Citation Nr: 21015975 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 17-31 910 DATE: March 18, 2021 ORDER For the entire period on appeal, an increased evaluation of 70 percent, but no greater, for the Veteran’s service-connected acquired psychiatric disability, to include major depressive disorder, is granted. REMANDED Entitlement to a total disability rating due to individual unemployability is remanded. FINDING OF FACT For the entire period on appeal, the Veteran’s service-connected acquired psychiatric disability, to include major depressive disorder, is productive of a disability level that more nearly approximates occupational and social impairment with deficiencies in most areas, to include work, family relations, judgment, thinking, and mood, but does not result in total social and occupational impairment. CONCLUSION OF LAW For the entire period on appeal, the criteria for an increased evaluation of 70 percent for the Veteran’s service-connected acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), as well as unspecified substance-related disorder and unspecified depressive disorder as secondary to PTSD, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. § § 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.126, 4.130, Diagnostic Code 9434. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the U.S. Air Force from July 1968 to March 1992, including service in Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersigned at a hearing held in February 2020; a transcript of that hearing is of record. In March 2020, the Board remanded this appeal for further development, including scheduling the Veteran for a VA examination to evaluate his acquired psychiatric disability. To the extent that the directed VA examination report was procured in July 2020, the Board finds that substantial compliance with its remand directives pertaining to the Veteran’s psychiatric claim has been accomplished. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Board notes that an August 2020 rating decision increased the Veteran’s disability rating from 30 percent to 70 percent, effective January 27, 2020. However, because this award amounts to less than the maximum benefit available for the Veteran’s service-connected acquired psychiatric disability, and because the Veteran has not indicated that he is satisfied with a 70 percent disability rating, the Veteran’s increased rating claim for his service-connected acquired psychiatric disability remains on appeal. See AB v. Brown, 6 Vet. App. 35, 39-40 (1993). During the pendency of the appeal the Veteran also reported that he was unable to work, in part, due to his acquired psychiatric disability. Accordingly, a claim for TDIU is raised by the record. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). For the entire period on appeal, an increased evaluation of 70 percent, but no greater, for the Veteran’s service-connected acquired psychiatric disability, to include major depressive disorder, is granted. The Veteran’s service-connected acquired psychiatric disability, to include major depressive disorder, is currently evaluated under the criteria of Diagnostic Code 9434 as follows: 0 percent disabling from April 15, 2002; 30 percent disabling from February 25, 2003; and 70 percent disabling from January 27, 2020. See 38 C.F.R. § 4.130. The Veteran contends that the severity of his service-connected acquired psychiatric disability warrants an increased evaluation in excess of those currently assigned, and for the reasons set forth below, the Board agrees that, for the entire period on appeal, the Veteran’s service-connected acquired psychiatric disability warrants an increased evaluation of 70 percent. The VA General Rating Schedule for mental disorders, including major depressive disorder, provides for a noncompensable evaluation where a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. See id. A 10 percent rating contemplates 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 continuous medication. A 30 percent rating contemplates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating contemplates 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; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. See id. A 70 percent evaluation contemplates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. See id. A 100 percent evaluation contemplates 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; and memory loss for names of close relatives, own occupation, or own name. See id. The VA Secretary recently amended the portion of the Schedule for Rating Disabilities dealing with psychiatric disorders and the associated regulations to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and replaced them with references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The DSM-V eliminated the DSM-IV’s reliance upon GAF scores, and accordingly, the Board will no longer afford GAF scores any probative value. See Golden v. Shulkin, 29 Vet. App. 221, 224-25 (2018). Evaluation under Section 4.130 is symptom-driven; therefore, symptomatology should be the primary focus when assigning a rating to a given mental health disability, and the frequency, severity, and duration of a veteran’s symptoms must play an important role in determining the appropriate disability rating. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). Significantly, the list of symptoms under the rating criteria is meant to be illustrative, not exhaustive; thus, the Board need not find all or even some of the listed symptoms in order to award a specific disability rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). In fact, it is the level of the veteran’s occupational and social impairment that determines the appropriate disability rating under Section 4.130; accordingly, if the evidence of record demonstrates that the veteran suffers from symptoms listed in the rating criteria or symptoms of a similar severity, frequency, and duration that cause occupational or social impairment equivalent to the criteria for a particular rating, then the corresponding rating shall be assigned. See id. at 443; see also Vazquez-Claudio, 713 F.3d at 117. In addition to the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission must also be considered, and the evaluation must rest upon all the evidence relating to occupational and social impairment, not solely the examiner’s assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126(a). Further, when evaluating the level of disability for a mental disorder, the extent of social impairment must be considered, but the evaluation shall not be assigned solely on the basis of social impairment. See 38 C.F.R. § 4.126(b). In January 2003, the Veteran was awarded service connection for an acquired psychiatric disability, to include major depressive disorder, with an initial evaluation of 0 percent, effective April 15, 2002. Subsequently, in July 2005, his evaluation was increased to 30 percent, effective February 25, 2003, and in August 2020, it was increased to 70 percent, effective January 27, 2020. Effective dates for disability ratings shall generally be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date the entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). When determining when the entitlement arose, an effective date for benefits can be no earlier than the date the disability at issue first manifested. See DeLisio v. Shinseki, 25 Vet. App. 45, 52 (2011). In this case, the Veteran submitted a noninitial increased rating claim on April 27, 2012; therefore, the Board has considered whether the Veteran’s service-connected psychiatric symptoms warrant an increased evaluation from April 27, 2011. The Veteran contends that his service-connected psychiatric disability warrants evaluations in excess of those currently assigned, due to the severity of his psychiatric symptoms which have been found to be caused by his exposure to combat stressors during his military service in Vietnam. After careful review, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that, for the entire period on appeal, an increased evaluation of 70 percent for the Veteran’s service-connected acquired psychiatric disability, but no greater, is warranted. However, in so finding, the Board further finds that, for the entire period on appeal, a preponderance of the evidence of record weighs against a finding that an increased evaluation in excess of 70 percent is warranted in this case, as the manifestations of the Veteran’s service-connected acquired psychiatric disability do not more closely approximate the criteria for total social and occupational impairment. Throughout the entire period on appeal, the evidence of record reflects that the Veteran’s psychiatric symptoms have included the following: depressed mood; irritability; anger; chronic sleep impairment; social isolation; nightmares; irritability; memory loss; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances, including work or a work-like setting. In June 2013, the Veteran was afforded a VA psychiatric examination which culminated in a report diagnosing the Veteran with major depressive disorder related to his in-service combat stressors, as well as an alcohol use disorder, reportedly in sustained full remission. The June 2013 VA examination report also concludes that the Veteran’s psychiatric condition manifests the following symptoms: recurrent distressing dreams of the event; exaggerated startle response; depressed mood on a daily basis; anxiety on a daily basis; intrusive memories on a daily basis; irritability or anger on a daily basis and displayed during examination; nightmares approximately three times a week related to military trauma; avoidance of people, places, and activities that trigger distressing reminders of trauma; avoidance of gun ranges and places where there are loud noises; detachment from marital relationship; restricted range of affect; difficulty expressing feelings; sense of foreshortened future; sleep impairment; impaired concentration including racing thoughts and losing things; and exaggerated startle response on a daily basis. During the course of the June 2013 VA examination, the Veteran further reported as follows: at the time of the June 2013 VA examination, he had been married for forty-two years, with two adult children and one grandchild; at the time of the June 2013 VA examination, his son was living with the Veteran and his wife due to his son’s recent incarceration; the Veteran expressed resentment that his son’s wife “got the house and most of his stuff,” and he can only see his granddaughter every other weekend; the Veteran’s son reportedly has a rare muscle disease and limited cognitive abilities so the Veteran and his spouse have been caring for him, which has been “a hell of a stress on us;” the Veteran also reported that he feels “mad all the time;” at the time of the June 2013 VA examination, the Veteran was employed full time as a maintenance technician for apartment buildings, which the Veteran reported was “stressful;” at the time of the June 2013 VA examination, the Veteran had been arrested four times, and his last arrest involved his second offense for driving under the influence (DUI), which caused him to lose his license; since that time, the Veteran reported that he has stopped using alcohol; and the Veteran denied having any suicidal or homicidal ideation or intent, though he reported contemplating suicide in 2009. The June 2013 VA examination report also notes that VA