Source: http://www.danaise.com/rk-v-shinseki-13-2908/
Timestamp: 2019-04-25 16:27:53+00:00

Document:
ERIC K. SHINSEKI, Secretary of Veterans Affairs, Appellee.
Whether the Board’s decision to deny Appellant TDIU is clearly erroneous and, therefore, must be reversed.
We argue that pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), the rating agency and the Board had a duty to investigate Veteran’s entitlement to TDIU. Even prior to the increase of the disability rating for diabetes mellitus from 20% to 40%, Veteran already met the schedular requirement for TDIU with 80% service-connected disabilities, including 50% for PTSD and peripheral neuropathy affecting all four limbs (each with a 10% rating). The Veterans’ Administration’s 2006 decision already established that Veteran was unemployed and has a lifelong difficulty in maintaining a job beyond marginal employment. The Board’s analysis based on Thun v. Peake, 22 Vet. App. 111 (2008), is inappropriate in this case, as the question was not of an extra-schedular rating but of schedular TDIU since Veteran already had an 80% disability rating. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court made it abundantly clear that the Veterans’ Administration has a duty to investigate the eligibility of a veteran for TDIU when the veteran requests a higher rating which will entitle him to schedular unemployability and the records indicate evidence of unemployability.
IV.The Board’s analysis regarding awarding TDIU on an extra-schedular basis is incorrect.
VI.Pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), the rating agency and the Board had a duty to investigate Veteran’s entitlement to TDIU.
VII.The Board may not deny unemployability based solely on the failure of the veteran to submit Form 21-8940.
The Board noted that it examined the claims file containing the veteran’s available service treatment records, reports of VA post-service treatment, and the veteran’s own statements in support of his claim. The veteran was afforded a VA examination responsive to the claim for an increased disability rating. The Board reviewed the examination report and opinion, and found it adequate for the purpose of deciding the claim for increased rating on appeal; the examination report contained all the findings needed to rate the Veteran’s service-connected diabetes mellitus, including his history and clinical evaluation.
hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that are not compensable if related separately. See 38 C.F.R. § 4.119, Diagnostic Code 7913. Thus, the Board found that Veteran’s symptoms more nearly approximate the criteria for a 40% disability evaluation. The Veteran does have complications from diabetes mellitus that are separately evaluated. In fact, the Veteran was diagnosed with peripheral neuropathy and erectile dysfunction, more likely than not associated with diabetes mellitus. The RO granted service connection for peripheral neuropathy in a May 2004 rating decision, and assigned a 10% rating for each extremity.
As to the consideration of referral for an extra-schedular rating, such consideration requires a three-step inquiry. See Thun v. Peake, 22 Vet. App. 111 (2008), affd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The first question is whether the schedular rating adequately contemplates the Veteran’s disability picture. Thun, 22 Vet. App. at 115. If the criteria reasonably describe the veteran’s disability level and symptomatology, then the veteran’s disability picture is contemplated by the rating schedule; the assigned schedular evaluation is, therefore, adequate and no referral is required. If the schedular evaluation does not contemplate the veteran’s level of disability and symptomatology and is found inadequate, then the second inquiry is whether the claimant’s exceptional disability picture exhibits other related factors such as those provided by the regulation as governing norms. If the veteran’s disability picture meets the second inquiry, then the third step is to refer the case to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether an extra-schedular rating is warranted.
symptoms have otherwise rendered impractical the application of the regular schedular standards. The VA examiner did not indicate that the Veteran lost any time from work due to his diabetes mellitus. Therefore, referral for consideration of an extra-schedular rating for the Veteran’s diabetes mellitus is not warranted. 38 C.F.R. § 3.321(b)(1). In the absence of exceptional factors associated with diabetes mellitus, the Board found that the criteria for submission for assignment of an extra-schedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995).
The veteran served in active duty from August 1967 to June 1969. The matter came before the Board of Veterans’ Appeals on appeal from the May 2009 rating decision by the Department of Veterans Affairs Regional Office in Wichita, Kansas. Prior to the Board’s decision the veteran already had service-connected disability ratings for PTSD with major depression 50% from September 7, 2005; diabetes 20%; peripheral neuropathy of the right upper extremity 10%, left upper extremity 10%, right lower extremity 10%, left lower extremity 10%; and erectile dysfunction associated with diabetes mellitus 0%. The combined evaluation was 80% from September 7, 2005.
The Board held that the symptoms related to Veteran’s diabetes most nearly approximated the criteria for a 40% disability evaluation. The Board also provided an analysis of extra-schedular rating pursuant to Thun v. Peake 22 Vet. App. 111 (2008). The Board determined that the veteran did not claim and the evidence did not reflect that there has been marked interference with employment. The VA examiner did not indicate that the veteran lost any time from work due to his diabetes mellitus. In Rice v. Shinseki, the Court held that a TDIU claim is not separate and apart from an increased rating claim. See Rice v. Shinseki, 22 Vet.App. 447 (2009). Instead, the Court held that a TDIU claim is an attempt to obtain an appropriate rating for a service-connected disability. The Court also found in Rice that when entitlement to TDIU is raised during the adjudicatory process of the underlying disability, it is part of the claim for benefits for the underlying disability. The Veteran’s TDIU claim was reasonably raised by the record.
VIII.Veteran is entitled to a disability rating of 70% for PTSD, due to GAF of 45 and the inability to work.
The Board has a duty to address all issues reasonably raised either by the Appellant or by the Record.
has clarified that “a request for TDIU, whether expressly raised by the veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate [evaluation] for a disability or disabilities,… [including] as part of a claim for increased compensation.“ Rice v. Shinseki, 22 Vet.App. 447, 453-54 (2009); see Comer v.
Peake, 552 F.3d 1362, 1368 (Fed. Cir. 2009) (claim for increased disability evaluation also raises claim for TDIU where there is evidence of unemployability).
In Patton v. West, No.97-828 (1999), the CAVC held that during personal hearings conducted by VA adjudicators, pursuant to 38 CFR §3.103(c), the VA has the responsibility to “suggest the submission of evidence which the claimant may have overlooked and which would be of advantage to the claimant’s position.” Accordingly, if the claimant or the records in the claims file put the VA on notice of the existence of evidence that may help substantiate the claim, the VA is required to obtain the evidence itself or advise the claimant to submit the evidence.
This should have triggered an evaluation of employability.
The rating agency determined in 2006 that there is evidence of occupational and social impairment with reduced reliability and productivity due to such symptoms as circumstantial speech; impairment of short and long-term memory; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships.
with major depression, 50% from September 7, 2005; diabetes 20%; peripheral neuropathy of the right upper extremity 10%, left upper extremity 10%, left lower extremity 10%, right lower extremity 10%; and erectile dysfunction associated with diabetes mellitus 0%. The combined evaluation was 80% from September 7, 2005. The analysis should have been conducted according to 38 C.F.R. § 4.16(a) and not according to 38 C.F.R. § 4.16(b). The only question before the Board was whether or not Veteran is capable of maintaining substantial gainful employment.
The Board must provide an adequate statement of reasons or basis for its findings on all material issues of fact and law presented. See 38 U.S.C. § 7104(d)(l); Gilbert v. Derwinski, 1 Vet.App. 49, 56-57 (1990). To comply with this requirement, 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. Caluza v. Brown, 7 Vet.App. 498, 507 (1995); see Allday v. Brown, 7 Vet.App.
four limbs (each with 10% rating). The Veterans’ Administration’s 2006 decision already established that Veteran was unemployed and has a lifelong difficulty in maintaining a job beyond marginal employment. The Board’s analysis based on Thun v. Peake 22 Vet. App. 111 (2008), is inappropriate in this case as the question was not of an extra-schedular rating but of TDIU; Veteran already had an 80% disability rating.
“It is clear from our jurisprudence that an initial claim for benefits for a particular disability might also include an assertion of entitlement to TDIU based on that disability (either overtly stated or implied by a fair reading of the claim or of the evidence of record)( emphasis added) ….The Federal Circuit’s recent decision in Comer v. Peake contains language consistent with this analysis: “A claim to TDIU benefits is not a free­standing claim that must be pled with specificity; it is implicitly raised whenever a pro se veteran, who presents cogent evidence of unemployability, seeks to obtain a higher disability rating.“ 552 F.3d 1362, 1367 (Fed. Cir. 2009). This statement of the law is consistent with and reiterated the Federal Circuit’s earlier decision in Roberson v.
Prinicpi, involving the assignment of an initial disability rating, which reversed this Court’s holding that Mr. Roberson failed to make “a claim for TDIU“ and held that consideration of TDIU is required once “a veteran submits evidence of a medical disability and makes a claim for the highest rating possible, and additionally submits evidence of unemployability.“ 251 F.3d 1378, 1384 (Fed. Cir. 2001); see also Bernklau v. Principi, 291 F.3d 795, 799 (Fed. Cir. 2002) (discussing a request for TDIU in the context of a claim for increased compensation for an already service-connected disability). Further, this Court has already stated this principal clearly: ”A TDIU rating is not a basis for an award of service connection. Rather, it is merely an alternate way to obtain a total disability rating without being rated 100% disabled under the Rating Schedule.” Norris v. West, 12 Vet.App. 413, 420-21 (1999).
“Development to produce the evidence necessary to establish the degree to which SC disability has impaired the Veteran’s ability to engage in self-employment must generally be more extensive than development in cases in which the Veteran worked for others. When determining entitlement of self-employed individuals to increased compensation based on IU, consider the relationship between the frequency and the type of service performed by the Veteran for his/her business and the Veteran’s net and gross earnings for the past 12 months.
• high gross earnings that indicate the Veteran is capable of engaging in a substantially gainful occupation.
In Johnson v. Brown, 7 Vet.App. 95 (1994), the Court determined the criteria for granting benefits for a mental disorder described under a 70% rating (as well as ratings of 100%, 50% and 30%). The criteria focus on: (1) a veteran’s ability to “maintain effective or favorable relationships with people“ and, (2) the effect of the psychoneurotic symptoms on the veteran’s ability “to obtain or retain employment.“ The Court also held that the two criteria for a 70% rating under 38 C.F.R. § 4.132, DC 9411 (1996) are each independent of the other.
and occupational functioning under a hypothetical continuum of mental illness. See AmericanPsychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994)(DSM-IV); see also Carpenter v. Brown, 8 Vet. App. 240, 243 (1995).
“A GAF score between 41 and 50 is indicative of serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g. no friends, unable to keep a job). Id.
“A 70 percent disability rating is assigned when the ability to establish and maintain effective or favorable relationships with people is severely impaired. The psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment.
A 50 percent disability rating is assigned when the ability to establish or maintain effective and wholesome relationships with people is considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment.
When the only compensable service-connected disability is a mental disability, and such mental disorder precludes a veteran from securing or following a substantially gainful occupation, the mental disorder shall be assigned a 100 percent schedular evaluation under the appropriate diagnostic code. 38 C.F.R. § 4.16 (c) (1996).
When there is a question as to which of two evaluations shall be assigned, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a GAF score of between 51 and 60 means that the veteran has moderate symptoms (flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A GAF score of between 41 and 50 means that the veteran has either serious symptoms or serious difficulty in social, occupational, or school functioning.
1331147, Decision Date: 09/27/13, Archive Date: 10/01/13, DOCKET NO. 08-22 151.
Remand is, therefore, necessary, to allow for adequate review of the medical records and vocational expert testimony regarding Veteran’s TDIU.
1001 W. San Martin Dr.

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