Citation Nr: 21006661 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 20-14 173 DATE: February 4, 2021 ORDER For the entire period on appeal, an initial rating of 100 percent for posttraumatic stress disorder with alcohol use disorder (PTSD) is granted, subject to the laws and regulations governing payment of monetary benefits. An initial compensable rating for residuals of a traumatic brain injury (TBI) is denied. The appeal seeking entitlement to a total disability rating based on individual unemployability (TDIU), having been rendered moot, is dismissed. An effective date prior to March 27, 2018 for the award of service connection for posttraumatic stress disorder with alcohol use disorder (PTSD) is denied. An effective date prior to March 27, 2018 for the award of service connection for residuals of a TBI is denied. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s PTSD most nearly approximated total occupational and social impairment. 2. The Veteran's residuals of a TBI did not include any cognitive, emotional/behavioral, or physical symptomatology other than manifestations associated with his service-connected PTSD. 3. As a 100 percent ("total") schedular rating for PTSD will be awarded for the entire rating period on appeal based on a finding of total occupational impairment, leaving no rating period where the schedular rating is "less than total," the issue of entitlement to a TDIU is rendered moot for the entire rating period. 4. In a May 2008 rating decision, the RO denied service connection for PTSD. The Veteran did not appeal this decision within one year, nor was new and material evidence received within one year of the decision; thus, it became final. 5. The next application to reopen the previously denied claim for service connection for PTSD was received by VA on March 27, 2018. 6. The initial application requesting service connection for residuals of a TBI was received by VA on March 27, 2018. Prior to March 27, 2018, there is no evidence of formal or informal claim of service connection for residuals of a TBI. CONCLUSIONS OF LAW 1. For the entire period on appeal, the criteria for an initial rating of 100 percent for PTSD have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411 (2019). 2. For the entire period on appeal, the criteria for an initial compensable rating for residuals of a TBI have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8045 (2019). 3. The matter of the Veteran's entitlement to a TDIU has been rendered moot by the award of a total (100 percent) schedular rating for PTSD for the entire appeal period, leaving no question of law or fact to decide regarding that issue. 38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.14, 4.16 (2019). 4. The criteria for an effective date prior to March 27, 2018, for the award of service connection for PTSD have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2019). 5. The criteria for an effective date prior to March 27, 2018, for the award of service connection for residuals of a TBI have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from March 2002 to September 2005. This case comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). By way of history, the Board notes that in a June 2018 rating decision, the Veteran was granted service connection for PTSD with an evaluation of 30 percent, and granted a noncompensable rating for TBI, both effective March 27, 2018. During the course of the appeal, a November 2019 rating decision increased the Veteran’s PTSD evaluation to 50 percent effective March 20, 2019. Thereafter, in a January 2020 rating decision, the Veteran’s PTSD evaluation was increased to 50 percent, effective March 27, 2018; and to 70 percent, effective March 20, 2019. As this does not constitute a full grant, this issue remains on appeal. AB v. Brown, 6 Vet. App. 35, 39 (1993). Further, when a veteran files a claim for an increased rating, he is presumed to be seeking the maximum benefit under any applicable theory, including total disability rating based on unemployability (TDIU). Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the Veteran asserted in written statements and in his VA medical record that PTSD has “ruined his career” (see 2019 notice of disagreement) and that he stopped working due to his PTSD and alcohol disorder. Therefore, the issue of entitlement to a TDIU has been added to the present appeal. The Board notes that in April 2020, the Veteran submitted a request for higher-level review as to the effective date assigned for the award of service connection of tinnitus. See April 2020 VA Form 20-0996, Decision Review Request: Higher-Level Review. In an April 2020 letter, the RO indicated that VA was already processing a pending appeal for tinnitus, which was received on January 15, 2019. However, review of the record indicates that there is no current appeal related to the effective date assigned for the award of service connection for tinnitus. The January 2019 notice of disagreement specifically states that it is limited to the issues addressed herein and never mentions tinnitus. Thus, the Board does not have jurisdiction over this issue and will not address it herein. In September 2019, during the pendency of the present appeal, the Veteran appointed John S. Berry, Jr., Esquire, as his new representative, thereby revoking all previous representatives. See 38 C.F.R. § 14.631(f)(1). The record reflects that VA-generated evidence has been added to the claims file since the claims on appeal were last adjudicated in a January 2020 Statement of the Case (SOC). In this regard, a January 2021 VA PTSD examination report and new VA treatment records have been added to the claims file since January 2020. However, a supplemental statement of the case (SSOC) was not issued with consideration of this new VA-generated evidence. While 38 U.S.C. § 7105(e) provides an automatic waiver of initial AOJ review if a veteran submits evidence to the AOJ or the Board with, or after submission of, a Substantive Appeal, this provision is only applicable to cases where the Substantive Appeal was filed on or after February 2, 2013 (applicable here), but does not apply to VA-generated evidence, such as VA examination reports or VA treatment records. 38 U.S.C. § 7105(e). In December 2020, the Board sent the Veteran a letter notifying him that VA-generated evidence has been added to the claims file since the January 2020 SOC and asking him to either waive initial AOJ review of this evidence or request that the appeal be remanded by the Board for initial AOJ review of this evidence. To date, no response has been received to the Board’s December 2020 letter, and there is no indication that the Veteran has specifically waived initial AOJ adjudication of the VA-generated evidence that has been added to the claims file since January 2020. However, given the 100 percent disability rating awarded herein for PTSD for the entire period on appeal, no prejudice to the Veteran could result from this decision. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Moreover, the Board finds the VA-generated evidence received since the January 2020 SOC is immaterial to the claims for a compensable initial rating for a TBI, a TDIU, and earlier effective dates for the awards of service connection for PTSD and residuals of a TBI, as the newly-generated VA medical evidence is not relevant to these claims. Therefore, no prejudice to the Veteran could result from any of the claims being decided herein. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the appellant and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Where a veteran is diagnosed with multiple disabilities of the same body part/system, and it is unclear from the record which symptoms are attributable to each distinct disability, the Board is precluded from differentiating between the symptomatology and the disabilities. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board has reviewed all the evidence of record. Although the Board has an obligation to provide adequate reasons and bases supporting its decisions, there is no requirement that the Board discuss every piece of evidence in the record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence, as deemed appropriate, and the Board’s analysis will focus on what the evidence shows, or fails to show, as to each claim. 1. Entitlement to an initial rating in excess of 50 percent for PTSD for the period prior to March 20, 2019, and in excess of 70 percent thereafter. The Veteran is in receipt of a 50 percent initial disability rating for PTSD prior to March 20, 2019, and a 70 percent rating thereafter, under 38 C.F.R. § 4.130, DC 9411. He seeks a higher rating for the entire period on appeal. The Veteran's PTSD is rated under the general rating formula for rating mental disorders pursuant to 38 C.F.R. § 4.130, DC 9411. Under such formula, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing effective work and social relationships. A 70 percent rating is warranted when the psychiatric disorder results in occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such an 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. A total schedular rating of 100 percent is warranted when the disorder results in 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 mental and personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. In applying the above criteria, the Board notes that, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected disability, such signs and symptoms shall be attributed to the service-connected disability. See 38 C.F.R. § 3.102; Mittleider v. West, 11 Vet. App. 181 (1998), citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996). Effective August 4, 2014, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM-IV and replace them with references to the updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction on or after August 4, 2014. Id. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014. See 80 Fed. Reg. 53, 14308 (March 19, 2015). Here, the RO certified the Veteran's appeal to the Board after August 4, 2014; therefore, the PTSD claim is governed by DSM 5 and the GAF scores are not relevant for consideration. See Golden v. Shulkin, 29 Vet. App. 221, 225-26 (2018) (holding that the Board errs when it uses GAF scores to assign a psychiatric rating in cases where DSM-5 applies). When evaluating mental health disorders, the factors listed in the Rating Schedule are simply examples of the type and degree of symptoms, or their effects, that would justify a particular rating; the analysis should not be limited solely to whether a veteran exhibited the symptoms listed in the Rating Schedule. Rather, the determination should be based on all of a veteran's symptoms affecting his level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The lists of symptoms under the Rating Schedule are meant to be examples of symptoms that would warrant the disability evaluation but are not meant to be exhaustive. Id. After a review of the evidence, the Board resolves any reasonable doubt in the Veteran's favor and finds that his PTSD symptoms have most nearly approximated total occupational and social for the entire period on appeal. The Veteran has had repeated suicidal ideations, including attempts to hurt himself. See January 2021 VA examination report (Veteran reported that “he has had involuntary psychiatric hospitalizations under the Baker Act five or six times,” most recently in November 2019); August 2020 VA treatment record (noting the Veteran’s report of 12 hospitalizations for alcohol withdrawal within the last 2 years); August 2019 VA treatment record (reporting 2 lifetime suicide attempts, with last attempted approximately 6 months ago); May 2019 VA examination report (noting a suicide attempt in January 2019 and numerous psychiatric hospitalizations); June 2017 VA Clinical Care Coordination note (indicating that the Veteran was involuntarily admitted (“Baker Act”) to inpatient mental health treatment at a private facility). He has experienced delusions or hallucinations resulting in grossly inappropriate behavior and gross impairment in thought processes or communication. See June 2017 VA Clinical Care Coordination note (indicating that that the Veteran was “hearing voices in his head to kill someone who was in his house that was raping” a nonexistent female roommate and he “began to shoot rounds off inside his house at the apparent bad guy.” He was “disconnected from reality and intoxicated.”). He has also reported experiencing significant memory impairment and intermittent inability to perform activities of daily living (ADLs), including maintenance of minimal personal hygiene. See January 2021 VA examination report (reporting neglecting hygiene at times and varied appetite based on stress levels); January 2019 VA treatment note (“reported severely poor nutrition over last 3 months during binge,” malnutrition noted); March 2017 VA TBI Cognitive Impairment Consult note (reporting very severe concentration and forgetfulness and moderate difficulty making decisions, as well as difficulties performing ADLs). For these reasons, and resolving all reasonable doubt in the Veteran's favor, the Board finds that the Veteran's PTSD symptoms more nearly approximate in total occupational and social impairment for the entire initial rating period on appeal, and as such, a 100 percent rating is warranted. 2. Entitlement to an initial compensable rating for a TBI. On appeal is the initial rating assigned by the RO. In the June 2018 rating decision, the RO granted service connection for residuals of a TBI, and assigned an initial noncompensable rating, effective March 27, 2018. The residuals of a TBI are rated under 38 C.F.R. § 4.124a, DC 8045, applicable to residuals of a TBI. Under DC 8045, there are three main areas of dysfunction listed that may result from TBI 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. 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. Adjudicators are to rate cognitive impairment under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Adjudicators are to rate subjective symptoms that are residuals of TBI, 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 TBI Not Otherwise Classified." However, they are to separately rate any residual with a distinct diagnosis that may be rated under another Diagnostic Code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table. Id. The Board notes that the Veteran is already in receipt of separate compensable ratings for tinnitus and PTSD. Adjudicators are to rate emotional/behavioral dysfunction under 38 C.F.R. § 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, they are to evaluate emotional/behavioral symptoms under the criteria in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Id. Here, the Veteran has a diagnosis of PTSD; therefore, such symptoms are evaluated separately under 38 C.F.R. § 4.130, DC 9411, as discussed above. Adjudicators are to rate physical (including neurological) dysfunction 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, adjudicators are to rate under the most appropriate Diagnostic Code. Adjudicators are to rate each condition separately, as long as the same signs and symptoms are not used to support more than one rating, and combine under § 4.25 the ratings for each separately rated condition. The rating assigned based on the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table will be considered the rating for a single condition for purposes of combining with other disability ratings. Id. The table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, 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. Adjudicators are to assign a 100-percent rating if "total" is the level of evaluation for one or more facets. If no facet is rated as "total," adjudicators are to assign the overall percentage rating based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent rating if 3 is the highest level of evaluation for any facet. Id. The rating assigned is based upon the highest level of severity for any facet of cognitive impairment and other residuals of TBI not otherwise classified as determined on examination. Only one rating is assigned for all the applicable facets. A rating evaluation is not warranted unless a higher level of severity for a facet is established on examination. Physical and/or emotional/behavioral disabilities found on examination that are determined to be residuals of traumatic brain injury are rated separately. Here, the Veteran is in receipt of a separate 100 percent rating for PTSD under 38 C.F.R. § 4.130, DC 9411, for the entire initial rating period on appeal. Certain impairments cited in the rating criteria for TBI are also specifically incorporated into the rating criteria for PTSD. The evaluation of the same manifestation under various different diagnoses is to be avoided. see 38 C.F.R. § 4.14; see also Brady v. Brown, 4 Vet. App. 203, 206 (1993) (holding that the rating schedule may not be employed as a vehicle for compensating a claimant twice or more for the same symptomology because such a result would overcompensate the claimant for the actual impairment of his earning capacity and would constitute pyramiding). After evaluating and analyzing the evidence, the Board finds that a compensable rating for the Veteran’s residuals of a TBI is not warranted, as the Veteran is in receipt of a separate 100 percent rating for PTSD that contemplates all manifestations of cognitive and emotional/behavioral dysfunction. See 38 C.F.R. § 4.14 (the evaluation of the same manifestation or disability under different diagnoses is to be avoided); see also 38 C.F.R. § 4.124, DC 8045, Note (1). The May 2018 VA examination report indicated that there were no subjective symptoms of TBI as reported by the Veteran. The examiner reported that an MRI of the brain indicated that he had multiple scattered small foci white matter which was nonspecific and may represent mild chronic ischemic disease or could be associated with chronic migraines; however, the Veteran has not reported experiencing such migraines. The examiner opined that the Veteran’s current clinical symptom presentation was most consistent with a behavioral health condition, but opined that the cognitive and neurobehavioral complaints are less likely due to TBI but more so due to PTSD, and that the final diagnosis was a TBI with no residuals. The June 2018 VA PTSD examination report indicated that the Veteran’s symptoms were able to be differentiated between TBI and PTSD. PTSD symptoms of depression, mild memory loss, irritability, low mood, feelings of guilt related to traumatic military event, hypervigilance, exaggerated startle response and sleep impairment were noted. The VA examiner further opined that these symptoms for PTSD were separate from TBI, as the Veteran’s TBI had no residuals. In a May 2019 VA examination, it was opined that there is a clinical overlap between PTSD and TBI; therefore, it is usually not possible to differentiate what symptoms are attributable to each diagnosis. However, the examiner noted that the Veteran had a final diagnosis of TBI with no residuals, and the symptoms were due to the Veteran’s PTSD. A treatment records also do not show TBI residuals that differ from his PTSD symptoms. For example, a July 2014 TBI screening showed the Veteran only reported having sleep problems after the TBI. In March 2017, the Veteran had a VA TBI cognitive impairment consult. While possible TBI symptoms were noted, including neurobehavioral and psychiatric symptoms, the examiner opined such symptoms were most consistent with behavioral health conditions such as PTSD and depression. Thus, the competent and highly probative medical evidence of record consistently reflects that the Veteran’s manifestations of cognitive and emotional/behavioral dysfunction and subjective symptoms are all attributable to the Veteran’s service-connected PTSD. Furthermore, the Board finds that such symptoms are contemplated by the 100 percent rating assigned herein for PTSD. The Board has considered the lay statements of the Veteran asserting that his service connected TBI warrants a compensable rating. The Board notes that although lay persons are competent to provide opinions on some medical issues, the specific issue of severity of a disability is outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Board finds that the probative value of the general lay assertions is outweighed by the medical evidence of record. In this regard, post-service medical records do not reflect any worsening of the Veteran’s TBI, and the Veteran himself reported no worsening of symptoms – rather, in a March 2018 statement the Veteran stated he now suffers from depression, anxiety, irritability, insomnia, and hypervigilance due to the head injury, and in the January 2019 NOD statement, he reported that PTSD ended his career and ruined his life; that he has had a seizure and checked into a detox facility. As discussed above, these symptoms were all contemplated when evaluating his PTSD and alcohol use disorder. A VA examiner found the Veteran’s TBI to be without residual problems, and two VA examiners otherwise found all his psychiatric symptoms to be attributable to his service-connected PTSD. The Veteran has submitted no competent evidence contrary to the VA examiners’ opinions. The Veteran has been allowed ample opportunity to furnish medical evidence in support of his claim, but he has not done so. The Board finds the medical examiners’ opinions are well-reasoned and thorough, having considered the entire record, including the Veteran’s medical history, and provide specific medical evidence for the opinions rendered. The medical opinions warrant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Thus, the preponderance of the evidence weighs against the Veteran’s claim of entitlement to a compensable rating for residuals of a TBI. As the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. As there are no remaining manifestations of TBI not already accounted for in the diagnostic criteria for the Veteran's anxiety disorder, the Board finds the preponderance of the evidence against a finding that there are any clearly separable manifestations of TBI to warrant a separate compensable evaluation. 38 C.F.R. § 4.124a, DC 8045, Note (1). As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable and the claim of entitlement to an initial compensable rating for residuals of TBI must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 55. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 3. Entitlement to a TDIU. As to the claim for a TDIU, this benefit contemplates a schedular rating less than total for the disability or disabilities on which the TDIU would be based. See 38 C.F.R. § 4.16(a). A TDIU is considered a lesser benefit than a 100 percent schedular rating, and the grant of a 100 percent rating generally renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. An exception to this is that a separate award at the housebound rate or a TDIU predicated on a single disability (perhaps not ratable at the schedular 100-percent level) when considered together with another disability separately rated at 60 percent or more may warrant payment of special monthly compensation (SMC) under 38 U.S.C. § 1114(s). Bradley v. Peake, 22 Vet. App. 280 (2008). As decided herein, the Veteran has now been awarded a 100-percent rating for PTSD on a schedular basis for the entire period under review. He is also in receipt of service connection for left lower extremity radiculopathy (rated 20 percent disabling from April 3, 2019); low back strain (rated 10 percent disabling from September 7, 2005, and 20 percent disabling from April 10, 2020); tinnitus (rated 10 percent disabling from April 4, 2019); residuals of a TBI (rated 0 percent disabling from March 27, 2018); and stress fractures of the left and right tibia (each rated 0 percent disabling from February 10, 2016). Thus, there is no disability separate from the PTSD that is rated at 60 percent or more. As such, entitlement to a TDIU is rendered moot and the issue of entitlement to SMC is not raised by the record. Earlier Effective Date Claims The effective date for an award of disability compensation based on an original claim for direct service connection, if the claim is received within one year after separation from service, shall be the day following separation from active service or the date entitlement arose; otherwise, and for reopened claims, it shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. A final decision is generally not subject to revision on the same factual basis. 38 C.F.R. § 3.104(a). Previous determinations that are final and binding, including decisions of service connection, degree of disability, age, marriage, relationship, service, dependency, line of duty, and other issues, will be accepted as correct in the absence of clear and unmistakable error (CUE). 38 C.F.R. §§ 3104(b), 3.105(a). The effective date based on the submission of new and material evidence received after a final disallowance is the date of the receipt of the new claim. 38 U.S.C. § 5110(a); 38 C.F.R. §§ 3.400(q)(2), 3.400 (r). It is settled law that the effective date for the grant of service connection following a final decision is the date of the reopened claim. See Sears v. Principi, 16 Vet. App. 244, 248 (2002) ("the Court thus holds that the effective date statute, 38 U.S.C. § 5110(a), is clear on its face with respect to granting an effective date for an award of VA periodic monthly benefits no earlier than the date that the claim for reopening was filed"). In the Sears case, the Court explained that the statutory framework did not allow for the Board to reach back to the date of the original claim as a possible effective date for an award of service-connected benefits that is predicated upon a reopened claim. The Court explained that the term, new claim, as it appeared in 38 C.F.R. § 3.400(q), means a claim to reopen a previously and finally decided claim. The terms “claim” and “application” mean a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Generally, the date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). A sympathetic reading as to all potential claims raised by the evidence is required. Szemraj v. Principi, 357 F.3d 1370 (Fed. Cir. 2004). A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C. § 5101(a). Regulations defining a "claim" were revised, effective March 24, 2015. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). The revision eliminated informal claims and required claims on specific forms. Prior to March 24, 2015, a claim was defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Thus, for the period prior to March 24, 2015, any communication indicating intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155(a). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to an effective date prior to March 27, 2018 for the award of service connection for PTSD. In this case, the Veteran filed an original service connection claim for PTSD in December 2007. The RO denied the Veteran’s original service connection claim in a May 2008 rating decision, and issued such rating decision with notice that same month. The Veteran did not appeal this decision and did not submit any new and material evidence with respect to this claim within the applicable one year period; therefore, the decision became final. Thereafter, on March 27, 2018, the Veteran sought to reopen the previously denied claim of service connection for PTSD. In a June 2018 rating decision, the RO reopened and granted the Veteran’s previously denied claim of service connection for PTSD, effective March 27, 2018, the date of the claim to reopen. On review of all evidence, there is no basis under the law to support an effective date earlier than March 27, 2018 for the award of service connection for PTSD. Notably, the May 2008 rating decision is final. Thereafter, the earliest possible communication that could be construed as a claim for service connection for PTSD was received by VA on March 27, 2018. Indeed, as noted, any award based on a subsequently filed application for benefits can be made effective no earlier than the date of the new application, which was March 27, 2018. The RO, in its DATE rating decision, has therefore already assigned the earliest possible effective date for its grant of the reopened claim. See Leonard v. Nicholson, 405 F.3d 1333 (Fed. Cir. 2005); Sears, 349 F.3d 1326. Based on the procedural history in this case, as discussed above, under the law, March 27, 2018, is the proper effective date for the grant of service connection for the Veteran's PTSD, because it is the date to reopen. There is no basis to assign an effective date earlier than March 27, 2018, for the award of service connection for PTSD. Indeed, the Court held, in Sears, 16 Vet. App. at 248, that, "[t]he statutory framework simply does not allow for the Board to reach back to the date of the original claim as a possible effective date for an award of service-connected benefits that is predicated upon a reopened claim." The Board acknowledges the Veteran’s attorney’s arguments accompanying the January 2019 notice of disagreement that effective dates are “the date of recognition of service connection” and that VA regulations “provide that the facts presented in the record determine the effective date.” The attorney also argued that “the date of disability is the date the record reflects it existed” when setting an effective date post filing the claim. However, these statements do not properly reflect, and are inconsistent with, the relevant laws and regulations, as clearly and unambiguously laid out in 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. The Board is appreciative of the Veteran's faithful and honorable service to our country; however, for the reasons and bases expressed above, the appeal for an earlier effective date is without legal merit, and must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994); 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 5. Entitlement to an effective date prior to March 27, 2018 for the award of service connection for residuals of a TBI. In this case, the RO assigned an effective date of March 27, 2018, for the award of service connection for residuals of a TBI; this date corresponds with the date the RO received the Veteran’s initial claim seeking service connection for residuals of a TBI. The Board has reviewed all relevant evidence and finds no basis under the law to award an effective date earlier than March 27, 2018, for the grant of service connection for residuals of a TBI. There is nothing in the record prior to that date which could be construed as a claim for service connection for residuals of a TBI, even under the broadest definition of a claim. As such, the RO has already assigned the earliest possible effective date for its grant of the original claim, which was determined to be March 27, 2018. Consequently, there is no legal basis upon which to grant an effective date prior to March 27, 2018, for the grant of service connection for residuals of a TBI. The Board is bound by the law governing the assignment of effective dates in its determination in this case. See 38 U.S.C. § 7104(c). The claim of entitlement to an effective date earlier than March 27, 2018, for the award of service connection for residuals of a TBI must be denied. Megan R. Thomas Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Hoy, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.