treatment records dated April 2013 reflected the following: the Veteran presented as well-groomed, calm and cooperative, and slightly irritable; the Veteran reported suffering from insomnia and irritability, and his psychiatric symptoms had slightly increased since his prior appointment in October 2012; he reported sleeping less and experiencing more job-related stress and irritability; and the Veteran had been prescribed Zoloft, trazodone, and prazosin to treat his psychiatric symptoms. In July 2020, the Veteran was afforded a second VA psychiatric examination which culminated in a report confirming the Veteran’s diagnosis of major depressive disorder, moderate, recurrent, manifested by the following symptoms: depressed mood; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; fatigue; irritability; low motivation or initiative; anhedonia or loss of pleasure from previously enjoyed activities; social withdrawal; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work like setting. The July 2020 VA examination report further noted the following: the Veteran arrived on time for his appointment; he was cooperative during the evaluation; he appeared alert and oriented to person, place, time and situation; his affect was topic-congruent; his mood was depressed; and he displayed good personal hygiene. The July 2020 VA examination report also notes the Veteran’s report of the following: he has been married since 1971; he described his relationship with his spouse as “good;” he remains in regular contact with his siblings; he has one adult son and one adult daughter; his son has been in and out of jail and abuses substances; the Veteran recently asked his son move out of the Veteran’s house, noting that he was a disruptive and disrespectful presence; ever since leaving the military, the Veteran reported that he has struggled to get along with his supervisors and co-workers; he retired from his job as an apartment maintenance technician in 2014; he has found his retirement to be challenging due to his tendency to stay home which often adds to his depression; he began to struggle with low mood following his deployment to Vietnam from 1969 to 1970, where he was exposed to mortar, rocket, and small arms fire while on base or in flight; his struggles with depression are periodic, with no seasonal pattern; he and his spouse first noticed his depressive periods in the 1980s, with his “blues” occurring for “no apparent reason;” he reports little social support from friends or family and that he calls his VA psychiatrist as his primary source of social support; he has been arrested three times for DUI-related incidents, most recently in 2009, at which time he was failed for fifteen days after completing thirty days of rehabilitation; and he denied any past or present suicidal or homicidal ideation. The July 2020 VA examination report further opines that the impact of the Veteran's psychiatric symptoms on his employment were likely to include the following: (1) the Veteran struggles with tolerance of others, with his short temper and low motivation making it hard to succeed at cooperative effort or a team approach; (2) his depression-related thinking and low motivation would make it hard to pursue desk work due to low concentration and slowed rate of work; (3) the Veteran struggles while working with others; his short temper and difficulty with cooperative effort make his placement in busy work settings or requiring regular interaction with others to be exacerbating and stressful for him; and (4) he would struggle with individual desk work or computer work that requires sustained attention and regular attendance, as his more symptomatic days leave him necessitate periods of days off. In February 2021, the Veteran was afforded a third VA psychiatric examination which culminated in a report confirming the Veteran’s diagnosis of major depressive disorder, moderate, recurrent, manifested by the following symptoms: depressed mood, to include feeling depressed most of the day, nearly every day chronically for the past several years; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; irritability; anhedonia; social withdrawal; impaired judgment; psychomotor agitation; low self-esteem; excessive guilt; impaired concentration causing significant impairment in his past and current social life as well as his past employment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work like setting; and an inability to establish and maintain effective relationships. The February 2021 VA examination report further noted the following: the Veteran was fully cooperative, with a good attitude and hygiene; his mood fluctuated between agitated (not angry), sad, and anxious at times; and he moved about often and evidenced psychomotor agitation frequently while sitting. The February 2021 VA examination report also notes the Veteran’s report of the following: he has not worked out of the home since 2014 due to problems with mood, irritability and focus; he regrets his irritable behavior with others; he reports ongoing difficulties with focus, and that he is easily distressed by stressors; it takes him much longer to accomplish tasks and chores; he has seen multiple providers for his psychiatric medication, including most recently in January 2020 when he was prescribed buproprion for depression and propranolol for anxiety. The February 2021 VA examination report also concludes that the Veteran’s alcohol use disorder, while severe, is in sustained remission, as the Veteran reports, and the evidence of record supports, a past history and diagnosis of alcohol use disorder, severe, in sustained remission. The record contains no current evidence of a current alcohol use disorder meeting diagnostic criteria since approximately 2009, when the Veteran completed thirty days of residential treatment. In an April 2012 lay statement submitted by the Veteran, he reports that he continues to have night sweats and nightmares related to his combat exposure in Vietnam, that he is “very jumpy” and easily startled, to the extent that “any loud noise, I hit the deck or crouch.” Also in April 2012, the Veteran submitted two lay statements provided by his co-workers: (1) the April 2012 statement of M.A. stating as follows: while employed with M.A., the Veteran appeared to suffer from “memory problems;” he tried to control his frustration and anger by repeating things over and over to himself in order to create a memory of his tasks; he would forget why he came into the office; and he worked “very hard” to overcome his frustrations; and (2) the April 2012 lay statement of M.K. stating as follows: while employed with M.K., the Veteran missed “a lot of time from work” because of his health; he appeared to be depressed and to suffer from “mood swings;” he would lose control “over little things” and “blow[] up;” his memory was “very bad;” he could not remember things like which apartment he had worked in, what changes he had made, where he had placed his keys, and several other things; he was very easily startled; and if he did not see his co-worker walk into the room, he would jump, yell, bring his arm back, and make a fist in order to defend himself. In October 2014, the Veteran submitted a lay statement provided by his spouse stating that after forty-three years of marriage, she has observed the Veteran’s psychiatric symptoms, to include the following: nightmares; ease of startle; depression, and mood swings. In addition, the Veteran’s spouse reports that when the Veteran hears a bang, he reacts in a manner as if he is “taking over,” and that he explained it is “because of the rocket attacks and sounds of gunfire” during his Vietnam service. In February 2020, the Veteran testified before the undersigned that his psychiatric disability manifests in the following symptoms: depression; anxiety; sleep impairment; intrusive memories of Vietnam; dreams that “I am still back in Vietnam” causing him to not “sleep very deeply;” short term memory loss, which causes him to forget things “after ten minutes;” irritability and angry outbursts which he is “unable to control” and which caused him to frequently lash out at co-workers while he was still employed; difficulty controlling his emotions; frequently and easily getting upset during conversations; yelling at his spouse and treating her poorly; a “violent” relationship with his adult son; severe depression which led him to load a gun one night and take it “out to the patio;” a history of alcohol abuse during his military service; and post-military DUI-related incidents involving rehabilitation, the loss of his drivers’ license, and incarceration. In light of the foregoing evidence, the Board finds that, for the entire period on appeal, an evaluation of 70 percent, but no higher, is warranted in this case, because the frequency, severity, and duration of the Veteran’s symptomatology resulted in social and occupational impairment in most areas, particularly with respect to his restricted social and occupational relationships, his pronounced irritability, his inability to form productive working relationships or to focus on job-related tasks, and his persistent mood dysregulation. See 38 C.F.R. § 4.130 (2020). In particular, the June 2013, July 2020, and February 2021 VA psychiatric examinations all culminated in reports concluding that the Veteran’s psychiatric symptomatology impairs his social and occupational relationships, his concentration and his mood, his ability to adapt to stressful circumstances, and his inability to establish and maintain effective relationships. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Guerrieri v. Brown, 4 Vet. App. 467, 470 (1993). In addition, the Board finds the Veteran’s competent and credible testimony regarding his current psychiatric symptomatology to carry significant probative weight, including his report of his combat-related nightmares, memory loss, chronic sleep impairment, and depressed mood, as well as his ongoing hypervigilance and irritability, as does the cumulative effect of the lay statements submitted by the Veteran’s spouse and co-workers. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Accordingly, in light of the foregoing lay and medical evidence, the Board finds that an evaluation of 70 percent, but no higher, during the entire period on appeal is warranted in this case, because the frequency, severity, and duration of the Veteran’s symptomatology during this period resulted in social and occupational impairment in most areas, particularly with respect to his family relations, employment, judgment, thinking, and mood. See 38 C.F.R. § 4.130. However, in so finding, the Board further finds that at no time during the pendency of the appeal have the criteria for a 100 percent rating for an acquired psychiatric disability been satisfied or approximated. See 38 C.F.R. § 4.130, Diagnostic Codes 9411, 9435. The Veteran’s examination and treatment records consistently reflect the absence of any reports or observations of the following: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. See id. Moreover, while the Board acknowledges that the evidence of record indicates that the Veteran was treated for suicidal ideations in 2009, throughout the period on appeal from April 27, 2011, the Veteran has consistently reported that his psychiatric condition no longer manifests suicidal or homicidal ideations, and the VA treatment records and examination reports of record also support such a finding. More importantly, the Board finds that the totality of the evidence of record does not warrant a finding that the Veteran’s psychiatric symptomatology more closely approximates the criteria enumerated for a 100 percent evaluation, as the competent evidence of record does establish total social or occupational impairment, and the presence of a specific symptom listed in evaluation criteria is not necessarily dispositive of any particular disability level. See Bankhead, 29 Vet. App. at 22. In addition, the Board further finds that the evidence of record reflects that, despite the interpersonal conflict that exists between the Veteran and his adult son, the Veteran has maintained close familial relationships with his spouse of nearly fifty years and his adult daughter, as well as regular contact with his siblings. See 38 C.F.R. § 4.130. Accordingly, in light of the foregoing, the Board finds that the preponderance of the evidence of record weighs against a finding that the Veteran’s psychiatric symptoms have resulted in total social impairment as contemplated by Section 4.130 for a total disability rating, and in so finding, the Board determines that the severity of the Veteran’s psychiatric symptomatology does not more nearly approximate the level of disability contemplated by a 100 percent rating. See Vazquez-Claudio, 713 F.3d at 117-118. As set forth above, a total disability rating under Section 4.130 requires an ultimate factual conclusion that the level of the Veteran’s psychiatric symptomatology resulted in both total occupational and total social impairment; however, the evidence in this case does not support a finding that the Veteran’s familial or social relationships were totally impaired as contemplated by a total disability rating. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Therefore, the Board finds that the Veteran’s psychiatric symptomatology more nearly approximates the rating criteria contemplated by the 70 percent disability rating rather than the 100 percent rating, and a rating of 100 percent is not warranted at any point during the period on appeal. Instead, an increased evaluation of 70 percent, and no higher, during such period on appeal is warranted in this case, due to the frequency, severity, and duration of the Veteran’s symptomatology resulting in social and occupational impairment in most areas, particularly in work, family relations, judgment, and mood. See id. Consideration has also been given the potential application of diagnostic codes for other mental disorders; however, the Board finds no basis upon which to assign increased or additional ratings for the Veteran’s acquired psychiatric disability at any point during the period of appeal, as the totality of the Veteran’s psychiatric symptoms have been encompassed in the current evaluation. Accordingly, the Board finds that an award of additional evaluations under Section 4.130 would constitute the sort of impermissible pyramiding proscribed by VA regulations for conditions that are duplicative or overlapping with the symptomatology of another condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); 38 C.F.R. § 4.14. Thus, all potentially applicable diagnostic codes have been considered, and there is no basis to assign an evaluation in excess of the rating assigned herein for the Veteran’s disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). In addition, the Board is not required to address additional issues unless specifically raised by the Veteran or reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). Accordingly, because neither the Veteran nor his representative has raised any other issue concerning the Veteran’s psychiatric disability, and no other issues have been reasonably raised by the record, the Board finds that, for the entire period on appeal, a disability rating of 70 percent, but no greater, for the Veteran’s service-connected acquired psychiatric disability is warranted in this case. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). REASONS AND BASES FOR REMAND An August 2020 rating decision deferred a decision on the issue of entitlement to TDIU. It appears the AOJ is continuing to develop this issue and has not yet issued a decision. Additionally, although the AOJ obtained a February 2021 VA examination and specifically requested an opinion as to how the psychiatric condition impacts the ability to function in an occupational environment and requested the examiner identify any functional limitations, the examiner restated some symptoms and did not provide the requested opinion. On remand further opinion to determine the aggregate effect of the Veteran's service-connected disabilities over his employability is necessary. Accordingly, the case is remanded for the following action: 1. Forward the Veteran’s claims file to an appropriate VA physician and schedule the Veteran for a VA examination with such physician (or telehealth interview, records review, etc., if an in-person examination is not feasible) to comment as to the aggregate effect of the Veteran’s service-connected disabilities over his ability to secure or follow substantial gainful employment. The VA examiner should comment on the functional effect of the Veteran’s service-connected disabilities on the ability to work (disregarding the effects of any disabilities that are not service connected), indicating what functions or types of employment would be inconsistent with or would be precluded by the service-connected disabilities, and what types of employment, if any, would remain feasible despite the service-connected disabilities. A complete rationale should be provided for any opinion rendered. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Marsdale 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.