Citation Nr: 1306498 Decision Date: 02/26/13 Archive Date: 03/01/13 DOCKET NO. 07-00 658 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. What evaluation is warranted for posttraumatic stress disorder (PTSD) from January 20, 2004 to February 8, 2010? 2. What evaluation is warranted for PTSD from February 9, 2010? 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: California Department of Veterans Affairs WITNESSES AT HEARING ON APPEAL The appellant and his spouse ATTORNEY FOR THE BOARD S. Mishalanie, Counsel INTRODUCTION The Veteran served on active duty from November 1966 to September 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office in Los Angeles, California. In December 2012, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge; a transcript of the hearing is of record. The Board notes that, in addition to the paper claims file, there is a Virtual VA electronic claims file associated with the Veteran's claim. The Virtual VA file has been reviewed in conjunction with the disposition of the issues on appeal. During the December 2012 hearing, the Veteran testified that his service-connected coronary artery disease, diabetes mellitus, and tinea versicolor have worsened in severity since they were last evaluated. The Board construes his testimony as informal claims for increased ratings for these disabilities. Because these issues have not been adjudicated by the Agency of Original Jurisdiction (AOJ), the Board does not have jurisdiction over them and they are referred to the AOJ for appropriate action. The issues of what evaluation for PTSD is warranted since February 9, 2010, and entitlement to a total disability rating based on individual unemployability are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDING OF FACT From January 20, 2004 to February 8, 2010, the Veteran's PTSD was manifested by not more than occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW From January 20, 2004 to February 8, 2010, the Veteran's PTSD met the criteria for not more than a 50 percent evaluation. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.130, Diagnostic Code 9411 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist Because service connection, an initial rating, and an effective date have been assigned, the notice requirements of the VCAA, 38 U.S.C.A. § 5103(a) have been met. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Consequently, discussion of VA's compliance with VCAA notice requirements as they relate to the increased rating claim would serve no useful purpose. VA fulfilled its duty to assist the Veteran in obtaining identified and available evidence needed to substantiate the claim, and as warranted by law, affording VA examinations. For the reasons discussed below, the Board finds that the examinations are adequate to make a determination on the issue addressed herein on the merits. In sum, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. 38 C.F.R. § 3.159(c). Legal Criteria Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (rating schedule). 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10 (2012). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). Where the claimant has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). The initial rating for the Veteran's PTSD has been assigned pursuant to Diagnostic Code 9411. The actual criteria for rating the Veteran's disability, however, are set forth in a General Rating Formula for evaluating psychiatric disabilities other than eating disorders. See 38 C.F.R. § 4.130. Under the formula, a 30 percent rating is assigned when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is assigned when there is 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; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, 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 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 inability to establish and maintain effective relationships. Id. The symptoms recited in the criteria in the rating schedule for evaluating mental disorders are "not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In adjudicating a claim for an increased rating, the adjudicator must consider all symptoms of a claimant's service-connected mental condition that affect the level of occupational or social impairment. Id. at 443. Psychiatric examinations frequently include the assignment of a Global Assessment of Functioning score. According to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the global assessment of functioning is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." There is no question that the global assessment of functioning score and interpretations of the score are important considerations in rating a psychiatric disability. See e.g., Richard v. Brown, 9 Vet. App. 266, 267 (1996); Carpenter v. Brown, 8 Vet. App. 240 (1995). The global assessment of functioning score assigned in a case, however, like an examiner's assessment of the severity of a condition, is not dispositive of the evaluation issue. Instead, the global assessment of functioning score must be considered in light of the actual symptoms of the Veteran's disorder, which provide the primary basis for the rating assigned. See 38 C.F.R. § 4.126(a) (2012). Analysis Considering the pertinent evidence in light of the applicable criteria and affording the Veteran the benefit of the doubt, the Board finds that the appellant met the criteria for a 50 percent rating, but no higher, for PTSD, from January 20, 2004 to February 8, 2010. In a February 2004 letter, a VA psychiatrist (Dr. A.A.) indicated that the Veteran had PTSD with symptoms of hypervigilance, recurrent panic attacks, insomnia, problems with nightmares once or twice a week, intrusive memories of combat incidents, and problems regulating his mood and affect and controlling irritability. During periods of heightened anxiety he became easily confused and had difficulties with concentration and memory. It was noted that he had been taking Trazadone and Xanax as needed and attending group therapy at a Vet Center. A March 2004 VA outpatient treatment record reflects that the Veteran reported that things were going "okay." He was not on any medication and did not wish to resume medication. His mood was holding; he had no suicidal or homicidal ideations, no psychosis, and no other complaints. In April 2004, it was noted that his global assessment of functioning score was 55. In an April 2004 letter, a social worker at the Vet Center (J.Y.) indicated that the Veteran's prognosis for recovery was severely limited and it was becoming increasingly difficult for him to function socially and industrially because of his problems with PTSD. It was noted that the Veteran sometimes required help from his spouse when dealing with business, claims, and health matters and that he had difficulty seeking and holding gainful employment. It was noted that the Veteran was forced to retire from the Post Office because of his PTSD. The social worker assigned a global assessment of functioning score of 35, noting that the Veteran had some impairment in reality testing including family relations, judgment, thinking, and mood problems with avoidance, depression, and neglect features secondary to PTSD. The social worker indicated that the Veteran's physical, social and economic challenges were increasing with prolonged severe impairment. The report of the June 2004 VA examination reflects the Veteran's complaints of difficulties falling and staying asleep on a nightly basis, severe problems with irritability and outbursts of anger, difficulties concentrating, hypervigilance, easy startle response, depression, intrusive thoughts on a daily basis, and flashbacks occurring once or twice a week. He reported severe paranoid ideation related to flashbacks, but denied any other psychosis. He also denied anhedonia and suicidal or homicidal ideations. He described avoidance tendencies, feelings of detachment, and social isolation. He said he used Trazadone and Xanax to help for sleep and anxiety problems. It was noted that he had worked for the Post Office for about thirty years and had retired in February 2003. He said he did not have a good relationship with his children because he always felt impatient. On mental status examination, the Veteran's grooming and hygiene were adequate. He was alert, cooperative, pleasant, and relaxed. His mood was described as okay; he did not appear depressed, anxious, or in any way emotionally distressed. His affect was constricted. His speech was fluent without pressure or retardation. He had no looseness of association, tangentiality, or circumstantiality. There was no psychomotor retardation or excitability. He was oriented to time, place, person, and purpose. His recent and remote memories were intact. He was able to recall three of three objects after three minutes and two of three objects in five minutes. Concentration was intact. He performed serial threes from 100 to 88 without mistakes, and was able to state the days of the week backwards. Abstract thinking was intact. Insight and judgment were good. There was no impairment of thought process or communication, no inappropriate behavior, and no obsessive or ritualistic behavior. His rate and flow of speech were not irrelevant, illogical, or obscure in their speech patterns. The diagnosis was PTSD, chronic type. The examiner indicated that there was no schizophrenia or schizo-affective disorder. The global assessment of functioning score was 62. In a June 2005 letter, Dr. A.A. stated that the Veteran continued to struggle with symptoms of anxiety and arousal on a daily basis. He continued to have panic and attacks and was impaired in his ability to modulate his mood and affect appropriately. It was also noted that under stressful situations, he had problems with memory and concentration. A December 2005 VA outpatient treatment record indicates the Veteran denied memory problems, suicidal and homicidal ideations, hallucinations, mood swings, and delusions. A PTSD screen was negative; he denied having nightmares, avoidance tendencies, being on guard or easily startled, or feeling numb or detached from others. The global assessment of functioning score was 60. In May 2006, a psychiatric progress note indicated that there were no acute changes; he was stable and not taking medication. He had no suicidal or homicidal ideations and was managing his symptoms well with the aid of group therapy. His mood was for the most part euthymic and his affect was a little constricted. It was noted that his relationship with his wife was better lately and he had no other complaints. In October 2006 and January 2007, the Veteran was mostly euthymic and he described his efforts to become more involved in guest preaching activities. An October 2006 VA outpatient treatment note also indicates that he denied flashbacks, nightmares, or startle response. A March 2007 VA outpatient treatment record indicates he had no suicidal or homicidal ideations, hallucinations, or delusions. He denied mood swings. It was noted that his PTSD symptoms were managed with group therapy. The global assessment of functioning score was 70. In November 2009, a VA psychiatry progress note indicates the Veteran reported lots of stress in his life due to his son being in jail. He was clinically unchanged with a stable mood described as fair, but a more stressed affect. He was a little excitable and irritable. He had no suicidal or homicidal ideations and no psychosis. Sensorium was intact. Depression screen was negative; he denied having little interest or pleasure in doing things, and feeling down, depressed, or hopeless. The report of a February 2010 VA examination reflects the Veteran's complaints of nightmares up to three times per week, increased irritability, and anger outbursts towards his wife. He said he avoided going out in pubic, and in public places sat so he could face the door. He endorsed easy startle response. He said he had been married 38 years. On a typical day, he said he reads the newspaper, takes a walk, and goes to the gym. On mental status examination, the Veteran was cooperative, and friendly. His personal hygiene was good. He was oriented to time, place, and situation. His speech was clear and coherent, and he exhibited no paranoia. He did not have any hallucinations or thought disorder. He did not demonstrate inappropriate behavior. He was not suicidal or homicidal. No panic attacks or impaired impulse control were observed. His recent, medium, and remote memory was intact. He exhibited no obsessive or ritualistic behavior. The rate and flow of his speech was in the normal range and his mood was appropriate. The diagnosis was PTSD and the global assessment of functioning score was 55. The examiner initially indicated that the global assessment of functioning score was 62, but then said that the interview indicated a somewhat lower score, noting that this was a subjective evaluation. The examiner stated that the Veteran was involved in group psychotherapy and able to do part-time work. VA treatment records also indicate that the Veteran attended and participated in group therapy sessions during the time period relevant to his claim. During the December 2012 Board hearing, the Veteran's wife testified that he was forgetful, had difficulties communicating effectively, became easily agitated, and was hypervigilant. The Veteran said that he worked for the United States Postal Service for 34 years and then retired. He said he had difficulties at work due to his PTSD symptoms, but that his supervisors understood and were accommodating. He described his workplace as sheltered and veteran-friendly. Since retirement, the appellant said he worked part-time for the school district. He estimated that he worked only two weeks in the past three months, but his wife believed he worked much less. In this case, the Board finds the above-stated evidence is adequate to evaluate the Veteran's PTSD prior to February 9, 2010. The Veteran's representative, in his May 2010 statement, argues that another VA examination is warranted because of a disparity in the record and the suggestion of co-morbid psychiatric disorders. The evidence reflects that the Veteran was hospitalized in the 1970s for schizophrenia; however, there has been no diagnosis of schizophrenia since. In this regard, the June 2004 VA examiner specifically indicated that there was no current schizophrenia. Likewise, although there is some notation in the Veteran's medical history of past drug use causing psychiatric symptoms, there is no evidence of drug use during the appeal period. The Veteran has reported being clean and sober for many years. The Board notes that the Veteran's social worker diagnosed the Veteran as also having major depression secondary to PTSD; however, his treating psychiatrist and the VA examiners, both board certified psychiatrists, did not diagnose the Veteran as having a separate depressive disorder. The Board finds the psychiatrists' opinions are more persuasive in this regard given their additional training and expertise. To the extent the Veteran has reported symptoms of depression, the Board has considered such symptomatology in evaluating his PTSD. To the extent that health care providers have provided different global assessment of functioning scores, the Board will address this disparity below as it weighs the relevant evidence below. In sum, the examination reports during this time period are adequate as the examiners reviewed the claims file and pertinent history, examined the Veteran and provided findings and rationales in sufficient detail, and where applicable, provided clarification. The VA examination reports, considered cumulatively, are thorough and supported by the record. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Collectively, the aforementioned medical evidence reflects that the Veteran's symptoms are representative of a 50 percent rating. As noted above, under the General Rating Formula, the 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity. In making that determination the Board looks, in part, to whether there is evidence of symptoms such as a 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, impaired judgment, or impaired abstract thinking. The Board also looks, in part, to whether there are disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. In this case, while the evidence did not show symptoms such as a near-continuous panic or depression affecting his ability to function independently, the Veteran complained of anxiety, recurrent panic attacks, irritability, and anger outbursts. The Board notes some discrepancy in the symptoms the Veteran reported to VA examiners versus the symptoms he reported to his VA treating physicians. VA outpatient treatment records often indicated that his mood was euthymic or stable during this time period; in fact, he often denied symptoms of depression. Although he reported having flashbacks, nightmares, and intrusive thoughts to VA examiners, he denied having these symptoms to treating physicians in December 2005 and October 2006. Furthermore, although there were subjective complaints of memory impairment, and while Dr. A.A. noted memory and concentration problems during stressful situations, on mental status examinations he demonstrated no impairment in memory, concentration, or thought processes. The Veteran consistently complained of problems falling and staying asleep, increased irritability, feelings of detachment and social isolation, and his affect was often described as constricted. In light of these symptoms and resolving the benefit of the doubt in the Veteran's favor, the Board finds that his symptomatology was productive of occupational and social impairment with reduced reliability and productivity and that a 50 percent rating is warranted. In addition, the Board has considered the global assessment of functioning scores. VA psychiatrists assigned global assessment of functioning scores ranging from 55 to 62 during this time period, which are consistent with the criteria for a 50 percent evaluation. Under the Diagnostic and Statistical Manual of Mental Disorders global assessment of functioning scores from 51 to 60 are indicative of 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). Global assessment of functioning scores from 61 to 70 are indicative of mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft with the household, but generally functioning pretty well, has some meaningful interpersonal relationships. In consideration of the Veteran's total symptomatology during this time period, the Board finds that the evaluation of PTSD more closely represents a 50 percent rating for this period. The Board acknowledges that the global assessment of functioning score of 35 assigned by his VA social worker (J.Y.) is suggestive of a higher level of impairment; however, the overwhelming preponderance of the evidence indicates the Veteran has never shown symptoms such as an impairment in reality testing or communication. As noted above, his judgment, thinking, speech, and ability to communicate were intact during this time period. Therefore, the basis for the score of 35 is unclear. The Board also acknowledges that the global assessment of functioning score of 70 assigned by a treating physician is indicative of mild symptomatology and less impairment than contemplated in the 50 percent rating; however, it is unclear whether this score was assigned based on psychiatric symptoms or physical symptoms. In any event, the opinions of board certified psychiatrists are more probative in this regard as they have more extensive training and experience in this area than the Veteran's social worker and general practitioners. At no point during the term addressed herein did the Veteran's PTSD meet the criteria for a 70 percent rating. Simply put, between January 20, 2004 and February 8, 2010, the appellant's PTSD was not manifested by symptoms such as occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood. The Veteran consistently denied suicidal and homicidal ideation. The treatment records are also silent as to any obsessional rituals and the evidence does not indicate near-continuous panic or depression affecting the ability to function independently. He also did not demonstrate neglect of personal appearance and hygiene. The majority of the Veteran's symptoms included sleep impairment, irritability, social isolation, flashbacks, intrusive thoughts, nightmares, hypervigilance, depression, anger, and memory problems; however, he reported these symptoms inconsistently and sometimes denied having any PTSD symptomatology at all. VA outpatient treatment records indicate his mood was stable and often euthymic. Despite his self assertions of social isolation, he was actively seeking guest preaching activities. He said he went for walks, went to the gym, and that his relationship with his wife was improving. Although he reported difficulties at work, he maintained employment with the United States Postal Service for 34 years. Therefore, the record preponderates against finding that the Veteran had difficulty in adapting to stressful circumstances (including work or worklike setting) or an inability to establish and maintain relationships. For these reasons, the Board finds that the Veteran did not meet the criteria for a rating in excess of 50 percent for this period. The Board considered the application of other various provisions, including 38 C.F.R. § 3.321(b)(1), for exceptional cases where schedular evaluations are found to be inadequate. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Thun v. Shinseki, 573 F.3d 1366 (Fed. Cir. 2009). Here, the rating criteria reasonably describe the Veteran's disability and symptomatology. The Veteran has described symptomatology involving sleep impairment, flashbacks, nightmares, intrusive thoughts, depression, anxiety, panic attacks, hypervigilance, memory and concentration problems, irritability, anger outbursts. The impact of such psychiatric symptoms on occupational and social functioning is specifically contemplated in the General Rating Formula. Furthermore, the General Rating Formula provides for higher ratings for PTSD. Hence, the rating criteria clearly contemplate the Veteran's disability picture. They include symptomatology of the type reported by the Veteran and by medical professionals on clinical evaluation. Therefore, the threshold factor for extraschedular consideration under step one of Thun has not been met. As the disability picture is contemplated by the Rating Schedule, the assigned schedular ratings are, therefore, adequate. Consequently, referral for extraschedular consideration is not required under 38 C.F.R. § 3.321(b)(1). ORDER Entitlement to an initial 50 percent evaluation, but no higher, for PTSD is granted for the period from January 20, 2004 to February 8, 2010, subject to the laws and regulations governing the payment of monetary benefits. REMAND During the Board hearing, the Veteran testified that his PTSD symptoms have worsened since his most recent VA examination in February 2010. Therefore, a new examination is required to evaluate the current degree of impairment. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (a veteran is entitled to a new examination after a two-year period between the last VA examination and a veteran's contention that the pertinent disability had increased in severity). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim of entitlement to a total disability evaluation based on individual unemployability due to service connected disorders is "part of," and not separate from, a claim of entitlement to an increased rating. Id. at 453. While the claim of entitlement to individual unemployability has not been certified for appeal, in light of the binding precedent set forth in Rice, the Board is compelled to remand this issue. Accordingly, the case is REMANDED for the following action: 1. The RO/AMC should obtain any outstanding treatment records regarding care for PTSD dating since February 2010. Any records obtained must be associated with the Veteran's claims folder. If the RO cannot locate any identified record, the RO/AMC must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO/AMC must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. The claimant must be given an opportunity to respond. 2. Thereafter, the Veteran must be afforded a VA psychiatric examination. The examiner is to be given access to the claims folder, a copy of this REMAND and Virtual VA. The examiner must specify in the report that the claims file and Virtual VA records have been reviewed. In accordance with the latest AMIE worksheets for rating PTSD, the examiner is to provide a detailed review of the appellant's pertinent medical history, current complaints, and the nature and extent of any disability due to that disorder. The examiner should note whether there has been an increase in severity since the last examination in February 2010 and, if so, the approximate date of the increase in severity. The examiner must opine whether it is at least as likely as not, i.e., is there a 50/50 chance, that the Veteran is unable to obtain and retain substantially gainful employment based on the PTSD alone. A complete rationale for any opinion offered must be provided. 3. The Veteran is to be notified that it is his responsibility to report for the scheduled examination and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for the aforementioned examination, documentation should be obtained which shows that notice scheduling the examinations was sent to the last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 4. After the development requested, the RO/AMC should review the examination report to ensure that it is in complete compliance with the directives of this REMAND. The AMC/RO must ensure that the examiner documented their consideration of Virtual VA, to include identifying the date range of Virtual VA records reviewed. If the report is deficient in any manner, the RO must implement corrective procedures at once. 5. The RO/AMC must develop and adjudicate the claims for increased ratings for coronary artery disease, diabetes mellitus, and tinea versicolor, and issue of entitlement to a total disability rating based on individual employability in a formal rating decision. In so doing, the RO/AMC must provide appropriate VCAA notice on those issues. With the exception of the claim of entitlement to a total disability evaluation based on individual unemployability due to service connected disorders, the Veteran is advised that the Board will only exercise jurisdiction over these new increased rating claims if he perfects a timely appeal. 6. Upon completion of the above requested development and any additional development deemed appropriate, readjudicate the issue of what evaluation is warranted for PTSD from February 9, 2010, to include the question of entitlement to a total disability evaluation based on individual unemployability due to service connected disorders. All applicable laws and regulations should be considered. If any benefit is not granted, the Veteran and his representative should be provided a supplemental statement of the case. An appropriate period of time should be allowed for response. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). ______________________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs