Citation Nr: 1320044 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 09-45 178 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to an initial disability rating in excess of 30 percent for service-connected posttraumatic stress disorder (PTSD), to include depression and alcohol abuse, prior to June 28, 2011 and entitlement to an initial disability rating in excess of 50 percent for PTSD, to include depression and alcohol abuse, from June 28, 2011. 2. Entitlement to service connection for residuals of a traumatic brain injury (TBI). 3. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J.M. Seay, Associate Counsel INTRODUCTION The Veteran had active service from July 1999 to February 2000 and from November 2001 to January 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, wherein the RO denied service connection for a TBI and granted service connection for PTSD and assigned an initial disability rating of 30 percent, effective March 25, 2008. In an August 2011 rating decision, the RO assigned a higher initial disability rating of 50 percent for PTSD, to include alcohol abuse and depression, effective June 28, 2011. Accordingly, staged ratings have been created, and the Board has recharacterized this issue as it appears on the first page of this remand, and the Veteran's claim remains on appeal. AB v. Brown, 6 Vet. App. 35 (1993) (in an appeal in which the veteran expresses general disagreement with the assignment of a particular rating and requests an increase, the RO and the Board are required to construe the appeal as an appeal for the maximum benefit allowable by law or regulation). Additional evidence has been associated with the claims file following the supplemental statement of the case. In the May 2013 brief, the Veteran's representative waived initial review by the AOJ of any additional evidence submitted. Therefore, the evidence is accepted for inclusion in the record. 38 C.F.R. §§ 19.9; 20.1304(c) (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. FINDINGS OF FACT 1. During the entire period on appeal, the Veteran's service-connected PTSD was manifested by occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood. 2. Resolving all doubt in favor of the Veteran, residuals of a TBI have been etiologically related to an in-service injury. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating of 70 percent, but no higher, for PTSD have been met for the entire appeal period. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). 2. Resolving all doubt in favor of the Veteran, the criteria for service connection for residuals of a TBI have been met. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's 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); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Duty to Notify Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative, if any, of any information and any medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice 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. VCAA notice should be provided to a claimant before the initial unfavorable decision by the agency of original jurisdiction on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). First, as will be discussed in detail below, the Board has granted entitlement to service connection for residuals of a TBI, which constitutes a complete grant of the Veteran's claim. Therefore, no discussion of VA's duty to notify or assist is necessary. Here, the Veteran is appealing the initial rating assignment as to his service-connected PTSD, to include depression and alcohol abuse. Once service connection has been granted, the context in which the claim initially arose, the claim has been substantiated; therefore, additional VCAA notice under § 5103(a) is not required because the initial intended purpose of the notice has been fulfilled, so any defect in the notice is not prejudicial. Goodwin v. Peake, 22 Vet. App. 128 (2008); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Rather, thereafter, once a notice of disagreement (NOD) has been filed, for example contesting a downstream issue such as the initial rating assigned for the disability, only the notice requirements for a rating decision and statement of the case (SOC) described in 38 U.S.C. §§ 5104 and 7105 control as to the further communications with the Veteran, including as to what evidence is necessary to establish a more favorable decision with respect to downstream elements of the claim. 38 C.F.R. § 3.159(b)(3). The RO has provided the Veteran the required SOC discussing the reasons and bases for not assigning a higher initial rating and citing the applicable statutes and regulations. Duty to Assist With regard to the duty to assist, the claims file contains service treatment records, service personnel records, VA treatment records, and lay statements provided by the Veteran. The Veteran underwent VA examinations in connection with his claim in January 2009 and June 2011. To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The examiners reviewed the claims file, noted the Veteran's reported symptoms, provided mental status examinations, and provided findings relevant to the criteria for rating the disability at issue. Nieves-Rodriguez v. Peake, 22 Vet App 295 (2008). Thus, the Board finds that VA's duty to assist with respect to obtaining an examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). As all relevant facts have been properly and sufficiently developed in this appeal, no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to his claim. Essentially, all available evidence that could substantiate the claim has been obtained. Initial Rating Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4 (2012). Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2012); see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). The primary concern in a claim for an increased evaluation for service-connected disability is the present level of disability. Although the overall history of the disability is to be considered, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The evaluation must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a) (2012). Although the extent of social impairment is a consideration in determining the level of disability, the rating may not be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126(b) (2012). According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV), a global assessment of functioning (GAF) score reflects the "psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness." DSM-IV, American Psychiatric Association (1994), pp. 46-47; 38 C.F.R. §§ 4.125(a), 4.130 (2012). A GAF score of 31-40 indicates 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; child frequently beats up younger children, is defiant at home, and is failing at school). A GAF score of 41-50 indicates 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). A GAF score of 51-60 represents 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). A GAF score of 61-70 indicates 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 generally functioning pretty well and has some meaningful interpersonal relationships. The Veteran's service-connected PTSD has been rated under the provisions of 38 C.F.R. § 4.130, Diagnostic Code 9411, which provides: A 30 percent disability rating is warranted 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). A 50 percent disability rating is warranted when the Veteran experiences 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. A 70 percent disability rating is warranted when the Veteran experiences occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work-like setting); and inability to establish and maintain effective relationships. A 100 percent disability rating is warranted for 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 ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. 38 C.F.R. § 4.130. Analysis The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant). The Veteran was provided a VA examination in January 2009. The claims file was reviewed. The Veteran reported the following symptoms of PTSD: painful intrusive memories of his combat experiences that occurred several times a week; nightmares that occurred on an almost nightly basis; self-medication with alcohol, pushing away painful thoughts, feelings, and memories; avoiding situations that he knows will cause him difficulties such as hearing news and seeing movies about combat; loss of interest in previously pleasurable activities, feeling emotionally walled off, numbed and detached from almost everyone and he lost two jobs due to irritability and difficulty with concentration and focus; feelings of anxiety and depression with a denial of suicidal ideation; disturbed sleep patterns; difficulty being angry, irritable, and short-tempered which caused difficulty at home and friction at work; difficulty with concentration, focus, and memory on a daily basis and difficulty in the workplace; and startles quite easily. It was noted that the Veteran was working full time at a heating and air conditioning company; however, the Veteran described the above difficulties with interactions with co-workers, as well as concentration and focus. He also described difficulty with similar symptoms leading to the loss of two other jobs since his discharge from the Marine Corps. With respect to social history, the Veteran stated that he had been married for seven years and he described difficulty at home because of his PTSD symptoms. He described complete social isolation due to lack of interest in social activities. This was in contrast to previously pleasurable levels of social activities in high school, when he was active in many functions and had a high grade point average. The mental status examination revealed that the Veteran appeared to be anxious and depressed and his affect was constricted and guarded. His thoughts were clear and goal oriented with no evidence of delusions or hallucinations. He described difficulty with concentration and memory. His judgment and capacity for abstraction were intact. Grooming and hygiene were appropriate and speech and communication were appropriate. There was no panic or obsessional rituals and no suicidal ideation. There was on-going hypervigilance. The diagnoses were listed as PTSD and Cognitive Disorder NOS. The examiner listed a GAF score of 55 for the Veteran's PTSD. The examiner commented that the Veteran's symptoms of PTSD appeared to be causing profound difficulties; both socially, causing complete social isolation as well as at home and the Veteran's PTSD symptoms were clearly impacting his work performance. It appeared that the Veteran had cognitive difficulties and the examiner assumed that the cognitive difficulties were also likely due to the impact of his significant PTSD. The VA treatment records show GAF scores ranging from 40 to 60. The Veteran has complained of irritability to include angry outbursts, depression, sleep impairment, limited affect, poor decision making relating to judgment, increased impulsivity, social isolation, and problems with concentration. The VA treatment records show that the Veteran's grooming has been evaluated as fair and adequate. In addition, the Veteran has reported experiencing suicidal thoughts. The September 2009 VA treatment record shows that the Veteran denied present suicidal or homicidal ideation; however, two weeks ago, he had thoughts, a plan and began fidgeting with a rifle slug. He did not act on his thoughts/plans due to his children. He denied history of a suicidal plan, but had occasional and brief fleeting thoughts. The September 2010 and April 2011 VA treatment records noted that the Veteran reported fleeting suicidal thoughts at times. The May 2010 VA treatment record shows that the Veteran had thoughts of suicide. The October 2010 VA treatment record shows that the Veteran had suicidal ideation three weeks ago. The June 27, 2011 VA treatment record noted that the Veteran reported putting his loaded .45 caliber pistol in his mouth on June 17, 2011 and that he actively considered shooting himself, but stopped on his own, and called a friend. He stated that he has had increasing periodic suicidal thoughts over time and, once in the past, while thinking about suicide, handled a handgun in a lingering manner. He also stated that he hears voices, always combat related. The June 2011 record noted that the Veteran evidenced some insight although significant limitations of this were apparent. The majority of the VA treatment records show that the Veteran denied homicidal ideation; however, the October 2010 VA treatment record noted that he had homicidal ideation towards his wife but he would "never do that." The VA treatment records also reveal notations of restricted affect. The Veteran was provided a VA examination on June 28, 2011. The claims file was reviewed. The Veteran reported depression, suicidal thoughts, intrusive thoughts, excessive anger and irritation, insomnia, guilt, appetite problems, nightmares, worries, and an inability to relax. He stated that last Friday, he had a gun in his mouth and then talked to a friend to calm him down. He had these same feelings yesterday. He connects them to long term PTSD and now going through a divorce. He had frequent suicidal thoughts but never made a suicide attempt. He estimates being depressed about 70 percent of the time. The Veteran stated that he was always nervous and panicking and avoided standing by windows or in crowds. He does not go shopping unless he has to and dislikes the people who are loud and having people behind him. He goes to restaurants occasionally but usually is not relaxed. He is not able to sleep without medication. He stated that he isolates and is more prone to arguing. He stated that he argues all the time and had a fight last Saturday with his best friend. He reported concentration problems when driving that cause him to miss turns all the time and had a tendency to be lost. He had poor appetite and sometimes forgets to eat dinner. He also reported flashbacks. He stated that he was going through a divorce. Since leaving the Marines, he worked as a restaurant manager, in heating and air conditioning, and in fast food. He did apartment maintenance for about seven months and then obtained his current job as a Disabled American Veterans Service Officer. He stated that he had been there for about three months and he loved it. He reported that he drinks about 1.75 liters of alcohol every five days. He has never had legal problems. The Veteran lived by himself and occupied himself by playing games on his computer. He has three children but sees them rarely since the separation from his wife. He has one friend but no friends he gets together with. He has not had contact with his family in two months because his mother blamed him for the divorce. Objectively, the Veteran demonstrated appropriate grooming and hygiene. His speech was clear and rapid. Orientation was appropriate and thinking was logical and productive, but disorganized. Thought content was notable for preoccupation with events that occurred in Iraq and for suicidal ideation. The relationships with others seemed fair in quality but with a low frequency of contact and a preference for being alone. Self-esteem was low and the Veteran had moderate substance abuse problems. His reasoning skills indicated the capacity for abstract thinking with an estimated intellectual functioning level in the average range. Judgment was diminished by depression leading to suicidal thinking and excessive alcohol use. He was currently receiving medication and recognized his need for counseling. The examiner noted that the Veteran's PTSD continued to be manifested by intrusive memories, nightmares, diminished interest in normal activities, detachment from others, restricted affect, sleep disturbance, anger outbursts, concentration problems, and hypervigilance. He has suicidal ideation and some recent increase in that related to his separation from his wife. The examiner indicated that intensity is moderate with impaired social relationships, marital functioning, judgment, mood, and range of activities. It interferes with being able to shop and eat in restaurants comfortably. The Veteran demonstrated reduced reliability and productivity in his occupational and social functioning because of flattened affect, impaired concentration, impaired judgment, disturbances of motivation and mood, and difficulty establishing and maintaining relationships. The examiner stated that the Veteran was currently employed and intended to continue that employment. His PTSD may have an effect on his employability at times because of how it could impair his concentration, social comfort, frustration tolerance, and anger control. He does currently seem to work a full day on a regular and reliable basis. The diagnoses were listed as PTSD, chronic and alcohol abuse. The GAF score was 51 due to low social tolerance, fighting, suicidal ideation, and few friendships. The Veteran has been assigned an initial 30 percent disability rating, effective March 25, 2008, and assigned an initial 50 percent disability rating for his PTSD, effective June 28, 2011. Fenderson v. West, 12 Vet. App. 119 (1999). However, the Board finds that the Veteran's PTSD is entitled to an initial 70 percent disability rating for the entire period on appeal. In this respect, the Board finds that the Veteran's symptomatology is more commensurate with occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood. The VA treatment records reflect that the Veteran has had poor decision making with respect to judgment and deficiencies in mood. The Veteran has reported being irritable and angry. During the June 2011 VA examination, he stated that he was depressed about 70 percent of the time. With respect to social impairment, the January 2009 VA examiner indicated that the Veteran's PTSD caused profound difficulties and complete social isolation. The June 2011 VA examiner noted that the Veteran only had one friend, but no current contact with family and no friends that he gets together with. With respect to occupational impairment, the record reflects that the Veteran was employed at different jobs during the pendency of the appeal including as a warehouse manager and worked installing heating and cooling systems. However, he stated that he had been fired from jobs due to conflicts with co-workers and an angry outburst at work. Indeed, the evidence reflects impaired impulse control. The Veteran has reported hurling a dog in anger and swatting his daughter. With respect to difficulty in adapting to stressful circumstances (including work or work-like setting), again the Veteran stated that he has been fired in the past due to angry outbursts and he may have difficulty adapting to stressful circumstances. Finally, the record reflects that the Veteran has suicidal ideation. Although the VA treatment records show that the Veteran has had fleeting thoughts, the Veteran has had a plan and held a gun when contemplating such thoughts. Therefore, although the most recent VA examiner evaluated the Veteran's PTSD as moderate, in reviewing all of the symptoms and the complete disability picture presented by the Veteran's PTSD, the Board finds that the evidence reflects occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood. See also Mauerhan v. Principi, 16 Vet. App. 436 (2002). However, the Board finds that a 100 percent disability rating is not warranted as the evidence does not reflect total occupational and social impairment. The evidence does not reflect gross impairment in thought processes or communication; persistent delusions or hallucinations; 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 closest relatives, own occupation, or own name. While the evidence does show that the Veteran reported hearing voices in a June 2011 VA treatment record, the majority of the evidence of record consisting of the VA examination reports and VA treatment records show that the Veteran has denied experiencing auditory or visual hallucinations and delusions on many occasions. Further, although the Veteran has reported homicidal ideation on occasion when he was married to his wife and suicidal thoughts, the evidence does not indicate that he is in persistent danger of hurting himself or others. The June 2011 VA treatment record noted that the Veteran reported putting his loaded .45 caliber pistol in his mouth on June 17, 2011 and that he actively considered shooting himself, but stopped on his own, and called a friend. He stated that he has had increasing periodic suicidal thoughts over time and, once in the past, while thinking about suicide, handled a handgun in a lingering manner. The Veteran has also stated that he had thoughts of slitting his wrists. The June 2011 VA examiner also noted that the Veteran had suicidal ideation. However, suicidal ideation is listed as a symptom for his currently assigned 70 percent disability rating. The evidence simply does not support a persistent danger of hurting self or others. Further, in considering the complete disability picture and PTSD symptoms, the Veteran's PTSD does not manifest in total occupational and social impairment. Throughout this period, VA physicians assigned GAF scores ranging from 40 to 60, indicating serious to moderate symptoms. Upon review of the evidence, the Board finds that the GAF scores are commensurate with the currently assigned 70 percent disability rating-reflecting serious impairment related to his PTSD. With respect to the lower GAF scores of 40, the Board does not find that the Veteran's overall symptoms and level of functioning support the higher disability rating of 100 percent. As noted above, the GAF score is only one component of a Veteran's disability picture and the Board finds that the reported clinical findings are consistent with the current 70 percent disability rating. For these reasons, the Board finds that the criteria for an initial disability rating of 70 percent, but no higher, for PTSD, to include depression and alcohol abuse, have been met for the entire appeal period. 38 C.F.R. § 4.130. By this decision, the Board has also found that a disability rating in excess of 70 percent is not warranted. As the preponderance of the evidence is against the assignment of a higher disability rating, there is no doubt to be resolved, and an initial disability rating in excess of 70 percent for PTSD, to include depression and alcohol abuse, is not warranted. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Extraschedular consideration An exceptional or unusual disability picture occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of a veteran's service-connected disability. Thun v. Peake, 22 Vet. App. 111, 115 (2008). If there is an exceptional or unusual disability picture, the Board must consider whether the disability picture exhibits other factors such as marked interference with employment and frequent periods of hospitalization. Id. at 115-116. When those two elements are met, the appeal must be referred for consideration of the assignment of an extraschedular rating to the Chief Benefits Director or the Director, Compensation and Pension Service. 38 C.F.R. § 3.321(b)(1) (2012). Otherwise, the schedular evaluation is adequate, and referral is not required. Thun, 22 Vet. App. at 116. Here, the Board finds the Veteran's disability picture is not so unusual or exceptional in nature as to render the rating assigned herein inadequate. The Veteran's service-connected PTSD is evaluated as a psychiatric disability, the criteria of which is found by the Board to specifically contemplate the level of occupational and social impairment caused by this disability. Thun, 22 Vet. App. at 115; see also 38 C.F.R. § 4.130, Diagnostic Code 9411. During the appeal period, the Veteran's PTSD was manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood including symptoms such as impaired impulse control, poor judgment, suicidal ideation, and social isolation. When comparing this disability picture with the symptoms contemplated by the Rating Schedule, the Board finds that the Veteran's symptoms are contemplated by a 70 percent disability rating. A rating in excess of 70 percent is provided for increased severity of PTSD, but the medical evidence demonstrates that the Veteran's PTSD is not more severe than that contemplated by the 70 percent rating. The criteria for the 70 percent disability rating assigned herein more than reasonably describe the Veteran's disability level and symptomatology, and therefore, the schedular evaluation is adequate, and no referral is required. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Service Connection for Traumatic Brain Injury Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). The Veteran states that he has residuals from a traumatic brain injury (TBI) that he incurred during his period of active service in Iraq. The medical evidence demonstrates that the Veteran has been diagnosed with a TBI. The January 2009 and June 2011 VA examination reports show that the Veteran has been diagnosed with mild TBI/residuals of TBI. The service treatment records are absent for any treatment, diagnosis or complaint related to a TBI. The record reflects complaints of dizziness, lightheadedness, and headaches; however, these symptoms were related to the Veteran's postprandial hypoglycemia, which were present prior to the Veteran's tour in Iraq wherein he stated that he experienced a TBI. In fact, the March 2005 report of medical history shows that the Veteran denied experiencing a head injury. However, the Veteran has submitted statements relating to his in-service TBI. In the notice of disagreement, the Veteran explained that his TBI warranted service connection because he was directly exposed to the blast from at least two direct impacts from high explosive rounds. One in particular exploded at the phone center onboard Camp Blue Diamond in Ramadi, Iraq. He stated that the building was composed of concrete and cinder block and was a huge "echo chamber." He stated that he suffered from memory loss for two weeks following the event. The January 2009 VA examination report shows that the Veteran reported a blast injury secondary to a mortar attack with loss of memory for two weeks. He also reported that he was in a blast area when a rocket-propelled grenade (RPG) detonated at 50 feet. In a July 2009 statement from a fellow serviceman, E.N.O. stated that he served with the Veteran in Ramadi, Iraq from February 2004 to June 2004. He stated that he remembered two incidents during which the Veteran was injured. The first was an indirect mortar fire attack against Camp Blue Diamond in Ramadi, Iraq in March or April 2004. A series of heavy mortar rounds hit the camp-several of which exploded on or near the camp phone center and that the Veteran was inside the phone center. He stated that he remembered seeing the Veteran exit the phone center with both of his hands clasping the sides of his head. E.N.O. stated that he yelled at the Veteran to see if he was okay, but that the Veteran was unresponsive to his questions. He also noticed that the Veteran changed after the event and was very forgetful and would complain about his head hurting. He stated that he saw the Veteran in the aid station on at least one other occasion with a complaint of a severe headache. He also stated that there was another incident consisting of an RPG attack in which an RPG exploded about 50 feet away from the Veteran. E.N.O. stated that the Veteran was knocked "loopy" and had blurry vision after that one. He explained that the Veteran continued to complain about headaches and dizziness throughout the rest of his tour in Iraq. The Board notes that the Veteran's military occupational specialty (MOS) was food service specialist. However, in the RO's own research, it was noted that the Veteran's unit had extensive contact with insurgents between February and June 2004, including the battle of Ramadi in April 2004. The Military Records Specialist indicated that it was entirely possible that the Veteran experienced some amount of mortar shelling and small arms fire in and around his area of operations. Thus, with respect to an in-service injury, disease, or event, the Board notes that there is no documentary evidence in the service treatment records demonstrating that the Veteran incurred a TBI during his period of service in Iraq. The Veteran denied experiencing a head injury after his return from his tour in Iraq. However, given the RO's own research regarding mortar and small arms fire in the location that the Veteran was stationed, E.N.O.'s statement, and the Veteran's own statements, the Board finds that the evidence is in equipoise as to whether the injuries occurred and will resolve any doubt in favor of the Veteran. 38 U.S.C.A. § 5107(b). Thus, the pertinent inquiry is whether the Veteran has a current disability that is etiologically or causally related to active service. In this respect, the Veteran was provided a VA examination in January 2009. The examiner reviewed the claims file. The Veteran reported that he was in a blast injury secondary to mortar attack with loss of memory post-event for two weeks. The Veteran also stated that he was in a blast area when an RPG detonated at 50 feet. At that time, he saw stars and experienced confusion for three to four hours and became light sensitive and developed tinnitus after that episode. The examiner listed a diagnosis of traumatic brain injury. The examiner opined that it was at least as likely as not that the Veteran's head injury results in the current condition. Inasmuch as the Veteran has a current diagnosis of residuals of a TBI, which have been found by the aforementioned VA examiner to be the result of the in-service head injury, the criteria for service connection for residuals of a TBI have been met. Service connection for residuals of a TBI is granted. 38 U.S.C.A. § 5107(b). ORDER Entitlement to an initial disability rating of 70 percent for PTSD, to include depression and alcohol abuse, is granted for the entire appeal period, subject to the laws and provisions governing the award of monetary benefits. Entitlement to service connection for residuals of a TBI is granted. REMAND The Court has held that a TDIU claim is part and parcel of an increased rating claim when raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). As a result, the Board has jurisdiction to consider the Veteran's possible entitlement to a TDIU when the issue is raised by assertion or reasonably indicated by the evidence and is predicated, at least in part, on the severity of the service-connected disability in question, regardless of whether the RO has expressly addressed this additional issue. See VAOPGCPREC 6-96 (Aug. 16, 1996); see also Caffrey v. Brown, 6 Vet. App. 377 (1994); Fanning v. Brown, 4 Vet. App. 225, 229 (1993). In this case, the Veteran has not filed a formal claim for a TDIU; however, the Veteran has reported that he lost several jobs due to his PTSD. During the most recent VA examination, the Veteran indicated that he was currently employed at the Disabled Americans Veterans office as a service officer. However, in the appellant's brief, the Veteran's representative indicated that there was no evidence that the Veteran was currently employed as a Disabled American Veterans Service Officer in St. Louis, Missouri. However, the Board does note that the Veteran may live closer to VA facilities or offices in Arkansas as he receives VA treatment at the VA Medical Center in Fayetteville, Arkansas. Thus, he may be employed at an office in Arkansas and not Missouri. Nevertheless, the Board finds that the record reasonably raises the issue of entitlement to a TDIU-whether the Veteran can secure or follow a substantially gainful occupation due to his service-connected disabilities. 38 C.F.R. § 4.16. Therefore, as the issue of entitlement to a TDIU has been reasonably raised by the evidence of record, the issue should be adjudicated as part of the claim on appeal. Id.; see also Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001); Bowling v. Principi, 15 Vet. App. 1 (2001). As such, the claim for entitlement to a TDIU is remanded for appropriate action. Accordingly, the case is REMANDED for the following action: 1. Send the Veteran VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, with instructions to return the form and request that the Veteran inform the RO/AMC as to whether he is currently employed. 2. The RO/AMC should complete any additional evidentiary development necessary to adjudicate a claim for a TDIU. 3. The RO should schedule the Veteran for an examination to determine the effect of his service- connected disabilities on his ability to secure or follow a substantially gainful occupation. The examiner is requested to offer an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran's service-connected disabilities, alone or in combination, prevent him from securing or following a substantially gainful occupation. When offering this opinion, the examiner should not consider the effects of age, or any non-service connected disability. A complete rationale for all opinions expressed must be provided. 4. Notify the Veteran that he must report for the examination and cooperate in the development of the claim. Failure to report for a VA examination without good cause may result in denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2012). 5. When the development requested has been completed, adjudicate the claim for entitlement to a TDIU. If the benefit sought is not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further appellate review. 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). 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). ______________________________________________ ROBERT C. SCHARNBERGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs