Citation Nr: 21074464 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 17-54 303 DATE: December 15, 2021 ORDER Entitlement to an initial rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD) is denied. REMANDED Entitlement to service connection for a headache disorder is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU), for the period prior to September 25, 2015 is remanded. FINDING OF FACT The Veteran's service-connected PTSD has caused at most occupational and social impairment with reduced reliability and productivity; it has not resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. CONCLUSION OF LAW The criteria for an initial rating in excess of 50 percent for service-connected PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from July 1965 to April 1969, including a period of active duty for training (ACDUTRA) service. This matter comes before the Board of Veterans Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ) in September 2015, granting service connection for PTSD with an initial 30 percent rating assigned effective May 29, 2015; and in April 2016, denying service connection for a headache disorder and for hypertension. In October 2017, the RO increased the disability rating assigned for the Veteran's PTSD to 50 percent effective May 29, 2015. This matter was previously remanded by the Board in May 2019, for additional development. The case has since been returned to the Board for further appellate action. As a preliminary matter, the Board finds there has been at least substantial compliance with the remand directives for the PTSD claim. Accordingly, the Board will proceed with adjudication of that claim. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). As discussed in greater detail below, additional development is still required with respect to the other appellate claims. While the case was in remand status, in an August 2019 rating decision, the RO granted service connection for erectile dysfunction. As the claim for service connection for erectile dysfunction has been granted in full, it is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Entitlement to an initial rating in excess of 50 percent for service-connected PTSD The Veteran is seeking an increased rating for his service-connected PTSD. He contends the assigned 50 percent rating does not reflect the severity of his symptoms. See October 2017 VA Form 9 (Substantive Appeal). Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations at any point during the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran's PTSD is currently rated as 50 percent disabling under Diagnostic Code 9411 for PTSD, in accordance with the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. Under the general rating formula, a 50 percent rating is warranted for 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 compete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for 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 actives; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A maximum 100 percent rating is warranted for 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. When considering ratings thereunder, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that an initial evaluation in excess of 50 percent for the Veteran's service-connected PTSD is not warranted. The probative evidence of record reflects that the Veteran's psychiatric symptomatology most nearly approximates occupational and social impairment with reduced reliability and productivity; it has not resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. The relevant evidence documents treatment for PTSD in June 2015. At that time the Veteran reported that his mood has been "pretty good" and that he "has not lost his temper lately." In this regard, he explained that he began to shake during an argument with his girlfriend and that he "just waited for it to stop." The Veteran reported that he keeps busy drawing, playing games on his phone, and with two young children in the home. The Veteran was noted to be alert, oriented, and cooperative. His speech had normal rate and tone. His thoughts were noted to be organized and his affect was euthymic. He denied suicidal ideation or homicidal ideation. The Veteran was afforded an initial VA examination in September 2015. The examiner noted the Veteran's report that he has resided with his girlfriend since 2000. The Veteran reported that he had been married twice and that he has no children. He reported that he is close with his siblings and that he has "associates," but no friends. The Veteran reported that he does not belong to any social clubs or organizations. He explained that he can tolerate crowds and groups of others, but that he is guarded around others. He reported that entertains himself and doesn't need to be around others. The Veteran reported that he was last employed by the postal service until he retired in 2001. He reported that he was able to do his job adequately. He reported that he had been fired four times, but that he was able to get his job restored. He reported treatment at the VA. However, he reported that he did not think his treatment was helpful. With regards to symptoms, the examiner noted persistent and exaggerated negative beliefs or expectations about oneself, others, or the world; persistent, distorted cognitions about the cause or consequences of the traumatic event(s); persistent negative emotional state; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; persistent inability to experience positive emotions; irritable behavior and angry outbursts; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; problems with concentration; and sleep disturbance. The examiner noted the Veteran's PTSD symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The examiner also noted symptoms to include depressed mood, anxiety, suspiciousness, near continuous panic or depression affecting the ability to function independently, appropriately, and effectively, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran was noted to be very polite and cordial. The examiner noted the Veteran's behavior was unremarkable. The examiner stated the Veteran was not considered to be in imminent or increased risk for suicidal ideation. The Veteran was diagnosed with PTSD and unspecified depressive disorder. The examiner explained that the Veteran experiences low energy, loss of interest, diminished appetite, and poor concentration due to his depression. The examiner indicated the Veteran's depression preceded PTSD; however, the Veteran's Vietnam deployment exacerbated his depression and that his PTSD developed in response to his combat experience. The examiner concluded the Veteran had occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran was then afforded a review VA examination in July 2016. The examiner noted the Veteran's report that he was living with his girlfriend and that he had gone to a family reunion the weekend prior. The Veteran reported that he has regular phone contact with his sister and limited contact with most others. The Veteran reported that he has a grandchild (his girlfriend's grandchild) who lives with them. He reported a positive relationship with his grandchild. He reported that he has acquaintances, but still "likes to keep [his] distance." He reported continued cordial, but limited interactions with others. He reported that he continues to be suspicious of other people and that he has been that way for several years. The Veteran reported that he has not worked in fifteen years. He reported that he had a history of difficulty getting along with supervisors and that on one occasion he had made plans to "jump the guy." The Veteran reported that he spent nine days on a psychiatric ward and that he was off work for ten months. He reported that he has not been hospitalized for mental health problems since his last examination. He reported seeing a psychiatrist every three months. With regard to symptoms, the examiner noted markedly diminished interest or participation in significant activities; persistent inability to experience positive emotions; irritable behavior and angry outbursts; exaggerated startle response, problems with concentration; and sleep disturbance. The examiner noted the Veteran's PTSD symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The examiner also noted symptoms to include depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran was noted to be on time for his appointment. The examiner noted the Veteran spoke frankly and that he was appropriately irritable at points in describing his history. The examiner remarked the Veteran was not clearly anxious. The examiner stated the Veteran's presentation and descriptions suggest moderate impairment in frustration tolerance due to PTSD and mild impairment in concentration. Occupationally, the examiner indicated the Veteran would have mild to moderate impairment socializing depending on the number of individuals involved and the behavior of co-workers/supervisors. The Veteran was diagnosed with PTSD and unspecified depressive disorder. The examiner concluded the Veteran had occupational and social impairment with reduced reliability and productivity. Subsequent VA treatment records document continued stress in the Veteran's relationship with his girlfriend. In an October 2016 VA treatment record, the Veteran reported that his girlfriend will "get under his skin" and that he will "holler at her." In a November 2016 VA treatment record, the Veteran reported he gets out of the house to shop and attend appointments at the VA. The Veteran also reported that he babysits his granddaughter whom he reports, "climbs all over him." The October 2016 and November 2016 VA treatment records document the Veteran was alert, oriented, and cooperative. His speech was noted to have normal rate and tone. His thoughts were noted to be organized. He denied suicidal ideation or homicidal ideation. In a February 2017 VA treatment record, the Veteran reported several issues with his girlfriend and complained of her many behaviors. He reported he might want to hurt his girlfriend but clarified that he was only joking. He reported that he continues to provide childcare for his young grandchildren and that he drives them around. He reported exercising and playing games on his phone. In a later February 2017 pain management note, the Veteran explained that his goal was to be able to spend more time playing with his grandchildren. He reported distress in his relationship with his girlfriend "caused greater limitation" than pain. The Veteran was noted to be appropriately dressed. He showed no signs of acute distress or agitation. His eye contact was within normal limits. His mood was described as "happy." His affect was noted to be congruent. His speech had normal tone, volume, rate, articulation, and intensity. He denied delusions, paranoia, suicidal ideation, or homicidal ideation. His thought process was noted to be organized with linear process. He was oriented to person, place, time, and situation. He was noted to be cooperative and friendly. In a November 2017 VA treatment record, the Veteran reported increased stress surrounding the purchase of his home. He described his mood as "alright" and as "6-7/10." He stated, "It'll never be at a 10 because I have a controlling girlfriend." He denied suicidal ideation. He reported that "about once per month" he thinks about harming his girlfriend or her son. He stated that was he stopped from doing so because of "my self-image." The Veteran reported that his stepson has a gun in the home that he doesn't always secure it or lock it up. He reported that his girlfriend does not want him to be in the kitchen. It was noted that the Veteran was encouraged to communicate in a more direct manner with his girlfriend and other family in his home so that he may keep the home safe, prepare meals that he wants, and to be in a less controlling environment. The Veteran appeared alert, oriented, and cooperative. His speech had normal rate and tone. His thoughts were noted to be organized. His affect was noted to be euthymic. After assessing the Veteran for suicidality and homicidality, the therapist opined that there was no acute threat to the Veteran or others and that he could be safely followed as an outpatient. In a January 2018 VA treatment record, the Veteran reported that he "feels things are going well." He reported that his girlfriend cooked Thanksgiving/birthday dinner and that they were joined by a cousin for dinner. He reported that he still sees his granddaughter. He reported a recent "episode" with his girlfriend, but that he "mostly tries to ignore her." He reported he has problems with his girlfriend's son, but that he "tries to let things go with him as well." He denied anxiety, but reported depressive feelings for one day in the past month. He reported that he had stopped exercising due to surgery, holidays, and home repairs. He reported that he continues to play games on his phone and provide care for his grandchild. He was noted to be alert, oriented, and cooperative. His speech had normal rate and tone. His thoughts were noted to be organized. He denied suicidal ideation or homicidal ideation. His affect was euthymic. He was noted to be sociable with peers, and in good spirits. It was noted there was no acute threat to self or others. A July 2018 VA treatment record noted the Veteran sees his granddaughter a couple of times per week and that he still drives "everyone, everywhere." He reported his sister was in town and that he was looking forward to going out to dinner. A November 2018 VA treatment record noted the Veteran denied depression, but experiences anxiety every now and again when increased life stressors occur. He reported his relationships were going fine and that one granddaughter lives with him and that another comes over often. Both treatment records note the Veteran was alert, oriented, and cooperative. His speech had normal rate and tone. His thoughts were noted to be organized. He denied suicidal ideation or homicidal ideation. It was noted there was no acute threat to self or others. A May 2019 VA treatment record noted the Veteran's report that he denied depression, but that he did have a couple of times a month when he experienced anxiety. He reported that he doesn't allow himself to get upset "because that only causes me a problem." He reported that his grandchild continues to live with them and that he continues to provide childcare for another granddaughter. He reported both grandchildren keep him busy. A September 2019 VA treatment record noted the Veteran's report that his stepson had moved and had taken his granddaughter with him. He reported his other stepson was living with them. He reported episodes of crying often, but was unable to give specifics about frequency, thoughts, or how it resolves. The therapist noted that they had not been contacted by the Veteran or notified of this. Both treatment records note the Veteran was alert, oriented, and cooperative. His speech had normal rate and tone. His thoughts were noted to be organized. He denied suicidal ideation or homicidal ideation. It was noted there was no acute threat to self or others. The Veteran was then afforded another review VA examination in February 2020. The examiner noted the Veteran's report that he currently lives with his significant other and is the process of buying a house. He reported that he and his significant other have been together for over 20 years. He described the relationship as "stressful" citing "she's controlling" as well as Veteran's own control issues. The Veteran reported that he has no biological children. He stated he had to take care of his five siblings, his sister's children, and his girlfriend's four children. He reported that he and his girlfriend have eleven grandchildren. He reported that he enjoys being around children. The Veteran reported that he is "not very social," that he does not currently belong to any social and/or religious organizations, and that "I pretty much stay in the house." He reported that he enjoys playing games on his phone and that he continues to be cordial in his limited interactions with others. He reported that he is suspicious of other people and has been that way for several years. He reported that he had left his job at the post office in 2001 after a conflict with his supervisor with only having ten months to go before retirement. The Veteran reported, at that time, there was a verbal altercation and that he was about to physically attack his supervisor. The Veteran denied any psychiatric hospitalizations. He indicated that he is not currently engaged in mental health treatment. With regard to symptoms, the examiner noted persistent and exaggerated negative beliefs or expectations about oneself, others, or the world; persistent negative emotional state; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; irritable behavior and angry outbursts; hypervigilance; exaggerated startle response; problems with concentration; and sleep disturbance. The examiner noted the Veteran's PTSD symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The examiner also noted symptoms to include depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less, chronic sleep impairment, mild memory loss, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work-like setting. The Veteran was noted to be on time for the appointment, was appropriately dressed, and had good grooming and hygiene. He was noted to be attentive and cooperative. His thought patterns and expressions were linear, relevant, and logical. His affect was noted to be full-ranging, consistent with mood, and appropriate to session content. He denied current suicidal ideation or homicidal ideation, plan, or intent, as well as any history of suicide attempts. The Veteran did not report and/or describe any current delusions and/or hallucinations. He was not deemed an imminent threat to himself or others at the time of the evaluation. The examiner noted that the Veteran denied any physical altercations since last examination as well as any periods of aggressive behavior (ie, punching walls, throwing objects, breaking things, yelling). The examiner noted the Veteran described his mood as "pretty laid back." The examiner noted that the Veteran did endorse experiencing anxiety and occasional panic attacks, as well as periods of sadness/depression, decreased interest and participation in activities, chronic sleep impairment (some of which is due to sleep apnea, and some of which is due to nightmares/distressing dreams), low energy throughout the day, difficulties with attention/concentration and memory, and decreased appetite. The Veteran was diagnosed with PTSD and unspecified depressive disorder with overlapping and intertwined symptoms. The examiner concluded that the Veteran had occupational and social impairment with reduced reliability and productivity. After engaging in a holistic analysis assessing the severity, frequency, and duration of the signs and symptoms of the Veteran's PTSD, recognizing that the symptoms listed in the rating criteria are non-exhaustive examples and when looking at the effects determining the impairment level, the Board finds that the social and occupational impairment associated with the Veteran's PTSD symptoms is best approximated by the existing 50 percent rating. An increased initial rating in excess of 50 percent is not warranted at any point during the appeal period. See Vazquez-Claudio, 713 F.3d at 117; Bankhead, 29 Vet. App. at 22. Collectively, the above-described evidence reflects that the Veteran's symptoms have included depressed mood, anxiety, suspiciousness, sleep impairment, mild memory loss, impaired judgment, disturbance of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Board acknowledges that the examiner who provided the September 2015 VA examination noted an additional symptom of near continuous panic attacks which is a symptom consistent with a 70 percent rating. However, the records throughout the course of treatment document normal speech, no psychomotor abnormalities, and full-range effect. The Veteran is consistently described as oriented to person, time, and place and he has not shown evidence of near continuous panic attacks. The VA treatment records also consistently document that the Veteran was well-groomed and has not neglected personal hygiene or his appearance. The Board has considered the Veteran's report of thoughts of harming his girlfriend and/or her son during his February 2017 and November 2017 VA therapy sessions. Such is consistent with a 100 percent rating. Additionally, the Board has considered the VA examination reports indicating the Veteran's symptoms to include irritable behavior and angry outbursts. However, the November 2017 VA treatment record notes that after assessing the Veteran for suicidality and homicidality, it was the therapist's opinion that there was no acute threat to the Veteran or others. Moreover, subsequent mental health treatment records indicated there was no acute threat to self or others. See January 2018, July 2018, and May 2019 VA treatment records. Additionally, the February 2020 VA examiner specifically indicated the Veteran denied any physical altercations since last examination as well as any periods of aggressive behavior (ie, punching walls, throwing objects, breaking things, yelling). Thus, there is no indication in the record that this rises to the level of impaired impulse control or persistent danger of hurting self or others. Indeed, the record throughout the appeal period indicates that the Veteran had good insight, judgment, and impulse control, with no violent episodes. Additionally, the record further documents familial relationships that more closely align with a 50 percent evaluation than with a 70 percent evaluation. The Veteran has cohabitated with his girlfriend to his wife for more than 20 years. He further reports a good relationship with his grandchildren. Additionally, the record indicates the Veteran has a good relationship with his sister and that he was able to spend Thanksgiving/birthday with family. Thus, even though he has little to no interest in becoming acquainted with new people, the Veteran has been able to maintain good relationships with those close to him. The Board further notes the record documents that upon competent medical evaluation the Veteran's symptoms of PTSD were found to result in, at most, occupational and social impairment with reduced reliability and productivity. See July 2016 and February 2020 VA examinations. Further, these findings are consistent with the other evidence of record. In arriving at this determination, the Board has considered the Veteran's report that he had a verbal altercation with his supervisor. However, the July 2016 VA examiner found that occupationally, the Veteran would have mild to moderate impairment socializing depending on the number of individuals involved and the behavior of co-workers/supervisors. Thus, there is no evidence of record indicating that the Veteran was unable to establish and maintain effective relationships or that his symptoms interfered with his ability to function independently warranting a higher evaluation for his PTSD. The Board finds that at no point during the period on appeal have the Veteran's symptoms and resulting impairment met, or more nearly approximated, the level of impairment contemplated in the next higher, 70 percent rating. In light of the foregoing, the Board concludes that the preponderance of evidence demonstrates that the frequency, severity, and duration of the Veteran's psychiatric symptoms due to his service-connected PTSD are more consistent with a 50 percent evaluation rather than a 70 percent evaluation. Because the weight of the evidence is against the Veteran's claim, the benefit-of-the-doubt doctrine does not apply, see 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), and his claim for entitlement to an increased initial rating in excess of 50 percent must be denied. REASONS FOR REMAND 1. Entitlement to service connection for a headache disorder is remanded. 2. Entitlement to service connection for hypertension is remanded. As detailed in the Board's May 2019 remand, regarding the above issues, the Board found that a VA examination was warranted to address the Veteran's contentions: (1) that his current headache disorder began during active service, and that he has experienced symptoms of headaches since service; and (2) that his current hypertension disorder is related to his active service, or, in the alternative, that it is due to the service-connected diabetes mellitus, type II disability. With regards to the Veteran's claimed headache disorder, the Board notes that the Veteran's service treatment records (STRs) dated January 1968 and March 1968 document in-service treatment for headaches. Additionally, an August 1976 record documents a diagnosis of tension headaches. With regards to the Veteran's claimed hypertension, the Board notes that post-service treatment records document diabetic hypertension. See December 2019 VA treatment record. After the May 2019 Board remand, the Veteran was apparently scheduled for VA examinations in January 2020, for which he failed to appear. However, there is no notification letter for the actual examinations, so it is unclear if the Veteran received proper notification for these examinations. Therefore, another remand is warranted to attempt to schedule the Veteran for these examinations. 3. Entitlement to a TDIU, for the Period Prior to September 25, 2015 is Remanded. As an initial matter, for the period on appeal from September 25, 2015, forward, the Veteran was assigned a 100 percent schedular rating and was in receipt of special monthly compensation (SMC) housebound pursuant to 38 U.S.C. § 1114 (s). Accordingly, entitlement to a TDIU, for the period from September 25, 2015, forward, is moot. However, the Board finds that an inferred claim for a TDIU has been reasonably raised by the record for the period prior to September 25, 2015. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (When evidence of unemployability is submitted during the pendency of a claim for an increased evaluation, the claim for TDIU is part and parcel of the claim for benefits for the underlying disability). On VA examination in July 2016, the examiner indicated the Veteran's PTSD could impact on his ability to work depending on the number and the behavior of co-workers/supervisors. The Board finds the Veteran has not had an adequate opportunity to present evidence and argument in support of this claim. In pertinent part, it does not appear he was sent correspondence requesting he complete a VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability); nor does the record reflect the Veteran has otherwise submitted a VA Form 21-8940 or comparable statement containing the information requested by this Form. The Board notes that a VA Form 21-8940 asks a claimant which service-connected disability or disabilities prevent him or her from securing or following a substantially gainful occupation, and the treatment he or she has received for the disability(ies). The claimant is further asked to supply information about his or her employment, including dates when his or her disability(ies) affected full-time employment, the date the veteran last worked full-time, and the date the veteran became too disabled to work. The VA Form 21-8940 also requests information regarding the veteran's employment, educational, and training history, to include all employers for the last five years, the hours worked per week, the time lost from illness, the circumstances under which the veteran left his or her last job, and whether the veteran has attempted to obtain employment since he or she became too disabled to work. As such information can be critical to resolution of this case, a claimant's failure to provide it could constitute abandonment of the TDIU claim. See 38 C.F.R. § 3.158; see also Jernigan v. Shinseki, 25 Vet. App. 220, 229-30 (2012). Thus, a remand is required to request the Veteran complete a VA Form 21-8940 or otherwise provide the requisite information, as well as any other development deemed necessary. The Board also notes that resolution of the Veteran's claims of service connection for headaches and hypertension may affect his entitlement to a TDIU. As such, these issues are inextricably intertwined. Therefore, the Board must defer adjudication of the TDIU claim until the development deemed necessary for the other appellate claims have been completed. The matters are REMANDED for the following action: 1. Send the Veteran an application for increased compensation based on unemployability (VA Form 21-8940) and request that he complete and return the Form or a comparable statement as to the information requested on this Form. 2. Schedule the Veteran for an examination with an appropriate clinician to determine whether the Veteran has current diagnoses for any and all headache disabilities. If the Veteran previously had any such medical condition, but is no longer extant, the examiner should identify when that condition resolved. Following review of the claims file and examination of the Veteran, the examiner should provide the following opinions: (a) whether the Veteran's headache disorder is a separate and distinct condition from the headache disorder indicated in the Veteran's STRs. (b) whether it is at least as likely as not related that the Veteran's headache disorder had its initial onset in service or is otherwise etiologically related to an in-service injury, event, or disease. In providing this opinion, the examiner must address the Veteran's lay statements regarding the onset and continuity of symptomatology since onset and/or since separation from service. In so doing, the examiner is asked to address whether there is any evidence to accept or reject the proposition that the Veteran has experienced a headache disorder since separation from service. The examiner must also address any other pertinent evidence of record, to include, the Veteran's STRs documenting complaints of headache pain: (i) to include the STRs dated January 1968, March 1968, and August 1976. 3. Schedule the Veteran for an examination with an appropriate clinician to determine whether the Veteran has a current diagnosis of hypertension. If the Veteran previously had any such medical condition, but is no longer extant, the examiner should identify when that condition resolved. Following review of the claims file and examination of the Veteran, the examiner should provide the following opinions: (c) For any hypertension disorder, state whether it is at least as likely as not that any hypertension disorder: (ii) had its onset during active service, or (iii) is etiologically related to his active service, or (iv) was proximately due to his service-connected disability(ies), to include diabetes mellitus, type II, or (v) underwent any incremental increase in disability, regardless of its permanence, due to a service-connected disability, to include diabetes mellitus, type II. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. In providing these opinions, the examiner must address the post-service treatment records documenting diabetic hypertension. A complete rationale for any opinion expressed must be provided. An examiner's report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. John Kitlas Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, 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.