Citation Nr: 20004285 Decision Date: 01/17/20 Archive Date: 01/17/20 DOCKET NO. 09-07 758 DATE: January 17, 2020 ORDER Service connection for a heart disorder, variously diagnosed, is denied. Service connection for hypertension is denied. Prior to January 16, 2019, a rating greater than 20 percent for residuals, fragment wound, right shoulder with tendinopathy and arthritis (“right shoulder disability”) is denied. From January 16, 2019, a rating of 30 percent, but no higher, for a right shoulder disability is granted, subject to the regulations governing the award of monetary benefits. Prior to February 4, 2014, a rating of 50 percent, but no higher, for posttraumatic stress disorder (PTSD) with major depressive disorder, recurrent, severe with psychotic features (“psychiatric disability”) is granted, subject to the regulations governing the award of monetary benefits. After February 4, 2014, a rating greater than 70 percent for a psychiatric disability is denied. REMANDED An effective date prior to February 4, 2014, for the award of a total disability rating based on individual employability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. A heart disorder was not incurred in service, to include in-service exposure to herbicide agents; was not caused or aggravated by service-connected PTSD; and does not qualify as ischemic heart disease. 2. Hypertension was not incurred in service, to include in-service exposure to herbicide agents; was not caused or aggravated by service-connected PTSD; and did not have its onset within one year of military separation. 3. Prior to January 16, 2019, a right shoulder disability manifested by subjective complaints of chronic pain; objective findings did not demonstrate limitation of motion of the arm midway between side and shoulder level. 4. After January 16, 2019, a right shoulder disability manifested by subjective complaints of chronic pain; objective findings demonstrate limitation of motion of the arm midway between side and shoulder level. 5. Prior to February 4, 2014, a psychiatric disability was productive of social and occupational impairment with reduced reliability and productivity due to such symptoms as chronic mood disturbances, frequent panic attacks, and difficulty in establishing and maintaining work and social relationships. 6. After February 4, 2014, a psychiatric disability was productive of occupational and social impairment with deficiencies in most areas due to such symptoms as passive suicidal ideations, near-continuous mood disturbances, the inability to adapt to stressful circumstances, and social impairment. CONCLUSIONS OF LAW 1. A heart disorder, variously diagnosed, was not incurred in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 3.307, 3.309. 2. Hypertension was not incurred in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 3.307, 3.309. 3. Prior to January 16, 2019, the criteria for a rating greater than 20 percent for a right shoulder disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5010-5201. 4. After January 16, 2019, the criteria for a 30 percent rating, but no higher, for a right shoulder disability have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5010-5201. 5. Prior to February 4, 2014, the criteria for a 50 percent rating, but no higher, for a psychiatric disability have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.130, DC 9411. 6. After February 4, 2014, the criteria for a rating greater than 70 percent for a psychiatric disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.130, DC 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1964 to March 1967, including foreign service in the Republic of Vietnam. For his meritorious service, the Veteran was awarded (among other decorations) the Purple Heart, the Combat Infantryman Badge, the Vietnam Campaign Medal, and the Army Commendation Medal with Device. The Veteran testified as to these matters during a November 2012 videoconference hearing. A transcript of this proceeding has been associated with the record. In June 2017, he was informed that the Veterans Law Judge (VLJ) who presided over the hearing was no longer with the Board, and offered a hearing before a different VLJ. The following month, the Veteran indicated that he did not wish to appear at another hearing and requested that the appeals be considered on the evidence of record. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. In December 2015 and at the request of the Veteran, his former representative informed VA of his intent to withdraw. The Veteran remains unrepresented at this time. See 38 C.F.R. § 20.608 These appeals were most recently remanded by the Board in September 2017 for additional development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Finally, the Board has repeatedly referred a claim seeking an earlier effective date for the award of service connection for a right shoulder disability. As no adjudicatory actions have yet been taken by the Agency of Original Jurisdiction (AOJ), the Board does not have jurisdiction over this issue, and it is once again referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b). Service Connection First, the Veteran seeks service connection for a heart disorder and hypertension on direct and secondary bases. As these appeals require similar analyses, they will be addressed simultaneously herein. Thus, direct service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Secondary service connection may also be warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). As to the first element, multiple examiners have diagnosed the Veteran with the claimed disorders during the period on appeal, to include: atrial fibrillation; resolved acute congestive heart failure; cardiomyopathy; sick sinus syndrome; and hypertension. See, e.g., VA examinations dated February 2014 and October 2019. These diagnoses are also present throughout VA and private treatment records spanning the period on appeal. Thus, the first element of service connection—current disabilities, classified here as a heart disorder, variously diagnosed, and hypertension—has been met for both appeals. Notably, the Veteran served in the Republic of Vietnam from approximately April 1966 to March 1967, such that his in-service exposure to herbicide agents is presumed. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307, 3.309. However, none of the Veteran’s diagnosed disorders are among those presumptively linked to herbicide exposure, such that service connection cannot be awarded on this basis for either appeal. See also February 2014 VA examination and January 2019 Disability Benefits Questionnaire (DBQ) (concluding that the Veteran does not demonstrate ischemic heart disease within the generally accepted medical definition). Additionally, the evidence does not establish that the Veteran’s hypertension onset within one year of military separation, such that service connection based upon chronicity cannot be presumed. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307, 3.309; see also December 2015 VA examination (noting that hypertension is not established via blood pressure readings until approximately 2006); October 2019 DBQ (concluding that the Veteran’s hypertension onset more than 15 years following his exit from service). The above findings do not preclude the Veteran from establishing service connection on direct or secondary bases. Specifically, he contends that the claimed disorders are causally related to in-service herbicide exposure and/or his service-connected PTSD, including related alcohol abuse. However, the competent medical evidence weighs against such a finding. In this respect, the record contains multiple medical opinions for consideration. Initially, a February 2014 VA examiner concluded that the Veteran’s claimed disorders were not related to his military service or service-connected PTSD. She then provided an extensive rationale that addressed, in pertinent part, the nature and onset of the Veteran’s current disorders; the absence of pertinent symptoms during service; the lack of a medically accepted nexus between the claimed disorders and psychiatric disabilities; known risk factors for the Veteran’s current disorders; and the likeliest causes thereof. In a December 2015 VA addendum opinion, the above examiner further concluded that it was less likely than not that the Veteran’s claimed conditions were aggravated beyond their natural progression by his service-connected PTSD. Here, the examiner assessed such factors as trends in the Veteran’s blood pressure readings over the past decade; the expected natural progression of his current disorders; and a review of medical literature which was not indicative of a causal nexus between the claimed disorders and psychiatric disabilities. A series of January 2019 examinations similarly decline to assert a direct nexus in this case, as the Veteran’s claims file lacks objective evidence that the claimed conditions onset during service. Moreover, none of the diagnosed conditions are conceded by VA as presumptively linked to herbicide exposure. However, the physician declined to offer an opinion as to secondary service connection, noting that it was impossible to do so without resorting to mere speculation. Nonetheless, the physician found no objective evidence to support that the Veteran’s history of alcohol abuse resulted from his PTSD. Most recently, an October 2019 opinion reports that it is less likely than not that the Veteran’s claimed disorders are causally related to his military service, including in-service exposure to herbicide agents. By way of rationale, the examiner indicated that the Veteran’s claimed disorders onset years after service, and medical literature, inclusive of a recent National Academy of Sciences, Engineering and Medicine (NAS) study, does not support a causal relationship between these conditions and herbicide exposure. Further, it was less likely than not that the claimed conditions were caused or aggravated by the Veteran’s PTSD, including a related history of alcohol abuse. Here, the physician reviewed such factors as the nature and onset of the Veteran’s claimed and service-connected disabilities; accepted nexus conclusions of the medical community at large; known risk factors for the claimed disorders; and the likeliest causes thereof. Importantly, the physician clearly attributed the Veteran’s heart conditions to his hypertension, for which service connection is not established herein. Upon review of the above, the greatest probative value is afforded to the October 2019 DBQ, which assesses the full scope of entitlement theories as presented by the record and offers due consideration to such pertinent factors as the Veteran’s in-service medical history, the nature and onset of the claimed conditions, and accepted conclusions of the medical community at large. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the “factually accurate, fully articulated, sound reasoning for the conclusion”). There is no indication that the October 2019 examiner was not fully aware of the Veteran’s past medical history or misstated any relevant fact in formulating the negative nexus opinions. Moreover, the examiner possesses the requisite expertise to render medical opinions regarding the etiology of the claimed disorders and had sufficient facts and data on which to base her conclusions. Compellingly, the October 2019 opinions are also directly supported by the prior February 2014, December 2015, and January 2019 opinions, which were provided by trained medical professionals and also based upon thorough review of the record. In contrast, the Veteran contends that a nexus is present with respect to these appeals. However, he lacks the requisite training and expertise to offer competent opinions as to medical matters. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Rather, greater probative value is afforded to the medical opinions of record, which support the conclusion that a nexus is not present with respect to either of the claimed conditions. Upon such a finding, the Board thus concludes that the Veteran’s current heart and hypertension disorders are neither directly related to his military service, including in-service herbicide exposure, nor caused or aggravated by his service-connected PTSD. Accordingly, the preponderance of the evidence is against the claims, the benefit-of-the-doubt rule is not applicable, and the appeals are hereby denied. Increased Ratings The Veteran is additionally pursuing increased ratings for his right shoulder and psychiatric disabilities. Disability ratings are determined by the applications of the VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Right Shoulder First, the Veteran seeks an initial rating greater than 20 percent for his right shoulder disability. He has been rated in accordance with DC 5010-5201. Hyphenated diagnostic codes are used when an unlisted disability is at issue. See 38 C.F.R. § 4.27. The second diagnostic code provides further detail regarding the origins of the unlisted disability, the bodily functions affected, the symptomatology, and anatomical location. Thus, the diagnostic code following the hyphen is the diagnostic code by which the disability is evaluated by analogy. Here, the Veteran has been rated for limitation of motion for the right shoulder. However, the Board will consider all potentially relevant diagnostic codes in assessing the merits of this appeal. In doing so, the Board notes that the Veteran’s right shoulder has been shown to be his major or dominant extremity for purposes of evaluation. Thus, the appeal may be granted upon evidence of the following: • Limitation of motion of the arm midway between side and shoulder level (30 percent under DC 5201). Other diagnostic codes pertaining to the shoulder include DCs 5200 (favorable ankylosis of the scapulohumeral articulation), 5202 (impairment or dislocation of the humerus), and 5203 (impairment of the clavicle or scapula). These disorders are not shown in the record during the entire period on appeal, such that application of these DCs is not warranted. However, staged ratings are appropriate in this case as based upon limitation of motion under DC 5201. See Hart v. Mansfield, 21 Vet. App. 505 (2007). First, a rating greater than 20 percent is not warranted prior to January 16, 2019. During February 2014 VA examination, range of motion testing yielded the following results: flexion to 110 degrees, with painful motion beginning at 90 degrees; abduction to 90 degrees, with painful motion beginning at 90 degrees; external rotation to 55 degrees; and internal rotation to 60 degrees. Additional limitation upon repetitive use was denied, but objective evidence of pain upon repetitive internal rotation was observed. A subsequent January 2015 DBQ reports flexion to 135 degrees, with painful motion beginning at 135 degrees; abduction to 95 degrees, with painful motion beginning at 95 degrees; external rotation to 50 degrees, with painful motion beginning at 50 degrees; and internal rotation to 40 degrees. The examiner opined that pain, weakness, fatigability, and incoordination also contributed to additional limitation of functional ability during flare-ups or upon repetitive use, with an estimated additional five-degree loss of range of motion in each direction. In assessing these results, the Board notes that normal ranges of motion of the shoulder are flexion (forward elevation) from 0 degrees to 180 degrees, abduction from 0 degrees to 180 degrees, external rotation from 0 degrees to 90 degrees, and internal rotation from 0 degrees to 90 degrees. 38 C.F.R. § 4.71, Plate I. Thus, at its most severe and as further limited by chronic pain, weakness, fatigability, and incoordination, the Veteran’s right shoulder demonstrated flexion to 110 degrees; abduction to 90 degrees; external rotation to 45 degrees; and internal rotation to 35 degrees prior to January 16, 2019. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also May 2007 VA contract examination (reporting right shoulder limitation of motion); see generally VA treatment records (establishing a history of chronic shoulder pain). Although these results are indicative of limited motion, it is not found that the Veteran’s range was so restricted as to equate limitation of motion midway between the side and shoulder. Rather, he was regularly assessed as only moderately limited in his capacity to function, such that he demonstrated difficulty with lifting or carrying heavy items but was generally able to “take care of [him]self” and perform personal and occupational tasks with minimal interruption. See, e.g., May 2007 contract and February 2014 VA examinations; January 2015 DBQ; see also November 2012 hearing transcript (describing right shoulder weakness and the inability to lift heavy objects). Accordingly, the Veteran’s restricted motion prior to January 16, 2019, does not rise to the level of limitation of motion midway between the side and shoulder. Rather, his disability picture, inclusive of moderate limitation of motion and chronic right shoulder pain, is best embodied in the criteria for a 20 percent rating, as currently assigned. However, a January 2019 DBQ signals a worsening of the Veteran’s disability. At that time, flexion was recorded to 90 degrees; abduction to 80 degrees; external rotation to 10 degrees; and internal rotation to 10 degrees. Pain was observed upon all motion, although additional functional impairment was not described in terms of range of motion. The physician further declined to provide an opinion as to whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use or over a period of time. However, the Veteran reported the inability to use his shoulder without significant pain at that time. Layno v. Brown, 6 Vet. App. 465, 470 (1994); see generally VA treatment records (noting chronic and significant right shoulder pain). Thus, at the time of the January 2019 examination, the Veteran demonstrated less than half of normal range of motion per VA regulations. Considering his competent testimony, his motion was further restricted by constant and severe right shoulder pain which was exacerbated upon use. In weighing this evidence in the light most favorable to the Veteran, it is thus found that his disability picture at the time of the January 2019 examination is more nearly approximated in the criteria for a 30 percent rating, and the appeal is granted as of the date of this evaluation. Briefly, the Board has also considered whether a higher rating is warranted after January 16, 2019. However, the evidence clearly weighs against a finding that the Veteran’s right shoulder disability was productive of limitation of motion to 25 degrees from the side, as required by the criteria for a 40 percent rating. Accordingly, such a rating is not established after January 16, 2019. PTSD The Veteran additionally seeks higher ratings for his PTSD. Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on an examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). Prior to February 4, 2014 Currently, the Veteran is in receipt of a 30 percent rating for his PTSD prior to February 4, 2014. Per DC 9411, a 50 percent rating is warranted upon evidence of the following: • 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 and maintaining effective work and social relationships. In considering the frequency, severity, and duration of the Veteran’s symptoms, a rating of 50 percent is warranted prior to February 4, 2014. The Veteran underwent one VA contract examination during the period on appeal. In May 2007, his primary symptoms were recorded as chronic sleep impairment and nightmares. As a result, the Veteran demonstrated “no major changes in his daily activities” due to his PTSD. However, “major social functioning changes” were described, including social avoidance and impaired communication skills. During mental status examination, the Veteran presented with normal orientation and concentration, appropriate behavior and hygiene, and unimpaired thinking, but also with “grossly impaired” communication, a flattened affect, and mild memory impairment. As such, the examiner assessed the Veteran as capable of performing the tasks of daily living without interruption from his psychiatric symptoms, but also with occupational and social impairment with reduced reliability and productivity. Such a disability picture is commensurate with a 50 percent rating per VA regulations. Additionally, the Veteran has offered credible and competent testimony as to the nature and severity of his disability during the period on appeal. Notably, during the November 2012 hearing, the Veteran spoke of such symptoms as chronic sleep impairment, nightmares, flashbacks, mood disturbances, and panic attacks. As a result, he presented with notable social and occupational impairment, such that he described no significant friendships, decreased motivation and enjoyment of hobbies, interference with his capacity to perform the tasks of daily living, and a history of isolation. A similar disability picture is endorsed by VA and private treatment records, which indicate that the Veteran required consistent treatment for his psychiatric symptoms. Nonetheless, he continued to demonstrate chronic sleep impairment, mood disturbances, and social deficiencies as a result thereof. Upon the above, it is found that the Veteran’s disability picture prior to February 4, 2014, is best embodied in the criteria for a 50 percent rating. During this time, he presented with chronic mood disturbances, mild memory impairment, and panic attacks which directly limited his capacity to establish and maintain meaningful social and occupational relationships. Despite consistent treatment, the Veteran continued to experience moderate functional impairment due to his symptoms, to include reduced reliability and productivity. Such a disability picture is commensurate with the criteria for a 50 percent rating, and the appeal is granted to this extent. Briefly, the Board has considered whether a higher rating is warranted during the period on appeal. However, the record is silent for a history of such symptoms as suicidal ideations, obsessional rituals, disorientation, or impaired impulse control as enunciated in the criteria for a 70 percent rating. Rather, the Veteran remained relatively capable of functioning during the period on appeal, to include the capacity to communicate appropriately and effectively with his examiner, maintain positive familial relationships, and tend to his appearance and hygiene. Thus, a 70 percent rating is not warranted prior to February 4, 2014. February 4, 2014 The Veteran is additionally seeking a rating greater than 70 percent for his PTSD after February 4, 2014. For a 100 percent rating to be warranted, the evidence must demonstrate: • 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 ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. In considering the frequency, severity, and duration of the Veteran’s symptoms, an increased rating is not warranted after February 4, 2014. In this respect, the Veteran underwent multiple examinations during the period on appeal. First, a February 2014 VA examiner recorded the Veteran’s primary symptoms as depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, suicidal ideations, and persistent delusions or hallucinations. During examination, he was found to be alert, coherent, and oriented in all spheres. His hygiene and grooming were adequate, but his mood was depressed. He further reported intermittent visual hallucinations at that time. Accordingly, the examiner assessed the Veteran’s symptoms as “severe,” with occupational and social impairment with deficiencies in most areas. Also of record is a January 2015 DBQ, which identifies the Veteran’s primary symptoms as follows: depressed mood; anxiety; chronic sleep impairment; flattened affect; difficulty in establishing and maintaining effective work and social relationships; and the inability to establish and maintain effective relationships. Behavioral observations did not yield reports of gross impairment in thought processes or communication, delusions or hallucinations, grossly inappropriate behavior, disorientation, or neglect of appearance or hygiene. Once again, the Veteran’s symptoms were classified as productive of occupational and social impairment with deficiencies in most areas. Most recently, a January 2019 DBQ records the Veteran’s primary symptoms as depressed mood, anxiety, near-continuous panic or depression, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and suicidal ideations. Upon examination, he was described as neatly groomed, with poor eye contact and low activity level. His mood was described as depressed, with “tight” thinking and no evidence of psychosis. Although the Veteran reported passive suicidal ideations at that time, he attributed this to the death of his spouse. The examiner thus assessed the Veteran as demonstrating occupational and social impairment with deficiencies in most areas. VA treatment records similarly reflect such a disability picture during the period on appeal. Collectively, these records establish the Veteran’s chronic symptoms of mood disturbances, sleep impairment, and passive suicidal ideations. Ongoing treatment methods did not yield any significant improvement to the Veteran’s disability. Taken in combination, the above evidence establishes that the Veteran demonstrates occupational and social impairment with deficiencies in most areas, due to such symptoms as passive suicidal ideations, near-continuous mood disturbances, the inability to adapt to stressful circumstances, and social impairment. Such a disability picture is most nearly approximated in the criteria for a 70 percent rating, as currently assigned, such that a higher rating is not warranted after February 4, 2014. In offering this conclusion, the Board acknowledges the Veteran’s contention that a higher rating is warranted. However, a 100 percent rating is not warranted unless the Veteran has been rendered totally occupationally and socially impaired as due to his psychiatric disability. Here, the Veteran clearly demonstrates significant occupational and social deficiencies. However, he also remains capable of communicating appropriately and effectively with others and maintaining basic self-care. At no time was he found to pose a threat to himself or others or demonstrate gross memory impairment. Thus, the evidence does not establish that the Veteran is totally impaired due to his psychiatric symptoms, such that his disability picture is not commensurate with the criteria for a 100 percent rating. Additionally, the Board acknowledges the Veteran’s history of delusions and/or hallucinations after February 4, 2014. However, it is not found that this symptom has rendered the Veteran as totally impaired. Notably, he has not reported any significant disruption to his daily functioning as due to this symptom, nor does he otherwise present as so impaired. Thus, the presence of this isolated symptom is insufficient upon which to award a 100 percent rating. Accordingly, the Veteran’s disability more nearly approximates the criteria for a 70 percent rating after February 4, 2014, and the appeal seeking a higher rating is hereby denied. The preponderance of the evidence is against the Veteran’s claim, and there is no doubt to be resolved. With respect to the above increased rating appeals, the Board has considered the Veteran’s contention that higher ratings are warranted. However, he lacks the medical training and expertise to competently identify a specific level of disability according to the applicable DCs. Jandreau, 492 F.3d at 1377 (Fed. Cir. 2007). Rather, his examiners possess the requisite expertise to render opinions regarding the degree of impairment caused by the Veteran’s disabilities and had sufficient facts and data on which to base their conclusions. In offering greater probative value to such opinions, it is found that the medical evidence supports the determinations offered herein. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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 Although the Board sincerely regrets the additional delay this will cause, further development is necessary prior to the adjudication of the earlier effective date appeal. Given the determinations herein, the Veteran is now service-connected as follows prior to February 4, 2014: (1) Psychiatric disability (50 percent); (2) right shoulder disability (20 percent); (3) tinnitus (10 percent); (4) bilateral hearing loss (noncompensable); and (5) right shoulder scar (noncompensable). With a combined rating of 60 percent, the Veteran does not meet the schedular threshold for a TDIU prior to February 4, 2014. However, the record contains competent evidence that his service-connected disabilities may have precluded his gainful employment prior to that date. As such, a remand is now warranted so the matter can be referred to VA’s Director, Compensation Service for consideration of an extraschedular rating under 38 C.F.R. § 4.16(b). The matter is REMANDED for the following action: Refer the issue of whether a TDIU is warranted prior to February 4, 2014, to VA’s Director of Compensation Service for consideration on an extraschedular basis. Include a full statement as to the Veteran’s service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue. See 38 C.F.R. § 4.16(b). Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kovarovic, 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.