Citation Nr: 21029424 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 19-31 454 DATE: May 13, 2021 ORDER New and material evidence having been received, the service connection claim for a right knee disability is reopened. Entitlement to service connection for headaches is denied. Entitlement to a compensable rating for a ruptured right tympanic membrane, to include on an extraschedular basis, is granted. REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to a temporary total rating for convalescence purposes for a right knee disability is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. A September 2015 rating decision denied service connection for a right knee disability. 2. Subsequent to the September 2015 rating decision, new and material evidence has been received regarding the Veteran's service connection claim for a right knee disability. 3. A current headache disability did not have its onset in service, has not been chronic or continuous since service separation, did not manifest within a year of separation from any period of active duty service, and is not due to or aggravated by a service-connected disability. 4. The Veteran's ruptured right tympanic membrane is characterized by intermittent suppuration of the right ear, but does not result in an unusual or exceptional disability level of impairment. CONCLUSIONS OF LAW 1. The September 2015 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 19.20. 2. New and material evidence sufficient to reopen the claim of entitlement to service connection for a right knee disability has been received. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 4. The criteria for entitlement to a compensable rating of 10 percent and no higher for a ruptured right tympanic membrane have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.85, 4.86, 4.87, Diagnostic Codes 6200-6211. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1980 to December 1980, from November 1990 to April21,1991, and from November 1991 to May 1992. He also had periods of active duty for training and inactive duty training as a member of the Alabama Army National Guard from March 1980 to March 2002. This matter comes before the Board of Veterans' Appeals (Board) on appeal from July and October 2018 rating decisions of a Regional Office (RO) of the Department of Veterans Affairs (VA). These issues were previously before the Board in October 2019 and March 2020, at which times they were remanded for additional development. They have now been returned to the Board. As noted in the Board's prior March 2020 remand, the Veteran's former representative has withdrawn from the appeal, and the Veteran is now unrepresented. 1. New and material evidence to reopen a service connection claim for a right knee disability The Veteran seeks to reopen a service connection claim for a right knee disability. In a September 2015 rating decision, VA denied the Veteran's service connection claim for entitlement to service connection for a right knee disability. The Veteran did not file a timely notice of disagreement or submit new and material evidence within one year of that rating decision, and it became final. 38 U.S.C. § 7105. Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means evidence not previously submitted to agency decisionmakers. Material evidence means evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). In order to be new and material, the evidence must not be cumulative or redundant, and must raise a reasonable possibility of substantiating the claim, a requirement which has been found to be enabling, not preclusive. See Shade v. Shinseki, 24 Vet. App. 110, 121 (2010). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). In denying the Veteran's service connection claim, the RO found no evidence that a current right knee disability was incurred in service, or was otherwise related to an in-service disease or injury. Evidence received since the September 2015 rating decision includes an April 2018 statement from the Veteran's mother. She wrote that upon his return from active duty in 1992, she noticed the Veteran had a limp, and he reported to her an in-service injury to his right knee. This evidence is material because it relates to unestablished facts necessary to establish the Veteran's claim; specifically, that the Veteran displayed right knee symptomatology immediately following service. Additionally, the evidence is neither cumulative nor redundant, as this evidence was not of record at the time of the prior denial. Therefore, this evidence is also new. Accordingly, for all of the above reasons, the Veteran's claims for entitlement to service connection for a right knee disability is reopened. 2. Entitlement to service connection for headaches The Veteran seeks service connection for headaches. He asserts such a disability began during active duty service as a result of his close proximity to an explosion. He also asserts his headaches are due to his service-connected right ear disability, a ruptured tympanic membrane. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). "Active service" includes active duty, a period of active duty for training (ADT) in which the individual was disabled from a disease or injury incurred or aggravated in the line of duty, and a period of inactive duty for training (IDT) in which the individual was disabled from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101 (21), (24)(B); 38 C.F.R. § 3.6 (a); see also Brooks v. Brown, 5 Vet. App. 484 (1994). ADT includes full-time duty performed for training purposes by members of the Reserves or National Guard. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). IDT is generally duty (other than full-time duty) prescribed for Reserves or duty performed by a member of the National Guard of any State (other than full-time duty). 38 U.S.C. § 101 (23); 38 C.F.R. § 3.6 (d). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Service connection may be awarded for any disability which is proximately due to or the result of, or is otherwise aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Considering first the service treatment records, these are unavailable. VA has attempted on multiple occasions to obtain the Veteran's service treatment records, having contacted his Alabama National Guard unit and other sources, without success. Under these circumstances, VA has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). Review of the record indicates the first reports of headaches date to October 2003, when he reported a history of headaches to a VA examiner. He also gave a history of an acoustic injury to the right ear in approximately 1991, following an explosion during training, resulting in right ear hearing loss, tinnitus, and rupture of the tympanic membrane. Subsequent VA and private treatment records show intermittent reports of headaches, along with occasions on which the Veteran denied headaches. Additionally, his headaches have been attributed to multiple sources, including sinus infections and a 2015 motor vehicle accident. As the Veteran's most recent period of active military service ended in May 1992, his first report of headaches was more than 10 years following such service. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000); see, e.g., Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). Indeed, when the Veteran initially filed a VA compensation claim in June 2003, he requested service connection for a right ear injury, but did not claim headaches at that time. If the Veteran had been experiencing headaches since his initial 1991 injury, as he currently alleges, it would reasonably be expected that he would have sought service connection for the same at that time. Thus, based on the lack of evidence within the medical record establishing headaches during any period of active military service, the Board must conclude that such a disability did not have its onset in service and has not been chronic or continuous following such service. The Veteran was afforded a VA medical examination and opinion in August 2019. After reviewing the claims file and examining the Veteran, the VA examiner determined that it was less likely than not any current headache disability was incurred in service or was otherwise related to a service-connected disability. In its March 2020 remand order, however, the Board noted the VA examiner mistakenly attributed onset of the Veteran's right ear injury to 2018; as such, this opinion lacked probative value. The Veteran was a afforded a second VA medical examination in August 2020. The claims file was reviewed in conjunction with the examination. The examiner diagnosed a migraine headache disorder. The examiner also noted the Veteran's assertion that his headaches began in 1991, following his right tympanic membrane rupture. The examiner further noted, however, that the evidence of record did not reflect reports of headaches until 2003, 12 years after the reported right tympanic membrane injury. Additionally, the Veteran's subsequent headaches were attributed to a variety of sources, including sinus infections and a 2015 motor vehicle accident. Thus, based on this evidence, the VA examiner concluded the Veteran's headaches were not due to or aggravated by the Veteran's service-connected right tympanic membrane rupture. As this competent evidence is uncontroverted within the record, the Board concludes that service connection for headaches is not warranted on a secondary basis. The Veteran himself asserts his headaches began during a period of active military service, and are the result of his service-connected right tympanic membrane disability. The Board acknowledges that the Veteran, a layperson, is competent to report such observable symptomatology as headaches. Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). In the present case, however, the Board does not find the Veteran a credible reporter of his claimed disability. Regarding the Veteran's credibility, the Board notes that on his initial VA compensation claim received in June 2003, he explicitly denied service in the Persian Gulf after August 1, 1990. Likewise, his service personnel records are negative for any foreign service. Subsequently, however, the Veteran claimed to have served in Iraq, according to a 2014 VA outpatient clinical record. He also filed for, and was awarded, service connection for posttraumatic stress disorder (PTSD) based on fear of hostile military or terrorist activity, despite having denied the same previously. As such, the Board does not find the Veteran's various assertions credible. In conclusion, the Board finds the preponderance of the evidence to be against the award of service connection for a headache disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 3. Entitlement to a compensable rating for a ruptured right tympanic membrane, to include on an extraschedular basis The Veteran seeks a compensable rating for his service-connected right tympanic membrane rupture. He asserts this disability results in pain and draining of the right ear, and a compensable rating is therefore warranted. Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In adjudicating increased rating claims, the level of disability in all periods since the effective date of the grant of service connection must be taken into account, to include the possibility that a staged rating may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. 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. 38 C.F.R. § 4.7. Most recently, the Veteran's right tympanic membrane rupture was rated under Diagnostic Code (DC) 6211, for perforation of the tympanic membrane. This DC provides a single noncompensable rating. 38 C.F.R. § 4.87, DC 6211. The Board notes, however, that the Veteran's right ear disability was originally granted service connection as a right ear infection, claimed as otitis, under DC 6200, for chronic suppurative otitis media, mastoiditis, or cholesteatoma (or any combination). Under this DC, an ear disability is evaluated at a maximum 10 percent level during suppuration, or with aural polyps. 