Citation Nr: 18143694 Decision Date: 10/22/18 Archive Date: 10/19/18 DOCKET NO. 16-19 125 DATE: October 22, 2018 ORDER Entitlement to an initial 30 percent rating for trigeminal neuralgia is granted. REMANDED Entitlement to an initial rating in excess of 30 percent prior to September 15, 2016, and to a rating in excess of 70 percent from September 15, 2016, forward, for posttraumatic stress disorder (PTSD) (previously characterized as an adjustment disorder with anxiety) is remanded. Entitlement to an initial rating in excess of 10 percent for sinus tachycardia with cardiomegaly is remanded. FINDING OF FACT The Veteran has severe, incomplete paralysis of the trigeminal nerve. CONCLUSION OF LAW The criteria for an initial 30 percent disability rating for trigeminal neuralgia have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.124, Diagnostic Code 8205 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION Entitlement to an initial rating in excess of 10 percent for trigeminal neuralgia. The Veteran served on active duty from July 1997 to July 2014. VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R., Part IV. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule for Rating Disabilities represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2017). Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The schedule recognizes that disability from distinct injuries or diseases may overlap. See 38 C.F.R. § 4.14. However, the evaluation of the same disability or its manifestation under various diagnoses, which is known as pyramiding, is to be avoided. Id. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Because the level of disability may have varied over the course of the claim, the rating may be “staged” higher or lower ratings for segments of time during the period on appeal in accordance with such variations, if such is supported by the evidence of record. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); see also Fenderson v. West, 12 Vet. App. 119, 126 (1999) (holding that staged ratings may be warranted in initial rating cases). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2015). If the preponderance of the evidence weighs against the claim, it must be denied. See id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Currently, the Veteran is assigned a 10 percent rating for his trigeminal neuralgia under diagnostic code (DC) 8205. He asserts that his symptoms are more severe and warrant a 30 percent rating. Diagnostic Code (DC) 8205 provides ratings specifically for diseases of the cranial nerves. Under DC 8205, a minimum 10 percent rating is warranted when the evidence demonstrates the veteran suffers from moderate, incomplete paralysis. A 30 percent rating is warranted when the veteran suffers from severe, incomplete paralysis. Lastly, a 50 percent rating occurs when a veteran suffers from complete paralysis. 38 C.F.R. § 4.124a, DC 8205. The terms “mild”, “moderate”, and “severe” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6 (2017). On VA examination in June 2015, the Veteran complained of pain, tingling, and numbness. The symptoms worsened upon palpation. The Veteran reported moderate symptoms of constant pain, intermittent pain, and dull pain on his lower face and the side of his mouth and throat. He reported severe symptoms of paresthesias and numbness on his lower face and the side of his mouth and throat. The Veteran was also reported to have severe difficulty chewing. On muscle strength testing, the examiner found the Veteran to have moderate muscle strength with respect to the muscles of mastication. On sensory examination, the Veteran had decreased feeling on the left lower side of his face. Overall, the examiner found moderate incomplete paralysis of the left side trigeminal nerve. The Veteran has asserted that his trigeminal nerve damage is severe and extremely painful. See August 2015 NOD; February 2016 Form 9. He also notes that he cannot eat cold, hot, or hard foods without severe pain. See August 2015 NOD. He has requested the assignment of a 30 percent rating under DC 8205. See August 2015 NOD. The Board finds the Veteran’s account of his symptoms to be competent and credible. See Washington v. Nicholson, 19 Vet. App. 362 (2005) (holding that a Veteran is competent to report what occurred during service because he is competent to testify as to factual matters of which he has first-hand knowledge); Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007) (holding that lay testimony is competent to establish the presence of observable symptomatology); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Given the Veteran’s statements regarding the severity of his nerve pain and functional impairment, and affording him the benefit of the doubt, the Board finds that the Veteran’s impairment of the trigeminal nerve is best described as severe, incomplete paralysis. Accordingly, a higher rating of 30 percent under Diagnostic Code 8205 is warranted. See 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8205. As the Veteran has specifically requested the assignment of a 30 percent rating, this constitutes a full grant of his appeal. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 30 percent prior to September 15, 2016, and to a rating in excess of 70 percent from September 15, 2016, forward, for PTSD is remanded. During the pendency of his increased rating claim for an adjustment disorder with anxiety, the Veteran filed a claim for entitlement to service connection for PTSD. In April 2018, he was afforded a VA examination in which the examiner determined that the Veteran’s diagnosis of PTSD was a progression of his anxiety disorder. See April 2018 VA C&P Examination Report; June 2018 Clarification Request. In light of the most recent VA C&P examination and the Veteran’s change in diagnosis, the claim must be remanded to the Regional Office to address this new evidence and issue a supplemental statement of the case (SSOC). 2. Entitlement to an initial rating in excess of 10 percent for sinus tachycardia with cardiomegaly is remanded. The Veteran asserts that his service-connected sinus tachycardia is more severe than is reflected by his current 10 percent disability rating. Pursuant to Diagnostic Code 7010, a 10 percent rating is assigned for supraventricular arrhythmias manifested by permanent atrial fibrillation (lone atrial fibrillation), or one to four episodes per year of paroxysmal atrial fibrillation, or other supraventricular tachycardia documented by an ECG or Holter monitor. A 30 percent rating, which is the maximum rating, is assigned for paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than 4 episodes per year documented by an ECG or Holter monitor. 38 C.F.R. 4.104, DC 7010. On VA examination in June 2015, the Veteran reported occasional tachycardia. The examiner found the Veteran to have paroxysmal arrhythmia with no documented episodes occurring within the last 12 months. In his notice of disagreement and substantive appeal, the Veteran has asserted that he experiences 2 to 3 episodes of tachycardia a day and over 600 episodes a year. See August 2015 NOD; February 2016 Form 9. As this suggests a possible worsening of his condition, he should be scheduled for a current VA examination on remand. His complete treatment records from Geisinger must also be obtained. The matter is REMANDED for the following action: 1. Make arrangements to obtain any outstanding VA treatment records. 2. Make arrangements to obtain the Veteran’s complete treatment records from Geisinger, dated from July 2014 forward. 3. After the above has been completed, schedule the Veteran for an appropriate VA examination to assess the current level of severity of his service-connected sinus tachycardia with cardiomegaly. The appropriate Disability Benefits Questionnaire (DBQ) should be completed. The claims folder and this remand must be made available to the examiner for review, and the examination report must reflect that such a review was undertaken. The examiner must specifically determine whether the Veteran experiences more than 4 episodes of tachycardia per year documented by an ECG or Holter monitor. The examination should include any necessary diagnostic testing or evaluation. All examination findings, along with the complete rationale for all opinions expressed, must be set forth in the examination report. 4. After completing any further development that may be indicated, readjudicate the claims on appeal. If the benefit sought is not granted, the Veteran and his representative must be furnished a supplemental statement of the case (SSOC) and afforded a reasonable opportunity to respond before the record is returned to the Board for further review. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Sinckler, Associate Counsel