 180 (1991) (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together). Therefore, further consideration of the claim of entitlement to an earlier effective date must be deferred. 4. The claim of entitlement to service connection for a psychiatric disorder is remanded. A May 2020 private treatment record documented the Veteran's complaint of psychiatric symptoms caused by his military experiences. The Veteran has not been afforded a VA examination with respect to his claim for service connection for a psychiatric disorder. Generally, VA must provide a medical examination or obtain a medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2), 38 C.F.R. § 3.159 (c)(4)(i). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, disease or injury is a low threshold. McLendon, 20 Vet. App. at 83. The Board finds the low threshold necessary to provide an examination has been established in this case. 5. The claim of entitlement to service connection for a left knee disorder is remanded. Please see discussion in paragraph 6. 6. The claim of entitlement to service connection for a right knee disorder is remanded. In August 2021, the Veteran reported that his service-connected foot disorders altered his gait, which impacted his knees. The Board finds the low threshold necessary to provide an examination has been established in this case. McLendon, 20 Vet. App. at 83. 7. The claim of entitlement to a TDIU is remanded. The issue of entitlement to a TDIU is intertwined with the issues remanded herein. Harris v. Derwinski, 1 Vet. App. 180 (1991) (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together). Therefore, further consideration of the claim of entitlement to a TDIU must be deferred. The record does not contain a VA Form 21-8940 or comparable information to determine the Veteran's employment and educational history. On remand, the Veteran should be provided a VA Form 21-8940 and the AOJ should undertake all appropriate development and then adjudicate the Veteran's TDIU claim. The matters are REMANDED for the following action: 1. The AOJ should undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claims. If any requested records are not available, the record should be annotated to reflect such, and the Veteran notified in accordance with 38 C.F.R. § § 3.159 (e). 2. Then, the AOJ must provide the Veteran with proper VCAA notice regarding the evidence and information necessary to substantiate his TDIU claim. He should also be requested to complete and return a VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability). 3. Then, the AOJ should schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the severity of his service-connected bilateral hammertoe of the fifth toes for the entire period on appeal (from July 21, 2014, to the present for the right fifth hammertoe and from July 12, 2016, to the present for the left fifth hammertoe). The electronic records should be made available to and reviewed by the examiner. All necessary studies should be performed. Ensure that all information required for rating purposes is provided. The examiner should reconcile the findings with the August 2021 medical opinion/findings provided by B.K., DPM. The AOJ should ensure that the examiner provides all information required for rating purposes 4. Thereafter, the AOJ should afford the Veteran a VA examination by a physician with sufficient expertise, to determine the nature and etiology of the Veteran's psychiatric disorder. All pertinent evidence of record must be made available to and reviewed by the examiner. Any necessary tests and studies should be accomplished. The examiner must identify all psychiatric disorders present during the period of the claim. The examiner should confirm or rule out a diagnosis of PTSD. Following the examination and a review of the relevant records and lay statements, the examiner should state an opinion as to whether it is at least as likely as not that the disorder is etiologically related to the Veteran's active duty service. The examiner must provide a complete rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 5. Thereafter, the AOJ should afford the Veteran a VA examination by a physician with sufficient expertise, to determine the nature and etiology of the Veteran's bilateral knee disorder. All pertinent evidence of record must be made available to and reviewed by the examiner. Any necessary tests and studies should be accomplished. The examiner must identify all knee disorders present during the period of the claim. Following the examination and a review of the relevant records and lay statements, the examiner should state an opinion as to the following: (a) Whether it is at least as likely as not that the disorder is etiologically related to the Veteran's active duty service. (b) Whether it is at least as likely as not that the disorder was caused or aggravated by his service-connected foot disorders. The examiner must provide a complete rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 6. Then, the AOJ should readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran's satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. McKinley, 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.