38 C.F.R. § 4.87, DC 6200. A note to DC 6200 provides for separate evaluations for hearing impairment and complications such as labyrinthitis, tinnitus, facial nerve paralysis, or bone loss of skull. Id. As several VA examination reports, including the most recent in June 2018, note suppuration of the right ear, the Board finds a compensable rating of 10 percent and no higher is warranted under DC 6200. The June 2018 VA examination also noted the right tympanic membrane remained ruptured, despite a prior surgical repair. While his suppuration of the right ear has not been noted to be constant, the Board finds, in light of 38 C.F.R. §§ 4.3 and 4.7, and affording the Veteran the benefit of the doubt, that a compensable rating is warranted. After considering the totality of the record, however, the Board finds a disability rating in excess of 10 percent is not warranted at any time during the pendency of the appeal. As noted above, a 10 percent rating is the highest schedular rating under DC 6200. The Veteran has already been granted separate awards of service connection with a 10 percent rating, for tinnitus, and, with a noncompensable rating, for hearing loss of the right ear resulting from his right tympanic membrane rupture. Additionally, the Board previously considered and denied entitlement to a compensable rating for this disability in its prior March 2020 decision, and that issue is not currently before the Board. The Board also acknowledges that, in its March 2020 remand order, referral for consideration of an extraschedular evaluation was ordered. Generally, disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in 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. 38 C.F.R. § 3.321 (b)(1). Such a rating is warranted when the case presents such an unusual disability picture with related factors such as marked interference with employment as to render impractical the application of the regular schedular standards. Id. Extraschedular consideration requires a three-step inquiry. Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). If (1) the schedular evaluation does not contemplate the claimant's level of disability and symptomatology, and (2) the disability picture exhibits other related factors such as marked interference with employment or frequent periods of hospitalization, then (3) the case must be referred to an authorized official to determine whether an extraschedular rating is warranted. Id. When the Board finds that an extraschedular rating may be warranted based on the above factors, it cannot grant an extraschedular rating in the first instance. Anderson v. Shinseki, 23 Vet. App. 423, 428-429 (2009). Rather, it must remand the claim to the RO for referral to the Director of Compensation Service. See Thun, 572 F.3d at 1366. In this case, the Board referred the matter to the Director in the March 2020 remand order. In January 2021 memorandum, the Director denied entitlement to an extraschedular rating. The Director's decision is not evidence, but, rather, the de facto RO decision, and the Board must conduct de novo review of this decision. Wages v. McDonald, 27 Vet. App. 233, 238-39 (2015) (holding that the Board conducts de novo review of the Director's decision denying extraschedular consideration); see also Kuppamala v. McDonald, 27 Vet. App. 447, 457 (2015) (wherein the Court reaffirmed that the Board has jurisdiction to review the entirety of the Director's decision denying or granting an extraschedular rating, and elaborated that the Board is authorized to assign an extraschedular rating when appropriate). Here, the Veteran was, at the time of the Director's decision, in receipt of a noncompensable schedular rating under DC 6211. A 10 percent rating under DC 6200 has been awarded herein. He has also been granted separate disability ratings for hearing loss and tinnitus. Nevertheless, the propriety of these schedular ratings is a separate analysis. See generally King v. Shulkin, 29 Vet. App. 174, 181 (2017) (holding that "the availability of higher schedular ratings plays no role in an extraschedular analysis and it is inappropriate for the Board to deny extraschedular referral on this basis.") After reviewing the record, the Board finds that an extraschedular rating is not warranted with respect to the Veteran's right tympanic membrane rupture. The examination reports, pertinent medical records, and lay statements of record establish his symptoms to include ear pain, drainage, tinnitus, and hearing loss. These symptoms are contemplated by the current schedular evaluations, which evaluate the Veteran's right ear disabilities based on suppuration and any decline in auditory acuity. See 38 C.F.R. §§ 4.85, 4.87, DCs 6100, 6200-11. The Veteran has described additional symptoms, such as vertigo and dizziness, which are not contemplated by the applicable criteria. However, these symptoms have been attributed by various examiners to a right knee disability, which results in an unsteady gait and the need to utilize a knee brace. VA examiners have also noted that the Veteran's claimed vertigo was first reported many years after the initial right tympanic membrane rupture, suggesting it is unrelated to this disability. The Board acknowledges that there is some evidence of interference with employment due to such symptoms as hearing loss and suppuration of the right ear. However, the record also demonstrates that the Veteran was able to continue serving in the National Guard following his injury, as well as engage in employment following his service retirement. Moreover, as noted above, the schedular evaluations assigned for this disability are designed to compensate the Veteran precisely for interference in occupational functioning. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that a schedular rating in itself is recognition that a claimant's industrial capacity is impaired to some degree). There is no probative evidence of "marked" interference of the sort contemplated under 38 C.F.R. § 3.321 (b), nor indeed is there evidence of other factors such as frequent periods of hospitalization due to Veteran's right tympanic membrane rupture symptomatology. It was on this basis that the Director denied entitlement to an extraschedular evaluation, and the Board finds the Director's reasoning supported by the evidence of record. The Board is aware of the recent Court decision in Smiddy v. Wilkie, 32 Vet. App. 350 (2020), which held that when the Board denies entitlement to an extraschedular rating under 38 C.F.R. § 3.321 (b), it must provide adequate reasons and bases for any factual determination that deviates from its earlier decision to remand the claim for referral to the Director. Here, the March 2020 Board remand which raised the issue of entitlement to an extraschedular rating did not make any explicit findings of fact relating to the Thun factors. Of note, the Board simply found that possible entitlement to extraschedular ratings under 38 C.F.R. § 3.321(b) was merely raised by the record. Liberally construed, the March 2020 remand order can be read to, at most, suggest that there was a reasonable possibility that one or more of the Thun factors were met. In Smiddy, the Court cited its earlier decision in Ray v. Wilkie, 31 Vet. App. 58 (2019), suggesting that "the certitude or equivocality of the Board's language in the referral decision could affect the amount of explanation required where there is deviation at the award stage." Smiddy, 32 Vet. App. at 358 (citing Ray, 31 Vet. App. at 67.) In this case, the Board's March 2020 remand contained language regarding the Thun factors that was equivocal at best. The Board did not find with certainty that an extraschedular evaluation was warranted or even that the rating criteria did not contemplate the Veteran's symptoms, but merely found that the reported symptomatology "may present an unusual or exceptional disability picture not contemplated by the relevant diagnostic code." The Board now finds, for the reasons addressed above, that the criteria for extraschedular ratings have not been met regarding the Veteran's service-connected right tympanic membrane disabilities. These findings are not in conflict with the Board's March 2020 remand instructions. In sum, the Board finds a compensable rating of 10 percent under DC 6200 is warranted for the Veteran's right tympanic membrane rupture. The Board further finds that the preponderance of the evidence is against a finding of an unusual or exceptional disability picture rendering the criteria in VA's Rating Schedule inadequate. 38 C.F.R. § 3.321 (b)(1). Consequently, entitlement to an extraschedular rating for the Veteran's right tympanic membrane rupture must be denied. As the evidence of record preponderates against a higher evaluation on any basis, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a right knee disability is remanded. The Veteran's service connection claim having been reopened, it may now be considered on the merits. Review of the record, however, indicates additional development is required. Specifically, a VA medical examination and opinion is necessary to determine if a current right knee disability was incurred in service, or is otherwise related to an in-service disease or injury. The Veteran asserts that while on active duty between November 1991 and May 1992, he injured his right knee when he jumped off a tank. Though a layperson, the Veteran is competent to report such observable symptomatology as joint pain. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Additionally, the Veteran has current diagnoses of a right knee disability, to include degenerative arthritis and/or osteoarthritis of the right knee, status post total knee replacement. 2. Entitlement to a temporary total rating for a right knee disability is remanded. The Veteran seeks a temporary total rating for convalescence purposes based on treatment of a right knee disability. Such a rating may be awarded when a service-connected disability requires hospitalization and/or convalescence for an extended period of time. 38 C.F.R. §§ 4.29, 4.30. Adjudication of this temporary total rating claim must be deferred, as this issue is inextricably-intertwined with his service connection claim for a right knee disability being remanded herein. See Harris v. Derwinski, 1 Vet. App. 180 (1991). 3. Entitlement to a TDIU is remanded. The Veteran seeks a TDIU due to his service-connected disabilities. He asserts his service-connected disabilities prevent him from obtaining or maintaining gainful employment. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. If there is only one service-connected disability, it must be rated at least 60 percent disabling to qualify for TDIU benefits; if there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In the present case, the Veteran has been granted service connection for PTSD, with a 70 percent rating, tinnitus, with a 10 percent rating, and a rupture of the right tympanic membrane, with a 10 percent rating assigned herein, for a combined rating of 80 percent. Thus, he meets the schedular criteria for a TDIU. Review of the record indicates that he has not been afforded a recent VA examination to assess his employability and the impact of his service-connected disabilities. While he underwent a VA psychiatric examination in June 2018, the VA examiner merely noted that the Veteran has not worked since 2009, and that he reported difficulty getting along with other people. The examiner also determined the Veteran was competent, but did not indicate whether his service-connected disabilities prevented employment. As such, the Board finds that a new examination and opinion is required. The Board also notes that this issue is inextricably-intertwined with an issue being remanded herein; as such, adjudication of this TDIU claim must be deferred. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for a VA orthopedic examination to determine the nature and etiology of any current right knee disability. The examiner must review the claims file in conjunction with the examination. Following review of the file and examination of the Veteran, the examiner is asked to provide a response to the following: a) For any right knee disability diagnosed, is it at least as likely as not that the disability is related to service, including any disease, injury, or other incident of service? b) For any right knee disability diagnosed, is it at least as likely as not that the disability (1) began during active service, (2) manifested within a year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? A clear rationale to support any opinion provided is necessary. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected disabilities, PTSD, tinnitus, and a right tympanic membrane rupture. The examiner should provide a full description of the various disabilities and report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms, along with any social and occupational impairment, resulting from the Veteran's service-connected disabilities alone. 3. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claims in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. James Springer Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Thomas D. Jones, 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.