Citation Nr: 0933428 Decision Date: 09/04/09 Archive Date: 09/14/09 DOCKET NO. 94-15 848 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to an initial compensable evaluation for service-connected posttraumatic stress disorder (PTSD). 2. Entitlement to specially adapted housing. 3. Entitlement to a special home adaptation grant. REPRESENTATION Appellant represented by: Sean Kendall, attorney ATTORNEY FOR THE BOARD T. Stephen Eckerman, Counsel INTRODUCTION The Veteran had active service from January 1969 to November 1970. This appeal arises from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In October 2006, the RO denied a claim of entitlement to specially adapted housing or a special home adaptation grant. In August 2008, the RO effectuated a July 2008 Board decision that granted service connection for PTSD; the RO assigned a noncompensable evaluation. In a statement received by the RO in July 2009, the Veteran's representative stated that the Veteran wished to withdraw his request for a hearing. See 38 C.F.R. § 20.702(e) (2008). Accordingly, the Board will proceed without further delay. FINDINGS OF FACT 1. The Veteran's PTSD is shown to have been productive of no more than definite social and industrial impairment, and no more than occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, as manifested by symptomatology that includes anger, depression, difficulty sleeping at night, hypervigilance, and an exaggerated startle response; it is not shown to be productive of considerable social and industrial impairment, or occupational and social impairment with reduced reliability and productivity. 2. The Veteran has effectively lost the use of both of his lower extremities, such as to preclude locomotion without the aid of braces, canes, or a walker, due to his service- connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation of 30 percent, and no more, for service-connected PTSD have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.132, Diagnostic Code (DC) 9411 (as in effect prior to November 7, 1996); 38 C.F.R. §§ 4.7, 4.130, DC 9411 (as in effect November 7, 1996, and thereafter). 2. The criteria for specially adapted housing have been met. 38 U.S.C.A. §§ 2101, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.809, 3.809a (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran asserts that an initial compensable evaluation is warranted for his PTSD, and that a 100 percent rating is warranted based on the evidence, to include a September 1995 VA report (discussed infra). See Veteran's representative's letters, received in August 2008 and July 2009. With regard to all issues on appeal, the Board notes that the U.S. Court of Appeals for Veterans Claims ("Court") has held that medical evidence is required to differentiate between symptomatology attributed to a nonservice-connected disability and a service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). In July 2008, the Board granted service connection for PTSD. In a rating decision effectuating the Board's decision, dated in August 2008, the RO evaluated the Veteran's PTSD as 0 percent disabling (noncompensable), with an effective date of February 1, 1993 for service connection. The Veteran has appealed the issue of entitlement to an initial compensable evaluation. Disability evaluations are determined by comparing the veteran's present symptomatology with the criteria set forth in the VA' s Schedule for Ratings Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4. The Veteran is appealing the original assignment of a disability evaluation following an award of service connection. In such a case, it is not the present level of disability which is of primary importance, but rather the entire period is to be considered to ensure that consideration is given to the possibility of staged ratings; that is, separate ratings for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board further notes that the Veteran filed his claim for service connection for PTSD in 1993. Effective November 7, 1996, the regulation governing mental disorders, 38 C.F.R. § 4.132, was revised and renumbered as 38 C.F.R. § 4.130. As a result of the revision, the criteria were changed. See 61 Fed. Reg. 52,701-702 (1996). According to VAOPGCPREC 7- 2003, 69 Fed. Reg. 25179 (2004), in Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003), the Federal Circuit overruled Karnas v. Derwinski, 1 Vet. App. 308 (1991), to the extent it conflicts with the precedents of the United States Supreme Court (Supreme Court) and the Federal Circuit. Karnas is inconsistent with Supreme Court and Federal Circuit precedent insofar as Karnas provides that, when a statute or regulation changes while a claim is pending before VA or a court, whichever version of the statute or regulation is most favorable to the claimant will govern unless the statute or regulation clearly specifies otherwise. Accordingly, the rule adopted in Karnas no longer applies in determining whether a new statute or regulation applies to a pending claim. Id. However, none of the above cases or General Counsel opinions prohibits the application of a prior regulation to the period on or after the effective date of a new regulation. Thus, the rule that a veteran is entitled to the most favorable of the version of a regulation that was revised during his appeal allows application of the prior version of the applicable criteria at 38 C.F.R. § 4.132 to the period on or after November 7, 1996 (i.e., the effective date of the new regulation). Under the former rating criteria, a 10 percent rating is available for symptoms that are less than the criteria for a 30 percent rating, with emotional tension or other evidence of anxiety productive of mild social and industrial impairment. 38 C.F.R. § 4.132, DC 9411 (1996). A 30 percent disability rating was available when there is definite impairment in the ability to establish or maintain effective and wholesome relationships with people, the psychoneurotic symptoms resulting in such reduction in initiative, flexibility, and efficiency and reliability levels as to produce definite industrial impairment. Id. In Hood v. Brown, 4 Vet. App. 301 (1993), the Veterans Court stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons and bases" for its decision. See 38 U.S.C.A. § 7104(d)(1) (West 2002). VA's General Counsel has concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." 59 Fed. Reg. 4752 (1994); VAOPGCPREC 9-93. The Board is bound by this interpretation of the term "definite." See 38 U.S.C.A. § 7104(c) (West 2002). The Global Assessment of Functioning (GAF) scale is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness." Diagnostic and Statistical Manual of Mental Disorders 32 (4th ed. 1994). GAF scores ranging between 61 to 70 reflect some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, and has some meaningful interpersonal relationships. See Quick Reference to the Diagnostic Criteria from DSM-IV at 47 (American Psychiatric Association 1994) ("QRDC DSM-IV"). See also Carpenter v. Brown, 8 Vet. App. 240, 242 (1995). A GAF score of 51 to 60 denotes moderate symptoms (e.g., 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). Scores ranging from 41 to 50 reflect 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). Scores ranging from 31 to 40 reflect some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up other children, is defiant at home, and is failing at school). Id. Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and a veteran's capacity for adjustment during periods of remission. The evaluation must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). Although the extent of social impairment is a consideration in determining the level of disability, the rating may not be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board further notes that although some of the Veteran's recorded symptoms are not specifically provided for in the ratings schedule (e.g., such symptoms as nightmares), the symptoms listed at 38 C.F.R. § 4.130 are not an exclusive or exhaustive list of symptomatology which may be considered for a higher rating claim. Meehan v. Principi, 16 Vet. App. 436 (2002). The Board first notes that each disability must be viewed in relation to its history. 38 C.F.R. § 4.1 (2008). In this case, the Veteran has a complex psychiatric and medical history. His service treatment reports show that he was treated for complaints of anxiety, and that he was provided with Valium. The reports note a character disorder with sociopathic features. His personnel file also shows that he received a number of disciplinary actions. After separation from service, in early 1973, he sustained four gunshot wounds, to include a gunshot wound to the head that resulted in the enucleation of his left eye. In 1976, he received treatment for psychiatric symptoms, with medications that included Serax and Valium. In 1978, he was diagnosed with anxiety-related psychiatric disorders, and he was hospitalized for alcoholism. Thereafter, he received intermittent treatment for psychiatric symptoms, with diagnoses that included anxiety, depression, and PTSD. He has reported a history of drug and alcohol abuse ending no later than 1980, that he was arrested about 15 times between 1970 and 1993, and that he was incarcerated between 1987 and 1990, and that he held about 15 jobs between 1970 and 1993, the longest of which was a construction job that lasted about five years (between 1980 and 1984) (some reports indicate that he reported his longest job had lasted only two years), that he had not worked since June 1993, that he felt that he was unable to work due to poor vision, and that he had been living with his second wife since late 1992. See VA examination reports, dated in March, April and November of 1993. He has also reported on many occasions that he shot himself in the head in a suicide attempt in 1987 (there are no contemporaneous treatment reports of record). In early 2002, he sustained a cerebrovascular accident, and in 2003, he underwent surgery for a cervical spine disorder, for which he received considerable postoperative rehabilitation treatment. Service connection is in effect for PTSD, with an effective date of February 1, 1993. Overall, the medical evidence dated since that time shows that the Veteran has received some form of ongoing treatment for psychiatric symptoms, with the exception of the period between 1999 and 2001, for which no treatment is shown. A decision of the Social Security Administration (SSA), dated in June 1994, shows that the SSA determined that the Veteran was disabled as of June 1993, with a primary diagnosis of "decreased fields of the right eye, statutory blindness," and a secondary diagnosis of "prosthesis of the left eye." At the outset, the Board notes that the record shows that the Veteran has received a variety of psychiatric diagnoses, to include alcohol and substance abuse (which appear to have been in remission for many years), however, the Board has not attempted to dissociate any psychiatric symptoms from the service-connected disability (PTSD). Mittleider. Simply stated, it is impossible in this case. The medical evidence is summarized as follows: the Veteran is shown to have complained of symptoms that included anger, bitterness over his service, "emotional numbing," hyperarousal, and depression. Although he has not worked since June 1994, the evidence shows that this is due to poor vision. See e.g., June 1994 SSA decision. Overall, VA progress notes show that the Veteran has, at times, participated in group therapy, and that he has used medications for control of his psychiatric symptoms beginning in May 1994. See May 1994 VA progress note; March 1994 report by M.B.P. He apparently separated from his second wife in late 1994. See February 1995 VA progress note. An April 1998 VA progress note characterized his symptoms as "moderate." There is no evidence of psychiatric treatment dated between 1999 and 2001. Reports dated beginning in 2002 show intermittent treatment for complaints of symptoms that included anxiety, depression, nightmares three to four times per week, and flashbacks once a week. They indicate that he went to Alcoholics Anonymous meetings, and show that his medications included Prozac, Alprazolam and Fluoxetine. VA examination reports, dated in March, April, and November of 1993, show complaints that included avoidance, hyperarousal, anger, rage, and depression. He reported a history of three to four suicide attempts in the past (most recently in 1987), but he denied current suicidal or homicidal thoughts. He denied taking any medications for his psychiatric symptoms since 1987. On examination, mood was depressed and mildly anxious. Speech was normally productive, relevant, and coherent. There were no hallucinations or delusions. He was oriented to time, person, and place. Knowledge, memory and recall were intact (another report noted intact long-term and immediate memory, with impaired short-term memory). Insight and judgment were "limited," or "intact." The diagnoses were moderate PTSD, moderate major depressive disorder, recurrent major depression without psychotic features, depressive disorder, and alcohol, heroin, valium, and marijuana abuse (all in remission). A VA examination report, dated in June 2007, indicates that the Veteran was taking Alprazolam and Fluoxetine, and that he stated that they were, "Better than anything else I have ever been on." He reported difficulty sleeping at night, hypervigilance, and an exaggerated startle response. On examination, he presented in a wheelchair. His psychomotor activity, and speech, were unremarkable. He was clean and casually dressed. Affect was normal, and mood was "good." Attention was intact. He was oriented to person, time, and place. Thought processes, and thought content, were unremarkable. There were no delusions or hallucinations. For "judgment," it was noted that he understood that he had a problem, and for "insight" it was noted that he understands the outcome of his behavior. There was no inappropriate behavior, obsessive/ritualistic behavior, panic attacks, or homicidal or suicidal thoughts. Impulse control was good, and there were no episodes of violence. Remote, recent, and immediate memory were normal. There was no persistent re-experiencing of a traumatic event, although he reported avoiding activities, places or people that aroused traumatic recollections. The Axis I diagnosis was depression. The Axis V diagnosis was a GAF score of 55. The examiner stated that the Veteran's GAF score was based on his self-recriminations (dysphoria) and social isolation, and that he felt vulnerable to outside threats. The Board finds that the evidence shows that the Veteran's PTSD symptoms are shown to have resulted in a definite impairment, and that the criteria for an initial rating of 30 percent for PTSD under DC 9411 (1996) have been met. Overall, the Veteran is shown to have received somewhat sporadic treatment for PTSD symptoms, with complaints that included nightmares, flashbacks, anger, difficultly sleeping at night, hypervigilance, and an exaggerated startle response. He is shown to have been taking medications for control of his PTSD symptoms since mid-1994. In addition, his PTSD was characterized as "moderate" in 1993, and the Axis V diagnosis in his June 2007 VA examination report was a GAF score of 55. This score is also evidence of moderate symptoms. See QRDC DSM-IV at 47. The Board therefore finds that the evidence is at least in equipoise, and that the criteria for an initial rating of 30 percent have been met. A rating in excess of 30 percent is not warranted. Under the old criteria, a 50 percent rating is warranted where the ability to establish or maintain effective or favorable relationships with people is considerably impaired; or by reason of psychoneurotic symptoms, the reliability, flexibility, and efficiency levels are so reduced as to result in considerable industrial impairment. 38 C.F.R. § 4.132, DC 9411 (1996). Under the current criteria, 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 stereotype 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 or motivation in mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, DC 9411 (2008). The Board first notes that overall, VA progress notes show fairly ongoing treatment for psychiatric symptoms between 1993 and 1998, with no treatment between 1999 and 2001, and that after 2001, there are only scattered reports for psychiatric symptoms; he primarily received treatment for severe disorders that included diabetes mellitus, a lumbar spine disorder, a CVA in 2002, and cervical spine surgery in 2003. With regard to the old criteria, there is no significant objective evidence of symptomatology such as (for example) delusions, hallucinations, or homicidal or suicidal ideation. The medical evidence also shows that his orientation, speech, thought processes, and thought content, have consistently been found to be unremarkable. Apart from a single 1993 notation of intact long-term and immediate memory, with impaired short-term memory, there is no objective evidence of impaired memory. There is no evidence of delusions, hallucinations, obsessive or ritualistic behavior, panic attacks, or homicidal or suicidal thoughts. He is shown to be unable to work due to vision impairment. No treatment whatsoever is shown between 1999 and 2001. After 2001, there are only scattered reports for psychiatric symptoms. The June 2007 VA examination report shows that he was oriented, that he had unremarkable thought processes and thought content, that there were no delusions or hallucinations, and that there was no inappropriate behavior, obsessive/ritualistic behavior, or panic attacks, or homicidal or suicidal thoughts. Memory was normal, and the Axis V diagnosis was a GAF score of 55. Based on the foregoing, the Board finds that overall, the evidence shows that the Veteran's symptoms are not shown to have been productive of considerable industrial impairment, and that the Veteran's PTSD is not manifested by symptomatology that approximates, or more nearly approximates, the criteria for an evaluation in excess of 30 percent under 38 C.F.R. § 4.132, DC 9411 (as in effect prior to November 7, 1996). See 38 C.F.R. § 4.7. With regard to the current criteria, as of November 7, 1996, there is insufficient evidence of such symptoms as flattened affect; irregular speech; difficulty in understanding complex commands; impairment of short- and long-term memory; and impaired abstract thinking, nor are the other PTSD symptoms shown to have resulted in such impairment. The VA progress notes show that the Veteran tended to be alert, oriented, with unremarkable speech, logical and coherent thought processes, no homicidal or suicidal ideation, intact memory, and no delusions or hallucinations, and fair-to-good insight and judgment. See e.g., VA progress notes, dated in November 2004, May 2005, and March 2006. No treatment whatsoever is shown between 1999 and 2001. The June 2007 VA PTSD examination report shows inter alia the following: his speech was unremarkable; attention was intact; he was oriented to person, time, and place; thought processes, and though content, were unremarkable; there were no delusions or hallucinations; there were no noted defects of judgment or insight; there was no inappropriate behavior, obsessive/ritualistic behavior, panic attacks, or homicidal or suicidal thoughts; memory was normal; there was no persistent re-experiencing of a traumatic event. The Axis V diagnosis was a GAF score of 55, which is representative of moderate symptomatology. With regard to employment, the evidence indicates that he has not worked since 1993 due to vision disorders, to include a left enucleation in 1973. In summary, the Veteran's symptoms are not shown to be sufficiently severe to have resulted in considerable industrial impairment, or an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, and the Board has determined that the preponderance of the evidence shows that the Veteran's PTSD more closely resembles the criteria for not more than a 30 percent rating. In reaching this decision, the Board has considered GAF scores ranging between 38 and 40 contained in two reports, dated in April 1993 and May 1994, (both reports are associated with the SSA's decision), as well as an August 2004 report by a private LPC (licensed professional counselor). However, the Board finds that these GAF scores are not sufficiently supported by accompanying findings to warrant an evaluation in excess of 30 percent. See generally, Brambley v. Principi, 17 Vet. App. 20, 26 (2003) (indicating that although a GAF Scale score may be indicative of a certain level of occupational impairment, it is only one factor in determining an appellant's degree of disability). Specifically, an April 1993 report from a social worker shows that the Veteran was neat and appropriately attired, relaxed, well-oriented, conversational, without apparent defects in memory, attention, or concentration. He was articulate and coherent, and free of hallucinations, and insightful, providing evidence against a finding of a 30 percent evaluation, let alone a higher evaluation. A May 1994 report, from M.B.P., notes "residual difficulties that interfere with "virtually every aspect of his life," complaints of "bitterness and resentment," guilt, anger, and sadness, and that he was participating in weekly group therapy. The August 2004 report, from D.D.S., a private social worker, notes symptoms that included a quick temper, defensiveness, an "inability to maintain employment," isolation, loneliness and estrangement from family members. The report mentions sleep difficulties, and that he maintains "passive suicidal thoughts." Finally, the Board has considered a September 1995 report from a VA social worker, which states that the Veteran is "unable to work due to physical and mental disability," and that the SSA considered him disabled due to PTSD and physical problems. The Veteran's representative has argued that this report is evidence that a 100 percent evaluation is warranted (under 38 C.F.R. § 4.132, DC 9411 [1996] the criteria for a 100 percent rating include "demonstrably unable to obtain or retain employment"). In the Board's judgment, the underlying findings pertaining to the Veteran's mental functioning are insufficient to support the assigned GAF scores, or the opinions on unemployability. In addition, the September 1995 VA report attributes the Veteran's inability to work due to both physical (nonservice related) and psychiatric disability. The Board further notes that the probative value of these reports is lessened by the fact that they are all from social workers, or a LPC. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches). In summary, when these statements and GAF scores are weighed together with the other evidence of record, particularly the findings as to his psychiatric condition and functioning, the Board finds that the evidence shows that the Veteran's symptoms, which include nightmares and sleep disturbances, are of such severity to approximate, or more nearly approximate, the criteria for an initial 30 percent evaluation, and no more, under DC 9411 (1996). See 38 C.F.R. § 4.7. The Veteran asserts that he is entitled to specially adapted housing allowance or special home adaptation grant. He argues that he has a "severe" disability evaluated at the "100% level," and that he has been issued braces for both of his legs, as well as a cane, due to his service-connected disabilities, which essentially "preclude locomotion." In January 2006, the Veteran filed his claims. In October 2006, the RO denied the claims. The Veteran has appealed. Applicable regulations provide that specially adapted housing is available to a veteran who has a permanent and total service-connected disability due to: (1) the loss, or loss of use, of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; or (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; or (3) the loss or loss of use of one lower extremity, together with residuals of organic disease or injury, or with loss of use of one upper extremity, which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes or a wheelchair. 38 U.S.C.A. § 2101(a) (West 2002); 38 C.F.R. § 3.809 (2008). The phrase "preclude locomotion" is defined as the necessity for regular and constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(d). If entitlement to specially adapted housing is not established, a veteran can qualify for a grant for necessary special home adaptations if he/she has compensation based on permanent and total service-connected disability which is due to one of the following: (1) blindness in both eyes with 5/200 visual acuity or less; or (2) includes the anatomical loss or loss of use of both hands. The assistance referred to in this section will not be available to any veteran more than once. 38 C.F.R. § 3.809(a). Loss of use of a hand or a foot, for the purpose of special monthly compensation, will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function of the hand or foot, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance and propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis. Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of two major joints of an extremity, or shortening of the lower extremity of 3 1/2 inches (8.9 cms.) or more, will be taken as loss of use of the hand or foot involved. Complete paralysis of the external popliteal nerve (common peroneal) and consequent, foot drop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will be taken as loss of use of the foot. 38 C.F.R. §§ 3.350(a)(2), 4.63. Service connection is in effect for disorders that include prostate cancer, peripheral neuropathy of the bilateral upper extremities and bilateral lower extremities, diabetes mellitus, type II, PTSD, and erectile dysfunction. The Veteran is also shown to be receiving special monthly compensation on account of being housebound, on account of loss of use of a creative organ, and under 38 U.S.C.A. § 114(s) based on a disability evaluated as 100 percent disabling and additional service-connected disabilities ratable at 60 percent or more. A total disability rating for compensation purposes based on individual unemployability due to service-connected disability (TDIU) was in effect from September 2007 to April 2008 (i.e., prior to the effective date of his 100 percent rating). The Veteran is shown to have undergone an enucleation of his left eye after service, in 1973, and to be legally blind. However, the evidence does not show, nor has the Veteran asserted, that he is blind or has visual acuity of 5/200 or less in both eyes due to service-connected disability. With regard to the other criteria, the Veteran is shown to have a complex medical history, with residuals of a CVA that occurred in 2002, and residuals of cervical spine disorder (with surgery in 2003, followed by considerable physical therapy), and a low back disorder. A review of the RO's October 2006 rating decision shows that the RO noted that the Veteran was shown to have been confined to a wheelchair, however, the RO essentially determined that that the residuals of his peripheral neuropathy were not sufficiently severe enough to meet the required criteria because his neurological impairment was primarily due to his (currently nonservice-connected) CVA and cervical spine disorders. The RO cited VA examination reports dated in January and May of 2006, in support of its decision. As an initial matter, the Board finds that the evidence is insufficient to dissociate the symptoms of the Veteran's service-connected disabilities from his nonservice-connected disabilities, specifically, the residuals of his CVA, and his cervical spine and low back disorders. Mittleider. In this case, the record includes four VA "aid and attendance and housebound" (AAHB) examination reports, dated between 2006 (three reports), and 2008 (one report). These reports all show that the Veteran could not walk, and that he required assistance or supervision in performing various activities of daily living (ADL's) that included attending to the needs of nature, getting out of bed, and feeing, dressing, and bathing himself. They further show that he required a wheelchair, that he required a brace for ambulation, and that his symptoms included lower extremity muscle weakness, limited motion in the knees and ankles, and abnormal balance. One examiner noted that he was totally unable to care for himself even in the house. In addition, VA examination reports for the peripheral nerves, dated in 2004, 2006, and 2007, show that he was wheelchair-bound with balance difficulties and a history of falls, and that he had atrophy of the hands, upper and/or lower extremity muscle weakness, with paresthesias and impaired sensation. In summary, this evidence shows that the Veteran is confined to a wheelchair, with an inability to ambulate, and that he has severe neurological and muscular impairments in his upper and lower extremities. Of particular note, none of this evidence includes an opinion in which the Veteran's peripheral neuropathy symptoms were dissociated from his nonservice-connected CVA, and cervical and lumbar spine disorders, or in which it was clearly stated that the Veteran did not meet the criteria for specially adapted housing based solely on the symptoms of his service-connected disabilities. In addition, there are several opinions of record which indicate that the criteria for specially adapted housing have been met. Specifically, in a statement dated in September 2006, L.T., M.D., states that the Veteran has increased disability due to neuropathy, and that he requires a wheelchair. In a statement dated in November 2006, S.P., M.D., states that the Veteran is totally disabled due to disabilities that include "severe diabetic peripheral neuropathy," and that he is unable to walk, and is wheelchair-bound, with a history of falls attempting to get up from his wheelchair. In a statement dated in March 2008, G.J.D., M.D., states that the Veteran is "quite disabled" neurologically, that he is essentially wheelchair-bound due to conditions that include diabetic neuropathy, and that he has a "dramatic" degree of hand atrophy and weakness that could be related to his peripheral neuropathy. Given the foregoing, the Board finds that the evidence is sufficient to show that the Veteran has lost the use of his lower extremities, and that his service-connected peripheral neuropathy symptoms preclude locomotion without the aid of assistive devices, as defined by the applicable regulation. See 38 U.S.C.A. § 2101(a); 38 C.F.R. § 3.809. The Board therefore finds that the evidence is at least in equipoise, and that affording the Veteran the benefit of all doubt, that the criteria for specially adapted housing have been met. Accordingly, entitlement to a certificate of eligibility for assistance in acquiring specially adapted housing under 38 U.S.C.A. § 2101(a) has been shown. As a final matter, in light of the grant of entitlement to specially adapted housing, the claim for a special home adaptation grant under 38 U.S.C.A. § 2101(b) is rendered moot as this benefit is available only if a veteran is not entitled to the more substantial benefit of specially adapted housing under 38 U.S.C.A. § 2101(a). Duties to Notify and Assist The Board finds that VA has satisfied its duties to the veteran under the Veterans Claims Assistance Act of 2000 (VCAA). A VCAA notice consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. As an initial matter, the Veteran's representative has waived his right to receive such notice. See statement, received in July 2009; Janssen v. Principi, 15 Vet. App. 370 (2001) (per curiam). VA has made all reasonable efforts to assist the Veteran in the development of his claims, has notified him of the information and evidence necessary to substantiate the claims, and has fully disclosed the government's duties to assist him. In a letter, dated in September 2006, the Veteran was notified of the information and evidence needed to substantiate and complete the claims for specially adapted housing, and a special home adaptation grant. With regard to the claim for an initial compensable evaluation for PTSD, a separate VCAA notice has not been provided, however, as this claim involves an initial compensable evaluation, the VCAA is no longer applicable. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 491 (2006). The Board has also considered the recent decision of Vazquez- Flores v. Peake, 22 Vet. App. 37 (2008). However, this case pertains to the requirements of 38 U.S.C.A. § 5103(a) for increased evaluation claims other than those based on initial evaluations. Here, the claim involves an initial evaluation, and the Court in Dingess held that in such cases section 5103(a) notice is not required, because the purpose that the notice was intended to serve has been fulfilled. The Board further finds that VA has complied with the VCAA's duty to assist by aiding the Veteran in obtaining evidence. It appears that all known and available records relevant to the issues on appeal have been obtained and are associated with the Veteran's claims files. The RO has obtained the Veteran's service medical records, as well as VA and non-VA medical records, and records from the Social Security Administration. The Veteran has been afforded examinations. The Board therefore concludes that decisions on the merits at this time do not violate the VCAA, nor prejudice the appellant under Bernard v. Brown, 4 Vet. App. 384 (1993). Based on the foregoing, the Board finds that the Veteran has not been prejudiced by a failure of VA in its duty to assist, and that any violation of the duty to assist could be no more than harmless error. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). ORDER An initial evaluation of 30 percent, and no more, is granted for posttraumatic stress disorder, subject to the regulations governing payment of monetary awards. Entitlement to a certificate of eligibility for specially adapted housing is granted, subject to the regulations governing payment of monetary awards. The issue of entitlement to a special home adaptation grant is moot, and is dismissed. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs