Citation Nr: 1317896 Decision Date: 06/03/13 Archive Date: 06/11/13 DOCKET NO. 09-09 645 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Evaluation of posttraumatic stress disorder, rated as 50 percent disabling. 2. Entitlement to a total disability rating by reason of individual unemployability (TDIU). REPRESENTATION Appellant represented by: Georgia Department of Veterans Services ATTORNEY FOR THE BOARD G. E. Wilkerson, Associate Counsel INTRODUCTION The Veteran served on active duty from January 1966 to April 1995. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. Jurisdiction was subsequently transferred to the RO in Atlanta, Georgia. In a June 2011 rating decision, the RO granted service connection for coronary artery disease. As this is a full grant of the matter previously on appeal, it is no longer before the Board. A review of the Veteran's Virtual VA electronic claims file reveals no additional records. In September 2012, the Veteran was scheduled for a Travel Board hearing at the RO; however, he failed to report and has not requested rescheduling. As such, his hearing request is deemed withdrawn. See 38 C.F.R. § 20.704 (2012). The issue of entitlement to a TDIU is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDING OF FACT The Veteran's PTSD has been productive of occupational and social impairment with deficiencies in most areas, including work, family relations, thinking, judgment, and mood. CONCLUSION OF LAW The schedular criteria for an evaluation of 70 percent, but no higher, for PTSD are met. 38 U.S.C.A. §§ 1155, 5107, 5110(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.400, 4.7, 4.130, Diagnostic Code 9411 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION I. The Veterans Claims Assistance Act The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012)) redefined VA's duty to assist the Veteran in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under the VCAA, 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 request that the claimant provide any evidence in his possession that pertains to the claim. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004); 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). The United States Court of Appeals for Veterans Claims (Court) has also held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) 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. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The claim on appeal arises from the Veteran's disagreement with the ratings assigned in connection with the grant of service connection for the disability. The courts have held, and VA's General Counsel has agreed, that where an underlying claim for service connection has been granted and there is disagreement as to "downstream" questions, the claim has been substantiated and there is no need to provide additional VCAA notice or prejudice from absent VCAA notice. Hartman v. Nicholson, 483 F.3d 1311, 1314-15 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112, 116-17 (2007); VAOPGCPREC 8-2003 (2003). The Court has elaborated that filing a notice of disagreement begins the appellate process, and any remaining concerns regarding evidence necessary to establish a more favorable decision with respect to downstream elements (such as a disability rating) are appropriately addressed under the notice provisions of 38 U.S.C.A. §§ 5104 and 7105 (West 2002). Goodwin v. Peake, 22 Vet. App. 128, 137 (2008). Consequently, further discussion of the VCAA's notification requirements with regard to the claim herein decided is unnecessary. The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In this case, VA obtained the Veteran's service treatment records and all of the identified post-service private and VA treatment records. While he was provided an opportunity to provide additional testimony at a Board hearing in September 2012, he failed to appear. The Veteran was also provided with VA examinations in January 2007 and September 2011 as to his disability on appeal. As these examinations were based on review of the Veteran's symptoms and complaints and discuss his disability in relation to the pertinent rating criteria, they are adequate for adjudication purposes. For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. The claim on appeal is thus ready to be considered on the merits. II. Analysis Disability evaluations are determined by application of the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Court has held that "staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App 119 (1999). As discussed below, the disability has not significantly changed and a uniform evaluation is warranted. The Veteran's PTSD is rated as 50 percent disabling pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. This Diagnostic Code provides that PTSD should be rated under the General Rating Formula for evaluating psychiatric disabilities other than eating disorders. Under the general formula, a 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 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. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Thus, any analysis should not be limited solely to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the specific rating criteria in determining the level of occupational and social impairment. In Vazquez-Claudio v. Shinseki, __ F.3d ___, No. 2012-7114 (Fed.Cir. April 8, 2013), the Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Psychiatric examinations frequently include assignment of a Global Assessment of Functioning (GAF) score. According to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), GAF is a scale reflecting the 'psychological, social, and occupational functioning on a hypothetical continuum of mental health illness.' There is no question that the GAF 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). However, the GAF score assigned in a case, like an examiner's assessment of the severity of a condition, is not dispositive of the evaluation issue; rather, the GAF 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). The pertinent evidence of record includes a November 2005 private psychiatric evaluation. The Veteran was referred by his work counselor. The Veteran complained of nightmares and flashbacks regarding his Vietnam War experiences. It was noted that the Veteran served for 2.5 years in Vietnam and then also served in Operation Desert Storm for approximately 6 months. Other symptoms included waking up in cold sweats, screaming in his sleep, exaggerated startle response, anger, and lack of trust. He denied any previous psychiatric hospitalizations, previous suicidal or homicidal attempts, abnormal fears, or history of obsessive compulsive disorder. A mental status examination revealed that the Veteran got easily angered and was preoccupied with nightmares and flashbacks about the war. No delusions were elicited. He denied any auditory or visual hallucinations or suicidal or homicidal thoughts, plans, or intentions. He was competent to understand the consequences of lying to the examiner and others. He could repeat 5 digits forward and 3 digits backward. He could remember 1 out of 3 objects after 5 minutes. He was able to give a coherent past history. The examiner concluded by diagnosing PTSD and assigning a GAF score of 44, with a high GAF score of 50 during the past year. It was recommended that the Veteran discontinue use of caffeine and perform regular exercise to control his anxiety and depression. He was prescribed Zoloft. Treatment records from Dr. D. dated in 2006 reflect treatment for the Veteran's psychiatric problems. A January 2006 report reflects that the Veteran worked for the government for about 40 hours per week. He indicated that he was feeling better and was less angry. He slept about 8 hours per night. He denied any suicidality or homicidality. In March 2006, the Veteran reported that he had seen a decrease in his nightmares and flashbacks, but he was still angry. He continued to see his work advisor for counseling. In June 2006, it was noted that the Veteran had run out of Zoloft and had been feeling sad and depressed with increased dreams at night. He reported a lot of flashbacks from the war, and indicated that he felt angry whenever he heard of any news regarding the war on television. A June 2006 report from the Veteran's office supervisor reflects that he got into an alteration at work in which he became angry and yelled obscenities at a coworker. He was given a formal letter of reprimand and was advised to seek counseling about his anger issues, as it was not the first incident. An August 2006 treatment report from Dr. D. reflects that the Veteran reported problems with anger since his service in Vietnam. He experienced nightmares, flashbacks, and night sweats. He denied suicidal or homicidal ideation. A November 2006 report from the Veteran's employer reflects that the Veteran was formally reprimanded for an incident in which he became very agitated with a coworkers and used obscenities and threats. It was noted that this reprimand came after a verbal reprimand only a few months prior. A December 2006 report from Dr. D. reflects that the Veteran's work advisor called informing him of the Veteran's work issues. The Veteran indicated that he still had problems with anger, nightmares, and flashbacks. He felt sad, withdrawn, worthless, and occasionally had passive death wishes, but denied any suicidality or homicidality at that time. On VA examination in January 2007, the Veteran reported that he had seen a psychiatrist for mediation management, as well as a counselor, for treatment of his symptoms. The Veteran indicated that, since entering treatment, the intensity of the anger outbursts had decreased, but he still had anger. With respect to military history, it was noted that the Veteran served in the Vietnam and Gulf wars. He had been awarded 7 Bronze Stars, the Legion of Merit, and a Combat Infantryman Badge. With respect to family relationships, the Veteran indicated that he had been married for the past 36 years. He had 2 daughters and 7 grandchildren whom he spent time with. He reported that his wife told him that she would leave him last year and he attempted suicide with an overdose. As regards a history of violence, the Veteran noted that he was almost fired from work due to his anger, but he only had verbal and not physical assaultiveness. The Veteran was noted to be struggling with anger, socially isolated, and dependent on his family emotionally. On mental status examination, the Veteran presented as casually dressed. Psychomotor activity was lethargic, attitude was cooperative and friendly, affect was constricted, and mood was depressed. He had difficulties with focus. The Veteran was described as intact to person, place and time. Thought content was unremarkable while thought process was noted to contain paucity of ideas. Judgment was noted to be good, but as regards insight, it was noted that the Veteran only partially understood that he had a problem. With respect to sleep impairment, the Veteran described difficulty both falling and staying asleep. He got about 3 hours of sleep per night and felt tired almost every day. He denied hallucinations and panic attacks. The examiner noted inappropriate behavior in that the Veteran had anger problems. There was a presence of homicidal and suicidal thoughts, but no plan. The examiner noted that impulse control was fair, though he described one incident in which he became angry at a person who came to his table at a restaurant, and he hit him. Remote memory was noted to the mildly impaired, while recent and immediate memory were moderately impaired. With respect to impact on daily living, the Veteran reported that he avoided travelling, shopping, and driving. With respect to employment, the Veteran was employed as a court clerk. The examiner diagnosed PTSD and major depression, severe. A GAF score of 50 was also assigned. The examiner noted that the Veteran had been a "warrior all of his life" and was worn out but refused to quit. The examiner commented that the Veteran needed to understand that he is human and that there was no shame in getting older and suffering from the effects of pushing himself mentally and physically too hard for too long. He worked nights so he did not have to be around too many people. With respect to impact on ability to function, the examiner noted that the Veteran had been in trouble at work due to his anger and his wife threatened to leave him if he did not get assistance. He suffered from stress-related illness and remained isolated except for family. He did not allow himself recreational pursuits. The examiner also noted that the Veteran was hypervigilant. The examiner noted that while there was not total occupational and social impairment due to PTSD, his PTSD signs and symptoms resulted in deficiencies in areas such as judgment, thinking, work, family relations, and mood. In describing these deficiencies, the examiner highlighted examples for each. He found judgment to be impaired in that the Veteran became angered at a restaurant when a man came to his table and asked him how he was doing. Thinking was indicated to be deficient because the examiner found the Veteran to be negative. Family relationships were impaired in that the Veteran's wife threatened to leave him, and work was impaired due to his being reprimanded for anger. Mood was indicated to be deficient in that the Veteran was depressed and angry. Statements from the Veteran's wife and daughters note their observations on the Veteran's behavior following service, including nightmares, flashbacks, anger, rage, and guilt. An August 2008 employer report reflects that the Veteran resigned his position for health reasons related to his PTSD. On VA QTC examination in September 2011, the Veteran endorsed symptoms of irritability, sleep disturbance, feelings of detachment, recurring dreams, intense anxiety, and tearfulness when discussing Vietnam. The severity of his symptoms was noted to be moderate and it was also noted that these symptoms were episodic or fluctuating. The Veteran reported that these symptoms affected his daily functioning, which resulted in persistent irritability. He also reported insomnia and night sweats. He denied a history of violent behavior or suicide attempts. With respect to current treatment, the Veteran indicated that he took Zoloft and Depakote in the past. He had not received psychotherapy for his mental condition in the past year. The Veteran described his relationship with his wife as poor, but indicated that his relationship with his children was very good. He indicated that he worked for 10 years as a deputy clerk in municipal court, and that his relationships with his supervisor and coworkers were poor. He reported interpersonal conflicts with both. He reported that he resigned from this position, but the examiner noted that the Veteran contended that his unemployment was not primarily due to the effects of a mental condition. On mental status examination, orientation was within normal limits. Appearance and hygiene were appropriate. He maintained good eye contact during the examination. Affect and mood were normal. Communication was within normal limits. Speech and concentration were within normal limits. Panic attacks were absent, and there was no suspiciousness present. There was no report of a history of delusions or hallucinations, and neither was observed on examination. Obsessive-compulsive behavior was absent. Thought processes were appropriate. He was able to understand direction and did not have slowness of thought or appear confused. Judgment was not impaired. Abstract thinking was normal. Memory was within normal limits. Suicidal and homicidal ideation was absent. There were no behavioral, cognitive, social, affective, or somatic symptoms attributed to PTSD. A diagnosis of PTSD and alcohol abuse in full sustained remission was assigned. A GAF score of 60 was also assigned. The examiner determined that the best description of the Veteran's current psychiatric impairment was that the Veteran's psychiatric symptoms caused occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks, although generally performing satisfactorily with routine behavior, self-care, and normal conversation. He had difficulty establishing and maintaining effective work and social relationships because of irritability and difficulty with interpersonal relationships. He also had difficulty maintaining effective family role functioning because of feelings of not being understood by his family and difficulty attaching emotionally. He had no difficulty with recreation or leisurely pursuits. The examiner encouraged the Veteran to resume treatment. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to a 70 percent disability evaluation throughout the initial appeal period. The aforementioned evidence reflects that the Veteran's PTSD has been manifested by difficulty sleeping, irritability, anger, anxiety, depression, isolative behavior, and interpersonal problems with coworkers and family members. Significantly, the Veteran has reported some suicidal ideation and impaired impulse control and judgment. Moreover, the January 2007 VA examiner specifically determined that the Veteran's PTSD was productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, consistent with the criteria for a 70 percent rating. While the Veteran has not demonstrated all of the symptoms listed in the rating formula as indicative of a 70 percent rating, and the September 2011 VA examination report is suggestive of less severe PTSD symptomatology, the Board finds that his overall symptomatology picture, particularly, isolative behavior, symptoms of depression and anxiety, and significant interpersonal conflict, more closely approximate occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood. Thus, with resolution of all reasonable doubt in the Veteran's favor, the Board finds that his PTSD has more nearly approximates the criteria for an initial 70 percent rating, but no higher. See 38 C.F.R. §§ 4.3 4.7. However, at no point has the Veteran's PTSD symptomatology met the criteria for the next higher 100 percent rating. As noted above, a 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name38 C.F.R. § 4.130. The evidence does not show that the Veteran has had impairment in thought processes or communication or disorientation to time or place. In fact, numerous medical records noted that his thought process and speech were normal and that he was oriented to person, time, and place. He also denied having any delusions or hallucinations on examination. Similarly, while the Veteran has expressed suicidal and homicidal ideation on VA examination in January 2007, the evidence does not show that there was a persistent danger and there is no further indication of plan. Moreover, he denied suicidal or homicidal ideation on all other treatment and on September 2011 VA examination. Thus, his thoughts of hurting himself or others do not appear to be persistent. Moreover, while the Veteran is socially isolated and reports problems with his wife, he is still married and reports good relationships with his children and his wife. Thus, it appears that the Veteran is able to maintain some social and family relationships. In addition, while the Veteran had documented problems with his coworkers and supervisors, and has indicated that he resigned due to PTSD, given the fact that the Veteran had been able to work for much of the appeal period, and, taken together with the other evidence noted above indicating at most severe PTSD but not total impairment, with few, if any, of the symptoms listed in the criteria for a 100 percent rating, the Board finds that a 100 percent rating is not warranted. The Board further notes that none of the GAF scores assigned since the effective date of the grant of service connection, ranging from 44 to 60, alone, provide a basis for assigning a rating in excess of 70 percent for PTSD. According to DSM-IV, a GAF score ranging from 41 to 50 reflects severe symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job), while a GAF score ranging from 51 to 60 reflects 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). The assignment of scores of 50 to 60, reflecting moderate to severe symptomatology, is consistent with the Board's decision to assign a 70 percent rating. While the GAF score of 44 assigned by the January 2007 VA examiner might suggest some impairment greater than that contemplated the initial 70 percent rating assigned, it is but one factor for consideration in assigning a rating in this case. When all of the evidence and findings contained therein are considered, including the degree of functioning as evidenced by these reported scales, the overall evidence does not establish a level of impairment that more nearly approximates a 100 percent rating. As noted above, the Veteran has maintained some relationships, and total occupational impairment has not been shown. Thus, it cannot be said that he has total social and occupational impairment. Accordingly, the Board finds that an initial 70 percent, but no higher, rating for PTSD is warranted for the entire appeal period. As to consideration of referral for an extraschedular rating, such consideration requires a three-step inquiry. See Thun v. Peake, 22 Vet. App. 111 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The first question is whether the schedular rating adequately contemplates the Veteran's disability picture. Thun, 22 Vet. App. at 115. 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. If the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, then the second inquiry is whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as governing norms. If the Veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether an extraschedular rating is warranted. The discussion above reflects that the symptomatology associated with the Veteran's disabilities is fully contemplated by the applicable rating criteria. The symptomatology reported by the Veteran and shown on examination is contemplated by the rating criteria used to assign disability evaluations, and there is no characteristic or manifestations shown that is outside the purview of the applicable rating criteria or is so exceptional as to render the criteria in applicable. All potentially relevant rating codes have been considered and evaluated. Consideration of whether the Veteran's disability picture exhibits other related factors such as those provided by the regulations as "governing norms" is therefore not required. The 70 percent rating considers the impact on the Veteran's employment. In any event, the Veteran did not claim, and the evidence does not reflect, that there has been marked interference with employment, frequent hospitalization, or that the Veteran's symptoms have otherwise rendered impractical the application of the regular schedular standards. Therefore, referral for consideration of an extraschedular rating for any of the disabilities on appeal is not warranted. 38 C.F.R. § 3.321(b)(1). For the foregoing reasons, the Board concludes that there is no basis for staged ratings of the Veteran's PTSD, as his symptoms have been primarily the same throughout the appeal period. In this regard, the Board finds that a higher 70 percent rating for this disability is warranted from September 13, 2006. In reaching this decision, the Board has favorably applied the benefit-of-the-doubt doctrine. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER A 70 percent rating for PTSD is granted, subject to the controlling regulations applicable to the payment of monetary benefits. REMAND Each time a Veteran files a claim for an increased rating and submits evidence of unemployability due to this disability, he has implicitly made a claim for a TDIU. The TDIU is not a separate claim that must be raised with specificity; it is a component of the increased rating claim. Rice v. Shinseki, 22 Vet. App. 447, 454-55 (2009) (TDIU "is part and parcel of the determination of the initial rating for [a] disability"). In this case, the Veteran's claim for an increased rating for PTSD included a claim for a TDIU, as evidenced by the Veteran's statement found on his VA Form 9, Appeal to the Board, that he has lost employment due to his PTSD. While the RO issued a notice letter to the Veteran with respect to this claim, it has not yet adjudicated the claim for a TDIU. The courts have not definitively indicated what the Board should do when faced with a TDIU claim that was implicitly raised as part of an increased rating claim but was not explicitly adjudicated by the RO. The Board is persuaded by the reasoning of the single judge decision in Muma v. Shinseki, No. 09-2734 (Oct. 21, 2010) that "a remand, not a referral, is the appropriate action when, as here, the Board has jurisdiction over a claim but the evidence has not been developed enough for proper appellate adjudication." See Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). As the Veteran may be entitled to a TDIU and such a claim was implicitly made along with the increased rating claim that the Board has decided herein, the RO should explicitly adjudicate this claim after performing any necessary development, to include obtaining a medical opinion as to the effect of the Veteran's service connected PTSD and other service-connected disabilities upon his employability. Accordingly, the claim for a TDIU is REMANDED for the following action: After considering whether any additional development (such as obtaining a medical opinion as to the effect of the Veteran's service-connected disabilities, to include PTSD, on his employability) is deemed necessary in light of any subsequently obtained evidence, the RO should adjudicate the Veteran's claim for entitlement to a TDIU rating. If the determination remains unfavorable to him, he and his representative must be furnished with a Statement of the Case regarding the TDIU, and given an opportunity to respond thereto. Then, if indicated, this case should be returned to the Board for the purpose of appellate disposition. The Veteran 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). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ____________________________________________ H. N. SCHWARTZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs