Citation Nr: 21026877 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-09 691 DATE: May 4, 2021 ISSUES 1. Entitlement to an initial disability rating in excess of 20 percent for residuals, status post fracture right ankle with surgical intervention (also claimed as right leg condition). 2. Entitlement to an initial disability rating in excess of 10 percent for bilateral tinnitus on an extraschedular basis. 3. Entitlement to an initial disability rating in excess of 10 percent for residual circular scar, status post right ankle fracture with surgical intervention. 4. Entitlement to an initial compensable disability rating for right ear hearing loss. 5. Entitlement to an initial compensable disability rating for residual scar lateral malleolus, status post fracture right ankle. 6. Entitlement to an initial compensable disability rating for residual suture scars, status post right ankle fracture with surgical intervention. ORDER Entitlement to an initial disability rating in excess of 10 percent for bilateral tinnitus on an extraschedular basis is denied. Entitlement to an initial compensable disability rating for right ear hearing loss is denied. REMANDED Entitlement to an initial disability rating in excess of 20 percent for residuals, status post fracture right ankle with surgical intervention (also claimed as right leg condition) is remanded. Entitlement to an initial disability rating in excess of 10 percent for residual circular scar, status post right ankle fracture with surgical intervention is remanded. Entitlement to an initial compensable disability rating for residual scar lateral malleolus, status post fracture right ankle is remanded. Entitlement to an initial compensable disability rating for residual suture scars, status post right ankle fracture with surgical intervention is remanded. FINDINGS OF FACT 1. The Veteran's tinnitus does not present an exceptional or unusual disability picture with related factors such as marked interference with employment or frequent periods of hospitalization so as to render impractical the application of the regular schedular standards. 2. Throughout the entire period on appeal, the Veteran's right ear hearing impairment has been no worse than a Level II impairment. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 10 percent for tinnitus on an extraschedular basis have not been met. 38 U.S.C. § 1155; 5107; 38 C.F.R. §§ 3.321, 4.87, Diagnostic Code 6260; 82 Fed. Reg. 57830 (Dec. 8, 2017) (effective January 8, 2018). 2. Throughout the period on appeal, the criteria for a compensable evaluation for right ear hearing loss have not been met or approximated. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.85, Diagnostic Code 6100, 4.86 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1990 to April 2010. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Jurisdiction over the case was subsequently transferred to the RO in Hartford, Connecticut. The Veteran provided testimony before the undersigned during a March 2017 Board videoconference hearing; a transcript of the hearing is associated with the record. When this case was previously before the Board in November 2017, it was remanded for additional evidentiary development. With regards to the issues herein decided, the Board finds that there has been substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The case has since been returned to the Board for further appellate action. VCAA The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2017). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed.Cir. 2015, cert denied, U.S.C. Oct.3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Disability Rating Legal Criteria and Analysis Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2017). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321(a), 4.1 (2017). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2017). In accordance with 38 C.F.R. §§ 4.1, 4.2 (2017) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the Veteran's service-connected disabilities. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. The Board notes that when it is not possible to separate the effects of a non-service-connected condition from those of a service-connected disorder, reasonable doubt should be resolved in the claimant's favor with regard to the question of whether certain signs and symptoms can be attributed to the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998); see also 38 C.F.R. § 3.102. Tinnitus Generally, disability ratings are determined by evaluating the extent to which a service-connected disability adversely affects the ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in VA's Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. However, to accord justice in the exceptional case where the criteria in VA's Rating Schedule are found to be inadequate, an extraschedular rating that is commensurate with the average earning capacity impairment caused by the service connected disability is warranted. An extraschedular rating is warranted when the case presents such an unusual disability picture with related factors such as marked interference with employment or frequent periods of hospitalization to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321 (b)(1). The Court has clarified that there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. Thun v. Peake, 22 Vet. App. 111, 115 (2008). Initially, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service connected disability are inadequate. See Yancy v. McDonald, 27 Vet. App. 484 (2016); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding that either the veteran must assert that a schedular rating is inadequate or the evidence must present exceptional or unusual circumstances); Sowers v. McDonald, 27 Vet. App. 472, 478 (2016) (the rating schedule must be deemed inadequate before extraschedular consideration is warranted). Second, if the schedular rating does not contemplate the veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether the veteran's disability picture exhibits other related factors such as marked interference with employment and frequent periods of hospitalization. Thun, 22 Vet. App. at 116. Third, if the first two Thun elements have been satisfied, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation Service to determine whether, to accord justice, the veteran's disability picture requires the assignment of an extraschedular rating. Thun, 22 Vet. App. at 116. In other words, the first element of Thun compares a veteran's symptoms to the rating criteria, while the second element considers the resulting effects of those symptoms; if either prong is not met, then referral for extraschedular consideration is not appropriate. Yancy, 27 Vet. App. at 494-95. Historically, the June 2010 rating decision, which forms the basis of the current appeal, granted service connection for tinnitus effective May 1, 2010. At that time, a 10 percent rating was assigned under 38 C.F.R. § 4.87, Diagnostic Code 6260. The applicable rating schedule for Diagnostic Code 6260 directs that recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head will be assigned a single 10 percent evaluation. 38 C.F.R. § 4.87. The Board finds the Veteran's tinnitus is properly evaluated under Diagnostic Code 6260, which is specific to the disorder, and was utilized in the assignment of the initial rating. See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015). The Veteran was afforded a VA audiological examination in February 2010 in which he reported that tinnitus was present "most of the time" which kept him up at night, impeded his ability to focus on tasks, and that it had gotten worse since 2004 to 2005. The Veteran was afforded a VA audiological examination in February 2020 in which he reported that his tinnitus was extremely bothersome and that it impacted his ability to hear. He stated that it was getting worse and more bothersome. The Veteran testified before the undersigned as to increased ringing and an inability to wear his hearing aids due to the ringing. In the April 2012 statement, the Veteran also noted that his tinnitus kept him awake at night. As pertinent in this case, the Board notes that on December 8, 2017, VA issued a Final Rule amending 38 C.F.R. § 3.321 (b)(1), effective January 8, 2018, to clarify that an extraschedular rating is not available based on the combined effect of multiple service-connected disabilities. See 82 Fed. Reg. 57830. The provisions of this final rule apply to all applications for benefits that are received by VA, or that are pending before VA, the Court, or the United States Court of Appeals for the Federal Circuit on or after January 8, 2018. See Thurlow v. Wilkie, 30 Vet. App. 231 (2018); Nat'l Org. of Veterans' Advocates, Inc. v. Sec'y of Veterans Affairs, 2019 U.S. App. LEXIS 18699 (Fed. Cir. June 24, 2019). As the Veteran's case on appeal here is pending before VA on or after January 8, 2018, this final rule is applicable to this case. Accordingly, the Board finds that an extraschedular rating based on the collective impact of multiple service-connected disabilities is not for consideration, as an extraschedular rating based on multiple service-connected disabilities is no longer a viable theory of entitlement in this appeal. In the November 2017 Board remand, the Board referred the issue of entitlement to an initial disability rating in excess of 10 percent for bilateral tinnitus to the Director of Compensation for consideration of extraschedular evaluations. Thereafter, in a memorandum, associated with the record in November 2020, the VA Director of Compensation Service denied an extraschedular rating for the service-connected tinnitus. In doing so, the Director found that based on the totality of evidence of record, there was no extra-schedular entitlement to an increased evaluation for tinnitus, pursuant to 38 C.F.R. § 3.321 (b)(1). The Director further explained that the Veteran reported tinnitus first developed in the right ear after the service then later developed in his left ear. The ringing in the ear was constant or nearly constant. The tinnitus occurred most of the time and kept him awake at night. The ringing in the ears was reported to impede his ability to focus on tasks. The tinnitus was reported to have gotten louder over time, and the Veteran associated increased tinnitus with increased background noise. The Veteran reported not being able to wear hearing aids with increased symptoms of tinnitus, but the Director stated that records showed that the Veteran did currently use hearing aids for hearing loss. The Director stated that while there were subjective complaints of tinnitus, and the Veteran reported the symptoms increased, the symptoms reported did not represent an exceptional or unusual factor showing the schedular evaluation for tinnitus was inadequate. The Director stated that extra-schedular evaluations were assigned in cases where an exceptional or unusual disability picture was presented with such related factors as marked interference with employment or frequent periods of hospitalization that renders application of regular rating schedular standards impractical. The Director found that no unusual or exceptional disability pattern was demonstrated that would render application of the regular rating criteria as impractical. Therefore, the Director found that an increased evaluation was not warranted on an extraschedular basis for tinnitus in pursuant to 38 C.F.R. § 3.321 (b)(1). The Board finds that the November 2020 Director's opinion contains adequate statement of reasons or bases and is supported by the overall evidence. Kuppamala v. McDonald, 24 Vet. App. 447 (2016). The Director cited to the relevant regulatory provisions and explained the rationale for concluding that an extraschedular rating was not warranted. Therefore, that decision is reviewable by the Board de novo. The rating schedule addresses recurrent tinnitus whether it be in one ear, both ears, or the head, and tinnitus "'a noise in the ears such as ringing, buzzing, roaring, or clicking.'" Smith v. Principi, 17 Vet. App. 168, 170 (2003) (quoting DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1714 (28th ed. 1994)). Considering the definition of tinnitus, as well as the notes following the diagnostic code, the Board finds that the rating criteria contemplate the Veteran's symptoms and the resultant functional impairment. This functional impairment does not place the Veteran's tinnitus outside of the disability picture contemplated by the schedular criteria. In other words, the schedular rating for tinnitus contemplates the Veteran's constant ringing in the ears and its functional effect on his daily life. In fact, the Court's decision in Doucette is reflective of the current case, as Doucette is a significant case in terms of how extraschedular cases are viewed and the Court made clear that a diagnostic code need not list every word or type of symptom to contemplate a type of functional effect. For instance, problems with hearing sounds in crowds, televisions or telephones are not listed in the diagnostic code for hearing loss but are nonetheless contemplated because they are the actual effects of the hearing loss in daily life. Doucette, 28 Vet. App. at 369-70. Here, although in the context of a tinnitus extraschedular rating claim, the Doucette decision by extension shows that the symptoms of the Veteran's tinnitus, and their functional effects, are contemplated by the rating schedule for evaluating the disability. Moreover, even considering that Diagnostic Code 6260 does not explicitly discuss difficulty sleeping and focusing on tasks, and assuming for argument that such symptoms are related to tinnitus, the Board has carefully reviewed the record and finds that the case does not present other evidence of an exceptional or unusual disability picture, such as marked interference with employment or frequent periods of hospitalization. Significantly, the evidence does not demonstrate that the Veteran's difficulty sleeping and focusing on tasks are so significant that they have caused a marked interference with employment. With regard to the question of whether other factors are present to establish an exceptional disability, the Veteran does not assert, and the evidence does not show, that he has had any hospitalizations for tinnitus, let alone any frequent hospitalizations for such. As discussed above, the schedular rating for tinnitus contemplates the Veteran's constant ringing in the ears and its functional effect on his daily life. Doucette, 28 Vet. App. at 369-70. Moreover, in this regard, the November 2020 Director's opinion explained that there was no evidence of frequent hospitalization, or marked interference with employment. In sum, the Board recognizes that tinnitus has some impact on the Veteran's life, but the functional effects from the ear ringing is contemplated by the 10 percent schedular rating currently assigned. Moreover, the Veteran has not described, and the evidence does not show, that the associated ear pain or discomfort that would interfere with occupational duties in a way that would cause marked interference with employment or has caused him to be frequently hospitalized. In short, there are no indications of an exceptional or unusual disability picture. For these reasons, the Board finds that an extraschedular rating for tinnitus is not warranted. In reaching the above-stated conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against a higher schedular rating or an extraschedular rating, that doctrine is inapplicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. Therefore, an initial rating in excess of 10 percent for tinnitus is not warranted. Hearing Loss Disability ratings for hearing loss disability are derived from mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The rating schedule establishes 11 auditory hearing acuity levels based upon average puretone thresholds and speech discrimination. See 38 C.F.R. § 4.85. An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations will be conducted without the use of hearing aids. 38 C.F.R. § 4.85(a). Table VI, "Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination," is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination (horizontal rows) and the puretone threshold average (vertical columns). The Roman numeral designation is located at the point where the row and column intersect. 38 C.F.R. § 4.85(b). Table VIa, "Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average," is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on puretone threshold average. Table VIa is used when the examiner certifies that the use of the speech discrimination test is not appropriate due to language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86. 38 C.F.R. § 4.85(c). "Puretone threshold average" as used in Tables VI and VIa is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz and divided by four. This average is used in all cases (including those of § 4.86) to determine a Roman numeral designation from Tables VI and VIa. 38 C.F.R. § 4.85(d). Table VII, "Percentage Evaluations of Hearing Impairment," is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment in each ear. The horizontal rows represent the ear having better hearing and the vertical columns represent the ear having the poorer hearing. The percentage evaluation is located at the point where the row and the column intersect. 38 C.F.R. § 4.85(e). Provisions for evaluating exceptional patterns of hearing impairment are as follows. (a) When the puretone thresholds at each of the four specified frequencies (1000, 2000, 3000 and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. (b) When the puretone thresholds are 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral; the numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86. If impaired hearing is service-connected in only one ear, as here, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I. 38 C.F.R. § 4.85 (f). In the present case, service connection for right ear hearing loss was granted in the June 2010 rating decision on appeal with an evaluation of 0 percent effective May 1, 2010. The Veteran was afforded a VA audiological examination in February 2010 in which he reported that hearing loss caused him to not partake in activities such as going to the movies and listening to music, especially when background noise was present. On examination his puretone thresholds were as follows: HERTZ 500 1000 2000 3000 4000 AVG. RIGHT 10 5 10 30 50 24 Speech recognition was 94 percent in the right ear. Applying the values above to Table VI results in an imputed Level I Roman numeral designation for the left ear and a Level I for the right ear. Application of these designations to Table VII results in a 0 percent rating. The Board has considered whether a higher rating is warranted by applying the exceptional hearing pattern provisions of 38 C.F.R. § 4.86; however, the exceptional hearing pattern criteria are not met. The Veteran was afforded a VA audiological examination in February 2020 in which he reported significant difficulty hearing, particularly when in the presence of background noise. He also reported difficulty understanding speech when in the movies. On examination his puretone thresholds were as follows: HERTZ 500 1000 2000 3000 4000 AVG. RIGHT 15 20 15 50 60 36 Speech recognition was 84 percent in the right ear. Applying the values above to Table VI results in an imputed Level I Roman numeral designation for the left ear and a Level II for the right ear. Application of these designations to Table VII results in a 0 percent rating. The Board has considered whether a higher rating is warranted by applying the exceptional hearing pattern provisions of 38 C.F.R. § 4.86; however, the exceptional hearing pattern criteria are not met. The Board notes that the Court has held that, "in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report." Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In accordance with this decision, the Board finds that the examiners sufficiently noted the effects the Veteran's hearing impairment had on his activities, to include not partaking in activities such as going to the movies and listening to music, especially when background noise was present, and significant difficulty hearing, particularly when in the presence of background noise. On review of the file, it is evident, and the preponderance of the evidence shows, that the criteria for a disability rating in excess of 0 percent for the service-connected right ear hearing loss under Diagnostic Code 6100 is not met. Accordingly, the benefit of the doubt is not for application and the claim must be denied. REASONS FOR REMAND The Board finds that further development is necessary prior to final adjudication of the Veteran's remaining claims on appeal. In response to the Board's remand, the Veteran was afforded a VA examination in June 2019 in which he reported that he continued to have severe pain in the ankle and extremely limited range of motion with swelling by the end of the day. He reported wearing an ankle brace, taking hydrocodone for the pain, and had an upcoming appointment with podiatry. The Veteran reported flare-ups of being unable to push off with his foot without getting severe pain. Physical examination showed pain on passive range of motion testing and pain in non-weight bearing testing; however, range of motion in degrees was not provided. In Correia v. McDonald, 28 Vet. App. 158 (2016), the U.S. Court of Appeals for Veterans Claims (Court) noted the final sentence of § 4.59, which states "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint." The Court found this sentence to be ambiguous because the regulation, considered as a whole, is meant to guide adjudicators in determining the proper level of disability of joints, and if the range of motion testing listed in the last sentence is not required, it is unclear how an adjudicator could adequately rate a claimant's joint disability and account for painful motion. However, compelled by § 4.59's place in the regulatory scheme (it preceded the disability rating schedule), the Court held that the final sentence of § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. As also relevant, a more recent Court decision addressed what constitutes an adequate explanation for an examiner's inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. The Board notes that in the subsequent January 2020 VA podiatry consultation treatment record, the Veteran complained of worsening right ankle pain making him walk funny. As the June 2019 examination report did not provide all of the information specified by Correia and Sharp, and the Veteran subsequently reported worsening pain, the Board finds that the claim must be remanded for new VA examination(s) to obtain the information necessary to properly adjudicate the claims. The matters are REMANDED for the following action: 1. The Veteran should be afforded VA examination(s) by an examiner with appropriate expertise to determine the current degree of severity of the service-connected residuals, status post fracture right ankle with surgical intervention; residual circular scar, status post right ankle fracture with surgical intervention; right ear hearing loss; residual scar lateral malleolus, status post fracture right ankle; and residual suture scars, status post right ankle fracture with surgical intervention. The electronic claims file must be made available to and reviewed by the examiner. Any indicated studies should be performed. All testing deemed necessary must be conducted and results reported in detail. The examiner should: Conduct all indicated tests and studies, to include range of motion studies expressed in degrees and in relation to normal range of motion, and should describe any pain, weakened movement, excess fatigability, and incoordination present. To the extent possible, express any functional loss in terms of additional degrees of limited motion of the Veteran's disabilities, i.e., the extent of the Veteran's pain-free motion. Pursuant to Correia v. McDonald, 28 Vet. App. 158 (2016), please record the results of range of motion testing for pain on both active and passive motion and in weight-bearing and non-weight-bearing. If a joint cannot be tested on "weight-bearing," please specifically indicate why that testing cannot be done. Pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017), the examiner is instructed to inquire whether there are periods of flare-ups. If the answer is "yes," the examiner should state their severity, frequency, and duration explaining if there are any additional or increased symptoms and limitations experienced during flares. The examiner must ALSO name the precipitating and alleviating factors. The examiner must ALSO estimate, "per [the] veteran," to what extent, if any, they affect functional impairment. A full and complete rationale for any opinions expressed is required. 2. After completing the requested actions, and any additional notification and/or development deemed warranted, the RO should readjudicate the claims on appeal. If any benefit sought on appeal remains denied, the RO must furnish the Veteran with an appropriate supplemental statement of the case and afford a reasonable opportunity for response. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M.K., 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.