Citation Nr: 20006541 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 19-07 477 DATE: January 27, 2020 ORDER Entitlement to an initial rating for chronic mixed headache syndrome with tension headaches of 30 percent from April 10, 2013 to June 18, 2014 is granted. Entitlement to a rating exceeding 50 percent from June 19, 2014 to November 30, 2014 for chronic mixed headache syndrome with tension headaches is denied. Entitlement to a rating for chronic mixed headache syndrome with tension headaches of 50 percent since December 1, 2014 is granted. Entitlement to an initial compensable rating for hypertension is denied. Entitlement to an effective date earlier than April 10, 2013 for service connection, or an initial rating for chronic mixed headache syndrome with tension is denied. Entitlement to an effective date earlier than April 10, 2013 for service connection, or an initial rating for hypertension (claimed as high blood pressure) is denied. REMANDED Entitlement to service connection for posttraumatic stress disorder is remanded. Entitlement to service connection for major depressive disorder is remanded. Entitlement to a total disability rating for compensation purposes based on individual unemployability is remanded. FINDINGS OF FACT 1. From April 10, 2013 to June 18, 2014, the Veteran’s chronic mixed headache syndrome with tension headaches manifested by features equal in severity to characteristic prostrating attacks occurring on an average once a month over the last several months. They did not manifest with very frequent completely prostrating and prolonged attacks productive of severe economic adaptability. 2. From June 19, 2014 to November 30, 2014, the Veteran was assigned the maximum schedular rating for migraine headaches. He did not have severe convulsive tic, Sydenham’s Chorea, Huntington’s chorea, athetosis, epilepsies, or narcolepsy. 3. Affording the Veteran the benefit of the doubt, since December 1, 2014, the Veteran’s chronic mixed headache syndrome with tension headaches manifested with very frequent completely prostrating and prolonged attacks productive of severe economic adaptability. He did not have severe convulsive tic, Sydenham’s Chorea, Huntington’s chorea, athetosis, epilepsies, or narcolepsy. 4. From April 10, 2013, the Veteran’s hypertension has not been manifested by a diastolic pressure predominantly 100 or more, or by a systolic pressure predominantly 160 or more, or by a history of diastolic pressure predominantly 100 requiring continuous medication for control. 5. The Veteran did not submit any correspondence prior to April 10, 2013 indicating an intent to claim entitlement to service connection for headaches. 6. The Veteran did not submit any correspondence prior to April 10, 2013 indicating an intent to claim entitlement to service connection for hypertension. CONCLUSIONS OF LAW 1. From April 10, 2013 to June 18, 2014, the criteria for entitlement to an initial rating of 30 percent, but no higher, for chronic mixed headache syndrome with tension headaches have been met. 38 U.S.C. § § 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.31, 4.124a, Diagnostic Code 8100. 2. From June 19, 2014 to November 30, 2014, the criteria for a rating higher than 50 percent for chronic mixed headache syndrome with tension headaches have not been met. 38 U.S.C. § § 1155, 5107; 38 C.F.R. § §§ 4.3, 4.7, 4.31, 4.124a, Diagnostic Code 8100. 3. Since December 1, 2014, the criteria for a 50 percent rating, but no higher, for chronic mixed headache syndrome with tension headaches have been met. 38 U.S.C. § § 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.31, 4.124a, Diagnostic Code 8100. 4. The criteria for entitlement to an initial compensable rating for hypertension have not been met. 38 U.S.C. § § 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.31, 4.104, Diagnostic Code 7101. 5. The criteria for entitlement to effective date earlier than April 10, 2013 for the grant of service connection and an initial rating for chronic mixed headache syndrome with tension headaches have not been met. 38 U.S.C. § 5110(d); 38 C.F.R. §§ 3.400, 3.400(a)(2). 6. The criteria for entitlement to an effective date earlier than April 10, 2013 for the grant of service connection and an initial rating for hypertension have not been met. 38 U.S.C. § 5110(d); 38 C.F.R. §§ 3.400, 3.400(a)(2). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1985 to May 1993, with additional service in the Army Reserve. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a September 2014 and December 2014 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In a January 2019 rating decision, the RO granted service connection for left knee instability and left knee painful motion. This was a full grant of the benefit the sought, and the issue is no longer on appeal. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Jurisdiction of the Board The Veteran filed a notice of disagreement in January 2015 in which he expressed disagreement with, and a desire to contest, the RO’s decision of certain issues in its rating decisions of September 2014 and December 2014. The issues placed on appeal by the January 2015 notice of disagreement were the five issues stated under the Order heading, and the two issues stated under the Remand heading, on the title page herein. Neither the Veteran nor his representative filed another notice of disagreement placing other issues on appeal within one year (depending on which rating decision addressed an issue) of the September 2014 or the December 2014 rating decision. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 20.201, 20.302. However, the January 2019 Statement of the Case treats not only the issues subject to order or remand herein but also issues that were not placed on appeal by the January 2015 notice of disagreement or any other. The unappealed issues treated in the January 2019 Statement of the Case were initial rating of supraventricular arrhythmia; initial rating of metatarsalgia, hallux valgus, and degenerative arthritis of the right foot; service connection for a right knee disability; service connection for bilateral shin splints; and service connection for a low back disability. The Board does not have jurisdiction over those issues. Questions as to the timeliness or adequacy of a response are determined by the Board. See 38 U.S.C. § 7105(d)(3). The Board may explicitly or impliedly waive the question of the timeliness of a substantive appeal. However, a timely filed notice of disagreement is necessary for the Board to exercise its appellate jurisdiction, and the Board may not waive this requirement. See Percy v. Shinseki, 23 Vet. App. 37, 41 (2009). The Board is bound by the legal requirement and has no authority to grant appellate status for equitable reasons. See 38 U.S.C. § § 503, 7104; see also Harvey v. Brown, 6 Vet. App. 415, 425 (1994). Accordingly, the Board finds that none of the issues presented in the Statement of the Case that were not raised in a timely notice of disagreement are before it on appeal. The Board will take no further action on those issues. See 38 U.S.C. § 7105. Disability Ratings Disability evaluations are determined by comparing the manifestations of a disability with the criteria set forth in the Diagnostic Codes of the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. § Part 4. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity (in civilian occupations) resulting from service-connected disability. 38 C.F.R. § 4.1. Relevant regulations do not require that all cases show all findings specified by the Rating Schedule; however, findings enough to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § §§ 4.7, 4.21. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § § 4.7. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The basis of disability evaluations is the ability of the body, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. To evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate evaluations can be assigned for separate periods from the effective date of service connection. Fenderson v. West, 12 Vet. App. 119 (1999). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt shall be resolved in favor of the claimant. 38 C.F.R. § § 4.3. 1. Entitlement to increased initial ratings for chronic mixed headache syndrome with tension headaches. The RO granted service connection for headaches in the December 2014 rating decision with a staged evaluation. The RO explained that it did so because VA examinations performed during the rating period showed that that the severity of condition varied. The Veteran’s headaches are rated under section 4.124a of the Schedule for Rating Disabilities (Rating Schedule), which concerns neurological conditions and convulsive orders. Diagnostic Code 8100 deals with migraine headaches. A noncompensable rating is assigned when headache attacks occur less frequently that one every two months. A 10 percent rating is assigned to headaches that involve characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is assigned to headaches with characteristic prostrating attacks occurring on an average once a month over the last several months; a 50 percent rating, the maximum percentage that is available under the diagnostic code, is assigned to headaches with very frequent completely prostrating and prolonged attacks productive of severe economic adaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. April 10, 2013 to June 18, 2014 A VA Disability Benefits Questionnaire examination for headaches was performed in April 2014. The examination report referred to a finding on his enlistment examination that the Veteran had headaches, and had suffered a head injury, prior to service. The VA examiner concluded, however, that the headaches had worsened during service beyond a natural progression. See 38 C.F.R. § § 3.306. The examination report states that the Veteran did not take medication for his headaches but had pulsating or throbbing head pain, pain on both sides of the head, and pain worsening with physical activity. The examination report states that the Veteran’s headaches were on both sides of the head, typically lasted less than 1 day, were not prostrating; and were not accompanied by non-headaches symptoms associated with headaches, including aura prior to headache. It was observed that the headaches were chronic and when present, made the Veteran unable to work. The RO assigned noncompensable evaluation from April 10, 2013 to June 18, 2014, after which period it assigned a 50 percent rating. The Board finds that the noncompensable evaluation from April 10, 2013 to June 18, 2014 should be raised to 30 percent. The examination report indicates that according to the Veteran, the headaches are chronic, and no other finding of their frequency is presented there. The Veteran’s representation of the frequency of his headaches is competent evidence that must be considered in their rating. The headaches are described in the examination report as pulsating, throbbing, and affecting both sides of the heads, and as limiting the ability of the Veteran to carry on physical activity and to work when they are present. The examination report does not reflect, however, that the headaches were frequent, completely prostrating, with prolonged attacks that are productive of severe economic inadaptability, and a rating of 50 percent is not warranted. While the examiner found that the Veteran did miss work when he had headaches, he did not have any prostrating attacks, and the Board does not find that his symptoms are the equivalent in severity of having very frequent completely prostrating attacks which cause economic inadaptability. The Board acknowledges that the Veteran later submitted a June 2018 evaluation from a private physician who wrote that the Veteran had reported having prostrating attacks three times a month for the past several years and that the Veteran’s headaches had been productive of severe economic inadaptability due to frequently prostrating attacks since at least April 10, 2013. The Board has considered this examiner’s opinion, but finds that his retrospective opinion regarding the severity of the Veteran’s headache disorder from April 2013 to June 2014 is less probative than the findings of the April 2014 VA examination, which was performed contemporaneously, with an in-person examination of the Veteran, and included consideration of his lay assertions made at that time. Accordingly, a rating of 30 percent, but no higher, will be granted for chronic mixed headache syndrome with tension headaches from December 1, 2014 to June 18, 2014. 38 C.F.R. § § 4.124a, Diagnostic Code 8100. June 19, 2014 to November 30, 2014 The RO assigned a 50 percent rating for the Veteran’s headaches from June 19, 2014 to November 30, 2014 because of findings reported for a VA Disability Benefits Questionnaire examination for headaches performed in June 2014. The June 2014 examination diagnosed the Veteran with tension headaches and attributed his symptoms to them. The examination report noted that the Veteran’s headaches were constant (in terms of their occurrence); would last less than one day; involved either pain localized on one side of the head or pain on both sides of the head; and were attended by non-headache symptoms associated with headaches consisting of nausea and worsening with stress. The examination report described the Veteran’s headache symptoms as pain behind the eyes to the left side of the head, pressure, and throbbing pain. The examination report stated that the Veteran had very frequent prostrating and prolonged attacks of headache pain. The RO then rated the headaches as 50 percent disabling for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. See 38 C.F.R. § § 4.124a, Diagnostic Code 8100. The Board notes that it is not clear from the evidence that the Veteran actually met the criteria for a 50 percent rating at this time; nevertheless, the Board will not revise the 50 percent rating that is already assigned from June 19, 2014 to November 30, 2014. A rating of 50 percent is the highest rating available under Diagnostic Code 8100, and there is no indication that any alternate rating criteria could be applied which would allow for a higher rating. Higher ratings are available to claimants under other diagnostic codes of Section 4.124a of the Rating Schedule. A rating of 60 percent is assigned for paramyoclonus multiples, rated as severe convulsive tic (Diagnostic Code 8104); ratings of 80 and 100 percent are assigned for Sydenham’s Chorea or Huntington’s chorea or athetosis that is severe or pronounced, respectively (Diagnostic Codes 8105, 8106, 8107); ratings of 60, 80, and 100 percent are assigned for epilepsies involving major or minor seizures and for narcolepsy, depending on frequency (Diagnostic Codes 8108, 8910, 8911). The Board notes that the Veteran entered service reporting a history of head injury. However, medical records and examination reports pertinent to the appeal period for the evaluation of his headaches do not contain a diagnosis of any of these conditions. Accordingly, a schedular rating of 50 percent assigned to chronic mixed headache syndrome with tension headaches from June 19, 2014 through November 30, 2014 will be continued. 38 C.F.R. § § 4.124a, Diagnostic Code 8100. December 1, 2014 to the present In the December 2014 rating decision, the RO assigned a noncompensable rating for the Veteran’s headaches because of findings reported for December 2014 VA Disability Benefits Questionnaire headaches examination. The RO reasoned that the examination showed that the Veteran’s condition had improved. The December 2014 examination report stated that the Veteran experienced non-headache symptoms associated with headaches, specifically, nausea, sensitivity to light, and sensitivity to sound. The examiner noted that the Veteran’s headaches manifested as migraine headaches sometimes and tension headaches other times and attributed non-headache symptoms associated with headaches to the migraines only. The examiner found that the head pain usually lasted less than 1 day and was on the right side of the head when from a migraine headache and on both sides of the head when from a tension headache. The examiner noted that the Veteran experienced characteristic prostrating attacks of both migraine and non-migraine headache pain but that these were less frequent (than one in two months) and were not productive of “severe” economic inadaptability. Clarifying these notations, the examiner stated that the Veteran’s prostrating headaches occurred only 3 times per year but his non-prostrating headaches, with pain, occurred more frequently than that but did not interfere with activity. In short, the examiner concluded that the Veteran’s mixed headache condition was comprised of tension headaches that were more severe than non-incapacitating and migraine headaches that brought on periods of incapacitation. The examiner confirmed that there were no other, significant diagnostic findings for the headaches and that the headache condition did not impair the Veteran’s ability to work. While this VA examination does not indicate that the Veteran had prostrating attacks productive of severe economic inadaptability, it does indicate that the Veteran had headaches with significant symptoms, including nausea and sensitivity to light and sound. These are symptoms that occur in addition to pain and raise the level of physical disability. At some point since the December 2014 VA examination, the Veteran’s symptoms associated with his headaches appear to have worsened. In May 2019, the Veteran’s representative submitted a Disability Benefits Questionnaire report dated June 6, 2018 in which a private physician described the frequency and severity of the Veteran’s headaches. The physician noted that he had interviewed the Veteran by telephone on the date of the report. The report was detailed and considered, and it demonstrated that the physician had not only reviewed thoroughly the medical history of headaches presented in the file but also interviewed the Veteran carefully about his experience of symptoms, including the duration and intensity of his headaches and how long over time he had dealt with them. The Board therefore finds this evidence to be highly probative. The physician noted that the Veteran had both tension and migraine headaches and their symptoms could not be separated. The physician stated that the headaches would occur spontaneously, often attended by nausea, and would last several hours or more, even for an entire day. The physician noted that the headaches were always severe, so much so that the Veteran would have to lie down. The physician concluded that the Veteran had prostrating headaches at least once each month, with severe economic inadaptability. The physician explained that the headaches could occur with increased frequency and severity when the Veteran felt anxious and/or depressed. The examiner wrote that the Veteran had reported having prostrating attacks three times a month for the past several years. In an addendum letter, the private physician wrote that the Veteran’s headaches had been productive of severe economic inadaptability due to frequently prostrating attacks since at least April 10, 2013. Affording the Veteran the benefit of the doubt, the Board accepts that a 50 percent rating is warranted from December 1, 2014. The disability picture presented in the private report is of headaches with very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. Because of the frequency and severity of the Veteran’s headaches reported by the private physician, the Board affords the Veteran the benefit of the doubt and accepts that the Veteran does meet the criteria for a 50 percent rating. The Board acknowledges that the effective date for an increased rating should not be assigned mechanically based on the date of an examination, but based on when the increase in the level of disability can be ascertained. See Swain v. McDonald, 27 Vet. App. 219, 224 (2015). While the Veteran did not have frequently prostrating attacks due to headaches at the time of his December 2014 VA examination, based on the findings of the June 2018 private physician’s opinion, the Veteran’s condition must have worsened at some time following the December 2014 VA examination. The June 2018 private examiner has provided probative evidence indicating that the Veteran’s condition was this severe throughout the entire period, and as it is not possible to ascertain exactly when this condition worsened, the Board accepts December 1, 2014 as the effective date for this increased rating. The Board acknowledges that the January 2019 VA examiner came to a differing conclusion regarding the severity of the Veteran’s headaches and wrote that he did not have prostrating attacks. However, it is not clear that the VA examiner actually considered the Veteran’s lay assertions regarding having such attacks, which diminishes this report’s probative value. As discussed above, a rating of 50 percent is the highest rating available under Diagnostic Code 8100. There is no indication that any alternate rating criteria could be applied which would allow for a higher rating. The Veteran has never been found to have convulsive tics, Sydenham’s chorea, Huntington’s chorea, athetosis, epilepsy, or narcolepsy, and these alternate rating criteria are not applicable. Accordingly, a rating of 50 percent, but no higher, will be granted for chronic mixed headache syndrome with tension headaches from December 1, 2014. 38 C.F.R. § § 4.124a, Diagnostic Code 8100. In reaching these conclusions, the Board has considered the benefit of the doubt doctrine but finds that the preponderance of the evidence is against any higher ratings than those now assigned. 38 U.S.C. § 5107(b). 2. Entitlement to an initial compensable rating for hypertension The RO granted service connection for hypertension, also claimed as high blood pressure, in the December 2014 rating decision with a noncompensable rating from April 10, 2013. The Veteran’s hypertension is rated under section 4.104 of the Rating Schedule, which concerns cardiovascular disorders. Diagnostic Code 7101 deals with hypertension as a disease of the arteries and veins. Under Diagnostic Code 7101, a rating of 10 percent requires diastolic blood pressure predominantly 100 or more; or systolic blood pressure predominantly 160 or more; or minimum evaluation for an individual with a history of diastolic blood pressure predominantly 100 or more who requires continuous medication for control. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. See 38 C.F.R. § 4.104, Diagnostic Code 7101. The rating schedule authorizes the assignment of a noncompensable rating in every instance in which the rating schedule does not provide for such a rating but the requirements for a compensable rating are not met. 38 C.F.R. § § 4.31. Blood pressure reading are contained in the Veteran’s VA outpatient treatment reports. Readings include 149/100 and 129/80 and 100/62 in May 2013; 130/82 in August 2013; 126/79 in October 2013; 146/97 in January 2014; 128/81 in February 2014; and 128/79 and 140/90 in July 2014. A February 2014 VA outpatient treatment record describes the Veteran’s hypertension as controlled. The Veteran had VA examinations for hypertension in October 2014 and with a VA contractor, Logistics Health Incorporated, in January 2019. In the report of the October 2014 Disability Benefits Questionnaire examination, a diagnosis of hypertension is entered, and it is stated that the Veteran was diagnosed with hypertension in 1990. The report identified current blood pressure readings for the Veteran as 140/90 on July 31, 2014, 136/87 on September 30, 2014, and 142/86 on the date of the examination, October 2, 2014. The report noted that the Veteran does not have a history of diastolic blood pressure elevation to predominantly 100 or more. The examiner concluded that the Veteran had no other physical findings, complications, conditions, or signs and symptoms related to the hypertension and that it did not impair the Veteran’s ability to work. The examiner found that the Veteran’s blood pressure was controlled well with medications. In the January 2019 VA examination report, the diagnosis of hypertension is confirmed, and the examiner observes that the condition has been controlled with medications since 2013. Because the Veteran had a previously established hypertension diagnosis at the time of the January 2019 examination, three blood pressure readings were taken during the examination itself rather than on different days. The readings were first, 120/80; second, 118/75; and third, 124/75. The examiner concluded that the Veteran did not have other physical findings, complications, conditions, or signs or symptoms related to hypertension and that the condition did not impair his ability to work. The Board finds that the Veteran’s hypertension beginning April 10, 2013 is noncompensable. The Veteran’s hypertension has never manifested by a diastolic pressure predominantly 100 or more, or by a systolic pressure predominantly 160 or more. None of the criteria for a compensable rating of 10 percent are fulfilled by the disability picture that is presented. Furthermore, the medical findings of record confirm that no additional disability symptoms or conditions related to the hypertension are present. Therefore, the noncompensable rating should not be increased under another provision of the Rating Schedule. The Board acknowledges that the Veteran takes continuous medications for his hypertension. Even if the Veteran’s hypertension might be more severe without the use of medication, the ameliorative effect of medication is a factor contemplated by the criteria for hypertension. McCarroll v. McDonald, 28 Vet. App. 267 (2016). Accordingly, the appeal is denied and the noncompensable evaluation for hypertension beginning April 10, 2013 is continued. 38 C.F.R. §§ 4.104, Diagnostic Code 7101. The Board has again considered the benefit of the doubt doctrine, but the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b). Extraschedular evaluations While the Board does not have authority to grant an extraschedular rating in the first instance, the Board has the authority to decide whether the claim should be referred to the VA Director of Compensation for consideration of an extraschedular rating. See 38 C.F.R. § 3.321(b)(1). The governing norm for an extraschedular rating is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or necessitated frequent periods of hospitalization as to render the regular schedular standards impractical. The threshold factor for extraschedular consideration is a finding that the evidence presents such an exceptional disability picture that the available schedular rating for the service-connected disability is inadequate. There must be a comparison between the level of severity and symptomatology of the service-connected disability with the established rating criteria. If the criteria reasonably describe the Veteran’s disability level and symptomatology, then the disability picture is contemplated by the established rating criteria, and the assigned schedular evaluation is, therefore, adequate and no referral is required. See Thun v. Peake, 22 Vet. App. 111 (2008). In this case, the Board finds that the symptoms of headaches and hypertension displayed by the Veteran are listed in the provisions of the Rating Schedule concerning those disabilities. The disability picture presented in each case is not unusual but rather, is one that is contemplated by the schedular rating criteria. Accordingly, the Board concludes in each case that referral of the claim for consideration of an extraschedular evaluation is not warranted. 38 C.F.R. § 3.321(b)(1); Thun, 22 Vet. App. at 115. The Board notes that VA revised 38 C.F.R. § 3.321(b)(1) to clarify, after a judicial decision was issued implying the contrary, that in evaluating entitlement to an extraschedular evaluation, VA must consider service-connected disabilities individually and may not evaluate their collective impact. See Extra-Schedular Evaluations for Individual Disabilities, 82 Fed. Reg. 57,830 (Dec. 8, 2017). This revised rule applies to all claims pending before VA or before the United States Court of Appeals for Veterans Claims on its effective date of January 8, 2018. See Thurlow v. Wilkie, 30 Vet. App. 231 (2018). Therefore, the revised rule applies to the Veteran’s claims on appeal. Accordingly, the Board has considered each of the service-connected disabilities at issue on this appeal separately, and not in their collective impact. in evaluating whether referral for an extraschedular evaluation should be made 38 C.F.R. § 3.321(b)(1). 3. Entitlement to an effective date earlier than April 10, 2013 for service connection, or an initial rating, for chronic mixed headache syndrome with tension headaches. 4. Entitlement to an effective date earlier than April 10, 2013 for service connection, or an initial rating, for hypertension. The Veteran submitted requests for service connection for his headache disability and his hypertension on April 10, 2013; under the law in effect at that time, these requests were informal claims. See 38 C.F.R. § § 3.155(a) (2014). He filed VA Form 21-526EZ, Application for Compensation and Pension, on February 28, 2014. See 38 C.F.R. §§ 3.155(a) (2014). Because the date of receipt of his formal claim was within one year after the date of receipt of his informal claims, the date assigned to his claims under the law in effect at that time was April 10, 2013. See 38 C.F.R. §§ 3.155(a) (2014). In the December 2014 rating decision, service connection was granted for each disability from April 10, 2013. The effective date of the grant of service connection for the Veteran’s headache and hypertension disabilities was under the law at the time of the December 2014 rating decision and is now, determined beginning with the date of the claim. Thus, the effective date of a grant of service connection as then, and is now, the date of the claim or the date entitlement to service connection arose, whichever is later. 38 C.F.R. § § 3.400(a)(2) (2014) (2019). The statutory and regulatory provisions in effect at the time that the Veteran submitted his claim required VA to look to all communications from the appellant, which may be interpreted as applications or claims—formal and informal—for benefits. In particular, VA was required to identify and act on informal claims for benefits. 38 C.F.R. §§ 3.1(p), 3.155(a) (2014); see Servello v. Derwinski, 3 Vet. App. 196 (1992). In this case, VA has already accepted the date of the Veteran’s informal claim as the effective date. There is no evidence in any document submitted by the Veteran prior to April 10, 2013 which could constitute a claim of entitlement to service connection for headaches or hypertension. The Veteran has not asserted that he sent in any request for service connection for these disorders prior to this date. The date of each claim was April 10, 2013. Hence, the effective date of service connection for each disability was properly established in the December 2014 rating decision as April 10, 2013. 38 C.F.R. § § 3.400(a)(2). Under the law in effect when the Veteran filed the service connection claims, a report of a medical examination or a hospitalization could be accepted as an informal claim for benefits if other applicable requirements were met. However, the provision applied only when the benefit sought was an increased rating of a disability that was already service connected or the reopening of a claim for service connection that had been previously denied. See 38 C.F.R. § § 3.157(b) (2014); see also 38 C.F.R. § § 3.158 (new and material evidence to reopen a service connection claim) (2014). The Veteran seeks on appeal not only effective dates earlier than April 10, 2013 for the grants of service connection for headaches and hypertension but earlier effective dates for the initial ratings of those disabilities. The proper effective date for service connection of each disability is April 13, 2013; the disabilities cannot be rated with respect to a time when they were not service connected. Accordingly, entitlement to an effective date of service connection for chronic mixed headache syndrome with tension headaches and for hypertension earlier than April 10, 2013 is denied. See 38 C.F.R. § § 3.155(a) (2014); § 3.400(a)(2). REASONS FOR REMAND Service connection for posttraumatic stress disorder The claim must be remanded for further development. The Veteran has a current diagnosis of posttraumatic stress disorder from VA medical professionals. However there has been no verification of an in-service stressor to which the diagnosis could be linked for purposes of the claim. See 38 C.F.R. §§ 3.304, 4.125(a). In April 2014, the RO sent the Veteran a letter in which it asked him to supply specific information about the stressor(s) that he alleged took place during his active duty service and caused him to develop his disease. The Veteran replied in June 2014 with a statement appended to the PTSD Questionnaire that the RO had enclosed with its letter. The Veteran described ongoing hazing and physical assault that he had endured from his fellow soldiers. He thus indicated that his claim was entitlement to service connection for posttraumatic stress disorder due to personal assault. See 38 C.F.R. § 3.304(f)(5). The RO did not provide the Veteran with the notice that is required for posttraumatic stress disorder claims that are based on an allegation of personal assault. VA will not deny such a claim without first having advised a veteran that evidence from sources other than the veteran’s service records or evidence of behavior changes may represent credible evidence that the stressor occurred and then allowing the veteran opportunity to furnish this evidence or advise VA of potential sources of such evidence. 38 C.F.R. § 3.304(f)(5). The record shows that the Veteran did submit, on his own, lay statements describing how his behavior changed after he left service. See 38 C.F.R. § 3.304(f)(5). However, the RO should send him and his representative the required notice. The Veteran should have the opportunity to fully inform the RO of potential evidence tending to verify his stressor of ongoing personal assault. The Veteran is hereby advised that after he has had to opportunity to supply such information, VA has the right to submit any evidence to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304(f)(5). This is a medical judgment. A factual determination is for VA. The RO must attempt to verify the Veteran’s alleged stressor with service records. The Veteran provided enough information in his statement to allow that effort to go forward. He alleged events that could be documented in records of his units, and he named at least one other soldier who was a witness and intervened to try to stop one assaults. VA has a duty to assist the Veteran in this case by, as a first step, requesting the Joint Services Records Research Center (JSRRC) to search for corroborating records. See Gagne v. McDonald, 27 Vet. App. 397, 404 (2015). Service connection for major depressive disorder The Veteran was diagnosed with depression (unspecified depressive disorder) and anxiety (unspecified anxiety disorder) disorder in a Disability Benefits Questionnaire for Mental Disorders in November 2017. The examination report states that the diagnoses conform to the criteria contained in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The VA examiner explained that the disorders shared the same symptoms. There is no notation that the Veteran displayed, or sought treatment for, depression or anxiety during his active duty service. However, it appears to the Board that a medical professional could conclude either that his depression and anxiety proceeded from the same in-service events that the Veteran has alleged have led to the development of posttraumatic stress disorder stressor. The Board finds, therefore, that the claims on appeal for service connection for posttraumatic stress disorder and major depressive disorder, respectively, are inextricably intertwined. Therefore, adjudication of the latter is deferred. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Total disability rating for compensation purposes based on individual unemployability In connection with his claim for greater initial ratings for headaches, the Veteran asserts that they make him unable to work. VA and private examiners have likewise found that during a headache attack, the Veteran in unable to work. A claim for a total disability rating based on individual unemployability has been raised. See Rice v. Shinseki, 22 Vet. App. 447 (2009). On remand, the RO must develop this claim. The matters are REMANDED for the following action: 1. Develop and adjudicate the issue of entitlement to a total disability rating based on individual unemployability. In so doing, the agency of original jurisdiction must notify the appellant and his attorney of VA’s duties to notify and assist in the development of that claim and provide him with a VA Form 21-8940. The Veteran should be specifically asked to provide information regarding the date that he stopped working full time and whether he is currently employed in gainful employment. 2. Contact the JSRRC and any other appropriate agency to obtain additional records associated with the Veteran’s active duty service in the United States and Germany. Attempt to verify the Veteran’s claimed stressor of ongoing personal assault, bullying, and ridicule, beginning in basic training at Fort Sill, Oklahoma. These additional records should include, but should not be limited to, morning reports. After obtaining the proper release from the Veteran, attempt to contact the member of his unit that the Veteran names in his PTSD Questionnaire statement, Pfc B-----, who the Veteran says saw him in a distressed state immediately after the first attack on him during basic training and intervened with other soldiers on his behalf; ask that individual to supply all information about the event that he can recall today. 3. If the agency of original jurisdiction cannot locate any records, cannot locate the individual in concern, and cannot verify the alleged ongoing stressor, it must issue a formal memorandum, documenting the attempts that were made to verify it, and explain in writing why further attempts to locate or obtain any records would be futile. Then it must (a) notify the Veteran and his representative of the records that it is unable to obtain, (b) explain the efforts VA made to obtain that evidence, and (c) describe any further action it will take with respect to the claim. The Veteran and his representative must be given an opportunity to respond. 4. Then, the RO must place a decision in the file as to whether it is as likely as not (a 50/50 probability) that the ongoing stressor that the Veteran describes took place. The RO must provide the Veteran and his representative with a copy of this decision, whether favorable or unfavorable to the claim, and allow them an opportunity to respond. 5. Then, whether the decision requested in paragraph 3 is favorable to the PTSD claim or not, the RO must schedule the Veteran for a VA examination with a VA psychiatrist or psychologist. The Veteran’s VBMS and Virtual VA/Legacy folders must be available to the examiner for review. The examiner should certify in the examination report that he or she has reviewed that material and a copy of this remand. In the examination report, the examiner must (a) identify, by medical diagnosis, each psychiatric disability found pursuant to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM -5). (b) opine whether the Veteran has posttraumatic stress disorder that is as likely as not (a 50/50 probability, or greater) based on a verified in-service stressor. If posttraumatic stress disorder is not diagnosed, but an in-service stressor is found to be verified, the examiner must explain why the Veteran does not meet the DSM-5 criteria for that diagnosis. (c) For any other psychiatric diagnosis pursuant to DSM-5 confirmed during the examination, to include major depressive disorder or depression, provide an opinion addressing whether it is as likely as not (a 50/50 probability, or greater) that any such diagnosis (a) encompasses anxiety, and (b) is directly related to the Veteran’s active duty service, to include his reports of ongoing bullying beginning in basic training; or (c) is secondary to, or has been aggravated by, the Veteran’s headache pain and/or incapacitation because of headache pain.. A complete, well-reasoned rationale must be provided for any opinion. If the requested opinions cannot be rendered without resorting to speculation, the examiner must explain why. Mary E. Rude Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Pitts, 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 it does not establish VA policies or interpretations of general applicability. 38 C.F.R. § § 20.1303.