Citation Nr: 1318418 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 10-32 523 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to a rating in excess of 30 percent prior to June 20, 2012 and a rating in excess of 70 percent thereafter for post-traumatic stress disorder (PTSD). 2. Entitlement to a compensable rating prior to June 15, 2012 and a rating in excess of 40 percent thereafter for traumatic brain injury (formerly, residuals of concussion blast to both eyes). 3. Entitlement to a rating in excess of 30 percent for macular degeneration with hole, right eye. REPRESENTATION Appellant represented by: Michael J. Brown, Esq. ATTORNEY FOR THE BOARD Amanda Christensen, Associate Counsel INTRODUCTION The Veteran had active military service from May 1943 to January 1946. This appeal comes to the Board of Veterans' Appeals (Board) from April 2009 and April 2010 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. Prior to June 20, 2012, the Veteran's service-connected PTSD was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. As of June 20, 2012 the Veteran's service-connected PTSD has been manifested by occupational and social impairment with deficiencies in most areas. 3. Since June 15, 2012, the Veteran's service-connected TBI has been characterized by mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment; normal motor activity most of the time, but is mildly slowed at times due to apraxia; normal judgment; routinely appropriate social interaction; normal visual spatial orientation; constant orientation to person, time place, and situation; subjective symptoms that do not interfere with work, instrumental activities of daily living, or work, family, or other close relationships; one or more neurobehavioral effects that do not interfere with workplace or social interaction; and an ability to communicate by spoken and written language and to comprehend spoken and written language. 4. Prior to June 15, 2012, the Veteran had not been diagnosed with a traumatic brain injury nor had symptoms of such disability been assessed. 5. The Veteran's best corrected visual acuity in his right eye has been measured at 20/400 throughout the pendency of this appeal. CONCLUSIONS OF LAW 1. The criteria for a rating greater than 30 percent for PTSD prior to June 20, 2012 have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.130, Diagnostic Code (DC) 9411 (2012). 2. The criteria for a rating greater than 70 percent for PTSD as of June 20, 2012 have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.130, DC 9411 (2012). 3. The criteria for a compensable rating prior to June 15, 2012 for TBI have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, DC 8045. 4. The criteria for a rating greater than 40 percent as of June 15, 2012 for TBI have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, DC 8045. 5. The criteria for a rating greater than 30 percent for macular degeneration with hole, right eye, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.75, 4.76, 4.79, DC 6066. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating 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. If there is disagreement with the initial rating assigned following a grant of service connection, as is the case with the Veteran's PTSD claim, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). See AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, as is the case with the Veteran's TBI and eye disability claims, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are appropriate for an increased rating claim if the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The claimant bears the burden of presenting and supporting his/her claim for benefits. 38 U.S.C.A. § 5107(a). See Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). In its evaluation, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C.A. § 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. Id. Another way stated, VA has an equipoise standard akin to the rule in baseball that "the tie goes to the runner." Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Notably, the benefit of the doubt doctrine is not applicable based on pure speculation or remote possibility. See 38 C.F.R. § 3.102. PTSD The Veteran's PTSD is currently evaluated as 30 percent disabling prior to June 20, 2012 and 70 percent thereafter under the criteria of Diagnostic Code 9411. See 38 C.F.R. § 4.13. In his June 2010 substantive appeal, the Veteran contended his PTSD should be rated at 50 to 70 percent. A 30 percent rating is assigned where 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, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating contemplates 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; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is 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; intermittently illogical obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted where there is 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; and memory loss for names of close relatives, own occupation, or own name. Id. Symptoms listed in VA's general rating formula for 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 (2002). The nomenclature employed in the portion of VA's Rating Schedule that addresses service-connected psychiatric disabilities is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (also known as "DSM-IV"). 38 C.F.R. § 4.130. DSM-IV contains a Global Assessment of Functioning (GAF) scale, with scores ranging between zero and 100 percent, representing the psychological, social, and occupational functioning of an individual on a hypothetical continuum of mental health illness. Higher scores correspond to better functioning of the individual. Under DSM-IV, GAF scores ranging between 61 and 70 are assigned when there are some mild symptoms (e.g., depressed mood and mild insomnia), or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but when the individual is functioning pretty well and has some meaningful interpersonal relationships. GAF scores ranging between 51 and 60 are assigned when there are moderate symptoms (like flat affect and circumstantial speech, and occasional panic attacks), or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). GAF scores ranging between 41 and 50 are assigned when there are serious 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). GAF scores ranging between 31 and 40 are assigned when there is some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family and is unable to work). According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126(a). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely the basis of social impairment. 38 C.F.R. § 4.126(b). In March 2010 the Veteran's private physician stated that the Veteran had a long-standing history of insomnia, tinnitus, and night terrors due to PTSD. The physician noted that although the Veteran has been able to function, his symptoms were getting progressively more difficult to endure. The Veteran was afforded a VA examination in March 2010. The examiner diagnosed PTSD and assigned a GAF of 65. The examiner found the Veteran to be appropriately dressed, oriented, and cooperative with unremarkable speech and thought process and normal memory. The examiner noted his psychomotor activity was tense, his affect constricted, his mood anxious and depressed, and he was easily distracted. His thought content involved obsessions and ruminations. The examiner found the Veteran understood the outcome of his behavior and had fair impulse control although he reported blowing up a lot. The Veteran reported interrupted sleep and obsessions and checking and order compulsions. He reported no panic attacks or suicidal or homicidal thoughts. The Veteran stated that he retired in 1985, but when he was working he got along with some people and not with others. The Veteran reported that he did not socialize often and had limited leisure activities. The examiner found that the Veteran's PTSD symptoms were mild, but he had limited social support. The examiner opined that the Veteran's PTSD symptoms did not cause total occupation and social impairment but the Veteran did have deficiencies in the areas of judgment (fair judgment), thinking (obsessions and ruminations), work, and mood (anxiety and depression). The examiner opined the Veteran's anxiety and depression could be obstacles to his productivity and reliability in a work setting if he was employed, and there would be an occasional decrease in work efficiency with intermittent periods of inability to perform occupational tasks with generally satisfactory functioning. At a May 2012 Decision Review Officer hearing, the Veteran testified to having trouble with his memory, such as remembering things he wanted to do and telephone numbers. He also reported having trouble sleeping. He stated that he has strong opinions and when he was working would get into discussions with co-workers that sometimes turned loud. He stated that he gets irritated easily. He reported he doesn't have many interests other than going to church and sometimes to the casino. The Veteran underwent another VA examination on June 20, 2012. The examiner diagnosed PTSD and assigned a GAF of 53. The examiner noted the Veteran had also been diagnosed with a TBI and stated that mild cognitive impairment and mild memory loss are related to his TBI as per a June 2012 neurologist evaluation. The examiner opined that the Veteran has occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner noted that the neurologist who examined the Veteran in June 2012 found the Veteran's TBI did not contribute to major deficiencies in the Veteran's potential to work and his social life. The examiner stated that the Veteran self-isolates, communicating mostly to his daughters and granddaughter. He reported no friends and a poor social support system. The examiner noted the Veteran experiences the following symptoms: depressed mood; anxiety; suspiciousness; panic attacks weekly or less; chronic sleep impairment; mild memory loss; flattened affect; disturbance of motivation and mood; difficulty establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or worklike setting; inability to establish and maintain effective relationships; and obsessional rituals that interfere with routine activities. In this case, the Board has considered all of the evidence but finds that a rating in excess of 30 percent prior to June 20, 2012 and a rating in excess of 70 percent thereafter is not warranted. The only medical evidence addressing the severity of the Veteran's PTSD prior to June 20, 2012 is a letter from the Veteran's private physician and his VA examination, both from March 2010. The symptoms noted by the Veteran's private physician of insomnia and night terrors are similar to those found at his March 2010 VA examination. The private physician offered no assessment of the severity of the Veteran's condition or its affect on the Veteran, other than that he has been able to function but is getting worse. However, the March 2010 VA examiner opined that the Veteran's symptoms would cause only occasional decrease in work efficiency with intermittent periods of inability to perform occupational tasks with generally satisfactory functioning, the criteria for a 30 percent rating. In making that assessment, the examiner recognized the Veteran's reports of obsessions, ruminations, anxiety, depression, and fair judgment. The Board notes that the Veteran reported that when he was working he got along with some people and not with others, suggesting some ability to function within the workplace. The Veteran also reported some socialization, although not often. Further, the assigned GAF score of 65 represents mild symptoms and is consistent with the 30 percent rating assigned. Here, the weight of the lay and medical evidence clearly supports a finding, overall, of a mild disability or, at minimum, a disability that does not met the requirements of the next higher 50 percent evaluation. The evidence does not show that prior to June 20, 2012, the Veteran's PTSD caused occupational and social impairment with reduced reliability and productivity due to such symptoms as (for example only) flattened affect; circumstantial, circumlocutory, or stereotyped speech; difficulty in understanding complex commands; impairment of short-and long-term memory; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships, notwithstanding the findings of the private examiner. Even taking into consideration all of the Veteran's symptoms as the Veteran himself indicated, there is no a basis to grant the Veteran's claim for an increased rating prior to June 20, 2012. As the preponderance of the evidence is against the increased rating, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). The Board further finds the Veteran is not entitled to a rating in excess of 70 percent as of June 20, 2012. On that date, the Veteran underwent a second VA examination and the examiner opined that the Veteran has occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. However, the evidence does not suggest the Veteran experiences the symptoms typically associated with a 100 percent evaluation, including total occupational and social impairment due to such symptoms as (for example only) 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. The Board notes that although the Veteran reported being isolated, he also said he communicates with his daughters and granddaughter, showing he does not experience total social impairment. The June 2012 examiner opined not that the Veteran was unable to work or maintain social relationships, only that he had difficulty establishing and maintaining such effective relationships and difficulty adapting to stressful circumstances, including work or a worklike setting. Further, a GAF of 53 represents moderate symptoms, and is consistent with no higher than a 70 percent disability rating. Accordingly, the Board finds the Veteran is entitled to a 70 percent rating, but not greater, as of June 20, 2012. As the preponderance of the evidence is against the increased rating, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 54-56. Traumatic Brain Injury / Residuals of Concussion Blast to Both Eyes The Veteran is service connected to residuals of concussion blast to both eyes with a noncompensable rating from May 1952. In his June 2010 substantive appeal of his increased rating claim, the Veteran contended he should be rated at 20 to 30 percent. In a July 2012 rating decision, the RO evaluated the Veteran's claim for residuals of concussion blast to both eyes as a traumatic brain injury (TBI), noting that the Veteran was already receiving a separate evaluation for decreased visual acuity. The RO then awarded a 40 percent rating from June 15, 2012. Diagnostic Code 8045 states that there are three main areas of dysfunction that may result from TBIs and have profound effects on functioning: cognitive (which is common in varying degrees after a TBI), emotional/behavioral, and physical. 38 C.F.R. § 4.124a. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Cognitive impairment should be evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, should be evaluated under the subjective symptoms facet in the same table, with the exception of any residual with a distinct diagnosis that may be evaluated under another diagnostic code. Id. Emotional/behavioral dysfunction should be evaluated under § 4.130 when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, such symptoms should also be evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. Physical (including neurological) dysfunction should be evaluated based on the following list, under an appropriate diagnostic code: motor and sensory dysfunction, including pain of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. Other residuals reported on an examination should be evaluated under the most appropriate diagnostic code. Each condition should be evaluated separately, as long as the same signs and symptoms are not used to support more than one evaluation, and then combined under § 4.25. The evaluation assigned based on the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. Id. The table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" contains 10 important facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, and labeled "total." A 100- percent evaluation should be assigned if "total" is the level of evaluation for one or more facets. If no facet is evaluated as "total," the overall percentage evaluation should be assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. Id. The Veteran underwent a VA examination June 15, 2012. The examiner found mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment, corresponding to a severity level of 2 for the memory, attention, concentration, executive functions facet on the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table. The examiner found the Veteran has normal motor activity most of the time, but is mildly slowed at times due to apraxia, corresponding to a severity level of 1 for the motor activity facet. The examiner found the Veteran had normal judgment; routinely appropriate social interaction; normal visual spatial orientation; and was always oriented to person, time place, and situation. The Veteran was also found to have subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. He was also noted to have one or more neurobehavioral effects that do not interfere with workplace or social interaction. Finally, the examiner determined the Veteran is able to communicate by spoken and written language and he comprehended spoken and written language. All of the above correspond to a severity level of zero. The examiner also noted the Veteran has hearing loss and/or tinnitus and visual impairment. The Veteran is separately rated for each. As the highest level of severity assigned for any facet is two, assigned for impairment of memory, attention, concentration, or executive functions, the Veteran is entitled to a 40 percent rating. As the Veteran was not evaluated at a severity level of 3 for any facet, he is not entitled to the next higher, 70 percent, rating. Moreover, it is important to recognize that the Veteran is separately rated for service-connected PTSD and the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran's service-connected disability. 38 C.F.R. § 4.14 (2012). The medical evidence does not show that the Veteran is entitled to a compensable rating prior to June 15, 2012, the first date on which the Veteran was diagnosed with a TBI and the severity of his symptoms evaluated, as the evidence does not support that the Veteran's condition was of a compensable level at that time. Because the diagnosis of TBI may not be made by a layperson, the Board affords significant probative weight to the medical evidence of record. As the preponderance of the evidence is against the increased rating, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 54-56. Right Eye Disability The Veteran is service-connected for a right eye disability due to macular degeneration with hole with a 30 percent rating. Disability ratings for impaired vision generally are based on corrected distance vision with central fixation. 38 C.F.R. § 4.76 (2012). A compensable rating is warranted when corrected visual acuity in the more impaired eye is 20/50 (or worse) and the less impaired eye is 20/40 (or worse); a rating in excess of 30 percent is first warranted where both eyes are 20/100, or where one is 20/200 and the other is 20/70. 38 C.F.R. § 4.79, DC 6066 (2012). Where a claimant reports visual acuity that is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation is used. 38 C.F.R. § 4.76(b)(4). Under 38 C.F.R. § 4.75(c), if visual impairment of only one eye is service-connected, the visual acuity of the other eye will be considered to be 20/40 for purposes of evaluating visual impairment. 38 C.F.R. § 4.75(c) (2012). The evaluation for visual impairment of one eye must not exceed 30 percent unless there is anatomical loss of the eye. 38 C.F.R. § 4.75(d) (2012). The Veteran underwent a VA eye examination in March 2009. He reported blurring in both eyes. He stated that he is incapacitated due to his eye disability six or more times per year for more than two weeks each time. The examiner noted the Veteran had a paracentral corneal scar. He diagnosed the Veteran with a macular scar/hole in the right eye secondary to blast injury, macular degeneration (age related), and age related cataracts in each eye. The examiner found the Veteran's best corrected visual acuity in his right eye was 20/400. In February 2013 the Veteran was afforded another VA optometry examination. The examiner's assessment was dry age-related macular degeneration in both eyes, cataracts in both eyes that are visually significant, mild anterior blepharitis with symptoms in both eyes, astigmatism in the left eye, and presbyopia in both eyes. The examiner measured the Veteran's best corrected visual acuity as 20/400 in the right eye and 20/60 in the left eye. The examiner opined that the Veteran's vision loss and macular degeneration is not due to his service-connected injury. However, as noted by the RO in the March 2013 supplemental statement of the case, the Veteran has been service-connected for his right eye disability since March 2003, and when service connection has been in force for ten or more years it shall not be severed except upon a showing that the original grant of service connection was based on fraud, or if it is clearly shown from military records that the person concerned did not have the requisite service or character of discharge. 38 U.S.C.A. § 1159; 38 C.F.R. § 3.957. The RO did not attempt to sever service connection. As the Veteran is service-connected for his right eye disability, the Board must consider whether an increased rating is warranted. Impairment of central visual acuity is rated under DCs 6061-6066. As the Veteran's visual acuity in his right eye was measured at both his March 2009 and February 2013 examinations as 20/400, DC 6066 applies. The Veteran is not service-connected for his left eye, so under 38 C.F.R. § 4.75(d), the maximum evaluation for visual impairment for one eye cannot exceed 30 percent as there is not anatomical loss of the eye. Further, under 38 C.F.R. § 4.75(c), for purposes of evaluating his service-connected visual impairment, the visual acuity in the Veteran's left eye is considered to be 20/40, which would result in a 30 percent rating under DC 6066. 38 C.F.R. § 4.79. Although the Veteran reported having incapacitating episodes at his February 2013VA examination, the Board notes that for purposes of rating under DCs 6000-6009, the Veteran has to have either choroidopathy, keratopathy, scleritis, retinopathy or maculopathy, intraocular hemorrhage, detachment of retina, or unhealed eye injury that causes a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. 38 C.F.R. § 4.79. The evidence does not show the Veteran had any incapacitating episodes as defined by VA regulation. The Board has also considered other ratings under the schedule of ratings for the eye, but finds that none apply. As the preponderance of the evidence is against the increased rating, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 54-56. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), 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. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her 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; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). Such notice should also address VA's practices in assigning disability evaluations and effective dates for those evaluations. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). While the required notice should be furnished prior to the issuance of the appealed rating decision, any initial errors of notice will not be prejudicial if: 1) corrective actions (e.g., issuance of a post-adjudication notice letter containing the required information) are taken, and 2) the appeal is readjudicated (e.g., in a Supplemental Statement of the Case). See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Here, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in March 2009 and March 2010. In the letters, the RO informed the Veteran of what evidence was required to substantiate the claims for service connection and of the Veteran's and VA's respective duties for obtaining evidence. In the letters the RO also provided notice with regard to how VA assigns disability ratings and effective dates in the event that service connection is established. VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). The Board finds that all necessary development has been accomplished. The RO has obtained the Veteran's service treatment records and VA treatment records. The Veteran also submitted statements. 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. The Veteran was afforded VA medical examinations in June 2012 and February 2013. The examiners, medical professionals, obtained an accurate history, listened to the Veteran's assertions, and performed the necessary tests. The examiners provided the Board with sufficient information to rate the Veteran's disabilities. Therefore, the Board finds that the examinations are adequate and contain sufficient information to decide the issues on appeal. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist 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, 16 Vet. App. 183. ORDER A rating in excess of 30 percent prior to June 20, 2012 and a rating in excess of 70 percent thereafter for PTSD is denied. A compensable rating prior to June 15, 2012 and a rating in excess of 40 percent thereafter for traumatic brain injury (formerly, residuals of concussion blast to both eyes) is denied. A rating in excess of 30 percent for macular degeneration with hole, right eye, is denied. ____________________________________________ M. TENNER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs