Citation Nr: 0525219 Decision Date: 09/15/05 Archive Date: 09/29/05 DOCKET NO. 00-02 285 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for right ear hearing loss. 2. Entitlement to service connection for a disability manifested by lethargy, claimed as a residual of exposure to Agent Orange (AO) 3. Entitlement to service connection for a disability manifested by decreased libido, claimed as a residual of exposure to AO. 4. Entitlement to an earlier effective date than April 23, 1997, for a 100 percent evaluation for post-traumatic stress disorder (PTSD). 5. Entitlement to a total disability rating based on individual unemployability (TDIU). ATTORNEY FOR THE BOARD Mark J. Swiatek, Counsel INTRODUCTION The veteran had active military service from December 1967 to December 1970. This matter is on appeal to the Board of Veterans' Appeals (Board) from a June 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. The Board remanded this case in March 2001 and October 2002 on the issues of service connection for right ear hearing loss and for a disability manifested by decreased libido and lethargy, to include residuals of exposure to AO. The Board deferred consideration of the claim for a TDIU pending the determination of intertwined issues of service connection in the remand order. The veteran brought an appeal to the United States Court of Appeals for Veterans Claims (CAVC) from that portion of the October 2002 Board decision that denied a disability evaluation in excess of 50 percent for PTSD. In January 2003, the CAVC vacated the October 2002 Board decision and remanded the case to the Board for readjudication and the issuance of a new decision on the issues of a disability rating in excess of 50 percent for PTSD, and an effective date earlier than May 9, 2000, for the 50 percent rating for PTSD. In November 2003, the Board remanded these issues to the RO for further development. The record shows that on remand a RO rating decision in September 2004 granted a 100 percent schedular evaluation for PTSD from April 23, 1997. The RO issued notice, the veteran disagreed with the effective date, and he was issued a statement of the case in May 2005 on several issues. In May 2005, the RO received the veteran's substantive appeal that was limited to the effective date for the 100 percent evaluation for PTSD and that did not include a request for an in person hearing. It is the Board's practice to consider all issues properly before it on appeal in one decision in order to avoid piecemeal adjudication. None of the exceptions to this policy are present in this appeal. FINDINGS OF FACT 1. The competent and probative medical evidence does not satisfactorily dissociate a hearing loss in the right ear that meets VA criteria for a hearing loss disability and noise exposure during the veteran's service that included combat. 2. Lethargy and decreased libido represent symptoms reasonably associated with the veteran's service-connected PTSD; however, alone they do not constitute a disability for which service connection may be granted. 3. The veteran did not appeal the RO rating decision in January 1996 that continued a 30 percent disability evaluation for PTSD; there was no ascertainable increase earlier than April 23, 1997. 4. The RO received the veteran's formal application for a TDIU in September 1998; there was no pending claim for a TDIU earlier than April 23, 1997. CONCLUSIONS OF LAW 1. A hearing loss disability of the right ear was incurred in active service. 38 U.S.C.A. §§ 1110, 1154 (West 2002), 38 C.F.R. §§ 3.303, 3.304 (2004). 2. Lethargy and decreased libido do not represent disability for which service connection may be granted. 38 U.S.C.A. § 1110 (West 2002), 38 C.F.R. § 3.303 (2004). 3. The criteria for an earlier effective date than April 23, 1997, for a 100 percent schedular evaluation for PTSD have not been met. 38 U.S.C.A. §§ 1155, 5110 (West 2002), 38 C.F.R. §§ 3.157, 3.160, 3.400 (2004). 4. There is no longer an issue of fact or law pertaining to a claim for TDIU benefits before the Board. 38 U.S.C.A. §§ 511, 7104, 7105 (West 2002); 38 C.F.R. §§ 20.101, 20.202, 20.204 (2004). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties To Notify And Assist The Veterans Claims Assistance Act of 2000 (VCAA), enacted on November 9, 2000, emphasized VA's obligation to notify claimants what information or evidence is needed in order to substantiate a claim, and it affirmed VA's duty to assist claimants by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A and 5107 (West 2002); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). In August 2001, VA issued regulations to implement the VCAA. 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2004). In the decision below, the Board has granted the veteran's claim of service connection for a right ear hearing loss and the claim of service connection for decreased libido and lethargy and therefore the benefits sought on appeal have been granted in full. Accordingly, regardless of whether the requirements of the VCAA have been met in this case, no harm or prejudice to the appellant has resulted. See, e.g., Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Bernard v. Brown, 4 Vet. App. 384 (1993); VAOPGCPREC 16-92. As for the claim of entitlement to a TDIU, as will be explained below, the Board finds that here the extant law regarding compensation as interpreted by the VA General Counsel controls the appellant's situation and no amount of assistance or additional notice from VA will change the outcome. See generally, Smith v. Gober, 14 Vet. App. 227, 231-32 (2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (holding that statutory interpretation questions not affected by enactment of VCAA). See also Kane v. Principi, 17 Vet. App. 103 (2003) (extending nonapplication to regulatory interpretation questions). See also Sabonis v. Brown, 6 Vet. App. 426 (1994). Turing to the claim for an earlier effective date for a 100 percent evaluation for PTSD, the claim arose from determination that granted the 100 percent evaluation. Current development obligations in such instances would support the conclusion that the VCAA notice would not be required in the "downstream" issue of the effective date where, as here, there was adequate notice and assistance given in the initial development of the claim for increase going forward from its filing in July 1997. Although the claim does not require another VCAA notice, the record shows that the RO issued a comprehensive VCAA notice letters in November 2001 and March 2004 directed to the increased rating for PTSD. The veteran appealed the determination regarding the effective date for the 100 percent schedular evaluation. In such circumstances the VA General Counsel has concluded that under 38 U.S.C.A. § 5103(a), VA, upon receipt of a complete or substantially complete application, must notify the claimant of the information and evidence necessary to substantiate the claim for benefits. Under 38 U.S.C.A. § 7105(d), upon receipt of a notice of disagreement in response to a decision on a claim, the "agency of original jurisdiction" must take development or review action it deems proper under applicable regulations and issue a statement of the case if the action does not resolve the disagreement either by a grant of the benefits sought or withdrawal of the notice of disagreement. If, in response to notice of its decision on a claim for which VA has already given the section 5103(a) notice, VA receives a notice of disagreement that raises a new issue, section 7105(d) requires VA to take proper action and issue a statement of the case if the disagreement is not resolved, but section 5103(a) does not require VA to provide notice of the information and evidence necessary to substantiate the newly raised issue. VAOPGCPREC 8-03. VA has completed the essential development and procedural steps outlined in the VA General Counsel's precedent opinion. Therefore there is no further assistance required on VA's part to insure an informed decision. As discussed below, the record does allow for a substantial grant of the benefits sought and it ahs been adequately development for an informed decision on the merits of each issue. Analysis Service Connection Following the point at which it is determined that all relevant evidence has been obtained, it is the Board's principal responsibility to assess the credibility, and therefore the probative value of proffered evidence of record in its whole. Owens v. Brown, 7 Vet. App. 429, 433 (1995); see Elkins v. Gober, 229 F.3d 1369 (Fed. Cir. 2000); Madden v. Gober, 125 F. 3d 1477, 1481 (Fed. Cir. 1997) (and cases cited therein); Guimond v. Brown, 6 Vet. App. 69, 72 (1993); Hensley v. Brown, 5 Vet. App. 155, 161 (1993). In determining whether documents submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511 (1995); see also Pond v. West, 12 Vet. App. 341, 345 (1999) (observing that, in a case where the claimant was also a physician, and therefore a medical expert, the Board could consider the appellant's own personal interest); citing Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (holding that while interest in the outcome of a proceeding "may affect the credibility of testimony it does not affect competency to testify." (citations omitted)). In order to establish direct service connection for a disorder, there must be (1) medical evidence of the current disability; (2) medical, or in certain circumstances, lay evidence of the in-service incurrence of a disease or injury; and (3) medical evidence of a nexus between the claimed in- service disease or injury and the current disability. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). The facts must demonstrate that a disease or injury resulting in current disability was incurred in active military service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2004). 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). However, continuous service for 90 days or more during a period of war, and post-service development of a presumptive disease such as sensorineural hearing loss to a degree of 10 percent within one year from the date of termination of such service, establishes a rebuttable presumption that the disease was incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the purpose of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The regulation does not prevent a veteran from establishing service connection on the basis of post-service evidence of hearing loss related to service when there were no audiometric scores reported at separation from service. See Ledford v. Derwinski, 3 Vet. App. 87 (1992). The threshold for normal hearing is 0 to 20 decibels and higher thresholds indicate some degree of hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Regarding a right ear hearing loss, the service medical records show a December 1967 audiology examination found right ear hearing thresholds at 500, 1,000, 2000, 3000 and 4000 Hertz (hereafter referred to as the relevant frequencies) of -10/-10/-5/X/-10. In February 1969 the right ear hearing thresholds at the relevant frequencies were 15/10/10/10/10. The December 1970 separation examination showed hearing was reported as 15/15 to the spoken and whispered voice in both ears. The VA examination in February 1998 showed the speech recognition score was 92% in the right ear. The hearing thresholds at the relevant frequencies were 5/10/15/20/25. On reexamination in December 2004, the speech recognition score was 96% in the right ear. The hearing thresholds at the relevant frequencies were 15/15/25/20/30. The Board noted in its March 2001 remand that the veteran had a right ear hearing loss on the February 1998 VA examination but that the examiner's opinion did not contain a statement of the etiology for it. The VA examiner in December 2004 reviewed the record and opined that it was likely that the present hearing loss was the result of the veteran's military duty. In general, it is not error for the Board to favor the opinion of one competent medical expert over that of another, provided that the Board gives an adequate statement of the reasons and bases. Owens v. Brown, 7 Vet. App. 429 (1995). Furthermore greater weight may be placed on one physician's opinion rather than on another's depending on such factors such as reasoning employed by the physicians and whether or not and the extent to which they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. at 40. Here the Board is confronted with two VA audiology examinations, conducted by the same examiner, that are deemed adequate for rating purposes but that have conflicting results. Thus neither examination outweighs the other from the standpoint of the validity or reliability of the results. However, the February 1998 examination clearly showed a hearing loss disability in the right ear and the more recent examination showed only a marginal improvement in the speech recognition while providing higher threshold loss, albeit not to the level of a recognized disability. The Board finds that the VA opinion is entitled to substantial weight. The examiner did review the veteran's medical records. As noted previously, the absence of hearing loss at separation from service is not critical to a claim. See Hensley, supra. Furthermore, the VA examiner did provide probative evidence that the veteran does have a noise-induced hearing loss, consistent with his military noise exposure history, a history that is not contradicted in the record. The VA examiner did not discount the earlier audiology evaluation in light of the more recent report. Thus, the situation here seems to be one that the benefit of the doubt rule should govern since there is no dispute as to the reliability of the comprehensive audiology examination that showed a right ear hearing disability. Furthermore, the veteran is service-connected for PTSD based upon his combat service as a medical corpsman and he received the Combat Action Ribbon. In summary, a hearing loss does not have to be shown in service for the purpose of service connection and there is competent evidence of a recognized hearing loss disability in the right ear during this appeal. 38 C.F.R. § 3.303(d), Hensley, supra. Therefore, the Board is inclined to find that the probative and competent medical evidence of record supports a grant of entitlement to service connection for a right ear hearing loss, as the competent evidence is in approximate balance. This permits the application of the benefit of the doubt rule. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.385, 4.3 (2004). Regarding a disability manifested by lethargy and/or decreased libido, the veteran initially claimed service connection in December 1997 by stating that lethargy and decreased libido could be from AO exposure, and he listed these manifestations among various symptoms in discussing PTSD. Thus, it was not exclusively an AO exposure-based claim. The VA examiner in February 1998 reported the veteran had very little libido. The VA examiner in May 2000 noted the veteran stated his libido had been good, however that examination was not on file at the time of the Board remand in March 2001. The March 2001 Board remand sought for examiners with appropriate expertise to determine if the veteran had current disability/disabilities manifested by decreased libido and/or lethargy and whether it was at least as likely as not that the such disability was related to his military service. The Board remand in October 2002 citing Stegall v. West, 11 Vet. App. 268 (1998) noted the prior remand instruction was not accomplished and asked that an examiner with "appropriate expertise" opine as to whether it was at least as likely as not that decreased libido or lethargy is related either to the veteran's military service, including exposure to AO, or his service-connected PTSD. Thus, the Board emphasized an association between lethargy and decreased libido and a previously service-connected disability as an alternative theory of entitlement. The VA psychiatry examiner in August 2004 was not instructed regarding this matter specifically, as the examination request was directed to the November 2003 Board remand order. The examiner noted that the veteran reported his libido had been poor. The genitourinary examiner in December 2004 stated that not being a psychiatrist he did not know if PTSD "effects libido", thus the appropriate specialist was obviously in psychiatry. The veteran stated that decrease libido was part of his problem but he did not complain of erectile dysfunction. The genitourinary examiner stated that he could not prove the veteran's claimed decreased libido, but this is not significant since the examiner in essence admitted a lack of competence to make such a determination. A layperson is competent to testify only as to observable symptoms. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995). A layperson is not, however, competent to provide evidence that the observable symptoms are manifestations of chronic pathology or diagnosed disability, unless such a relationship is one which a layperson's observations is competent. See Savage, 10 Vet. App. at 495-97. In Voerth v. West, 13 Vet. App. 117, 120 (1999), holding that where a claimant's personal belief, no matter how sincere, was unsupported by medical evidence, the personal belief cannot form the basis of a claim. It is noteworthy that the psychiatry examiner in 2004 stated he had reviewed the Board remands in 2002 and 2003, so he was aware of the opinion being sought regarding the etiology of lethargy and/or decreased libido. Furthermore, the examiner stated, as he had on the February 1998 examination, that it would be difficult to dissect out effects of PTSD versus other diagnoses (emphasis added). Thus, this is a case the examiner being aware of the remand instructions concluded that it would be difficult to clearly differentiate PTSD effects/symptoms, and this statement viewed liberally is a statement that favors the claim, to the extent that it implicitly recognizes decreased libido and lethargy as symptoms of psychiatric disability that cannot reasonably be dissociated from PTSD. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) referring to 61 Fed. Reg. 52695, 52698 (Oct. 8, 1996) for the VA rating principle that when it is not possible to separate the effects of the (service-connected and nonservice-connected) conditions, VA regulations require that reasonable doubt on any issue be resolved in the claimant's favor, clearly dictate that such signs and symptoms be attributed to the service-connected condition. See Wisch v. Brown, 8 Vet. App. 139, 140 (1995) holding an examiner's silence specifically as it relates to an etiology for decreased libido and/or lethargy cannot be relied on as evidence against a claim. Furthermore the existence of lethargy and decreased libido were not ruled out and it is generally regarded that diminished libido and lethargy are typical signs and symptoms of psychiatric illness. See Comprehensive Textbook of Psychiatry 468, 923 (5th ed. 1989). The veteran is competent to relate symptoms or complaints. When, after consideration of all of the evidence and material of record in an appropriate case before VA, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Board must assess the weight and credibility to be given to the evidence. Sanden v. Derwinski, 2 Vet. App. 97, 101 (1992). On this point, the examiner's opinion appears to have been based upon a consideration of the pertinent record in each instance that took into account the veteran's various psychiatric disabilities. Struck v. Brown, 9 Vet. App. 145, 155 (1996); Owens v. Brown, 7 Vet. App. 429, 433 (1995). As with any piece of evidence, the credibility and weight to be attached to these opinions is an adjudication determination. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The Board must emphasize that decreased libido and lethargy are being recognized as manifestations of psychiatric illness and they are considered in establishing the service-connected rating. See for example 38 C.F.R. §§ 3.303(b), 3.310(a), 4.14 and Allen v. Brown, 7 Vet. App. 439 (1995). See, e.g., Sanchez-Benitez v. West, 13 Vet. App. 282 (1999) (holding that pain alone, without a diagnosed or identifiable underlying condition, does not constitute a disability for which service connection may be granted). It is the obligation of VA to render a decision which grants every benefit that can be supported in law while protecting the interests of the Government, with due consideration to the policy of the Department of Veterans Affairs to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 C.F.R. §§ 3.103, 3.303(a). Thus, lethargy and decreased libido are symptoms related to PTSD, which represents the identifiable underlying condition for which service connection has been granted. The symptoms cannot constitute a disability that is subject to service connection, including as a residual of AO exposure, and accordingly service connection is denied. Earlier Effective Date Except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. Unless specifically provided, on basis of facts found. 38 U.S.C.A. § 5110(a), (b)(2); 38 C.F.R. § 3.400(a). The law and regulations governing the effective date for an award of increased compensation are set out in 38 U.S.C.A. § 5110(a), (b)(2) and 38 C.F.R. §§ 3.400, 3.400(o)(1), (2) which provide that the effective date shall be the date of claim or date entitlement arose, whichever is later, but that increased disability compensation may be granted from the date an ascertainable increase occurred during the one year period prior to the date of receipt of claim, otherwise date of claim. Ascertainable (to ascertain) means "to find out definitely; learn with certainty or assurance; determine". The Random House College Dictionary, 78 (Rev. ed. 1982). However, in general, where the increase does not precede the date of claim, the effective date is governed by the later of the date that it is shown that the requirements for an increased evaluation are met or the date the claim for an increased evaluation is received. See, Harper v. Brown, 10 Vet. App. 125 (1997); Quarles v. Derwinski, 3 Vet. App. 129, 135 (1993) and VAOPGCPREC 12-98. The veteran seeks an earlier effective date than April 23, 1997, for a 100 percent evaluation for PTSD. In summary the record shows that in October 1988, the RO granted service connection for PTSD and assigned a 30 percent initial evaluation from September 1985. The RO considered claims for increase on several occasions through September 1991 and continued the 30 percent evaluation. In December 1995 and January 1996 decisions the RO again continued the 30 percent evaluation and issued notice to the veteran in January 1996. The veteran filed a notice of disagreement with the January 1996 decision and the RO issued a statement of the case in March 1996. The next pertinent correspondence was received at the RO in July 1997, when the veteran's representative submitted a copy of a VA hospital summary and stated the veteran was seeking a 100 percent evaluation based on the recent admission. The summary showed the veteran was admitted on April 23, 1997, for PTSD and discharged to outpatient follow-up after more than a month as an inpatient. The GAF score was reported as 36. A July 1997 RO rating decision continued the 30 percent evaluation from June 1997 after assigning a 100 percent evaluation under 38 C.F.R. § 4.29 from April 23, 1997, through May 1997. He requested an increase in December 1997. A VA psychiatry examiner in February 1998 reported the veteran was not currently receiving any psychiatric treatment and that he had not availed himself of services at VA facilities, other than at an urgent care clinic, because he did not drive and had difficulty getting there. The GAF was 51-60 currently and in the past year. The June 1998 rating decision continued the 30 percent evaluation and the RO issued notice in June 1998 and he completed an appeal filed in December 1999. After the Board remand in March 2001, the RO rating decision in February 2002 increased the evaluation for PTSD to 50 percent from May 9, 2000 but he continued the appeal seeking a 100 percent evaluation for his PTSD. The September 2004 RO rating decision granted a 100 percent schedular evaluation for PTSD, effective April 23, 1997, the date he was admitted to a VA medical center. He disagreed stating, without greater specificity, that the effective date should be earlier. The Board observes that the VA outpatient records beginning in the early 1990's show that after being seen in December 1995, the veteran was next seen on February 27, 1997, for neurology and psychiatry appointments. He was described in the neurology report as alert and oriented in four spheres, with normal speech and language. The psychiatry clinician reported veteran was contacted via telephone and stated he now desired to go through PTSD treatment that he had considered a year earlier. He reported his life was conducive to leaving for treatment. His mood was described as good. He was not living with his spouse, although they saw each other regularly and she brought him to the hospital. According to the report, he appeared to be doing well with his limited vision. On the February 1998 VA psychiatry evaluation, the veteran stated he could not see to drive. The Board finds that this record supports the 100 percent evaluation from the date of hospital admission in April 1997, but not earlier. The claim adjudicated early in 1996 was a finally adjudicated claim as it was disallowed and had become final by the failure to complete an appeal within the time period after the date of notice. The April 1997 hospital admission represented an informal claim under 38 C.F.R. §§ 3.155 and 3.157, with the formal application being received in July 1997. Thus there was an ascertainable increase from the date of admission in April 1997, but not earlier in the year preceding that admission. The pertinent information in the February 1997 neurology and psychiatry outpatient reports does not show any manifestations of PTSD that could support an ascertainable increase as of that time. The 100 percent evaluation contemplated 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. 38 C.F.R. § 4.130, Diagnostic Code 9411 effective November 7, 1996. Nothing from the February 1997 reports indicates symptoms of this type were present. Moreover, the record of treatment is consistent with the summary the VA examiner gave in February 1998. That is, there was an extended period from late in 1995 through early in 1997 without any record of treatment being sought or directed to PTSD. In addition, in March 1996 the veteran asked to have his nonservice-connected disability pension evaluation reinstated in lieu of the evaluation for PTSD, his only service-connected disability which is evidence that his PTSD was not appreciably worse. Thus under the framework of analysis set forth in Harper and VAOPGCPREC 12-98, an earlier effective date than April 23, 1997, is not warranted for the 100 percent PTSD evaluation. Mootness of the Claim for a TDIU The record reflects that the veteran filed a formal application for a TDIU in September 1998. However, the veteran's claim for increase in July 1997 was implicitly a claim for a TDIU and, as previously indicated, with an earlier pending claim for increase based on the April 1997 VA hospital admission the claim for a TDIU would be reasonably raised as well. As the Board observed in its March 2001 remand, the issue of entitlement to TDIU benefits had been properly placed in appellate status through the notice of disagreement filed in December 1999. The veteran perfected an appeal in January 2002. The Board finds that the issue was mooted with the RO's decision in September 2004 granting a 100 percent schedular evaluation for PTSD from April 23, 1997. The RO issued notice but there does not appear to have been a request in the notice letter or through a separate communication asking the veteran if the increase satisfied the TDIU claim. In December 2004, the veteran inquired regarding entitlement to a TDIU earlier than April 23, 1997. The RO then issued a supplemental statement of the case in February 2005 that discussed the issue and noted the decision granting the 100 percent scheduler evaluation mooted the pending claim for a TDIU. However, the Board must provide reasons and bases to support this disposition and in this case the veteran did not withdraw his appeal of the TDIU claim. 38 C.F.R. § 20.204; see also ZP v. Brown, 8 Vet. App. 303 (1995). In essence, with the grant of a 100 percent scheduler evaluation, there no longer exists any case or controversy as to the entitlement to a TDIU. Having resolved the veteran's claim on a schedular basis and thereby granting the maximum benefit, there is no longer a question or controversy regarding the entitlement to a TDIU. In this case there was no pending claim for a TDIU earlier than April 1997. In essence, the same analysis applied to the claim for an earlier effective date for a schedular 100 percent evaluation is applicable here. Furthermore the veteran was rated no higher than 30 percent for PTSD prior to April 23, 1997, when he claimed entitlement to a 100 percent evaluation and in March 1996 he had asked to receive his nonservice-connected pension benefit in lieu of the service-connected evaluation for PTSD since the former was the greater benefit. In addition, the veteran has not argued any factual basis for an earlier date for the TDIU. Thus VA was not obligated to consider a TDIU earlier than the July 1997 claim since the veteran did not make a claim for the highest rating possible, and additionally submits evidence of unemployability. Roberson v. Principi, 251 F.3d 1378, 1384 (2001); cf. Norris (Robert) v. West, 12 Vet. App. 413, 419-21 (1999) (concluding that appellant had presented informal claim for TDIU rating when he had been assigned service-connected rating of at least 60% and record on appeal contained evidence of unemployability resulting from that disability). Nor was the issue raised in either of the February 1997 VA outpatient reports. See Moody v. Principi, 360 F.3d 1306 (Fed.Cir.2004); Szemraj v. Principi, 357 F.3d 1370 (Fed.Cir.2004); Roberson, supra; Andrews (Edward) v. Principi, 18 Vet. App. 177, 184-85 (2004) (analyzing Moody, Szemraj, and Roberson, all supra ). Nor are any exceptions to the mootness doctrine present. See, for example, Thomas v. Brown, 9 Vet. App. 269, 270 (1996); Hudgins v. Brown, 8 Vet. App. 365, 367-68 (1995) and Bond v. Derwinski, 2 Vet. App. 376, 377 (1992). See also, 38 U.S.C.A. §§ 511, 7104, 7105; 38 C.F.R. § 20.101 and VAOPGCPREC 6-99. ORDER Entitlement to service connection for right ear hearing loss is granted. Entitlement to service connection for lethargy and decreased libido is denied. Entitlement to an earlier effective date than April 23, 1997, for a 100 percent evaluation for PTSD is denied. The claim of entitlement to a TDIU is dismissed. ______________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs