Citation Nr: 18159999 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 16-53 353A DATE: December 20, 2018 ORDER An initial rating of 70 percent for other specified trauma and stressor-related disorder is granted, subject to the laws and regulations governing the payment of monetary benefits. An initial rating in excess of 10 percent for tinnitus is denied. An effective date prior to July 22, 2013, for the award of service connection for other specified trauma and stressor-related disorder is denied. An effective date prior to July 22, 2013, for the award of service connection for tinnitus, is denied. Service connection for migraines is granted. Service connection for bilateral hearing loss is denied. From May 21, 2016, a total disability rating for compensation based on individual unemployability (TDIU) is granted, subject to the laws and regulations governing the payment of monetary benefits. REMANDED An initial rating in excess of 70 percent for other specified trauma and stressor-related disorder is remanded. Entitlement to service connection for a left leg disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a back disorder is remanded.   FINDINGS OF FACT 1. The Veteran’s psychiatric disorder most closely approximates at least occupational and social impairment with deficiencies in most areas. 2. The Veteran is receiving the maximum schedular rating for his tinnitus. 3. The Veteran’s claims of service connection for a psychiatric disorder and tinnitus were received on July 22, 2013. 4. The Veteran’s migraines are related to his service-connected psychiatric disability and tinnitus. 5. The Veteran does not have hearing loss for VA purposes. 6. From May 21, 2016, the Veteran is precluded from securing and following substantially gainful employment as a result of his service-connected psychiatric disability. CONCLUSIONS OF LAW 1. The criteria for an initial rating of at least 70 percent for the psychiatric disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9410. 2. The criteria for an initial rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.87, DC 6260. 3. The criteria for an effective date earlier than July 22, 2013, for the award of service connection for other specified trauma and stressor-related disorder have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 4. The criteria for an effective date earlier than July 22, 2013, for the award of service connection for tinnitus have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 5. The criteria for migraines, as secondary to service-connected disabilities, have been met. U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for service connection for hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 7. From May 21, 2016, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 2003 to February 2004 and from July 2007 to June 2008. The case is on appeal from a December 2012 rating decision. Additional evidence was received subsequent to the September 2016 and September 2018 statements of the case (SOC), including VA and private treatment records, as well as lay evidence. The Board finds that the additional evidence is either not pertinent or duplicative of that already of record with regard to the claims denied herein. Thus, a remand for a supplemental statement of the case is not necessary for these five claims. See 38 C.F.R. § 20.1304(c). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran, his representative and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Although the Board is remanding several claims below for additional development, remand is not necessary for the five issues denied herein, as there is no reasonable possibility that further assistance would substantiate these claims. See 38 C.F.R. § 3.159(d). Increased Ratings General Legal Criteria Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified 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. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings.” Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). 1. An initial rating in excess of 30 percent for other specified trauma and stressor-related disorder. The Veteran’s psychiatric disability has been evaluated under the provisions of DC 9410 throughout the appeal period. This DC provides for a 30 percent rating where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). A 50 percent 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 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. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, including work, school, family relationships, judgment, thinking or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting 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 work-like setting); and inability to establish and maintain effective relationships. The highest rating of 100 percent is warranted where there is 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. Following the Veteran’s July 2013 psychiatric claim, he was afforded a February 2014 VA examination in which the examiner indicated the Veteran’s symptoms did not meet the diagnostic criteria for posttraumatic stress disorder (PTSD) under DSM-5 criteria. He stated the Veteran is diagnosed with other specified trauma and stressor related disorder. The examiner indicated the Veteran suffers psychiatric symptoms of avoidance, irritability, hypervigilance, sleep disturbances, chronic sleep impairment and suspiciousness. He noted the Veteran has good hygiene, memory and communication, as well no suicidal ideations or intentions. Following the Veteran’s March 2015 notice of disagreement, an August 2016 medical