Citation Nr: 1321044 Decision Date: 07/01/13 Archive Date: 07/12/13 DOCKET NO. 08-12 780 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for peripheral vascular disease, to include as secondary to service-connected posttraumatic stress disorder (PTSD) or coronary artery disease. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD or coronary artery disease. 3. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as secondary to service-connected PTSD or coronary artery disease. 4. Entitlement to initial disability ratings for PTSD in excess of 30 percent prior to August 21, 2008, and in excess of 50 percent prior to March 8, 2010. 5. Entitlement to special monthly compensation (SMC) pursuant to 38 U.S.C.A. § 1114(s) (except for the period as of March 8, 2010, during which SMC has been granted). REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD David Gratz, Counsel INTRODUCTION The Veteran served on active duty from July 1961 to April 1969. He served in the Republic of Vietnam from December 11, 1966 to July 14, 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California, which granted the Veteran's claim of service connection for PTSD, and assigned a 30 percent disability rating effective as of the January 10, 2006 date of claim. In subsequent rating decisions, including most recently in February 2012, the RO increased the Veteran's initial rating to 50 percent as of August 21, 2008, and to 100 percent as of March 8, 2010, both being the dates of VA examinations. This matter also comes before the Board on appeal from an August 2007 rating decision of the VA RO in Los Angeles, California, which denied the Veteran's claims of service connection for peripheral vascular disease, hypertension, and COPD. In January 2013 2000, the Board requested the opinion of a medical specialist from the Veterans Health Administration (VHA). The requested opinion was received in March 2013. In April 2013, the Board informed the Veteran and his representative that it had requested a specialist's opinion in conjunction with the adjudication of his appeal, provided him and his representative a copy of that opinion and indicated that he was entitled to submit additional evidence or argument provided within 60 days of the date of that letter. To date, neither the Veteran nor his representative has responded and the 60 day period has expired. Accordingly, the Board will proceed with the consideration of his case. The Veteran requested and was scheduled to attend a Board hearing in November 2012 but failed to report. As such, his request is deemed withdrawn. FINDINGS OF FACT 1. Service connection is in effect coronary artery disease and for PTSD, and each is evaluated as 100 percent disabling. 2. The preponderance of the evidence shows that the Veteran's peripheral vascular disease was not present in service or until many years thereafter and is not related to service or to an incident of service origin, including to his service-connected coronary artery disease and/or PTSD. 3. The preponderance of the evidence shows that the Veteran's hypertension was not present in service or until many years thereafter and is not related to service or to an incident of service origin, including to his service-connected coronary artery disease and/or PTSD. 4. The preponderance of the evidence shows that the Veteran's COPD was not present in service or until many years thereafter and is not related to service or to an incident of service origin, including to his service-connected coronary artery disease and/or PTSD. 5. Throughout the appellate period, the Veteran's PTSD is characterized by total occupational and social impairment due to PTSD signs and symptoms, such as social isolation, marital discord, strained relationships with children, anhedonia, depression, anxiety, stress, increased anger, decreased frustration tolerance, sleep initiation and maintenance difficulties, nightmares, interpersonal difficulties, road rage, avoidance of all activities other than shopping, and inability to work. 6. The Veteran has a 100 percent disability rating for coronary artery disease as of December 15, 2005, and a separate 100 percent disability rating for PTSD as of January 10, 2006. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral vascular disease have not been met. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 U.S.C.A. §§ 3.102, 3.303, 3.310 (2012). 2. The criteria for service connection for hypertension have not been met. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2012). 3. The criteria for service connection for COPD have not been met. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). 4. Throughout the appellate period, the criteria for an initial 100 percent disability evaluation for PTSD have been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. § 3.102, 3.321, 4.3, 4.130 Diagnostic Code (DC) 9411 (2012). 5. The criteria for special monthly compensation at the housebound rate, effective January 10, 2006, have been met. 38 U.S.C.A. §§ 1114(s), 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.350 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Board is granting in full the Veteran's request for a higher initial rating for his service-connected PTSD. As such, no discussion of VA's duty to notify and assist with respect to that issue is necessary. VA has a duty to provide notification to the Veteran with respect to establishing entitlement to benefits, and a duty to assist with development of evidence under 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159(b). With respect to the issues of entitlement to service connection for peripheral vascular disease, hypertension, and COPD, the duty to notify was satisfied prior to the initial Agency of Original Jurisdiction (AOJ) decision by way of a letter sent to the Veteran in February 2007 that informed him of his duty and the VA's duty for obtaining evidence. In addition, the letter met the notification requirements set out in Dingess v. Nicholson, 19 Vet. App. 473 (2006). In October 2007, prior to subsequent readjudications of the claims in April 2008, September 2008, and June 2009, the AOJ satisfied the duty to notify the Veteran of the requirements for obtaining service connection on a secondary basis. VA also has a duty to assist the Veteran in the development of the claims. This duty includes assisting the Veteran in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all relevant facts have been properly developed, and that all available evidence necessary for equitable resolution of the issue has been obtained. The Veteran's service treatment records, VA and private treatment records, and lay statements have been obtained. VA also obtained a VHA opinion in March 2013. The Board finds that the March 2013 VHA opinion is sufficient for adjudicatory purposes, as the physician addressed the Veteran's reported history, as well as his current symptoms and diagnoses. The opinion rendered is also sufficient as it included adequate rationales for the negative nexus opinions, namely the facts that the Veteran's history of tobacco use, the dates of onset of his disorders, and the doctor's application of pertinent published medical studies demonstrate that it is less likely than not that his peripheral vascular disease, hypertension, and COPD are attributable to service, or to his service-connected PTSD or coronary artery disease. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran has not indicated there are any additional records that VA should obtain on his behalf. Thus, the Board finds that all reasonable efforts were made by VA to obtain evidence necessary to substantiate the Veteran's claims, and no further assistance to develop evidence is required. Analysis: Service Connection for Peripheral Vascular Disease, Hypertension, and COPD The Veteran contends in a February 2007 statement that his peripheral vascular disease, hypertension, and COPD resulted from exposure to the herbicide Agent Orange. In his August 2007 notice of disagreement and April 2008 substantive appeal, the Veteran contends that his peripheral vascular disease, hypertension, and COPD resulted from his service-connected PTSD. In July 2009, the Veteran contends that his peripheral vascular disease resulted from both PTSD and coronary artery disease. As the Veteran served in the Republic of Vietnam from December 11, 1966 to July 14, 1967, and in the absence of affirmative evidence to the contrary, he is presumed to have been exposed to herbicides during his Vietnam service. 38 C.F.R. § 3.307(a)(6)(iii). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). The current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). Service connection may also be established for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a) (2012). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310 (2012); Allen v. Brown, 7 Vet. App. 439 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on all things of which he has personal knowledge derived from his own senses); 38 C.F.R. § 3.159(a)(2). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). In Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that the Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is credible, the Board may properly consider the internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). In the present case, the Board finds that the preponderance of the evidence is against a grant of service connection for peripheral vascular disease, hypertension, and COPD. The Board acknowledges that the Veteran has a current diagnosis of peripheral vascular disease, hypertension, and COPD during the pendency of the claim-in this case, in or after October 2006. Specifically, a private physician, S. Bhakta, MD, diagnosed the Veteran with peripheral vascular disease and COPD in March 2008, and another private physician, B. Quy, MD, diagnosed him with hypertension in March 2008. McClain v. Nicholson, 21 Vet. App. 319 (2007) (the current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or during the pendency of that claim). As an initial matter, the Board notes that the Veteran does not contend, and the evidence does not show, that his peripheral vascular disease, hypertension, or COPD began during his service. Further, in Reports of Medical Examination dated July 1962, July 1965, and March 1969, clinicians found that the Veteran's lungs, chest, heart, and vascular system were normal. In March 2008, Dr. Bhakta opined that the Veteran's service-connected PTSD had exacerbated his COPD and peripheral vascular disease with claudication symptoms. He provided no rationale for this conclusion. In March 2013, the Board obtained a VHA physician's opinions regarding the Veteran's peripheral vascular disease, hypertension, and COPD. The physician noted that the Veteran had peripheral vascular disease in January 2001, hypertension in April 2000, and COPD in December 1998. He opined: It is very unlikely (less than 20% probability) that the above stated medical conditions of peripheral vascular disease, hypertension or COPD were related or had their onset while in the service. Based on the closest after service medical records (Kaiser) from 1971, there [were] no diagnostic or treatment progress notes of the aforementioned medical conditions until December 1998, when a diagnosis of "probable COPD" was entered in his medical records.... There are no current studies showing a positive correlation between Agent Orange exposure and peripheral vascular disease, hypertension, and/or COPD. As such, it is quite unlikely (less than 20% probability) that the veteran's peripheral vascular disease, hypertension and/or COPD were caused or aggravated by his Agent Orange exposure in Vietnam.... The above referenced medical conditions are caused primarily by a long history of tobacco use. Other than hypertension, to my knowledge there are no studies linking directly, indirectly or beyond the natural progression of COPD and peripheral vascular disease with PTSD. There is epidemiological evidence that hypertension can result from PTSD if diagnosed after PTSD is clinically evident. [Citation omitted.] A review of the records noted initial treatment for hypertension was in April 2000. Treatment for anxiety/depression which evolved to PTSD was initiated in April 2001. The conclusion based on the literature and onset of hypertension and PTSD in this patient is that it is very unlikely (less than 20%) probability that the medical conditions of the patient (peripheral vascular disease, hypertension and/or COPD[)] were caused or aggravated by his service-connected PTSD and/or his coronary artery disease, either singularly or in the aggregate.... With the exception of hypertension which would have to occur following a diagnosis of PTSD, there is no literature to my knowledge to support causation or aggravation by a combined effect from service-connected PTSD, coronary artery disease or Agent Orange exposure. Where, as here, conflicting competent opinions are of record, the Board can ascribe greater probative weight to one opinion over another, provided that a rational basis is given. Winsett v. West, 11 Vet. App. 420 (1998), aff'd 217 F.3d 854 (Fed. Cir. 1999). The Board finds that the VHA physician's March 2013 opinion warrants greater probative value than Dr. Bhakta's opinion because, unlike Dr. Bhakta's opinion, it includes meaningful rationales in support of its conclusions. By contrast, the Board finds that Dr. Bhakta's opinion is inadequate because it includes no rationale. See, e.g., Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). Similarly, the Board finds that the VHA physician's March 2013 opinion warrants greater probative value than the Veteran's own statements. The Veteran's own lay statements linking his peripheral vascular disease, hypertension, and COPD to his herbicide exposure and/or service-connected disorders are not entitled to any probative weight because under the circumstances of this particular case he is not competent to opine on the relationships between such complex medical disorders. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (lay evidence is not always competent evidence of a diagnosis or nexus-particularly where complex medical questions or the interpretation of objective medical tests are involved); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011); Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). In this case, the Veteran is competent to report that he has peripheral vascular disease, hypertension, and COPD. However, because such disorders and any possible interactions with PTSD and coronary artery disease involve complex medical questions and the interpretation of objective medical tests, the Veteran is not competent to render a nexus opinion on those matters. Woehlaert, 21 Vet. App. at 462. Consequently, the Veteran's lay statements asserting a nexus do not constitute a competent medical nexus opinion. In sum, the Board finds that the most probative evidence fails to link the Veteran's peripheral vascular disease, hypertension, and COPD to service, or to his service-connected PTSD and/or coronary artery disease. Accordingly, service connection for peripheral vascular disease, hypertension, and COPD is not warranted. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Analysis: Initial Rating for PTSD Disability ratings are based upon VA's Schedule for Rating Disabilities as set forth in 38 C.F.R. Part 4. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity in civil occupations. 38 U.S.C.A. § 1155. The disability must be viewed in relation to its history. 38 C.F.R. § 4.1. A higher evaluation shall be assigned where the disability picture more nearly approximates the criteria for the next higher evaluation. 38 C.F.R. § 4.7. Where, as here, the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged ratings" is required. Fenderson v. West 12 Vet. App. 119, 126 (1999). The Board notes that the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as the veteran's relevant medical history, his current diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Veteran contends in his December 2006 notice of disagreement that his PTSD warrants a rating greater than 30 percent. In a July 2009 statement following the rating increase from 30 to 50 percent, the Veteran asserted that VA had not fully considered his ongoing treatment for PTSD and the effects that it has on his whole being. The RO has evaluated the Veteran's PTSD under 38 C.F.R. § 4.130, Diagnostic Code 9411 at 30 percent as of the January 10, 2006 date of claim; at 50 percent as of August 21, 2008, the date of a new VA examination; and at 100 percent as of March 8, 2010, the date of another VA examination. The Veteran's PTSD has been evaluated under the General Rating Formula for Mental Disorder. 38 C.F.R. § 4.130, DC 9411. Under the General Rating Formula, 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, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent disability rating is warranted when 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; 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. Id. A 100 percent disability rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; gross 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 own name. Id. The symptoms listed in Diagnostic Code 9411 are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In addition, in Mittleider v. West, 11 Vet. App. 181 (1998), the U.S. Court of Appeals for Veterans Claims (Court) held that VA regulations require that when the symptoms and/or degree of impairment due to a veteran's service-connected psychiatric disability cannot be distinguished from any other diagnosed psychiatric disorders, VA must consider all psychiatric symptoms in the adjudication of the claim. In evaluating psychiatric disorders, the VA has adopted and employs the nomenclature in the rating schedule based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV). See 38 C.F.R. § 4.130. As such, the diagnosis of a mental disorder should conform to DSM-IV. See 38 C.F.R. § 4.125(a). Diagnoses many times will include an Axis V diagnosis, or a Global Assessment of Functioning (GAF) score. The GAF is a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996), citing Diagnostic and Statistical Manual of Mental Disorders (4th ed.1994). GAF scores ranging between 71 and 80 reflect that if symptoms are present they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). A GAF of 61 to 70 is indicative of 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, has some meaningful interpersonal relationships. A GAF score of 51 to 60 is defined as 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 41 to 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). Following a review of the evidence of record, the Board finds that an initial 100 percent rating is warranted throughout the Veteran's appeal-e.g., as of the January 10, 2006 date of claim. In reaching this decision, the Board has considered the evidence of record, including the fact that all three VA examiners opining on the question have independently determined that the Veteran's PTSD signs and symptoms cause total occupational and social impairment, and the Veteran's treating VA psychiatrist likewise found that he is totally and permanently disabled due to his chronic PTSD. First, the October 2006 VA examiner, a Ph.D. neuropsychologist, found that the Veteran has severe daily PTSD symptoms, including social isolation, marital discord, strained relationships with children, anhedonia, depression, anxiety, stress, increased anger, decreased frustration tolerance, sleep initiation and maintenance difficulties, and nightmares. He concluded that the Veteran has total occupational and social impairment due to PTSD signs and symptoms. Second, the March 2008 VA treating psychiatrist opined that the Veteran is totally and permanently disabled due to his chronic PTSD. Third, the August 2008 VA examiner, a psychologist, found that the Veteran has severe daily PTSD effects, including isolation, sleep impairment, nightmares, depression, anxiety, anger, interpersonal difficulties, road rage, avoidance of all activities other than shopping, social isolation, conflict and strained relationships with family, inability to work, and sleep disturbance. He concluded that the Veteran has total occupational and social impairment due to PTSD signs and symptoms. Fourth, the March 2010 VA examiner, a psychologist, found that it is unlikely that the Veteran will see much, if any, improvement in his PTSD symptoms. She concluded that the Veteran has total occupational and social impairment due to PTSD signs and symptoms. In light of the foregoing, and attributing the benefit of the doubt to the Veteran, the Board finds that the 100 percent disability rating which the AOJ assigned as of the date of the March 2010 VA examination applies throughout the entire appeal period-e.g., as of January 10, 2006. 38 C.F.R. § 4.3 (2012). Analysis: Special Monthly Compensation VA has a well-established duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); See also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C.A § 1114 (West 2002). See Bradley, 22 Vet. App. 280, 294 (2008) (finding that SMC "benefits are to be accorded when a Veteran becomes eligible without need for a separate claim"). In this case, the AOJ accorded the Veteran SMC benefits in its February 2012 rating decision, effective as of March 8, 2010-the date at which it first assigned the 100 percent rating to the Veteran's PTSD disability. The Veteran is in receipt of a separate 100 percent rating for coronary artery disease as of December 15, 2005, and, pursuant to this decision, he is in receipt of a 100 percent rating for his PTSD as of January 10, 2006. Consequently, the Veteran's SMC benefits are therefore effective as of January 10, 2006. ORDER Service connection for peripheral vascular disease is denied. Service connection for hypertension is denied. Service connection for chronic obstructive pulmonary disease is denied. An initial rating of 100 percent for PTSD is granted as of January 10, 2006, subject to the applicable criteria governing the payment of monetary benefits. Special Monthly Compensation at the housebound rate under 38 U.S.C.A. § 1114(s) is granted, effective January 10, 2006, subject to the controlling regulations applicable to the payment of monetary benefits. ____________________________________________ STEVEN D. REISS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs