Citation Nr: 0814942 Decision Date: 05/06/08 Archive Date: 05/12/08 DOCKET NO. 07-15 479 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to an effective date earlier than February 15, 2002 for the award of service connection for post traumatic stress syndrome (PTSD). 2. Entitlement to an effective date earlier than May 6, 2005 for the grant of a 100 percent evaluation for post traumatic stress syndrome (PTSD). 3. Entitlement to special monthly compensation based upon the need for regular aid and attendance or on account of being housebound. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARINGS ON APPEAL Appellant and his spouse. ATTORNEY FOR THE BOARD A.G. Alderman, Associate Counsel INTRODUCTION The veteran had active military service from November 1966 to August 1968. This case comes before the Board of Veterans' Appeals (Board) on appeal from multiple rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. On appeal is the March 2005 decision which assigned service connection and an effective date of February 15, 2002 for his 50% rating for PTSD. The veteran appealed the service connection date and the disability rating. In July 2005, the RO assigned a 100 percent disability rating for PTSD, with an effective date of May 6, 2005. The veteran appealed the effective date of this decision. Also on appeal is the June 2006 rating decision that denied special monthly compensation based on aid and attendance or housebound status. The Board notes that the veteran's spouse has been appointed his trustee. Both the veteran and his spouse appeared at hearings held at the RO in June 2004 and December 2006. Transcripts of those hearings have been associated with the claims file. The veteran and his spouse also appeared before the undersigned for a hearing in September 2007. A transcript of that hearing has been associated with the claims file. FINDINGS OF FACT 1. The veteran filed his original claim for service connection for PTSD on February 15, 2002. 2. No informal claims for service connection for PTSD were filed prior to February 15, 2002. 3. The veteran's PTSD symptoms prior to May 6, 2005 did not cause total occupational and social impairment. 4. The veteran's service-connected PTSD does not render him so helpless that he requires aid and assistance on a regular basis. CONCLUSIONS OF LAW 1. The criteria for the assignment of an effective date earlier than February 15, 2002, for the award of service connection for PTSD are not met. 38 U.S.C.A. §§ 5101(a), 5107, 5110 (West 2002); 38 C.F.R. §§ 3.1(p), 3.151, 3.155, 3.400(b) (2007). 2. An effective date prior to May 6, 2005 for the grant of a 100 percent evaluation for (PTSD) is not warranted. 8 U.S.C.A. §§ 5101(a), 5107, 5110 (West 2002); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.157, 3.400 (2007). 3. The criteria for special monthly compensation based on the permanent need for aid and attendance of another person or on account of being housebound have not been met. 38 U.S.C.A. § 1114 (West Supp. 2005); 38 C.F.R. §§ 3.351, 3.352 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Effective Dates A. Effective Date of Service Connection The effective date of an award of disability compensation to a veteran will be the day following separation from active service or date entitlement arose if the claim is received within one year of separation from active service; otherwise, it will be the date of receipt of claim, or the date when entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). In general, "date of receipt" means the date on which a claim, information or evidence was received in VA. 38 C.F.R. § 3.1(r). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C.A. § 5101(a); 38 C.F.R. § 3.151(a). A "claim" means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action, indicating intent to apply for one or more benefits under the laws administered by VA, from a claimant, his duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within 1 year from the date it was sent to the claimant, the formal claim will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a). A report of examination or hospitalization will be accepted as an informal claim for benefits under an existing law or for benefits under a liberalizing law or Department of Veterans Affairs issue, if the report relates to a disability which may establish entitlement. 38 C.F.R. § 3.157(a). When there has not been a prior allowance or disallowance of compensation for the claimed disorder (i.e., service connection awarded, but disorder rated as noncompensable), VA records can not be accepted as an informal claim under 38 C.F.R. § 3.157. See Crawford v. Brown, 5 Vet. App. 33 35-36 (1993); see also Lalonde v. West, 12 Vet. App. 377, 382 (1999) (because the appellant had not been granted service connection for his anxiety disorder, the mere receipt of medical records cannot be construed as an informal claim); Kessel v. West, 13 Vet. App. 9, 23 (1999) (there has not been a prior allowance or disallowance of a claim for service connection for the claimed condition, and any examination reports could not be accepted as an informal claim). Once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of report of examination or hospitalization by Department of Veterans Affairs or uniformed services will be accepted as an informal claim for increased benefits or an informal claim to reopen. The date of an outpatient or hospital examination at, or admission to, a VA hospital will be accepted as the date of receipt of the informal claim to reopen when a claim specifying the benefit sought is received within one year from the date of such examination, treatment, or hospital admission. 38 C.F.R. § 3.157(b)(1). Evidence from a private physician or layperson can also constitute an informal claim for increase, but the date of receipt of such evidence will constitute date of claim, if the evidence is within the competence of those reporting it, and it shows a reasonable probability of an allowance. 38 C.F.R. § 3.157(b)(2). VA is required to identify and act on informal claims for benefits. 38 C.F.R. § 3.155(a). See also Servello v. Derwinski, 3 Vet. App. 196, 198-200 (1992). In determining whether there was an earlier claim, the Board is required to determine all potential claims raised by the evidence, applying all relevant laws and regulations, regardless of whether the claim is specifically labeled as a claim for the benefit. Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001). However, an "informal claim must identify the benefit sought." Id. The Federal Circuit has elaborated that VA, "has a duty to fully and sympathetically develop the veteran's claim to its optimum in order to determine if an informal claim had been raised. With respect to all pro se pleadings,...VA [must] give a sympathetic reading to the veteran's filings by determining all potential claims raised by the evidence, applying all relevant laws and regulations. " Szemraj v. Principi, 357 F. 3d 1370 (2004). After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C.A. § 7104(a). When there is an approximate balance of 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; 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. First, in his notice of disagreement, dated June 2005, the veteran argues that he originally filed his claim for PTSD in February 2000 and that his service connection date should have been February 2000, not February 2002. Another statement from the veteran's spouse, dated August 2005, indicates that the veteran was admitted to a psychiatric ward in February 2000 after receiving a diagnosis of PTSD from Dr. Bobo, a private physician. She further stated that the veteran's records clearly show a service connected diagnosis of PTSD at that time; therefore, benefits should be retroactive back to that date. Upon examination of the claims file, it appears that the first correspondence related to a PTSD claim from the veteran to the RO was the original claim, which was received at the RO on February 15, 2002. It also appears that the veteran's private and VA medical records show that the veteran was not treated for symptoms of PTSD until February 2002. He was finally diagnosed with PTSD by Dr. Cook., a private practitioner, in July 2002, and by VA in November 2002. At the hearing before the Board in September 2007, the veteran's trustee, his spouse, claimed that the veteran went to VA to fill out paperwork for his disability in November 2001 and that the effective date for service connection should be November 2001. She also testified that she filed a claim with the Social Security Administration (SSA) at that point and that the veteran was awarded benefits for PTSD from November 2001. First, the Board has reviewed all VA medical records and notes that there is no indication that the veteran sought treatment or filled out paperwork regarding the veteran's PTSD prior to February 2002. However, even if the veteran had sought VA treatment prior to February 2002, he provided no communication or action indicating an intent to apply for one or more benefits under the laws administered by VA; therefore, the Board cannot find that the veteran submitted an informal claim for service connection. Second, the Board also notes that the veteran's claim for SSA was not submitted until February 2002. The fact that SSA benefits were granted, effective November 2001, is of no consequence as both VA and SSA have differing sets of laws and guidelines for granting benefits. Applying the pertinent VA regulations to the facts of this claim, it is clear that an effective date prior to February 15, 2002, is not warranted. The provisions of 38 C.F.R. § 3.400 specifically provide that the effective date of an award of compensation will be the date of receipt of the claim, or the date entitlement arose, whichever is later. There is no evidence or statement dated prior to the February 15, 2002 claim for service connection for a psychiatric disorder that can be construed as an earlier claim. 38 C.F.R. § 3.155. The law is clear. The effective date of an award of compensation based on original claim (received beyond one year after service discharge) or a claim reopened after final adjudication shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of the application thereof (emphasis added). 38 U.S.C.A. § 5110(a); 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary ........must be filed in order for benefits to be paid or furnished to any individual under the laws administered by the Secretary. 38 U.S.C.A. § 5101(a). The pertinent facts are not in dispute, and the law, specifically 38 U.S.C.A. §§ 5101 & 5110, is dispositive in this matter. Together, these two Sections mandate that a claim must be specific, and that the effective date of an award shall not be earlier than the date of receipt of the claim (emphasis added). VA is not required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. See Brannon v. West, 12 Vet. App. 32, 35 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). There is no provision in the law for awarding an earlier effective date based on the veteran's assertion that the disability existed before he filed the claim. The U.S. Court of Appeals for Veterans Claims (Court) has held that where the law not the evidence is dispositive, the Board should deny an appeal because of an absence of a legal merit or the lack of entitlement under the law. Sabonis v. Brown, 6 Vet. App. 426 (1994). The veteran has failed to allege facts which meet the criteria in the law or regulations, and his claim must be denied. B. Effective Date of 100 Percent Rating The veteran also seeks an effective date earlier than May 6, 2005 for his 100 percent rating for PTSD. VA initially granted the veteran a 50 percent rating, effective as of the date of his claim, February 15, 2002. The veteran appealed the rating and was granted a 100 percent rating in July 2005, effective May 6, 2005, the date of the veteran's notice of disagreement. Since this appeal ensued after the veteran disagreed with the initial rating assigned following a grant of service connection, separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staging." See Fenderson v. West, 12 Vet. App. 119 (1999). Reasonable doubt as to the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. VA's Schedule for Rating Disabilities (Rating Schedule) determines the disability ratings that apply in each case, 38 C.F.R. Part 4. The percentage ratings represent the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. The veteran's disability is currently evaluated under Diagnostic Code (DC) 9411, which pertains to PTSD. Under DC 9411, a 50 percent disability rating requires moderate occupational and social impairment with reduced reliability and productivity with such symptoms as impaired judgment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where the disorder is manifested by 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 that is 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 work-like setting); and an inability to establish and maintain effective relationships 38 C.F.R. § 4.130, DC 9411. A 100 percent rating is indicative of 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 of names of close relatives, own occupation or own name. Id. The Board has thoroughly reviewed all the evidence in the veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). On November 20, 2002, the veteran had a VA examination for mental disorders. The veteran reported that he had problems with falling asleep, guilt, flashbacks, and public contact. He said he has withdrawn from his family, has trouble concentrating, has a startle response, and has intrusive thoughts. He indicated that he left his last job less than a year prior to the exam. When asked about his daily routine, he indicated that he will eat breakfast and then sit all day doing nothing. The examiner indicated that his affect was depressed, shallow and restricted. He indicated no suicidal ideation. The examiner noted that the veteran showed no evidence of a thought disorder, and his orientation to person, place, and time was within normal limits. The veteran's memory was intact but has trouble concentrating. His insight was not developed. The veteran was diagnosed with chronic PTSD and the examiner stated that the veteran showed signs of exposure to the threat of death on the battlefield, re-experiencing, avoidance behavior, symptoms of increased arousal, prolonged duration of disturbances, and significant impairment in social, occupational and other areas of functioning. The veteran had a VA PTSD evaluation for stressors on November 26, 2002. The examiner had reviewed the claims file and indicated that the veteran was able to give a history consistent with the information provided in his claims file. The examiner stated that the veteran exhibited symptoms of depression with withdrawal, and that the veteran feels hopeless, suicidal, and feels cut off from people. He further stated that the veteran has concentration problems, which are indicated with his difficulty making decisions due to anxiety. The veteran showed mixed results for PTSD as he did not show evidence of hypervigilance, irritability, physiological arousal, concentration problems or anger. However, the veteran admitted to traumatic experiences, painful guilt, disturbing dreams, and detachment from others. In the diagnosis, the examiner indicated that the veteran shows significant depression and it is the more prominent symptom over his anxiety disorder, which is likely PTSD. The examiner noted that the veteran had premorbid anxiety prior to entering service, as well as emotional detachment evidenced by his personality disorder which is prominently schizoid and avoidant in nature. He concluded that the personality factors likely contribute to the veteran's emotional detachment, lack of bonding in relationships as well as occupational problems. He stated that the veteran has flashbacks which interfere with his functioning, however, it was the examiner's opinion that the major depression and personality disorder have more prominent manifestations in the veteran's current level of social and occupational functioning. VA outpatient treatment records from 2002-2005 report similar symptoms and conditions related in the November 2002 VA examinations. Based upon the evidence, the Board finds that the symptoms and findings reported in the VA examinations and in the VA outpatient treatment records prior to May 2005 do not support a rating of 100 percent. Specifically, prior to May 2005 (which is the only issue before the Board regarding this claim, at this time) the evidence does not show that the veteran's disability is manifested by 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 of names of close relatives, own occupation or own name. In fact, the VA examiner attributed most of the veteran's occupational and social difficulties to his anxiety and personality disorder. It is important for the veteran and his spouse to understand that not all evidence in this record supports the current finding of a 100 percent evaluation for PTSD, let alone a finding that the veteran should have received more compensation for PTSD earlier than May 2005. In fact, significant evidence exists in this case that does not support a 100 percent evaluation for PTSD, including indications of personality disorder. Service connection may not be granted for a personality disorder. 38 C.F.R. §§ 3.303(c), 4.9. See Winn v. Brown, 8 Vet. App. 510, 516 (1996), and cases cited therein. Further, outpatient treatment records in April 2005 indicate that the veteran was doing "fairly well" until he attempted to reduce his medication, clearly not supporting his claim for a 100 percent evaluation at this time. Finally, the May 2005 VA examination, which appears to be the basis for the 100 percent evaluation, does not always indicate difficulties that would clearly support a 100 percent finding, providing more evidence against the current claim before the Board at this time that the veteran should have received the 100 percent evaluation prior to this time. In sum, the weight of the credible evidence demonstrates that the veteran is not entitled to an initial evaluation of 100 percent for PTSD prior to May 2005. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). II. Special Monthly Compensation Special monthly compensation (SMC) is payable to a veteran who is, as a result of his service-connected disabilities, so helpless as to need or require the regular aid and attendance of another person. 38 U.S.C.A. § 1114(l); 38 C.F.R. § 3.350(b)(3). A veteran will be considered in need of regular aid and attendance if he: (1) is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to five degrees or less; (2) is a patient in a nursing home because of mental or physical incapacity; or (3) establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a). 38 C.F.R. § 3.351(c). The following criteria will be considered in determining whether the veteran is in need of the regular aid and attendance of another person: the inability of the veteran to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which, by reason of the particular disability, cannot be done without such aid; the inability of the veteran to feed himself through the loss of coordination of upper extremities or through extreme weakness; the inability to attend to the wants of nature; or an incapacity, physical or mental, which requires care or assistance on a regular basis to protect the veteran from the hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a). In Turco v. Brown, 9 Vet. App. 222 (1996), the Court held that it was not required that all of the disabling conditions enumerated in the provisions of 38 C.F.R. § 3.352(a) be found to exist to establish eligibility for aid and attendance and that such eligibility required at least one of the enumerated factors be present. The Court added that the particular personal function which the veteran was unable to perform should be considered in connection with his condition as a whole and that it was only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need In this case, no medical evidence indicates that the veteran is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to five degrees or less; or that he is a patient in a nursing home because of mental or physical incapacity. It appears that the veteran's claim is based solely on a factual need for aid and attendance of another person under the criteria set forth in 38 C.F.R. § 3.352(a). If the veteran does not qualify for increased benefits for aid and attendance, increased compensation benefits may still be payable if the veteran has a single permanent disability rated 100 percent disabling, and has either additional service-connected disability or disabilities independently ratable at 60 percent or more, or is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C.A. § 1114(s); 38 C.F.R. § 3.351(d). A veteran is "permanently housebound" when he is substantially confined to his house (ward or clinical areas, if institutionalized) or immediate premises due to service-connected permanent disability or disabilities. 38 C.F.R. § 3.350(i)(2). The veteran is currently service connected for PTSD at 100 percent; however, he does not have an additional disability rated at 60 percent or more. Therefore, he does not qualify for SMC under this provision. The veteran was afforded a VA examination for aid and attendance in May 2007. The examiner recorded that the veteran was age 62 at the time, and that his spouse puts out his medications for him. The veteran indicated that he avoids crowded places, but that he has a driver's license and drove alone in the early morning to a grocery store two months prior to the exam. He also indicated that he gardens. When questioned, he indicated that he bathes himself, uses the bathroom, feeds himself, and dresses himself. The examiner noted that he was wearing lace-up combat boots, which the veteran laced himself. He stated that his spouse cooks his meals. The examiner indicated that the veteran's statements were at odds with those reported in a February 2006 VA examination, and the examiner indicated that further assessment of the veteran's capabilities was needed. The examiner further stated that it did not appear that the veteran was experiencing major problems with the basic activities of daily living (ADLs), other than having his medications set out for him. In the addendum to the examination, the examiner indicated that he had reviewed a psychological test report, dated June 2007, which indicated that the veteran's inability to perform ADLs appear more related to his mood and psychotic disorder functioning than due to a cognitive disorder. The examiner indicated that he was unsure as to which ADLs the veteran was unable to complete as the veteran had stated that he could bath, dress and toilet independently, and drives short distances. It was the examiner's opinion that the veteran does not need aid and attendance on the basis of his diagnosis of PTSD, providing persuasive evidence against the veteran's claim. The Board finds this exam highly probative, weighing against the veteran's claim, as he indicated that he could use the bathroom, feed himself and dress himself. He was able to lace his combat boots. He also stated that he could drive short distances and garden, all of which weigh against the need for aid and attendance. The VA exam conducted in February 2006 indicates that the veteran needs assistance with all ADLs except eating. The spouse indicated that if she did not take the veteran to the bathroom that he would not go. The veteran would not soil himself, but he would refuse to take himself to the rest room. The veteran did not suffer incontinence. The examiner opined that these symptoms did not appear to be related to the veteran's PTSD, weighing against he veteran's claim for aid and attendance based on a service connected disorder. The veteran indicated that his eyesight impairs him, however, the VA examiner found that the condition was not related to PTSD. The examiner further opined that the veteran's cognitive problems appear to be a separate unrelated entity from PTSD and depression and will require further evaluation, which also weighs against the claim. The physician's report for SMC, completed by Dr. Easley in November 2005, indicates that the veteran has urinary incontinence, poor memory, and agitation. Dr. Easley indicated that the veteran had loss of bladder and anal sphincter control, that the veteran was not competent to manage his financial affairs, and that he was not bedridden or blind. Dr. Easley further noted that the veteran needed assistance less than 50 percent of the time with dressing and ambulation, needed assistance more than 50 percent of the time with feeding and protecting himself from everyday hazards of everyday life, and was totally dependent on others for bathing, hygiene, using the toilet, and preparing meals. VA outpatient treatment record dated October 2005 shows that the spouse indicated that the veteran had become increasingly forgetful and was not changing his clothes unless it was firmly requested that he do so. She also indicated that the veteran was unable to maintain his medication regimen without assistance and that he had been having problems with incontinence. The veteran expressed guilt associated with not being able to do things for himself. At a hearing before the decision review officer (DRO) in December 2006, the veteran's spouse testified that she had to quit work to take care of the veteran because he refused to bath, eat, take his medications, go to the bathroom, and because he has problems around people. She testified that the veteran was capable of doing the tasks himself but that he would not perform his ADLs because of his medications. For example, when going to the bathroom, he will go but he misses the toilet. She also testified that he had seizures on a regular basis. In September 2007 at a hearing before the undersigned, the veteran's spouse testified that she put out the veteran's medications, and makes sure he eats and is groomed. She stated that she lays out his clothes and takes care of his nails. She testified that she drives him wherever he needs to go. She also testified that the veteran has to be told to get dressed. The Board has also considered the multiple lay statements by the veteran's spouse that indicates that she has to help the veteran with all his basic needs, including a letter received by the RO in September 2007. In this letter, the veteran's spouse indicated that she quit her job to care for the veteran. She also stated that the veteran can dress himself and use the bathroom, providing evidence against the claim. Overall, the examinations and treatment records provide persuasive evidence against the need for regular aid and attendance and against this claim. These records simply do not show that the veteran requires assistance bathing, dressing, cleaning, or with the activities of daily living due to a service connected or non-service connected disability. Per the May 2007 and February 2006 VA exams, it was the examiner's opinion that the veteran does not need aid and attendance on the basis of his diagnosis of PTSD. The veteran stated in his exam that he could do most ADLs, as well as garden and drive, providing evidence against his own claim. The veteran's spouse testified that the veteran could dress himself and use the bathroom. She also indicated at the VA outpatient exam that the veteran had to be told to get dressed, but she did not indicate that he could not dress himself. She testified before the DRO in December 2006 that the veteran was capable of doing tasks himself but that he will not perform his ADLs because of his medications. The post-service medical record, as a whole, is found to provide evidence against this claim. The evidence does not show that (while the veteran may need to be reminded to do certain tasks) the veteran is unable to dress or undress himself or to keep himself ordinarily clean and presentable. The evidence does not show that the veteran cannot feed himself through the loss of coordination of upper extremities or through extreme weakness; or that he cannot attend to the wants of nature. The evidence also fails to show that the veteran has an incapacity, physical or mental, which requires care or assistance on a regular basis to protect him from the hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a). The spouse herself has never indicated that such a situation exists in this case. The Board does not dispute the fact that the veteran has significant problems; however, the standard for aid and attendance status is quite high. Consequently, it is apparent from the medical evidence that the basic requirements for special monthly pension or compensation on the account of regular aid and attendance have not been met. 38 C.F.R. § 3.352(a). Accordingly, the Board finds that the preponderance of the evidence is against special monthly pension or compensation by reason of need for regular aid and attendance. 38 U.S.C.A. § 5107. As such, the evidence is not so evenly balanced as to require resolution of doubt in the claimant's favor. Id. The appeal is denied. III. The Duty to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from 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) must ask the claimant to provide any evidence in his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction, or regional office (RO). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). For an increased-compensation claim, section § 5103(a) requires, at a minimum, that the Secretary notify the claimant that, to substantiate a claim, the claimant must provide, or ask the Secretary to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life. Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). Further, if the Diagnostic Code under which the claimant is rated contains criteria necessary for entitlement to a higher disability rating that would not be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life (such as a specific measurement or test result), the Secretary must provide at least general notice of that requirement to the claimant. Additionally, the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant Diagnostic Codes, which typically provide for a range in severity of a particular disability from noncompensable to as much as 100 percent (depending on the disability involved), based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment and daily life. As with proper notice for an initial disability rating and consistent with the statutory and regulatory history, the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask the Secretary to obtain) that are relevant to establishing entitlement to increased compensation-e.g., competent lay statements describing symptoms, medical and hospitalization records, medical statements, employer statements, job application rejections, and any other evidence showing an increase in the disability or exceptional circumstances relating to the disability. Vazquez-Flores, 22 Vet. App. 37. Here, the duty to notify was not completely satisfied prior to the initial unfavorable decisions on the claims by the RO. 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 claims. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (where notice was not provided prior to the RO'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 RO) 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 RO decision by way of a letters sent to the veteran in March 2002, May 2005, August 2005, and December 2005 that fully addressed all notice elements, including the Vazquez-Flores criteria. The letters informed the veteran of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. The veteran was also asked to submit evidence and/or information in her or his possession to the RO. The letters also informed the veteran of effective date assignments as well as the criteria for increased ratings. Although the notice letters were not sent before the initial RO 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 RO also readjudicated the case by way of a supplemental statement of the case issued in July 2007 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. VA has a duty to assist the veteran in the development of the claim. This duty includes assisting the veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained VA outpatient treatment records and records from SSA. The veteran submitted private treatment records and lay statements, and was provided an opportunity to set forth his contentions during the hearing before the undersigned Veterans Law Judge. The veteran was afforded multiple VA medical examinations. Significantly, neither the veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the veteran is required to fulfill VA's duty to assist him in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). ORDER An effective date earlier than February 15, 2002, for the award of service connection for PTSD is denied. An effective date earlier than May 6, 2005 for the grant of a 100 percent evaluation for PTSD is denied. Entitlement to special monthly pension by reason of regular aid and attendance is denied. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs