Citation Nr: 0215988 Decision Date: 11/07/02 Archive Date: 11/14/02 DOCKET NO. 93-15 956 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Newark, New Jersey THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to a disability rating in excess of 50 percent for anxiety reaction. 3. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU). REPRESENTATION Veteran represented by: Kenneth M. Carpenter, Attorney at Law WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD N. W. Fabian, Counsel INTRODUCTION The veteran served on active duty from March 1969 to March 1971. Service in Vietnam is indicated by the evidence of record. Service connection for anxiety reaction was granted in a May 1976 rating decision, and a 10 percent disability rating was assigned. These matters come to the Board of Veterans' Appeals (the Board) on appeal of a September 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (the RO). In that rating decision, the RO denied the veteran's claim of entitlement to service connection for PTSD and denied entitlement to a disability rating in excess of 10 percent for service-connected anxiety reaction. The veteran's appeal was previously before the Board in July 1994, at which time the Board remanded the case to the RO for additional development. On return of the case to the Board, in a June 1996 decision the Board denied entitlement to service connection for PTSD and assigned a 50 percent disability rating for anxiety reaction. The veteran appealed the Board's June 1996 decision to the United States Court of Appeals for Veterans Claims (the Court). As the result of a joint motion submitted by the parties, in a June 1997 order the Court vacated that part of the Board's decision denying service connection for PTSD and denying entitlement to a disability rating in excess of 50 percent for anxiety reaction. The Court remanded the case to the Board for readjudication. The Board remanded the case to the RO in March 1998 for additional development. While the case was pending at the RO, in a July 1998 rating decision the RO denied entitlement to TDIU. The veteran perfected an appeal of the July 1998 decision. The RO continued the denials of service connection for PTSD and a rating in excess of 50 percent for anxiety reaction, most recently via a Supplemental Statement of the Case in August 2002, and returned the case to the Board for further consideration of the veteran's appeal. FINDINGS OF FACT 1. The medical evidence establishes that the veteran has PTSD, his claimed in-service stressors have been successfully corroborated, and the medical evidence indicates that the PTSD is related to the corroborated stressors. 2. The veteran's service-connected psychiatric disorders result in virtual isolation in the community, totally incapacitating symptoms and the demonstrated inability to obtain or retain employment. CONCLUSIONS OF LAW 1. PTSD was incurred in active service. 38 U.S.C.A. § 1110 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303, 3.304(f) (2001). 2. The criteria for a 100 percent disability rating for anxiety reaction are met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2002); 38 C.F.R. § 4.132, Diagnostic Code 9400 (1988); 38 C.F.R. §§ 4.1, 4.3, 4.126, 4.130, Diagnostic Code 9400 (2001). 3. Because a 100 percent schedular rating has been granted for anxiety reaction, the veteran's claim of entitlement to a total disability rating based on individual unemployability is moot. 38 U.S.C.A. § 7104 (West 1991 & Supp. 2002); 38 C.F.R. § 20.101 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The procedural history of this case has been set forth in the Introduction above. The issues of entitlement to service connection for PTSD and entitlement to an increased disability rating for anxiety reaction were remanded to the Board by the Court in June 1997. The Board initially wishes to make it clear that it is aware of the Court's instructions in Fletcher v. Derwinski, 1 Vet. App. 394, 397 (1991) to the effect that a remand by the Court is not "merely for the purposes of rewriting the opinion so that it will superficially comply with the 'reasons or bases' requirement of 38 U.S.C. § 7104(d)(1). A remand is meant to entail a critical examination of the justification for the decision." The Board's analysis has been undertaken with that obligation in mind. The veteran contends that he has PTSD due to trauma that occurred in Vietnam, and that his psychiatric symptoms were incorrectly diagnosed as anxiety reaction in 1976. He further contends that the severity of his psychiatric symptoms has rendered him unemployable. In the interest of clarity, the Board will initially review various laws generally pertaining to the issues on appeal. The Board will then move on to an analysis of these issues. Although all of the evidence in the claims file may not be specifically cited in the Board's decision, the Board has reviewed and considered all of the evidence in the claims file in reaching its conclusions. The VCAA The Board has considered VA's duty to inform the veteran of the evidence needed to substantiate his claim and to assist him in obtaining the relevant evidence, and finds that the provisions of the laws and regulation apply to the veteran's claims. See, in general, the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000). The Board further finds that development of the issues on appeal has proceeded in accordance with the laws and regulation. See 38 U.S.C.A. §§ 5103, 5103A (West Supp. 2002); 38 C.F.R. § 3.159 (2002). Duty to notify On receipt of a claim for benefits VA will notify the veteran of the evidence that is necessary to substantiate the claim. VA will also inform the veteran which information and evidence, if any, that he is to provide and which information and evidence, if any, VA will attempt to obtain on his behalf. VA will also request that the veteran provide any evidence in his possession that pertains to the claim. Duty to Assist, 66 Fed. Reg. 45,620, 45,630 (Aug. 29, 2001) (codified at 38 C.F.R. § 3.159); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The RO informed the veteran of the evidence needed to substantiate his claim of entitlement to service connection for PTSD in July 1990, December 1990, and August 1994 by instructing him to provide detailed information regarding the in-service events he claimed to have caused PTSD. Although the Board's June 1996 decision as to these issues has no adjudicative authority because it was vacated by the Court, in that decision the Board informed the veteran of the regulatory requirements for establishing service connection for PTSD and a higher rating for anxiety reaction. In August 1997 the Board informed the veteran of the Court's remand and his right to submit additional evidence and argument in support of his claims. In the March 1998 remand to the RO the Board informed the veteran of the evidence needed to establish service connection for PTSD, the conflicts in the available evidence, and the evidence needed to resolve those conflicts. Following the March 1998 remand, in a March 1998 notice the RO again informed the veteran of the necessity of providing detailed information regarding his claimed stressors. The veteran did not provide any additional information in response to that request. In a July 1998 supplemental statement of the case the RO informed the veteran of the revised criteria for evaluating mental disorders, and gave him the opportunity to submit evidence and argument in response. The RO provided the veteran a statement of the case in September 1999 in which the RO informed the veteran of the regulatory requirements for establishing entitlement to a total rating based on unemployability, and the RO's rationale in determining that the evidence he had then submitted did not show that the requirements were met. In a July 2001 notice the RO informed the veteran of the provisions of the VCAA, including VA's duty to notify him of the evidence needed to substantiate his claims and to assist him in obtaining the relevant evidence. In that notice the RO informed the veteran of the specific requirements for establishing service connection for PTSD and a higher rating for anxiety reaction. The RO also informed the veteran of the information and evidence he was required to submit, and what evidence VA would obtain on his behalf. The RO also instructed him to submit any evidence in his possession that was relevant to the claims, including any documentation he had regarding his retirement from employment. The veteran's representative has been provided copies of the claims file on multiple occasions, and did not indicate that the veteran had any additional evidence to submit. The RO notified the veteran each time his case was sent to the Board, and informed him that any additional evidence that he had should be submitted to the Board. The Board finds, therefore, that VA has fulfilled its obligation to inform the veteran of the evidence needed to substantiate his claims. Duty to assist In general, the VCAA provides that VA will make reasonable efforts to help the veteran obtain evidence necessary to substantiate the claim, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. VA's duty includes making efforts to obtain his service medical records, if relevant to the claim; other relevant records pertaining to service; VA medical records; and any other relevant records held by any other source. The veteran is also required to provide the information necessary to obtain this evidence, including authorizations for the release of medical records. Duty to Assist, 66 Fed. Reg. 45,620, 45,630 (Aug. 29, 2001) (to be codified at 38 C.F.R. § 3.159). In a claim for compensation benefits, the duty to assist includes providing a VA medical examination or obtaining a medical opinion if VA determines that such an examination or opinion is necessary to make a decision on the claim. 38 U.S.C.A. § 5103A (West Supp. 2002); 38 C.F.R. § 3.159 (2002). In this case, the RO provided the veteran VA psychiatric examinations in February 1990, October 1995, June 1998 and March 1999, which will be described below. In the March 1998 remand the Board instructed the RO to provide the veteran a VA psychiatric examination by an examiner who had not previously examined him. That examination was to include review of the evidence in the claims file. An examination was provided in June 1998, but the veteran's representative asserted that the examination was not adequate because the examiner had not complied with the Board's remand instructions. The RO then provided the veteran an additional psychiatric examination in March 1999. The Board finds that the examiner in March 1999 fully complied with the Board's remand instructions, and that no further examinations are required. See Stegall v. West, 11 Vet. App. 268 (1998) [the veteran is, as a matter of law, entitled to compliance with the Board's remand instructions]. The RO has obtained the veteran's service medical and personnel records and the VA treatment records he identified. The RO requested verification of the veteran's claimed stressors from the United States Army and Joint Services Environmental Support Group (ESG), and that organization properly responded to the RO's request. The veteran presented hearing testimony before the RO Hearing Officer in January 1993. The veteran and his representative have been accorded the opportunity to present evidence and argument, and have done so. The veteran has not indicated the existence of any other evidence that is relevant to his appeal. The Board concludes that all relevant data has been obtained for determining the merits of the veteran's claims and that no reasonable possibility exists that any further assistance would aid him in substantiating his claims. See Wensch v. Principi, 15 Vet. App. 362, 368 (2001). Factual Background The veteran's service personnel records indicate that he served in Vietnam from May 1970 to March 1971. His military occupational specialty (MOS) was a data processing equipment operator. He did not receive any medals or citations indicative of combat service. 38 C.F.R. § 3.304(f). In a May 1971 rating decision the RO granted service connection for bronchial asthma. While undergoing a periodic medical examination in April 1976 the veteran reported symptoms that the examiner found to be indicative of a psychiatric impairment; the veteran was referred for a psychiatric examination. The psychiatric examination resulted in a diagnosis of anxiety reaction with somatic features, mild to moderate. In a May 1976 rating decision the RO granted service connection for anxiety reaction as secondary to bronchial asthma. [The Board notes in passing that there appears to have been no medical evidence of record pointing to a relationship between bronchial asthma and anxiety reaction.] The RO assigned a 10 percent rating for anxiety reaction. The veteran claimed entitlement to an increased rating for his service-connected psychiatric disorder in February 1989. Evidence developed in conjunction with that claim revealed that he was hospitalized for psychiatric treatment from October to December 1989 with a diagnosis of chronic PTSD. The RO undertook development to determine whether service connection for PTSD should be granted. The RO asked the veteran to describe the specific stressors to which he attributed his PTSD symptoms. The veteran responded in an August 1990 statement that he had had a complete mental breakdown in the fall of 1987, following which he was given the diagnosis of PTSD. He asserted that PTSD was not a new diagnosis, but that the anxiety reaction for which service connection had been established had been re-characterized as PTSD. He stated that after 20 years he was no longer able to remember the dates of events or the names of other individuals involved, and that his dreams and memories had become so confused he was no longer able to remember what was real. He also stated that while in Vietnam he had been exposed to a number of rocket, mortar and sapper attacks, and that he had served on a reaction force for 10 months and as a fire team leader for the last five months. He reported that his VA therapist had told him that his experiences constituted sufficiently traumatic and stressful events. The RO provided the veteran a VA psychiatric examination in February 1990, during which he reported having served in combat while in Vietnam. He also reported that his activities in Vietnam were "classified," but that he participated in fire fights and witnessed casualties. He further reported that he was exposed to rocket and mortar attacks, small and automatic weapons fire, and booby traps. He stated that he had been anxious, tense, and irritable since returning from Vietnam, had had an emotional breakdown in 1987, was bedridden for two years, and had been unemployed since November 1987. The veteran reported that one of the most stressful events he experienced occurred in the spring of 1970, when an oil depot at Cam Ranh Bay was hit by rockets and exploded. He was about 100 yards away when this occurred, and 23 soldiers were burned alive in the fire. He heard their screams, but was unable to help them. He was unable to describe any of his additional stressors due to claimed emotional distress. The veteran's reported psychiatric symptoms included interrupted sleep, persistent and severe fatigue, night sweats, recurrent combat nightmares, intrusive memories, flashbacks, severe startle reaction, impaired concentration, social withdrawal, and feelings of persecution. He was unable to pursue goal-directed activities, was hypervigilant, and was unable to experience sensations of interest or pleasure. On examination he appeared tense and anxious, he was oriented, his speech was rambling and circumstantial, his affect intense, and his mood tearful and depressed. He expressed paranoid persecutory ideation, and his memory and concentration were impaired. His insight was poor, and his judgment had been compromised. The examiner provided a diagnosis of PTSD, chronic and severe, and stated that the PTSD had been previously erroneously diagnosed as anxiety neurosis. In the September 1990 rating decision here on appeal the RO determined that although the veteran's psychiatric symptoms had been diagnosed as PTSD, he had not provided sufficiently detailed information to allow verification of the claimed stressors. Service connection for PTSD was, therefore, denied. The RO did not provide any rationale for continuing the 10 percent rating for anxiety reaction. VA treatment records disclose that the veteran underwent a psychological evaluation in December 1990, during which he reported being unemployed since having a nervous breakdown in 1987. He had been employed as a data processor from 1971 to 1987. His psychiatric symptoms then included extreme anxiety, depression, stress, a sleep disorder with nightmares related to his military experiences, variable appetite, hyperalertness, extreme introversion, and suicidal ideation with no current plan. He spent his days "hiding" in his apartment and was unable to get along with his relatives. The results of psychological testing were indicative of severe, combat-related PTSD, approaching psychotic proportions, with confused, deviant thinking; persecutory ideation; impaired memory and concentration; impulsivity; painful sensitivity to criticism; severe depression and anxiety; and multiple somatic complaints. The psychologist described the veteran as shy, withdrawn, introverted, isolated, anxious, ruminative, and fearful, with low self- esteem, significant family problems, and decision-making problems leading to his unemployability. The psychologist found that he was unemployable, and that he would continue to be so without significant improvement in his psychological condition. The RO requested verification of the veteran's claimed stressors from the United States Army and Joint Services Environmental Support Group (ESG). In July 1992 the ESG provided copies of the Operational Reports--Lessons Learned from the U.S. Army Support Command, Cam Ranh Bay, for the periods ending April 30, 1970, and July 31, 1970. Those reports show that 16 different Vietcong units were then located within a 30 kilometer radius of Cam Ranh Bay, and that on March 31-April 1, 1970, the tank farm located at Cam Ranh Bay was exploded as a result of infiltration by Vietcong. In addition, from May 1 to July 31, 1970, there were 19 rocket and mortar attacks, five sapper attacks, three ambushes, and two acts of sabotage by enemy forces in the Cam Ranh Bay Special Sector. The veteran provided testimony before a RO Hearing Officer in January 1993. He stated that he was not comfortable responding to questions about Vietnam, and that he was unable to remember specific details of what occurred there. He stated that he had no job and no social life, he lived with his mother, and he spent 70 percent of his time in bed. He did not associate with his relatives, and could tolerate his mother only because she was 82 years old and did not bother him. He had nightmares about Vietnam, which were accompanied by cold sweats. He stated that he was unable to work due to depression, which prevented him from getting out of bed. In a September 1993 statement the veteran reported that between September 1970 and April 1971 the building in which he worked in Vietnam was rocketed just minutes before he was to enter it. He also stated that he was exposed to a rocket attack in the beach area in April 1970. In response to the RO's August 1994 request for additional information regarding his claimed stressors, in a September 1994 statement the veteran reported that the ESG had confirmed his claimed stressors of numerous rocket attacks and the tank farm explosion. He stated that although the ESG had not confirmed that the tank farm explosion had resulted in 23 casualties, he had been informed that 23 soldiers were then killed. He again stated that his long-term memory was impaired. Following the Board's remand in July 1994, the veteran underwent a VA psychiatric examination by a panel of two psychiatrists in October 1995. He was then living with a friend (his mother was then deceased) and his only income was his VA compensation. He again stated that his psychiatric impairment had been misdiagnosed as anxiety when service connection was established, and that the correct diagnosis was PTSD. From his point of view, service connection for PTSD had already been established, and he was seeking entitlement to an increased rating. He was not then receiving any psychiatric treatment. In reviewing the file the examiners noted that the veteran's claimed stressors had not been verified, and that service connection for PTSD had not been established. The veteran reported that while in Vietnam he was a point man in a rifle reaction team. His team scouted the hills around Cam Ranh Bay, looking for mortar nests. He stated that he encountered ground fire on one occasion. He experienced many mortar and rocket attacks, but none occurred in his immediate area. He denied having been injured by a mortar round, or having to deal with bodies. The examiners found that he could provide no details indicating that he experienced direct sustained eminent threat to life as a result of ground combat, and that other claimed events had not been documented. On mental status examination the veteran did not report experiencing any nightmares, intrusive thoughts, or other recollections of his Vietnam service. He was disheveled and spoke in a soft, slow, monotonous voice. As the interview progressed, however, he became more demonstrative. He denied auditory and visual hallucinations, any out of contact experiences, or suicidal thoughts. His demeanor was alert, clear, and coherent. He was not then depressed, but related having been previously depressed. There was no evidence of dysphoria or a psychotic process. The examiners found an absence of PTSD symptomatology, and noted that there was no evidence of sustained threat to life while in Vietnam. They found that the stresses the veteran experienced in Vietnam were typical of any individual on a rifle team in a combat zone. They noted that he had functioned very well for 15 years after service, and that his symptoms emerged sub-acutely in 1986 more as fatigue and not nightmares, flashbacks, or behavioral symptoms indicative of PTSD. In addition, his behavioral history was not consistent with an individual with PTSD. They also noted that his anxiety reaction had originally been found to be secondary to bronchial asthma. The examiners described his "breakdown" in 1987 as a major depressive episode, from which he had not fully recovered. The examiners then provided diagnoses of an anxiety disorder, previously diagnosed at time of discharge in 1970; and major depressive episode, unrelated to the anxiety disorder diagnosed in 1970. The residuals of the depressive episode included impaired concentration, recall, initiative, and motivation. The examiners assessed the veteran's social and occupational functioning at 50 percent. As described more fully in the Introduction, in a June 1996 decision the Board granted the veteran's a 50 percent disability rating for anxiety reaction and denied service connection for PTSD. The veteran appealed to the Court; the Court remanded the case to the Board in June 1997, and the Board in turn remanded the case to the RO in March 1998. In response to the RO's March 1998 request for detailed information regarding stressors, the veteran reported that during the last 10 months of his 12 months in Vietnam he participated in a reactionary force. For five of those ten months he was fire team leader. The main function of the reactionary force was to perform "standup alerts" resulting from rocket attacks. He again reported his exposure to rocket attacks and the explosion of the oil tanks. During a June 1998 VA psychiatric examination the veteran reported that he was assigned to Cam Ranh Bay while in Vietnam, and that he worked with electronics and computers. He also worked on a reactionary force for 10 months, including service as a team leader. He reported experiencing rocket attacks, claimed to have been hit by shrapnel in the right flank, exchanged fire with enemy forces on several occasions, and saw an ammunition dump being blown up by an enemy rocket. He was approximately 3/4 of a mile away when the ammunition dump exploded, but he heard that 23 people were killed in the explosion. The veteran reported that he underwent inpatient treatment for PTSD in 1990, but had not received any treatment since then. In terms of his psychosocial functioning, he had a few friends but generally stayed at home. He watched television and worked around the house. He complained of fatigue and feeling overwhelmed. He experienced rages, but did not know why he was mad. He slept only three or four hours a night, felt depressed and suicidal, and sometimes cried. The examination resulted in a diagnosis of a generalized anxiety disorder, chronic, mild. The examiner provided a global assessment of functioning (GAF) score of 75. The examiner found that there was no evidence to substantiate a diagnosis of PTSD. The examiner noted that the veteran was unable to describe an appropriate traumatic event of sufficient severity, nor did he present symptoms meeting the diagnostic criteria for PTSD. As noted above, the RO determined that the June 1998 examination report was not adequate, and provided the veteran an additional VA psychiatric examination in March 1999, which included a review of his claims file. The examiner reviewed the entire file, conducted psychological testing, and interviewed the veteran. The veteran then reported that while in Vietnam he served for 10 months on a reactionary force at Cam Ranh Bay, and that he was subjected to rocket and mortar attacks. He went on missions after the rocket and mortar attacks and witnessed individuals who had been killed. He described being four blocks from an explosion at an oil farm. These experiences frightened him and caused him to feel helpless. He saw a friend who had been shot, although he did not witness the shooting, and saw a young Vietnamese girl shot. The veteran stated that he generally stayed alone and had a very limited range of activities. He stayed in bed many days. He was restless and anxious, had two friends he saw rarely, and most of the time he remained isolated. The examiner noted that in terms of his psychosocial functioning the veteran had a very limited life. Psychological testing revealed extreme elevations with a prominently anxious, depressed, confused, socially withdrawn and somatic picture. Prominent elevations were also shown on the PTSD subscales. The testing revealed intense anxiety and moderately severe depression. The symptoms the veteran reported in the testing were consistent with the presence of PTSD. The examiner interpreted the testing as revealing an individual in acute psychological distress, with no question that he was extremely anxious, depressed, and confused, with somatic features and intense difficulty concentrating. The examiner found that the psychological picture was consistent with anxiety, PTSD, and depression, and provided diagnoses of a generalized anxiety disorder, chronic and severe, and PTSD with chronic depression. The examiner provided a GAF score of 30, which he described as the inability to function in almost all areas of life. The veteran stayed in bed all day, had not worked since 1987, and was unable to hold a job. He had virtually no friends and did not socialize, and was generally unable to function. The examiner found that the veteran's behavior was considerably influenced by intrusive recollections about the war; intense, uncontrollable anxiety; and severe depression with thoughts of suicide. The examiner, who also conducted the examination in June 1998, found that a revision in the diagnosis previously made was appropriate, and that in addition to an anxiety disorder of severe clinical proportions, the veteran's symptoms then met the criteria for a diagnosis of PTSD. He found that the difficulty in previous evaluations was the veteran's inability or unwillingness to recall significantly stressful events in service and to articulate the affects of those events. He found, nonetheless, that the veteran had, in fact, experienced these events and had intrusive memories about them. The examiner also found that it was very difficult, if not impossible, to distinguish the affects of the generalized anxiety disorder from those of PTSD. Both disorders contributed to the veteran's inability to function. The examiner found, however, that each disorder contributed 50 percent to the veteran's social and occupational impairment. CONTINUED ON NEXT PAGE 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). Relevant law and regulations Service connection - in general Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303. Service connection - PTSD The Board notes that subsequent to initiation of the veteran's claim, a specific regulation was promulgated pertaining to the establishment of service connection for PTSD. Following its promulgation, the regulation pertaining to service connection for PTSD, 38 C.F.R. § 3.304(f), was revised. In accordance with the Court's holding in Karnas v. Derwinski, 1 Vet. App. 308 (1991), if a regulation changes after the claim has been filed but prior to the conclusion of the appellate process, the provision that is more favorable to the veteran applies. In addition, the Board is required to determine whether the original or revised version of the regulation is more favorable to the veteran. VAOPGCPREC 3- 00. Prior to the initial promulgation of 38 C.F.R. § 3.304(f) in 1993, entitlement to service connection for PTSD was determined by applying the provisions of the Veterans' Benefits Administration Manual M21-1 (hereafter Manual M21- 1), which required essentially the same elements as those included in the 1993 version of 38 C.F.R. § 3.304(f). See Cohen v. Brown, 10 Vet. App. 128, 138 (1997), citing Manual M21-1, Subchapter XII, 50.45 (Jan. 25, 1989). The Manual M21-1 provisions relied upon the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), which defined and required specific symptomatology and stressors in diagnosing PTSD. Effective in November 1996, VA adopted the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for evaluating mental disorders. 38 C.F.R. § 4.130. Pursuant to 38 C.F.R. § 3.304(f) as it was initially promulgated in 1993, service connection for PTSD required medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between the current symptomatology and the claimed in-service stressor. The regulation made no reference to any criteria, in terms of the sufficiency of the symptomatology or stressor, to be applied in determining if the veteran had PTSD. In determining whether the occurrence of the claimed in- service stressor was supported by credible evidence, if the claimed in-service stressor was related to combat, service department evidence that the veteran served in combat was accepted, in the absence of evidence to the contrary, as conclusive evidence of the in-service stressor. 38 C.F.R. § 3.304(f) (1993). If the veteran did not serve in combat, the record had to contain corroborative evidence that the in- service stressor occurred. See Zarycki v. Brown, 6 Vet. App. 91 (1993). That evidence is not limited to service department records, but may include other evidence of the in- service stressor. Doran v. Brown, 6 Vet. App. 283, 289 (1994), recon. denied, (U.S. Vet. App. March 30, 1994), appeal dismissed, (Fed. Cir. May 6, 1994). The Court has held that the DSM-III-R diagnostic criteria, and by deduction the DSM-IV criteria, cannot be read in a manner that imposes requirements over and above those included in 38 C.F.R. § 3.304(f). Therefore, a "clear diagnosis" of PTSD by a mental health professional, regardless of whether the diagnosis is based on DSM-III-R or DSM-IV, must be presumed to concur with the applicable diagnostic criteria for that disorder in terms of the adequacy of the symptomatology and the stressor. If the Board finds that the diagnosis does not comply with the applicable diagnostic criteria pertaining to the adequacy of the symptomatology or the severity of the stressor, remand of the case for clarification of the diagnosis or additional examination is required. Cohen, 10 Vet. App. at 140. The regulation was revised in 1999 in order to bring it into conformance with the Court's holding in Cohen. Direct Service Connection (Post Traumatic Stress Disorder), 64 Fed. Reg. 32,807 (June 18, 1999) (codified at 38 C.F.R. § 3.304(f)). The change in the regulation was effective March 7, 1997, the date of the Court's decision in Cohen. According to the revised regulation, service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between the current symptoms and an in- service stressor; and credible supporting evidence that the claimed in-service stressor occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (2000). If the veteran did not serve in combat, or if the claimed stressor is not related to combat, corroborative evidence of the claimed stressor is required. Moreau v. Brown, 9 Vet. App. 389, 395 (1996). If the diagnosis of a mental disorder does not conform to the DSM-IV, or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. 38 C.F.R. § 4.125(a). When the veteran's claim was adjudicated in September 1990, the RO applied the Manual M21-1 provisions in determining whether service connection was warranted. In the June 1996 decision the Board applied the 1993 version of 38 C.F.R. § 3.304(f) in denying service connection for PTSD. Although the Board instructed the RO in the March 1998 remand to re- adjudicate the issue of the veteran's entitlement to service connection for PTSD, the RO has not considered the 1993 or 1999 version of the regulation, nor has the RO provide the revised regulation to the veteran. In light of the disposition of the veteran's appeal, however, the Board finds that it can consider both versions of the regulation in the first instance without prejudice to the veteran. Bernard v Brown, 4 Vet. App. 384 (1993) (the Board does not have authority to consider an issue in the first instance if prejudice to the veteran would result). The Board further finds that neither version of the regulation is more favorable to the veteran. VAOPGCPREC 3-00. Standard of review The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C.A. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. §§ 3.102. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "when the positive and negative evidence relating to a veteran's claim are in 'approximate balance,' thereby creating a 'reasonable doubt' as to the merits of his or her claim, the veteran must prevail." Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). If the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable. Ortiz, 274 F.3d at 1365. Analysis As discussed above, service connection for PTSD may be established if the following elements are demonstrated: (1) a diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressors actually occurred; and (3) a link, established by medical evidence, between the current symptomatology and the claimed in-service stressors. 38 C.F.R. § 3.304(f) Diagnosis of PTSD There is conflicting evidence of record regarding whether the veteran has PTSD and, if so, whether the PTSD represents a set of symptoms and clinical signs that is separate and independent of the service-connected anxiety disorder. He was hospitalized with a diagnosis of PTSD from October to December 1989, and the medical summary documenting that hospitalization shows the symptoms and in-service stressors supporting that diagnosis. The VA examination in February 1990 resulted in a diagnosis of PTSD. A psychological evaluation in November 1990 supported a diagnosis of PTSD. There is evidence to the contrary. A panel of two psychiatrists in October 1995 found that the veteran did not have PTSD. During their evaluation the veteran did not report having any nightmares, intrusive thoughts, or other recollections of his Vietnam experiences, and the examiners found that his symptoms were not sufficient to support a diagnosis of PTSD. Although the evidence in the claims file clearly documents the PTSD symptoms previously reported by the veteran, and psychological testing had previously shown that he has PTSD, the examiners apparently did not consider that evidence in reaching their conclusion. Because the panel of psychiatrists did not consider the PTSD symptoms previously reported and apparently relied on a criterion that was not included in DSM-III-R, the Board finds that their opinion is of low probative value. The examiner in June 1998 also found that the veteran did not describe the symptoms indicative of PTSD, and that he had not reported a traumatic event of sufficient severity to support a diagnosis of PTSD. That opinion was not, however, based on review of the claims file. The examiner revised that finding when he re-examined the veteran in March 1999, which examination included review of the claims file. He then found that previous examiners (including himself) had not determined that the veteran had PTSD because of his inability or unwillingness to recall certain events associated with combat. When he did so, he apparently demonstrated the symptoms of PTSD. Because the opinion of the examiner in March 1999 was based on review of the evidence in the claims file, it is highly probative. See Owens v. Brown, 7 Vet. App. 429, 433 (1995) (an opinion that is based on review of the entire record is more probative than one that is not). In summary, the most probative evidence indicates that the veteran does have PTSD. The Board finds, therefore, that a diagnosis of PTSD has been established. Corroborating evidence of claimed stressors In essence, in order for the second prong of 38 C.F.R. § 3.304(f) to be met, there must be evidence of participation in combat or if not there must be corroboration of stressful events in service as reported by the veteran. In adjudicating a claim for service connection for PTSD, the Board is required to make a specific finding as to whether the veteran was engaged in combat when the alleged stressor occurred. See Gaines v. West, 11 Vet. App. 353 (1998). If the veteran was engaged in combat, and the claimed stressor is related to combat, the occurrence of a stressful event in service is presumed. See Doran, 6 Vet. App. at 289; 38 C.F.R. § 3.304(f). The statute and regulations do not define "combat." VA's General Counsel has held, however, that the phrase "engaged in combat with the enemy" means more than having served in a theater of combat operations. In order to be considered a combat veteran, the evidence must show that the veteran personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. A statement that the veteran participated in a particular operation or campaign does not establish that the veteran engaged in combat, in that those terms encompass both combat and non-combat duties. See VAOPGCPREC 12-99. The veteran has attributed his PTSD at least in part to participating in short-range patrols as a member and/or leader of a rifle reaction force. He initially reported having engaged the enemy on one occasion, and he later reported having done so on several occasions. He has not provided any detailed information regarding these claimed encounters, nor has he presented any corroborative evidence of having participated in combat. The Court has held that a determination as to combat status is to be made based on the evidence of record; 38 U.S.C.A. § 1154(b) does not require that the veteran's assertion of combat be accepted. See Gaines, 11 Vet. App. at 359. The veteran's service records indicate that while in Vietnam his MOS was that of a data processing equipment operator. He did not receive any medals or citations indicative of combat service. Although he participated in an unnamed campaign, there is no indication in the service records that he did so in a combat, rather than a non-combat, role. The Board finds, therefore, that the veteran did not personally participate in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality, and that he was not engaged in combat while in service. The veteran has also attributed his PTSD symptoms to observing the explosion of an oil tank farm in which many soldiers were killed. The ESG provided evidence showing that the tank farm located at Cam Ranh Bay did in fact explode as a result of infiltration by Vietcong on March 31-April 1, 1970. The veteran's service records, however, indicate that he did not arrive in Vietnam until May 1, 1970. The records do not indicate that an explosion occurred at the tank farm after the veteran arrived in Vietnam. Verification of the explosion does not, therefore, constitute corroborating evidence of the claimed stressor. The evidence also indicates that the veteran reported being exposed to multiple rocket, mortar, and sapper attacks while serving at Cam Ranh Bay. In this regard the Board notes that the Court has held that probative evidence showing that the unit to which the veteran was assigned was stationed at a base when a verified mortar attack occurred is sufficient to establish the occurrence of the stressor, regardless of the veteran's proximity to the bombardment. See Pentecost v. Principi, 16 Vet. App. 124, 128 (2002). The ESG also provided evidence showing that from May 1, 1970, when the veteran arrived in Vietnam, to July 31, 1970, there were 19 rocket and mortar attacks, five sapper attacks, three ambushes, and two acts of sabotage by enemy forces in the Cam Ranh Bay Special Sector. The ESG did not make an express finding that the veteran's unit was stationed at Cam Ranh Bay at that time. Because the ESG was asked to verify the veteran's stressors, which he claimed to have occurred at Cam Ranh Bay, and the ESG provided evidence regarding Cam Ranh Bay, the Board presumes that the service department records indicated that the veteran's unit was, in fact, stationed at Cam Ranh Bay in 1970. The Board finds, therefore, that credible supporting evidence shows that the claimed in- service stressor actually occurred. Medical nexus evidence With respect to the third 38 C.F.R. § 3.304(f) element, the medical evidence reflecting a diagnosis of PTSD also shows that the in-service stressors reported by the veteran included exposure to rocket and mortar attacks. The VA examiners who determined that the veteran had PTSD found that the in-service events that caused the veteran to have PTSD included the rocket and mortar attacks. The Board finds, therefore, that the claim for service connection for PTSD is supported by a diagnosis of PTSD, credible supporting evidence showing that a claimed in- service stressor actually occurred and medical evidence of a nexus between the diagnosis of PTSD and the verified stressor. All three elements of the regulation have accordingly been met. For these reasons the Board has determined that the evidence supports the grant of service connection for PTSD. 2. Entitlement to a disability rating in excess of 50 percent for anxiety reaction. Relevant law and regulations Disability ratings are based on the average impairment of earning capacity resulting from disability. The percentage ratings for each diagnostic code, as set forth in VA's Schedule for Rating Disabilities, codified in 38 C.F.R. Part 4, represent the average impairment of earning capacity resulting from disability. Generally, the degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Subsequent to the veteran's claim for an increased rating, the regulations pertaining to the evaluation of psychiatric disorders were revised effective November 7, 1996. See 61 Fed. Reg. 52695 (Oct. 8, 1996) [codified at 38 C.F.R. § 4.130]. VA General Counsel has held that where a law or regulation changes during the pendency of an appeal, the Board should first determine which version of the law or regulation is more favorable to the veteran. See VAOPGCPREC 3-00; see also Karnas v. Derwinski, 1 Vet. App. 308 (1991). In making that determination it may be necessary for the Board to apply both the old and the new versions of the regulation. If application of the revised regulation results in a higher rating, the effective date for the higher disability rating can be no earlier than the effective date of the change in the regulation. See 38 U.S.C.A. § 5110(g). Prior to the effective date of the change in the regulation, the Board can apply only the original version of the regulation. Before November 7, 1996, the VA Rating Schedule read as follows: General Rating Formula for Psychoneurotic Disorders: 100% The attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community. Totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment. 70% Ability to establish and maintain effective or favorable relationships with people is severely impaired. The psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. 50% Ability to establish or maintain effective or favorable relationships with people is considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment. 38 C.F.R. § 4.132, Diagnostic Code 9400 (1996). With regard to the former criteria for a 100 percent disability rating, the Court has held that each of these three bases constitutes an independent basis for granting a 100 percent schedular rating. Thus, if the impairment resulting from a psychiatric disability meets any one of the three independent criteria required for a 100 percent rating, a 100 percent rating shall be awarded. See Johnson v. Brown, 7 Vet. App. 95 (1994). On and after November 7, 1996, the VA Schedule for Rating Disabilities read in pertinent part as follows: 100% 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. 70% 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. 50% 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 effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9400 (2001). In a February 1996 supplemental statement of the case the RO provided the veteran the original regulations pertaining to the evaluation of mental disorders, and provided him the revised regulations in a July 1998 supplemental statement of the case. The RO considered both versions of the regulations in denying entitlement to a disability rating in excess of 50 percent. The veteran was provided the opportunity to present evidence and arguments in response. The Board finds, therefore, that it may proceed with a decision on the merits of the veteran's claim, with consideration of the original and revised regulations, without prejudice to him. See Bernard v. Brown, 4 Vet. App. 384 (1993). GAF Global Assessment of Functioning (GAF) is a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996), citing Diagnostic and Statistical Manual of Mental Disorders (4th ed.1994). A GAF of 61 to 70 is defined as 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, with some meaningful interpersonal relationships. A GAF of 51 to 60 is defined as 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). A GAF of 41 to 50 is defined as serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifter) 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). A score from 21 to 30 is indicative of behavior which is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment or inability to function in almost all areas. A score of 11 to 20 denotes some danger of hurting one's self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) or occasionally fails to maintain minimal personal hygiene (e.g., smears feces) or gross impairment in communication (e. g., largely incoherent or mute). A GAF score of 1 to 10 is assigned when the person is in persistent danger of severely hurting self or others (recurrent violence) or there is persistent inability to maintain minimal personal hygiene or serious suicidal acts with clear expectation of death. See 38 C.F.R. § 4.130 [incorporating by reference the VA's adoption of the American Psychiatric Association: DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS, Fourth Edition (DSM-IV), for rating purposes]. Analysis The veteran in essence contends that the manifestations of his service-connected psychiatric impairment have rendered him totally incapacitated. The veteran's service-connected anxiety reaction is currently evaluated as 50 percent disabling. Service connection for PTSD has been granted by the Board, as discussed immediately above. The medical evidence of record is somewhat unclear as to what degree the veteran's psychiatric impairment is due to the service-connected anxiety reaction or PTSD for which the Board now has granted service connection, although the most recent psychiatric evaluation appeared to ascribe the psychiatric symptomatology to anxiety reaction and PTSD on a 50-50 basis. The evidence is also unclear as to whether "anxiety reaction" was an erroneous diagnosis in 1976, as the veteran contends, and whether the psychiatric symptoms then demonstrated by the veteran were actually due to PTSD. The Board is precluded from considering the rating to be assigned for PTSD disorder in the first instance. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) [a notice of disagreement filed in response to the denial of service connection does not give the Board jurisdiction of the downstream issue of the rating to be assigned with the subsequent grant of service connection]. The Board has given thought to allowing the RO to do this. However, for reasons expressed immediately below, the Board believes that both expediency and Court precedent allow for the assignment of a 100 percent disability rating for anxiety reaction without further ado. The Board is also cognizant of the length of time it has taken to see this case through the adjudication process. As the Court stated in Erspamer v. Derwinski, 1 Vet. App. 3, 11 (1990): "Ten years is an undeniably, and unacceptably, long time to have passed since [the appellant] first filed the claim for benefits with the VA. The delays have benefited neither the parties nor the public and they cannot be permitted to continue. The petitioner has a right to a decision on her claim." Although the resolution in the instant case has been delayed by numerous factors, many of which were not within the Board's control, the Board agrees with the stated goals of the Court and does not believe that additional delay would be in the best interest of the veteran. As noted above, the most recent VA examiner indicated that 50 percent of the veteran's psychiatric impairment was due to anxiety and that 50 percent was due to PTSD. The examiner also stated, however, that it was virtually impossible to distinguish the symptoms of anxiety reaction from the symptoms of PTSD. The Court has held that if the symptoms of a non-service connected psychiatric impairment cannot be reasonably distinguished from the service-connected impairment, all of the symptoms are attributed to the service-connected disorder. See Mittleider v. West, 11 Vet. App. 181, 182 (1998), citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996). The Board will therefore ascribe all of the veteran's psychiatric symptomatology to the anxiety reaction. The Board further finds that under Karnas the pre-November 1996 version of the VA schedular criteria are more favorable to the veteran. This conclusion is based In large measure on the fact that, per Johnson v. Brown, supra, the criteria for a 100 percent rating are disjunctive, not conjunctive, i.e. only one of the three criteria for a 100 percent rating [virtual isolation in the community or totally incapacitating psychoneurotic symptoms or demonstrably unable to obtain or retain employment] need be met. In this case, after a review of the evidence of record, which has been summarized in some detail in the factual background section above, the Board concludes that the evidence is sufficient to support a 100 percent schedular rating for anxiety reaction, based on symptoms of anxiety reaction which result in virtual isolation in the community, are totally incapacitating and have led to demonstrated inability of the veteran to obtain or retain employment. With respect to virtual isolation in the community, the veteran testified in January 1993 that he had no job and no social life and that he spent 70 percent of his time in bed. The October 1995 VA examiners indicated that he was isolated in the community and that he had difficulty entering and maintaining himself in group situations. The examiner in June 1998 noted that the veteran had few friends and was generally confined to his house. When examining the veteran again in March 1999, the examiner found that the veteran had a very limited range of activities and spent many days in bed. The examiner noted that in terms of his social and occupational functioning, the veteran had a very limited life. With respect to the matter of the veteran's psychiatric symptomatology being totally incapacitating, VA examiners in October 1995 found that he experienced stress to such an extent that he was "overwhelmed by even trivial responsibilities and requirements" and that he was unable to function in a conventional setting. Based on an interview with the veteran and the results of the psychological testing, the March 1999 examiner described him as extremely anxious and depressed with confused thinking, somatic features, and intense difficulty concentrating. The veteran stayed in bed all day, had virtually no friends, did not socialize, and was generally unable to function. The examiner assigned a GAF score of 30, which is indicative serious impairment in communication or judgment or the inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends). See DSM-IV, page 32. The psychologist evaluating the veteran in December 1990 found that the veteran was unemployable due to his psychiatric impairment and that he would continue to be so without significant improvement in his psychological condition. The examiner in March 1999 stated that the veteran had not worked since 1987 and was unable to hold a job. In summary, the Board finds that the evidence supports a 100 percent schedular rating for anxiety reaction, based on the rating criteria in effect prior to November 1996. Each of the three independent criteria for the assignment of a 100 percent rating have been met. As noted above, these former rating criteria may be applied after November 1996. VAOPGCPREC 3-00. In summary, for the reasons and bases expressed above, the Board assigns a 100 percent disability rating for the veteran's service-connected anxiety reaction. The appeal is accordingly granted. 3. Entitlement to a total disability rating based on individual unemployability due to service-connected disability. In addition to seeking a 100 percent disability rating for his service-connected anxiety reaction, the veteran has also sought a TDIU. For reasons explained below, the Board finds that by its action in granting a 100 percent rating for service-connected anxiety reaction, the TDIU claim is rendered moot. All questions of law and fact necessary to a decision by the Secretary under a law that affects the provision of benefits by the Secretary to veterans or their dependents or survivors shall be subject to one review on appeal to the Board. 38 U.S.C.A. § 7104(a); 38 C.F.R. § 20.101. The Board does not have jurisdiction to review a case if no benefit would accrue to the claimant, because the claim does not then arise "under a law that affects the provisions of benefits by the Secretary." Mintz v. Brown, 6 Vet. App. 277 (1994). The Court has held that a claim for a total rating based on individual unemployability becomes moot if the Board grants a 100 percent schedular rating. Herlehy v. Principi, 15 Vet. App. 33 (2001) (per curiam); see also VAOPGCPREC 6-99. With the Board's grant of the 100 percent schedular rating for anxiety reaction the veteran's claim for a total rating based on individual unemployability is, therefore, moot. The Board observes as a final matter that any potential "downstream" issues such as effective dates have not yet been decided by the RO, and the Board is accordingly without jurisdiction to address them. See Herlehy, 15 Vet. App. at 35; see also Grantham v. Brown, supra [if the Board grants a claim as to an issue, the notice of disagreement pertaining to that issue ceases to be valid in terms of instilling with the Board any authority to consider downstream issues such as the effective date]. ORDER Service connection for PTSD is granted. A 100 percent schedular rating for anxiety reaction is granted, subject to the laws and regulations pertaining to the payment of monetary benefits. The claim of entitlement to a total disability rating based on individual unemployability due to service-connected disability is dismissed as moot. Barry F. Bohan 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.