Citation Nr: 1320296 Decision Date: 06/24/13 Archive Date: 07/02/13 DOCKET NO. 06-37 005A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to an initial rating in excess of 30 percent rating for posttraumatic stress disorder (PTSD) from August 22, 1983, to July 23, 2001. 2. Entitlement to an initial disability rating for PTSD in excess of 50 percent from July 24, 2001, to February 22, 2007. 3. Entitlement to an effective date earlier than May 16, 1996, for the grant of entitlement to service connection for ischemic heart disease (coronary artery disease). 4. Entitlement to an initial disability rating in excess of 20 percent for ischemic heart disease (coronary artery disease) from May 16, 1996, to May 22, 2000. 5. Entitlement to an effective date earlier than May 8, 2001, for the grant of entitlement to service connection for type II diabetes mellitus. 6. Entitlement to a disability rating in excess of 10 percent for type II diabetes mellitus from May 8, 2001. 7. Entitlement to a disability rating in excess of 20 percent for type II diabetes mellitus from March 8, 2004. 8. Entitlement to effective date earlier than July 24, 2001, for the grant of entitlement to special monthly compensation based on housebound status. 9. Entitlement to effective date earlier than May 23, 2000, for the grant of entitlement to eligibility to Dependents' Educational Assistance under 38 U.S.C. chapter 35. REPRESENTATION Appellant represented by: Robert V. Chisholm, Esq. WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD D. Cherry, Counsel INTRODUCTION The Veteran served on active duty from August 1968 to August 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The January 2006 rating decision granted the Veteran service connection for PTSD and assigned a 30 percent rating, effective July 24, 2001. Thereafter, a subsequent May 2009 rating decision increased the rating to 100 percent, effective February 23, 2007. Regardless of the RO's actions, the issue remained before the Board because the assigned rating prior to February 23, 2007 was not a complete grant of the maximum benefits available. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran had a video hearing before the undersigned in July 2010. A transcript of that proceeding has been associated with the claims file. In October 2010, the Board granted an earlier effective date of August 22, 1983, for the grant of entitlement to service connection for PTSD. The Veteran's claim was remanded by the Board in October 2010 as the issue of an increased initial rating was inextricably intertwined with the grant of an earlier effective date for his PTSD and the issue of increased rating was deferred pending the assignment of a rating for the period prior to July 24, 2001. In an October 2010 rating decision, the Appeals Management Center assigned a 30 percent disability rating for PTSD effective August 22, 1983. In December 2011, the Board granted a 50 percent disability rating for PTSD effective August 22, 1983. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (the Court). In August 2012, the Court granted a joint motion for remand and remanded the part of the Board's decision that denied entitlement to an initial rating greater than 50 percent prior to February 23, 2007, for PTSD. As will be discussed in further detail below, it appears that the RO has not full implemented the Board's grant of a 50 percent rating for PTSD, effective August 22, 1983. Instead, in a January 2012 rating decision, the RO assigned the 50 percent disability rating effective July 24, 2001, instead of August 22, 1983. The Veteran's counsel filed a notice of disagreement with that decision. Since the RO did not fully implement the Board's decision, the issue of entitlement to a rating in excess of 30 percent for PTSD for the period from August 22, 1983, to July 23, 2001, remains in appellate status and is before the Board. Therefore, a statement of the case regarding the January 2012 rating decision is unnecessary. The RO in a February 2012 rating decision adjudicated various issues, and later that month the Veteran's counsel filed a notice of disagreement with that decision in its entirety. In light of the above as well as the Board's decision below, the issues are as stated on the title page. The issues of entitlement to an effective date earlier than May 5, 2006, for the grant of a total disability rating based on individual unemployability; specially adapted housing or a special home adaption grant; and additional compensation for formerly dependent child, R, effective August 22, 1983, have been raised by the record, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. All issues except entitlement to an initial 50 percent disability rating for PTSD from August 22, 1983, to July 14, 1995; and entitlement to higher disability ratings for PTSD from July 15, 1995, to February 22, 2007; are addressed in the REMAND portion of the decision below and are REMANDED to the Department of Veterans Affairs Regional Office. FINDINGS OF FACT 1. From August 22, 1983, to July 14, 1995, the Veteran's PTSD was manifested by symptoms such as anxiety, flashbacks, nightmares, intrusive thoughts, hypervigilence, concentration problems, loss of interest, exaggerated startle response, feelings of guilt, memory problems, and outbursts of anger and irritability, but without suicidal or homicidal ideation; obsessional rituals that interfere with routine activities, illogical, obscure or irrelevant speech; near continuous panic or depression affecting the ability to function independently, spatial disorientation; or neglect of personal appearance or hygiene; all resulting in moderate social and occupational impairment. 2. The Board's December 2011 decision reflects that it found based on the above finding of fact that a 50 percent disability rating for PTSD was warranted from August 22, 1983, to July 14, 1995. 3. From July 15, 1995, to February 22, 2007, the evidence is in equipoise as to whether Veteran's PTSD resulted in him being demonstrably unable to obtain or retain employment. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 50 percent for PTSD from August 22, 1983, to July 14, 1995, have been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 200 & Supp 2012); 38 C.F.R. §§ 4.131, 4.132, Diagnostic Code 9411 (in effect prior to February 3, 1988); 38 C.F.R. § 4.132, Diagnostic Code 9411 (effective February 3, 1988); 38 C.F.R. § 4.130, Diagnostic Code 9411 (effective November 7, 1996). 2. Resolving doubt in the Veteran's favor, the criteria for a disability rating of 100 percent for PTSD from July 15, 1995, to February 22, 2007, have been met. 38 U.S.C.A. §§ 1155, 5107(b); 38 C.F.R. §§ 4.131, 4.132, Diagnostic Code 9411 (in effect prior to February 3, 1988); 38 C.F.R. § 4.132, Diagnostic Code 9411 (effective February 3, 1988); 38 C.F.R. §§ 3.102, 4.3, 4.130, Diagnostic Code 9411 (effective November 7, 1996). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The requirements of the Veterans Claims Assistance Act of 2000 (VCAA) have been met to the extent necessary to adjudicate the claims of entitlement to an initial 50 percent disability rating for PTSD from August 22, 1983, to July 14, 1995; entitlement to an initial disability rating for PTSD in excess of 30 percent from July 15, 1995, to July 23, 2001; and entitlement to an initial disability rating for PTSD in excess of 50 percent from July 24, 2001, to February 22, 2007. Given the decision below, a detailed explanation of how VA complied with the Act is unnecessary. Increased Compensable Rating Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 2002). Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4 (2012). The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2012). VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the issue involves the assignment of an initial rating for a disability following the initial award of service connection for that disability, as is the case here, the entire history of the disability must be considered and, if appropriate, staged ratings may be applied. Fenderson v. West, 12 Vet. App. 119 (1999). If there is a question as to which evaluation to apply to the Veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). As noted above, a January 2006 rating decision granted the Veteran service connection for PTSD and assigned a 30 percent rating, effective July 24, 2001. Thereafter, a subsequent May 2009 rating decision increased the rating to 100 percent, effective February 23, 2007. The previous October 2010 Board decision granted an earlier effective date for the Veteran's service-connected PTSD of August 22, 1983. A subsequent October 2010 rating decision assigned a 30 percent rating from August 22, 1983. The Veteran claims the rating does not accurately depict the severity of his condition during this time period. Specifically, the Veteran contends that his 100 percent rating should be effective from July 15, 1995, at which point he stopped working. The RO has listed the Veteran's service-connected PTSD as being rated under Diagnostic Code 9411 prior to December 14, 1999. Twice during the time frame of this appeal, effective February 3, 1988, and then again effective November 7, 1996, VA has revised the criteria for diagnosing and evaluating mental disorders, including PTSD. The Board will evaluate the Veteran's claim under all three sets of schedular criteria in the VA Schedule for Rating Disabilities and the current regulations in order to ascertain which version would accord him the highest rating. According to VAOPGCPREC 7-2003 (Nov. 19, 2003), in Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit (Federal Circuit) overruled Karnas v. Derwinski, 1 Vet. App. 308 (1991), to the extent it conflicts with the precedents of the United States Supreme Court (Supreme Court) and the Federal Circuit. Karnas is inconsistent with Supreme Court and Federal Circuit precedent insofar as Karnas provides that, when a statute or regulation changes while a claim is pending before VA or a court, whichever version of the statute or regulation is most favorable to the claimant will govern unless the statute or regulation clearly specifies otherwise. Accordingly, the rule adopted in Karnas no longer applies in determining whether a new statute or regulation applies to a pending claim. Id. However, none of the above cases or General Counsel Opinions specifically prohibits the application of a prior regulation to the period on or after the effective date of a new regulation. Thus, the rule that the Veteran is entitled to the most favorable of the versions of a regulation that was revised during his appeal allows application of the prior versions of the applicable DCs at 38 C.F.R. §§ 4.130 and 4.132 to the period on or after the effective dates of the new regulations. The effective date of any rating assigned under the revised schedular criteria may not be earlier than the effective date of that change; the Board must apply only the earlier version of the regulation for the period prior to the effective date of change. See VAOPGCPREC 3-2000; 38 U.S.C.A. § 5110(g) (West 2002 & Supp. 2012) (where compensation is awarded pursuant to any Act or administrative issue, the effective date of such award or increase shall be fixed in accordance with the facts found but shall not be earlier than the effective date of the Act or administrative issue). Initially, the Board notes that PTSD was added to VA's rating schedule on April 11, 1980. See 45 Fed. Reg. 26,326 (1980). 38 C.F.R. § 4.132, Diagnostic Code 9401, as in effect prior to February 3, 1988, provided for a noncompensable rating if there were neurotic symptoms which may somewhat adversely affect relationships with others but which do not cause impairment of working ability. See 38 C.F.R. § 4.132, Diagnostic Codes 9411 (1983). A 10 percent rating was assigned when emotional tension or other evidence of anxiety were productive of moderate social and industrial impairment. A 30 percent rating was assigned for definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms resulted in such reduction in initiative, flexibility, efficiency and reliability levels as to produce considerable industrial impairment. A 50 percent rating was assigned when ability to establish or maintain effective or favorable relationships with people was substantially impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels were so reduced as to result in severe industrial impairment. A 70 percent rating was assigned when ability to establish and maintain effective or favorable relationships with people was seriously impaired. The psychoneurotic symptoms were of such severity and persistence that there was pronounced impairment in the ability to obtain or retain employment. A 100 percent rating was assigned when the attitudes of all contacts except the most intimate were so adversely affected as to result in virtual isolation in the community; when the individual had totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality, with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior; and when the individual was demonstrably unable to obtain or retain employment. Effective February 3, 1988, the schedular criteria to rate psychiatric disorders was revised. See 38 C.F.R. § 4.132, Diagnostic Codes 9411 (1988); 53 Fed. Reg. 1441 (Jan 19, 1988). A 10 percent rating was assigned when there was less than the criteria for a 30 percent disability rating, with emotional tension or other evidence of anxiety productive of mild social and industrial impairment. A 30 percent rating was assigned when there was definite impairment in the ability to establish or maintain effective and wholesome relationships with people, and psychoneurotic symptoms resulted in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment. A 50 percent evaluation required that the Veteran's ability to establish or maintain effective or favorable relationships with people was considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels were so reduced as to result in considerable industrial impairment. A 70 percent evaluation required that the Veteran's ability to establish and maintain effective or favorable relationships with people was severely impaired. The psychoneurotic symptoms were of such severity and persistence that there was severe impairment in the ability to obtain or retain employment. A 100 percent evaluation required the attitudes of all contacts except the most intimate were so adversely affected as to result in virtual isolation in the community; totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior; or demonstrably unable to obtain or retain employment. 38 C.F.R. Part 4, Diagnostic Code 9411 (1988). Note (1) to the General Rating Formula for Psychoneurotic Disorders as in effect prior to November 7, 1996, provided that social impairment per se will not be used as the sole basis for any specific percentage evaluation, but was of value only in substantiating the degree of disability based on all of the findings. 38 C.F.R. § 4.132 (1995). The terms "considerable" and "severe" in 38 C.F.R. § 4.132 were quantitative in nature. See Hood v. Brown, 4 Vet. App. 301, 303 (1993). VA's Office of General Counsel issued a precedent opinion concluding that "considerable" was to be construed as "rather large in extent or degree." See VAOPGCPREC 9-93. The Board is bound by this interpretation of the term "considerable." See 38 U.S.C.A. § 7104(c). Under the current criteria, effective from November 7, 1996, the General Rating Formula for Mental Disorders provides, in pertinent part: 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) . . . . . . . . 30 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 . . . . . . . . . . . . . . . . . . . . . . . 50 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 a worklike setting); inability to establish and maintain effective relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or name . . . . . . . . . . . . . . . . . . . . . . . . . 100 38 C.F.R. § 4.130, DC 9411 (2012). Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase 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). Accordingly, the evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a Veteran's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the DSM-IV (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994)). Id. Additionally, a Global Assessment of Functioning (GAF) score is often used by treating examiners to reflect the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." See Richard v. Brown, 9 Vet. App. 266 (1996). GAF scores ranging between 61 and 70 reflect 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. GAF scores ranging from 51 to 60 reflect 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). Scores ranging from 41 to 50 reflect 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). See 38 C.F.R. § 4.130 [incorporating by reference the VA's adoption of the DSM-IV, for rating purposes]. Scores ranging from 31 to 40 reflect 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 other children, is defiant at home, and is failing at school). Analysis Entitlement to an initial 50 percent disability rating for PTSD from August 22, 1983, to July 14, 1995 In its December 2011 decision, the Board noted that throughout the appellate time period, the Veteran's PTSD was manifested by symptoms such as anxiety, flashbacks, nightmares, intrusive thoughts, hypervigilence, concentration problems, loss of interest, exaggerated startle response, feelings of guilt, memory problems, and outbursts of anger and irritability. October 2010 Board decision, page 20. The Board concluded that a 50 percent rating was warranted for the entire appellate period prior to February 23, 2007. Id. at 24. In light of the above, from August 22, 1983, to July 14, 1995, the Veteran's PTSD was manifested by symptoms such as anxiety, flashbacks, nightmares, intrusive thoughts, hypervigilence, concentration problems, loss of interest, exaggerated startle response, feelings of guilt, memory problems, and outbursts of anger and irritability, but without suicidal or homicidal ideation; obsessional rituals that interfere with routine activities, illogical, obscure or irrelevant speech; near continuous panic or depression affecting the ability to function independently, spatial disorientation; or neglect of personal appearance or hygiene; all resulting in moderate social and occupational impairment. The Board's December 2011 decision reflects that it found based on the above finding of fact that a 50 percent disability rating for PTSD was warranted from August 22, 1983, to July 14, 1995. As noted, this part of the Board's decision was not overturned by the Court, and 50 percent disability rating for PTSD must be assigned for the period from August 22, 1983, to July 14, 1995. The Board will address the issue of entitlement to a rating in excess of 50 percent for PTSD from August 22, 1983, to July 14, 1995, in the remand section of this decision, and thus is not adjudicating this matter at this time. Entitlement to an initial disability rating for PTSD in excess of 30 percent from July 15, 1995, to July 23, 2001, and entitlement to an initial disability rating for PTSD in excess of 50 percent from July 24, 2001, to February 22, 2007. The evidence, to include medical evidence and Social Security Administration records, show that the Veteran stopped working on June 14, 1995, following a back injury. The Social Security Administration eventually granted disability benefits effective July 15, 1995, based on lumbar degenerative disc disease, panic disorder without agoraphobia, and obsessive-compulsive personality disorder. Therefore, the evidence shows that the Veteran was demonstrably unable to obtain or retain employment. The question is whether he was demonstrably unable to obtain or retain employment, a criterion for a 100 percent disability rating under both the pre-February 1988 and the February 1988 rating schedule. The record is replete with conflicting medical evidence on this question. The record on appeal demonstrates that, in addition to PTSD, medical professionals have diagnosed various anxiety and mood disorders as well as personality disorders. The Board is precluded from differentiating between symptomatology attributed to a non-service-connected disability and a service-connected disability in the absence of medical evidence which does so. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). All psychiatric symptoms will be considered in the rating assigned in the absence of medical evidence attributing such symptoms to a disorder other than PTSD. An October 1995 VA examination shows a diagnosis of PTSD, with the possibility of bipolar functioning that was not prominent. The examiner described the impairment as only being moderately severe in nature. In a May 1996 statement to the Social Security Administration, the Veteran's treating psychiatrist diagnosed major depressive disorder and indicated that given the combination of the psychiatric symptomatology and physical complaints, it was unlikely that the appellant could maintain consistent work at this time. The Board notes that the medical evidence, to include VA treatment records and a January 2013 private psychiatrist evaluation by Dr. Smith, reflect that the mood disorder currently diagnosed as a depressive disorder has been associated with or cannot be separated from the PTSD. A January 1996 clinical interview summary reflects that following examination, the examiner diagnosed pain disorder, bipolar II disorder, PTSD, and personality disorder not otherwise specified. She assigned a GAF score of 48. The examiner noted that the Veteran's ability to maintain concentration and attention necessary to sustain employment was fair and that his ability to interact with fellow employees or the general public was impaired. The examiner indicated this was due to his symptom preoccupation, hypervigilence, tendency to be defensive, and other factors. The examiner concluded that his ability to tolerate the stress associated with normal employment is judged as impaired. With regard to the employment-impairment symptoms, the Board notes that a November 2005 VA examiner indicated that the Veteran's PTSD symptoms included irritability, trouble concentrating, and hyperviligance. The Board also notes that in an October 2007 statement the Veteran's treating doctor noted that his symptoms of PTSD included poor concentration, difficulty in performing moderately complex tasks, and avoidance of moderately stressful situations. In a July 1996 statement, the Veteran's treating psychiatrist stated that the Veteran had a rigid, inflexible personality style, and that it was highly unlikely that he could sustain employment because the employment would have to meet the needs of his protective, rigid personality style. The psychiatrist, however, added that while it is likely that his personality style began during his childhood, his personality style was exacerbated by his active service and that exacerbation contributed greatly to his employment difficulties. A December 1996 letter from the Veteran's private psychiatrist indicates that the Veteran exhibited paranoia and depressive symptoms and had a rigid and inflexible personality style. The psychiatrist opined that the appellant would have difficulty sustaining employment, as demonstrated by the large number of jobs the Veteran had held and his difficulty relating to co-workers and superiors, handling situations that are "gray" or unclear, being flexible in terms of rules and procedures, and staying on task in complex tasks that were emotionally laden. The diagnosis was PTSD and obsessive compulsive personality disorder and the GAF score assigned was 50. A May 1998 letter from the same psychiatrist noted that the claimant was classified as severely mentally disabled and that his primary diagnosis was a personality disorder, as well as symptoms of major depressive disorder and PTSD. The psychiatrist indicated that the personality disorder was likely to interfere with the Veteran's employment and could not sustain employment in an environment where he had to interact with other employees. The Board notes that this psychiatrist previously indicated in July 1996 that the personality style was exacerbated by his active service. A December 2003 VA examination report shows that the examiner diagnosed panic disorder in partial remission, bipolar disorder type 2 (provisional), and compulsive personality disorder. The examiner assigned only a GAF score of 60. As to the provisional diagnosis of a bipolar disorder, the Board notes that a November 2005 VA examiner stated that the Veteran's mood disorder, a provisional diagnosis of bipolar disorder, may have started before his service in Vietnam but that it had certainly worsened since his Vietnam experience. With regard to the diagnosis of a panic disorder, an April 2009 VA examiner stated that panic disorders were part of his PTSD symptomatology. A November 2005 VA examination report shows that the examiner diagnosed PTSD; bipolar disorder, provisional, with a history of mixed symptoms; history of paranoid personality disorder; and history of obsessive compulsive disorder. The assigned GAF score was 50 to 55 and that his GAF score for PTSD would only be 55. The examiner stated that the Veteran's most prominent psychiatric problem on examination was his serious mood disorder. The examiner attributed his extreme hostility, anger, impulsivity, poor judgment at times, circumstantial nature in his talking, and poor concentration were consistent with a hypomanic or manic symptomatology. In regard to the mood disorder, the examiner indicated that the appellant was not functioning well and his GAF score would be 45 to 50, consistent with moderate to severe symptomatology. The examiner opined that while his mood disorder may have started before he was in Vietnam it had certainly worsened since the Veteran's experience in Vietnam. The Board again notes that the medical evidence to include VA treatment records and January 2013 private psychological evaluation by Dr. Smith reflect that the mood disorder currently diagnosed as a depressive disorder has been associated with or cannot be separated from the PTSD. The examiner noted that his depression, anxiety, and hostility would prevent him from working, as evidenced by his past job history and repeated evidence of hostility in the record. As to this employment-impairment symptomatology, the Board notes that not only does the medical evidence show that depression and anxiety are related to PTSD but also that the April 2009 VA examiner indicated that irritability is a symptom of PTSD. In the January 2013 psychological evaluation, Dr. Smith in essence opined that the Veteran was unable to demonstrably unable to obtain or retain employment since he stopped working on July 14, 1995. Given this plethora of conflicting medical evidence in which the Board has addressed the inadequacies of much of the unfavorable medical evidence, the Board concludes that the evidence is in equipoise as to whether from July 15, 1995, to February 22, 2007, the Veteran's PTSD resulted in him being demonstrably unable to obtain or retain employment. Therefore, a 100 percent disability rating for PTSD from July 15, 1995, to February 22, 2007, is warranted. As the Board is assigned a 100 percent disability rating for PTSD during this period under the pre-1996 criteria, the Board does not need to address whether a 100 percent disability rating is warranted for the period from November 7, 1996, to February 22, 2007, under the current rating criteria for psychiatric disorders. ORDER Entitlement to an initial 50 percent disability rating for PTSD from August 22, 1983, to July 14, 1995, is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a 100 percent disability rating for PTSD from July 15, 1995, to February 22, 2007, is granted, subject to the laws and regulations governing the payment of monetary benefits. REMAND A June 1988 Dayton Vet Center treatment record shows that the Veteran was unemployed and an undated statement from that Vet Center reflects that the Veteran has had periods of employment and unemployment. A July 1997 statement of the Veteran in the Social Security Administration records provides some details about his employment history. He claimed that he was employed as a driver for one company from 1983 to possibly 1986, that he worked as a driver and laborer for another company in 1987, and that he worked at Roadway Express from June 1987 to July 1995. In a January 2013 statement, the Veteran reported that he was out of work for five years prior to working for Roadway Express and that he was fired from Roadway Express six times. The RO should obtain additional clarification about the appellant's employment history from August 1983 to July 1995. Through the years, the Veteran has received treatment at the Dayton VA Medical Center. A review of the claims file shows that the records from the Dayton VA Medical Center from 1983 to April 1991 have been obtained. The RO should attempt to obtain any records from the Dayton VA Medical Center from April 1991 to July 1995. A review of the claims file shows that the records from the Dayton Vet Center up to September 1988 have been obtained. The RO should attempt to obtain any records from the Dayton Vet Center from September 1988 to July 1995. A review of the claims file reflects that the Veteran has received treatment from various private medical providers during the period from 1983 to 1995 for which there are not complete records: Dr. Litle, D.O., starting in 1983; Dr. Chamberlain; Dr. Barry, M.D., starting in 1990; and Dr. Frenkel, M.D., starting in November 1993. The RO should attempt to obtain all records from these doctors up to July 1995. An October 2007 statement from Dr. Schwartz, M.D., reflects that he has been treating the Veteran. It is unclear when the Veteran started receiving treatment from Dr. Schwartz. The RO should attempt to obtain any records from Dr. Schwartz prior to August 1995. In a February 2012 rating decision, the RO granted an earlier effective date of May 16, 1996, for the grant of service connection for ischemic heart disease (coronary artery disease) and assigned a 20 percent disability rating effective May 16, 1996, and a 100 percent disability rating from May 23, 2000. The RO changed the effective date for the grant of service connection for type II diabetes mellitus from May 2, 2002, to May 8, 2001. The RO assigned a 10 percent disability rating for type II diabetes mellitus effective May 8, 2001, and denied a rating in excess of 20 percent for type II diabetes mellitus since March 8, 2004. The RO granted an earlier effective date earlier of July 24, 2001, for the grant of entitlement to special monthly compensation based on housebound status. The RO granted an earlier effective date of May 23, 2000, for the grant of entitlement to eligibility to Dependents' Educational Assistance under 38 U.S.C. chapter 35. Later that month, the Veteran's counsel filed a notice of disagreement with that decision in its entirety. As such, the RO must issue a statement of the case concerning the issues adjudicated in the February 2012 rating decision. Manlincon v. West, 12 Vet. App. 242 (1999). Accordingly, the case is REMANDED for the following action: 1. The RO should ask the Veteran to provide a detailed employment history from August 1983 to June 1987 prior to his employment with Roadway Express, to include the nature of his jobs and whether the jobs were full-time or part-time, as well as a detailed history of his periods of unemployment after being fired from Roadway Express six times during the period from June 1987 to July 1995. 2. The RO should ask the Veteran to identify all treatment for his psychiatric disorders from August 1983 to July 1995. In addition to any other medical providers the appellant identifies, the RO should attempt to obtain records from the following providers: Dr. Litle, D.O., from August 1983 to July 1995; Dr. Chamberlain, from August 1983 to July 1995; Dr. Barry, M.D., from 1990 to July 1995; Dr. Frenkel, M.D., from November 1993 to July 1995; and Dr. Schwartz, M.D., for the period prior to July 1995. Regardless of the Veteran's response, the RO should attempt to obtain all records from the Dayton VA Medical Center from April 1991 to July 1995 and the Dayton Vet Center from September 1988 to July 1995. Any obtained records should be associated with the Veteran's claims file. 3. The RO should issue a statement of the case addressing the issues of entitlement to an effective date earlier than May 16, 1996, for the grant of entitlement to service connection for ischemic heart disease (coronary artery disease); entitlement to an initial disability rating in excess of 20 percent for ischemic heart disease (coronary artery disease) from May 16, 1996, to May 22, 2000; entitlement to an effective date earlier than May 8, 2001, for the grant of entitlement to service connection for type II diabetes mellitus; entitlement to a disability rating in excess of 10 percent for type II diabetes mellitus from May 8, 2001; entitlement to a disability rating in excess of 20 percent for type II diabetes mellitus from March 8, 2004; entitlement to effective date earlier than July 24, 2001, for the grant of entitlement to special monthly compensation based on housebound status; and entitlement to effective date earlier than May 23, 2000, for the grant of entitlement to eligibility to Dependents' Educational Assistance under 38 U.S.C. chapter 35. The Veteran is hereby informed that the Board may only exercise appellate jurisdiction over this matter if he perfects an appeal in a timely manner. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.200 (2012). 4. The RO should undertake any additional development based on the evidence obtained as to the claim of entitlement to an initial rating in excess of 50 percent for PTSD from August 22, 1983, to July 14, 1995. If the benefit is not granted, the Veteran should be furnished with a supplemental statement of the case, with a copy to his counsel, and afforded an opportunity to respond. The appellant has the right to submit additional evidence and argument on the 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). ______________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs