Citation Nr: 0206415 Decision Date: 06/17/02 Archive Date: 06/27/02 DOCKET NO. 92-13 977 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUES 1. Entitlement to an increased rating for labyrinthitis with tinnitus, currently evaluated as 10 percent disabling. 2. Entitlement to an initial compensable rating for post- traumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: Puerto Rico Public Advocate for Veterans Affairs WITNESSES AT HEARINGS ON APPEAL The veteran, his supervisor, and a coworker ATTORNEY FOR THE BOARD K. Conner, Counsel INTRODUCTION The veteran had active military service from November 1967 to July 1969, and from August 1973 to September 1977. This matter comes to the Board of Veterans' Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) San Juan Regional Office (RO). By August 1991 decision, the RO denied a rating in excess of 10 percent for labyrinthitis with tinnitus. The veteran appealed the RO determination and in March 1992, he testified at a hearing at the RO. In April 1993, the Board remanded the matter for additional development of the evidence. While the matter was in remand status, the veteran submitted a claim of service connection for PTSD. By October 1995 decision, the RO denied service connection for PTSD. The veteran appealed the RO determination. In June 1997, the Board, inter alia, denied service connection for PTSD. The issue of entitlement to an increased rating for labyrinthitis with tinnitus was again remanded for additional evidentiary development. While the matter was in remand status, the veteran submitted a request to reopen his claim of service connection for PTSD. By March 2001 decision, the RO granted his claim, and assigned an initial zero percent rating for PTSD from June 25, 1998. The veteran appealed the RO decision to assign a zero percent rating, claiming entitlement to a compensable rating for his PTSD. See Fenderson v. West, 12 Vet. App. 119 (1999). In July 2001, the veteran testified at a hearing at the RO in support of his appeal. FINDINGS OF FACT 1. The veteran's service-connected labyrinthitis with tinnitus is manifested by complaints of dizziness, ringing in the ears, and occasional staggering and falls. 2. His service-connected PTSD is manifested by nightmares, difficulty sleeping, and some isolation and depression, with no probative evidence of flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks, difficulty in understanding complex commands, memory impairment, impaired judgment or abstract thinking, disturbances of motivation, or difficulty in establishing and maintaining effective work and social relationships. CONCLUSIONS OF LAW 1. The criteria for a 30 percent rating for labyrinthitis with tinnitus has been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2001); 38 C.F.R. §§ 3.321, 4.86, Diagnostic Codes 6204, 6260 (effective prior to June 10, 1999), and as amended. 2. The criteria for a separate 10 percent rating for tinnitus has been met from June 10, 1999. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2001); 38 C.F.R. §§ 3.321, 4.86, Diagnostic Code 6260 (2001). 3. The criteria for an initial 30 percent rating, but no higher, for PTSD have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2001); 38 C.F.R. §§ 3.321, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board notes that there has been a change in law during the pendency of this appeal with enactment of the Veterans Claims Assistance Act of 2000 (VCAA), which provides that on receipt of a complete or substantially complete application, VA shall notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to VA that is necessary to substantiate the claim. 38 U.S.C. § 5103 (West Supp. 2001). VCAA also requires VA to make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate a claim for benefits, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C. § 5103A (West Supp. 2001). In this case, the Board finds that VA has satisfied its duties to the veteran, under both former law and the new VCAA. A review of the record indicates that the veteran has been informed of the evidence of record and the nature of the evidence needed to substantiate his claim via rating decisions, letters from the RO, and Statements of the Case. The Board concludes the discussions in these documents adequately complied with VA's notification requirements. Moreover, as set forth below, the RO has completely developed the record; thus, the requirement that the RO explain the respective responsibility of VA and the veteran to provide evidence is moot. The Board further notes that VA has conducted appropriate evidentiary development in this case, including obtaining the veteran's service medical records and a record of his post- service medical treatment. He was also afforded VA medical and psychiatric examinations and the examiners rendered considered medical opinions regarding the pertinent issues in this appeal. Based on the facts of this case, therefore, the Board concludes that there is no reasonable possibility that any further assistance to the veteran would aid in substantiating his claim. As VA has fulfilled the duty to assist and notify, and as the change in law has no additional material effect on adjudication of this claim, the Board finds that it can consider the merits of this appeal without prejudice to the veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The record shows that by June 1982 rating decision, the RO assigned a 10 percent rating for service-connected tinnitus under Code 6260, effective November 17, 1978. This 10 percent rating has remained in effect to date; thus, it is protected from reduction. 38 C.F.R. 3.951(b) (2001). In September 1986, the veteran filed a claim of service connection for vertigo, secondary to his service-connected tinnitus. By December 1989 decision, the RO granted his claim, recharacterizing the veteran's disability as labyrinthitis with tinnitus. A 10 percent rating was assigned for this disability under Codes 6204-6260. In August 1990, the veteran filed a claim for increased ratings for his service-connected disabilities, including labyrinthitis with tinnitus. The RO obtained VA clinical records dated from September 1988 to June 1990, which in pertinent part show that the veteran was seen in September 1989 with complaints of tinnitus and occasional vertigo, relieved by taking Dramamine. He was thereafter examined in the neurology clinic where he had adequate balance and coordination without nystagmus. The assessment was vertigo of peripheral etiology. By August 1991 rating decision, the RO denied a rating in excess of 10 percent for labyrinthitis with tinnitus, finding that the veteran's labyrinthitis disability had been shown to be no more than moderate, with tinnitus and occasional dizziness. The veteran appealed the RO decision, and in March 1992, he testified at a hearing at the RO, claiming that his disability was manifested by staggering and that he had fallen on occasion due to dizziness. He stated that he had been prescribed Dramamine for vertigo, which completely alleviated his symptoms of dizziness. He argued that because he had to take daily medication to prevent dizziness, his disability should be classified as severe. The RO subsequently obtained additional VA clinical records, dated from June 1990 to January 1993. These records show that the veteran received refills of Dramamine for complaints of tinnitus and vertigo. On VA medical examination in September 1993, the veteran reported a history of noise exposure, with tinnitus and vertigo spells since 1975. No pertinent abnormality was noted on physical examination. In September 1993, the veteran submitted a claim of service connection for PTSD, stating that his duties in service included graves registration. In connection with his claim, the veteran underwent VA psychiatric examination in April 1995 by a board of three psychiatrists. On examination, he reported that he was receiving no psychiatric treatment and that he had been working full-time as a veterans' service officer since 1982. After further examining the veteran and reviewing his claims folder, it was the unanimous opinion of the psychiatrists that the veteran had no specific mental disorder. In that regard, it was noted that he admitted to sleeping well, feeling well, relating well, eating well, etc. By October 1995 decision, the RO denied service connection for PTSD, noting that the record did not contain a diagnosis of PTSD. The veteran appealed the RO determination. In June 1997, the Board, inter alia, denied service connection for PTSD, finding that the record lacked competent medical evidence that the veteran currently had PTSD. The issue of entitlement to an increased rating for labyrinthitis with tinnitus was again remanded for additional evidentiary development. In August 1997, the veteran underwent VA medical examination at which he reported recurrent dizziness and tinnitus. Physical examination was negative. While the matter was in remand status, in March 1999, the veteran submitted a statement request to reopen his claim of service connection for PTSD. In support of his claim, he submitted an August 1999 VA clinical record showing a diagnosis of PTSD, based on the veteran's reports of nightmares of war experiences. On VA psychiatric examination in October 1999, the veteran reported that he had been employed in a veteran's affairs office for the last 18 years and that he lived with his wife and daughter. He explained that he had filed a claim of service connection for PTSD at the insistence of his supervisor. He described current symptoms of nightmares and difficulty sleeping. He indicated that he was "very well" at work, his performance was outstanding, and that nobody had any complaints about him. After examining the veteran and reviewing the claims folder, the diagnoses were polysubstance dependence in alleged remission, and anti-social personality disorder. A Global Assessment of Functioning (GAF) score of 90 was assigned. In May 2000, the veteran testified at another hearing at the RO. A psychiatrist with whom the veteran apparently worked testified that the veteran worked with other veterans because he wanted to do something for them because he felt that his work in Vietnam was unfinished. The veteran's supervisor testified that he had asked the veteran to file a claim of service connection for PTSD because he felt that the veteran was highly affected by his Vietnam experiences. He indicated that he felt that the veteran's work with other veterans was therapeutic for him. In connection with his claim, a Social and Industrial Survey was performed in August 2000. It was noted that the veteran worked full time in a veteran's service office and that he had seen a private psychiatrist, who had prescribed no medication. The veteran was talking with one of his neighbors when the social worker arrived and it was noted that he was clean and well dressed. His house was in a middle class neighborhood and it was noted to be in good condition and clean both inside and out. The veteran reported that he did not socialize with anyone and did not get out of the house except to attend church. One of his neighbors indicated that the veteran did not converse much with the other neighbors, but he indicated that many people visited the veteran seeking his advice. Another neighbor, however, indicated that the veteran conversed with neighbors and offered to help them whenever he could. Neither neighbor reported any abnormal behavior. On VA psychiatric examination in September 2000, the veteran reported that he was somewhat affected by nightmares related to his Vietnam experiences, as well as some isolation and depression. He did not describe any other major symptoms of PTSD and he denied difficulty relating to others. The examiner indicated that there was no evidence of impairment of thought processes, communication, delusions, hallucinations, inappropriate behavior, memory loss, ritualistic behavior, abnormal speech, panic attacks, or impulse control problems. The diagnosis was PTSD, very mild. The examiner indicated that the veteran's disability had never shown significant interference with his overall functioning. A GAF of 85 was assigned. By March 2001 decision, the RO granted service connection for PTSD, and assigned an initial zero percent rating under Code 9411, from June 25, 1998. The veteran appealed the RO decision, claiming that he was entitled to a compensable rating for his PTSD. In July 2001, the veteran testified at a hearing at the RO that he had been working in a veterans' service office for about 20 years and that his duties included representing veterans before VA in their claims. The veteran indicated that while he had good relationships at work, his supervisor had noticed his PTSD symptoms and encouraged him to file a claim. His coworker, a psychiatrist, testified that the veteran exhibited symptoms of depression, low tolerance, and a hostile attitude. He indicated that he would assign a GAF of 40-50 to the veteran and felt that he was at risk of committing suicide. His supervisor testified that the veteran's performance at work suffered as a result of his PTSD and that he had to be admonished verbally. On VA medical examination in May 2001, the veteran described symptoms of ringing in the right ear, unstable balance, and occasional dizziness. He indicated that he was currently treated with vitamin tablets. Physical examination revealed no abnormalities. The diagnosis was tinnitus, right ear. The examiner noted that there were no specialized otological centers in Puerto Rico with which to test the severity of the veteran's labyrinthitis. VA clinical records dated from January to July 2001 show that the veteran was treated for PTSD. A March 2001 treatment record notes that the veteran was employed full time, paid his mortgage, and had been married for 27 years. In May 2001, he reported feeling increasingly anxious. On VA psychiatric examination in September 2001, the veteran reported that he had received outpatient psychotherapy, but had received no medications. He indicated that he continued to work at the veterans' service office. He reported symptoms of nightmares, and difficulties talking about his Vietnam experiences. He indicated that he had no trouble dealing with clients at work, although he had had some arguments with his supervisor. On examination, the veteran was clean and neatly dressed. His affect, concentration, memory, and attention were good. His speech was clear and his insight and judgment was fair. The diagnosis was PTSD, mild by record. A GAF of 80 was assigned. The examiner commented that based on the veteran's records and evaluation, he was able to keep adequate and productive social, familial, and occupational functioning. In March 2002, the veteran's supervisor stated that the veteran's productivity as a service officer had been greatly affected by his nervous condition. He indicated that the veteran had forced them to create a "protected work environment" by giving him more time to prepare reports and giving him time to attend medical appointments. He indicated that while the veteran's work was therapeutic for him, he strongly felt that he wouldn't be able to continue in his position for very long "since the deterioration of his emotional condition is more evident as days passed." II. Law and Regulations Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate rating codes identify the various disabilities. 38 C.F.R. Part 4. 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 (2001). Any reasonable doubt regarding the degree of disability is resolved in favor of the veteran. 38 C.F.R. § 4.3 (2001). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings, nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. 4.20 (2001). The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided. 38 C.F.R. § 4.14 (2001). Nevertheless, VA is required to provide separate evaluations for separate manifestations of the same disability which are not duplicative or overlapping. See Esteban v. Brown, 6 Vet. App. 259 (1994). The determination of whether an increased evaluation is warranted is to be based on review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. § 4.1, which requires that each disability be viewed in relation to its history. The U.S. Court of Appeals for Veterans Claims (Court) held in Francisco v. Brown, 7 Vet. App. 55 (1994), that compensation for service-connected injury is limited to claims which show present disability, and where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. More recently, however, the Court determined that the above rule is inapplicable to the assignment of an initial rating for a disability following an initial award of service connection for that disability. At the time of an initial award, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). In exceptional cases where the schedular evaluations are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extra-schedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability. The governing norm is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent period of hospitalizations as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (2001). III. Analysis Labyrinthitis with tinnitus The veteran's labyrinthitis with tinnitus has been evaluated by the RO as 10 percent disabling under the provisions of 38 C.F.R. § 4.87, Codes 6204-6260. During the pendency of this appeal, VA issued new regulations for evaluating diseases of the ears and other sense organs. These new regulations were effective June 10, 1999. See 62 Fed. Reg. 25,202-25,210 (May 11, 1999). The Court has held that where the law or regulations change after a claim has been filed or reopened and before administrative or judicial process has been concluded, the version most favorable to the veteran applies, unless Congress provided otherwise or permitted the Secretary of VA to provide otherwise and the Secretary has done so. Karnas v. Derwinski, 1 Vet. App. 308 (1991). However, the effective date of a rating assigned under the revised schedular criteria may not be earlier than the effective date of that change; the Board must apply only the earlier version of the regulation for the period prior to the effective date of change. See VA O.G.C. Prec. Op. No. 3-2000 (Apr. 10, 2000), 65 Fed. Reg. 33,421 (2000); 38 U.S.C.A. § 5110(g). Under 38 C.F.R. § 4.87a, Code 6260, as in effect prior to June 10, 1999, a maximum 10 percent rating was warranted when tinnitus was persistent as a symptom of head injury, concussion, or acoustic trauma. Under the new rating criteria, in effect from June 10, 1999, a maximum 10 percent rating is provided for recurrent tinnitus, regardless of cause. 38 C.F.R. § 4.87a, Code 6260 (2001). The Note that follows provides that a separate rating for tinnitus may be combined with a rating under Codes 6100, 6200, 6204, or other diagnostic code, except when tinnitus supports an rating under one of those diagnostic codes. Under 38 C.F.R. § 4.87a, Code 6204, as in effect prior to June 10, 1999, a 10 percent rating was warranted when chronic labyrinthitis was moderate with tinnitus and occasional dizziness. A maximum rating of 30 percent was assigned for severe chronic labyrinthitis with tinnitus, dizziness, and occasional staggering. Under 38 C.F.R. § 4.87, Code 6204, as in effect from June 10, 1999, peripheral vestibular disorders are assigned a 10 percent evaluation for occasional dizziness and a maximum 30 percent evaluation for dizziness and occasional staggering. The Note that follows provides that objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable rating can be assigned. Turning to the merits of the veteran's claim, it is noted that a 10 percent rating is the maximum rating available for tinnitus, under both the old and new criteria. Thus, an increased rating under either version of Code 6260 cannot be granted, regardless of the severity of this disorder. Under Code 6204, however, as in effect prior to June 10, 1999, a maximum rating of 30 percent was assigned for severe chronic labyrinthitis with tinnitus, dizziness, and occasional staggering. In this case, the pertinent evidence of record shows that the veteran has complained of dizziness, tinnitus, occasional staggering, and falls. Thus, the Board finds that a 30 percent rating for labyrinthitis with tinnitus is warranted. This is the maximum rating available for labyrinthitis under either version of Code 6204; therefore, a rating in excess of 30 percent is obviously not warranted. The Board has considered assigning a separate rating for tinnitus, but notes that the veteran's symptoms of tinnitus have been considered in assigning a 30 percent rating under Code 6204, as in effect prior to June 10, 1999. As set forth above, the Rating Schedule may not be employed as a vehicle for compensating a claimant twice for the same symptoms. 38 C.F.R. § 4.14. Thus, the Board finds the criteria for a separate 10 percent rating for tinnitus have not been met, prior to June 10, 1999. Esteban, 6 Vet. App. at 261-62. However, under 38 C.F.R. § 4.87, Code 6204, as in effect from June 10, 1999, a maximum 30 percent rating is assigned for dizziness and occasional staggering. Again, the record shows that the veteran has complained of dizziness and occasional staggering. However, because the amended rating criteria does not list tinnitus as a symptom considered in assigning a 30 percent rating under Code 6204, the Board finds that the veteran's service-connected tinnitus warrants a separate 10 percent rating under Code 6260 from June 10, 1999. PTSD Under 38 U.S.C.A. § 4.130, Code 9411, a 10 percent rating is warranted for PTSD which produces occupational and social impairment due to mild or transient symptoms with decreased work efficiency and the ability to perform occupational tasks only during periods of significant stress, or where the symptoms are controlled by continuous medication. A 30 percent rating is warranted for PTSD, productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, and recent events). A 50 percent rating is warranted when there is 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. A 70 percent rating is warranted when there is 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 worklike setting); inability to establish and maintain effective relationships. A 100 percent evaluation is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Applying the facts in this case to the criteria above, and affording the veteran the benefit of the doubt, the Board finds that since the effective date of the award of service connection, his PTSD has been manifested by symptoms which more nearly approximate the criteria for a 30 percent rating. As summarized above, the evidence reveals that the symptoms of the veteran's PTSD include a depressed mood, some isolation, nightmares, difficulty sleeping, and difficulty discussing Vietnam experiences. His supervisor and a coworker have also testified as to the veteran's difficulties at work, such as taking longer than normal to complete a report and low tolerance. The Board finds that these symptoms more nearly approximate the criteria for a 30 percent rating for PTSD. However, the criteria for an initial rating in excess of 30 percent clearly have not been met. For example, VA psychiatric examinations and a social and industrial survey have found the veteran to have normal routine behavior, self- care, and conversation. On VA medical examination in September 2000, the examiner indicated that the veteran exhibited no evidence of impairment of thought processes, communication, delusions, hallucinations, inappropriate behavior, memory loss, ritualistic behavior, abnormal speech, panic attacks, or impulse control problems. He described the PTSD as mild and concluded that the veteran's disability had never shown any significant interference with his overall functioning. Similar findings were noted on September 2001 VA psychiatric examination. At that time, the veteran was clean and neatly dressed. His affect, concentration, memory, and attention were good. His speech was clear and his insight and judgment was fair. The Board has considered the statements offered by the veteran's supervisor and coworker, to the effect that his PTSD is severe and interferes with his work. However, the veteran's supervisor is a lay person and his opinion regarding the severity of the veteran's PTSD and its effect on his ability to work is of limited probative value. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). With respect to the opinion of the veteran's psychiatrist/coworker to the effect that the veteran's PTSD is severe, the Board observes that he has never claimed to have treated or examined the veteran, nor has he examined the veteran's claims file. Thus, the Board finds that his opinion regarding the severity of the veteran's PTSD is of low probative value when compared to the opinions offered by the VA medical examiners in September 2000 and September 2001, both of whom described the veteran's PTSD as mild, after examining him and reviewing the claims folder. In summary, although the veteran has been found to experience some of the criteria contemplated for a 50 percent rating, such as mood disturbance, the probative evidence of record has not shown the presence of most of the other symptoms, such as flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once per week, difficulty in understanding complex commands, impaired judgment, and impaired abstract thinking. On the contrary, the veteran's speech is normal, there is no evidence of any panic attacks, and his understanding, judgment, and abstract thinking were all within normal limits. Thus, after a careful review of the record, the Board finds that the preponderance of the evidence is against an initial rating in excess of 30 percent for PTSD. In reaching its decisions with respect to both issues on appeal, the Board has given consideration to the potential application of 38 C.F.R. § 3.321(b)(1) (2001). In this regard, however, the evidence does not show an exceptional or unusual disability picture as would render impractical the application of the regular schedular rating standards. The current evidence of record does not demonstrate, nor has it been contended, that these disabilities resulted in frequent periods of hospitalization. Moreover, while these disabilities may have an adverse effect upon employment, as noted by the veteran's supervisor, it bears emphasis that the schedular rating criteria are designed to take such factors into account. Consequently, the Board finds that no further action on this matter is warranted. (CONTINUED ON NEXT PAGE) ORDER A 30 percent rating for labyrinthitis with tinnitus is granted, subject to the law and regulations governing the payment of monetary benefits. A separate 10 percent rating for tinnitus is granted, effective June 10, 1999, subject to the law and regulations governing the payment of monetary benefits. An initial 30 percent rating for PTSD is granted, subject to the law and regulations governing the payment of monetary benefits. J.F. GOUGH Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.