Source: https://va-claim.com/2019/01/03/entitlement-to-service-connection-for-a-lumbar-spine-disability-gastritis-denied-posttraumatic-stress-disorder-ptsd-citation-nr-18123949/
Timestamp: 2019-04-21 08:37:34+00:00

Document:
Entitlement to service connection for gastritis is denied.
An effective date of October 23, 2012, but not earlier, for the award of service connection for posttraumatic stress disorder (PTSD) is granted.
From October 23, 2012, a 70 percent rating for PTSD is granted, subject to regulations governing the payment of monetary benefits.
Entitlement to service connection for a depressive disorder is remanded.
Entitlement to increased rating in excess of 70 percent for PTSD is remanded.
1.   The competent and credible evidence, both lay and medical, indicates that the Veteran’s current low back disabilities, to include low back syndrome and lumbar degenerative disc disease, were not incurred in service and are not otherwise etiologically related to service.
2.  The Veteran does not have a current diagnosis of gastritis.
3.  For the entire period on appeal, beginning October 23, 2012, the Veteran’s PTSD more nearly result in symptoms approximating occupational and social impairment with deficiencies in most areas.
4.  By a May 14, 2013 notification letter, the RO acknowledged that they received the Veteran’s claim for a mental disability on October 23, 2012, a day earlier than the currently assigned effective date.
1.  The criteria for service connection for a lumbar spine disability, to include low back syndrome and lumbar degenerative disc disease, have not been met.  38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017).
2.  The criteria to establish service connection for a gastrointestinal disorder, to include gastritis, have not been met.  38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.303 (2017); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).
3.  For the entire period on appeal, beginning on October 23, 2012, the criteria for a 70 percent disability for PTSD are met.  38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.130, Diagnostic Code (DC) 9411 (2017).
4.  The criteria for an effective date of October 23, 2012, but not earlier, for the grant of service connection for PTSD have been met.  38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.1(p), 3.102, 3.151, 3.155, 3.159, 3.400 (2017).
The Veteran served on active duty from January 1982 to June 1991.
In February 2017, the Veteran’s attorney withdrew from representing him.  By a May 2017 correspondence, the Board found that good cause was shown, and the Veteran was notified of the withdrawal and provided with the opportunity to appoint new representation; however, he has not done so.  The Board finds that he chooses to proceed unrepresented in this matter.
The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record.  See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record); Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015).
Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.  38 C.F.R. § 3.303(d).
Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009).
In the case of any veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, campaign, or expedition, the Secretary shall accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran.  Service connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary.  The reasons for granting or denying service-connection in each case shall be recorded in full.  38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d).
The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant.  Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011).  This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record.  See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012).
The Board is charged with the duty to assess the credibility and weight given to evidence.  Wensch v. Principi, 15 Vet. App. 362, 367 (2001).  In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness.  Caluza v. Brown, 7 Vet. App. 498 (1995); Macarubbo v. Gober, 10 Vet. App. 388 (1997); Coburn v. Nicholson, 19 Vet. App. 427, 432 (2006) (Board may reject such statements of the veteran if rebutted by the overall weight of the evidence).
The Board notes that the mere absence of medical records does not contradict a Veteran’s statements about his symptom history.  Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006).  However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service.  Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000).
A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement.  Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).  In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence.  Id. at 1287 (quoting 38 U.S.C. § 5107 (b)).
The Veteran asserts that his currently diagnosed low back disabilities are related to his active duty service.
Initially, the Board notes that the Veteran has a current diagnosis of a back disability, namely degenerative disc disease and low back pain/low back syndrome.  See e.g., private treatment notes dated in August 2010.
However, the Board next finds that the weight of the competent lay and medical evidence of record demonstrates that the current low back disabilities were not incurred in service and are not otherwise etiologically related to it.
There is evidence of low back pain during service.  The Veteran’s service treatment records show complaints of back pain.  For example, treatment records dated in February 1985 show that the Veteran complained of back pain with an assessment of moderate generalized back pain.  Later that same month, the Veteran complained of upset stomach with associated low back pain Thereafter treatment records dated in May 1985 show that the Veteran complained of back pain after he was changing clothes with an assessment of low back pain/sacroiliitis.  In his May 1991 separation examination, the Veteran reported recurrent back pain, but noted that he was in good health.  The Board additionally finds that due to the Veteran’s combat service, his reported in-service injury is presumed, regardless of whether it is related to his documented in-service back complaints.  38 U.S.C. § 1154(b).
Nonetheless, from 1991 to 2010, the record is silent of any complaints, treatment, or diagnoses of any back disability.  In fact, in a Report of Medical History completed in January 2002 prior to his enlistment to the Reserves, the Veteran denied recurrent back pain, and again stated that he was in good health.
It was not until 2010 that private treatment records dated in August 2010 show that the Veteran was involved in a work-related injury in May 2010 after an altercation with a dog.  He had physical therapy for two months after the injury.  The assessment was degenerative disc disease and low back pain/low back syndrome.  The treatment notes also contain a magnetic resonance image (MRI) of the lumbar spine showing evidence of multilevel degenerative disc disease and facet arthropathy with associated central spinal canal/neural foraminal narrowing.
Thereafter, in September 2010, the Veteran filed a service connection claim for a lumbar spine disability.  Subsequent private and VA treatment notes continue to show complaints of back pain and treatment.  The Veteran was scheduled for a VA examination for his back in August 2012, but failed to report, he has not made any lay assertions showing good cause, nor provided any lay assertions in support of his claim.
Despite the current back disabilities and the in-service back complaints, the record does not establish a competent nexus between the two.  The Veteran has not submitted any competent evidence relating his current back disabilities to his military service.
Moreover, the Board notes that the Veteran’s statements beginning in 2010 reporting symptoms of the claimed back disability are shown to be specifically related to a work-related injury with no reference to any prior back problems from service.  See AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present).
Notably, despite the Veteran receiving treatment for back pain during service, it was not until approximately 19 years later that he had low back pain complaints Moreover, based upon the language and context of the 2010 medical records, the Veteran’s back disability diagnosed at that time was specifically associated with his post-service work injury and not with his in-service complaints of back pain.  The long time-gap between service separation and 2010 without any back complaints, weighs against the Veteran’s claim.  Therefore, the lack of relevant symptoms or complaints from service discharge to 2010 is persuasive evidence that he had not experienced back problems after service until the work-related injury.  The Board finds that the medical records contemporaneous to the 2010 work related injury are more probative than, and outweigh, the Veteran’s present recollection of onset.
The Board not only considers the absence of back complaints for decades after service, to include the denial of back complaints during his Reserves enlistment examination in 2002, but also the evidence contemporaneous to the 2010 work injury which does not reference any prior back problems related to service.
Thus, to the extent that the Veteran now asserts that his current low back disabilities are related to his active service, the Board finds not credible his current assertions made for VA compensation purposes.  Indeed, his current assertions are contradicted with and outweighed by his earlier lay and medical evidence.  See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes).  See also, Savage v. Gober, 10 Vet. App. 488, 496-97 (1997).  In other words, the absence of low back complaints from service discharge to 2010 bears on the credibility of any lay statements regarding continuity of back symptoms since service.
While the Veteran is competent to describe symptoms of back pain that he experiences at any given time, the Board finds, based on the record as a whole, that he is not competent to relate his current disabilities to service.  As discussed in detail above, the medical record demonstrates no back complaints for almost two decades after service discharge.  Under the facts of this case, his lay statements of a nexus are not competent and they are inconsistent with, and outweighed by, the medical evidence.
In sum, the weight of the competent and credible evidence demonstrates no relationship between the current low back disabilities and active duty service.  For these reasons, the Board finds that a preponderance of the evidence is against the claim for service connection for a low back disability, and the claim must be denied.  Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application.  38 U.S.C. § 5107; 38 C.F.R.  § 3.102.
The Veteran asserts that he has a current diagnosis of gastritis that is related to service.  The record, however, does not reveal that the Veteran has met the threshold element of any service connection claim, namely a current disability.
The Board recognizes that service treatment records show that the Veteran had an appendicitis and appendectomy prior to service, and in-service complaints of abdominal pain followed by gastroenteritis in 1988.  However, a review of the post-service private and VA medical records reveal no gastritis complaints, treatment, or diagnoses.
Furthermore, aside from his August 2010 claim for “gastritis,” the Veteran provided no additional information and has not identified any treatment or even complaints of a gastrointestinal disorder.  In response to both the September 2012 rating decision and the May 2015 statement of the case, the Veteran failed to make any argument or identify any current symptoms associated with his in-service complaints and or treatment.
The laws authorizing Veterans’ benefits provide benefits only where there is current disability, as identified by a medical diagnosis.  In the absence of proof of a current disability, there is no valid claim of service connection.  Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).  The Board concludes that the Veteran has not presented competent evidence showing that he has a current diagnosis of gastritis.  See 38 U.S.C. § 5107 (a) (“[A] claimant has the responsibility to present and support a claim for benefits.”); Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009) (holding that it is the claimant’s general evidentiary burden to establish all elements of the claim).
In analyzing this claim, the Board recognizes that the Veteran is competent to report his observable symptoms and signs of gastritis; however, his lay statements do not provide any such information and at any rate, he is not competent to diagnose a medical disorder as he is not shown to possess the requisite medical training.
For the reasons and bases discussed above, the preponderance of the evidence is against the Veteran’s claim, and it therefore must be denied.  See 38 U.S.C. § 5107(b) (2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990).
Generally, the effective date of an award of service connection is the date the claim was received or the date entitlement arose, whichever is later.  38 U.S.C. § 5110(a) (2012); 38 C.F.R. § 3.400 (2017).  The same is true for an award based on a claim reopened after final adjudication, as VA laws and regulations stipulate that the effective date of such an award shall be fixed in accordance with the facts found, but shall not be earlier than the date the claim was received, or the date entitlement arose, whichever is later.  See Id.; 38 C.F.R. § 3.400(r).
The effective date for a grant of service connection following a final prior disallowance is the date of receipt of the application to reopen, or the date entitlement arose, whichever is later.  38 U.S.C. § 5110; 38 C.F.R. § 3.400.
A formal claim is one that has been filed in the form prescribed by VA.  See 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a).  An informal claim may be any communication or action, indicating intent to apply for one or more benefits under VA law.  See Thomas v. Principi, 16 Vet. App. 197 (2002); see also 38 C.F.R. §§ 3.1(p), 3.155(a) (2017).  An informal claim must be written, see Rodriguez v. West, 189 F. 3d. 1351 (Fed. Cir. 1999), and it must identify the benefit being sought.  Brannon v. West, 12 Vet. App. 32, 34-5 (1998).
Turning to the evidence, a notification letter dated on May 14, 2013 indicates that the RO received the Veteran’s request for VA benefits on October 23, 2012, but were unable to accept it as a claim because he had to submit the claim on the proper claim form.  On May 15, 2013, the Veteran called to file a claim for PTSD, and indicated that his attorney submitted a claim to the Chicago RO in October 2012, and on a May 17, 2013.  Thereafter, by a June 2013 statement in support of claim, the Veteran indicated that this was a formal claim for depression.
In a July 2014 rating decision, the RO granted service connection for PTSD effective May 14, 2013, the date the RO determined they received the Veteran’s service connection claim.  Subsequently, in an April 2016 rating decision, the RO granted an earlier effective date of October 24, 2012, finding that this was the date the Veteran filed his original claim for a mental disability.
Nevertheless, as noted above, the RO specifically confirmed that they received the Veteran’s claim on October 23, 2012, namely, a day earlier than the currently assigned effective date of October 24, 2012.
The Board reviewed all relevant evidence and finds no basis under the law to award an effective date earlier than October 23, 2012, the date the RO confirmed receipt of his original claim.
The Board has carefully reviewed the entire record and found no other evidence that could be construed as formal or informal claim for a psychiatric disorder prior to the receipt of the October 23, 2012 claim.  Accordingly, the Board finds that an effective date of October 23, 2012, but not earlier is warranted.
The Veteran asserts that his service-connected psychiatric disorder warrants a higher rating than the currently assigned 50 percent.
The criteria for rating psychiatric disabilities, other than eating disorders, are set forth in the General Rating Formula (General Rating Formula) for Mental Disorders.  See 38 C.F.R. § 4.130.
The RO has rated the Veteran’s PTSD as 50 percent disabling pursuant to DC 9411 of the Rating Formula.  See 38 C.F.R. § 4.130, DC 9411 (2017).
This appeal stems from a July 2014 rating decision that assigned the initial rating for the psychiatric disorder.
Under the General Rating Formula, a 30 percent rating is assigned for PTSD is warranted for occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of an 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, and mild memory loss (such as forgetting names, directions, recent events). Id.
A 50 percent is warranted for 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 (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.  Id.
A 70 percent rating is warranted for 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; speech intermittently illogical, obscure, or irrelevant; 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 work like setting); and/or inability to establish and maintain effective relationships.  Id.
A 100 percent rating (total occupational and social impairment) is warranted for total social and occupational 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; memory loss for names of close relatives, own occupation, or own name.  Id.
In applying the above criteria, the Board notes that, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected disability, such signs and symptoms shall be attributed to the service-connected disability.  See 38 C.F.R. § 3.102 (2017); Mittleider v. West, 11 Vet. App. 181 (1998) citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996) (the Board is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence which does so).
When determining the appropriate disability evaluation to assign, the Board’s primary consideration is the Veteran’s symptoms, but it must also make findings as to how those symptoms impact a Veteran’s occupational and social impairment.  Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013).  The use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.  Mauerhan v. Principi, 16 Vet. App. 436 (2002).  Thus, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating.  Id. at 442.  Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran’s impairment must be “due to” those symptoms; a Veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.  Vazquez-Claudio, 713 F.3d at 118.  The Board recognizes that the Court in Mauerhan, 16 Vet. App. 436, stated that the symptoms listed in VA’s general Rating Formula for mental disorders is not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating; however, the Court further indicated that, without those examples, differentiating between rating evaluations would be extremely ambiguous.
For the reasons expressed below, the Board finds that the Veteran’s service-connected PTSD more nearly approximates occupational and social impairment with deficiencies in most areas, the criteria consistent with a 70 percent rating.
Turning to the evidence, the Veteran was provided with a VA examination in June 2014, where the examiner confirmed a diagnosis of PTSD.  The Veteran reported that he had been experiencing anxiety since he stopped abusing alcohol.  He stated that he slept approximately five hours per night and had nightmares where he would wake up scared four or five times a week.  He would also wake up suddenly smelling some chemical/putrid smell.  His anxiety is more intense when he smelled stench, and the examiner noted that when he spoke about the smell of decomposing bodies and the fear of chemical weapons being activated, he was visibly upset.  He reported that when he gets angry he throws objects around the house to release frustration, and after he would feel sad and down, but the depressed mood was not persistent.  He stated that he was hypervigilant and startle easily, and the examiner noted that he displayed avoidant behavior and did not talk about his experiences with family or friends.  His wife told him that the first thing he does when he wakes up is to shake his boots or house shoes to get rid of any scorpions found in the desert and pulls down his bed sheets to check for snakes.  The Veteran denied any suicidal or homicidal ideation or delusions or hallucinations.
In terms of social impairment, the examiner noted that the Veteran divorced twice post-service and was close to his sister and brother.  He got married for the third time, and indicated that this marriage was strained due to his behavior.  He reported that he made a few friends since his discharge from the military.  He had no biological children, but his step-daughter’s children lived with them, and he indicated that he enjoyed spending time with them.
In terms of occupational impairment, it was noted that post-service the Veteran worked for five or six months with Motorola and “quit for various reasons.”  He then worked as a carpet cleaner at Sears for nine to ten months and left the job for a better job with Ameritech for a year, but was fired after a customer claimed that she paid the Veteran money.  He then worked as a driver for a company that provided services to disabled persons for seven to eight months, but quit to work at Union Pacific Railroad; however, he did not get along with others due to prejudice issues and quit 9 or ten months later.  Thereafter, he worked in the haircare industry for four years, at which time he worked his way up to a supervisor, but quit when he got his current job (of seven years at the time of the examination) with the United States Postal Service, where he has been receiving excellent performance evaluations.
The examiner identified symptoms of depressed mood; anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and persistent delusions or hallucinations.  During the examination, the Veteran’s attention span was “fair,” his speech was normal, and his thought process was logical.  His mood was anxious and affect was mood congruent.  The examiner concluded that the Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, and or mood.
The Veteran was provided with an additional VA examination in January 2016 to assess the severity of his service-connected PTSD, at which time the examiner confirmed that the Veteran continued to meet the criteria for a diagnosis of PTSD, shown by clinically significant avoidance behaviors.  The Veteran also exhibited clinically significant altercations in cognition and mood that were associated with the traumatic events such as persistent negative emotional state such as depression; anxiety; anger; and, markedly diminished interest or participation in significant activities.  The Veteran reported that his most pressing concern was his depression.
In terms of functional impact, the examiner noted that the Veteran exhibited mild to moderate deficits, such as intermittent periods of work inefficiency and inability to perform occupational tasks.  The Veteran also noted that he typically took three days off per month due to feeling depressed or because he was in too much pain due to back problems.  He also indicated that he struggled to work in close proximity to others, so he enjoyed the fact that he primarily worked by himself as a mail carrier.  He often lacked motivation to complete tasks and participate in various activities, but noted that his grandchildren motivate him to go to work and be active with the family.  He maintained normal daily routine and good self-care and hygiene.  He indicated that he had supportive friends, but preferred to keep to himself, because he was easily agitated by others.  The Veteran stated that his relationship with his wife was good and he felt supportive by her.  He also maintained contact with his brothers and sisters.
At the interview, the Veteran was appropriately dressed and well-groomed, fully oriented, and his thought processes were logical and coherent.  There was no evidence of delusions or hallucinations, and the Veteran denied any suicidal ideation.  He admitted that he had occasional homicidal thoughts when agitated by coworkers or customers at work, but denied any current thoughts, plan, or intent of hurting or killing others.  The examiner identified symptoms of depressed mood; anxiety; chronic sleep impairment; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships.  The examiner then concluded that the Veteran’s PTSD resulted in 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 medication.
Subsequent VA psychiatry note dated in June 2018 indicate that the Veteran reported he believed his PTSD was getting worse.  He stated, “I’m not sleeping,” and told the mental health professional that when he was in Iraq, he saw a little girl “whose arms were blown off and she was burnt.”  He then described that when he was driving the postal truck a week earlier, he “saw the little in the road, and I don’t know if I fell asleep or if I was hallucinating.”  He denied any other history of visual or auditory hallucinations.  Upon mental status examination, it was noted that the Veteran’s was dressed casually and weather appropriately, with good grooming and hygiene.  His mood was normal and affect mildly anxious, reactive, with full range.  He denied suicidal and homicidal ideation, auditory and visual hallucinations, and no delusions were elicited.  His insight and judgement were good.
On review, the Board finds that the Veteran’s PTSD more nearly approximates occupational and social impairment with deficiencies in most areas for the entire appellate period.  Although the Board notes that the January 2016 VA examiner provided that the Veteran’s PTSD was only mild, the symptoms described by the Veteran and other mental health professionals, to include the June 2014 VA examiner, suggests that his PTSD is more severe.  In addition, the Veteran endorsed homicidal ideation at least once during the appeal period.  Lastly, although the Veteran reported having friends, he admitted that he preferred to be alone, and the only source of socialization was described as his close family.
Based on the foregoing, the Board assigns a 70 percent disability rating for the entire period on appeal beginning on October 23, 2012.  The question of whether a rating higher than 70 percent is warranted is addressed below in the remand portion of this decision.
The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record.  See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).
First, a remand is necessary to obtain an addendum opinion regarding the Veteran’s service connection claim for depression and to further develop the newly raised TDIU claim.
Although the Board notes that VA treatment records dated in June 2018 continue to show diagnosis of PTSD and specifically rule-out major depressive disorder, additional treatment notes dated later in June 2018 show a diagnosis of an unspecified depressive disorder, in addition to PTSD.  Given this new diagnosis, the Board finds that an addendum opinion is necessary to clarify whether the Veteran currently has a depressive disorder that is a separate and distinct diagnosis from the Veteran’s service-connected PTSD, and if so, whether it is related to service or service-connected disability.
Regarding entitlement to a TDIU, although the Board notes that the Veteran continued to work, most recently he noted that he felt that his psychiatric disability prevented him from doing so, and notably, even when working, he specifically associated his ability to work with the fact that he was working alone as a mail carrier without a regular interaction with others.  Moreover, the Veteran was unable to hold prior jobs, which required working with other people.  When a request for a TDIU is made during the pendency of a claim, whether expressly raised by a veteran or reasonably raised by the record, it is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability as part of the initial adjudication of the claim.  Rice v. Shinseki, 22 Vet. App. 447, 453-454 (2009).  The issue of entitlement to TDIU has not been developed nor considered by the RO in the first instance.
Second, the issue of entitlement to a rating higher than 70 percent for PTSD should also be remanded and held in abeyance until completion of all indicated development of the TDIU claim.  Indeed, the question of whether the Veteran is entitled to a rating higher than 70 percent is intertwined with the TDIU issue, as both issues contemplate, in part, occupational impairment.
1.  Ensure that all outstanding VA treatment notes are associated with the claims file.
2.  Provide the Veteran with VA Form 21-8940 and appropriate notice about the evidence needed to establish entitlement to a TDIU.
3.  Develop the TDIU claim, to include verifying prior employment or obtaining any evidence the Veteran identifies.
4.  Obtain an addendum opinion regarding the nature and etiology of the Veteran’s claimed depression.  The claims file and a copy of this Remand must be made available to the reviewing examiner, and the examiner shall indicate in the addendum report that the claims file was reviewed.  The need for another examination is left to the discretion of the medical professional offering the addendum opinion.
(a) Does the Veteran have a current diagnosis of depressive disorder, or just symptoms of depressed mood that are associated with his PTSD.  In doing so, please address the June 2018 diagnosis of an unspecified depressive disorder.
(b) If it is determined that the Veteran has a separate diagnosis of a depressive disorder, provide an opinion as to whether it is at least as likely as not (50 percent or more probability) that it is related to service, or caused or aggravated by his service-connected PTSD.
The examiner should provide a complete rationale for all opinions (on direct, causation, and aggravation).
5.  Then, readjudicate the service connection claim for a depressive disorder, the claim seeking higher than 70 percent for PTSD, and the TDIU claim on appeal.  If the benefits on appeal remain denied, furnish the Veteran and his attorney with a copy of a supplemental statement of the case and allow an appropriate time for response.

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