Citation Nr: 0813208 Decision Date: 04/22/08 Archive Date: 05/01/08 DOCKET NO. 06-15 850 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUE Entitlement to an effective date earlier than January 21, 2004, for entitlement to a total disability rating based on individual employability (TDIU). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD N. Kroes, Associate Counsel INTRODUCTION The veteran served on active duty from July 1965 to July 1967. This case comes before the Board of Veterans' Appeals (Board) on appeal from the Houston, Texas, Department of Veterans Affairs (VA) Regional Office (RO). In March 2008, the veteran testified at a personal hearing before the undersigned Veterans Law Judge at the RO. A transcript of that hearing has been associated with the claims file. FINDINGS OF FACT 1. January 1983 and November 1991 rating decisions, which in part essentially denied evaluations in excess of 10 percent for residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve, were supportable by the facts and law extant at the time of the decisions. The RO clearly considered headaches as part of residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve in reaching these decisions. 2. The veteran filed the claim for which this appeal stems on January 21, 2004. At that time, the veteran claimed that vision difficulties, vertigo, constant headaches, memory loss, tinnitus, major depressive disorder and residuals of right shoulder injury were directly related to his active duty head trauma. 3. In October 2004, the RO issued a rating decision granting service connection for constant headaches, evaluated as 50 percent disabling effective January 21, 2004; major depressive disorder with minor cognitive defects, evaluated as 30 percent disabling effective January 21, 2004; and recurrent vestibulopathy, evaluated as 10 percent disabling effective January 21, 2004; granting a TDIU and Dependents' Educational Assistance (DEA), effective January 21, 2004; continuing a 10 percent evaluation for residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve; and denying service connection for right shoulder injury and tinnitus. 4. The veteran did not meet the schedular criteria for a TDIU prior to January 21, 2004, and no informal claim, formal claim, or written intent to file a claim for a TDIU was received from November 8, 1991 (the date the veteran's last claim for service connection and an increase in service- connected disabilities was denied) and January 21, 2004 (the date of the current claim). CONCLUSIONS OF LAW 1. January 1983 and November 1991 rating decisions, which denied evaluations in excess of 10 percent for residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve, did not contain clear and unmistakable error. 38 U.S.C.A. § 5109A (West 2002); 38 C.F.R. § 3.105(a) (2007). 2. The criteria for an effective date earlier than January 21, 2004, for the award of a TDIU have not been met. 38 U.S.C.A. §§ 5107, 5110 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.155, 3.157, 3.400, 3.340, 3.341, 4.16 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The Veterans Claims Assistance Act (VCAA) (codified at 38 U.S.C.A. §§ 5100, 5102- 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2007)) imposes obligations on VA in terms of its duty to notify and assist claimants. When VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2007); 38 C.F.R. § 3.159(b) (2007); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004), the United States Court of Appeals for Veterans Claims (Court) held that VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) request that the claimant provide any evidence in his possession that pertains to the claim. VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Id. As to the part of the veteran's claim wherein he asserts that there was clear and unmistakable error in January 1983 and November 1991 rating decisions, the Court has determined that the provisions of the VCAA are not applicable to a claim of clear and unmistakable error. Livesay v. Principi, 15 Vet. App. 165 (en banc) (2001); Parker v. Principi, 15 Vet. App. 407 (2002). Thus, the Board will not address whether the VCAA has been met as to those claims. Considering the veteran's claim for an earlier effective date, the duty to notify was not satisfied prior to the initial unfavorable decision on the claim by the AOJ. Under such circumstances, VA's duty to notify may not be "satisfied by various post-decisional communications from which a claimant might have been able to infer what evidence the VA found lacking in the claimant's presentation." Rather, such notice errors may instead be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (where notice was not provided prior to the AOJ's initial adjudication, this timing problem can be cured by the Board remanding for the issuance of a VCAA notice followed by readjudication of the claim by the AOJ) see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as an SOC or SSOC, is sufficient to cure a timing defect). In this case, the VCAA duty to notify was satisfied subsequent to the initial AOJ decision by way of a letter sent to the veteran in September 2005 that fully addressed all four notice elements. The letter informed the veteran of what evidence was required to substantiate the claim and of his and VA's respective duties for obtaining evidence. The veteran was also asked to submit evidence and/or information in his possession to the AOJ. Although the notice letter was not sent before the initial AOJ decision in this matter, the Board finds that this error was not prejudicial to the veteran because the actions taken by VA after providing the notice have essentially cured the error in the timing of notice. Not only has the veteran been afforded a meaningful opportunity to participate effectively in the processing of his claim and given ample time to respond, but the AOJ also readjudicated the case by way of a statement of the case issued in March 2006 after the notice was provided. For these reasons, it is not prejudicial to the veteran for the Board to proceed to finally decide this appeal as the timing error did not affect the essential fairness of the adjudication. During the pendency of this appeal, on March 3, 2006, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the VCAA notice requirements apply to all five elements of a service connection claim. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. The first 4 elements are not in dispute (the veteran is rated as totally disabled). The veteran was given information about element (5) in the September 2005 letter (after he appealed the effective date assigned). VA must also make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim for the benefit sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. In connection with the current appeal, VA has of record VA treatment records, Social Security Administration records (showing employment earnings), hearing transcripts, photographs, and service treatment records. There is no indication that any other treatment records exist that should be requested, or that any pertinent evidence has not been received. A VA examination is not necessary for this claim. For the foregoing reasons, the Board therefore finds that VA has satisfied its duty to notify (each of the four content requirements) and the duty to assist pursuant to the VCAA. See 38 U.S.C.A. §§ 5102 and 5103 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159(b), 20.1102 (2007); Pelegrini, supra; Quartuccio, supra; Dingess, supra. Any error in the sequence of events or content of the notice is not shown to have any effect on the case or to cause injury to the claimant. Thus, any such error is harmless and does not prohibit consideration of this matter on the merits. See Dingess, supra; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Clear and Unmistakable Error On a cover sheet submitted with evidence in September 2005, the veteran's representative asserted that there was clear and unmistakable error (CUE) in the "first rating." At the veteran's personal hearing before the undersigned, he and his representative clarified that they were contending that there was CUE in rating decisions issued in January 1983 and November 1991. It was alleged that his complaints of headaches were not considered in these decisions and that if these complaints were considered the veteran would have been awarded a TDIU earlier than January 21, 2004. The Board notes that at the veteran's personal hearing he testified that he worked full-time until January 2000. This is reflected in employment earnings reported by the Social Security Administration as well. The veteran also testified that in 1991 when he complained about his headaches he was told that he could file a claim but that at that point he had no case. He reported that he was told this by his representative. There is no indication that he was ever told this by a VA employee. Section 3.105(a) of Title 38, Code of Federal Regulations, provides in pertinent part: "[P]revious determinations which are final and binding . . . will be accepted as correct in the absence of clear and unmistakable error. Where evidence establishes such error, the prior decision will be reversed or amended." See 38 U.S.C.A. § 5109A (West 2002); Cook v. Principi, 318 F.3d 1334 (Fed. Cir. 2002) (en banc), cert. denied, 539 U.S. 926 (2003). For clear and unmistakable error to exist either (1) the correct facts in the record were not before the adjudicator or (2) the statutory or regulatory provisions extant at the time were incorrectly applied. See Damrel v. Brown, 6 Vet. App. 242, 245 (1994). In addition, "the error must be 'undebatable' and of the sort 'which, had it not been made, would have manifestly changed the outcome at the time it was made.'" Id. (quoting Russell v. Principi, 3 Vet. App. 310, 313-14 (1992) (en banc)); see Busto v. West, 179 F.3d 1378, 1380 (Fed. Cir. 1999) (expressly adopting "manifestly changed the outcome" language of Russell, supra). "In order for there to be a valid claim of clear and unmistakable error . . . [t]he claimant, in short, must assert more than a disagreement as to how the facts were weighed or evaluated." Russell, 3 Vet. App. at 313. That is because, "even where the premise of error is accepted, if it is not absolutely clear that a different result would have ensued, the error complained of cannot be, ipso facto, clear and unmistakable." Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993). The Board must emphasize that the Court has consistently stressed the rigorous nature of the concept of clear and unmistakable. Id. ("It must always be remembered that [clear and unmistakable error] is a very specific and rare kind of 'error'" and, there is a "presumption of validity to otherwise final decisions" and the "presumption is even stronger" when such cases are collaterally attacked on the basis of error). An August 1981 rating decision awarded service connection for residuals of left frontal temporal craniotomy with ligation of aneurysm and assigned a 10 percent disability evaluation under 38 C.F.R. § 4.124a, DC 8009 (1981). Relevant Law in 1983 and 1991 Under 38 C.F.R. § 4.21 (1982 & 1991), it stated the following: In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. Under 38 C.F.R. § 4.124a (1982 & 1991), it stated the following, in relevant parts: Schedule of ratings-neurological conditions and convulsive disorders. [With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule...] 8009 Brain, vessels, hemorrhage from: Rate the vascular condition under Codes 8007 through 8009, for 6 months...................................... ............................100 Rate residuals, thereafter, minimum..................................10 8100 Migraine: With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability....50 With characteristic prostrating attacks occurring on an average once a month over last several month.......................30 With characteristic prostrating attacks averaging one in 2 months over the last several months........................10 With less frequent attacks........................................0 1. January 1983 rating decision Initially, the Board notes that effective February 1, 1990, Title 38 U.S.C. § 5104(b) required ROs to specify, in each rating decision, the evidence considered and the reasons for the disposition; before that time, rating decisions generally lacked such specificity. See 38 U.S.C.A. § 5104(b) (West 2002); Crippen v. Brown, 9 Vet. App. 412, 420 (1996). Thus, "[s]ilence in a final RO decision made before February 1990 cannot be taken as showing a failure to consider evidence of record." Crippen, 9 Vet. App. at 421. In August 1982, the veteran's representative alleged CUE in the August 1981 rating decision that granted service connection for residuals of left frontal temporal craniotomy with ligation of aneurysm. The veteran contended that a burr hole in the left frontal area and partial paralysis of the third cranial nerve were not considered in assigning the 10 percent rating for the veteran's disability. In the August 1982 letter, the veteran's representative also noted that treatment records showed, among other things, headaches. A January 1983 rating decision found CUE in the August 1981 rating decision because it failed to consider skull loss for service connection and evaluation. The veteran's disability was then assigned 2 separate ratings - a 30 percent rating for skull loss left frontal area under DC 5296, and a 10 percent evaluation for residuals of left frontal temporal craniotomy and ligation of aneurysm, with impairment third cranial nerve, under DC 8009. The January 1983 decision noted that third cranial nerve impairment was considered as part of the residuals of craniotomy with ligation of aneurysm, and that the current examination showed only minimal residuals. The veteran is essentially arguing that headaches were shown at that time but not considered as part of the rating for residuals of craniotomy. The examination report from the veteran's most current VA examination at that time, from October 1982, showed that he reported that a year and a half prior he started to experience headaches at the craniotomy site in the left frontal temporal area. He stated that he had these headaches almost everyday and that he was taking Motrin which he felt relieved the headaches pretty well. It was noted that the headaches apparently only lasted for a short time and the veteran did not have any associated symptomatology with the headaches. The examiner's diagnosis noted that the veteran initially had some difficulty with the third cranial nerve and that there was still some residual as manifest by a slightly larger pupil on the right. The examiner also stated that the veteran otherwise had made a good recovery. The Board has carefully reviewed the evidence of record at the time of the January 1983 rating decision and the law extant at that time and concludes that the application of the law to the facts in this case is against a finding that a clear and unmistakable error was committed by the RO in the January 1983 rating decision. While the RO did not mention headaches in the January 1983 rating decision (which cannot be taken as showing a failure to consider evidence of record, see Crippen, 9 Vet. App. at 421), it did mention that the "current exam[ination]" showed "only minimal residuals." It is clear that the October 1982 VA examination report, which detailed the veteran's headache complaints but still noted that in the examiner's opinion the veteran had made a good recovery other than having a slightly larger pupil on the right, was considered by the RO at that time. Further discussion as to whether the RO improperly weighed and evaluated the evidence is unnecessary as such contentions can never rise to the stringent definition of CUE. See Fugo, 6 Vet. App. at 44; see also 38 C.F.R. § 20.1403(d)(3) (2007). 2. November 1991 rating decision A November 1991 rating decision denied service connection for a left ear laceration and denied increased ratings for skull loss of the left frontal area (continued as 30 percent disabling) and residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve (continued as 10 percent disabling). In that rating decision, the RO specifically stated that "[r]esiduals of aneurysm shows [subjective] complaints of blurred and double vision and headaches with normal neurological examination, therefore current 10 percent evaluation will continue." The Board has carefully reviewed the evidence of record at the time of the November 1991 rating decision and the law extant at that time and concludes that the application of the law to the facts in this case is against a finding that a clear and unmistakable error was committed by the RO in the November 1991 rating decision. The veteran's complaints of headaches are discussed in the November 1991 rating decision and were clearly considered. The veteran is essentially arguing that the evidence was improperly evaluated and that his headaches were worse than reflected by the rating assigned. Contentions that the RO improperly weighed and evaluated the evidence can never rise to the stringent definition of CUE. See Fugo, 6 Vet. App. at 44; see also 38 C.F.R. § 20.1403(d)(3). III. Earlier Effective Date A TDIU was awarded to the veteran as of January 21, 2004. The veteran asserts that date should be earlier. The assignment of effective dates of awards is generally governed by 38 U.S.C.A. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on a claim for increase (which includes a claim for individual unemployability) shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C.A. § 5110(a); see 38 C.F.R. § 3.400. An effective date for a claim for increase may also be granted prior to the date of claim if it is factually ascertainable that an increase in disability had occurred within one year from the date of claim. 38 U.S.C.A. § 5110(b)(2); 38 C.F.R. §§ 3.400(o)(1) and (2); see Harper v. Brown, 10 Vet. App. 125, 126 (1997). Additionally, under 38 C.F.R. § 3.155(a) (2007), the veteran or a representative of the veteran can file an informal claim by communicating an intent to apply for one or more VA benefits. The benefit sought must be identified, see Stewart v. Brown, 10 Vet. App. 15, 18 (1997), but need not be specific, see Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). See id. Under 38 C.F.R. § 3.157(b), once a claim for compensation has been allowed, receipt of a VA outpatient or hospital examination or admission to a VA hospital will be accepted as an informal claim for increased benefits. The date on the VA outpatient or hospital examination will be accepted as the date of claim. Id. In cases where the schedular rating is less than 100 percent, a total disability rating may be assigned when the individual is unable to secure or follow a substantially gainful occupation as the result of service-connected disability, without regard to advancing age. 38 C.F.R. §§ 3.340, 3.341, 4.16. Total disability ratings for compensation may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Disabilities resulting from common etiology or a single accident will be considered as one disability. Id. When an RO is considering a rating increase claim from a claimant whose schedular rating meets the minimum criteria of section 4.16(a) and there is evidence of current service- connected unemployability in the claimant's claims file or under VA control, evaluation of that rating increase must also include an evaluation of a reasonably raised claim for a total rating based on individual unemployability, and VA is required to adjudicate that claim. Norris v. West, 12 Vet. App. 413, 418 (1999); see also Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001) (Once veteran submits evidence of medical disability and additionally submits evidence of unemployability, VA must consider total rating for compensation based upon individual unemployability). A brief description of the facts follows. The veteran was awarded service connection for residuals of left frontal temporal craniotomy with ligation of aneurysm by an August 1981 rating decision. Subsequently, a January 1983 rating decision found CUE in the August 1981 rating decision and awarded a 30 percent evaluation for skull loss of left frontal area and a 10 percent evaluation for residuals of left frontal temporal craniotomy and ligation of aneurysm, with impairment third cranial nerve, both effective May 1981. The veteran's combined disability evaluation was 40 percent. The veteran later filed a claim for an increase in his disability evaluations and a claim for service connection for a left ear laceration. These claims were denied by a November 1991 rating decision. The veteran filed the claim for which this appeal stems on January 21, 2004. At that time, the veteran claimed that vision difficulties, vertigo, constant headaches, memory loss, tinnitus, major depressive disorder and residuals of right shoulder injury were directly related to his active duty head trauma. In October 2004, the RO issued a rating decision granting service connection for constant headaches, evaluated as 50 percent disabling effective January 21, 2004; major depressive disorder with minor cognitive defects, evaluated as 30 percent disabling effective January 21, 2004; and recurrent vestibulopathy, evaluated as 10 percent disabling effective January 21, 2004; granting a TDIU and DEA, effective January 21, 2004; continuing a 10 percent evaluation for residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve; and denying service connection for right shoulder injury and tinnitus. The veteran perfected an appeal as to the proper effective date for the grant of a TDIU. A VA physician note from September 4, 2003 shows that the veteran was examined on that date in part for his headaches, which as explained above, were rated at that time as part of his residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve. This examination report could be seen as an informal claim for an increase for his residuals of left frontal temporal craniopathy and ligation of aneurysm with impairment of third cranial nerve. See 38 C.F.R. § 3.157. The note does not show any report by the veteran, or finding by the physician, that he was unemployable due to his service-connected disabilities. Additionally, at that time the veteran's combined disability evaluation was only 40 percent and evidence showing current service-connected unemployability was not in the veteran's claims file or under VA control. Such evidence would be obtained later. Accordingly, at that time there was no need for the RO to consider a TDIU. The veteran's claims file does not contain any informal claim, formal claim, or written intent to file a claim for a TDIU from November 8, 1991 (the date the veteran's last claim for service connection and an increase in service-connected disabilities was denied) and the current effective date assigned, January 21, 2004 (the date of the current claim). The Board notes that at the veteran's personal hearing it was conceded that he had not filed a claim for a TDIU prior to January 21, 2004. The veteran was eventually granted a separate 50 percent evaluation for constant headaches and awarded a TDIU based in part on this evaluation. The 50 percent evaluation for constant headaches was assigned an effective date of January 21, 2004, as were the other disability evaluations assigned. The veteran did not appeal the effective dates assigned for any of these disabilities. Accordingly, the veteran did not meet the schedular requirements for a TDIU prior to January 21, 2004, as his combined disability evaluation prior to that date was only 40 percent. See 38 C.F.R. § 4.16(a). As a result, the Board is not able to award the veteran a TDIU prior to January 21, 2004, as he did not meet the schedular criteria for a TDIU prior to that date. See 38 C.F.R. § 4.16(a). The veteran asserts that he stopped working full-time in January 2000. Social Security Administration records showing employment earnings support this assertion. At the veteran's personal hearing he testified that he had to stop working because of his headaches. In determining the appropriate effective date for the claim for increase, VA must also consider whether there is evidence that an increase in disability occurred within one year preceding the date of claim that would be sufficient to warrant an effective date earlier than the date of claim. See 38 U.S.C.A. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2); Hazan v. Gober, 10 Vet. App. 511, 518 (1997). In this case, the veteran's claim was filed more than one year after the date he alleges he became too disabled to work. The Court and VA's General Counsel have interpreted the provisions under 38 U.S.C.A. § 5110(b)(2) as meaning that if the increase occurred (which includes individual unemployability) more than one year prior to the claim, the increase is effective the date of claim. Harper v. Brown, 10 Vet. App. 125 (1997); VAOPGCPREC 12-98 (1998). Assuming that the veteran was unemployable due to service-connected disability or disabilities as of January 2000, this date is more than one year prior to the date of the veteran's claim and the appropriate effective date is therefore the date of claim- here, January 21, 2004. See 38 U.S.C.A. § 5110(a) and (b). For the above reasons, the Board finds that an effective date earlier than January 21, 2004, for the award of a TDIU cannot be granted. The benefit-of-the-doubt rule is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2007). ORDER Entitlement to an effective date earlier than January 21, 2004, for entitlement to a TDIU is denied. ____________________________________________ WAYNE M. BRAEUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs