Citation Nr: 21073178 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 16-36 275 DATE: December 7, 2021 ORDER The claim for entitlement to service connection for a back disability to include degenerative arthritis, degenerative joint disease, and degenerative disc disease of the lumbar spine is denied. Beginning November 5, 2012, the claim for entitlement to an initial 20 percent rating, and no greater, for left knee disability evaluated as residuals of meniscal impairment of the left knee is granted. The claim for entitlement to an initial rating greater than 10 percent for left knee disability evaluated as limitation of flexion is denied. The claim for entitlement to an initial rating greater than 10 percent for left hip degenerative joint disease with limitation of flexion is denied. The claim for entitlement to an initial compensable rating for left hip degenerative joint disease with limitation of extension is denied. The claim for entitlement to an initial compensable rating for left hip degenerative joint disease with impairment of the left thigh is denied. REMANDED The claim for entitlement to service connection for a headache disorder, to include as secondary to the service-connected temporomandibular joint (TMJ) disorder is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. A back disability to include degenerative arthritis, degenerative joint disease, and degenerative disc disease of the lumbar spine did not have its onset during active service, is the not the result of active service or any incident therein and may not be presumed to be. 2. Beginning November 5, 2012, and throughout the period on appeal, the service-connected left knee disability is manifested by symptomatic residuals of debrided cartilage including meniscal tear with frequent episodes of joint locking and clinicals findings of effusion. 3. The 20 percent rating is the highest rating afforded under Code 5258. 4. Throughout the period on appeal, the service-connected left knee disability is manifested by zero degrees extension to 90 degrees flexion at its most limited with consideration for pain, pain on movement, pain on with and without weightbearing; and pain, weakness, fatigability, incoordination or lack of endurance on flare-ups and repetitive motion; and is not manifested by ankylosis, impairment of the tibia and fibula, or genu recurvatum. 5. Throughout the period on appeal the service-connected left hip disability is manifested by zero degrees extension to 80 degrees flexion at its most limited and is not productive of abduction motion lost beyond 10 degrees, adduction or rotation motion limited such that crossing legs or toeing-out more than 15 degrees is prohibited with consideration for pain, pain on movement, pain with and without weightbearing; and pain, weakness, fatigability, incoordination or lack of endurance on flare-ups and repetitive motion; and is not manifested by ankylosis, flail joint, or other impairment of the femur with nonunion, fracture of the surgical neck with false joint, or malunion. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability to include degenerative arthritis, degenerative joint disease, and degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. Beginning November 5, 2012 and throughout the period on appeal, the criteria for an initial 20 percent rating and no greater for symptomatic residuals of left knee meniscal impairment with episodes of locking and effusion 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5257, 5258. 3. The criteria for a rating greater than 10 percent for left knee degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, Codes 5260, 5261, 5256, 5262, 5263. 4. The criteria for a rating greater than 10 percent for degenerative joint disease of the left hip evaluated as left hip flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (Code) 5252. 5. The criteria for a compensable rating for degenerative joint disease of the left hip evaluated as left hip extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, Code 5251. 6. The criteria for a compensable rating for degenerative joint disease of the left hip evaluated as left thigh impairment have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, Codes 5253, 5250, 5254, 5255. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active service with the U.S. Army from May 1980 to May 1983. Service records show the Veteran served in the U.S. Army Reserve from May 1983 to June 1986. These claims come before the Board from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. During the pendency of this appeal, the claim for service connection for TMJ was granted in a February 2021 rating decision. Hence, the claim for service connection is no longer on appeal. This case was remanded in January and May 2020. That development having been completed, the case is now again before the Board. For reasons explained below, the issues of entitlement to service connection for migraine headaches and to TDIU are again remanded for additional development. The Veteran's attorney withdrew representation in July 2020. In a June 2021 letter, the Board advised the Veteran of this and asked the Veteran to select another representative, should he wish to do so. The Veteran selected Disabled American Veterans (DAV), but neglected to have a representative from DAV sign the power of attorney (VA Form 21-22). In July 2021 and August 2021 letters, the Board advised the Veteran he need to have a representative of DAV sign the power of attorney to make representative effective, and if he did not, the Board would proceed as though he was not represented. The Veteran did not respond. The Board will therefore proceed with the appeal as though the Veteran is unrepresented. 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, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 391 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a one-year presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran argues generally that his current back disability is the result of active service. Private treatment records and VA examinations show the Veteran is diagnosed with degenerative arthritis, degenerative joint disease, and degenerative disc disease of the lumbar spine. In addition, the Veteran reported that he injured his back in a motor vehicle accident (MVA) overseas while on active duty. This meets the first two elements of Shedden. However, the record does not show a causal nexus between the currently diagnosed degenerative arthritis, degenerative joint disease, and degenerative disc disease of the lumbar spine and the Veteran's active service. As such, the criteria under Shedden are not met. Reports of medical history and examination at entrance to active service show no reports of spine injury or back pain, or of observations of back or spine symptoms, abnormalities, diagnoses or other findings. In 1983, the Veteran elected not to have a separation examination prior to his discharge. Afterward, medical evidence documents it was not until after a post-service MVA in 2001 that the Veteran sought treatment for a back injury. See Medical Treatment Records Non-Government Facility, received 9/30/2013, pp. 16, 20, and generally; see also Medical Treatment Records Non-Government Facility received 2/26/2014, p. 8. VA examiners in 2013 and 2020 opined the diagnosed back disabilities were not the result of active service or any incident therein. The Veteran reported to both examiners that his back pain began during active service. In addition, he identified two injuries. First, in 2013, he reported falling six to seven feet off a howitzer. In 2020, he further reported the inservice MVA, which he described as occurring while he was stationed overseas. The 2013 VA examiner's rationale is not adequate in that the examiner relied on medical evidence demonstrating no specific cause for the current back disability. The absence of evidence of a back injury, alone, is not an appropriate basis for a negative opinion. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). However, the 2020 VA examiner explained the medical evidence of record showing treatment for a back condition occurring after the post-service MVA provided evidence of an intervening injury to the back. This evidence, the examiner explained, was the more likely cause of the currently diagnosed back disabilities. The 2013 and 2020 VA examiners indicated they had examined the Veteran and reviewed the claims file; and both detailed the Veteran's lay statements in their examination reports. Crucially, the 2020 VA examiner had for review the previous 2013 VA examination, private medical and VA treatment records, and service records as well as having interviewed and examined the Veteran. The Board therefore finds the 2020 VA examination to be probative as to the issue of nexus, because the VA examiner had review of the record, examined the Veteran, and considered the Veteran's lay statements in arriving at the negative medical opinion. In sum, the Veteran has provided medical evidence he is diagnosed with a back disability to include degenerative arthritis, degenerative joint disease, and degenerative disc disease of the lumbar spine. In addition, he has provided lay evidence of the onset of back pain during active service and has attested to inservice injuries including a fall, and an inservice MVA occurring overseas. However, he has not provided medical evidence showing or tending to show a causal link, or nexus, between the currently diagnosed back disability and active service. The 2020 VA examiner opined the currently diagnosed back disability is not the result of active service or any incident therein; there is no medical evidence of a diagnosis of or symptoms of a back disability during active service or within one year of discharge that may be viewed as chronic when viewed in context with the current back disability diagnoses. Rather, the medical evidence shows the onset of the Veteran's back symptoms and treatment following an MVA in 2001/2002. The Veteran has claimed the onset of back pain during active service, which he is competent to do. See Layno, supra. However, the record does not show he has the medical expertise to diagnosis such symptoms as a back disorder or to provide an opinion as to its etiology. Therefore, his lay statements cannot be probative as to the missing element of the etiology of his current back disorder. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). There are no other medical findings, medical statements or opinions showing or tending to show the claimed back disability had its onset during active service or that degenerative arthritis, degenerative joint disease, or degenerative disc disease of the lumbar spine is the result of active service or any incident therein. Accordingly, and because the critical third element of etiology under Shedden is not met, service connection for a back disability to include degenerative arthritis, degenerative joint disease, and degenerative disc disease of the lumbar spine cannot be warranted, and the claim is denied. Increased Ratings The Veteran generally seeks higher ratings for his service-connected left knee and left hip disabilities. These claims arise from the rating decision setting initial ratings