Citation Nr: 21062432 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 18-17 173 DATE: October 7, 2021 ORDER Prior to March 20, 2019, an initial 10 percent rating, but not higher, for traumatic brain injury (TBI) is granted. Beginning March 20, 2019, a rating higher than 40 percent for TBI is denied. An initial 30 percent rating, but not higher, for headaches associated with TBI is granted. Entitlement to a separate rating for depressive disorder as a manifestation of TBI is granted. REMANDED Entitlement to a total rating based individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Prior to March 20, 2019, the Veteran's TBI symptomatology approximates the criteria for Level 1 impairment but does not satisfy the criteria for level 2 impairment in any facet; does not result in subjective symptoms other than the service-connected headaches and psychiatric manifestations; does not result in emotional or behavioral dysfunction other than the service-connected psychiatric manifestations; and does not result in physical dysfunction. 2. Beginning March 20, 2019, the Veteran's TBI symptomatology meets the criteria for Level 2 impairment but does not more nearly approximates Level 3 impairment in any facet. 3. Resolving all doubt in favor of the Veteran, throughout the initial rating period on appeal, he had characteristic prostrating attacks of headaches occurring on an average of at least once a month over the prior several months; however, very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability were not shown. 4. Resolving all doubt in the Veteran's favor, his psychiatric disorders are a manifestation of TBI. CONCLUSIONS OF LAW 1. Prior to March 20, 2019, the criteria for an initial 10 percent rating for TBI are approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8045. 2. Beginning March 20, 2019, the criteria for a rating higher than 40 percent for TBI are not met or approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8045. 3. For the entire initial rating period on appeal, the criteria for a 30 percent rating, but not higher, for a headache disability are approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8100. 4. The criteria for a separate rating for psychiatric manifestations of TBI, diagnosed as depressive disorder, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.2, 4.10, 4.126, 4.130, DC 9434. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1952 to February 1955. In an October 2016 rating decision, the RO granted service connection for TBI and assigned a noncompensable rating, effective October 23, 2007, the date of the Veteran's original claim for compensation. In August 2018, the Board remanded the claims for initial compensable rating for TBI and entitlement to a TDIU for further development. In a December 2019 rating decision, the RO increased the TBI rating to 40 percent, effective March 20, 2019, granted a separate noncompensable rating for headaches, and denied entitlement to a TDIU. In February 2020, August 2020, and December 2020, the Board remanded the issues of increased rating for TBI and headaches and entitlement to a TDIU for further development. The case has since returned to the Board for further appellate consideration. Increased Rating Applicable Laws and Regulations Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran's condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Where the veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). TBI Rating Criteria Diagnostic Code 8045 provides evaluation for three main areas of dysfunction that may result from traumatic brain injury and have profound effects on functioning: Cognitive (which is common in varying degrees after a traumatic brain injury), emotional/behavioral, and physical. 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." Id. Emotional/behavioral dysfunction is to 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, evaluate emotional/behavioral symptoms under the criteria in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. Subjective symptoms may be the only residual of traumatic brain injury or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of traumatic brain injury are evaluated, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury 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, may be separately evaluated even if that diagnosis is based on subjective symptoms, rather than under the "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified" table. 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. Id. The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate 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 combine under § 4.25 the evaluations for each separately rated condition. 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. Id. The need for special monthly compensation 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. should also be considered. Id. Under Diagnostic Code 8045, the table titled "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified" contains 10 important facets of traumatic brain injury 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 4th level, the highest level of impairment, labeled "total." A 100 percent evaluation will be assigned it "total" is the level of evaluation for one or more facets. If no facet is evaluated at "total," the overall evaluation is based on the level of the highest facet as follows: 0 = 0 percent; 1=10 percent; 2=40 percent; and, 3=70 percent. However, not every facet has every level of severity. The "subjective symptoms" facet, for example, provides for an impairment level of 0, 1, or 2, which corresponds to 0 percent; 10 percent; and 40 percent, respectively. Notes are included with 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 Traumatic Brain Injury Not Otherwise Classified" with manifestations of a combined mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, more than one evaluation is not to be assigned based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions is to be assigned. However, if the manifestations are clearly separable, a separate evaluation for each condition will be assigned. 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" traumatic brain injury, which may appear in medical records, refer to a classification of traumatic brain injury 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. TBI Rating Analysis Prior to March 20, 2019 During this initial rating period, the Veteran's TBI is rated as noncompensable. On review, the Board finds that an initial 10 percent rating, but not higher, is warranted. VA treatment records dated from 2003 to 2009 are silent for any complaints, treatment, or diagnosis of TBI other than the separately rated headaches. In an August 2009 statement in support of claim, the Veteran indicated that it was his belief that his TBI was the cause of his difficulty understanding complex commands. In February 2010, the Veteran underwent a VA TBI examination, at which time the examiner concluded that the Veteran had no diagnosis of TBI because he did not complain of headaches until recently. Though, the examiner noted that the Veteran had mild memory impairment, decreased attention, and difficulty concentrating. There was a complaint of mild memory loss, attention, concentration, or executive functions, but without objective evidence on testing. Judgment was normal. Social interaction was routinely appropriate. The Veteran was always fully oriented. Motor activity and visual spatial orientation were normal. Subjective symptoms did not interfere with work, instrumental activities of daily living, or work, family, or other close relationships. There were one or more neurobehavioral effects that did not interfere with workplace or social interaction. The Veteran was able to communicate by spoken and written language and to comprehend spoken and written language. Consciousness was normal. In September 2016, the Veteran underwent a VA TBI examination, at which time he reported having headaches and anger since sustaining a TBI in service. There were no complaints of impairment of memory, attention, concentration, or executive functions. Judgment was normal. Social interaction was routinely appropriate. The Veteran was always fully oriented. Motor activity and visual spatial orientation were normal. Headaches and mild anxiety were the only subjective symptoms reported, which did not interfere with work, instrumental activities of daily living, or work, family, or other close relationships. Neurobehavioral effects included getting angry very quickly, which also resolved very quickly and did not interfere with workplace or social interaction. The Veteran was able to communicate by spoken and written language and to comprehend written and spoken language. Consciousness was normal. The residuals did not cause functional loss. According to January 2019 VA treatment records, the medical professional noted that the Veteran denied that his symptoms changed or worsened recently. The medical professional further noted that the Veteran was quite active and went to aquatic exercise class twice a week. He lived with his spouse. Based on the foregoing, the Board finds that the criteria for an initial 10 percent rating is approximated. Initially, the Board observes that the Veteran is in receipt of a separate rating for posttraumatic headaches associated with his TBI under 38 C.F.R. § 4.124a, DC 8100, as well as based on the Board's decision herein, separate ratings for the psychiatric symptoms associated with the TBI. Consequently, the Board only considered the symptoms associated with the Veteran's TBI that are rated under DC 8045. The evidence of record, including treatment records from 2007 to 2019, and February 2010 and September 2016 residuals of TBI examinations, does not show a level of impairment for any of the facets according to the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table of 2 or higher. Only the 2010 examination showed that the Veteran had impairment of 1 for memory, attention, concentration, executive functions and for subjective symptoms. He had impairment of 0 for the remaining facets during both examinations. The examinations also did not show subjective symptoms other than the service-connected headaches and psychiatric symptoms. Consequently, as the highest level of impairment for any facet shown has been 1, an initial 10 percent rating, but not higher, is warranted. 38 C.F.R. § 4.124a, DC 8045. The Board acknowledges the attorney's argument that a 40 percent rating is warranted for the entire initial rating period on appeal; however, the competent medical evidence does not justify the assignment of a rating higher than 10 percent. In this regard, the private December 2019 and updated November 2020 psychological reports do not provide a retroactive opinion regarding TBI symptomatology and there is no indication that the signing psychologist treated the Veteran prior to the 2019 evaluation. Accordingly, an initial 10 percent rating, but not higher, for TBI, is warranted during this rating period on appeal. Beginning March 20, 2019 During this rating period on appeal, the Veteran's TBI is rated as 40 percent disabling. On review, the Board finds that a rating higher than 40 percent is not warranted. In March 2019, the Veteran underwent a TBI compensation examination, at which time the examiner confirmed a diagnosis of TBI. The Veteran reported that the course of the condition since onset was the same. Current symptoms were described as headaches. Regarding memory, attention, and executive functions, the examiner noted that the Veteran complained of mild memory loss such as inability to remember his cell phone number. Judgement was normal. Social interaction was routinely appropriate. Regarding orientation, the examiner noted that the Veteran was occasionally disoriented. Specifically, he was not oriented to the year during this examination. Motor activity was mildly decreased or with moderate slowing due to apraxia. The examiner noted that the Veteran used a cane following his stroke and walked more slowly but without incoordination. Visual spatial orientation was normal. Subjective symptoms included headaches and mild anxiety that did not interfere with work, instrumental activities of daily living, or work, family, or other close relationships. There were one or more neurobehavioral effects, to include anger and irritability, impulsivity, and verbal aggression. The Veteran was able to communicate by spoken and written language and to comprehend written and spoken language. Consciousness was normal. The 2020 private reports noted normal intellectual functioning and cognitive functioning. There were deficits noted in visuoconstructional drawing and judgment. The testing suggested that the deficits were related to TBI and not dementia. On review, the Board finds that a rating higher than 40 percent is not warranted during this rating period on appeal. Initially, although the Veteran did not limit his appeal to 40 percent, his attorney indicated that the relief sought was a 40 percent rating. Notably, the evidence does not show the Veteran's symptoms are severe or pervasive enough to warrant a level 3. Specifically, the evidence does not reflect objective evidence of moderate memory impairment, moderately severely impaired judgment, social interaction that is inappropriate most or all of the time, motor activity moderately decreased due to apraxia, or moderately severely impaired visual spatial orientation. Furthermore, the record does not reflect that he gets lost even in familiar settings or would be unable to use an assistive device such as a GPS. He does not have three or more subjective symptoms moderately affecting work that are not separately rated, or neurobehavioral effects that preclude workplace or social interaction. Finally, he does not experience an inability to communicate at least half the time. Accordingly, the criteria for a rating higher than 40 percent are not met or approximated. Headaches Rating Criteria Pursuant to DC 8100, migraine headaches with less frequent attacks than the criteria for a 10 percent rating are rated as non-compensable. Migraine headaches with characteristic prostrating attacks averaging one in two months over the last several months are rated 10 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. The term "prostrating attack" is not defined in regulation or case law but can be defined as extreme exhaustion or powerlessness. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999) (quoting Diagnostic Code 8100 verbatim but not specifically addressing the definition of a prostrating attack); DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1531 (32d ed. 2012). Further, "severe economic inadaptability" is also not defined in VA law. See Pierce v. Principi, 18 Vet. App. 440, 446 (2004). In addition, the Court has held that nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Id. It was explained by the Court that if "economic inadaptability" were read to import unemployability, the appellant, should he or she meet the economic-inadaptability criterion, would then be eligible for a TDIU rather than just a 50 percent rating. Id. citing 38 C.F.R. § 4.16. The Court discussed the notion that consideration must also be given as to whether the disability was capable of producing severe economic inadaptability, regardless of whether the condition was actually causing such inadaptability. See Pierce, 18 Vet. App. at 446. In this regard, VA conceded that the words "productive of" could be read to mean either "producing" or "capable of producing." Id. at 446-447. The Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). Headaches Rating Analysis According to May 2009 VA treatment records, the Veteran reported having daily headaches since service usually from 5:00 PM to 10:30 PM when he went to sleep. They seldomly kept him awake. The pain was described as dull and throbbing 5 out of 10 in severity. There was no vision changes or aura. Occasionally, he had morning headaches that were milder and relieved by taking two Aleve every morning. He did not take medication in the evenings. The Veteran indicated that he felt as if he had a bump on his head when he had headaches. Later in May 2009, the Veteran reported that the headaches worsened and were present almost every day. They were relieved by medication. In October 2009, the Veteran reported chronic headaches that were 5 out of 10 in severity and treated with Naproxen. During a February 2010 TBI examination, the Veteran reported having daily headaches that were 8 out of 10 in severity. He treated those with Naproxen. He also described hypertensivey to light and sound. According to July 2012 VA treatment records, the Veteran complained of headaches every morning when he woke up. He took 2 Aleve, and the headaches went away. In August 2014, the Veteran reported having occasional headaches. In September 2015, the Veteran had reported that he had occasional headaches, which were better than they used to be. During a September 2016 VA TBI examination, the Veteran reported that his headaches occurred randomly approximately six times a week and did not last very long. He took Advil for headache pain. According to August 2017 VA treatment records, the Veteran reported having headaches that were rated as 6 out of 10 in severity. He indicated that those headaches did not last long and that he waited for them to resolve. In January 2019, the Veteran denied having current headaches. During a March 2019 TBI examination, it was noted that the Veteran had non-severe headaches. In March 2019, the Veteran underwent a headache compensation examination, at which time the examiner rendered a diagnosis of chronic headaches. The Veteran reported that his headaches worsened since their onset. Medicine alone used to be adequate for symptom resolution but no longer helped. The headaches resulted in pain and nausea. The pain was described as constant head pain with nausea and sensitivity to light and sound. The duration of a typical head pain was less than one day. The Veteran had characteristics prostrating attacks of headaches with less frequent attacks. The headaches were not productive of severe economic inadaptability. The headaches did not impact his ability to work. After review of all the evidence, lay and medical, the Board resolves all doubt in the Veteran's favor in finding that his headaches had characteristic prostrating attacks occurring on an average once a month over last several months, which warrants a 30 percent rating. While the Board acknowledges that some of the medical evidence during the pendency of the appeal perhaps suggested that the Veteran did not have characteristic prostrating attacks, the Veteran as a lay person is competent to describe the severity and frequency of his headaches. As noted above, the term "prostrating attack" is not defined by the rating criteria. Here, the Veteran described that his headaches were severe enough to cause nausea and, at times, were not improved by medication. Accordingly, the Board finds that the episodes of the Veteran's severe headaches that occurred approximately twice per month were in fact prostrating. As such, the evidence is at least in equipoise regarding the frequency of the Veteran's prostrating headaches, which occurred more often than once every two months as required by the criteria for a 10 percent rating. In addition, the Veteran was prescribed medication, which he reported stopped working throughout the pendency of the claim. As such, the Board finds that the evidence is at the very least in equipoise to support an increase to a 30 percent disability rating for the entire initial rating period on appeal. Accordingly, an initial 30 percent rating is warranted. However, a higher rating is not warranted. There is no evidence that the Veteran's headaches are very frequent and completely prostrating. Moreover, the medical evidence shows that the headaches alone do not impact the Veteran's ability to work. In sum, a 30 percent initial rating, but not higher, is warranted. Psychiatric Disorder During a February 2010 TBI examination, the examiner noted that the Veteran felt depressed when he had headaches. The 2016 examiner acknowledged the Veteran's reports of having anxiety and anger and even noted that the mild anxiety was part of a neurobehavioral symptoms of TBI. However, in a September 2016 addendum opinion, the examiner opined that the anger issues occurred years later were not related to the TBI. In support of his claim, the Veteran submitted a private January 2020 rehabilitation psychological report signed by a certified rehabilitation counselor and a licensed psychologist. The report noted that the depressive disorder was due to the service connected TBI. In a March 2020 addendum opinion, a psychiatrist opined that given the mild nature of the Veteran's injury, it was unlikely that there was any overlap between PTSD and TBI for the Veteran's mental health symptoms including depression, irritability, and anxiety. The psychiatrist added that these symptoms were more likely associated with PTSD than with TBI. This examiner further opined that the Veteran's mental health symptoms of irritability and to a lesser extent anxiety and depression could be exacerbated by headaches. The psychiatrist concluded that PTSD was the underlying cause, but headaches could certainly temporarily aggravate these symptoms. In an October 2020 addendum opinion, the same psychiatrist opined that the Veteran's headaches less likely as not caused or aggravated beyond natural progression the depression, irritability, or anxiety. The psychiatrist reasoned that aside from the previous examination, there was no evidence of the severity or frequency of the Veteran's headaches. The psychiatrist added that if headaches were a frequent source of stress then mood and anxiety may be negatively impacted between headaches as well. In this case, there was sufficient evidence to determine the severity or frequency of the Veteran's headaches. The psychiatrist concluded that because of this it was not possible to conclude that the Veteran's headaches had a significant impact on depression, irritability, or anxiety. Regarding TBI, the psychiatrist opined that it was less likely than not that the Veteran's TBI caused or aggravated the depression, irritability, or anxiety. The psychiatrist reasons that given the mild nature of the Veteran's TBI in 1953 with lack of evidence of chronic neurological complaints following the incident, it was unlikely that the Veteran's TBI directly resulted in any mental health sequelae including depression, anxiety, or irritability. The Veteran provided an updated November 2020 authored by the by a certified rehabilitation counselor and a licensed psychologist who disagreed with the 2020 opinions by the psychiatrist. The opinion explained that even mild TBI can result in psychiatric manifestations and that the Veteran's headaches at the very least aggravated his psychiatric symptoms. In support, the report cited to the Veteran's medical record showing that contrary to the psychiatrist indication that the severity and frequency of headaches was not documented, there was ample evidence discussing both the severity and frequency. In addition, the report cited to evidence of record in support of the conclusion that the psychiatric symptoms were caused by the service connected TBI. The report further discussed medical literature that pertained to this Veteran and explained how it supported the conclusion that the psychiatric symptoms were a manifestation of TBI. In a March 2021 addendum, the examiner opined that the Veteran's headaches less likely than not caused or aggravated beyond natural progression the depression, irritability, or anxiety. The examiner reiterated that other than the compensation examination there was no evidence of the severity or frequency of the Veteran's headaches. The examiner further opined that the psychiatric symptoms were not a manifestation of TBI because of the mild nature of the TBI in service. However, the examiner specifically noted that the Veteran was noted to have anxiety, irritability, impulsivity, and verbal aggression after the TBI. On review, the Board assigns a higher probative weight to the private psychological report. Specifically, contrary to the 2019, 2020, and 2021 opinions, which misstated the Veteran's medical history, the private report cited to relevant evidence of record. This evidence considered the severity and frequency of the Veteran's headaches, which were documented throughout the pendency of the appeal, as well as to evidence in support of the conclusion that the psychiatric symptoms manifested after the sustained TBI and caused by it. Accordingly, resolving all doubt in the Veteran's favor, a separate rating for psychiatric symptoms associated with TBI is warranted. REASONS FOR REMAND A remand is necessary for the RO to implement the Board's decisions herein and then readjudicate the intertwined issue of entitlement to a TDIU. The matters are REMANDED for the following action: (Continued on the next page) 1. Implement the Board's decision herein granting a 10 percent rating for TBI prior to March 20, 2019, a 30 percent rating for headaches, and the grant for a separate rating for depressive disorder as a manifestation of TBI. With the latter (depressive disorder), assign the initial rating in the first instance. 2. Thereafter, conduct any other development deemed necessary and readjudicate the issue of entitlement to a TDIU. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Yaffe, 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.