Citation Nr: 21006434 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 19-38 761 DATE: February 4, 2021 ORDER Entitlement to an evaluation in excess of 10 percent for tinnitus is denied. Entitlement to an effective date prior to August 24, 2017, for the grant of service connection for headaches is denied. REMANDED The request to reopen the claim of entitlement to service connection for increased urinary frequency is remanded. Entitlement to service connection for an eye disability, claimed as macular holes is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a compensable evaluation for erectile dysfunction is remanded. Entitlement to an evaluation in excess of 30 percent for anxiety and mood disorder, to include insomnia, is remanded. Entitlement to an initial evaluation in excess of 10 percent for traumatic brain injury (TBI) is remanded. Entitlement to an evaluation in excess of 20 percent for right shoulder supraspinatus tendonitis and impingement (right shoulder disability) is remanded. Entitlement to a compensable evaluation for bilateral hearing loss is remanded. Entitlement to an evaluation in excess of 10 percent for cervical strain is remanded. Entitlement to an evaluation in excess of 20 percent prior to August 24, 2017, and in excess of 40 percent thereafter, for lumbosacral degenerative disc disease (DDD) is remanded. Entitlement to a separate compensable evaluation prior to April 10, 2019, and in excess of 20 percent thereafter for left lower lumbar radiculopathy is remanded. Entitlement to an initial evaluation in excess of 50 percent for headaches, to include on an extraschedular basis, is remanded. Entitlement to an evaluation in excess of 10 percent for right calcaneal spurring is remanded. Entitlement to an evaluation in excess of 10 percent for right knee patellofemoral pain syndrome (right knee disability) is remanded. Entitlement to an evaluation in excess of 10 percent for left knee patellofemoral pain syndrome (left knee disability) is remanded. Entitlement to an effective date prior to August 24, 2017, for the increased 10 percent evaluation for right knee disability is remanded. Entitlement to an effective date prior to August 24, 2017, for the increased 10 percent evaluation for left knee disability is remanded. Entitlement to an effective date prior to August 24, 2017, for the increased 10 percent evaluation for cervical strain is remanded. Entitlement to an effective date prior to August 24, 2017, for the increased 20 percent evaluation for right shoulder disability is remanded. Entitlement to a total disability evaluation due to unemployability based on service-connected disabilities (TDIU) is remanded. Entitlement to nonservice-connected pension is remanded. FINDINGS OF FACT 1. The Veteran’s tinnitus is assigned a 10 percent rating, the maximum rating authorized under Diagnostic Code (DC) 6260. 2. On August 24, 2017, years after the Veteran’s separation from service, the RO received the first formal claim for service connection for headaches. CONCLUSIONS OF LAW 1. There is no legal basis for the assignment of a schedular evaluation in excess of 10 percent for tinnitus. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.87 DC 6260 (2019). 2. The criteria for an effective date earlier than August 24, 2017, for the award of service connection for headaches have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2007 to September 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2018 decision. The TDIU claim was raised as part of the claims on appeal for increased ratings. See Rice v. Shinseki, 22 Vet. App. 447, 454-455 (2009). In October 2019, the RO granted an increased 40 percent rating for lumbosacral DDD effective April 10, 2019. The claim remains in controversy as less than the maximum benefit available was awarded. See AB v. Brown, 6 Vet. App. 35 (1993). The same decision also awarded service connection for left lower lumbar radiculopathy and assigned a 20 percent evaluation effective April 10, 2019. The Board has taken jurisdiction of the issue as it is part and parcel of the claim for increased evaluation for the lumbar spine disability. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note 1. The Board is aware the certain issues on appeal have been remanded for additional development. Such development has no bearing on the issue of entitlement to an evaluation in excess of 10 percent for tinnitus, which may be determined as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The claim for an earlier effective date for the award of service connection for headaches rests upon evidence in the file dated prior to August 24, 2017, as the Board is constrained by the law and regulations governing the establishment of effective dates for the award of compensation. The development has no bearing on this issue of earlier effective and thus, the Board shall proceed with adjudication. Entitlement to an evaluation in excess of 10 percent for tinnitus The Veteran’s tinnitus is currently rated as 10 percent disabling, effective September 12, 2012. The Veteran contends that his tinnitus is more severe than what is represented by a 10 percent disability rating. Under DC 6260 only a single 10 percent evaluation is assigned for “recurrent” tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Note (2) (2019); See also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). In this case, the Veteran has already been assigned a 10 percent rating for tinnitus under DC 6260, which is the maximum rating assignable for the Veteran’s bilateral tinnitus. An increased schedular rating or assignment of a compensable evaluation for each ear is not available. Under these circumstances, the disposition of this claim is based on the law, and not the facts of the case, and the claim for an increased rating must be denied based on a lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Entitlement to an effective date prior to August 24, 2017, for the grant of service connection for headaches The law provides that the effective date for an award of service connection is the day following separation from active duty, or the day entitlement arose, if the claim is filed within the year after active duty. When the claim is filed more than a year after active duty, the effective date for service connection will be the date of VA receipt of the claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a), (b)(1); 38 C.F.R. § 3.400 (b)(2). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 U.S.C. § 5101 (a); 38 C.F.R. § 3.151 (a). The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement, to a specific benefit (i.e. must be in writing and must identify the benefit sought). 38 C.F.R. § 3.1 (p). The Veteran separated from service in September 2012. In June 2011, the Veteran filed a VA/DOD Joint Disability Evaluation Board Claim, which did not include a claim for headaches. On August 24, 2017 (years after the Veteran’s separation from service), the RO received the first formal claim for service connection for headaches. See VA Form 21-526, Veteran’s Application for Compensation and/or Pension. The RO, in a January 2018 rating decision, subsequently granted service connection for headaches secondary to TBI. The Veteran has not presented any argument regarding why he believes an earlier effective date is warranted. In his June 2018 notice of disagreement, he simply checked “effective date of award,” as the area of disagreement. The Board notes that the medical evidence of record indicates that the Veteran complained of headaches as early as September 2012, but, as stated above, the date of service connection is the date entitlement arose or the date of claim, whichever is later. See 38 C.F.R. § 3.400 (b)(2)(i). Unfortunately, the “mere presence” of a diagnosis of a specific disorder in a VA medical report “does not establish an intent on the part of the Veteran” to seek service connection for that disorder. Brannon v. West, 12 Vet. App. 32, 35 (1998); see MacPhee v. Nicholson, 459 F.3d 132 (Fed. Cir. 2006) (VA medical examination reports standing alone can constitute informal claims only with regard to claims that previously have been granted service connection). The Veteran filed his claim of entitlement to service connection for headaches more than one year after his separation from active service, and years following the first complaints and/or treatment for headaches. The Board is constrained by the law and regulations governing the establishment of effective dates for the award of compensation. Absent receipt of an earlier claim, the Board is not permitted to award an effective date prior to August 24, 2017. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (b)(2). REASONS FOR REMAND All remanded issues, including request to reopen the claim of entitlement to service connection for increased urinary frequency; and entitlement to increased ratings for erectile dysfunction, anxiety and mood disorder, and TBI The record reveals the Veteran applied for Social Security Administration (SSA) disability benefits. A December 2020 SSA inquiry appears to indicate the Veteran’s claim for disability benefits was denied; however, there has been no reply to the RO’s December 2020 request for SSA medical records for the Veteran. A remand is required to allow VA to obtain these records. In January 2021, the Veteran’s attorney submitted blank VA Forms 21-4142a, General Release for Medical Provider Information to VA. The Veteran’s attorney failed to identify the provider or facility name, the disabilities for which treatment was sought, and the dates of treatment. This raises the question as to whether there may be outstanding private medical records. The Private Medical Records Retrieval Center rejected the medical records request for incomlete provider information. A remand is required to clarify whether there are outstanding private medical records that need to be obtained in support of the issues on appeal and if so, to allow VA to obtain authorization and request these records. Review of the record shows that additional relevant evidence was added to the file by VA since the last Supplemental Statement of the Case (SSOC) was issued on these claims in May 2020 and after the claims were certified to the Board. Notably, VA outpatient treatment records and a peripheral nerves examination were added to the claims folder. The Veteran has not waived AOJ review of this evidence. Furthermore, this evidence was not submitted by the Veteran and therefore there is no basis for a waiver under 38 C.F.R. § 20.1304 (c). Thus, these claims must be returned to the AOJ for consideration of the newly received evidence and the issuance of an SSOC. Entitlement to service connection for an eye disability, claimed as macular holes The Veteran contends that he has macular holes as a result of his military service. VA treatment records contain evidence of lattice degeneration and atrophic retinal holes. The Veteran has not been afforded a VA examination in connection with this claim and the Board cannot make a fully-informed decision on the issue of service connection because no VA examiner has provided an opinion on etiology. Entitlement to service connection for PTSD More information is needed to allow the Board to make a fully-informed decision. The Veteran claims that he has PTSD as a result of his military service. His DD-214 shows that he was an infantryman with service in Iraq. However, it is unclear whether the Veteran has a current diagnosis of PTSD as there is conflicting evidence of record. For example, the 2011 VA examiner found no signs or symptoms of PTSD. VA treatment record list PTSD in computerized problem lists and contain a February 2019 postivie screen. Whereas there was no mention of PTSD in the January 2020 VA examination report. Consequently, the matter must be remanded to afford the Veteran a new VA examination. Entitlement to increased evaluations for right shoulder disability, bilateral knees, cervical strain, and bilateral hearing loss. The last VA examinations of the Veteran’s right shoulder, cervical strain, and bilateral knee disabilities were in December 2017 and of the Veteran’s bilateral hearing loss disability was in January 2018. As the Veteran maintains that these disabilities are worse than currently rated and they that have resulted in his ability to secure or following substantially gainful employment, these examinations are too old to adequately evaluate the disabilities. Thus, a remand is necessary to arrange for new VA examinations. See 38 C.F.R. §§ 3.326, 3.327; Snuffer v. Gober, 10 Vet. App. 400, 403 (1997 Entitlement to increased evaluations for lumbosacral DDD, right calcaneal spurring, and left lower lumbar radiculopathy The Veteran was afforded VA examinations of his lumbar spine and right ankle in April 2019; however, the examination reports did not comply with the requirements of Correia v. McDonald, 28 Vet. App. 158 (2016). In addition, with regard to the lumbar spine, the examiner noted pain range of motion testing of the lumbar spine but did not specify at which point pain began during range of motion testing. In conducting these measurements, the examiner should note not only whether pain on motion is present, but if present, where in the range of motion the pain sets in and whether that pain causes functional loss. Correia, supra. Accordingly, the examination findings are not adequate for a contemporaneous rating since the Board cannot properly assess functional impairment which is done with consideration of pain. Knowing where pain sets in is particularly important in this case where functional impairment has been noted. Thus, further examination is necessary. 38 C.F.R. § 3.159 (c)(4). As the new examination of the lumbar spine will involve evaluating neurological impairment/radiculopathy the claim for increased rating for left lower lumbar radiculopathy is intertwined. Entitlement to an evaluation in excess of 50 percent for headaches, to include on an extraschedular basis, is remanded. The Veteran’s headaches have been assigned the maximum 50 percent schedular rating under DC 8100. The Veteran contends that his headaches are daily. He further maintains that two to three times per week they are productive of nausea, vomiting, light sensitivity and pain so debilitating it forces him to lie down in a dark room for several hours. See December 2017 report of VA examination and October 2019 letter from Dr. MB. He has also asserted that his headaches interfere with employment. The Board finds that a request for extraschedular consideration has been reasonably raised by the record as it would appear that he is alleging that his disability level and symptomatology are not contemplated by the rating schedule or the assigned schedular evaluation and therefore not adequate. The Board cannot assign an extraschedular rating for a disability in the first instance. Thus, the matter is referred to the VA Director of Compensation and Pension Services for extraschedular consideration. Entitlement to earlier effective dates prior to August 24, 2017, for the increased evaluations for right and left knee disabilities, cervical strain, and right shoulder disability; Entitlement to nonservice-connected pension A decision on the remanded issues for service connection and increased rating, could significantly impact a decision on these issues. Thus, the matters are inextricably intertwined and a remand of the claims is required. Entitlement to a TDIU The Veteran is seeking a TDIU. In an August 2020 TDIU application, in pertinent part, the Veteran reported becoming too disabled to work in 2012. A decision on the remanded issues for service connection, increased rating, and earlier effective dates could significantly impact a decision on this issue. Thus, the matters are inextricably intertwined, and a remand of the claim is required. In addition, on remand the RO should obtain an opinion to assess the functional impairments, if any, of the Veteran’s disabilities. The matters are REMANDED for the following action: 1. Obtain the Veteran’s federal records from SSA, to include all administrative decisions and medical records. Document all requests for information as well as all responses in the claims file. 2. Ask the Veteran to complete a VA Form 21-4142 for each private provider and/or facility from which he has sought treatment for the claimed disabilities. The Veteran must provide completed forms that identify the specific provider/facility, the disabilities for which treatment was sought, and the dates of treatment. Make two requests for the authorized records from any identified providers unless it is clear after the first request that a second request would be futile. 3. Refer the issue of entitlement to a rating in excess of 50 percent for headaches to the Director of Compensation and Pension Service pursuant to the provisions of 38 C.F.R. § 3.321 (b) for consideration of whether an extraschedular rating is warranted for this disability. 4. Schedule the Veteran for a VA examination to evaluate the current level of severity of the lumbar spine disability on appeal. The claim folder and all pertinent treatment records should be made available to the examiner for review, and review of such records should be noted in any subsequent report. A) The examiner is asked specifically to provide range of motion testing (ROM) for the lumbar spine for active motion, passive motion, in both weight-bearing, and nonweight-bearing. B) In addition, the examiner must discuss pain for ROM movements on active, passive, and repetitive use testing. The examiner is asked to address the following questions: (i) Are any ROM movements painful on active, passive, and repetitive use testing? If yes, identify whether active, passive, and repetitive use; and, identify at the point where pain starts. (ii) If yes (there are painful movements), does the pain contribute to functional loss or additional limitation of ROM? Please further describe the functional loss or additional limitation of ROM, to include noting the exact point at which pain starts. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. (iv) When considering his functional loss along with his range of motion, does he have unfavorable ankylosis of the entire thoracolumbar spine, or limitation equivalent to or nearly approximating unfavorable ankylosis? C) In addition, the examiner must discuss pain when used in weight-bearing or in nonweight-bearing. The examiner is asked to address the following questions: (i) Is there pain when the joint is used in weight-bearing or nonweight-bearing? If yes, identify whether weight-bearing or nonweight-bearing. (ii) If yes (there is pain when used in weight-bearing or nonweight-bearing), does the pain contribute to functional loss or additional limitation of ROM? Please further describe these limitations. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. For all ROM testing, if pain is noted, the exact point at which pain is first noted must be specified. D) The examiner is asked to address the Veteran’s contentions with regard to flare-ups, if any, in terms of ROM. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. E) The examiner must state whether the Veteran has intervertebral disc syndrome (IVDS) and if so, comment on the duration of incapacitating episodes in the last 12 months. F) Finally, a full neurological examination shall also be conducted for a report on the current severity of his radiculopathy, along with a report on whether there are any other neurological abnormalities resulting from his service-connected lumbar DDD. The examiner is asked to provide an opinion, from review of the records, as to whether the Veteran’s radiculopathy manifested prior to April 2019, and if so, when? 5. Schedule the Veteran for a VA examination to evaluate the current level of severity of the cervical spine disability on appeal. The claim folder and all pertinent treatment records should be made available to the examiner for review, and review of such records should be noted in any subsequent report. A) The examiner is asked specifically to provide range of motion testing (ROM) for the cervical spine for active motion, passive motion, in both weight-bearing, and nonweight-bearing. B) In addition, the examiner must discuss pain for ROM movements on active, passive, and repetitive use testing. The examiner is asked to address the following questions: (i) Are any ROM movements painful on active, passive, and repetitive use testing? If yes, identify whether active, passive, and repetitive use; and, identify at the point where pain starts. (ii) If yes (there are painful movements), does the pain contribute to functional loss or additional limitation of ROM? Please further describe the functional loss or additional limitation of ROM, to include noting the exact point at which pain starts. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. (iv) When considering his functional loss along with his range of motion, does he have favorable or unfavorable ankylosis of the entire cervical spine, or limitation equivalent to or nearly approximating favorable or unfavorable ankylosis? C) In addition, the examiner must discuss pain when used in weight-bearing or in nonweight-bearing. The examiner is asked to address the following questions: (i) Is there pain when the joint is used in weight-bearing or nonweight-bearing? If yes, identify whether weight-bearing or nonweight-bearing. (ii) If yes (there is pain when used in weight-bearing or nonweight-bearing), does the pain contribute to functional loss or additional limitation of ROM? Please further describe these limitations. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. For all ROM testing, if pain is noted, the exact point at which pain is first noted must be specified. D) The examiner is asked to address the Veteran’s contentions with regard to flare-ups, if any, in terms of ROM. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. E) The examiner must statement whether the Veteran has IVDS and if so, comment on the duration of incapacitating episodes in the last 12 months. F) Finally, a full neurological examination shall also be conducted to determine whether there are any neurological abnormalities resulting from his service-connected cervical strain. 6. Schedule the Veteran for a VA examination to evaluate the current level of severity of the right calcaneal spurring disability on appeal. The claim folder and all pertinent treatment records should be made available to the examiner for review, and review of such records should be noted in any subsequent report. A) The examiner is asked specifically to provide range of motion testing (ROM) for the right ankle for active motion, passive motion, in both weight-bearing, and nonweight-bearing. B) In addition, the examiner must discuss pain for ROM movements on active, passive, and repetitive use testing. The examiner is asked to address the following questions: (i) Are any ROM movements painful on active, passive, and repetitive use testing? If yes, identify whether active, passive, and repetitive use; and, identify at the point where pain starts. (ii) If yes (there are painful movements), does the pain contribute to functional loss or additional limitation of ROM? Please further describe the functional loss or additional limitation of ROM, to include noting the exact point at which pain starts. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. C) In addition, the examiner must discuss pain when used in weight-bearing or in nonweight-bearing. The examiner is asked to address the following questions: (i) Is there pain when the joint is used in weight-bearing or nonweight-bearing? If yes, identify whether weight-bearing or nonweight-bearing. (ii) If yes (there is pain when used in weight-bearing or nonweight-bearing), does the pain contribute to functional loss or additional limitation of ROM? Please further describe these limitations. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. For all ROM testing, if pain is noted, the exact point at which pain is first noted must be specified. D) Finally, the examiner is asked to address the Veteran’s contentions with regard to flare-ups, if any, in terms of ROM. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. 7. Schedule the Veteran for a VA examination to evaluate the current level of severity of the bilateral knee disabilities on appeal. The claim folder and all pertinent treatment records should be made available to the examiner for review, and review of such records should be noted in any subsequent report. A) The examiner is asked specifically to provide range of motion testing (ROM) for the bilateral knees for active motion, passive motion, in both weight-bearing, and nonweight-bearing. B) In addition, the examiner must discuss pain for ROM movements on active, passive, and repetitive use testing. The examiner is asked to address the following questions: (i) Are any ROM movements painful on active, passive, and repetitive use testing? If yes, identify whether active, passive, and repetitive use; and, identify at the point where pain starts. (ii) If yes (there are painful movements), does the pain contribute to functional loss or additional limitation of ROM? Please further describe the functional loss or additional limitation of ROM, to include noting the exact point at which pain starts. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. C) In addition, the examiner must discuss pain when used in weight-bearing or in nonweight-bearing. The examiner is asked to address the following questions: (i) Is there pain when the joint is used in weight-bearing or nonweight-bearing? If yes, identify whether weight-bearing or nonweight-bearing. (ii) If yes (there is pain when used in weight-bearing or nonweight-bearing), does the pain contribute to functional loss or additional limitation of ROM? Please further describe these limitations. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. For all ROM testing, if pain is noted, the exact point at which pain is first noted must be specified. D) The examiner is asked to address the Veteran’s contentions with regard to flare-ups, if any, in terms of ROM. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. E) The examiner is asked to address whether the Veteran’s bilateral knee disabilities are productive of recurrent subluxation or lateral instability and if so, classify it as slight, moderate, or severe. 8. Schedule the Veteran for a VA examination to evaluate the current level of severity of the right shoulder disability on appeal. The claim folder and all pertinent treatment records should be made available to the examiner for review, and review of such records should be noted in any subsequent report. A) The examiner is asked specifically to provide range of motion testing (ROM) for the right shoulder for active motion, passive motion, in both weight-bearing, and nonweight-bearing. B) In addition, the examiner must discuss pain for ROM movements on active, passive, and repetitive use testing. The examiner is asked to address the following questions: (i) Are any ROM movements painful on active, passive, and repetitive use testing? If yes, identify whether active, passive, and repetitive use; and, identify at the point where pain starts. (ii) If yes (there are painful movements), does the pain contribute to functional loss or additional limitation of ROM? Please further describe the functional loss or additional limitation of ROM, to include noting the exact point at which pain starts. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. C) In addition, the examiner must discuss pain when used in weight-bearing or in nonweight-bearing. The examiner is asked to address the following questions: (i) Is there pain when the joint is used in weight-bearing or nonweight-bearing? If yes, identify whether weight-bearing or nonweight-bearing. (ii) If yes (there is pain when used in weight-bearing or nonweight-bearing), does the pain contribute to functional loss or additional limitation of ROM? Please further describe these limitations. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. For all ROM testing, if pain is noted, the exact point at which pain is first noted must be specified. D) Finally, the examiner is asked to address the Veteran’s contentions with regard to flare-ups, if any, in terms of ROM. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. 9. Schedule the Veteran for a VA examination to evaluate the current level of severity of the bilateral hearing loss disability on appeal. The claim folder and all pertinent treatment records should be made available to the examiner for review, and review of such records should be noted in any subsequent report. The examiner should provide a detailed report of the Veteran’s bilateral hearing loss, to include audiogram results. 10. After completing all of the above development, obtain an opinion from an appropriate clinician regarding the functional limitations on employability caused by the Veteran’s service-connected disabilities. The need for any additional clinical evaluations is left to the discretion of the medical professional rendering the opinion. A complete copy of the claims file must be made available to the examiner and the examination report should specifically state that a review of the record was conducted. After a thorough review of the medical and lay evidence of record, the examiner should discuss the functional effects of the Veteran’s service-connected disabilities on his ability to perform the physical and mental acts, as appropriate, required to sustain substantially gainful employment consistent with his education and occupational experience. This discussion should include both sedentary and non-sedentary labor. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. (Continued on next page)   11. After completing all of the above, and any additional development deemed warranted, readjudicate the claims on appeal in light of all the evidence of record, to include evidence added to the claims folder after the May 2020 SSOC was issued. If the benefits on appeal remain denied, furnish the Veteran and his representative with a copy of a supplemental statement of the case (SSOC) and allow an appropriate time for response. Thereafter, return the file to the Board for further appellate consideration. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. L. Wallin, 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.