Citation Nr: 18161169 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 17-00 216 DATE: December 28, 2018 ORDER From December 29, 1980, a 100 percent initial disability rating for posttraumatic stress disorder (PTSD) is granted. The claim of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is dismissed as moot. FINDINGS OF FACT 1. From the December 29, 1980, date of service connection, the evidence is at least evenly balanced as to whether the Veteran’s service-connected PTSD symptoms more nearly approximated virtual isolation in the community. 2. For the entire period on appeal, the Veteran has been in receipt of a 100 percent rating for PTSD and does not have other service-connected disabilities, without consideration of his PTSD, which prevent him from obtaining and maintaining gainful employment. CONCLUSIONS OF LAW 1. The criteria for an initial 100 percent disability rating for PTSD have been met for the entire period on appeal. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1-4.7, 4.132, Diagnostic Code 9411 (1996). 2. The claim for a TDIU has been rendered moot by the grant of a 100 percent disability rating for PTSD for the entire period on appeal. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 4.16 (2018); Bradley v. Peake, 22 Vet. App. 280 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service with the United States Marine Corps from August 1966 to June 1969, including service in the Republic of Vietnam. The Veteran received the Combat Action Ribbon, among other commendations. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, in December 1980, the Veteran filed a request to reopen a claim of service connection for a psychiatric disorder. In a December 1981 rating decision, the RO denied service connection for a psychiatric disorder. In July 2010, the Veteran filed a request to reopen his claim for service connection for a psychiatric disorder, specifically claiming PTSD. In an August 2011 rating decision, the RO granted service connection for PTSD, assigning a disability rating of 50 percent, effective July 12, 2010. In September 2011, the Veteran filed a notice of disagreement (NOD), appealing the initial evaluation of his service-connected PTSD and the effective date for the grant of service connection. Then, in November 2011, the Veteran filed a claim asserting that there was clear and unmistakable error (CUE) in the December 1981 rating decision that denied service connection for a psychiatric disorder. In a February 2014 rating decision, the RO determined that there was no CUE in the December 1981 rating decision, and continued the 50 percent evaluation for PTSD from July 12, 2010. In March 2014, the Veteran filed a NOD, appealing the denial of his claim of CUE. In a November 2014 rating decision, the RO granted an earlier effective date for the grant of service connection for PTSD based on CUE in the December 1981 rating decision. The RO assigned an initial disability rating of 10 percent, effective December 29, 1980, then assigned a 100 percent rating from January 31, 2009. In December 2014, the Veteran filed a NOD, appealing the initial evaluation of his service-connected PTSD. A statement of the case (SOC) was issued in November 2016, to which the Veteran filed a timely substantive appeal (VA Form 9), perfecting the issue to the Board. In July 2016, the Veteran testified at a hearing before a Decision Review Officer (DRO). A transcript of the hearing has been associated with the Veteran’s electronic claims file. The Board notes that the Veteran is in receipt of Special Monthly Compensation (SMC) benefits under 38 U.S.C. § 1114(s), as of October 9, 2009. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The Schedule is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When two evaluations are potentially applicable, VA will assign the higher evaluation when the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. VA will resolve reasonable doubt as to the degree of disability in favor of the Veteran. 38 C.F.R. § 4.1. If the evidence for and against a claim is in equipoise, the claim will be granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. In accordance with 38 C.F.R. §§ 4.1, 4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the service-connected disabilities at issue. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability. Each disability is viewed in relation to its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). The Board notes that where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. 38 C.F.R. §§ 4.1, 4.2 (2016); see also Francisco v. Brown, 7 Vet. App. 55 (1994). In Hart v. Mansfield, 21 Vet. App. 505 (2007), however, the Court held that “staged ratings” are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. Section 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). VA must consider all favorable lay evidence of record. 38 U.S.C. § 5107(b); Caluza v. Brown, 7 Vet. App. 498 (1995). The Veteran is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that all of the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Because the Veteran is challenging the initially assigned disability rating, it has been in continuous appellate status since the original assignment of service connection. The evidence to be considered includes all evidence proffered in support of the original claim filed in December 1980. Fenderson v. West, 12 Vet. App. 119 (1999). For historical purposes, the RO granted service connection for PTSD effective July 12, 2010, in an August 2011 rating decision. As previously discussed, a November 2014 rating decision determined that there was CUE in a December 1981 rating decision, and granted an earlier effective date of December 29, 1980, the date of the Veteran’s request to reopen his claim of service connection for a psychiatric disorder. The Veteran’s PTSD is currently rated under Diagnostic Code 9411. 38 C.F.R. § 4.130, Diagnostic Code 9411 (2018). He is in receipt of a 10 percent rating from December 29, 1980, and a total rating from January 31, 2009. He contends that a higher initial rating for PTSD is warranted prior to January 31, 2009. During the pendency of this appeal, the rating criteria for evaluating mental disorders were amended (effective November 7, 1996). Where a law or regulation changes during the pendency of a claim for increased rating, the Board should first determine whether application of the revised version would produce retroactive results. In particular, a new rule may not extinguish any rights or benefits the claimant had prior to enactment of the new rule. VAOPGCPREC 07-03. However, if the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As explained below, a total rating is being granted pursuant to the old regulations. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). Further discussion of the amended rating criteria is not necessary. Prior to November 7, 1996, Diagnostic Code 9411 for PTSD was rated under the General Rating Formula for Psychoneurotic Disorders. 38 C.F.R. § 4.132, Diagnostic Code 9411. Under this General Rating Formula, a 10 percent rating required less than the criteria for the 30 percent rating, with emotional tension or other evidence of anxiety productive of mild social and industrial impairment. A 30 percent rating required definite impairment in the ability to establish or maintain effective or wholesome relationships with people, and psychoneurotic symptoms that result in such reduction in flexibility, efficiency, and reliability levels as to produce definite social impairment. The term “definite” has been defined as “distinct, unambiguous, and moderately large in degree,” representing a degree of social and industrial inadaptability that was “more than moderate but less than rather large.” VAOPGCPREC 9-93, 59 Fed. Reg. 4752 (1994); see also Hood v. Brown, 4 Vet. App. 301 (1993). A 50 percent rating required considerable impairment in the ability to establish or maintain effective or favorable relationships with people, and psychoneurotic symptoms that result in such reduction in reliability, flexibility, and efficiency levels as to produce considerable industrial impairment. A 70 percent evaluation required severe impairment in the ability to establish and maintain effective or favorable relationships with people; the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. A 100 percent evaluation required virtual isolation in the community, totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality, or demonstrable inability to obtain or retain employment. Further, the United States Court of Appeals for Veterans Claims (Court) held that these criteria provide three independent bases for granting a 100 percent disability evaluation. See Johnson v. Brown, 7 Vet. App. 95, 97 (1994). Note 1 provided that social impairment per se will not be used as the sole basis for any specified percentage evaluation, but is of value only in substantiating the degree of disability based on all of the findings. In addition, VA promulgated 38 C.F.R. § 4.16(c), effective March 1, 1989, which stated that in cases where a mental disorder was assigned a 70 percent evaluation, and such mental disorder precluded a Veteran from securing or following a substantially gainful occupation, in such cases, the mental disorder must be assigned a 100 percent schedular evaluation under the appropriate diagnostic code. See 54 Fed. Reg. 4280-01 (Jan. 30, 1989). Notably, 38 C.F.R. § 4.16(c) (1996) was repealed when the revised criteria for rating psychiatric disabilities became effective on November 7, 1996. 61 Fed. Reg. 52695 Oct. 8, 1996). In his December 1980 request to reopen his claim of service connection for PTSD, the Veteran associated his PTSD symptoms with his combat service in Vietnam. In July 1981, the Veteran underwent a VA psychiatric examination. The examiner noted that the Veteran’s service medical records were not available for his review; however, few of the Veteran’s post-service medical records were available for his review. On examination, the examiner reported that the Veteran appeared to be somewhat more ill than that of a posttraumatic stress neurosis, noting that he demonstrated major symptomatology. The Veteran recounted multiple Vietnam stressors. The Veteran reported that in 1970, shortly after his discharge from active service, he sought outpatient psychiatric treatment at a VA medical center (VAMC) in Washington, D.C. He further reported that he had been receiving treatment with VA for at least the last five years. He complained of a variety of combat flashbacks, which occurred in the late evening, while he was asleep, or during the day. He indicated that he had received a variety of minor tranquilizers at the VAMC. For his work history, the examiner noted that the Veteran had been out of work for at least a year and a half. The Veteran indicated that he was unable to find work. The examiner also noted that the Veteran was due to get married; however, his fiancée decided she no longer wanted to get married to him because he was “crazy.” He lived with his father, mother, and brother. With respect to his psychiatric complaints, the examiner noted that the Veteran reported complaints of light-headedness. The examiner indicated that the light-headedness had “some rather bizarre characteristics to it.” The Veteran stated, “When I look straight ahead, it feels as if my head is moving as if everything is spinning around.” The examiner emphasized that he was very careful to determine that the Veteran was not in fact describing symptoms of vertigo. Instead, he was describing a bizarre sense of perception. Additionally, the Veteran stated that if he is walking at night along a dark street with hedges, he feels certain that he is walking back in the jungle of Vietnam. He further reported that he woke up often at night with terrors and sweating, thinking about combat experiences in Vietnam. A mental status examination was notable for vegetative signs of depression and a somewhat subdued tone of voice. The Veteran reported that he felt himself to be quite isolated from people, that he felt anxious around them, and that he did not get close to them. Based on the findings, the examiner indicated that the bizarre somatic complaints and the somewhat borderline delusional experiences all suggested that there may in fact be an underlying thought disorder. The examiner further stated that it was quite clear that the Veteran was functioning in a very marginal fashion, and given his intelligence and his capacity of work in the past as a computer operator, it was probably a manifestation of his psychiatric illness that he was having such trouble finding a job. The examiner diagnosed posttraumatic stress neurosis with a possibility of an underlying chronic schizophrenia. In September 1981, the Veteran underwent another VA psychiatric examination with the July 1981 examiner, as the Veteran’s medical records were made available to him at that time. Again, the Veteran recounted multiple Vietnam stressors. The examiner indicated that, based on a review of the Veteran’s medical history and examination of the Veteran, all of the examiners agreed that the Veteran had some psychiatric impairment involving anxiety and depression. The examiner cited the 1972 VA psychiatric examination report, indicating that after a careful review of that report, it was clear that there was significant evidence for a degree of paranoia present in the Veteran at that time. He indicated that this was consistent with his findings as reported in the July 1981 examination report. In sum, consistent with his findings during the July 1981 examination, the examiner attributed the Veteran’s psychiatric symptoms, including paranoia and neurotic difficulties, to his combat service in Vietnam. A November 2010 VA mental health record shows that the Veteran reported going through a period of depression, isolation, and flashbacks of Vietnam. The Veteran presented with sleep impairment, diminished interest in pleasurable activities, feelings of guilt about things he did in the military, low energy, and impaired concentration. The Veteran reported that he sometimes heard voices of people crying out for help. No delusions were elicited. The Veteran admitted to cocaine use after returning from Vietnam. He completed substance abuse treatment and had been clean for 30 years. The Veteran endorsed nightmares and feeling as though he was re-experiencing his time in Vietnam. He also endorsed a general paranoia and stated that he was always aware of people. He often checked locks and doors. The Veteran reported that he had been divorced for the past three years. He indicated that he had problems with holding down jobs for more than six months to a year at a time. He stated that he had a problem with authority. In June 2011, the Veteran underwent a VA psychiatric examination. The Veteran reported that his PTSD symptoms began in 1968 as a result of his service in Vietnam. He endorsed symptoms of intrusive recollections of the war, anger, and depression. The symptoms were constant and moderate in severity. The Veteran indicated that the symptoms affected total daily functioning, which resulted in poor adjustment in civilian life. He reported suffering from sleep impairment for the last 40 years. Regarding his work history, the Veteran reported that he had about 10 different jobs since the 1970s, describing the jobs as “odd jobs.” He further indicated that he was like a drifter, sometimes relying on his father to find him a job. The Veteran indicated that his problem with employment was his inconsistency to stay with any job. The examiner noted that the Veteran had markedly diminished interest or participation in significant activities, which continued to persist. He was living a very isolated existence until starting to attend group therapy session a few months ago. He demonstrated feelings of detachment or estrangement from others, which continued to persist. Additionally, he demonstrated symptoms of irritability, outbursts of anger, an exaggerated startle response, and hypervigilance. The Veteran indicated that he avoided crowds, malls, and most places where many people were gathered. Based on the findings, the examiner noted that the effects of the Veteran’s PTSD symptoms on his employment and quality of life included his depression and anger. The examiner further noted that the Veteran had difficulty establishing and maintaining effective work/school and social relationship because of his PTSD symptoms. Additionally, he had difficulty with maintaining effective family role functioning because of his PTSD symptoms. The examiner indicated that the Veteran needed more PTSD treatment to manage his symptoms. In February 2013, the Veteran underwent another VA psychiatric examination. The Veteran reported that he was married to his second wife and described their relationship as “poor.” He further reported that he had “poor” relationships with his children due to historical issues with abandonment. As for work history, the Veteran reported a sporadic history since his separation from service, as he had several short-lived jobs. He was unemployed at that time. The examiner continued the Veteran’s diagnosis of PTSD; however, the examiner noted that the Veteran did not need to seek any follow-up treatment at that time. In a March 2013 private treatment record, Dr. W. R., a licensed psychiatrist, indicated that the Veteran was unable to function in any work capacity due to the severity of his PTSD symptoms. Dr. W.R. further indicated that the Veteran was 100 percent disabled, and most likely, had been for many years. Dr. W.R. noted that since his discharge from service, the Veteran had a multitude of jobs from a meter reader to real estate sales, all ending due to his PTSD symptoms – most often ending in arguing with clients and superiors. A psychiatric evaluation revealed that the Veteran had suicidal ideations in the past, and, at that time, wished life would end. He demonstrated symptoms of depression, anxiety, anergy, anhedonia, initial and mild insomnia, nightmares of the war and awakening with cold sweats, and hypervigilance. It was also noted that he rarely left the house and avoided crowds, even his family. The Veteran reported that he had issues with controlling his rage. He indicated that his many job losses were due to this agitation. Based on his findings, Dr. W.R. diagnosed severe PTSD. Dr. W.R. emphasized that the Veteran had no history of mental illness or depression prior to his service, nor was there any genetic history linking to any mental illness, including depression. He concluded that, with little doubt, the Veteran’s depression was associated with his PTSD. He also indicated that the Veteran required future follow-up. In an August 2014 private treatment record, a licensed clinical social worker (LCSW) indicated that the Veteran was referred to her agency in October 2010 after being challenged by his PTSD symptoms. His symptoms included anxiety, depression, social isolation, insomnia, nightmares, intrusive memories, and agitation. The LCSW noted that since the Veteran’s combat service in Vietnam, he has had distressing recollections of various experiences, which manifest in his dreams and interfere with daily perceptual experiences. He avoids social activities and often feels emotionally detached from others. He has had difficulty sleeping, poor concentration, and agitation leading to outbursts of anger. The LCSW indicated that the Veteran was seeking treatment for his PTSD with her agency on a bi-weekly basis for individual and group counseling sessions. In July 2016, the Veteran’s representative submitted records from the Social Security Administration (SSA), which document the Veteran’s annual wages from 1963 to 2014. As relevant, they showed that from 1969 to 1985, he had very little or no earnings. From 1995 to 1997, he had marginal employment, and no earnings from 1998 to 1999. From 2007 to 2009, he had marginal employment, and no earnings from 2010. As such, the SSA records show that since his separation from service, the Veteran has had a very sporadic employment history, with periods of little or no earnings. The Veteran contends that a higher initial rating is warranted for his service-connected PTSD. As explained below, the Board finds that a total rating for PTSD is warranted from December 29, 1980, under the pre-amended Diagnostic Code 9411 rating criteria based upon virtual social isolation. 38 C.F.R. §§ 4.3, 4.7, 4.132, Diagnostic Code 9411 (1996). The evidence clearly indicates that the Veteran’s PTSD symptoms have been of a nature, frequency, and duration to cause substantial impairments in occupational and social function since the December 29, 1980, claim. Notably, the VA examiner who conducted the psychiatric examinations in July 1981 and September 1981 identified serious PTSD symptoms, to include a bizarre sense of perception and vegetative signs of depression, among others. The Veteran’s isolative behaviors at that time essentially preclude any social activity. The VA examiner specifically noted that the Veteran’s fiancée decided not to marry him because he was “crazy.” The evidence does not reflect that the Veteran had any non-family social contacts during the pendency of the appeal. Although the evidence between 1981 and the initial November 2010 VA mental health record is limited, it is reasonable to infer that the Veteran had very poor social function and used isolative activities as a coping mechanism instead of seeking formal treatment for PTSD symptoms. There is no clear evidence of sustained improvement in symptoms from those documented in the July 1981 and September 1981 VA psychiatric examinations. The Board notes that the February 2013 VA examination report indicates some response to treatment. However, this report conflicts with the March 2013 and August 2014 private treatment records, which indicate that the Veteran’s PTSD symptoms were severe and required ongoing treatment. Thus, the Board finds that the Veteran had severe baseline PTSD symptoms that did not materially change from 1980 and onward. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the nature, frequency, and duration of the PTSD symptoms more nearly approximated a total rating under the pre-amended Diagnostic Code 9411 for PTSD. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). The prior total rating criteria under 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996) contemplated virtual isolation in the community. The Court has held that this factor alone is an independent basis for a total rating. See Johnson, 7 Vet. App. at 97. The Board observes that this standard is vague as to extent of social isolation required. However, the medical and lay evidence undoubtedly shows that the Veteran had near total social impairment throughout the rating period. His social contacts were essentially limited to his mother, father, and brother. The record reflects that his relationships with his prior wives and his children were poor. He expressed concerns about his abilities to maintain these relationships when he finally sought PTSD treatment. Then, his employment is more accurately characterized as marginal or sheltered. 38 C.F.R. § 4.16(a). Dr. W.R. provided a clear opinion that total occupational and social impairment was shown since 1980, based upon his review of the record. The Board finds the evidence to be at least in a state of relative equipoise regarding whether virtual isolation in the community is demonstrated since the December 29, 1980, claim. A 100 percent initial rating for PTSD is granted effective from the December 29, 1980, service connection claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. TDIU Pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), a claim for a TDIU is considered part and parcel of an increased-rating claim when the issue of unemployability is raised by the record. VA’s duty to maximize benefits requires it to assess all of a claimant’s service-connected disabilities to determine whether any combination of the disabilities establishes eligibility for SMC under 38 U.S.C. § 1114(s) (2012). See Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). In Bradley, 22 Vet. App. 280, the Court held that 38 U.S.C. § 1114(s) permits a TDIU rating based on a single disability to satisfy the statutory requirement of a “total” rating. When a veteran is awarded TDIU based on a single disability and receives schedular disability ratings for other conditions, SMC based on the statutory housebound criteria may be awarded so long as the same disability is not counted twice, i.e., as a basis for TDIU and as a separate disability rated 60 percent or more disabling. See 75 Fed. Reg. 11,229, 11,230, Summary of Precedent Opinions of the VA General Counsel (March 10, 2010) (withdrawing VAOPGCPREC 6-1999 in light of Bradley, 22 Vet. App. at 280). A veteran with a 100 percent schedular disability rating for a single service-connected disability could also obtain a TDIU on a single separate disability (though not on multiple service-connected disabilities), in order to meet the SMC requirements (100 percent rating plus 60 percent rating). A TDIU could meet the SMC requirements by either: a) increasing a single disability rating of less than 60 percent to at least 60 percent (in a case where a separate 100 percent rating is already established), or b) increasing a single disability that is less than 100 percent to a “total” (100 percent) rating, in a case where there is already established a combination of other ratings that meet the separate 60 percent rating requirement for SMC. See Buie at 249-50. At the outset, the Board notes that, in a November 2014 rating decision, the RO awarded SMC benefits under 38 U.S.C. § 1114(s), from October 9, 2009. As previously indicated, at that time, the RO increased the Veteran’s evaluation for PTSD to 100 percent, effective January 31, 2009. As the Veteran was also service connected for other disabilities ratable at 60 percent or more from October 9, 2009, the increase of PTSD to a total rating allowed the Veteran to meet the criteria for a SMC award from October 9, 2009; thus, the RO awarded SMC benefits from that date. In this case, the Veteran has been awarded entitlement to a 100 percent rating for PTSD, effective December 29, 1980. A review of the record shows that the Veteran has not alleged that other service-connected disabilities, without regard to his PTSD, render him unable to obtain and maintain gainful employment. Thus, in this particular case, the Board finds that a TDIU is effectively rendered moot by the total rating award of PTSD for the entire period on appeal in the instant decision. (CONTINUED ON NEXT PAGE) Furthermore, the instant decision awarding a 100 percent rating for PTSD, effective December 29, 1980, does not affect the Veteran’s SMC award under 38 U.S.C. § 1114(s). As of October 9, 2009, the Veteran also has additional service-connected disabilities independently ratable at 60 percent (nephropathy with hypertension at 30 percent, diabetes at 20 percent, and left lower extremity peripheral artery disease at 20 percent), warranting SMC benefits from that date. See 38 C.F.R. § 4.25. Thus, the instant decision awarding a total rating for PTSD from December 29, 1980, does not change the fact that the Veteran initially met the criteria for SMC as of October 9, 2009. Therefore, SMC benefits are not warranted prior to that date. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Y. MacDonald, Associate Counsel