opinion was submitted in which the examiner concluded the Veteran suffers from occupational and social impairment with deficiencies in most areas. She indicated the Veteran suffers from depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, mild memory loss and flattened affect. She further reported symptoms of difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, suicidal ideation, impaired impulse control, persistent delusions or hallucinations and persistent danger of hurting himself or others. The examiner noted the Veteran has great ongoing difficulty with his symptom pattern and he reports he can no longer enjoy the simplest of activities. The examiner further indicated the Veteran’s psychiatric disability causes him to miss work three or more times per month, as well as causing him difficulty concentrating and irritability. A review of the VA treatment records suggests psychiatric symptoms consistent with many of those noted in the August 2016 medical opinion. VA treatment records in 2016 support that the Veteran was experiencing suicidal ideation, including records from November and December 2016. An April 2017 VA treatment record noted the Veteran had a previous suicide intention in December 2016, when he believed he was being fired from his job. He reported the suicidal thoughts built for two days and ended with him being unable to access a gun. The examiner indicated his mood improved thereafter, however, he still reported passive suicidal ideation, including that his family may be better off without him. The examiner stated the Veteran has a history of suicide attempts and is at a chronically elevated risk of harm to self. After a careful review of the record, the Board determines the evidence supports a rating of at least 70 percent throughout the entire appeal period. When the Veteran’s symptoms are taken in totality, including ongoing suicidal ideation, the Board finds that the criteria for an initial disability rating of at least 70 percent have been met. This is so particularly when reasonable doubt is resolved in the Veteran’s favor. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. The February 2014 VA examiner indicated psychiatric symptoms of avoidance, hypervigilance and chronic sleep impairment. However, the August 2016 medical report noted significantly more severe symptoms, including panic attacks, mild memory loss, difficulty in establishing and maintaining effective work and social relationships, suicidal ideation, impaired impulse control and delusions or hallucinations. In consideration of these symptoms, and when affording the Veteran all reasonable doubt, an initial rating of at least 70 percent is supported. The Board notes the medical evidence supports that the Veteran’s psychiatric symptoms include ongoing suicidal thoughts, as shown in the August 2016 opinion, as well as the VA treatment records. Such symptomatology is highly suggestive of a 70 percent rating. See Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017) (noting the importance of suicidal ideation in the criteria for a 70 percent rating). Therefore, the Board determines that from the date of service connection, the Veteran’s psychiatric symptoms approximate occupational and social impairment with deficiencies in most areas, and a 70 percent rating. 38 C.F.R. § 4.130. Thus, after resolving reasonable doubt in the Veteran’s favor, the Board finds his psychiatric symptoms warrant at least an initial 70 percent rating. Such determination is based on the totality of the medical evidence. See 38 U.S.C. § 5017(b); 38 C.F.R. §§ 3.102, 4.3. While an initial rating of 70 percent is supported, the August 2016 medical examiner indicated symptoms which may suggest an even higher 100 percent rating, for total occupational and social impairment. Thus, entitlement to a rating in excess of 70 percent is remanded below. 2. An initial rating in excess of 10 percent for tinnitus. The Veteran contends that his tinnitus warrants a rating in excess of 10 percent. The rating code provides for a single 10 percent rating for recurrent tinnitus, 38 C.F.R. § 4.87, DC 6260, whether in one ear or both. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). This is the maximum schedular rating available and entitlement to a rating is not warranted. The Veteran was afforded a February 2014 VA examination in which he reported constant tinnitus since service. The examiner indicated the Veteran’s tinnitus does not impact the ordinary conditions or daily life. The Board finds a rating in excess of 10 percent is not warranted for his service-connected tinnitus. The current 10 percent rating assigned for the Veteran’s tinnitus is intended to compensate for all of these demonstrated symptoms associated with the condition and is the maximum schedular rating. The degree of disability, that is, the degree to which tinnitus impairs the Veteran’s earning capacity, is the same regardless of how the tinnitus is perceived. Thus, there are no symptoms not contemplated by this rating schedule. Kuppamala v. McDonald, 27 Vet. App. 447, 457 (2015). Therefore, there is no basis in law for assigning a higher rating under DC 6260. See Smith v. Nicholson, 451 F. 3d 1344 (Fed. Cir. 2006). The Board determines an increased rating for tinnitus is not warranted. Earlier Effective Date Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The effective date of an original award of direct service connection is the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service; otherwise, date of receipt of claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). A claim is a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit. 38 C.F.R. § 3.1(p). The essential elements for any claim, whether formal or informal, are “(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing.” Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). Although VA now requires claims to be filed on the proper standardized form, this applies to claims filed on or after March 24, 2015. See 38 C.F.R. § 3.155. Effective dates earlier than July 22, 2013 for other specified trauma and stressor-related disorder and tinnitus. The Veteran asserts that he should receive an earlier effective date than July 22, 2013 for his service-connected psychiatric disorder and tinnitus. A review of the record shows the Veteran’s claims for a psychiatric disorder and tinnitus were received July 22, 2013. While the Board acknowledges the Veteran’s general claims that his psychiatric disorder and tinnitus effective dates for service connection are prior to July 22, 2013, there is no evidence to support such contention. The effective date for service connection in this case is the date of receipt of the claim or the date entitlement to service connection arose, whichever is later. In this case, no formal or informal communication requesting a determination of entitlement, or evidencing a belief in entitlement, to service connection for a psychiatric disorder or tinnitus was submitted prior to July 22, 2013. Additionally, even if these disorders were shown in medical records at an earlier time, the mere presence of medical evidence does not establish an intent to seek service connection. See Brannon v. West, 12 Vet. App. 32, 34-35 (1998) (holding that the mere receipt of medical records could not be construed as an informal claim); see also Criswell v. Nicholson, 20 Vet. App. 501, 503 (2006) (“[W]here there can be found no intent to apply for VA benefits, a claim for entitlement to such benefits has not been reasonably raised.”). As the preponderance of the evidence is against the claims for earlier effective dates for the award of service connection for the psychiatric disorder and tinnitus, the benefit-of-the-doubt doctrine is not applicable and the claims are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, earlier effective dates are not warranted. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service” the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. 1. Service connection for migraines. The Veteran contends that his he has a migraine disorder which is related to his service-connected disabilities, including his psychiatric disability and tinnitus. Following the Veteran’s July 2013 claim for migraines, he was afforded a March 2014 VA examination which he failed to attend. Thereafter, a September 2016 medical opinion was submitted from Dr. H.S. which indicated the Veteran is diagnosed with migraines. He concluded it is as likely as not that the Veteran’s migraines are caused by his service-connected tinnitus, as well as his psychiatric disability. He stated the Veteran was diagnosed with tinnitus and when it flares, it brings on migraines. He indicated medical literature supports that damage to the auditory system which results in tinnitus can cause headaches. The examiner indicated another contributing factor of the Veteran’s migraines is his psychiatric diagnosis. He noted medical research supports that patients with mental health conditions are more likely to develop headaches because pain and mood are regulated by the same part of the brain. He stated mental disorders both cause and aggravate headaches and the relationship between the two is supported by medical literature. He noted the Veteran experiences migraines 2-3 times per week that can last 2-12 hours in duration and can be so severe that he is forced to lie down in a dark environment. The Board finds that the Veteran’s migraine headaches are related to his service-connected disabilities, including his psychiatric disorder and tinnitus. In this regard, the September 2016 physician’s opinion provides the weight of the medical evidence and concluded the Veteran’s migraines are linked to his other service-connected disabilities. Further, his VA treatment records support ongoing treatment for migraines. While the Veteran failed to attend the previously scheduled VA examination, the Board finds the September 2016 medical opinion to be adequate, accurate and thorough, as well as supported by relevant medical literature. Therefore, affording the Veteran all reasonable doubt, service connection for his migraines is warranted. Thus, resolving reasonable doubt in the Veteran’s favor, the Board finds that Veteran’s migraines were caused or aggravated by his service-connected psychiatric disability and tinnitus. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Accordingly, service connection is warranted for migraines on a secondary basis. 2. Service connection for bilateral hearing loss. The Veteran contends that he suffers from hearing loss which is related to his service. The Veteran contends his military occupational specialty (MOS) as a multiple launch rocket system (MLRS) crewmember exposed him to hazardous noise which led to hearing loss. Hearing loss for the purpose of VA disability compensation is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran’s service treatment records do not show hearing loss for VA purposes. There were also no records of treatment or diagnosis for hearing loss in service. However, given his MOS, the Board notes he had a high likelihood of being exposed to hazardous noise during service. The Veteran was afforded a February 2014 VA examination in which testing showed pure tone thresholds in his right ear were 10, 10, 10, 10 and 25 decibels, at 500, 1000, 2000, 3000 and 4000 Hertz respectively. In his left ear, pure tone thresholds were 10, 15, 15, 15 and 35 decibels, at 500, 1000, 2000, 3000 and 4000 Hertz, respectively. Further, speech recognition scores were 98 percent and 96 percent in the right and left ear, respectively. Thus, current hearing loss was not found. 