Citation Nr: 21076121 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 18-00 258A DATE: December 22, 2021 ORDER Entitlement to an initial rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), prior to February 2, 2021, is granted. Entitlement to a rating of 70 percent, but no higher, for PTSD and TBI, between February 2, 2021 and July 2, 2021 is granted. Entitlement to a rating in excess of 70 percent for PTSD and TBI, since July 3, 2021, is denied. Entitlement to service connection for chronic sinusitis and allergic rhinitis is granted. REMANDED Entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. During the entire period on appeal, the Veteran's service-connected PTSD and TBI resulted in occupational and social impairment with deficiencies in most areas. 2. Sinusitis and allergic rhinitis were incurred in service. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent rating, but no higher, for PTSD and TBI, prior to February 2, 2021, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9410. 2. The criteria for a rating of 70 percent rating, but no higher, for PTSD and TBI, between February 2, 2021 and July 2, 2021, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, DC 9411. 3. The criteria for a rating in excess of 70 percent, for PTSD and TBI, since July 3, 2021, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, DCs 8045-9411. 4. Sinusitis and allergic rhinitis are presumed to have been incurred in service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309; 86 Fed. Reg. 42,724 (Aug. 5, 2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 2003 to February 2004, October 2005 to August 2007, and from December 2007 to April 2011. The Veteran testified before the undersigned Veteran's Law Judge (VLJ) in September 2021. A copy of the transcript is of record. Increased Ratings 1. Entitlement to an initial rating in excess of 30 percent for PTSD and TBI, prior to February 2, 2021. 2. Entitlement to an initial rating in excess of 50 percent for PTSD and TBI, between February 2, 2021 and July 2, 2021. 3. Entitlement to an initial rating in excess of 70 percent for PTSD and TBI, since July 3, 2021. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Board should consider only those factors contained in the rating criteria. Massey v. Brown, 7 Vet. App. 204 (1994). The Board will also consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's PTSD has been rated under various diagnostic codes pursuant to 38 C.F.R. § 4.130, as 30 percent disabling prior to February 2, 2021, as 50 percent disabling between February 2, 2021 and July 2, 2021, and as 70 percent disabling since July 3, 2021. Based on a review of the record during the appeal period, the Board finds that a 70 percent rating is warranted for his PTSD and TBI for the entirety of the appeal period. Under Diagnostic Code 9411, a 30 percent rating is warranted if there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, DC 9411. A 50 percent rating is warranted when there is occupational and social impairment, but with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, 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 task); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. The maximum rating of 100 percent requires total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. The specified factors for each incremental psychiatric rating are not requirements for a particular rating but are examples providing guidance as to the type and degree of severity, or their effects on social and work situations. Thus, the analysis should not be limited solely to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the specific rating criteria in determining the level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The classification outlined in the portion of VA's Schedule for Rating Disabilities that addresses service-connected psychiatric disabilities is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, of the American Psychiatric Association (DSM-5). 38 C.F.R. § 4.130. A review of the evidence reflects that a rating of 70 percent is warranted for the entire period on appeal. The Veteran initially attended a March 2017 VA examination. It was noted that the Veteran had an insomnia disorder and no TBI. His disability was noted to cause mild or transient symptoms. In the Veteran's September 2017 notice of disagreement, he reported that his disability caused a negative impact on his workability as well as his family life. He also reported that his patients had lodged complaints against him at work. In a November 2017 statement, the Veteran reported that his disability impacts his marriage, job, and ability to continue his graduate education. He reported that he had lost his job in February 2017, related to patient complaints while working as a physician assistant. He also reported marriage counseling and that he had requested medical withdrawal from his online MBA program. He reported numerous medical treatment visits that were impacting his job, marriage and schooling. In a January 2018 statement, the Veteran's wife reported that the Veteran had a great deal of trouble sleeping. She reported that he becomes frustrated with too many menial house tasks and repairs. She reported that he was forgetful sometimes and has issues with her family at times. She reported that he is very irritable and unhelpful in the morning and has a great deal of anxiety regarding his job and ability to provide for the family. In a January 2018 statement, the Veteran reported several crisis visits at the Vet Center. He reported having lost his job and marital difficulties. In another January 2018 statement the Veteran reported that after he lost his job at a clinic for unsatisfactory work performance he was hired at another job in May 2017 and had already received two patient complaints. In a February 2018 letter, the Veteran's private treating physician noted that the Veteran's symptoms appear to be affecting his home and work life as well as effecting his mood in general. It was noted that the Veteran had been through counseling with his wife and has had several jobs in the past 5 years. In a June 2018 statement, the Veteran reported feeling isolated and irritated. In a December 2018 statement, the Veteran reported still being on probation at work. In a March 2019 statement, the Veteran reported work and marital problems. He reported that he was still on probation at work. In a September 2019 statement, the Veteran reported that he was on probation at work and had been written up twice. He also reported that his marriage was essentially "roommates who co-parent." In a November 2019 statement the Veteran reported that he is currently not practicing emergency medicine any longer for almost three years. A January 2020 VA treatment record noted that the Veteran had been fired due to his irritability at work and poor patient scores. He reported having been fired several times in the past. In an April 2020 statement, the Veteran reported that he was still unemployed in his usual industry, since January 2020, and had now started manual labor. He reported that he was underemployed. He stated that this was the fourth time he was unemployed in 10 years and this was just another reminder that lost wages for disabled Veterans is very real. A January 2021 VA examination was completed. It was noted that the Veteran's previous service-connected diagnosis of insomnia disorder is considered subsumed under his PTSD diagnosis and a separate diagnosis is not warranted at this time. It was noted that the Veteran did not have a TBI. The VA examiner stated that the Veteran's symptoms resulted in occupational and social impairment with reduced reliability and productivity. He reported that he was still married but felt like his marriage was falling apart. He reported having good relationships with his children. The Veteran reported working at an urgent care center from May 2017 to January 2020, but was asked to resign from his position and had not practiced since that time. He reported that he could not give good customer service and his irritability came out with customers and co-workers alike. The VA examiner noted that the Veteran's symptoms included: depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work like setting. In a February 2021 VA treatment record, it was noted that the Veteran's chronic symptoms of PTSD, secondary to his deployments to Iraq and Afghanistan, as an infantry man and PA, result in symptoms that currently significantly interfere with interpersonal and occupational functioning. In a March 2021 statement, the Veteran reported marital stress and occupational stress. He stated that he was having performance problems at work, twice in the past 90 days. He reported two write-ups and verbal discipline at work. He also reported having problems with his in-laws. Most recently, the Veteran underwent a VA examination in August 2021. He was diagnosed with both PTSD and a TBI. The examiner noted that the Veteran's condition resulted in occupational and social impairment with reduced reliability and productivity. The Veteran reported being married but they had talked about divorce. He stated that they co-exist in the house for the sake of the kids. He reported feeling like a burden to his friends and family and that he felt isolated. He reported that he was underemployed and was now doing manual labor and light duty at a cemetery. The Veteran stated that he had been written up once and counseled on two occasions. His symptoms were noted to include depressed mood, anxiety, a chronic sleep impairment, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, including work or a work-like setting, and suicidal ideation. The examiner noted that all abnormalities noted in the examination represent overlapping symptoms of both TBI and PTSD. The examiner noted that it is impossible to say without mere speculation how much each condition contributes to the abnormalities. Following a review of the evidence, to include the statements of the Veteran (who has medical training), his wife, and the extensive records, the Board finds that the Veteran's service-connected psychiatric disability has been most consistent with a 70 percent disability rating for the entire period on appeal, not the 30 or 50 percent ratings currently assigned for different portions of the appeal. Although some treatment records appear to reflect milder psychiatric symptomatology, the evidence as a whole is most consistent with a 70 percent disability rating. The evidence as a whole reflects that for the entire period on appeal the Veteran has had occupational and social impairment with deficiencies in most areas such as work and family relations. The evidence demonstrates his difficulty in adapting to stressful circumstances, including at work. The evidence shows that the Veteran's service-connected psychiatric disability has resulted in both significant problems in his relationships and in significant issues at work, ultimately resulting in his inability to practice as a physician assistant. Accordingly, and based on these findings, the Board finds that a 70 percent rating is warranted. Nevertheless, the Board finds that a rating in excess of 70 percent is not warranted for any period during the pendency of the claim, as the Veteran's symptomatology did not manifest as total occupational and social impairment, due to such symptoms as (for example only): gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The Veteran's reported social functioning was fairly consistent throughout the period on appeal, with social isolation and some interaction. Thus, while limited, he was still able to continue relationships with some people, including some family. Although he experienced unemployment during the appeal period, a rating of 100 percent is only warranted for both total social and total occupational impairment. The Board concludes the criteria for a 100 percent rating for the Veteran's service-connected psychiatric disability have not been met at any point during the period on appeal. 38 C.F.R. § 4.130, DC 9411. His own reports at various evaluations regarding how his service-connected psychiatric disability impacted him, overall, would provide additional evidence against this claim, clearly indicating the level of symptomatology cited within the 100 percent rating were not met at any point during the period on appeal. In summary, while the Veteran was significantly socially limited by his service-connected psychiatric disability, the evidence fails to show that this impairment was "total" so as to warrant a 100 percent rating. Based on the foregoing discussion, the Board finds that Veteran's PTSD has more nearly approximated the rating criteria for a 70 percent rating. As such, a rating of 70 percent is granted, but a rating in excess of 70 percent is not warranted. The Board notes that the RO has now changed the diagnostic code used to rate the Veteran's PTSD from DC 9411 to DCs 8045-9411, to now include a TBI. See September 2021 rating decision. The Board further finds that a rating in excess of 70 percent for PTSD with TBI is not warranted under the TBI Table pursuant to Diagnostic Codes 8045-9411. Residuals of TBI are rated under Diagnostic Code 8045, which states that there are three main areas of dysfunction that may result from TBIs and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. 38 C.F.R. § 4.124a. 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 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 evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" (hereinafter "TBI Table"). Subjective symptoms may be the only residual of a TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, are evaluated under the subjective symptoms facet in the TBI Table. However, any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, should be separately evaluated, even if that diagnosis is based on subjective symptoms, rather than under the TBI Table. Emotional/behavioral dysfunction is evaluated under 38 C.F.R. § 4.130 for rating mental disorders when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, emotional/behavioral symptoms are evaluated under the criteria in the TBI Table. Physical (including neurological) dysfunction is evaluated based on the following list, under an appropriate diagnostic code: motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. Diagnostic Code 8045 stipulates that the preceding list of types of physical dysfunction does not encompass all possible residuals of a TBI. Residuals not listed that are reported on an examination are evaluated under the most appropriate diagnostic code. Each condition is evaluated separately, as long as the same signs and symptoms are not used to support more than one rating, and each separately rated condition is combined under 38 C.F.R. § 4.25. The rating assigned based on the TBI Table will be considered the rating for a single disability for purposes of combining with other disability ratings. The TBI Table contains 10 important facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a fifth level, the highest level of impairment, and labeled total. However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than "total," since any level of impaired consciousness would be totally disabling. A 100 percent rating is to be assigned if total is the level of evaluation for one or more facets. If no facet is evaluated as total, the overall percentage rating based on the level of the highest facet is to be assigned as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. The regulation provides the following example: assign a 70 percent rating if 3 is the highest level of evaluation for any facet. One rating is to be assigned based on the highest level of severity for any of the 10 facets of cognitive impairment. There may be an overlap of manifestations of conditions evaluated under the TBI Table with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. 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. 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. Those 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. The terms mild, moderate, and severe TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. That classification does not affect the rating assigned under Diagnostic Code 8045. The Veteran underwent February 2021 and August 2021 VA TBI examinations. A review of the record does not show that a severity level of total is warranted for any of the facets tested, and as such a rating in excess of 70 percent is not warranted under the TBI table at any time during the course of this appeal. In addition, the TBI evaluations have not identified symptoms related to the TBI that are not considered in assigning the rating for PTSD. Therefore, the preponderance of the evidence is against the assignment of any separate rating. The Board also notes that the Veteran is already in receipt of a separate rating for his post-traumatic headaches with migrainous features associated with a TBI. In short, the Board finds that entitlement to an increased rating, from 30 and 50 percent to 70 percent, but no higher, is warranted for the Veteran's PTSD with TBI. To the extent that a rating in excess of 70 percent is sought, the Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, the claim is not in equipoise. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, entitlement to a rating in excess of 70 percent must be denied. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present 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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Finally, 38 U.S.C. § 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may be granted for a Persian Gulf veteran with objective indications of a qualifying chronic disability that manifested either during active service in the Southwest Asia theater of operations or to a degree of 10 percent or more not later than December 31, 2026. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1); 86 Fed. Reg. 51,000 (Sept. 14, 2021). A "qualifying chronic disability" for purposes of 38 U.S.C. § 1117 is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome (CFS), fibromyalgia, or functional gastrointestinal disorder) that is defined by a cluster of signs or symptoms. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317 (a)(2)(i). Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multisymptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). The term chronic means that the disability has existed for 6 months or more, to include intermittent episodes of improvement or worsening over that period. 38 C.F.R. § 3.317(a)(4). 4. Entitlement to service connection for chronic sinusitis and allergic rhinitis. Service treatment records reflect that the Veteran served in Afghanistan and Iraq. Therefore, he is a Persian Gulf Veteran. Service treatment records additionally reflect treatment for allergic rhinitis and sinus issues. See May 2007, July 2007, February 2011 treatment records. Several VA examinations were completed during the pendency of the appeal. In the meantime, VA issued an interim final rule in the Federal Register that VA was amending its regulations (specifically, 38 C.F.R. § 3.320) to establish presumptive service connection for three chronic respiratory conditions, to include rhinitis and sinusitis, in associate with exposure to fine particulate matter for those Gulf War Veterans who served in Southwest Asia. The effective date was August 5, 2021 for all current respiratory claims pending before VA. See 86 Fed. Reg 42,724 (Aug. 5, 2021). The rule creates two presumptions, a presumption that a veteran who served in the Southwest Asia theater of operations or Afghanistan, Syria, Djibouti, or Uzbekistan on or after September 19, 2001 was exposed to fine, particular matter during service and a presumption that asthma, rhinitis, and sinusitis, to include rhinosinusitis, are service connected if they manifest to any degree within 10 years of separation. Here, a respiratory disability of allergic rhinitis and sinusitis has been established (see numerous VA and private treatment records including May 2016 VA treatment record showing recurrent sinusitis and October 2016 VA treatment record showing allergic rhinitis). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds no consistent evidence the diseases were not incurred during or aggravated by a qualifying period of service; the diseases were caused by a supervening condition or event that occurred between the veteran's most recent departure from a qualifying period of service and the onset of the disease; or that the diseases were the result of the Veteran's own willful misconduct. The presumption is thus applicable, and service connection for rhinitis and sinusitis is granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102, 86 Fed. Reg 42,724. REASONS FOR REMAND 1. Entitlement to TDIU is remanded. The Veteran has indicated that his service-connected disabilities impact his ability to work. See April 2020 and August 2021 Statements. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a TDIU claim is part of an increased rating claim when such claim is reasonably raised by the record. The Board finds that the issue of entitlement to a TDIU has been reasonably raised by the record and is properly before the Board by virtue of the Veteran's increased rating claims pursuant to Rice. Veterans Claims Assistance Act of 2000 (VCAA) notice should be provided to the Veteran. Further development is necessary prior to adjudication of this claim and it is therefore remanded. The matters are REMANDED for the following action: Provide the Veteran with notice in compliance with the VCAA that notifies him of what evidence he must show to support a claim for a TDIU. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. M. Clark, 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.