Citation Nr: 19158455 Decision Date: 07/30/19 Archive Date: 07/29/19 DOCKET NO. 12-05 122A DATE: July 30, 2019 ORDER Entitlement to a rating in excess of 10 percent for residuals of a traumatic brain injury (TBI (claimed as head injury)) is denied. Entitlement to an effective date earlier than January 10, 2005 for residuals of a TBI (claimed as head injury) is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include peristent depressive disorder, to include as superimposed on a personality disorder and as secondary to a TBI is remanded. FINDINGS OF FACT 1. The Veteran’s residuals of a TBI are not manifested by any facet equating to higher than a level “1” under the Table of Facets of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified. 2. Service connection for blackouts was denied in an unappealed April 1977 rating decision. Service connection for a mental disorder and hepatitis was denied in an unappealed August 1998 rating decision. The Veteran filed a new claim for service connection for a head injury in January 2005. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 10 percent for residuals of TBI are not met. 38 U.S.C. §§ 1154(a), 1155, 5107(b); 38 C.F.R. § 3.102, 4.124a, DC 8045. 2. The criteria for an effective date earlier than January 10, 2005, for the grant of service connection for residuals of a TBI have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.160(d), 3.400, 20.1103. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Marine Corps from September 1975 to October 1975 and in the U.S. Navy from June 1976 to November 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal from June 2009 and October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In July 2011, the claim for service connection for a psychiatric disorder as a residual of TBI was remanded by the Board for further development, to include obtaining a VA examination. VA examinations were obtained in January 2012, May 2018, and June 2018. Notably, it appears that the Veteran desires to file a claim, alleging that the RO committed clear and unmistakable error (CUE) of fact regarding his claim for a TBI. Specifically, he asserts he was granted service connection for a TBI effective January 10, 2005. However, he had the same or similar symptoms since service and should have been awarded service connection as of the date of his November 1976 application for service connection for blackouts. When CUE is alleged with a rating decision, the CUE motion is filled with the RO and first adjudicated by the RO. Each new theory of CUE is a separate and distinct matter, and the Board lacks jurisdiction over any theory of CUE in a rating decision that has not been adjudicated by the RO in the first instance. Andre v. Principi, 301 F.3d 1354, 1361 (Fed. Cir. 2002); Jarell v. Nicholson, 20 Vet. App. 326, 332-33. Therefore, should he wish to file a motion seeking revision of the November 1976 RO decision, he should file the appropriate form(s) for a CUE motion. The RO is directed to provide the appropriate form(s) to assist the Veteran in the furtherance of his claim. Increased Rating 1. Entitlement to a rating in excess of 10 percent for residuals of a TBI In the October 2014 rating decision on appeal, service connection for a TBI was granted, and a 10 percent rating was assigned effective January 10, 2005, under 38 C.F.R. §4.124a, Diagnostic Code 8045. Diagnostic Code 8045 states that there are four main areas of dysfunction that may result from TBIs and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), subjective symptoms, emotional/behavioral dysfunction, and physical dysfunction. Each of these areas of dysfunction may require evaluation. 38 C.F.R. § 4.124a, Diagnostic Code 8045. 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. Cognitive impairment is to be evaluated under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” Subjective symptoms may be the only residual of a TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, are to be evaluated under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere’s disease, should be evaluated separately rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table, even if that diagnosis is based on subjective symptoms. Emotional/behavioral dysfunction should be evaluated under § 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, emotional/behavioral symptoms should be evaluated under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” Physical (including neurological) dysfunction is to be evaluated 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. Diagnostic Code 8045 stipulates that the preceding list of types of physical dysfunction does not encompass all possible residuals of a TBI. Residuals not listed here that are reported on an examination are to be evaluated under the most appropriate diagnostic code. Each condition should be evaluated separately as long as the same signs and symptoms are not used to support more than one evaluation, and the evaluations for each separately rated condition should be combined under § 4.25. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. Diagnostic Code 8045 also stipulates that the need for special monthly compensation (SMC) for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc., must be considered. Diagnostic Code 8045 also states that the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of a 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, and 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. A 100-percent evaluation is to be assigned if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” the overall percentage evaluation based on the level of the highest facet is to be assigned as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. The regulation provides the following example: assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet. There are five notes that accompany the current version of Diagnostic Code 8045. Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one’s own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. Note (4): The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under Diagnostic Code 8045. Note (5): A Veteran whose residuals of TBI are related under a version of § 4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran’s disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating award as a result of such review, VA will apply 38 C.F.R. § 3.114, if applicable. Upon reviewing the pertinent evidence in light of the governing authority, the Board finds that a rating in excess of 10 percent is not warranted as the Veteran’s residuals of a TBI are not manifested by any facet equating to higher than a level “1” under the Table of Facets of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified. Specifically, the Veteran was afforded three VA examinations to assess the severity of his TBI. On VA examination in January 2013, the examiner reviewed the Veteran’s service treatment records (STRs), which noted he was found by police on the road confused and was brought to the hospital where he was admitted. He remained confused that night but awoke the next morning normal. He had a superficial bruise on his head. His neurological examination was normal. He denied having any brain scans EEG or CAT scans done at the hospital at the time. The Veteran stated that he was told by his fellow Navy guys who was there that night that he ran out from the club and did not return. The Veteran also stated that they were drinking, and he was told by them that they put something in his drinks that made him confused. The examiner noted that the Veteran also carried a diagnosis of depression and was on multiple medications for control of depression. The Veteran complained of getting “psychiatric fits” where he is awake but is very irritable, argumentative and wants to be left alone, lasting an hour at a time. He also complained of scary dreams. The examiner noted that the Veteran only served active duty for a period of four months from November 1979 to January 1980 in the Navy and was separated because of serious personality problems and unsuitability for military service. He was a deck hand as his military occupational specialty (MOS) with a rank of E2 at separation. After the Veteran left the service, he had a lot of psychiatric problems and was various psychiatric hospitals. He was given different diagnoses, including schizophrenia, bipolar disorder and depression; but never given a diagnosis of TBI. The examiner determined that the Veteran did not have TBI or any residuals of a TBI. On testing, the examiner found there was no complaints of impairment of memory attention, concentration, or executive functions, corresponding to level “0” impairment. Judgement was normal, corresponding to level “0” impairment. Social interaction was routinely appropriate, corresponding to level “0” impairment. The Veteran was always oriented to person, time, place, and situation, corresponding to level “0” impairment. Motor activity was normal, corresponding to level “0” impairment. Visual spatial orientation was normal, corresponding to level “0” impairment. There were no complaints of subjective symptoms, corresponding to level “0” impairment. Neurobehavioral effects included one or more effects that did not interfere with workplace interaction or social interaction, corresponding to level “0” impairment. Communication was manifested by the ability to communicate by spoken and written language (expressive communication), and comprehend spoken and written language, corresponding to level “0” impairment. Consciousness was normal. The Veteran did not have any subjective or any mental, physical or neurological conditions or residuals attributable to a TBI, corresponding to level “0” impairment. He did not have scars related to any conditions or to treatment of residual of a TBI. He had no other pertinent physical findings, complications, conditions, signs or symptoms. The examiner concluded the Veteran did not have residual conditions attributed to a traumatic brain injury that would impact his or her ability to work. The examiner explained he did not find any evidence of a TBI or mTBI. The history that is documented in his file is not the same as provided by the Veteran. The examiner explained to make a diagnosis of TBI, original evaluation of any head injury or loss consciousness is needed. The examiner did not find the original emergency room evaluation and drug and alcohol testing at the time. His neurological examination was non-focal and MOCA (Montreal Cognitive assessment) testing he scored 28/30, which is normal (one incorrect counting by 7’s from 100 and missed “daisy” on 5-minute recall of 5 words). Yet, on VA examination in January 2016, the examiner opined the Veteran has a TBI since 1976. At this examination, the Veteran reported that while in service in Spain, something struck him in the head. He lost consciousness. He was reportedly found having a seizure. He did not remember the inciting incident. He has had seizures since the incident and continues to have absence seizures on occasion. The examiner noted that the Veteran’s treatment plan includes taking continuous medication, including Trazadone, Levetiracetam, Xanax, Sertraline, Buspirone, and Ambien. On testing, the Veteran had a complaint of mild memory loss (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing, corresponding to level “1” impairment. The examiner determined the Veteran had mildly impaired judgment; for complex or unfamiliar decisions, occasionally unable to identify, understand and weigh the alternatives, understand the consequences of choices and make a reasonable decision, corresponding to level “1” impairment. Social interaction was routinely appropriate, corresponding to level “0” impairment. As for orientation, he is occasionally disoriented to one of the four aspects (person, time , place, situation) or orientation, corresponding to level “1” impairment. Motor activity was normal, corresponding to level “0” impairment. Visual spatial orientation was normal, corresponding to level “0” impairment. There were no subjective symptoms, corresponding to level “0” impairment. There were no neurobehavior effects, corresponding to level “0” impairment. Communication was manifested by the ability to communicate through spoken and written language expressive communication, and comprehend spoken and written language, corresponding to level “0” impairment. Consciousness was normal. However, the examiner determined that the Veteran had residual of seizures that are attributed to his TBI, which impacts his ability to work in that it affects his ability to concentrate and with orientation; to which he completed a seizure disorder questionnaire. The third VA examination was afforded to the Veteran in July 2016, which also confirmed the Veteran has a TBI as of 1975. The Veteran complained of difficulty with memory, recalling some remote events, problems with naming and being forgetful when he is driving of where he is going. He also stated that he forgets his medications about three times a week and forgets information told to him. He tries to make notes or forgets it. His wife noticed some memory problems in 1977, but he did not acknowledge it as a concerned at the time. As for the in-service event, the Veteran now stated that he went with friends to a store and walked out. He was found lying on the ground with his head bleeding and reported that he had convulsions. He reported loss of consciousness and woke up in a base hospital. He stated he had no other problems at the time, but he later became depressed because he was not organized and could not do his job. One month after the TBI accident, he slashed his wrist and was hospitalized in a psychiatric unit for two weeks in Spain. He was given an honorable discharge but was sent to Philadelphia for two to three weeks prior to discharge for administrative duties. He reported feeling very sad and overwhelmed. He also reported that he has experienced 5-6 seizures in his life with the last one occurring in 2006 when he fell down steps and hit his head. He also reported bilateral temporal headaches about three time a week. He reported mood regulation problems with sadness and crying. His main symptoms were seizures, insomnia, anxiety and depression. He medicated with Buspirone, Duloxetine, Zolpidem, Trazadone, and Alprazolam. CT was negative. In a prior appeal, the examiner noted that the Veteran reported having temporal headaches ever since engaging in a pugil stick fight in October 1975 where he was diagnosed with trauma from being hit while servicing in the United States Marine Corps. STRs confirm the Veteran complained of headaches since being hit by a pugil stick and was diagnosed with trauma headache. Several days later, the Veteran was discharged from service by reason of unsuitability. The examiner concluded there was no indication that he was discharged due to headaches or other physical symptoms. The examiner also reviewed the October 1976 Medical Board report which reflected the Veteran was hospitalized on October 10, 1976 for the accident that occurred while serving in in the U.S. Navy. The Veteran was found in a confused state and was thought to have some type of “spell.” He complained of having a headache and an abrasion over his right eye. He denied having used alcohol or any drugs and did not appear intoxicated. He was disheveled and somewhat confused and had poor memory for recent or remote events. He was oriented in all spheres. On October 12, 1976, the Veteran was discharged to duty with a diagnosis of suspected head trauma. On October 13, 1976, he was readmitted a day later with multiple superficial wrist lacerations. At the time, the Veteran was withdrawn, tearful and expressed a strong desire to return home. On October 15, 1976, the Veteran was discharged with a diagnosis of schizoid personality. On October 22, 1976, he appeared before a Medical Board. At the time, the general physical and neurological examinations were within normal limits. His mental status examination was unremarkable. Based on the record, his diagnosis was changed from schizoid personality to immature personality which was found to preexist service. The Medical Board agreed and found that the Veteran did not have a service-connected disability. The Medical Board recommended that the Veteran be discharged as unsuitable for service. The examiner noted that the Veteran was currently taking the following medications: Buspirone, Duloxetine, Zolpidem, Trazadone, and Alprazolam. On testing, there was a complaint of mild memory loss (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing, corresponding to level “1” impairment. Judgment was normal, corresponding to level “0” impairment. Social interaction was occasionally appropriate, corresponding to level “1” impairment. He was always oriented to person, time, place and situation, corresponding to level “0” impairment. Motor activity was normal, corresponding to level “0” impairment. His visual special orientation was deemed mildly impaired. He reported that he occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions; yet, is able to use assistive devices such as GPS (global positioning system), corresponding to level “1” impairment. The examiner determined there are three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family or other close relationships; examples of findings that might be seen to this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days, corresponding to level “1” impairment. The examiner explained those symptoms are frequent headaches, anxious and fearfulness that frequently interferes with his ability to focus or concentrate, loud sounds and people talking causes irritation, and poor sleep with frequent awakening. The examiner also noted the Veteran has one or more neurobehavior effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them, corresponding to level “1” impairment. The examiner determined the Veteran is able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language, corresponding to level “0” impairment. His consciousness was normal. In addition, the examiner opined the Veteran has the following the following residuals attributable to his TBI: seizures, headaches, mental disorders; which were evaluated separately. The examiner noted that the Veteran underwent neuropsychological testing in August 2009, which confirmed his diagnoses of cognitive disorder NOS and depression NOS. An EEG was also conducted in December 2014 returned normal. The examiner opined that the TBI residuals impacts his ability to work as the Veteran’s memory impairment negatively impacts his ability to complete complex tasks. The examiner opined he is prone to misplacing and losing items with the potential to hamper occupational function. Notably, some of the residuals of TBI have been service connected; tension headaches associated with residuals of head injury at 50 percent effective January 1, 2005 and absence seizures or petit mal or atonic seizures associated with residual of head injury at 20 percent effective November 2015. Therefore, a rating in excess of 10 percent is not warranted for the Veteran’s TBI at any portion of the appeal period. On VA examinations, the highest level of impairment found was a level “1,” which corresponds to a 10 percent rating. Level “0” impairment was found in all other parameters, corresponding to a noncompensable evaluation. The Board has considered the need for special monthly compensation based on the TBI but finds that discussion in this regard is not warranted, as the evidence does not raise issues such as loss of use of an extremity, sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), or housebound status due to the TBI. Accordingly, the appeal is denied. Earlier Effective Date 2. Entitlement to an earlier effective date for service connection of residuals of a TBI (claimed as head injury) Section 5110(a), Title 38, United States Code, provides that “[u]nless specifically provided otherwise in this chapter, the effective date of an award based on an original claim... of compensation... shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.” The implementing regulation, 38 C.F.R. § 3.400, similarly states that the effective date of service connection “will be the date of receipt of the claim or the date entitlement arose, whichever is the later.” Historically, the Veteran first filed for service connection for blackouts in November 1976. The claim was denied in an April 1977 decision. In January 1998, the Veteran filed for service connection for mental disorder and hepatitis. The claim was denied in an August 1998 rating decision. However, the Veteran did not appeal either the April 1977 and August 1998 rating decisions. Rather, he filed a new claim in January 2005, which was initially denied in a September 2005 rating decision. The Veteran appealed the decision in a January 2006 Notice of Disagreement (NOD). VA issued a Statement of the Case (SOC) in February 2007. The Veteran filed a substantive appeal in March 2007. In a June 2014 Board decision, residuals of a head injury was granted. In an October 2014 rating decision, service connection for residuals of a head injury was granted with an evaluation of 10 percent, effective January 10, 2005; the date VA received his claim in accordance with the regulations and case law noted above. The Veteran has not made specific contentions as to why he is entitled to an earlier effective date. He implies that he is entitled to an effective date as of the date of his April 1977 application for service connection for blackouts. Yet, as previously mentioned, the Veteran has not yet raised a motion of CUE or otherwise challenged the finality of the April 1977 rating decision; therefore, the Board does not have jurisdiction to adjudicate such claim. Additionally, he has reiterated that it is clear he had severe psychiatric symptoms since service as he was hospitalized a few days after his inservice head injury for multiple superficial wrist lacerations and was described as being withdrawn and tearful. However, the effective date of an award of service connection is not based upon the date of the earliest medical evidence demonstrating entitlement, but instead on the date that the application upon which service connection was eventually awarded was filed with VA. Lalonde v. West, 12 Vet. App. 377 (1999). The Veteran may also be awarded an earlier effective date if he filed a claim for service connection for a TBI in between April 1977 and January 2005, which was not acknowledged by the VA. A ‘claim” is defined broadly to include a form or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998). However, a review of the claims file reflects no submission or communication within the specified time period that could be construed as such a claim. The only claim filed was that was filed during that period was a claim for service connection for a mental disorder and hepatitis, which was denied in an unappealed August 1998 rating decision. For these reasons, an effective date earlier than January 10, 2005, for the grant of service connection for a TBI is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for acquired psychiatric disorder, to include persistent depressive disorder secondary to a TBI is remanded. Regrettably, the claim must be remanded to obtain a VA addendum opinion as to the etiology of the Veteran’s peristent depressive disorder. The Veteran claims entitlement to service connection for persistent depressive disorder secondary to a TBI. Notably, the evidence indicates that the Veteran was diagnosed with a personality disorder in service. Congenital or developmental defects, such as personality disorders are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). However, if such a defect is subjected to superimposed disease or injury which creates additional disability, then service connection may be warranted for the resultant disability. See VAOPGCPREC 82-90. Specifically, disability resulting from a mental disorder that is superimposed upon a personality disorder may be service-connected. 38 C.F.R. § 4.127. The record reflects that the Veteran had a diagnosis of a personality disorder in service; and years later, he was diagnosed with peristent depressive disorder. Specifically, a closer review of his STRs reflects October 1975 medical records indicating the Veteran tried to cut his wrist; which the Veteran contends occurred after an in-service personal assault in the U.S. Marine Corps. No comments pertaining to his mental state were provided. He was discharged shortly thereafter. On the October 1976 Medical Board report, during his second period of active service in the U.S. Navy, the examiners changed his diagnosis from schizoid personality to immature personality disorder, which was found to preexist service. The Medical Board found that the Veteran did not have a service-connected disability. The Medical Board recommended that the Veteran be discharged as unsuitable for service. Yet, the medical opinions of record do not address whether the Veteran’s persistent depressive disorder was superimposed upon his personality disorder in service. Additionally, the medical opinions are also silent as to whether the Veteran’s persistent depressive disorder has been associated with his TBI. As such, an addendum opinion with an adequate rationale must be obtained on remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the following: (a.) What are all of the Veteran’s psychiatric diagnoses? (b.) For each diagnosis, is it at least as likely as not caused or aggravated by his military service? (c.) For each diagnosis, other than personality disorder, is it at least as likely as not caused or aggravated by a service-connected disability, to include his service connected TBI? If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to an in-service stressor, to include the October 1975 incident where the Veteran cut his left wrist and was subsequently discharged. If the Veteran is diagnosed with a personality disorder and an additional psychiatric disability, the examiner must opine whether the additional psychiatric disability was at least as likely as not superimposed on the personality disorder during active service and resulted in additional disability. The examiner should consider the Veteran’s contentions of an in-service personal assault, October 1975 records indicating he sought treatment for slashes to his left wrist. Matthew Tenner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Pendleton, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.