assigned, in October 2013. At that time, the agency of original jurisdiction granted service connection for meniscal tear left knee, evaluated under Code 5260 for limitation of flexion movement, and for degenerative joint disease of the left hip, evaluated under Code 5003-5252 for limited and painful but noncompensable extension motion. A 10 percent rating was assigned for each effective November 5, 2012. The Veteran appealed the evaluations initially assigned. Thereafter, and during the course of this appeal, the agency of original jurisdiction (AOJ) granted service connection for left hip degenerative joint disease with limited and painful but uncompensable extension motion and thigh impairment. Zero percent ratings were assigned under Codes 5003-5251 and 5003-5253, effective November 5, 2012. These evaluations have been continued since. Disability evaluations are determined by the application of a schedule of ratings that is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Additionally, in evaluating joint disabilities, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). At the outset, it is noted that the regulations for rating disabilities of the ankle were revised during the pendency of the Veteran's appeal, effective February 7, 2021. See 85 Fed. Reg. 230 (Nov. 30, 2020). Where the law or regulations governing a claim are changed while the claim is pending, the version most favorable to the claimant is applied. While the new version of the regulations may apply only from the effective date of change, here February 7, 2021, the old version of the regulations may apply both prior to the change in regulation and after the change in regulation. Karnas v. Derwinski, 1 Vet. App. 308 (1991); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003 (Nov. 19, 2003), 69 Fed. Reg. 25179 (2004). Here, the old criteria are the more favorable. Concerning the left knee disability, the old criteria are again more favorable. Codes 5256, 5258, 5259, 5260, 5261, and 5263 were not been changed by the revision. Codes 5262 is changed, but does not apply, as the Veteran does not have impairment of the tibia or fibula. Code 5003 and 5010 are changed, but the new Code 5010 requires that post-traumatic arthritis be rated as limitation of motion, dislocation, or other instability under the affected joint. Code 5257, also changed by the revision, now contemplates ligament tear or sprain without or without repair, persistent instability and, for ratings above 10 percent, the prescription by a medical provider of an assistive device or brace, or both. In the case of either Code 5010 or Code 5257, the grant of a separate and/or higher evaluation is uncertain. The new Code 5010 appears to foreclose the award of a separate compensable rating under 5010 and 5257 by including instability as part of the criteria for 5010. The new Code 5257 addresses ligament injury and persistent instability, which the medical evidence does not show for either knee. Rather, the medical evidence reflects no instability in the left knee. Concerning the left hip disability, Codes 5250, 5251, 5252, 5253 and 5254 were not impacted by this change. As to Code 5255, which contemplates malunion of the femur, the regulations were changed; but the medical evidence shows no findings of such nonunion or malunion of the femur. Thus, there is no need to address these revisions further. In any event, the revised regulations would not apply until February 2019, when they came into effect. Given the limited applicability of the new regulations, the Board finds the old criteria are more favorable. The Board will not apply the new regulations to the left knee and left hip claims in the present case. a) Left Knee The Veteran asserts his left knee disability has worsened over time. The medical evidence supports his contentions. Beginning November 5, 2012, the medical evidence supports a 20 percent evaluation under Code 5258 for symptoms of meniscal impairment with frequent episodes of locking and effusion in the left knee joint. This is because VA examination in 2013 shows objective findings of past debrided meniscal tear with current and frequent episodes of joint locking and effusion. In addition, VA examinations in March and September 2020 show frequent locking in the left knee joint with clinical findings of post-operative lateral meniscus changes and effusion by magnetic resonance imaging (MRI). See 38 C.F.R. § 4.71a, Codes 5257, 5258; see also 2013, 2018, March 2020 and September 2020 VA Examinations. The Board is aware the 2018 VA examiner diagnosed left knee meniscal tear but did not attribute any symptoms to the condition. However, for the following reasons the Board still finds the 20 percent rating is warranted during this time period. First, the VA examiner reported not having reviewed the record in conjunction with the examination. Especially here, where the examiner conducted no new clinical tests, the lack of review of the record minimizes the probative value of any conclusions the examiner made as to the totality of the left knee disability because the examiner does not have a historical understanding of past medical procedures, such as the likelihood of any meniscal symptomatology post meniscal debridement. Second, treatment records do not show any additional intervening meniscal repair between the 2013 and 2018 VA examinations. Finally, the Veteran reported worsening symptoms, including inability to stand and walk for prolonged periods of time and inability to climb stairs. These assertions are corroborated in part by the VA examiner's observation that the Veteran was now using a brace regularly in addition to the cane reported and observed in 2013. Hence, the Board finds it improbable that symptoms of meniscal impairment resolved or lessened at the time of the 2018 VA examination. Rather, it is more probable that such symptoms, in fact, continued as reflected in March 2020 VA examination. Accordingly, an initial separate 20 percent rating, and no more, is warranted beginning November 5, 2012 for episodes of locking and effusion in the left knee joint resulting from meniscal impairment under Code 5258. This is the highest rating afforded by Code 5258. See 38 C.F.R. § 4.71a, Code 5258. The Veteran's left knee disability has been assigned a 10 percent rating for left knee limited but uncompensable flexion motion with degenerative joint disease under Code 5260, as explained above. The Board herein changes that Code 50 5003-5260. A higher rating could be warranted under Code 5260 for limitation of flexion to 30 degrees or more. Higher or separate evaluations could also be assigned for limitation of extension motion to 10 degrees or greater under Code 5261, for ankylosis under Code 5256, for recurrent subluxation or lateral instability under Code 5257, for impairment of the tibia and fibular with nonunion or malunion under Code 5262, or genu recurvatum under Code 5263. However, the required manifestations are not present. Rather, and throughout the period on appeal, the service-connected left knee disability is manifested by zero degrees extension to 90 degrees flexion at its most limited with consideration for pain, pain on movement, pain on with and without weightbearing; and pain, weakness, fatigability, incoordination or lack of endurance on flare-ups and repetitive motion. In addition, the medical evidence presents no findings of findings of ankylosis, subluxation or lateral instability, impairment of the tibia and fibula, or genu recurvatum at any time throughout this appeal. 38 C.F.R. § 4.71a, Codes 5003, 5260, 5256, 5261, 5263; see also 2013, 2018, March 2020 and September 2020 VA examinations. The Veteran is competent to report symptoms which he can observe, such as his pain, painful motion, inability to climb stairs, and in ability to stand or walk for long periods of time. The medical evidence is consistent with his assertions, as noted above, and an additional 20 percent rating for symptomatic meniscal impairment with findings of locking and effusion in the left knee joint has been granted herein. However, painful and limited motion is consistent with the 10 percent rating already assigned for limitation of flexion with degenerative arthritis otherwise uncompensable under the diagnostic code. As the evidence does not show, and the Veteran has not stated, he is medically qualified to establish the nature and extent of his left knee disability, the Board finds his statements alone cannot provide the evidence required to award initial greater or additional ratings greater than the 20 percent for impairment of left knee meniscus and the 10 percent for limited left knee flexion. See Layno v. Brown, 6 Bet. App. 465 (1994); Davidson v. Shinseki, 581 F. 3d 1313, 1316 (Fed. Cir. 2009). Accordingly, and based on the medical and lay evidence, beginning November 5, 2013, an additional initial 20 percent is warranted for left knee meniscal impairment with locking and effusion. The appeal is granted. However, and based on VA examinations in 2013, 2018, March 2020, and September 2020 as well as VA and private treatment records, a rating greater than 10 percent for left knee disability manifested by limited flexion is not warranted. The appeal is denied. b) Left Hip The Veteran asserts his left hip disabilities have worsened over time. However, the medical evidence does not support his contentions. The Veteran is currently assigned a 10 percent rating under Code 5003-5252 for impairment of the left hip manifested clinical findings of arthritis by painful and limited flexion motion of the left hip joint that is not otherwise compensable under Code 5252. See Code 5003. However, to warrant a 20 percent rating, there would need to be involvement of two or more major joints, which cannot occur in the case of the hip joint (see Id), or limitation of flexion to 30 degrees or less. However, the medical evidence does not show the required manifestation is present. Rather, left hip flexion motion is limited to 80 degrees at its most limited with consideration for pain, pain on movement and additional impairment due to pain, weakness, fatigability, lack of endurance and/or incoordination due to flare-ups and repetitive motion. See 38 C.F.R. § 4.71a, Codes 5003, 5252; see also, 2013, 2018, March 2020 and September 2020 VA Examinations. Higher or separate ratings are afforded for ankylosis under Code 5250; limitation of extension to 5 degrees or less under Code 5251; impairment of abduction motion lost beyond 10 degrees, or of adduction such that one cannot cross his or her legs, or of rotation such that one cannot toe-out more than 15 degrees under Code 5253. However, the medical evidence does not show that the required manifestations are present. Medical evidence shows no findings of ankylosis, of extension limited to greater than five degrees, of loss of abduction motion beyond 10 degrees, or of adduction or rotation so limited as to preclude crossing his legs or toeing out the affected leg more than 15 degrees. Rather, extension is shown to be limited to greater than five degrees at its most limited with consideration for pain and painful motion, and additional impairment on flare-ups and repetitive motion due to pain, weakness, fatigability, lack of endurance, and/or incoordination. See VA examinations in 2013, 2018, March 2020 and September 2020; see also 38 C.F.R. § 4.71a, Codes 5250, 5251, 5253. It is noted that the 2020 VA examination shows a decrease in joint strength from 5 of 5 to 4 of 5. However, this manifestation in considered in the limited motion assessed, overall, due to weakness as additional impairment resulting from flare-ups and repetitive motion because the VA examiner stated this finding could be expressed in additional limitation of motion. Furthermore, no VA examiner or other medical health care provider has observed findings of atrophy or of muscle injury associated with left hip impairment or of impairment resulting in manifestations other than that of the limited and weakened movement already considered in the overall limitation of motion measurements reported. Additional or higher evaluations may also be afforded for flail joint and for impairment of the femur with fracture, nonunion, or malunion with knee or hip disability under Codes 5254 and 5255. However, these manifestations have not been found to be present at any time throughout the pendency of this appeal. 38 C.F.R. § 4.71a, Codes 5254, 5255. The Veteran is competent to report symptoms which he can observe, such as his pain and painful motion. And the medical evidence is consistent with his assertions, showing painful and limited motion with findings of weakness during the appeal period. Such is consistent with the 10 percent rating already assigned. The evidence does not show, and the Veteran has not stated, he has the qualifications necessary to establish the nature and extent of his left hip injury. Thus, the Board finds the evidence contained in treatment records and VA examinations to be more probative of the extent of the Veteran's left hip disability. Accordingly, and based on the medical and lay evidence, including VA examinations in 2013, 2018, March 2020, and September 2020 as well as VA and private treatment records; An initial rating greater than 10 percent for the service-connected left hip disability manifested as limitation of flexion is not warranted. The appeal is denied. An initial compensable rating percent for the service-connected left hip disability manifested as limitation of extension is not warranted. The appeal is denied. An initial compensable rating for the service-connected left hip disability manifested as impairment of the thigh is not warranted. The appeal is denied. REASONS FOR REMAND The 2021 VA examination for TMJ disorder notes migraine headaches as a symptom of TMJ, and that the Veteran reported that discomfort in his jaw triggers his headaches. Service connection was granted for TMJ in a March 2021 rating decision that assigned a 30 percent evaluation effective from November 2012. Crucially, the 2021 VA examiner linked the Veteran's TMJ to an inservice injury to the jaw. The Veteran reported he noted the onset of popping in the right jaw, pain in his jaw and headaches after this injury. Thus, the medical evidence provides a plausible basis for finding the claimed headaches are the result of or aggravated by the service-connected TMJ. The 2020 VA examiner provided a negative opinion as to a causal nexus between the service-connected tinnitus and the diagnosed headache disorder. However, TMJ was not then service-connected. Remand is required to determine whether the diagnosed headache disorder may be the result of the service-connected TMJ. In addition, by this decision, the Board has granted an increased initial rating for the Veteran's service-connected left knee disorder. The determination as to entitlement to TDIU must await the outcome of a determination as to service connection for a headache disorder as well as to allow the AOJ the opportunity to assign disability evaluations granted by the above decision concerning the service-connected left knee. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matter is REMANDED for the following action: 1. Return the 2020 examination for headaches to the examiner who performed the examination. If the examiner is not available or it is determined the Veteran should have a new examination, schedule the Veteran for examination with the appropriate specialist to determine the nature and etiology of his headache disorder, to include as the result of the service-connected TMJ. The claims file must be reviewed in conjunction with the examination. All headache pathology must be identified. For any headache pathology, the examiner is asked to opine: (a.) Is it more likely than not (50 percent or greater probability) that any currently diagnosed headache disorder is the result of the same inservice head injury that caused the service-connected TMJ or; (b.) in the alternative, is the currently diagnosed headache disorder the result of or aggravated by the service-connected TMJ. 1. For any aggravation found, the examiner must state to the best of their ability the baseline of symptomatology of the headache disorder and amount, quantified if possible, of aggravation of the headache disorder beyond the baseline symptomatology caused by the service connected TMJ. 2. The examiner must provide a full and complete rationale for all opinions expressed. 3. Conduct all appropriate development required and adjudicate the claim for TDIU. 4. If any claims are denied, provide the Veteran and his representative, if any, with a supplemental statement of the case and an appropriate time within which to respond. Thereafter, return the claim to the Board, if in order. N. RIPPEL Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bakke, Lila J. 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.