Citation Nr: 18129690 Decision Date: 08/27/18 Archive Date: 08/27/18 DOCKET NO. 12-26 563 DATE: August 27, 2018 ORDER Service connection for sleep apnea is denied. An initial rating in excess of 10 percent for residuals of removal of the right great toenail is denied. For the entire period on appeal, an initial rating of 100 percent for residuals of TBI is granted, subject to controlling regulations governing the payment of monetary awards. Prior to August 31, 2011, a 70 percent initial rating for acquired psychiatric disorders is granted, subject to controlling regulations governing the payment of monetary awards. From August 31, 2011, forward, a 100 percent rating for acquired psychiatric disorders is granted, subject to controlling regulations governing the payment of monetary awards. Prior to December 6, 2016, a rating of 50 percent, but no higher, for headaches, as a residual of TBI, is granted, subject to controlling regulations governing the payment of monetary awards. From December 6, 2016, a rating in excess of 50 percent for headaches, as a residual of TBI, is denied. Prior to November 19, 2016, a rating of 10 percent, but no higher, for a head scar, as a residual of TBI, is granted, subject to controlling regulations governing the payment of monetary awards. From November 19, 2016, a rating in excess of 10 percent for a head scar, as a residual of TBI, is denied. Prior to November 19, 2016, an initial rating of 10 percent, but no higher, for a painful head scar, as a residual of TBI, is granted, subject to controlling regulations governing the payment of monetary awards. From November 19, 2016, a rating in excess of 10 percent for a painful head scar, as a residual of TBI, is denied. For the entire period on appeal, an initial rating of 10 percent, but no higher, for tinnitus, as a residual of TBI, is granted, subject to controlling regulations governing the payment of monetary awards. For the entire period on appeal, an initial rating of 10 percent, but no higher, for dizziness, as a residual of TBI, is granted, subject to controlling regulations governing the payment of monetary awards. For the entire period on appeal, SMC at the (t) rate is granted, subject to controlling regulations governing the payment of monetary awards. The appeal seeking entitlement to a TDIU, having now been rendered moot, is dismissed. REMANDED Entitlement to a rating in excess of 10 percent for a right knee disability is remanded. Entitlement to a rating in excess of 10 percent for a left knee disability is remanded. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of sleep apnea. 2. For the entire period on appeal, the Veteran’s residuals of removal of the right great toenail were characterized by pain. 3. For the entire period on appeal, the objective evidence shows that the Veteran’s residuals of TBI were rated as “total” in the judgment facet 4. Prior to August 31, 2011, the Veteran’s acquired psychiatric disorders were characterized by occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment. 5. From August 31, 2011, forward, the Veteran’s acquired psychiatric disorders were characterized by total occupational and social impairment. 6. For the entire period on appeal, the Veteran’s headaches have been characterized by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 7. For the entire period on appeal, the Veteran’s head scar, as a residual of TBI, results in only one characteristic of disfigurement, but does not result in visible or palpable tissue loss and either gross distortion or asymmetry of any features. 8. For the entire period on appeal, the Veteran has one painful scar. 9. For the entire period on appeal, the Veteran experiences tinnitus as a residual of TBI. 10. For the entire period on appeal, the Veteran experiences occasional dizziness as a residual of TBI, but the dizziness was not accompanied by occasional staggering. 11. For the entire period on appeal, the Veteran has been in need of regular aid and attendance for the residuals of TBI, is not eligible for compensation under 38 U.S.C. § 1114(r)(2), and in the absence of such regular aid and attendance would require hospitalization, nursing home care, or other residential institutional care. 12. The claim of entitlement to a TDIU is now rendered moot in light of the Board’s grant herein of a total schedular disability rating for residuals of TBI for the entire period on appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). 2. The criteria for a rating in excess of 10 percent for residuals of removal of the right great toenail have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.27, 4.118, DC 7899-7804 (2017). 3. For the entire period on appeal, the criteria for an initial rating of 100 percent for residuals of TBI have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.124a, DC 8045 (2017). 4. Prior to August 31, 2011, the criteria for a separate rating of 70 percent, but no higher, for an acquired psychiatric disorder, to include MDD, PTSD, and major neurocognitive disorder due to TBI, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.130, DC 9433 (2017). 5. From August 31, 2011, forward, the criteria for a rating of 100 percent for an acquired psychiatric disorder, to include MDD, PTSD, and major neurocognitive disorder due to TBI, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.130, DC 9433 (2017). 6. Prior to December 6, 2016, the criteria for a separate rating of 50 percent for headaches, as a residual of TBI, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, DC 8100 (2017). 7. From December 6, 2016, the criteria for a rating in excess of 50 percent for headaches, as a residual of TBI, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.124a, DC 8100 (2017). 8. Prior to November 19, 2016, the criteria for a rating of 10 percent for a head scar, as a residual of TBI, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, DC 7800 (2017). 9. From November 19, 2016, forward, the criteria for a rating in excess of 10 percent for a head scar, as a residual of TBI, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, DC 7800 (2017). 10. Prior to November 19, 2016, the criteria for a rating of 10 percent, but no higher, for a painful scar, as a residual of TBI, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, DC 7804 (2017). 11. From November 19, 2016, forward, the criteria for a rating in excess of 10 percent for a painful scar, as a residual of TBI, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.27, 4.118, DC 7804 (2017). 12. For the entire period on appeal, the criteria for a separate 10 percent rating for tinnitus, as a residual of TBI, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.87, DC 6260 (2017). 13. For the entire period on appeal, the criteria for a separate 10 percent rating for dizziness, as a residual of TBI, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.87, DC 6204 (2017). 14. For the entire period on appeal, the criteria for SMC at the (t) rate have been met. 38 U.S.C. §§ 1114, 5107 (2012); 38 C.F.R. §§ 3.102, 3.350, 3.351, 3.352 (2017). 15. The matter of the Veteran’s entitlement to a TDIU has been rendered moot by the award of a total (100 percent) schedular rating for residuals of TBI for the entire appeal period, leaving no question of law or fact to decide regarding that issue. 38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.14, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from August 2009 to October 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions of Department of Veterans Affairs (VA) Regional Offices (ROs). In a March 2011 rating decision, the VA RO in Louisville, Kentucky, in pertinent part, denied service connection for MDD and awarded service connection for the following disabilities, all effective October 17, 2010: residuals of removal of the right great toenail, rated 10 percent disabling; residuals of TBI, rated 10 percent disabling; a left knee disability, rated zero percent disabling; and a right knee disability, rated zero percent disabling. In an April 2014 rating decision, the VA RO in Montgomery, Alabama, in pertinent part, denied service connection for OSA, entitlement to SMC based on the Veteran’s need for aid and attendance/housebound status, and entitlement to a TDIU. In an April 2017 rating decision, a VA RO increased the rating for residuals of TBI from 10 to 70 percent disabling, effective November 19, 2016. The RO also increased the ratings for the right and left knee disabilities from 0 to 10 percent disabling, effective October 17, 2010. In addition, the RO awarded service connection for the following disabilities: PTSD, rated 70 percent disabling, effective December 6, 2016; headaches, rated 50 percent disabling, effective November 19, 2016; a painful head scar, rated 10 percent disabling, effective November 19, 2016; and a scar as a residual of TBI, rated 10 percent disabling, effective November 19, 2016. As to the separate compensable ratings for residuals of TBI that were awarded during the pendency of the appeal and are addressed herein, the Board finds that, to the extent that less than the maximum available benefit for a schedular rating was awarded and the separate ratings were not awarded for the entirety of the claims period, the claims remain before the Board. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35 (1993). The Board notes that no statement of the case (SOC) has been issued as to the issues of entitlement to increased ratings for PTSD, headaches, a painful head scar, a scar as a residual of TBI, and residuals of removal of the right great toenail. However, in January 2018, the Veteran’s representative asked the Board to take jurisdiction of these issues and explicitly waived the SOC as to these issues. The Board finds that these issues are inextricably intertwined with the present appeal for an increased initial rating for residuals of TBI; thus, in the interest of judicial efficiency, the Board has taken jurisdiction of these issues. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran’s claim for the second issue). The Veteran requested a Board hearing in his September 2012 and December 2015 VA Form 9’s. However, in June 2017, the Veteran’s representative withdrew his requests for hearings. In September 2016, the Veteran executed a new power-of-attorney appointing Adam Neidenberg, attorney-at-law, as his representative. This new appointment effectively revoked the Veteran’s prior appointment Kenneth L. LaVan, attorney-at-law. See 38 C.F.R. § 14.631(f)(1). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran 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); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303(a) (2017). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease incurred in service. 38 C.F.R. § 3.303(d) (2017). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Congress specifically limited entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In absence of proof a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. 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 disability, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017). 1. Entitlement to service connection for sleep apnea. The Veteran seeks service connection for sleep apnea. He claims that he has current sleep apnea that is related to, or caused by, service. After a review of all of the evidence of record, both lay and medical, the Board finds that the weight of the competent evidence demonstrates that the Veteran does not have a diagnosis of sleep apnea. While the record contains the Veteran’s extensive service, VA, and private treatment records do not reflect a current diagnosis of sleep apnea. To the contrary, a June 2014 VA treatment record indicates that while the Veteran reported experiencing symptoms similar to those of sleep apnea, a sleep study was normal. Insomuch as the Veteran has attempted to establish a diagnosis of sleep apnea through his own lay assertions, the Board finds that the Veteran is not competent to diagnose that he has a current diagnosis of sleep apnea due to the medical complexity of the matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007) (“sometimes the layperson will be competent to identify the disability where the disability is simple, for example a broken leg, and sometimes not, for example, a form of cancer”). Thus, the Veteran is not competent to render such a diagnosis. Importantly, service connection may only be granted for a current disability; when a claimed disability is not shown, there may be no grant of service connection. See 38 U.S.C. § 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). “In the absence of proof of a present disability there can be no valid claim.” See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Here, the record contains no current diagnosis of sleep apnea. As the Veteran is not currently diagnosed with sleep apnea, his service connection claim must be denied. As there is no current disability, a discussion of any in-service incurrence or aggravation of a disease or injury, or nexus, is unnecessary. Entitlement to service connection for sleep apnea is denied. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disability. 38 U.S.C. § 1155 (2012). Evaluation of a service-connected disability requires a review of the Veteran’s entire medical history regarding that disability. 38 C.F.R. §§ 4.1, 4.2 (2017); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. See 38 C.F.R. § 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,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2017). The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the diagnosis, and demonstrated symptomatology. Any change in a diagnostic code by a VA adjudicator must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses. See Layno, 6 Vet. App. 465, 469. 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, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2017). 2. Entitlement to an initial rating in excess of 10 percent for residuals of removal of right great toenail. The Veteran is currently in receipt of an initial rating of 10 percent for residuals of removal of the right great toenail. He contends that a higher rating is warranted. The Veteran’s residuals of removal of the right great toenail are currently rated under 38 C.F.R. § 4.118, DCs 7899-7804, applicable to painful or unstable scars. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. When an unlisted condition is encountered, as with residuals of removal of the right great toenail, it is permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. According to the policy in the Rating Schedule, when a disability is not specifically listed, the Diagnostic Code will be “built up,” meaning that the first 2 digits will be selected from that part of the schedule most closely identifying the part of the body involved, and the last 2 digits will be “99.” 38 C.F.R. § 4.27. Under DC 7804, a 10 percent rating is warranted for 1 or 2 scars that are unstable or painful. A 20 percent rating is warranted for 3 to 4 scars that are unstable or painful. A 30 percent disability rating is warranted for 5 or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Id. Given that the Veteran does not have a painful scar, the rating criteria in this case is imprecise, but the Board’s analysis focuses on the Veteran’s primary residual symptom of pain and an altered appearance, which is closely analogous to the symptomatology of a painful scar. Therefore, the Board finds DC 7804 to be the most appropriate diagnostic code for rating this disability. Turning to the evidence, an October 2009 service treatment record indicated that the Veteran had been diagnosed with a right toenail infection that was treated via a surgical toenail removal. The Veteran was afforded a VA examination in February 2011. Since his toenail was removed during service, it was growing back very slowly. However, the toenail was not normal and was tender at times in the toenail area. After a review of the evidence, both lay and medical, the Board finds that an initial rating in excess of 10 percent for residuals of removal of the right great toenail is not warranted. The evidence of record indicates that the Veteran’s only residuals of the removal of the right great toenail is an altered appearance of the toenail and tenderness at times in the toenail area. These symptoms of a single instance of altered appearance and pain are consistent with a rating of 10 percent, but no higher, under DC 7804. As the preponderance of the evidence is against the claim for a rating higher than 10 percent, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 3. Entitlement to an initial rating in excess of 10 percent for residuals of TBI prior to November 19, 2016, and in excess of 70 percent thereafter. The Veteran is seeking an increased rating for residuals of a TBI. He is currently service connected, in pertinent part, for the following disabilities: (1) residuals of TBI, rated 10 percent prior to November 19, 2016 and 70 percent thereafter, under 38 C.F.R. § 4.124a, DC 8045, applicable to residuals of TBI; (2) PTSD, rated 70 percent from December 6, 2016, under 38 C.F.R. § 4.130, DC 9411, applicable to PTSD; (3) posttraumatic headaches, rated 50 percent from November 19, 2016, under 38 C.F.R. § 4.124a, DC 8100, applicable to migraine; (4) a scar as a residual of TBI, rated 10 percent from November 19, 2016, under 38 C.F.R. § 4.118, DC 7800, applicable to scar(s) of the head, face, or neck; and (5) a painful head scar, rated 10 percent from November 19, 2016, under 38 C.F.R. § 4.118, DC 7800, applicable to scar(s), unstable or painful. Each of these disabilities is a residual of TBI. As each of these disabilities is a residual of TBI, the Board will consider them both together and separately in order to assign the highest possible combined rating. A. Summary of the Relevant Evidence An August 2009 service treatment note indicated that Veteran told someone that he grew up in a rough neighborhood and while growing up he had thoughts of wanting to harm others. The Veteran denied ever harming others and denied current thoughts of wanting to harm others. He stated that he got frustrated a lot and was currently frustrated because he had medical issues (knee) that had not allowed him to train. He stated that all he had been able to do was sit and watch everyone else train. He stated that he was depressed, but he did not meet the clinical criteria for depression. A September 2009 service treatment record indicated that the Veteran had an acute problem of adjustment disorder with depressed mood. He stated that it was “hard to be here and not training with the rest of the company.” The Veteran was having some knee problems. The physician stated that the Veteran had “no motivation to be here, but wants to be able to come back after he heals up.” No psychiatric disorder was diagnosed, and the Veteran was released without limitations. A July 2010 service treatment record noted a diagnosis of depression not otherwise specified (NOS). The Veteran had been in Afghanistan for one month. He reported a history of depression going back to childhood, but it had become more intense since his arrival in theatre. He reported poor sleep, reduced interest in activities, poor appetite with a 10-pound weight loss, and frequent suicidal ideation. The Veteran put a loaded gun to his head, but did not pull the trigger. His noncommissioned officer took the gun away from him and he was sent to behaviour health and then Landstuhl Regional Medical Center. The Veteran reported depressive symptoms since early childhood. He was not specific about causes, but reported social withdrawal, anhedonia, dysphoria, and irritability as long as he could remember. He reported about five previous suicidal gestures either with a gun or a knife. He had never been in treatment for depression. The Veteran reported currently having three to five hours of interrupted sleep a night. He did not wake up refreshed. His energy and interest levels were reduced and his concentration was poor. The Veteran reported frequent thoughts of suicide (every other day), but he denied having current thoughts of suicide. His mood was dysthymic and his affect was mood congruent. His speech was fluent, but soft and monotone. The Veteran reported using alcohol only occasionally. A separate July 2010 service treatment record indicated that the Veteran reported that he had been feeling depressed since childhood (around the age of 10) and that his mood would fluctuate slightly, but he mostly felt down. The Veteran stated that he had “tried just about everything for his depression,” but could not remember the names or dosages of any of the medications and reported not finding them to be helpful. He recounted that it was around the age of eight that he began being prescribed psychotropics. The Veteran reported that when he was 11 years old he held a knife to his throat, but did not actually cut himself. Additionally, he reported trying to use his step-father’s gun at the age of 14, but that he could not find any bullets. The Veteran also reported at the age of 17 holding a knife to his chest with thoughts of killing himself, as well as cutting his arms. No scars were apparent and he did not require medical attention. The Veteran reported ongoing suicidal/homicidal ideations and possible plans (i.e., bashing his head with a rock or using a knife to repeatedly stab someone/strangle someone) during the evaluation. In addition, the Veteran reported that he did not have a will to live. The Veteran reported sleeping approximately five hours per night, feelings of worthlessness, difficulty concentrating, decreased appetite, isolating from others, and suicidal ideations/plans. The Veteran described his childhood as “normal.” He reported that he graduated from high school with okay grades (mostly C’s), had several friends during school, and a good relationship with most of his teachers. He stated that he had trouble with authority figures. He had several friends in his unit, but preferred to be alone most of the time. He did not feel that he could do his job at that time as he was having difficulty concentrating and had been feeling very depressed. The Veteran reported that prior to joining the military he would smoke marijuana on a daily basis beginning at the age of 17. He reported that while he was in garrison he would drink approximate two to three 12 packs of beer and one to two bottles of Patron in a night. He disclosed instances of blacking out in the past and needing to have an eye opener after PT in the morning. The Veteran reported spending time in jail for theft and being written up since being in the military for his “attitude” and disobeying orders, but denied having ever received any Article 15’s. On examination, the Veteran’s mood was annoyed, his affect was depressed and appropriate to content, he had poor eye contact, and his attitude was cooperative, but vague. The Veteran was diagnosed with major depressive episode, recurrent, chronic. The evaluating physician opined that the Veteran appeared to be in acute distress, reported a history of poor coping, and was currently suicidal/homicidal. The physician also opined that a strong likelihood existed that the Veteran was exaggerating the severity of his current impairment based on noted incongruities. In July 2010, a military psychiatrist recommended the Veteran be separated from service due to his psychiatric symptoms. An August 2010 Report of Behavioral Health Evaluation for the purposes of separation from service noted a diagnosis of “adjustment disorder with depressed mood, alcohol abuse.” The Veteran was afforded a VA PTSD examination in January 2011. The Veteran served in combat in Afghanistan as a combat engineer for two months and said that during that time he had some suicidal thoughts and feared for his life. He reported having nightmares with accompanying night sweats three to four times a week. He said that he was depressed, but that his depressive symptoms were not such that he had sought treatment. He reported sleeping about four hours a night. The Veteran noted that at time he got upset and angry, and said “my guys are still there.” The Veteran stated that he had been depressed since childhood including having some thoughts of suicide. He reported having no problems when he was in high school. He was living with his parents. The Veteran had been arrested for theft prior to service. He reported drinking non-problematically while in high school, but said he drank heavily while in service. He continued to be a light drinker and said that he did not consume alcohol heavily any longer. He had a totally negative history of any drug use or abuse. The Veteran stated that he spent his free time looking for work, watching television, listening to music, using his computer, and socializing with friends going to the movies. During the examination, the Veteran’s concentration was impaired as he was not able to spell either “watch” or “world” backwards. The VA examiner diagnosed the Veteran with depressive disorder NOS in possible remission. The Veteran was afforded a VA examination in February 2011. A current complaint of tinnitus was indicated. The Veteran reported having continued periodic headaches with irritation to light and sound, dizziness, some memory loss and confusion since the TBI during service. The Veteran reported getting headaches everyday which were moderate to severe and lasted about 30 minutes to one hour, with throbbing and irritation to light and sound and resembling migraine headaches. The Veteran had dizziness two to three times daily. The Veteran had difficulty falling asleep and would wake up in the middle of the night with difficulties falling asleep. He had psychiatric symptoms of anxiety and depression. He also had cognitive symptoms of moderate memory impairment, decreased attention, difficulty concentrating, and difficulty with executive functions. He had neurobehavior symptoms of frequent irritability and restlessness. The Veteran reported that with his headaches he experienced decreased vision for short periods of time. He also reported having difficulty expressing himself with words. He had frequent chills, fever, and night sweats. As to memory, attention, concentration, and executive functions, the VA examiner opined that the Veteran had a mild complaint of memory loss, attention concentration, or executive functions, but without objective evidence on testing. Judgment was mildly impaired. Social interaction was occasionally inappropriate. The Veteran was occasionally disoriented as to one of the four aspects (person, time, place, situation) of orientation. Motor activity was normal. Visual spatial orientation was mildly impaired. He had three or more subjective symptoms that mildly interfered with work; instrumental activities of daily living; or work, family, or other close relationships. He had one or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both, but do not preclude them. As to communication, the Veteran’s comprehension or expression, or both, of either spoken language or written language was only occasionally impaired. The Veteran’s consciousness was normal. He had not been employed since his discharge from service. The VA examiner opined that the Veteran’s residuals of TBI would result in increased absenteeism from work, as well as difficulty following instructions, lack of stamina, and pain. The Board notes that VA sent the Veteran a letter in July 2016 indicating that this initial TBI examination was not performed by a competent specialist. As such, the Board finds this examination to be inadequate and have little probative value. A June 2011 VA treatment note indicated that the Veteran reported having a migraine headache about every two days. The headaches started about two years earlier. The pain effected the entire head and the Veteran reported light sensitivity and blurred vision with headaches. The headaches usually lasted for about two hours and the Veteran usually went ot sleep when the pain started. He saw spots (aura) before the pain began. The Veteran stated that he found it difficult to fall asleep and stay asleep. He often was awakened by nightmares. This problem had been ongoing for about eight months. The Veteran reported having suicidal thoughts about three weeks earlier. A June 2011 VA treatment note indicated that the Veteran had a positive PTSD screening test. A June 2011 VA TBI second level evaluation indicated that the Veteran exhibited the following neurobehavioral symptoms: mild dizziness; mild loss of balance; moderately poor coordination, clumsiness; severe headaches; severe vision problems; moderate sensitivity to light; moderate sensitivity to noise; mild loss of appetite or increased appetite; moderately impaired concentration; moderate forgetfulness; moderate difficulty making decisions; moderate issues with slowed thinking, difficulty getting organized, and difficulty finishing things; mild fatigue, loss of energy, getting tired easily; moderate difficulty falling or staying asleep; mildly feeling anxious or tense; moderately feeling depressed or sad; moderate irritability, easily annoyed; and, mildly poor frustration tolerance, feeling easily overwhelmed by things. These symptoms had moderately interfered with life in the past 30 days. Psychiatric symptoms of depression and PTSD were suspected/probable. A July 2011 VA speech pathology consultation note indicated that the Veteran indicated that at times he felt like he “can’t think” and sometimes forgot what he was going to say. Throughout testing, the Veteran was soft spoken, eye contact was intermittent, and his affect was flat. The Veteran showed good preplanning skills with visual tasks. He used a calendar or wrote down information to remember. Results of testing indicated all tested areas in the normal range. An August 2011 VA neuropsychological consultation note indicated that the Veteran reported that he continued to experience depression, headaches, memory loss, and loss of focus since service. He reported that he would forget easily, such as forgetting to brush his teeth or to wash his face. He reported difficulty recalling recent events. He noted that this resulted in significant frustration. The Veteran reported continued problems in attention and concentration. During the evaluation, the Veteran focused more on his emotional problems. He reported decreased attention and concentration. He averaged only four hours of sleep a night, with nightmares as well as problems with the onset and maintenance of sleep. The Veteran reported flashbacks as well as intrusive recurrent thoughts that tended to be “frightening.” He was rather withdrawn and social isolated. He reported anhedonia. He noted that he generally spent his time around the house. He denied recreational drug use and stated that he might drink three to four beers a day. While the Veteran’s parents accompanied him to the evaluation, he was not seated with his parents in the waiting room, made no effort to introduce the examiner to his parents, and was not amenable to having his parents sit in on the interview. While the Veteran’s speech was generally fluent, spontaneous, and goal-oriented, he tended to mumble somewhat and ramble on occasion. The majority of the content of his speech was logical and coherent, but he did tend to be somewhat vague on occasions. He demonstrated a restricted range of affect. He was rather flat and emotionally blunted. He was not observed to smile or laugh throughout the evaluation. He denied suicidal and homicidal ideation on the day of the evaluation. The Veteran’s initial test scores were far below expectations based on his current presentation and reported background information. There was concern as to whether he was putting forth optimal effort. An objective measure of motivation and effort was administered. His scores on all three trials were significantly below expectations and suggestive of poor effort in testing. His test scores were therefore deemed to likely be an underestimate of his true level of cognitive functioning. The neuropsychologist opined that the Veteran’s current attention and concentration, working memory and immediate and delayed memory for verbal information all appeared within normal limits. Based on the testing results, the neuropsychologist opined that it was likely that the Veteran did not demonstrate any true cognitive deficits at the present time. His presentation and reported information were suggestive of significant emotional distress characterized by depression and possible symptoms of posttraumatic stress disorder. A November 2011 VA psychiatry treatment note indicated that the Veteran reported that his thoughts seemed to run on beyond his control, impairing his ability to fall asleep. When he did fall asleep, he would awaken in two to three hours. Sometimes he was unaware of why he had awakened, while at other times it was clearly due to disturbing dreams, generally related to his combat experiences. He also reported episodically hearing voices, just calling his name and nothing else. He found that to be scary. He also believed he caught movement out of the corner of his eye every now and then, but there was never anything there. His major concern was his loss of memory, but he had a difficult time giving the psychiatrist concrete examples of deficits. On examination, the Veteran had little to no spontaneity in action and stared. His affect was constricted, depressed, and anxious. His speech was slow, but generally accurate. He mumbled a bit and made slight errors from time to time and strongly denied the same. For example, he said “eid” instead of “IED,” and denied making the error. The Veteran admitted hearing voices repeating only his name and sometimes seeing shadows out of the corner of his eye. Insight was impaired and poor. Judgment was intact, but poor. The Veteran was diagnosed with PTSD, adjustment disorder with mixed emotional features, and cognitive impairment disorder of unclear etiology. The psychiatrist opined that the Veteran’s presentation had the flavor of major emotional dysfunction as opposed to functional impairments. A January 2012 VA psychiatry treatment note indicated that the Veteran reported having a little improvement in his rest as the frequency of his nightmares had decreased. The voices remained, but seemed not as intense. He was getting four to five hours of sleep. A March 2012 VA psychiatry treatment note indicated that the reported having problems with his memory and his inability to retain any info past or present. The psychiatrist asked him a number of questions regarding current events and opined that the deficits he displayed should prohibit his ability to travel from place to place and were not supported by his affect, conversational exchange, and exhibited body language. In September 2012, the Veteran’s mother stated that he had never been diagnosed with any mental or depressive disorder prior to service. He had a very good childhood and never lived in a dangerous environment. She stated that his service record clearly reflected how his mental status changed after being in combat, resulting in him stating things that never happened. She stated that since service the Veteran did not sleep at night, was easily startled and jumpy, walked back and forth in the house, and sometimes talked to himself. She stated that she had to make him do things with his family, because he would otherwise stay to himself in his room. She had to wake him many times due to him having nightmares. She stated that sometimes when she spoke to him it was like his mind was somewhere else. She had to constantly remind him to take his medication. In September 2012, the Veteran’s sister stated that he had not been the same since his return from Afghanistan. He stayed in his room by himself all the time. He hardly ever slept and paced at night back and forth as if he was guarding or watching something, while mumbling to himself. He had nightmares and outbursts at times when asleep. She stated that the Veteran looked down and depressed all the time. In September 2012, the Veteran’s step-father stated that the Veteran was full of life prior to service and now felt like he would never have a life. The Veteran had flashbacks, increased anxiety, nightmares, difficulty falling asleep, depression, difficulty concentrating, was jumpy at times, and had no interest in activities and people. The step-father stated that he recognized these symptoms because he was also a veteran and had been diagnosed with PTSD. A December 2012 VA psychiatry nurse practitioner note indicated that the Veteran spoke minimally in monosyllabic answers, with a flat affect and minimal production. He reported delayed sleep, inadequate sleep, and a depression and anxious mood. He was socially isolated and socially anxious. The nurse practitioner noted that he may have some cognitive deficits or at least inefficient thinking related to TBI history. A December 2012 VA caregiver program support note indicated that the Veteran’s mother was his caregiver. The Veteran’s mother stated that she had been in the role of a caregiver since he was discharged from service. She scheduled and attended his medical appointments, provided daily reminders for him to complete personal hygiene tasks (including bathing, brushing his teeth, brushing his hair, and grooming), administered and managed his medications, and prepared his meals. The Veteran could not be left home alone. He could use the microwave, but did not do any cooking on the stove. In the event of an emergency, the Veteran would talk to himself and pace back and forth. The Veteran did not sleep at night and was constant on-guard. A March 2013 VA treatment note indicated that the Veteran reported symptoms of poor sleep, moodiness, flashbacks, and nightmares nearly every day. The treatment provider noted that the Veteran had somewhat concrete thinking, was mildly inattentive, fair insight, and fairly good judgment. A January 2013 VA caregiver application for comprehensive assistance note indicated that the Veteran’s mother had to assist him with his hygiene. The Veteran was very forgetful and his mother had to constantly remind him to do the necessary things. A January 2013 VA clinical eligibility for primary caregiver note indicated that, due to an injury related to service, the Veteran needed a family caregiver to support his health and well-being, perform personal functions required in everyday living, and ensure that he remained safe from hazards or dangers incident to his daily environment. Specifically, he had difficulty with planning and organizing, needed protection from safety risks and with self-regulation, had difficulty with sleep regulations and recent memory, had delusions or hallucinations, and needed assistance with grooming. The Veteran required moderate assistance with grooming, self-regulation, and avoiding safety risks. He required total assistance with planning and organizing, as well as maximal assistance with sleep regulation, supervision as a result of delusions/hallucinations, and recent memory. A June 2013 VA treatment note indicated that the Veteran had recurring nightmares from combat every night. He woke up with a cold sweat and was easily startled with loud noises. He reported getting anxious and panicky. He isolated himself. His mother reported that he talked to himself. The Veteran stated that he sometimes heard voices calling his name. He denied any command hallucinations, drug abuse, alcohol abuse, or current suicidal ideas, intent, or plans. On examination, his affect was flat and his mood was depressed and anxious. Cognition was grossly intact. In June 2013, the Veteran’s mother indicated that he was depressed and had developed a drinking problem. An August 2013 VA vocational rehabilitation note indicated that the Veteran presented as shy and did not show any energy. His communication was not spontaneous. He conformed with everything said, but did not take necessary action. An October 2013 VA caregiver program support note indicated that the Veteran’s caregiver (his mother) commented that she had to remind him to do everything. A December 2013 VA treatment record indicated that the Veteran had been prescribed medications to treat PTSD and “PTSD-related insomnia.” In January 2014, the Veteran was afforded VA Residuals of TBI examination. The VA examiner did not indicate that he had reviewed the Veteran’s claims folder. As to the facet of memory, attention, concentration, and executive functions, the VA examiner opined that the Veteran had a complaint of mild memory loss, attention, concentration, or executive functions, but without objective evidence on testing. The Veteran complained of some memory problems, but the VA examiner opined that they seemed mostly related to his chronic and severe drug abuse rather than his TBI. The judgment, social interaction, orientation, motor activity, visual spatial, orientation, and consciousness facets were all normal. The Veteran had no subjective symptoms or neurobehavioral effects. He was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. The VA examiner opined that the Veteran did not have any subjective symptoms or any mental, physical, or neurological conditions or residuals attributable to a TBI. The VA examiner also opined that the Veteran did not have any scars related to a TBI. No diagnostic testing was performed. The VA examiner noted that the Veteran had an unrelated diagnosis of alcohol dependence and was drinking alcohol on a day-to-day basis. During the evaluation, the Veteran reported some memory problems, but was very vague and unclear. On testing for memory problems, the Veteran had very close answers and the examiner was not able to elicit any symptoms suggestive of TBI related memory problems. The VA examiner opined that the Veteran’s claimed memory problems seemed mostly related to his chronic and severe drug abuse rather than his TBI. The Board finds this examination inadequate, as the findings are inconsistent with the other evidence of record and the examiner did not review the record. Therefore, it has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based upon an inaccurate factual premise has no probative value). In January 2014, the Veteran was also afforded a VA PTSD examination. Alcohol dependence was the only diagnosis noted. The VA examiner opined that the Veteran’s current symptoms were related to the alcohol dependence, since the TBI was in remission without current residuals. The VA examiner opined that while a mental condition had been formally diagnosed, the symptoms were not severe enough either to interfere with occupational or social functioning or to require continuous medication. The VA examiner stated that the Veteran’s VA claims file was not reviewed, but his e-folder (VBMS or Virtual VA) was reviewed. The VA examiner stated that all records provided in the e-folder were reviewed, including the DD-214, January 2011 VA PTSD examination report, January 2011 VA TBI examination, a March 2011 brain CT without contrast, the March 2011 rating decision showing no PTSD diagnosed and a TBI rated at 10 percent. The Veteran reported drinking a bottle of hard liquor every day for the past two years. The VA examiner opined that the Veteran did not meet the full criteria for a diagnosis of PTSD. The Veteran’s psychiatric symptoms included depressed mood and anxiety. The VA examiner stated that it was not clear from the records if the Veteran had a VA established diagnosis of PTSD, and opined that the Veteran did not meet the DSM-V criteria for PTSD based on this evaluation. The VA examiner opined that the alcohol dependence was not a progression of the VA-established diagnosis of TBI, but no rational was given to support this opinion. A June 2014 VA treatment record indicated that the Veteran’s mother was his caregiver. A March 2016 VA psychiatry treatment note indicated that the Veteran initially sat quietly while his mother did all the talking. He stated that the recent death of his cousin triggered a panic attack. The Veteran’s mother stated that he was not good at recall. The Veteran’s mood was anxious. His memory was slow to recall, and his insight and judgment were fair. A November 2015 VA treatment note indicated that the Veteran reported having anxiety attacks almost every other day. He said that he felt terrified and would start screaming and sweating. His mother had to come into his room and calm him down. The Veteran stated that he was not sleeping more than three to four hours per night. A January 2016 VA psychiatry treatment note indicated that the Veteran drank almost daily about three liquor bottles. He did not see it as a problem and did not listen to his family who were worried about him. He was not working, and spent his day at home and isolated. He noted that he was frustrated by the claims and used that as an excuse to drink. His mother had threatened to kick him out of the home due to his alcohol abuse. The Veteran reported that his mother had control of his funds and found the bottles, and that was why he was seeking help. In November 2016, the Veteran was afforded VA-sponsored headache examination. He was diagnosed with posttraumatic headaches. The VA examiner stated that the Veteran’s condition had worsened and he had headaches almost daily. The headaches lasted a couple of hours and were rated seven out of 10 on a pain scale. The Veteran stated that the pain was behind his eyes and radiated to the back of his head. The headaches were also associated with symptoms of nausea, sensitivity to light and sound, and changes in vision. The Veteran had very prostrating and prolong attacks of migraines/non-migraine pain productive of severe economic inadaptability. The Veteran had characteristic prostrating attacks of migraine/non-migraine headache pain once every month. In November 2016, the Veteran was afforded a VA-sponsored scar examination. The Veteran had one scar due to the TBI. The scar was on the back of his head at the midline occiput and was painful. The scar was not unstable or caused by burns. The scar was 4cm long and 0.6cm wide, with no abnormal pigmentation or texture. It was not tender to palpation. There was no gross distortion or asymmetry of facial features or visible or palpable tissue loss. The scar did not result in limitation of function or disfigurement, and did not impact the Veteran’s ability to work. Color photographs of the scar were included with the examination report and show a scar that is consistent with the VA examiner’s description. In November 2016, the Veteran was afforded a VA-sponsored Residuals of TBI examination. The VA examiner noted that the Veteran developed recurrent headaches after the TBI, became depressed and expressed suicidal ideation, and was diagnosed with PTSD after service. The Veteran’s condition had worsened. He had memory issues. As to the facets of TBI-related impairment, the Veteran had objective evidence on testing of moderate impairment of memory, attention, concentration, or executive functions resulting in moderate functional impairment. He was unable to recall two of three words after a few minutes and had difficulty with concentration. He had moderately severely impaired judgment, with poor decision making. His social interaction was frequently inappropriate, such that he isolated himself even from family. The Veteran was occasionally disoriented to two of the four aspects (person, time, place, situation) of orientation or often disoriented to one aspect of orientation. The VA examiner noted that the Veteran was disoriented as to time. The Veteran’s motor activity was normal. His visual spatial orientation was moderately impaired, as he was unable to follow GPS directions. The Veteran had three or more subjective symptoms that mildly interfered with work, instrumental activities of daily living, or work, family, or other close relationships. These symptoms were described as headaches, dizziness, and insomnia. He had one or more neurobehavioral effects that frequently interfered with workplace interaction, social interaction, or both, but did not preclude them, including irritability, verbal and physical aggression, and moodiness. The Veteran was unable to communicate either by spoken language, written language, or both, more than occasionally, but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. He was unable to communicate complex ideas and took a long time to prepare thoughts so communication was very slow. The Veteran’s consciousness facet was normal. The Veteran had headaches, a mental disorder, and a scar that were attributable to the TBI. The functional impact of the Veteran’s residuals of TBI included that he had difficulty finishing tasks, difficulty focusing, and his communication was very slow. The VA examiner stated that the examination included review of the Veteran’s c-file. The VA examiner’s specialty was family medicine. In December 2016, the Veteran was afforded a VA-sponsored PTSD examination. The VA examiner diagnosed the Veteran with PSD with panic attacks. The VA examiner stated that the Veteran’s impairments seem to be primarily due to his PTSD symptoms and panic attacks, noting that the January 2014 VA TBI examination indicated that there were no residuals related to TBI. The VA examiner opined that the Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The Veteran lived with his mother and step-father. His mother was his caregiver. She managed his medications, planned his appointments, drove him to appointments, woke him up to help calm him down when he had anxiety attack sin the middle of the night, cooked for him, and managed his finances. The Veteran had a license, but did not drive. He had not driven since prior to his military service, at least seven years ago, due to issues with getting glost, forgetfulness, and disorientation to place. The Veteran reported receiving “good grades” in high school and did not receive any special education services. He denied a history of behavior issues. The Veteran had not been employed since his discharge from service. The Veteran stated that his symptoms, as well as the medication side effects, made it difficult to maintain steady employment. He noted that he was “a difficult person to interact with,” due to “moodiness” (which he described as being characterized by sadness and irritability), a tendency to keep to himself, and interpersonal problems that arose when he was around others. The Veteran reported attending group treatment for PTSD through the VA. The Veteran described his typical mood as “irritable more than anything.” He reported having “anxiety attacks’ approximately two to three times per month in which he had cold sweats, trouble breathing, hyperventilation, increased heart rate, and dissociation or dream-like feeling. His mother reportedly would get up to check on him and help him to calm down, telling him “everything is okay” and that he “has nothing to worry about,” as well as helping him to slow his breathing. He noted that his panic attacks were always triggered by combat-related experiences. The Veteran reported occasional periods of disorientation to place and general confusion. He indicated that he did not drive because he would get lost and be unable to identify how to get home. He reported forgetfulness with activities of daily living, such as brushing his teeth and bathing, and his mother often had to remind him ot do the activities. He reported feeling ashamed that his mother helped him with daily activities. The Veteran’s PTDS symptoms included depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, impairment of short- and long-term memory, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, spatial disorientation, and neglect of personal appearance and hygiene. The VA examiner opined that the Veteran’s PTSD is less likely than not proximately due to or the result of the Veteran’s TBI. While the same traumatic incident (IED explosion) may have precipitated both his PTSD and his TBI, the TBI itself did not lead to his PTSD. A May 2017 private mental capacity assessment indicated that the Veteran had marked impairment in his ability to carry out very short and simple instructions, his ability to interact appropriately with the general public, and his ability to work in coordination with or in proximity to others without being distracted by them. In all other areas, he had extreme impairment, including in his ability to maintain attention and concentration for extend periods, carry out detailed instructions, sustain an ordinary routine without special supervision, make simple work-related decisions, complete a normal workday without interruptions from psychologically based symptoms, ask simple questions or request assistance, get along with coworkers or peers, maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness, respond appropriately to changes in the work setting, be aware of normal hazards and take appropriate precautions, travel in unfamiliar places or use public transportation, and set realistic goals or make plans. All of these impairments were based on his diagnoses of chronic PTSD and residuals of TBI. The evaluator opined that the use of alcohol and other substances had no impact in arriving at this assessment. The evaluator also opined that the Veteran was not a malingerer and did not have the ability to voluntarily control the use of alcohol or other substances. In May 2017, the Veteran’s treating VA physician completed VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. Diagnoses of TBI, chronic PTSD, insomnia, headaches, and knee arthralgia were noted. The physician stated that the Veteran’s TBI and PTSD, and related cognitive impairment, restricted the listed activities/functions. The Veteran was not able to prepare his own meals as he did not remember cooking on the stove. He required medication management as he did not remember to take his medications without assistance. The Veteran did not have the ability to manage his own financial affairs, and his mother took care of all those issues. While the Veteran was able to bathe, dress, and feed himself, he needed someone to remind him to do those things. The Veteran ambulated free of assistance, with a steady gait. The Veteran had memory issues and could become confused and disoriented. He also suffered from nightmares associated with PTSD. He was unable to drive or leave the house alone. In August 2017, the Veteran was afforded a VA-sponsored TBI residuals examination. The Veteran’s current TBI symptoms were insomnia, depression, anxiety, impaired memory, irritability, and social isolation. As to the facets of TBI-related cognitive impairment and subjective symptoms, the Veteran had objective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment. He had difficulty sustaining attention and concentration. The Veteran reported having difficulty remembering the details of recent conversations and events. He reported that he often has difficulty understanding what is being said to him. The Veteran had severely impaired judgment. He stated that he did not understand the consequences of his decisions and reported poor decision making. He stated that he could not identify, understand, and weigh the alternatives and did not understand the consequences of choices. His social interaction was inappropriate most or all of the time. The Veteran stated that he did not interact with others outside his family. He stated that he spent most of his time in his room. As to the orientation facet, the Veteran was often disoriented to two or more of the four aspects (person, time, place, situation) of orientation. He stated that he was disoriented to time and would get lost in familiar places. He was with his mother at all times. The Veteran’s motor activity was normal. His visual spatial orientation was moderately severely impaired. He was unable to use a GPS, did not drive, could not follow directions or read a map, could not judge distance, and was with his mother at all times. The Veteran had three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living, or work, family, or other close relationships. These subjective symptoms included insomnia, tinnitus, moderate to severe headaches, fatigue, hypersensitivity to light and sound, and anxiety. The Veteran had one or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both, but do not preclude them. He reported mood swings, irritability, anger outbursts, verbal aggression, and lack of empathy. The Veteran’s communication facet was characterized by an inability to communicate by either spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. He was unable to communicate complex ideas, took long periods of time to prepare thoughts, and his communication was slow and deliberate. The Veteran’s consciousness facet was normal. The VA examiner stated that the Veteran had subjective symptoms or residuals attributable to TBI, including hearing loss/tinnitus; visual impairment; gait, coordination, and balance, headaches, and mental disorder. The functional impact of the Veteran’s residuals of TBI impacted his ability to work. He would be unable to remember and follow instructions, use judgment, show insight and think abstractly, concentrate, interact with coworkers due to irritability, work in public or in enclosed spaces, and work in a loosely supervised situation. He also required little interaction with the public. The VA examiner, a psychologist, opined that the Veteran required total care by another individual. The Veteran was accompanied by his mother who reported that he required total care and she could not leave him alone. She stated that the Veteran required respite care when she had to leave him. The Veteran and his mother stated that he could not drive, cook, or complete household duties. The Board finds this TBI examination to have greater probative value than the November 2016 VA examination, as it was performed by a VA psychologist. The opinion of the VA psychologist is afforded greater weight the opinion from the November 2016 contract physician who specialized in family medicine, as the VA psychologist has more training and experience in evaluating residuals of TBI. In August 2017, the Veteran was afforded a VA-sponsored mental disorder examination. A diagnosis of major neurocognitive disorder due to TBI was noted, and the VA examiner opined that this diagnosed condition resulted in total occupational and social impairment. The Veteran reported that he lived with his sister as he could no longer care for himself. His sister had power of attorney and assisted him in managing his finances. He stated that he could not sustain attention and concentration. He reported that he has poor judgment and difficulty understanding the consequences of choices. He could no longer remember the names of family members and people that he had known for many years. His sister, who accompanied him, stated that he could no longer make decisions. The Veteran reported that he was irritable and often verbally and physically aggressive. He reported that he spent most of his day in his room. His sister reported that he could no longer be left alone and that she had to hire a caregiver when she left him. The Veteran had symptoms of depressed mood, anxiety, chronic sleep impairment, memory loss for names of close relatives, flattened affect, impaired abstract thinking, gross impairment in thought processes or communication, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances. The VA examiner opined that the Veteran would be unable to remember and follow instructions, use judgment, show insight and think abstractly, concentrate, interact with coworkers, work in public or enclosed spaces, or work in a loosely supervised situation. He required little interaction with the public. In August 2017, the Veteran was afforded a VA headaches examination. The Veteran experienced head pain, dizziness, sensitivity to sound and light, and changes in vision. The headaches typically lasted for less than one day. The Veteran had very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. The Veteran’s headache condition impacted his ability to work, as he had to relax when getting the severe headache attacks and worked with pain and medication with milder attacks. The Veteran had prostrating attacks more than once per month productive of economic inadaptability. In August 2017, the Veteran was afforded a VA eye conditions examination. He was diagnosed with a visual field defect and left eye ptosis. The VA examiner noted that the ptosis had been present since the Veteran’s youth. The Veteran reported experiencing visual impairment since his TBI, specifically frequent blurred vision and light sensitivity. While diminished uncorrected distance visual acuity was noted, the Veteran’s corrected near and distance visual acuity was 20/40 or better, bilaterally. The VA examiner stated that while the Veteran had a visual field defect and a contraction of a visual field, he did not have a loss of a visual field. The VA examiner stated that the Veteran had some constriction in the left visual field, associated with his ptosis. During an authorized audiological evaluation conducted in August 2017, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 10 20 20 25 LEFT 15 15 10 15 20 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and of 100 percent in the left ear. An August 2017 VA mental health treatment note indicated that the Veteran reported doing about the same. He reported being “moody” and depressed three to four days out of the week. He reported experiencing auditory and visual hallucinations. The Veteran stated that he slept about three to four hours each night and reported having nightmares and night sweats at times. He reported occasional alcohol usage. In November 2017, the Veteran’s treating VA physician completed VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. A diagnosis of residuals of TBI was noted. The VA physician stated that the Veteran was not able to prepare his own meals and all of his meals were prepared by his mother. He needed assistance with bathing and tending to other hygiene needs. He required medication management and did not have the ability to manage his own financial affairs. The VA examiner noted that the Veteran was casually groomed, his gait was unbalanced, and he demonstrated a lack of attention and concentration. The Veteran also had symptoms of memory loss, dizziness, lack of attention and concentration, light sensitivity, and lack of judgment. He only traveled away from home under his parents’ supervision. The Veteran also submitted a January 2018 private vocational assessment from a vocational rehabilitation consultant. The consultant gave a detailed review of the Veteran’s medical and employment history, and opined that the Veteran had not bene able to secure or maintain any substantially gainful occupation within the general labor market since his discharge from service. This was based on the Veteran’s documented cognitive deficits and the frequency of his headaches. The consultant opined that the Veteran’s severe level of cognitive, behavioral, and functional limitations would preclude him from performing any occupation, even unskilled work, within the general labor market since his discharge from service and continues to preclude from any substantially gainful employment to date. The consultant also opined that the Veteran was unemployable solely based on his service-connected TBI. B. Applicable Laws and Regulations – Residuals of TBI Under DC 8045, there are three main areas of dysfunction listed that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Adjudicators are to rate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” Id. Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Adjudicators are to rate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, they are to separately rate any residual with a distinct diagnosis that may be rated under another Diagnostic Code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table. Id. Therefore, as discussed herein, the Board has separately rated the Veteran’s diagnosed nystagmus, seizure disorder with narcolepsy, visual field defect, craniotomy scar, left upper extremity weakness, and left lower extremity weakness. Adjudicators are to rate emotional/behavioral dysfunction under 38 C.F.R. § 4.130 (Schedule of ratings--mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, they are to evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” Id. Here, the Veteran has a diagnosis of a mental disorder; therefore, such symptoms are evaluated separately under 38 C.F.R. § 4.130, DC 9433. Adjudicators are to rate physical (including neurological) dysfunction based on the following list, under an appropriate Diagnostic Code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. Id. The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, adjudicators are to rate under the most appropriate Diagnostic Code. Adjudicators are to rate each condition separately, as long as the same signs and symptoms are not used to support more than one rating, and combine under § 4.25 the ratings for each separately rated condition. The rating assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the rating for a single condition for purposes of combining with other disability ratings. Id. The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Adjudicators are to assign a 100-percent rating if “total” is the level of evaluation for one or more facets. If no facet is rated as “total,” adjudicators are to assign the overall percentage rating based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent rating if 3 is the highest level of evaluation for any facet. Id. The rating assigned is based upon the highest level of severity for any facet of cognitive impairment and other residuals of TBI not otherwise classified as determined on examination. Only one rating is assigned for all the applicable facets. A rating evaluation is not warranted unless a higher level of severity for a facet is established on examination. Physical and/or emotional/behavioral disabilities found on examination that are determined to be residuals of traumatic brain injury are rated separately. Based on review of the evidence, lay and medical, the Board finds that, for the reasons stated above, the August 2017 VA TBI examination is the most probative evidence of record as to the severity of the Veteran’s residuals of TBI. Based on this evidence, the Veteran’s memory, attention, concentration, and executive functions facet is assigned level “total” severity based objective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment. This is based on the Veteran’s difficulty sustaining attention and concentration, understanding what was said to him, and remembering the details of recent conversations and events. A level of severity of “total” has been assigned for the Veteran’s judgment facet based on the evidence that the Veteran did not understand the consequences of his decisions and demonstrated poor decision making. He reported that he could not identify, understand, and weigh the alternatives and did not understand the consequences of choices. A level of severity of “3” has been assigned for the Veteran’s social interaction based on social interaction that is inappropriate most or all of the time. The evidence consistently reflects that the Veteran did not interact with others outside his family and spent most of his time in his room. A level of severity of “3” has been assigned for the Veteran’s orientation facet based on the April 2010, January 2013, and May 2014 VA examiners’ findings that the Veteran’s reports that he was disoriented to time and would get lost in familiar places. However, the Veteran’s symptoms of disorientation to time and place have been attributed to the Veteran’s acquired psychiatric disorders and considered in assigning the separate rating for that disability. A level of severity of “0” has been assigned for normal motor activity. A level of severity of “3” has been assigned for the Veteran’s moderately severe impairment of visual spatial orientation. The evidence has consistently indicated that the Veteran was unable to use a GPS, did not drive, could not follow directions or read a map, could not judge distance, and stayed with his mother at all times. A level of severity of “2” has been assigned for subjective symptoms based on three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family, or other close relationships. The August 2017 VA examiner indicated that the Veteran had subjective symptoms of tinnitus, insomnia, moderate to severe headaches, fatigue, hypersensitivity to light and sound, and anxiety. The Board has assigned a level of severity of “2” for neurobehavioral effects based on the August 2017 VA examiner’s finding of “one or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them.” The August 2017 VA examiner indicated that the Veteran had neurobehavioral symptoms of mood swings, irritability, anger outbursts, verbal aggression, and lack of empathy. However, the Veteran’s symptoms of anger and irritability have been attributed to the Veteran’s acquired psychiatric disorders and considered in assigning the separate rating for that disability. A level of severity of “2” has been assigned for the Veteran’s communication based on his inability to communicate by spoken or written language, or both, or to comprehend spoken or written language, or both, more than occasionally, but less than half of the time. The August 2017 VA examiner noted that the Veteran was unable to communicate complex ideas, took long periods of time to prepare thoughts, and his communication was slow and deliberate The Veteran’s consciousness facet was consistently normal, as there is no indication that he has been in a persistently altered state of consciousness. Based on these assigned levels for each facet, the Board finds that the Veteran’s residuals of TBI more nearly approximate a rating of 100 percent for the entire period on appeal. In this regard, the evidence indicates that level of severity “total” as the highest facet, thus warranting a 100 percent rating. The Board specifically notes that this is based on the evidence of a “total” level of severity for the judgment facet, the symptoms of which do not overlap with the symptoms considered for any other assigned rating. In so finding, the Board emphasizes that DC 8045 explicitly states that “symptoms [of cognitive impairment] may fluctuate in severity from day to day.” For these reasons, the Board finds that the weight of the evidence supports a rating in of 100 percent for the entire period on appeal. C. Entitlement to a Separate Compensable Rating for an Acquired Psychiatric Disorder, to include PTSD, prior to December 6, 2016, and in Excess of 70 Percent Thereafter. The Veteran is in receipt of a 70 percent rating for PTSD from December 6, 2016, under 38 C.F.R. § 4.130, DC 9411. He contends that a separate compensable rating for PTSD, is warranted for the period prior to December 6, 2016, and a rating in excess of 70 percent thereafter. Of note, the Veteran has a separate pending appeal for entitlement to service connection for MDD. Throughout the course of the present appeal, the Veteran’s current psychiatric disability has been characterized as PTSD, adjustment disorder with depressed mood, depression not otherwise specified (NOS), major neurocognitive disorder due to TBI, and alcohol dependence. The Board notes that the United States Court of Appeals for Veterans Claims (Court) has held that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and other information of record). Based on the evidence of continuous psychiatric symptoms during and since service and the medical evidence indicating that the Veteran’s acquired psychiatric disorder symptoms and the symptoms of his residuals of TBI overlap, and in light of the Court’s holding in Clemons, the Board finds that the different characterizations of the Veteran’s disability during the present appeal encompassed the same symptoms and are considered to be part of a single claim. Therefore, the Board has recharacterized the pending claims with regard to all acquired psychiatric issues as stated above. All psychiatric disabilities are evaluated under a General Rating Formula for Mental Disorders. Under such formula, 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 effective work and social relationships. A 70 percent rating is warranted when the psychiatric disorder results in occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such an 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. A total schedular rating of 100 percent is warranted when the disorder results in 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 mental and personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. In applying the above criteria, the Board notes that, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected disability, such signs and symptoms shall be attributed to the service-connected disability. See 38 C.F.R. § 3.102 (2017); Mittleider v. West, 11 Vet. App. 181 (1998) citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996) (the Board is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence which does so). Effective August 4, 2014, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term “psychosis” to remove outdated references to the DSM-IV and replace them with references to the updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction on or after August 4, 2014. Id. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014. See 80 Fed. Reg. 53, 14308 (March 19, 2015). Here, the RO certified the Veteran’s appeal to the Board after August 4, 2014; therefore, the PTSD claim is governed by DSM 5 and the Global Assessment of Functioning (GAF) scores are not relevant for consideration. See Golden v. Shulkin, 29 Vet. App. 221, 225-26 (2018) (holding that the Board errs when it uses GAF scores to assign a psychiatric rating in cases where DSM-5 applies). When evaluating mental health disorders, the factors listed in the Rating Schedule are simply examples of the type and degree of symptoms, or their effects, that would justify a particular rating; the analysis should not be limited solely to whether a veteran exhibited the symptoms listed in the Rating Schedule. Rather, the determination should be based on all of a veteran’s symptoms affecting his level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The lists of symptoms under the Rating Schedule are meant to be examples of symptoms that would warrant the disability evaluation, but are not meant to be exhaustive. Id. After a review of all the evidence, lay and medical, the Board finds that the Veteran’s acquired psychiatric disorder symptoms most nearly approximated occupational and social impairment with deficiencies in most areas from October 17, 2010 to August 31, 2011. The service treatment records, VA treatment records, and January 2011 VA examination report indicate that the Veteran had symptoms of suicidal ideation, impaired impulse control, difficulty in adapting o stressful circumstances, and inability to establish and maintain effective relationships during this period. However, the evidence during this period does not show symptoms of gross impairment in thought processes or communication, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place, intermittent inability to perform activities of daily living (ADLs), persistent delusions or hallucinations, or memory loss of names of close relatives, own occupation, or own name. For these reasons, the Board finds that the weight of the evidence supports a finding that a separate 70 percent rating, but no higher, is warranted for the Veteran’s acquired psychiatric disorder(s) from October 17, 2010 to August 30, 2011. From August 31, 2011, the weight of the evidence indicates that the Veteran’s acquired psychiatric disorder symptoms most nearly approximate total occupational and social impairment. This finding takes into consideration the Veteran’s symptoms of persistent auditory and visual hallucinations, disorientation to time and place, and intermittent inability to perform ADLs. The inability to perform ADLs was first noted in the August 2011 VA neuropsychology consultation note, and the persistent auditory and visual hallucinations were first noted in a November 2011 VA psychiatry treatment note. Therefore, the Board finds that the Veteran’s acquired psychiatric disorder symptoms more nearly approximate total occupational and social impairment from August 31, 2011, and as such, a 100 percent rating is warranted from this date. In summary, the Board finds that the Veteran’s PTSD symptoms more nearly approximate the criteria under DC 9411 for a rating of 70 percent, but no higher, from October 17, 2010 to August 30, 2011, and 100 percent thereafter. 38 U.S.C. § 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.130. D. Entitlement to a Separate Compensable Rating for Posttraumatic Headaches Prior to November 19, 2016, and in Excess of 50 Percent Thereafter. The Veteran is in receipt of a 50 percent rating for posttraumatic headaches from November 19, 2016, under 38 C.F.R. § 4.124a, DC 8100, applicable to migraine. He contends that a separate compensable rating for headaches is warranted for the period prior to November 19, 2016, and a rating in excess of 50 percent thereafter. Under DC 8100, a 50 percent rating is warranted with very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability. A 30 percent evaluation is warranted with characteristic prostrating attacks occurring on an average once a month, over the preceding several months. A 10 percent evaluation is warranted with characteristic prostrating attacks averaging once per two months, over the preceding several months. A noncompensable rating is warranted with less frequent attacks. 38 C.F.R. § 4.124a. The Rating Schedule does not define “prostrating,” nor has the Court. See Fenderson v. West, 12 Vet. App. 119 (1999) (quoting DC 8100 verbatim, but not specifically addressing the matter of what is a prostrating attack). By way of reference, “prostration” is defined as “extreme exhaustion or powerlessness.” See Dorland’s Illustrated Medical Dictionary 1531 (32nd ed. 2012). Similarly, “prostrate” is defined as “physically or emotionally exhausted; incapacitated.” See Webster’s II New College Dictionary 889 (2001). Further, “severe economic inadaptability” is also not defined in VA law. See Pierce v. Principi, 18 Vet. App. 440, 446 (2004). In addition, the Court has held that nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Id. In this regard, it was explained by the Court that if “economic inadaptability” were read to import unemployability, the appellant, should he or she meet the economic-inadaptability criterion, would then be eligible for a TDIU rather than just a 50 percent rating. Id., citing 38 C.F.R. § 4.16. The Court discussed the notion that consideration must also be given as to whether the disability was capable of producing severe economic inadaptability, regardless of whether the condition was actually causing such inadaptability. See Pierce, 18 Vet. App. at 446. In this regard, VA conceded that the words “productive of” could be read to mean either “producing” or “capable of producing.” Id. at 446-447. On review, the Board finds that the criteria for a 50 percent rating for headaches are met for the entire period on appeal based on evidence of very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability. In support of this finding, the Board notes that the Veteran has consistently reported experiencing frequent severe headaches. In February 2011, the Veteran reported getting headaches every day, which were moderate to severe and lasted about 30 minutes to one hour, with throbbing, irritation to sound and light, pain, and decreased vision. In June 2011, the Veteran reported having a migraine headache about every two days, with symptoms of severe pain, light sensitivity, blurred vision, and auras. In November 2016, the Veteran again reported having headaches almost daily that lasted a couple of hours and were described by the VA examiner as very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. For these reasons, the Board finds that a rating of 50 percent is warranted for the Veteran’s headaches for the entire period on appeal. As the Veteran is receiving the maximum schedular rating for headaches, a rating higher than 50 percent for headaches is not for consideration. E. Entitlement to Separate Compensable Rating for a Painful Head Scar Prior to November 19, 2016, and in Excess of 10 Percent Thereafter. The Veteran is in receipt of a 10 percent initial rating for a head scar from November 19, 2016, under 38 C.F.R. § 4.118, DC 7800, applicable to scars of the head, face, and neck. He is also in receipt of a separate 10 percent initial rating for a painful scar from November 19, 2016, under 38 C.F.R. § 4.118, DC 7804, applicable to painful or unstable scars. He contends that higher ratings are warranted for the entire period on appeal. DC 7800 provides that a skin disorder with one characteristic of disfigurement of the head, face, or neck be rated 10 percent disabling. A skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement, is rated 30 percent disabling. A skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement, is rated 50 percent disabling A skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement, is rated 80 percent disabling. Note (1) to DC 7800 provides that the 8 characteristics of disfigurement, for purposes of rating under 38 C.F.R. § 4.118, are: (A) Scar is 5 or more inches (13 or more cm.) in length; (B) Scar is at least one-quarter inch (0.6 cm.) wide at the widest part; (C) Surface contour of scar is elevated or depressed on palpation; (D) Scar is adherent to underlying tissue; (E) Skin is hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.);(F) Skin texture is abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); (G) Underlying soft tissue is missing in an area exceeding six square inches (39 sq. cm.); and (H) Skin is indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Diagnostic Codes 7801 and 7802 rate scars not of the head, face, or neck, and do not apply in this case as the craniotomy scar is located on the head. 38 C.F.R. § 4.118. Under DC 7804, a 10 percent rating is warranted for 1 or 2 scars that are unstable or painful. A 20 percent rating is warranted for 3 to 4 scars that are unstable or painful. A 30 percent disability rating is warranted for 5 or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Id. DC 7805 provides that other scars (not otherwise considered under the DCs 7800 -7804) are to be rated according to their disabling effects under an appropriate diagnostic code. See 38 C.F.R. § 4.118, DC 7805. Upon review of the evidence of record, the Board finds that a rating of 10 percent, but no higher, is warranted under DC 7800 for the entire period on appeal, based on the presence of one characteristic of disfigurement, specifically, the scar was 0.6 cm. wide at the widest part. In addition, a separate rating of 10 percent, but no higher, is warranted under DC 7804 for a single painful head scar. However, as there is only one painful scar and no unstable scars, a rating in excess of 10 percent under DC 7804 is not warranted. Finally, the evidence of record does not indicate that the Veteran’s head scar is productive of limitation of function; therefore, a compensable rating is not warranted under DC 7805. In summary, after considering all of the applicable diagnostic codes, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that the evidence supports the assignment of 10 percent rating, but no higher, under DC 7800 for a head scar with one characteristic of disfigurement, for the entire period on appeal. In addition, a separate 10 percent rating is warranted under DC 7804 for a single painful craniotomy scar, for the entire period on appeal. However, a compensable rating is not warranted for scars under DC 7805. F. Entitlement to a Separate Compensable Rating for Tinnitus The February 2011 VA TBI examination report indicated that the Veteran had a current complaint of tinnitus. Therefore, the Board considered whether a separate rating is warranted under 38 C.F.R. § 4.87, DC 6260, for recurrent tinnitus. Under DC 6260, a 10 percent rating is warranted for recurrent tinnitus. This is the sole rating available under DC 6260. Based on a review of the evidence, both lay and medical, the Board finds that a separate 10 percent rating for tinnitus is warranted. Evidence in support of this finding includes the August 2017 VA TBI examination report indicating that tinnitus is a subjective symptom attributable to the TBI. For these reasons, the Board finds that a separate rating of 10 percent, but no higher, is warranted for tinnitus. G. Entitlement to a Separate Compensable Rating for Dizziness The February 2011 VA TBI examination report indicated that the Veteran reported experiencing dizziness two to three times daily. Therefore, the Board considered whether a separate rating is warranted under 38 C.F.R. § 4.87, DC 6204, for peripheral vestibular disorders. Under DC 6204, a 10 percent rating is assigned for peripheral vestibular disorder manifested by occasional dizziness. A maximum 30 percent rating is assigned for peripheral vestibular disorder manifested by dizziness and occasional staggering. See 38 C.F.R. § 4.87, Diagnostic Code 6204 (2017). A Note to Diagnostic Code 6204 provides that objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this Diagnostic Code. Id. Based on a review of the evidence, both lay and medical, the Board finds that a separate rating of 10 percent, but no higher, is warranted for the Veteran’s dizziness. Evidence in support of this finding includes the February 2011 VA examination report indicating that the Veteran had dizziness two to three times daily, the June 2011 VA examination indicating that the Veteran exhibited symptoms of mild dizziness and mild loss of balance, the November 2016 VA examination report indicating that the Veteran had a symptom of dizziness as a residual of TBI, the August 2017 VA headaches examination indicating that Veteran experienced dizziness, and the November 2017 statement from the Veteran’s treating physician indicating that the Veteran had a symptom of dizziness. While it is not clear that there are any objective findings of dizziness in the record, the Board has resolved all reasonable doubt in the Veteran’s favor and finds that the consistent medical evidence of dizziness is sufficient to support a rating of 10 percent for dizziness under DC 6204. However, as there is nothing in the record to indicate that the dizziness is more than occasional or that the dizziness is manifested by occasional staggering, the Board finds that a rating in excess of 10 percent under DC 6204 is not warranted. For these reasons, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that a separate rating of 10 percent, but no higher, is warranted for dizziness under DC 6204. H. Other Potentially Relevant Diagnostic Codes The Board also considered whether a compensable rating was warranted under other potentially relevant DCs. While the Veteran reported visual impairment since his TBI during the August 2017 VA eye conditions examination, the VA examination report indicated that the Veteran’s diagnosed visual field defect, ptosis, and decreased visual acuity are not etiologically related to his service-connected TBI. Instead, the VA examiner opined that the Veteran’s ptosis existed prior to service and the visual field defect was etiologically related to the ptosis. While decreased uncorrected distance visual acuity was noted, the Veteran’s corrected distance visual was 20/40 or better bilaterally. See August 2017 VA eye conditions examination report. However, the rating schedule does not provide for a compensable rating unless corrected visual acuity is less than 20/40 in at least one eye. See 38 C.F.R. § 4.79, DC 6066. Therefore, a separate compensable rating is not warranted for visual impairment or any diagnosed eye condition. While the August 2017 VA examination report indicated that the Veteran had “hearing loss/tinnitus” as a residual of TBI, the Board finds that a separate compensable rating for hearing loss is not warranted as the Veteran does not have current hearing loss that meets the auditory thresholds required for service connection. For purposes of applying VA laws, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz 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. An August 2017 VA audiological evaluation indicated that the Veteran’s current bilateral hearing loss did not meet these standards. Therefore, a separate compensable rating for bilateral hearing loss is not warranted. Finally, the Board notes that neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 4. Entitlement to SMC. The Veteran contends that he is entitled to SMC based on his need for aid and attendance. Additionally, he seeks a higher level of special monthly compensation, under 38 U.S.C. § 1114(t), based on his need for aid and attendance for residuals of TBI. SMC is authorized in particular circumstances in addition to compensation for service-connected disabilities. See 38 U.S.C. § 1114 (2012); 38 C.F.R. §§ 3.350, 3.352 (2017). SMC is authorized under subsections (k) through (s), with the rate amounts increasing the later in the alphabet the letter appears (except for the “s” rate). SMC at the (k) and (k) rates are paid in addition to any other SMC rates, with certain monetary limits. SMC at the (k) rate is provided for loss or loss of use of certain body parts. 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350(a). SMC at the (l) rate is payable when the veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance under the criteria set forth in 38 C.F.R. § 3.352(a). See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). Determinations as to need for aid and attendance must be based on actual requirements of personal assistance from others. In making such determinations, consideration is given to such conditions as the following: Inability of claimant to dress or undress himself or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliance which by reason of the particular disability cannot be done without aid; inability of claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a). It is not required that all the disabling conditions enumerated in § 3.352(a) be found to exist before a favorable rating may be made. The particular personal functions which the Veteran is unable to perform should be considered in connection with his condition as a whole. 38 C.F.R. § 3.352(a); see also Turco v. Brown, 9 Vet. App. 222, 224 (1996) (holding that at least one factor listed in section 3.352(a) must be present for a grant of SMC based on need for aid and attendance). SMC at the (m) rate is warranted if the veteran, as a result of service-connected disability, has suffered the anatomical loss or loss of use of both hands, or of both legs at a level, or with complications, preventing natural knee action with prosthesis in place, or of one arm and one leg at levels, or with complications, preventing natural elbow and knee action with prosthesis in place, or has suffered blindness in both eyes having only light perception, or has suffered blindness in both eyes, rendering such veteran so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(m); 38 C.F.R. § 3.350(c). SMC at (n) rate is warranted if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of both arms at levels, or with complications, preventing elbow action with prostheses in place, has suffered the anatomical loss of both legs so near the hip as to prevent the use of prosthetic appliances. 38 U.S.C. § 1114(n); 38 C.F.R. § 3.350(d). SMC at the (n) rate is also warranted if the veteran’s service-connected disability has caused him to suffer anatomical loss of one arm and one leg so near the shoulder and hip as to prevent the use of prosthetic appliances, or to suffer blindness without light perception in both eyes. Id. SMC at the (o) rate is warranted if the veteran, as the result of service-connected disability, has suffered disability under conditions which would entitle such veteran to two or more of the rates provided in one or more of § 1114(l) through § 1114(n), no condition being considered twice in the determination, if the veteran has suffered the anatomical loss of both arms so near the shoulder as to prevent the use of prosthetic appliances, or bilateral deafness (and the hearing impairment in either one or both ears in service connected) rated at 60 percent or more disabling with service-connected total blindness with 5/200 visual acuity or less. SMC at the (o) rate is also warranted for total deafness in one ear or bilateral deafness (and the hearing impairment in either one or both ears is service connected) rated at 40 percent or more disabling and the veteran has also suffered service-connected blindness having only light perception or less. 38 U.S.C. § 1114(o); 38 C.F.R. § 3.350(e). Paralysis of both lower extremities together with the loss of anal and bladder sphincter control will entitle a veteran to the (o) rate of SMC, through the combination of loss of use of both legs and helplessness. The requirement of loss of anal and bladder sphincter control is met even though incontinence has been overcome under a strict regimen of rehabilitation of bowel and bladder training and other auxiliary measures. 38 C.F.R. § 3.350(e)(2). Determinations for entitlement to the (o) rate of SMC must be based upon separate and distinct disabilities. That requires, for example, that where a veteran who had suffered the loss or loss of use of two extremities is being considered for the maximum rate on account of helplessness requiring regular aid and attendance, the latter must be based on need resulting from pathology other than that of the extremities. 38 C.F.R. § 3.350(e). If the loss of use of two extremities or being permanently bedridden leaves the person helpless, increase is not in order on account of this helplessness. Under no circumstances will the combination of “being permanently bedridden” and “being so helpless as to require regular aid and attendance” without separate and distinct anatomical loss, or loss of use, of two extremities be taken as entitling the veteran to the maximum benefit. The fact, however, that two separate and distinct entitling disabilities, such as loss of use of both hands and both feet, result from a common etiological agent, for example, one injury or rheumatoid arthritis, will not preclude maximum entitlement. 38 C.F.R. § 3.350(e). 38 U.S.C. § 1114(p) provides for “intermediate” SMC rates between the different subsections based on anatomical loss or loss of use of the extremities or blindness in connection with deafness and/or loss or loss of use of a hand or foot. 38 U.S.C. § 1114(p); 38 C.F.R. § 3.350(f). In addition to the statutory rates payable under 38 U.S.C. § 1114(l) through (n) and the intermediate or next-higher rate provisions set forth under 38 U.S.C. § 1114(p), additional single permanent disability or combinations of permanent disabilities independently ratable at 50 percent or more will afford entitlement to the next-higher intermediate rate, or if already entitled to the next-higher intermediate rate, then to the next-higher statutory rate under 38 U.S.C. § 1114, but not above the (o) rate. The disability or disabilities independently ratable at 50 percent or more must be separate and distinct and involve different anatomical segments or bodily systems from the conditions establishing entitlement under 38 U.S.C. § 1114(l) through (n) or the intermediate rate provisions of 38 U.S.C. § 1114(p). 38 C.F.R. § 3.350(f)(3). Also, additional single permanent disability or combinations of permanent disabilities independently ratable at 100 percent apart from any consideration of individual unemployability will afford entitlement to the next-higher intermediate rate, or if already entitled to the next-higher intermediate rate, then to the next-higher statutory rate under 38 U.S.C. § 1114, but not above the (o) rate. The disability or disabilities independently ratable at 100 percent or more must be separate and distinct and involve different anatomical segments or bodily systems from the conditions establishing entitlement under 38 U.S.C. § 1114(l) through (n) or the intermediate rate provisions of 38 U.S.C. § 1114(p). 38 C.F.R. § 3.350(f)(4). A veteran receiving SMC at the (o) rate, at the maximum rate under 38 U.S.C. § 1114(p), or at the intermediate rate between (n) and (o) plus SMC at the (k) rate, who is in need of regular aid and attendance or a higher level of care is entitled to an additional allowance during periods that he is not hospitalized at the United States Government’s expense. Determination of this need is subject to the criteria of 38 C.F.R. § 3.352. 38 C.F.R. § 3.350(h). The regular or higher-level aid and attendance allowance is payable whether or not the need for regular aid and attendance or a higher level of care was a partial basis for entitlement to the maximum rate under 38 U.S.C. § 1114(o) or (p), or was based on an independent factual determination. 38 C.F.R. § 3.350(h). The amount of the additional allowance payable to a veteran in need of regular aid and attendance is specified in 38 U.S.C. § 1114(r)(1) (“r1” rate). The amount of the additional allowance payable to a veteran in need of a higher level of care is specified in 38 U.S.C. § 1114(r)(2) (“r2” rate). The higher-level aid and attendance allowance authorized by 38 U.S.C. § 1114(r)(2) is payable in lieu of the regular aid and attendance allowance authorized by 38 U.S.C. § 1114(r)(1). 38 C.F.R. § 3.350(h)(3). SMC at the (r)(2) rate requires a showing that the Veteran required daily personal health care services by a medical professional, or under the supervision of such, without which institutional care would be required. 38 C.F.R. § 3.350(h)(2). Special monthly compensation provided by 38 U.S.C. § 1114(t) is payable where a veteran, as the result of service-connected disability, is in need of regular aid and attendance for the residuals of TBI, is not eligible for compensation under subsection (r)(2), and in the absence of such regular aid and attendance would require hospitalization, nursing home care, or other residential institutional care. A Veteran entitled to this benefit shall be paid, in addition to any other compensation under this section, a monthly aid and attendance allowance equal to the rate described in subsection (r)(2). An allowance authorized under this subsection shall be paid in lieu of any allowance authorized by subsection (r)(1). Essentially, this type of special monthly compensation is warranted for veterans who need regular aid and attendance for the service-connected residuals of TBI, but are not eligible for a higher level of aid and attendance, and would require hospitalization, nursing home care, or other residential institutional care in the absence of regular aid and attendance. 38 U.S.C. § 1114(t). As an initial matter, the Board finds that the evidence does not reflect that the Veteran requires required daily personal health care services by a medical professional, or under the supervision of such, without which institutional care would be required. 38 C.F.R. § 3.350(h)(2). The evidence has consistently indicated that the Veteran lives with his family, under the care of either his mother or sister. Therefore, SMC at the (r)(2) rate is not warranted. However, the Board finds that SMC at the (t) rate is warranted for the entire period on appeal. For the entire period, the Veteran has been in need of regular aid and attendance due to the residuals of TBI. The evidence reflects that he has lived with his parents and has actually required personal assistance from others since separation from service. His mother has consistently administered and managed the Veteran’s medications, provided daily reminders to complete personal hygiene tasks, prepared his meals, attended all medical appointments, helped him to calm down after nightmares and panic attacks, and accompanied him whenever he went outside the home. See September 2012 statement from the Veteran’s mother, December 2012 VA caregiver program support note, January 2013 VA caregiver application, October 2013 VA caregiver support note, December 2016 VA examination report, May 2017 VA Form 21-2680, August 2017 VA TBI and mental disorder examination reports, and November 2017 VA Form 21-2680. In addition, the Board afforded great probative value to the VA medical center’s determination that the Veteran needed a family caregiver to support his health and well-being, perform personal functions required in everyday living, and ensure that he remained safe from hazards of dangers incident to his daily environment. See January 2013 VA clinical eligibility for primary caregiver note. For these reasons, the Board finds that the Veteran has been in need of regular aid and attendance due to residuals of TBI since October 17, 2010. 5. TDIU Claim. As to the claim for a TDIU, this benefit contemplates a schedular rating less than total for the disability or disabilities on which the TDIU would be based. See 38 C.F.R. § 4.16(a). The Board nevertheless recognizes that the Court has held that the receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. Bradley v. Peake, 22 Vet. App. 280 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, the Court’s decision in Bradley recognizes that a separate award of a TDIU predicated on a single disability may form the basis for an award of SMC. See id.; 38 U.S.C. § 1114. The Bradley case, however, is distinguishable from the instant case. In Bradley, the Court found that a TDIU was warranted in addition to a schedular 100 percent evaluation where the TDIU had been granted for a disability other than the disability for which a 100 percent rating was in effect. Under those circumstances, there was no “duplicate counting of disabilities.” Bradley, 22 Vet. App. at 293. Here, the Veteran has asserted that his unemployability is a result of both his residuals of TBI and PTSD, which is supported by the medical evidence. Notably, the Veteran is in receipt of a 100 percent rating for residuals of TBI from October 17, 2010 and a 100 percent rating for an acquired psychiatric disorder, to include PTSD, from August 31, 2011. In addition, the Board has awarded herein SMC at the (t) rate for the entire period on appeal. Accordingly, because the Veteran is entitled to a 100-percent rating for residuals of TBI and an acquired psychiatric disorder on a schedular basis for the entire period under review, as well as SMC at the (t) rate, entitlement to a TDIU is rendered moot. See Vettese v. Brown, 7 Vet App. 31 (1994) (observing that a “claim for TDIU presupposes that the rating for the condition is less than 100 percent”); Holland v. Brown, 6 Vet App. 443 (1994). Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Further development is necessary prior to analyzing the merits of the remaining claims. Once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 1. Entitlement to ratings in excess of 10 percent for right and left knee disabilities is remanded. The Veteran was afforded VA knee examinations in February 2011, January 2014, and November 2016. While the February 2011 and November 2016 VA examination reports indicate that the Veteran had no history of bilateral recurrent subluxation or lateral instability, normal joint stability testing, and no history of a meniscus condition, the January 2014 VA examination indicated that the Veteran had decreased muscle strength, mild bilateral lateral instability, moderate bilateral recurrent patellar subluxation/dislocation, symptoms of swelling/locking/giving way, and a bilateral meniscal condition. No explanation has been given for the dramatically different findings in the January 2014 VA examination report. Therefore, the Board finds that remand is necessary to determine the current nature and severity of the Veteran’s right and left knee disabilities. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file the Veteran’s relevant VA treatment records since December 2017. 2. Then, schedule the Veteran for a VA examination to determine the nature and severity of his right and left knee disabilities. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner. All appropriate tests, studies, and consultation should be accomplished and all clinical findings should be reported in detail. 3. Thereafter, readjudicate the remanded claims. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Thomas, Associate Counsel