Citation Nr: 21066822 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 08-10 053 DATE: November 2, 2021 ORDER Entitlement to a 70 percent rating effective July 11, 2007, but no higher and no earlier, for posttraumatic stress disorder (PTSD) is granted. Entitlement to a rating in excess of 10 percent for the appeal period prior to July 26, 2011 for coronary artery disease is denied. Entitlement to a 30 percent rating from July 26, 2011 to May 8, 2019, but no higher and no earlier, for coronary artery disease is granted. Entitlement to a 60 percent rating from May 8, 2019 to September 1, 2020, but no higher and no earlier, for coronary artery disease is granted. Entitlement to higher ratings for residuals of inactive prostate cancer with urinary residuals, rated as 20 percent disabling from February 8, 2011 to May 9, 2013, 40 percent disabling from May 9, 2013 to September 1, 2020, and then 60 percent thereafter, is denied. Entitlement to a compensable rating for orchiectomy of the left testicle is denied. Entitlement to a rating in excess of 10 percent for residuals of frostbite in the right ear is denied. Entitlement to a rating in excess of 10 percent for diverticulitis with constipation and lymphocytic colitis is denied. REMANDED Entitlement to a rating in excess of 10 percent for eczema bilateral lower extremities is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran's favor, the Board find that a letter received on July 11, 2007 detailing the effects of his PTSD as an informal claim sufficient to constitute a claim for increased rating; thereafter, for the complete appeal period beginning on July 11, 2007, the Veteran's PTSD manifested as occupational and social impairment with deficiencies in most areas due to symptoms such as suicidal ideation without total social and occupational impairment. 2. For the appeal period prior to July 26, 2011, the Veteran's coronary artery disease manifested in a workload of greater than 7 metabolic equivalents (METs) but not greater than 10 METs that results in dyspnea, fatigue, angina, dizziness, or syncope without a workload of 7 METs or less, cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or X-ray. 3. For the appeal period from July 26, 2011 to May 8, 2019, the Veteran's coronary artery disease manifested in a workload of greater than 5 METs but not greater than 7 METs that results in dyspnea, fatigue, angina, dizziness, or syncope without more than one episode of acute congestive heart failure in the past year, a workload of 5 METs or less or a left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 4. For the appeal period from May 8, 2019 to September 1, 2020, the Veteran's coronary artery disease manifested in a workload of greater than 3 METs but not greater than 5 METs that results in dyspnea, fatigue, angina, dizziness, or syncope without chronic congestive heart failure, a workload of 3 METs or less or left ventricular dysfunction with an ejection fraction of less than 30 percent. 5. For the appeal period from February 8, 2011 to May 9, 2013, the Veteran's residuals of inactive prostate cancer manifested as urinary incontinence, with urinary residuals manifesting in symptoms requiring the wearing of absorbent materials which must be changed less than twice per day without a daytime voiding interval less than one hour, awakening to void five or more times per night, obstructed voiding, or renal dysfunction. 6. For the appeal period from May 9, 2013 to September 1, 2020, the Veteran's residuals of inactive prostate cancer manifested as urinary incontinence requiring the wearing of absorbent materials which must be changed twice to four times per day without renal dysfunction. 7. For the appeal period beginning on September 1, 2020, the Veteran's residuals of inactive prostate cancer manifested as urinary incontinence requiring the wearing of absorbent materials which must be changed more than four times per day without renal dysfunction. 8. Throughout the period on appeal, the Veteran's orchiectomy of the left testicle manifested as removal of the left testicle without removal or absence of the right testicle. 9. Throughout the period on appeal, the Veteran's residuals of frostbite in the right ear manifested as no more severe than arthralgia, pain, numbness, or cold sensitivity in the right ear without tissue loss, color changes, or hyperhidrosis. 10. Throughout the period on appeal, the Veteran's diverticulitis has manifested in abdominal pain accompanied with frequent episodes of bowel disturbance with abdominal distress, and does not more closely approximate more or less constant abdominal distress. CONCLUSIONS OF LAW 1. The criteria for entitlement to a 70 percent rating effective July 11, 2007, but no higher and no earlier, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to a rating in excess of 10 percent for the appeal period prior to July 26, 2011 for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.31, 4.104, Diagnostic Code 7005. 3. The criteria for entitlement to a 30 percent rating from July 26, 2011 to May 8, 2019, and a 60 percent rating from May 8, 2019 to September 1, 2020, but no higher and no earlier, for coronary artery disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.31, 4.104, Diagnostic Code 7005. 4. The criteria for entitlement to higher ratings for residuals of inactive prostate cancer with urinary residuals, rated as 20 percent disabling from February 8, 2011 to May 9, 2013, 40 percent from May 9, 2013 to September 1, 2020, and 60 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.27, 4.115a, 4.115b, Diagnostic Code 7528. 5. The criteria for entitlement to a compensable rating for orchiectomy of the left testicle have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.115b, Diagnostic Code 7524. 6. The criteria for entitlement to a rating in excess of 10 percent for residuals of frostbite in the right ear have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 3.102, 4.14.14, 4.104, Diagnostic Code 7122. 7. The criteria for entitlement to a rating in excess of 10 percent for diverticulitis with constipation and lymphocytic colitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.114, Diagnostic Codes 7327, 7319. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 1954 to December 1956, and then again from August 1957 to September 1974, including verified combat service within the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal of numerous rating decisions issued by Regional Offices (RO) of the Department of Veterans Affairs (VA). In short, the claims were most recently remanded on July 26, 2021 as pertinent medical evidence was associated by VA with the claims file after a January 25, 2021 Supplemental Statement of the Case (SSOC). A waiver of agency of original jurisdiction (AOJ) review in the first instance was solicited in April 2021 but ultimately not returned by the Veteran. As a result, the claims were remanded. After this remand, the Veteran was subsequently issued a SSOC on August 7, 2021. The Board concludes that the Veteran has been afforded substantial compliance with all previous remand directives except as to the claim for eczema, see Stegall v. West, 11 Vet. App. 268, 271 (1998), and the Board accordingly reasserts jurisdiction. This appeal is advanced on the docket on account of the Veteran's advanced age. 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered because of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods 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). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims. 1. Entitlement to a rating of 70 percent effective July 11, 2007, but no higher and no earlier, for PTSD is granted. By way of background, the Veteran was first granted service connection for PTSD in a May 20, 2006 rating decision. See Rating Decision ( May 20, 2006 ). The Veteran later returned a timely and valid Notice of Disagreement (NOD) that specifically listed disagreements with other issues listed in the May 2006 rating decision, but did not list disagreement with the initial PTSD rating. See NOD (rec'd July 10, 2006 ). The Board concludes that the initial rating for PTSD became final at that point, when the NOD for specific issues other than PTSD was received. The Court of Appeals for Veterans Claims (Court) has explained that, in an original claim for service connection, the date entitlement arouse is governed by the date the claim is received, not the date of the medical evidence submitted to support a particular claim. See McGrath v. Gober, 14 Vet. App. 28 (2000). Where a prior unappealed decision becomes final and binding on a Veteran, the effective date of a subsequent award of service connection is the date of receipt of a reopened claim, not the date of receipt of the original claim. Sears v. Principi, 16 Vet. App. 244 (2002); Melton v. West, 13 Vet. App. 442 (2000). Under VA laws and regulations, a specific claim in the form prescribed by the VA must be filed in order for benefits to be paid or furnished to any individual under laws administered by the VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). Any communication or action indicating intent to apply for one or more benefits under laws administered by the VA, and identifying the benefits sought, may be considered an informal claim. 38 C.F.R. § 3.155(a). The provisions of 38 U.S.C. § 5101(a) mandate that a claim must be filed in order for any type of benefit to accrue or be paid. See Jones v. West, 136 F.3d 1296, 1299 (Fed. Cir. 1998). Further, the mere presence of medical evidence in the record does not establish intent on the part of the Veteran to seek service connection for the benefit in question. Brannon v. West, 12 Vet. App. 32, 34-5 (1998). While the Board must interpret the Veteran's submissions broadly, the Board is not required to conjure up issues that were not raised by the Veteran. Id. The provisions of 38 U.S.C. § 5101(a) mandate that a claim must be filed in order for any type of benefit to accrue or be paid. See Jones v. West, 136 F.3d 1296, 1299 (Fed. Cir. 1998). Further, the mere presence of medical evidence in the record does not establish intent on the part of the Veteran to seek service connection for the benefit in question. Brannon v. West, 12 Vet. App. 32, 34-5 (1998). While the Board must interpret the Veteran's submissions broadly, the Board is not required to conjure up issues that were not raised by the Veteran. Id. In this regard, as of such date, a claimant, or certain other individuals as specified in section 3.155(b), may indicate a claimant's intent to file a claim for benefits by submitting an intent to file a claim to VA. 38 C.F.R. § 3.155(b). An intent to file a claim must provide sufficient identifiable or biographical information to identify the claimant. Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form prescribed by the Secretary, as defined in 38 C.F.R. § 3.160(a), appropriate to the benefit sought within one year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date of the intent to file a claim was received. 38 C.F.R. § 3.155(b). In this regard, VA may not pay a benefit before a claim is made. 38 U.S.C. § 5101; Jones v. West, 136 F.3d 1296, 1299 (Fed. Cir. 1998) (stating that "[38 U.S.C.A. §] 5101 is a clause of general applicability and mandates that a claim must be filed in order for any type of benefits to... be paid under the laws administered by the Secretary.") The mere presence of medical evidence does not establish intent on the part of the Veteran to seek service connection for a disability. Lalonde v. West, 12 Vet. App. 377, 382 (1999); Brannon v. West, 12 Vet. App. 32, 35 (1998). More specifically, a medical examination report is only considered an informal claim for an increase in disability benefits if service connection has already been established for the disability. MacPhee v. Nicholson, 459 F.3d 1323, 1327 (Fed. Cir. 2006); see also 38 C.F.R. § 3.157(b)(1) (medical records can serve as informal claim "when such reports relate to examination or treatment of a disability for which service-connection has previously been established"). Likewise, the mere presence of a disability does not establish intent on the part of the Veteran to seek service connection for that condition. Crawford v. Brown, 5 Vet. App. 33, 35 (1995); KL v. Brown, 5 Vet. App. 205, 208 (1993). On July 11, 2007, the AOJ received a statement from the Veteran's wife, in which she confirmed that "[a]nother ongoing serious problem for him is the torture of PTSD." No later than March 17, 2008, the AOJ subsequently received a typed statement with the Veteran's signature stating "I request the VA reopen my claim for disability compensation benefits for PTSD. My condition has worsened and I request a reevaluation." See VA Form 21-4138 ( Jan. 30, 2008 ) (rec'd Mar. 17, 2008). Resolving all reasonable doubt in the Veteran's favor, the Board interprets the July 11, 2007 submission as an informal claim completed within one year (in this case, on March 17, 2008). As such, the appellate period for PTSD starts on July 11, 2007. While the Board concludes that it simply has no jurisdiction over the propriety of any PTSD rating prior to July 11, 2007, a 70 percent rating is warranted for the entire period on appeal, for reasons to be more fully discussed below. 38 C.F.R. § 4.130 delineates a schedule of ratings for mental disorders other than eating disorders, based upon the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ("DSM-5"). The Veteran's PTSD is rated under the General Rating Formula for Psychiatric Disabilities (General Formula). 38 C.F.R. § 4.130. As per the General Rating Formula, a 50 percent rating is warranted when the Veteran exhibits 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. See 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent rating is warranted when the Veteran exhibits 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. Id. A 100 percent rating is warranted when the Veteran exhibits 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. Id. The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation...requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.3d at 117-118; 38 C.F.R. § 4.130, Diagnostic Code 9411. The Board acknowledges that psychiatric examinations frequently include assignment of a global assessment of functioning (GAF) score. The American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5), and 38 C.F.R. § 4.130 has been revised to refer to the DSM-5. The DSM-5 does not contain information regarding GAF scores. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, without change, the interim final rule and clarified that the provisions of the final rule did not apply to claims that were pending before the Board, this Court, or the United States Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In Golden v. Shulkin, 29 Vet. App. 221 (2018), the Court held that given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. This appeal was certified to the Board in August 2021. As such, the DSM-5 applies, and the GAF scores will not be considered. Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38 C.F.R. § 4.126(a). The Court of Appeals for Veterans Claims (the Court) has held that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment in most areas, warranting a 70 percent rating. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). The Board, in consideration of the Court's holding in Bankhead, duly notes that his PTSD manifested in suicidal ideation as early as July 17, 2007. See VAMC Other Output ( July 17, 2007 ) (rec'd Feb. 13, 2008), at Question No. 11 ("Admits to having had thoughts of suicide, not homicide. Has guns in home but wife has them hid. He is a minister and does not think that God will like it if he commits suicide."); Bankhead, supra. Other suicidal ideations are present throughout the period on appeal. See, e.g.: VA Medical Record (Sept. 26, 2008; Oct. 7, 2008). As there are only six days between the July 17 documented treatment record and the July 11 informal intent to file the claim on appeal, the Board resolves reasonable doubt in the Veteran's favor, by concluding that suicidal ideations are present throughout the appellate period. In addition to the Veteran's documented suicidal ideation throughout the period on appeal, the Board also notes that "[h]e reports depressed mood daily, with attempts to isolate, anhedonia, sleep impairment, concentration decline, low energy." See VA Examination ( July 31, 2008 ), at "Frequency, Severity, and Duration of Non-PTSD Psychiatric/Medical Symptoms." The Board interprets this specific finding of daily depressed mood as indicative of near-continuous panic or depression affecting the ability to function independently. The Board also notes that whereas the Veteran formerly loved golfing and intended to introduce one of his grandchildren to the sport, see VAMC Other Output ( July 17, 2007 ) (rec'd Feb. 13, 2008), supra at Question No. 11 ("[h]e plans to teach him golf. Veteran plays golf to relieve stress and for enjoyment."), this no longer appears possible for the Veteran, see contra VA Medical Record ( Sept. 26, 2008 ) ("According to Veteran, he used to play golf but he lost interest."). The Board concludes that this is comparable to an inability to establish and maintain effective relationships. All of the above are specifically contemplated in a 70 percent rating for PTSD and amount to occupational and social impairment with deficiencies in most areas. 38 C.F.R. § 4.130, Diagnostic Code 9411. The Board also notes that the Veteran has complained of memory loss at the same time, see VA Medical Record (Sept. 26, 2008), supra ("He has difficulty remembering."), and the evidence suggests that the Veteran moved slowly and talks softly albeit clearly. These symptoms alone appear to approximate a 50 percent rating instead of 70 percent. However, the Board can resolve reasonable benefit of the doubt in the Veteran's favor by concluding that the evidence is at least evenly balanced between finding that the of occupational and social impairment more closely approximates deficiencies in most areas, as opposed to merely evincing reduced reliability and productivity. Here, with evenly balanced evidence for a 50 percent rating or a 70 percent rating throughout the period on appeal, the Board awards the higher of these. On account of all of the above, and after resolving all reasonable doubt in the Veteran's favor, the evidence is at least evenly balanced to suggest that the Veteran is entitled to a 70 percent rating effective July 11, 2007, but no earlier and no higher. 38 C.F.R. §§ 4.3, 4.7. As detailed above, the Board has no jurisdiction over the Veteran's PTSD ratings prior to July 11, 2007. The Board must now consider whether the Veteran may be entitled to a rating in excess of 70 percent (in other words, 100 percent) at any time on appeal. The Board concludes that the Veteran is not so entitled. Simply stated, the Veteran does not appear to be totally impaired, both occupationally and socially. The Veteran maintained a relationship with his wife during the appeal period and hence was not totally socially impaired. Upon most recent VA examination, the examiner had the opportunity to endorse the following manifesting symptoms in the Veteran, but did not: 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, or memory loss for names of close relatives, own occupation, or own name. See VA Exam ( Sept. 14, 2020 ), at Question No. 4; see also VA Medical Records ( May 6, 2020 ) (rec'd Jan. 11, 2021), at Page 9 ("Wife says they are doing fine; [...] Orientation: x4. There is no evidence of psychotic thought process. Thoughts are logical, coherent, and linear."). In other words, even though the rating criteria of 38 C.F.R. § 4.130 is not an exhaustive or restrictive list of acceptable symptoms for consideration, the Board concludes that out of many that are specifically contemplated in the rating criteria for a 100 percent rating for PTSD, the Veteran exhibited none of them. 38 C.F.R. § 4.130, Diagnostic Code 9411; Mauerhan v. Principi, 16 Vet. App. at 442, supra. In making its determinations in this case, the Board has carefully considered the Veteran's contentions with respect to the nature of his PTSD and notes that his testimony is competent to describe certain symptoms associated with that disability. The Veteran's history and symptom reports have been considered, including as presented in the medical evidence discussed above, and has been contemplated by the disability ratings that have been assigned. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence when evaluating the pertinent symptoms of the Veteran's PTSD. As such, while the Board accepts the Veteran's testimony concerning the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluations of functional impairment, symptom severity, and details of clinical features of the service-connected condition at issue. The Board has also considered whether a staged rating under Hart, supra is appropriate for the Veteran's PTSD. By awarding a 70 percent rating effective July 11, 2007, the Board has in fact awarded a maximum rating for a psychiatric disorder that is not both totally occupationally and totally socially disabling throughout the period on appeal. The only higher available rating PTSD is for total occupational and social impairment, which has never been demonstrated by any competent or credible evidence of record. Therefore, assigning a staged rating for such disability is not possible or warranted. Finally, neither the Veteran nor his attorney have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). To the extent that the Veteran's new rating increase to 70 percent earlier than previously awarded for PTSD may affect TDIU, see Rice v. Shinseki, supra, this will be further discussed below with respect to special monthly compensation (SMC). Otherwise, there is no further doubt to resolve. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran's claim for increased rating for PTSD is granted to the following extent only: a 70 percent rating effective July 11, 2007, but no higher and no earlier. The remainder of this claim is denied. 2. Entitlement to a 10 percent rating prior to July 26, 2011, then a 30 percent rating thereafter until prior to May 8, 2019, and then a 60 percent rating thereafter until prior to September 1, 2020, but no higher and no earlier, respectively, for coronary artery disease is granted. The Veteran was afforded a rating of 100 percent for coronary artery disease effective September 1, 2020. This grant of a 100 percent rating effective then is a full grant of the sough benefit. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). As such, that portion of the rating is no longer in appellate status. Higher ratings prior to September 1, 2020 are available throughout the remaining period on appeal. The Veteran is presumed to seek the maximum available benefits for disabilities. As such, this claim has been recharacterized accordingly on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). More specifically, the Veteran's claim for service connection for coronary artery disease was first granted in a January 10, 2011 rating decision. This rating decision assigned a 10 percent initial rating effective July 18, 2005. The Veteran has continuously prosecuted an appeal for increased ratings ever since. See, e.g.: NOD (rec'd Feb. 21, 2011 ). The Board accordingly asserts jurisdiction of the ratings from July 18, 2005 until September 1, 2020. See, e.g.: SSOC (Jan. 25, 2021). The disability is rated under 38 C.F.R. § 4.104, Diagnostic Code 7005. This Diagnostic Code assesses coronary artery disease. The Veteran and his attorney have offered no particular argument as to why increased ratings are warranted. The Board has considered other potentially applicable diagnostic codes; however, assuming arguendo that any residual of a heart disorder could be combined without constituting impermissible pyramiding, 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994), the Board concludes that coronary artery disease is the primary disability, and there is no alternative diagnostic code that appears to be more beneficial to the Veteran. By way of background, as of the date of the most recent SSOC, the Veteran's coronary artery disease was rated accordingly: 10 percent from July 18, 2005 until prior to September 1, 2020, and 100 percent thereafter. The Board has thoroughly reviewed the Veteran's medical records as pertaining to coronary artery disease, and it has found evidence suggesting entitlement to a 30 percent rating effective July 26, 2011 and entitlement to a 60 percent rating effective May 8, 2019; however, the Board was unable to find any evidence of entitlement to a 100 percent rating any earlier than September 1, 2020, as already awarded. The Board grants staged rating increases accordingly, to 30 percent effective July 26, 2011 to May 8, 2019, and to 60 percent effective thereafter to September 1, 2020. To the extent that any remaining claim remains, the Board must deny the claim for increased ratings for coronary artery disease in excess of 10 percent from July 18, 2005 until prior to July 26, 2011; in excess of 30 percent thereafter until prior to May 8, 2019; and in excess of 60 percent thereafter until prior to September 1, 2020. Under Diagnostic Code 7005, coronary artery disease is rated accordingly: A 10 percent rating is warranted when a workload of greater than 7 METs but not greater than 10 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required. 38 C.F.R. § 4.14. A 30 percent rating is warranted when a workload of greater than 5 METs but not greater than 7 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilation on electro-cardiogram, echocardiogram, or X-ray. Id. Meanwhile, 60 percent rating is warranted for more than one episode of acute congestive heart failure in the past year, or; when a workload of greater than 3 METs but not greater than 5 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; when there is left ventricular dysfunction with an ejection fraction of 30 to 50 percent. Id. Finally, a 100 percent rating is warranted for chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. Id. The Board has fully and sympathetically considered all medical evidence of recordboth from VA Medical Centers and from non-government facilities. The Veteran appears to have undergone stress tests indicating tolerance of a workload of 5.7 METs on July 26, 2011, and 4.6 METs on May 8, 2019. See Medical Treatment Records Non-Government Facilities ( July 26, 2011 ) (rec'd March 11, 2013); (May 8, 2019) (rec'd Sept. 17, 2019 ). Entitlements to 30 percent and 60 percent effective these dates, respectively, but no earlier and no higher, are duly based upon metabolic equivalent workloads as measured on those dates. Meanwhile, there is simply no evidence to suggest any earlier entitlements to these higher ratings as there is no evidence of a workload of 7 METs or less, nor evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or X-ray any earlier than July 26, 2011. In addition, there is no evidence of more than one episode of acute congestive heart failure in the past year, nor a workload of 5 METs or less, nor evidence of left ventricular dysfunction with an ejection fraction of 30 to 50 percent any earlier than May 8, 2019 and no evidence of chronic congestive heart failure nor workload of 3 METs or less nor left ventricular dysfunction with an ejection fraction of less than 30 percent any earlier than September 1, 2020 (as already awarded). See, e.g.: VA Form 21-0960A ( Oct. 5, 2010 ), at Question No. 5C (measuring left ventricular ejection fraction at greater than 55 percent); Medical Treatment Records Non-Government Facilities ( Jan. 19, 2005 ) (rec'd Oct. 25, 2005); ( Sept. 28, 2007 ) (rec'd Sept. 10, 2016) ("Ejection fraction was estimated at 60 percent."); ( July 10, 2009 ) (rec'd Mar. 29, 2010) ("He has had no angina, palpitations, syncope, or edema"). As a result of these findings within the Veteran's clinical records, a 30 percent rating is warranted effective July 26, 2011 to May 8, 2019, at which time a 60 percent rating is warranted until September 1, 2020, but no higher and no earlier. No higher ratings are warranted, including any higher than 10 percent from July 18, 2005 until prior to July 26, 2011. In reaching its conclusions, the Board acknowledges the Veteran's belief that his coronary artery disease is more severe than is reflected by the currently assigned disability rating. While the Board agreesas clearly endorsed by this Board decision that assigns certain staged rating increases, see Hart v. Mansfield, supra, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his reports regarding the severity of his coronary artery disease. Furthermore, the Veteran has not raised any other issues, nor has any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, supra. There is no further doubt to resolve. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran's claim for an increased rating for coronary artery disease is granted to the following extent only: a 10 percent rating effective July 18, 2005 to July 26, 2011, then a 30 percent rating effective thereafter to May 8, 2019, and then 60 percent disabling effective thereafter to September 1, 2020 (and no earlier or higher), at which point the Veteran is already in receipt of a 100 percent rating for this disorder, and, as a result, the Board no longer has jurisdiction over the claim. The remainder of this claim is denied. 3. Entitlement to higher ratings for residuals of inactive prostate cancer with urinary residuals, currently rated as 20 percent disabling effective February 8, 2011 to May 9, 2013, then 40 percent thereafter to September 1, 2020, and then 60 percent thereafter, is denied. The Veteran's residuals of inactive prostate cancer with urinary residuals are currently rated as 20 percent disabling effective February 8, 2011 to May 9, 2013, then 40 percent thereafter to September 1, 2020, and then 60 percent thereafter, pursuant to the provisions under 38 C.F.R. § 4.115a. Higher ratings are available throughout the period on appeal, while the Veteran is presumed to seek the maximum available benefits for disabilities. As such, this claim has been recharacterized accordingly on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Veteran and his attorney have offered no particular argument as to why increased ratings are warranted. More specifically, the Veteran's residuals of inactive prostate cancer are currently rated under 38 C.F.R. § 4.115a (ratings of the genitourinary system) by considering the predominant area of dysfunctionin this Veteran's case, "continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence." When this residual is the predominant area of dysfunction, a 20 percent rating is warranted when requiring the wearing of absorbent materials which must be changed less than twice per day; a 40 percent rating, must be changed twice to four times daily; a maximum 60 percent rating, must be changed more than four times daily. Id. In other cases, when this residual is not the predominant area of dysfunction, alternative ratings are awarded pursuant to any of the following other alternative residuals: renal dysfunction, urinary frequency, obstructed voiding, or urinary tract infection. Id. All of these except for renal dysfunction are classified as varieties of voiding dysfunction, just like urinary incontinence, as the Veteran's disorder is currented rated. Id. The Board lists these rating criteria for alternative predominant areas of dysfunction in passing, because the Veteran and his attorney have made no argument that any area of dysfunction other than urinary incontinence is predominant. Alternatively, the Board has fully and sympathetically considered all available and pertinent evidence of recordincluding VA treatment record and previous VA examinations, and concludes that there is no competent or credible evidence to suggest this alternative either. By the previous examinations of record, the Veteran was initially afforded a minimum 20 percent rating for residuals of prostate cancer manifesting in urinary incontinence. See VA Examination (Apr. 5, 2011), at Page 2. As of this examination, urinary incontinence was the predominant symptom, but the Veteran did not even require wearing absorbent material. Id.; see also contra, e.g.: VA Medical Record ( Jan. 11, 2012 ) (rec'd Mar. 12, 2020) ("Urine Frequency once at night, pressure and then can't hold it, HAS [FOLLOW-UP WITH A DIFFERENT DOCTOR] FOR THIS") (all capital letters in original). The Board notes in passing that of all potentially predominant symptoms under 38 C.F.R. § 4.115a, a minimum 20 percent rating for urinary incontinence is more advantageous than any other symptom by which the Veteran's residuals of prostate cancer could have been rated. Then, the Veteran underwent subsequent examinations on May 9, 2013, and September 1, 2020. By specific findings at these examinations, respectively, the Veteran then required the use of absorbent materials changed "2 to 4 times per day," and "more than 4 times daily." See VA Exams (May 9, 2013; Sept. 1, 2020), at Question No. 4a, respectively. As such, staged increases to a 40 percent and a 60 percent rating, respectively, were warranted effective those dates. There is no evidence or allegation suggesting that these symptoms were so severe any earlier than what has already been awarded to the Veteran. There is also no evidence or allegation suggesting that urinary incontinence is not the predominant symptom; therefore, the others do not appear to apply to the Veteran in rating this disability. Interpreting this evidence as sympathetically as possible to the Veteran, the Board concludes that the staged rating as is currently provided appears to adequately compensate him for his residuals of inactive prostate cancer rated under 38 C.F.R. § 4.115a with urinary incontinence as the predominant symptom, and as a voiding dysfunction, with no evidence of renal dysfunction. As a result, higher ratings are not warranted. In making its determination in this case, the Board acknowledges the Veteran's belief that his genitourinary disorder may be more severe than reflected by the currently assigned rating. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his own reports regarding the severity of such condition. The Board has also considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's residuals of inactive prostate cancer; however, the Board finds that the Veteran's current staged rating accurately reflects the severity of the disorder and adequately compensates him for it. Ultimately, there is no further staged rating available, nor is there a more advantageous staged rating available that applies to the Veteran's case, nor is there any evidence suggesting that a staged rating should actually be effective earlier than is already being awarded. Therefore, assigning any different staged rating for such disability is not warranted. Furthermore, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the higher rating claim adjudicated herein. See Doucette v. Shulkin, supra. As a result of all of the above, the Board finds that the preponderance of the evidence is against this claim, and higher ratings for residuals of inactive prostate cancer with urinary incontinence as the predominant symptom in excess of what is already awarded must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 4. Entitlement to a compensable rating for orchiectomy of the left testicle is denied. The Veteran generally contends that he is entitled to a higher rating for left orchiectomy, currently rated as noncompensable under Diagnostic Code 7524 for removal of testis/testes. Under this diagnostic code, a noncompensable rating is warranted for the removal of one testis, and a 30 percent rating is warranted for the removal of both testes. 38 C.F.R. § 4.115b. A Note to the diagnostic code provides that, in cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, a rating of 30 percent will be assigned for the service-connected testicular loss. The Note also provides that a testis which is undescended or congenitally undeveloped is not a ratable disability. Id. There is no serious dispute that the Veteran required removal of the left testis due to service-connected trauma. On the other hand, there is simply no evidence or allegation to suggest that the Veteran's right testis is nonfunctional or absent. See contra, e.g.: Medical Treatment Record Non-Government Facility ( Mar. 28, 2010 ) (rec'd Sept. 10, 2016); ( Apr. 5, 2018 ) (rec'd Sept. 16, 2019). The Veteran was afforded a VA examination for the male reproductive organs in January 2021. See VA Exam ( Jan. 13, 2021 ) (rec'd Jan. 15, 2021). This examination confirmed that as of that date, the Veteran underwent removal of the left testis only, but never the right. See id. at Questions Nos. 1 and 2 et seq. The Veteran's erectile dysfunction is already service connected, and he receives special monthly compensation based on the loss of a creative organ for it. To the extent that this examination may have established any entitlement to a compensable rating on account of further residuals of the right (remaining) testis, the Veteran's testes were noted to have been not examined on request of the Veteran. See id. at Question No. 7b. The Board notes here that the Veteran must be prepared to meet his obligations by cooperating with VA efforts to provide an adequate medical examination. See Olson v. Principi, 3 Vet. App. 480 (1992). In this regard, the Court has held that "[t]he duty to assist is not always a one-way street. If a Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Having reviewed the evidence of record, the Board finds that the Veteran has not cooperated with VA efforts to provide him with an adequate medical examination. In this particular circumstance, the Board remanded the Veteran's claim for an addendum opinion on his right testis, on the specific theory that if the Veteran exhibited separate symptomatology there, then he may be entitled to an initial compensable rating. Nevertheless, the Veteran clearly attended this updated examination, but declined examination of the testes. The July 2021 remand, as indicated previously, was simply to allow the AOJ to consider new VA medical evidence in the first instance without a waiver. The August 2021 SSOC then followed. Thus, the Board concludes that the Veteran has been afforded substantial compliance with previous remand directives, see Stegall, supra, and a remand to attempt to obtain another VA examination is not required. See also Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (holding that remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant are to be avoided). After a thorough review of the entirety of the evidence of record, the Board finds that a compensable rating for the Veteran's residuals of orchiectomy is not warranted. In this regard, the Board notes that while the Veteran has clearly undergone orchiectomy of the left testis, there is no evidence suggesting that the right testis is absent or nonfunctional. As such, the evidence of record is insufficient to support a compensable rating under the mechanical application of Code 7524. Additionally, the Veteran has not claimed, nor does the evidence show, that his right testicle is nonfunctioning. Ultimately, the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 5. Entitlement to a rating in excess of 10 percent for residuals of frostbite in the right ear is denied. The Veteran is currently rated at 10 percent for cold injury to the right ear, under Diagnostic Code 7122 which pertains to cold injury residuals. 38 C.F.R. § 4.104. Under Diagnostic Code 7122, a 10 percent rating requires arthralgia or other pain, numbness, or cold sensitivity in affected parts. A 20 percent rating requires arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) in affected parts. A maximum 30 percent rating is warranted for arthralgia or other pain, numbness, or cold sensitivity plus two or more of the following in affected parts: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis). 38 C.F.R. § 4.104, Diagnostic Code 7122. Note (1) to Diagnostic Code 7122 instructs the rater to separately evaluate amputations of fingers or toes, and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy, under other diagnostic codes. Separately evaluate other disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud's phenomenon, muscle atrophy, etc., unless they are used to support an evaluation under Diagnostic Code 7122. The Board concludes that as fingers and toes are not affected by the frostbite on appeal, this Note is not for application. Note (2) to Diagnostic Code 7122 states that each affected part is to be evaluated separately and the ratings combined in accordance with 38 C.F.R. § 4.25 and § 4.26. In order to have a higher evaluation for the right ear, there must be arthralgia or other pain, numbness, or cold sensitivity plus one of the following for 20 percent, or two or more of the following for 30 percent: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) in affected parts. Ultimately, the Veteran was most recently afforded a VA examination on September 1, 2020. Simply stated, there are simply no symptoms in the right ear at this time. There is no serious dispute that the diagnosis is correct and that service connection is warranted; however, there are no symptoms, the Veteran simply stays out of the cold, and there is no evidence that any of the additional symptoms that could warrant a rating in excess of 10 percent have ever been present at any time during the period on appeal. See VA Exam ( Sept. 1, 2020 ), at Questions Nos. 1-3. Aside from this examination result, there is no evidence or allegation of additional symptoms related to residuals of frostbite in the right ear to include tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities. Consequently, the Board concludes that there is no evidence of record to support a rating in excess of 10 percent for residuals of frostbite manifesting in the right ear. As such, the claim must be denied. In reaching these conclusions, the Board finds that the preponderance of the evidence is against the claims. As such, the benefit of the doubt rule is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, supra. 6. Entitlement to a rating in excess of 10 percent for diverticulitis is denied. The Veteran is currently rated at 10 percent for diverticulitis. Disabilities of the digestive system are evaluated under 38 C.F.R. § 4.114, which provides that ratings under Diagnostic Codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348, inclusive, will not be combined with each other. Rather, a single rating will be assigned under the diagnostic code which reflects the predominant disability picture, with evaluation of the next higher rating where the severity of the overall disability warrants such rating. 38 C.F.R. § 4.114. The Veteran's service-connected diverticulitis has been evaluated under the criteria set forth in 38 C.F.R. § 4.114, Diagnostic Code 7327, relating to diverticulitis. Diagnostic Code 7327 instructs to rate as for irritable colon syndrome, peritoneal adhesions, or ulcerative colitis, depending on the predominant disability picture. In this case, a 10 percent rating has been assigned for moderate irritable colon syndrome resulting in frequent episodes of bowel disturbance with abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319. A maximum 30 percent rating is assigned for severe irritable colon syndrome causing diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. Id. Ultimately, the Veteran underwent an updated VA examination on September 1, 2020. At this examination, the examiner concluded that the Veteran does not suffer from ulcerative colitis nor peritoneal adhesions. See VA Exam ( Sept. 1, 2020 ), at Question No. 1B. As Diagnostic Code 7327 instructs the Board to rate the disability according to the predominant area of dysfunction, 38 C.F.R. § 4.114, the Board concludes that as those two symptoms are deemed not applicable, the only remaining applicable Diagnostic Code is 7319 (for irritable colon syndrome)not Diagnostic Code 7323. The examiner then concluded that the Veteran's abdominal distress manifests in frequent episodesnot "more or less constant abdominal distress." See VA Exam, supra, at Question No. 4. While the Board has fully and sympathetically reviewed all pertinent evidence within the claims file, the Board concludes that there is no clinical evidence or allegation to suggest that the Veteran's diverticulitis manifests in symptoms any more severe than "frequent episodes." In other words, the Board concludes that the Veteran's disorder has been adequately compensated throughout the appellate period at 10 percent disabling. See 38 C.F.R. § 4.114, Diagnostic Code 7319. The Veteran is competent to report observable symptoms, such as abdominal pain, constipation, and diarrhea. Layno v. Brown, 6 Vet. App. 465 (1994). However, the competent medical evidence, which offers detailed and specific determinations relating to the rating criteria, is the most probative evidence with regard to evaluating the pertinent symptoms for diverticulitis. The lay testimony has been considered together with the probative medical evidence in evaluating the severity of the Veteran's current symptomatology. There is no evidence of record indicating the Veteran's disability is manifested by weight loss, malnutrition, or serious complications, tumors, or neoplasms that may indicate the predominant disability picture warranted consideration under a different diagnostic code. 38 C.F.R. § 4.114. Neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra. As the preponderance of the evidence is against a finding that the Veteran's disability more nearly approximates the criteria for a higher rating, a higher rating is not warranted. Ultimately, the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND 1. Entitlement to a rating in excess of 10 percent for eczema is remanded. The Board has reviewed the findings from the most recent examination dated September 1, 2020 as to this claim, and the Board concludes that it is precluded from issuing a final determination as to this claim at this time. Even though the examiner concluded that the Veteran has only required topical medication for the past 12 months (albeit with constant or near-constant application), see VA Exam ( Sept. 1, 2020 ), at Question No. 3A, the appellate period spans from October 13, 2005 to the present. Meanwhile, the examiner also stated that symptoms included a rash and itching on legs and went up on his body, and treatment included a pill for "about six to 12 months in the past[, and a] cream and wrapped legs in saran wrap overnight for 1-2 weeks." See id. at Question No. 2A; see also id. at Question no. 2B (no skin disorders listed as "resolved," even though therapies by pill and saran wrap appear to have ended). The Board cannot discern whether this pill was for eczema or else a nonservice-connected disorder. Finally, the Board is also unable to reconcile contradictory statements that the Veteran "Now use[s] cream when needed. Stable with occasional breakouts now." see id at Question No. 2A, except now that topical therapy is "constant/near-constant," see id. at Question No. 3A. As such, a remand is required so that an addendum opinion can be procured. The Board sincerely regrets additional delay that may be incurred as a result of this remand. See Stegall v. West, supra. 2. Entitlement to a TDIU is remanded. The Board notes that a May 2019 rating decision awarded a TDIU effective May 21, 2019, the date service connection for the disability that precluded the Veteran from obtaining gainful employment, namely Parkinson's disease. However, the Board took jurisdiction of the TDIU issue in its December 2017 remand. See Rice v. Shinseki, 22 Vet. App. 447 (2009); see Harper v. Wilkie, 30 Vet. App. 356 (2018) (holding that a grant of TDIU for a portion of the appeal period does not bifurcate the appeal and, therefore, is considered a partial grant of the benefit sought). As a decision on the remanded issue could significantly impact a decision on the TDIU rating issue, the issues are inextricably intertwined. A remand of the TDIU claim is required. See Harris v. Derwinski, 1 Vet. App. 181 (1991). The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, return the claims file to the September 2020 examiner who attempted to assess the current severity of the Veteran's service-connected eczema of the bilateral lower extremities. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following: (a.) The examiner should specifically state which specific skin disorders are still active throughout the appellate period, and which ones have resolved, and when. (b.) The examiner should fully delineate the history of the Veteran's body coverage of characteristic lesions and the nature of systemic therapy from October 13, 2005. The examiner should also indicate the period of time (in terms of start date and end date) during which he was prescribed a pill, and also during which he pursued therapy including cream and saran wrap overnight for weeks, and whether either or both of these treatments were for a service-connected disorder. See VA Exam (Sept. 1, 2020), at Question No. 2B. (c.) The examiner should reconcile the conclusion that the Veteran's current skin disorder requires cream when needed, while it is stable with occasional breakouts, see id. at Question No. 2B, with the contradictory conclusion that same required constant or near-constant topical therapy, see id. at Question No. 3A. (Continued on the next page) The claims file must be made available to and reviewed by the examiners in conjunction with those examiners, and any indicated tests and/or studies should be performed, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael B. Engle, 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.