Citation Nr: 1329398 Decision Date: 09/13/13 Archive Date: 09/20/13 DOCKET NO. 10-09 546 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to an increased rating for posttraumatic stress disorder (PTSD), rated 50 percent prior to September 13, 2012, and 70 percent as of September 13, 2012. 2. Entitlement to a total rating for compensation by reason of individual unemployability due to service connected disability (TDIU). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Joseph P. Gervasio, Counsel INTRODUCTION The Veteran served on active duty from November 1965 to November 1970. This case comes to the Board of Veterans' Appeals (Board) on appeal of a September 2008 rating decision of the Roanoke, Virginia, Regional Office (RO) of the Department of Veterans Affairs (VA). The issue of entitlement to TDIU is REMANDED to the RO via the Appeals Management Center in Washington, D.C. FINDINGS OF FACT 1. Prior to June 8, 2008, the Veteran's PTSD was primarily manifested by depression, anxiety, and short term memory difficulties, that were productive of moderate impairment. It was noted that the Veteran denied suicidal or homicidal ideations, auditory or visual hallucinations, and delusions. His GAF score was 50. 2. As of June 8, 2009, the Veteran's PTSD is primarily manifested by depression, intermittent suicidal ideation, anxiety, auditory hallucinations, flashbacks, hypervigilance, sleep disturbance, intrusive thoughts, irritability, and being easily startled; without symptoms such as obsessional rituals; intermittently illogical, obscure, or irrelevant speech; and near-continuous panic attacks or depression that affects the ability to function independently. His GAF score was 45. CONCLUSIONS OF LAW 1. The criteria for an increased rating in excess of 50 percent for PTSD were not met prior to June 8, 2009. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.130, Diagnostic Code (Code) 9411 (2012). 2. The criteria for an increased rating in excess of 70 percent for PTSD have not been met as of June 8, 2009. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.130, Code 9411 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist VA has duties to notify and assist claimants in substantiating claims for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). In a claim for increase, the notice requirement is generic notice of the type of evidence needed to substantiate the claim, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, and general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). The Veteran was advised of VA's duties to notify and assist in the development of the claim prior to the initial adjudication of the claim. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). A June 2007 letter explained the evidence necessary to substantiate the claim, the evidence VA was responsible for providing, and the evidence the Veteran was responsible for providing. The Veteran has had ample opportunity to respond or supplement the record. With regard to the duty to assist, the Veteran's pertinent post-service treatment records have been secured. The Veteran was afforded VA medical examinations, most recently in September 2012. The Board finds that the opinions obtained are adequate. The opinions were provided by qualified medical professionals and were predicated on a full reading of all available records. The examiners also provided a detailed rationale for the opinions rendered. Barr v. Nicholson, 21 Vet. App. 303 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). While the Veteran's representative argues that the examination was performed by a physicians assistant who specializes in hematology and oncology, it has been clarified that the examination was actually performed by a doctorate level psychologist. Accordingly, the Board finds that VA's duty to assist, including with respect to obtaining a VA examination or opinion, has been met. 38 C.F.R. § 3.159(c)(4) (2012). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2012); 38 U.S.C.A. § 1155 (West 2002). It is not expected that all cases will show all the findings specified. However, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21 (2011). Where there is a question as to which of two ratings shall be applied, the higher rating 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). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of a matter, reasonable doubt shall be resolved in favor of the claimant. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 4.3 (2011). Staged ratings are appropriate for an increased rating claim where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board notes that it has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to the appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. The Board is required to render a finding with respect to the competency and credibility of the lay evidence of record. Coburn v. Nicholson, 19 Vet. App. 427 (2006). Competent, credible lay evidence could be, in and of itself, sufficient to establish a fact necessary to support a finding of service connection. Jandreau v. Nicholson, 492 F. 3d 1372 (2007). As a fact finder, the Board is obligated to determine whether lay evidence is competent and credible. The Board cannot determine that lay evidence lacks credibility solely because it is unaccompanied by contemporaneous medical evidence, but it may consider a lack of contemporaneous medical evidence as one factor in determining the credibility of lay evidence. Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Credibility is a factual determination going to the probative value of the evidence, to be made after the evidence has been admitted or deemed competent. Cartright v. Derwinski, 2 Vet. App. 24 (1991). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465 (1994). A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived or experienced, were directly through the senses. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (2012). Lay testimony is competent as to symptoms of an injury or illness, which are within the realm of one's personal knowledge. Personal knowledge is that which comes to the witness through the use of the senses. Lay testimony is competent only so long as it is within the knowledge and personal observations of the witness. Layno v. Brown, 6 Vet. App. 465 (1994). Lay testimony is competent to establish the presence of observable symptomatology where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (2007). Also, a veteran as a layperson is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009). VA must consider the competency of the lay evidence and cannot outright reject lay evidence on the basis that lay evidence can never establish a medical diagnosis or nexus. However, that does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the layman is competent and does not otherwise require specialized medical training and expertise to do so. The Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when a layperson is competent to identify the medical condition; the person is reporting a contemporaneous medical diagnosis; or lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); 38 U.S.C.A. § 1154(a) (West 2002). Posttraumatic stress disorder is rated using the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). A 50 percent rating is warranted for occupational and social impairment with reduced reliability, and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for 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 ideations; 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 worklike settings); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions 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 own name. 38 C.F.R. § 4.130, Diagnostic Code 9411, General Rating Formula for Mental Disorders (2012). The list of symptoms are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive. The Board need not find all or even some of the symptoms to award a specific rating. If the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Mauerhan v. Principi, 16 Vet. App. 436 (2002); Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). The Global Assessment of Functioning (GAF) score is a scale indicating the psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness. Richard v. Brown, 9 Vet. App. 266 (1996). A score of 21 to 30 is assigned for behavior that is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) or inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends). A score of 31 to 40 is assigned where there is some impairment in reality testing or communication (e.g., speech is at times illogical, obscure or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work). A score of 41 to 50 is assigned where there are serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A score of 5 to 60 is assigned where there are 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 score of 61 to 70 is assigned for mild symptoms (e.g., depressed mood and mile insomnia) or difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household). American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 47 (4th ed. 1994). PTSD Service connection for PTSD was granted by the RO in an April 2004 rating decision. A 50 percent initial disability rating was awarded under the provisions of Diagnostic Code 9411. That rating was continued in a July 2005 rating decision. The Veteran submitted a claim for increase in May 2007. The 50 percent rating was continued in a September 2008 decision that was appealed by the Veteran. The rating was increased to 70 percent, effective September 13, 2012, by a rating decision in May 2013. The Veteran continues to express disagreement with the 70 percent rating, and it is less than the maximum under the applicable criteria, so the claim for an increased rating remains on appeal. AB v. Brown, 6 Vet. App. 35 (1993). An examination was conducted by VA in June 2007. At that time, it was noted that the Veteran worked part-time for an auto body shop where he had worked for many years. The Veteran reported that his PTSD symptoms had worsened since the last evaluation in June 2004. He remained depressed at least 75 percent of his time. That occurred especially when he watched war news on television. He felt hopelessness about his situation, and had decreased motivation, loneliness, low frustration tolerance, and anger. He also described excessive worry, nervousness, and sleep problems. He was not able to sleep more than four and a half hours. He complained of flashbacks and nightmares of Vietnam related events. He had additional complaints of feeling paranoid and remaining hypervigilent. For that reason he avoided crowds and stayed isolated. He was startled by noise and avoided stimuli and any provoking situations. He denied suicidal or homicidal ideation and auditory or visual hallucinations. The symptoms were described as interfering with interpersonal, social, and occupational functioning to a moderate degree. He had not been in any relationship since his divorce in 1979 and had limited contact with his son. His only friends were through the PTSD program after care group. On mental status examination, the Veteran was alert and fully oriented. He was anxious, but cooperative. He was appropriately groomed and dressed. He had fair eye contact, with no evidence of any abnormal psychomotor activity. Mood was depressed and affect was anxious. Speech was of normal tone. Thought process was linear and logical and organized. He denied suicidal or homicidal ideations, auditory or visual hallucinations, or delusions. He reported difficulty remembering names, addresses, and had short term memory problems, which had been going on for many years. Insight and judgment were intact. The assessment was PTSD. His GAF score was 50. The examiner stated that the Veteran had moderate symptoms of PTSD that affected his personal, social, and occupational functioning to a moderate degree. He was having problems with his job and conflicts at home where he lived with his cousin. He led an isolative life. An examination was conducted by VA on September 13, 2012. At that time, the Veteran was diagnosed as having PTSD, with a GAF score of 45. The examiner commented that the Veteran continued to report moderate to severe symptoms of PTSD and now reported having been fired from his job, which he had held for years. He stated that was due to fighting. He reported that he did not have friends and was not in a relationship. He stated that he could not get along with people and that his primary support system was a brother, his cousin, and other members of his aftercare group. He reported hearing voices saying "help me" when he was reminded of Vietnam and recurrent suicidal ideation when he looked back at his life. The examiner opined that the Veteran had deficiencies in most areas such as work, school, family relationships, judgment, thinking, and mood. The examiner noted that the Veteran stated that he could not "get along with nobody." He lived with his cousin, where he had been for the past seven or eight years, but might have to move out as his cousin was getting married. He reported getting fired over a year ago from the auto body shop where he had worked "on and off" for years. He stated that he had been fired for fighting and was currently not working. The Veteran was alert and oriented to person, place, time and situation. He was cooperative and responded appropriately to questions. He had poor eye contact, looking at the floor during most of the interview. Conversational speech was slow and he was soft spoken. Mood was depressed and affect was flat. Thought process was linear, logical, and goal oriented. Insight and judgment were intact and within normal limits. The Veteran admitted to occasional suicidal thoughts, about once per month, and stated that "my life is a shambles." He reported having regrets and anger about the past. He thought of different ways to kill himself, stating that "there is no easy way." He denied current thoughts of suicide. He denied homicidal ideation, but stated that "if somebody messes with me I will hurt him." He continued to attend a weekly aftercare group at the VA. He took several medications for mood. He had problems falling and staying asleep. He stated that he had to have his back to the wall when he went out and stated that he hated crowds. He reported hearing voices, currently around three times per week. The voice said "help me." Triggers for the voice included hearing a helicopter, sounds that resembled gunfire or a blast, or watching scenes of combat on television. He had thoughts about men who were killed or injured in combat and reported flashbacks. He only spoke of his experiences with other Vietnam veterans. News stories about world events, such as the recent death of an American Ambassador, made him worry. Symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, difficulty adapting to stressful circumstances, an inability to establish or maintain effective relationships, suicidal ideation, and persistent delusions or hallucinations. VA outpatient treatment records dated from June 2007 show that the Veteran has been regularly attending group therapy sessions. In April 2008, it was noted that his depression had minimally improved and that he was able to control his irritability using coping skills. His PTSD level was mild overall, with re-experiencing being the most prominent. Hyperarousal was moderate and avoidance was mild. He had problems with insomnia, with awakening in the middle of the night. Thought content revealed no delusions, obsessions, suicidal ideation, homicidal ideation, or hallucinations. The Veteran was alert and fully oriented with a normal level of concentration. The assessment was his mood symptoms were better on medication, but that he did have problematic side effects. A note on June 8, 2009, shows that the Veteran exhibited nightmares, flashbacks, intrusive thoughts, hypervigilance, irritability, being easily startled, depressed mood, anhedonia, guilt, low energy, difficulty concentrating, psychomotor retardation, and difficulty sleeping. On mental status evaluation, it was noted that the Veteran was positive for intermittent auditory hallucinations related to Vietnam. He had no visual hallucinations. He was placed on an additional medication for auditory hallucinations. In November 2009, the Veteran continued to report possible auditory hallucinations, versus memories of people yelling in Vietnam. The assessment included possible psychotic symptoms versus intrusive memories. In January 2010, the medication for auditory hallucinations was increased. Additional VA outpatient treatment records continued to show complaints of auditory hallucinations and in May 2013, a group therapy session noted shows that he was sleeping better than before. He reported nightmares once a week and hearing voices "off and on" that were described as auditory hallucinations that were more like flashbacks of Vietnam. At the time of the Veteran's claim for increased rating, his PTSD symptoms primarily included depression, feelings of hopelessness, decreased motivation, frustration, anger excessive worry, nervousness, sleep problems such as nightmares and insomnia, flashbacks, and hypervigilance. At that time, he denied suicidal or homicidal ideation, delusions, or hallucinations and his symptoms were considered to interfere with social and occupational function to a moderate degree. Significantly, it was noted that the Veteran continued to work at a job that he had held for a number of years. It is not shown that he had more than reduced reliability of his occupational and social adaptability. For that reason, Board does not find that a rating in excess of the 50 percent that was continued was warranted. The evidence prior to June 8, 2009, does not show occupational and social impairment with deficiencies in most areas, such as work, school family relations, judgment, thinking, or mood. The evidence does not show such symptoms as suicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; spatial disorientation; neglect of personal appearance and hygiene; or an inability to establish and maintain effective relationships. Although the Veteran had consistent depression and some impaired impulse control, his overall level of symptomatology did not rise to the level contemplated by the 70 percent rating criteria prior to June 8, 2009. His depression, impaired impulse control, and difficulty adapting to stressful situations were not shown to be near-continuous or to cause deficiencies in most areas. The examination on September 13, 2012, found that the Veteran had deficiencies in most areas such as work, school, family relationships, judgment, thinking, and mood. Primary symptoms included depression, flat affect, occasional suicidal thoughts, anger, sleep disturbance, persistent auditory hallucinations, flashbacks, anxiety, suspiciousness, difficulty adapting to stressful circumstances, an inability to establish or maintain effective relationships, and persistent delusions. The record shows that the Veteran needed to attend weekly therapy sessions and needed continued use of several medications. However, while those symptoms are shown to meet the criteria for a 70 percent rating, the Board finds that the criteria for a 100 percent schedular rating are not demonstrated. The Veteran's symptoms are not shown to be totally disabling. While the Veteran lost his job and is no longer employed, it is not shown that he is unable to perform activities of daily living. He is shown to be well oriented and his memory is intact, with the exception of forgetting some names and some short term memory impairment. His GAF score of 45 indicates an ability to continue to function in his activities of daily living. Therefore, the Board finds that the criteria for a 100 percent schedular rating for PTSD are not met. The evidence does not show 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 own name. His memory loss is not for the names of close relatives or his own name. While persistent auditory hallucinations are shown, his symptoms are not shown to result in total occupational and social impairment. He continues to maintain some social relationships. The Board has reviewed the entire record, including VA outpatient treatment records, and finds that the symptoms meeting the criteria for the 70 percent rating, primarily auditory hallucinations were demonstrated prior to the September 13, 2012 VA examination. The June 8, 2009, VA outpatient treatment note first demonstrates that the Veteran had complaints of possible auditory hallucinations. While it was not clear that that time that those were actual hallucinations rather than intrusive thoughts, the Veteran was placed on a mediation that is used to treat hallucinations, which was increased in later visits, and later evidence confirmed that they were auditory hallucinations. Therefore, resolving any reasonable doubt in favor of the Veteran, the Board finds that the criteria for a 70 percent rating were met as of June 8, 2009, the date as of which an increase in severity of the PTSD symptomatology is first shown. 38 U.S.C.A. § 5110(a)(b) (West 2002); 38 C.F.R. § 3.400(o) (2012). The Board finds that the preponderance of the evidence is against the assignment of a rating greater than 50 percent for PTSD prior to June 8, 2009. The Board further finds that the preponderance of the evidence is against the assignment of a rating greater than 70 percent for PTSD as of June 8, 2009. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Extraschedular Ratings The Board has also considered whether an extraschedular rating is warranted for PTSD. In exceptional cases an extraschedular rating may be provided. 38 C.F.R. § 3.321 (2010). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular rating for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular rating is adequate, and no referral is required. However, if the schedular rating does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as marked interference with employment or frequent periods of hospitalization. When the rating schedule is inadequate to rate a claimant's disability picture and that picture has related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. 38 C.F.R. 3.321(b)(1) (2012). The Board finds that the symptomatology and impairment caused by the Veteran's PTSD is specifically contemplated by the schedular rating criteria, and no referral for extraschedular consideration is required. The schedular rating criteria specifically provide for disability ratings based on a combination of history and clinical findings. In this case, considering the lay and medical evidence, the Veteran's PTSD has manifested depression, a flat affect, anger, sleep disturbances, flashbacks, anxiety, suspiciousness, difficulty adapting to stressful circumstances, an inability to establish or maintain effective relationships, and, as of June 8, 2009, persistent auditory hallucinations, delusions, and occasional suicidal thoughts. Those symptoms are part of the schedular rating criteria. In addition, the level of occupational and social impairment are explicitly part of the schedular rating criteria. In addition, the GAF scores are incorporated as part of the schedular rating criteria as they tend to show the overall severity of symptomatology or overall degree of impairment in occupational and social functioning. Moreover, all the Veteran's psychiatric symptomatology is contemplated by the schedular rating criteria, which rates by analogy psychiatric symptoms that are "like or similar to" those explicitly listed in the schedular rating criteria. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The schedule is intended to compensate for average impairments in earning capacity resulting from service- connected disability in civil occupations. 38 U.S.C.A. § 1155 (West 2002). Generally, the degrees of disability specified in the rating schedule are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1 (2012). In this case, the problems reported by the Veteran are specifically contemplated by the criteria discussed above, including the effect on his daily life. In the absence of exceptional factors associated with PTSD, the Board finds that the criteria for submission for consideration of the assignment of an extraschedular rating pursuant are not met. 38 C.F.R. § 3.321(b)(1) (2012); Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). ORDER A rating in excess of 50 percent for PTSD prior to June 8, 2009, is denied. A rating in excess of 70 percent for PTSD as of June 8. 2009, is denied. REMAND The Veteran's representative has raised the issue that the Veteran is unemployable as a result of his service-connected PTSD, and noted that he lost his job specifically due to a fight that occurred while the Veteran was at work. Therefore, that constitutes a claim for TDIU. A claim for a TDIU rating is part of an increased rating claim when the TDIU claim is raised by the record during an increased rating claim. Rice v. Shinseki, 22 Vet. App. 447 (2009). Accordingly, the case is REMANDED for the following action: Adjudicate the issue of entitlement to a TDIU. If the decision remains unfavorable to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the claim to the Board. 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 or the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ Harvey P. Roberts Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs