Citation Nr: 21006368 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 06-08 600 DATE: February 4, 2021 ORDER Entitlement to an initial compensable disability evaluation for migraine headaches prior to September 2, 2010, and in excess of 30 percent from September 2, 2010, to July 8, 2011, is denied. REMANDED Entitlement to an initial disability evaluation in excess of 50 percent for posttraumatic stress disorder (PTSD), prior to October 6, 2016, is remanded. FINDINGS OF FACT 1. Prior to September 2, 2010, the Veteran did not have at least characteristic prostrating attacks of migraine headache pain averaging one in two months over the last several months. 2. For the period of September 2, 2010, to July 8, 2011, the Veteran’s migraine headaches did not have very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSION OF LAW The criteria entitlement to an initial compensable disability evaluation for migraine headaches prior to September 2, 2010, and in excess of 30 percent from September 2, 2010, to July 8, 2011, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from November 1990 to June 1991 and February 2003 to June 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April 2005 and May 2011 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). In the April 2005 decision, the RO granted service connection for migraine headaches and assigned a noncompensable evaluation, effective from June 25, 2004, and denied service connection for PTSD. The Veteran testified at a hearing before the undersigned Acting Veterans Law Judge at the RO in February 2010. A transcript of that hearing was associated with the claims file. The Board remanded the Veteran’s claims for further development in April 2010. In a May 2011 rating decision, the RO granted service connection for PTSD and assigned a 50 percent evaluation, effective from June 25, 2004, which the Veteran then appealed as to the assigned evaluation. In a November 2011 rating decision, the Veteran’s evaluation for migraine headaches was then increased to 30 percent, effective from September 2, 2010. The Board then remanded the Veteran’s claims in March 2013. Upon remand, an August 2013 rating decision granted an increased 50 percent rating for the Veteran’s migraine headache disorder, effective July 9, 2011. The agency of original jurisdiction (AOJ) increased the Veteran’s PTSD evaluation to 70 percent, effective from October 6, 2016, in a December 2016 rating decision. In an October 2017 decision, the Board, in pertinent part, denied the issue of entitlement to an evaluation in excess of 50 percent for PTSD prior to October 6, 2016, and remanded the Veteran’s claim for a compensable evaluation for migraine headaches prior to September 2, 2010, and in excess of 30 percent thereafter. The Veteran then appealed the October 2017 decision to the United States Court of Appeals for Veterans Claims (Court). In an August 2018 order, the Court vacated the October 2017 Board decision as to the PTSD issue and granted a joint motion for partial remand (2018 Joint Motion) for above listed PTSD claim. In an August 2019 decision, the Board denied the issues of entitlement to an evaluation in excess of 50 percent for PTSD prior to October 6, 2016, and entitlement to a compensable evaluation for migraine headaches prior to September 2, 2010, in excess of 30 percent from September 2, 2010, to July 8, 2011, and in excess of 50 percent thereafter. The Board also dismissed a total disability based upon individual unemployability (TDIU) claim in that decision. The Veteran appealed the August 2019 decision to the Court. In a July 2020 order, the Court vacated the August 2019 Board decision as to the PTSD issue, as well as to the issue of entitlement to a compensable evaluation for migraine headaches prior to September 2, 2010, and a rating in excess of 30 percent for migraine headaches from September 2, 2010, to July 8, 2011, and granted a joint motion for partial remand (2020 Joint Motion) for above listed claims. The appeal as to other issues was dismissed. Law and Analysis Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. This Rating Schedule is primarily a guide in the rating of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. For the application of this schedule, accurate and fully descriptive medical examinations are required, with emphasis upon the limitation of activity imposed by the disabling condition. Over a period of many years, a veteran’s disability claim may require re-ratings in accordance with changes in laws, medical knowledge and his or her physical or mental condition. It is essential, both in the examination and in the evaluation of disability, that each disability be viewed in relation to its history. 38 C.F.R. § 4.1. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2. Consideration of factors wholly outside the rating criteria constitutes error as a matter of law. Massey v. Brown, 7 Vet. App. 204, 207-08 (1994). If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board notes that the Veteran is appealing the initial assignment of a disability rating, and as such, the severity of the disability is to be considered during the entire period from the initial assignment of the evaluation to the present time. Fenderson v. West, 12 Vet. App. 119 (1999). In determining whether evidence submitted by a claimant is credible, VA may consider internal consistency, facial plausibility, and consistency with other evidence. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). A medical opinion based upon an inaccurate factual premise may be discounted entirely. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Migraine Headaches In this case, VA records show a noncompensable, 0 percent, rating is assigned for the Veteran’s service-connected migraine headaches for the period from June 25, 2004, to September 1, 2010, and a 30 percent rating for the period from September 2, 2010, to July 8, 2011, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under that diagnostic code, a 10 percent rating is assigned for migraine headaches with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is provided for migraine headaches with characteristic prostrating attacks occurring on an average once per month over the last several months. A maximum 50 percent rating is assigned for migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. VA regulations, including the rating criteria, do not define the terms “characteristic prostrating attacks,” “very frequent.” or “completely prostrating and prolonged attacks” as used in Diagnostic Code 8100. In an October 2020 statement the Veteran’s attorney asserted a 50 percent rating was warranted for the period from 2004 to 2010. It was noted that VA defined “very frequent” as “on average, [ ] less than one month apart over the last several months.” M21-1 Manual, pt. III, subpt iv, ch. 4, sec. N, topic 7, subpt f. It was asserted, citing Overton v. Wilkie, 30 Vet. App. 257, 264 (2018), that the Board was required to discuss relevant provisions of the M21-1. It was further asserted that “prostration” has been defined as “complete physical or mental exhaustion.” Merriam-Webster On-line Dictionary, Definition, Prostration, available at http://www.merriam-webster.com/dictionary/prostration (last visited Oct. 29, 2020). “Prostration” was also defined as “extreme exhaustion or powerlessness.” Dorland’s Illustrated Medical Dictionary 1531 (32nd ed. 2012). It was further noted that the M21-1 definition for “completely prostrating” was “extreme exhaustion or powerlessness with essentially total inability to engage in ordinary activities.” M21-1 Manual, pt. III, subpt iv, ch. 4, sec. N, topic 7, subpt. b. The determination regarding prostration was asserted to be an adjudicative question to be answered by an adjudicator rather than a medical examiner. M21-1 Manual, pt. III, subpt iv, ch. 4, sec. N, topic 7, subpt. c. Additionally, it was asserted that the phrase “productive of severe economic adaptability” was not been clearly defined. The Court has noted that “productive of” can either have the meaning of “producing” or “capable of producing.” Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, migraines need not actually “produce” severe economic inadaptability to warrant the 50 percent rating. Id. at 445-46. Further, “economic inadaptability” does not mean unemployability, as such would undermine the purpose of regulations pertaining to a total disability rating based upon individual unemployability. Id. at 446; see also 38 C.F.R. § 4.16. The Court stated that “it is noteworthy that in 1996 the Secretary revised the only other section of title 38 of the Code of Federal Regulations that contained the word “inadaptability”. 61 Fed. Reg. 52700 (1996) (effective Oct. 8, 1996). Prior to that revision, which eliminated that word “inadaptability”, 38 C.F.R. § 4.129 (1996) related “social inadaptability” to “abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity”.” Id. at 446. The Board also notes that “severe economic inadaptability” is defined as denoting a degree of substantial work impairment. It does not mean that the individual is incapable of any substantially gainful employment. Evidence of work impairment includes, but is not necessarily limited to, the use of sick leave or unpaid absence. M21-1 Manual, pt. III, subpt iv, ch. 4, sec. N, topic 7, subpt. e. The term “substantial” is defined as considerable in quantity. Merriam-Webster On-line Dictionary, Definition, substantial, available at http://www.merriam-webster.com/dictionary/substantial (last visited Feb. 2, 2021). As such, the Board construes the phrase “productive of severe economic adaptability” as requiring that very frequent completely prostrating and prolonged migraine headache attacks be capable of producing a substantial work impairment with an impairment of earning capacity. The October 2020 statement of the Veteran’s attorney also disputed that the evidence as to the Veteran’s reports of time lost from work were inconsistent. In support of the claim it was asserted that “[i]t was entirely possible that the Veteran missed three weeks of work sometime between August 2009 and November 2009 and missed an additional four weeks of work between August 2010 and November 2010.” Such a scenario, it was noted, would account for his reports of five missed weeks from December 2009 to December 2010. The Veteran was reported to have “had weekly headaches with most attacks described as prostrating, and missed between four and eight weeks of work per year.” As an initial matter, the Board notes agreement with the Veteran and his attorney as to the definitions of pertinent terms in Diagnostic Code 8100 as reported in the October 2020 statement, including those identified as relevant from the M21-1. It is also agreed that the determination as to prostration is a question to be answered by an adjudicator rather than a medical examiner. See M21-1 Manual, pt. III, subpt iv, ch. 4, sec. N, topic 7, subpt. c. The Board finds, however, that the hypothetical scenario presented in the October 2020 statement that it was possible that the Veteran missed three weeks of work sometime between August 2009 and November 2009 and missed an additional four weeks of work between August 2010 and November 2010 to be neither an assertion of fact nor to be consistent with the Veteran’s own reports as to the frequency and severity of headache attacks during this period. In fact, at his February 2010 hearing in response to a specific question about how many times in the past year he had taken time off work because of his headaches or migraines the Veteran testified that in the past year he had missed “probably two weeks at the most.” He also testified that he had four to five episodes per month that normally lasted an hour when he took medication and without medication for a day or so. Nor is there any other credible evidence of record supporting the claim that the Veteran missed three weeks of work sometime between August 2009 and November 2009 and missed an additional four weeks of work between August 2010 and November 2010. The pertinent evidence of record includes a December 2009 statement from the Veteran in which he reported having very severe migraines “at least (5) times per month with at least 3-4 of these leaving [him] totally incapacitated.” He stated he was totally sensitive to light and sound to a very high degree that required he go to a very quiet, dark room. He stated his migraines made him miss a great deal of work and was a threat to his ability to earn a living. At his personal hearing in February 2010 he reported having headache episodes four to five times per month and stated he had missed work probably two weeks at most over the past year due to the disorder. In a January 2012 statement he asserted, in essence, that his migraines impacted his ability to earn a living and had caused him to miss work. In a November 2018 statement the Veteran reported having had severe migraine headaches since 2003. He rated his pain as “always being at a nine or a ten” on a ten-point scale. He described it as sometimes squeezing and at other times throbbing. He stated his vision got blurry with migraine attacks and caused nausea and vomiting. He stated his headaches always caused him to become dizzy or light-headed and stated that since onset he had experienced migraines at least two times per week. He stated that “they usually last for two or more days” and that they had “always lasted around two to four days. He stated that even though he took several medications for migraines the only real relief he got was when he lay down and that he needed to lay down for at least two hours to get any relief at all. He reported that his migraines had negatively impacted his ability to work and that when he had migraine episodes he went to the breakroom to attempt to get relief. He stated he had missed at least three days per month from work and that he had been written up several times for failing to call out of work at least two hours before the start of a shift. In his November 2016 TDIU application he reported the most he had ever earned in one year was $71,000 in 2007. He stated that he had lost 3 years from illness for the period from 1997 to present. No additional comments as to the time lost was provided. VA treatment records include a July 2004 report noting the Veteran described having migraines a couple of times per month. It was noted his migraine headaches were helped with medication. A January 2007 private treatment report noted complaints of headaches, stopped up nose, and dizziness and a June 2007 report noted he described having occasional morning headaches. A September 2008 VA treatment report noted a review of systems revealed a history of headaches in the past. A January 2010 report noted he complained of occasional tension headaches. An August 2010 VA examination included a diagnosis of tension headaches and noted the effect on his occupation was increased absenteeism. It was also noted the Veteran reported having had sinus headaches one to two times per week and that he stated that he took Tylenol which was effective. The examiner noted the Veteran was employed fulltime as a correctional officer and that he had lost four weeks of time from work during the past 12-month period due to headaches. A September 2, 2010, VA treatment report noted the Veteran described having headaches over the past several months that were occurring more frequently and were becoming more severe. He stated he had approximately eight episodes per month with four of those being debilitating. The examiner noted he also described having some occasional tension headaches. A November 2010 VA examination report noted the Veteran had history of weekly migraine headaches over the past twelve months and that less than half of the attacks were prostrating. They were described as classic headaches last about one to two days with nausea/vomiting and photophobia. Current treatment was sumatriptan with fair response and was not treated with continuous medication. The Veteran reported that he had lost eight weeks from work over the previous 12 months due to his headaches and doctor visits. A December 2010 VA PTSD examination noted he reported having lost five weeks from work over the previous 12 months due to headaches, medical appointments, and having some days when he just could not cope with going to work. VA treatment records dated in March 2011 noted the Veteran’s headaches were stable and being controlled with medication. A July 9, 2011, VA examination report noted the Veteran had migraine headaches that with a stable course since onset which required medication, sumatriptan, twice per week. The examiner noted he reported having weekly migraine headaches, most of which were prostrating, lasting longer than 2 days. It was noted that the Veteran’s headaches caused increased absenteeism and limited his performance of tasks around the house. The Veteran reported that he had missed four weeks of work over the last 12 months due to his headaches. The examiner noted that his headaches had improved in the last three months and that he had approximately six headaches in that time. It was further noted that his migraines had been stable in frequency for several years with a reduction in frequency over the last three months, going from one per week to one in two weeks. VA treatment records dated in April 2012 and October 2012 noted the Veteran’s migraines and hypertension were stable and were controlled with medication. A June 2013 report noted he had a history of migraines and some sinus headaches with treatment using Excedrin Migraine. It was noted he reported he last used sumatriptan probably a month earlier. The examiner added medication for migraines and requested the Veteran return in two months or to call sooner if his migraines were not improved. Reports dated in August 2013, October 2013, July 2014, January 2015, and August 2016 noted his migraines were about the same on verapamil. Based upon a comprehensive review of the overall evidence of record, the Board finds prior to September 2, 2010, the Veteran did not have at least characteristic prostrating attacks of migraine headache pain averaging one in two months over the last several months. To the extent that the Veteran’s statements indicate that prior to this date he had characteristic prostrating attacks of migraine headache pain averaging one in two months over any several month period, the Board finds such statements to be not credible due to inconsistency with the other evidence of record. It is noted that in his December 2009 statement the Veteran reported to having very severe migraines “at least (5) times per month with at least 3-4 of these leaving [him] totally incapacitated,” and that in his November 2018 statement he reported having had severe migraines since 2003 at least two times per week. At his personal hearing in February 2010 he testified that he had headaches episodes four to five times per month. Although due to the nature of migraine headache disabilities it is not expected that each episode of characteristic prostrating attacks of migraine headache pain would be documented by a treatment report, the Board finds it is reasonable to assume that if the Veteran experienced such attacks as he described which left him totally incapacitated he would have reported it to his medical care providers when they addressed his medical history of headaches. See M21-1 Manual, pt. III, subpt iv, ch. 4, sec. N, topic 7, subpt. G, (noting probative evidence may include medical progress notes, competent and credible lay evidence on how often the claimant experiences symptoms (as long as those symptoms have been competently identified as symptoms of migraine headaches), contemporaneous notes (a headache journal), prescription refills, and witness statements. The absence of treatment reports is not necessarily probative on the question of headache frequency as a claimant may not seek treatment for headaches during every episode.). The available VA and private treatment records in this case dated prior to September 2, 2010, do not include any report describing an attack of migraine headache pain indicating a prostrating attack nor is any other probative evidence as to this matter of record. The Board notes that in a July 2004 VA treatment report the Veteran described having migraines a couple of times per month that were improved with medication. A June 2007 private treatment report noted he described having occasional morning headaches and a January 2010 VA treatment report noted he complained of occasional tension headaches. An August 2010 VA examination provided a diagnosis of tension headaches without indication as to whether there was evidence of any characteristic prostrating attacks of migraine headache pain. It was noted, however, that the Veteran reported having had sinus headaches one to two times per week that he effectively treated with Tylenol. The Board also notes that service-connection is established for maxillary sinusitis with intermittent vertigo with an assigned 50 percent evaluation from June 25, 2004. Although the September 2, 2010, VA examiner noted the Veteran described having headaches over the past several months that were occurring more frequently and that were becoming more severe, there is no factually ascertainable date to assign an earlier increased 30 percent rating. The Board finds that the overall credible evidence of record demonstrates that a compensable rating for migraine headaches is not warranted prior to September 2, 2010. The Board further finds that for the period of September 2, 2010, to July 8, 2011, the Veteran’s migraine headaches did not have very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The Veteran’s claims as to having had very frequent completely prostrating and prolonged attacks during this period are supported by VA medical findings (four debilitating episodes per month on September 2, 2010; weekly migraine headaches over the past twelve months with less than half that were prostrating in November 2010; and weekly migraine headaches, most of which were prostrating, lasting longer than 2 days on July 9, 2011). The Board finds, however, that his statements, reports, and testimony as to having lost a substantial amount of time from work due to his service-connected migraine headaches during this period are not credible due to inconsistency with the evidence of record. The Board notes that the Veteran has reported having missed time from work and that his migraine headache disability had impacted his ability to earn a living. He has not, however, provided any supporting evidence as to his claims of having missed time from work and has not described how his ability to earn a living had been impacted. There is no evidence that he was denied increases in pay, promotion, or other employment due solely to his service-connected migraine headaches. It is undisputed that he was employed fulltime for the period at issue in this appeal. Rather he has asserted that he had very frequent completely prostrating and prolonged attacks that were capable of producing severe economic inadaptability, presumably due to missed work. Evidence of work impairment is noted to include, but not be limited to, the use of sick leave or unpaid absence. M21-1 Manual, pt. III, subpt iv, ch. 4, sec. N, topic 7, subpt. e. The use of sick leave or unpaid absence, however, must be shown by probative or credible evidence. The evidence of record as to the Veteran’s reported missed time from work includes an August 2010 report that he missed four weeks of work in the previous 12-month period due to headaches. In November 2010, he reported missing eight weeks of work during the past 12-month period. A month later, his December 2010 VA PTSD examination noted he only reported missing five weeks of work due to medical appointments, headaches, and days when he just could not cope with going to work. The Board finds that due to the inconsistencies in his reported missed time from work the Veteran’s statements as to this matter are not credible. In the absence of any credible evidence as to periods of missed work due to the service-connected migraine headache disability, the accepted reports of very frequent completely prostrating and prolonged attacks are not found to rise to the level of being capable of producing severe economic inadaptability. There is no indication that the Veteran is able or willing to provide additional supporting, probative evidence of actual time lost from work. As such, the Board finds further efforts to assist him in substantiating this claim are not warranted. Based upon the overall evidence of record, the Board finds that a rating in excess of 30 percent for the period of September 2, 2010, to July 8, 2011, is not warranted. The Board acknowledges that the Veteran is competent to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He is not, however, competent to identify a specific level of disability. The medical findings directly address the criteria under which the disability is evaluated. The Board accords these objective records greater weight than the Veteran’s subjective complaints of increased symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). The preponderance of the evidence in this case is against the claim. REASONS FOR REMAND Upon review, the Board finds that a remand is necessary to comply with the 2020 Joint Motion. Specifically, the parties to the 2020 Joint Motion agreed that the Board should address whether the Veteran had impaired impulse control and in doing so, should consider whether the Veteran’s actions themselves demonstrated impaired impulse control, regardless of whether he sought to de-escalate the situations afterwards. It was noted that the Veteran’s acknowledged actions of having yelled, raised his voice, and occasionally threw objects or hit a wall during workplace confrontations with inmates should be considered as demonstrating impaired impulse control, regardless of whether he sought to de-escalate the situations afterwards. Although a January 2011 VA examiner found the Veteran’s extent of impulse control was fair, it was also noted that he had episodes of violence. The acknowledged actions identified in the 2020 Joint Motion were noted as examples of the effects on his motivation/mood. The Board notes that VA treatment records dated in August 2007 show the Veteran described having difficulties at home and in the workplace secondary to increased irritability and isolation and reported having increased anger outburst and decreased motivation at his job. VA regulations pertinent to evaluations for mental disorders include impaired impulse control as a symptom associated with a 70 percent rating. It is noted, parenthetically, that impaired impulse control was unprovoked irritability with periods of violence. 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the United States Court of Appeals for the Federal Circuit has held that the application of “[38 C.F.R. § 4.130] requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” As such, the Board finds that an additional VA medical opinion is required for an adequate determination. Accordingly, the case is REMANDED for the following action: 1. Obtain a VA medical opinion as to the severity of the Veteran’s service-connected PTSD prior to October 6, 2016, specifically in the context of any manifest impaired impulse control. To the extent possible, the examiner should identify any symptoms manifest during the period from June 25, 2004, to October 6, 2016, and address whether those symptoms have caused occupational and social impairment. Only if deemed necessary by the VA examiner is an actual examination required. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. In so doing, the examiner is asked to consider and specifically discuss any instances of the Veteran yelling, raising his voice or similar confrontation with his family or in the workplace; any reports of use of force or excessive force in the workplace; reports that he occasionally threw objections or hit a wall; reports that he went on spending spree(s) when depressed; and/or any other relevant evidence. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 2. After completing these actions, the Agency of Original Jurisdiction (AOJ) should conduct any other development as may be indicated. T. L. DOUGLAS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Rideout-Davidson, 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.