38 C.F.R. § 3.385. The examiner noted the Veteran’s reports of difficulty hearing, and found the Veteran’s hearing loss is related to service. However, as noted, the audiological test results did not support current hearing loss in either ear for VA purposes. 38 C.F.R. § 3.385. The Board notes no further medical or lay evidence supporting current hearing loss was received following the VA examination. Moreover, a June 2016 VA treatment record indicated the Veteran has no hearing loss, only chronic tinnitus. After review of all of the evidence, the Board accepts that the Veteran was exposed to hazardous noise during service. His MOS was such that it is reasonable to find that he was exposed to ongoing loud noise from service. However, the Board finds that the preponderance of the evidence is against the claim. The evidence overall, including the audiological test results from February 2014, does not show the Veteran has current hearing loss for VA purposes under 38 C.F.R. § 3.385. The Board sympathizes with the Veteran, but concludes that he is not currently diagnosed with hearing loss, at least at the Hertz levels relevant to VA testing. Absent sufficient evidence of hearing loss for VA purposes under 38 C.F.R. § 3.385, the first element of service connection has not been established with regard to the hearing loss claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that in the absence of proof of a present disability, there can be no valid claim). To the extent the Veteran believes he suffers from hearing loss, the Board notes lay persons are competent to report symptoms of perceived worse hearing, as the disability is capable of lay observation. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (a lay person is competent to report symptoms based on personal observation when no special knowledge or training is required). However, based on the objective test results, including from the February 2014 VA examination, audiometric data (which is required to affirmatively show hearing loss, per 38 C.F.R. § 3.385) fails to reflect hearing loss for VA purposes. Given that the probative evidence of record fails to show current hearing loss, the preponderance of the evidence is against the Veteran’s hearing loss claim. Thus, there is no reasonable doubt to be resolved and service connection for hearing loss is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. TDIU A TDIU may be assigned where the schedular rating is less than total and when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. § 4.16(a). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to a TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. at 452 (2009). Therefore, in adjudicating a TDIU claim, VA must take into account the individual veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164, 168 (1991). When there is an approximate balance of positive and negative evidence regarding any material issue, all reasonable doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert at 49. As noted above, the current decision increases the Veteran’s psychiatric rating to 70 percent from the date of the claim, July 22, 2013. During the February 2014 VA examination, the examiner indicated the Veteran suffers from avoidance, irritability, hypervigilance, sleep disturbances, chronic sleep impairment and suspiciousness. In the August 2016 medical opinion, the examiner noted the Veteran has been married to his second wife for eleven years and has one child. She indicated he is a high school graduate and took some college classes, but did not graduate. She noted his most recent employment was as an assistant manager at Walmart. The examiner indicated the Veteran suffers from occupational and social impairment with deficiencies in most areas. She noted symptoms of depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, mild memory loss and flattened affect. She further reported psychiatric symptoms of difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, suicidal ideation, impaired impulse control, persistent delusions or hallucinations and persistent danger of hurting himself or others. The examiner noted the Veteran has great ongoing difficulty with his symptom pattern and can no longer enjoy the simplest of activities. She further indicated the Veteran’s psychiatric disability impacts his employment, causing him to miss work three or more times per month, as well as causing him difficulty concentrating and irritability. The Board finds that the evidence has reached a level of equipoise and affording the Veteran all reasonable doubt, the impairment from his service-connected psychiatric disability precludes him from securing and following a substantially gainful occupation. This is particularly so when reasonable doubt is resolved in his favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran was working full-time as an assistant manager at Walmart; however, the evidence supports that he has been unable to maintain substantially gainful employment since May 21, 2016. A record from the Social Security Administration (SSA) indicates the Veteran asserts he is unable to function and/or work in his job at Walmart as of May 21, 2016. Consistent with this record, a July 2016 VA treatment record noted the Veteran’s need for psychotherapy had increased significantly and he had been experiencing increasing anxiety and anger in recent month, including at work. The July 2016 VA record indicated the Veteran stopped work and was on leave at that time, and could only leave his home when absolutely necessary based on his symptoms of avoidance. Thus, the medical evidence supports the conclusion that the Veteran’s psychiatric disability prevents substantially gainful employment. The August 2016 medical examiner determined there is severe functional impact related to his psychiatric disability and the record suggests he stopped working full-time in May 2016. Additionally, the Board finds the Veteran meets the schedular criteria for a TDIU under 38 C.F.R. § 4.16(a), since May 21, 2016. In this regard, the current decision increases his psychiatric disability rating to 70 percent, effective July 22, 2013. Therefore, he has a service-connected disability rated as at least 60 percent disabling as of May 21, 2016. 38 C.F.R. § 4.16(a). Based on the foregoing, and when resolving reasonable doubt in the Veteran’s favor, the Board finds that he has been unable to secure and follow a substantially gainful occupation as a result of his service-connected psychiatric disability since May 21, 2016. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, entitlement to a TDIU is warranted from that date. REASONS FOR REMAND 1. A rating in excess of 70 percent for the psychiatric disability. The current decision increased the Veteran’s initial psychiatric rating from 30 percent to 70 percent. However, the August 2016 medical opinion indicated several symptoms which support a potentially higher rating increase to 100 percent for the psychiatric disability. The examiner indicated symptoms of disturbances of motivation and mood, difficulty in establishing and maintaining work and social relationships, difficulty adapting to stressful circumstances, suicidal ideation, impaired impulse control, such as unprovoked irritability with periods of violence, persistent delusions or hallucinations and persistent danger of hurting self or others. In light of these severe symptoms, the Board finds a VA examination is necessary to assess the current severity of the psychiatric disability to determine if total occupational and social impairment is indicated. 2. Service connection for left leg and right ankle disorders. The Veteran contends he has left leg and right ankle disabilities related to service. The Veteran’s service treatment records contain a July 2003 record which indicated the Veteran complained of left knee pain, including sharp pain after running and dull pain while walking. He noted that squatting caused him discomfort. An August 2003 record indicated moderate right ankle swelling seen laterally, some irregularity of the bone outline at the proximal dorsal aspects of the tarsonavicular bone, found as “probably” related to a healed chip fracture. A December 2003 service record indicated the Veteran reported feeling sick due to medication he was taking at the time and his left leg was numb. A later December 2003 record noted the Veteran reported an ankle stress fracture one month prior. The Veteran was scheduled for VA examinations for the claims in 2014 and failed to attend. In addition, a December 2013 statement was submitted in which the Veteran indicated he injured his right ankle in basic training in 2003 and it has bothered him ever since. He stated it alters his gait and swells if he stands for prolonged periods of time. In light of the evidence, the Board finds a VA examination is necessary to determine the nature and etiology of any diagnosed left leg and right ankle disorders. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 3. Service connection for a back disorder. The Veteran reports that he has a low back disorder that began during service. On his application for benefits, he reported chronic back pain since 2003. During a November 2016 VA medical appointment, he reported back pain for the last “8-9 years,” which coincides with his second period of active duty service. Additionally, his VA medical records show an impression of mild disc space disease at the L3-L4 level. Although there is no indication of treatment for back symptoms in service, the Veteran is competent to report the onset of his symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). Thus, the Board finds that an examination addressing the etiology of the Veteran’s back disorder is warranted. The matters are REMANDED for the following action: 1. Obtain all outstanding VA medical records and ask the Veteran to provide authorizations for any private medical records he would like considered in connection with his appeal. 2. Thereafter, schedule the Veteran for a VA examination with an appropriate medical professional to assess the severity of his service-connected psychiatric disability. 3. Schedule the Veteran for a VA examination with an appropriate medical professional to determine the nature and etiology of any diagnosed left leg, right ankle and low back disorders. The examiner should identify any current left leg, right ankle and low back disorders. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any identified left leg, right ankle or low back disorder had an onset during, or is otherwise related to, service. The Veteran’s service treatment records should be addressed, as well as his lay statements in support. TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Isaacs, Associate Counsel