Citation Nr: 21016107 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 18-51 903 DATE: March 19, 2021 ORDER Entitlement to a uniform initial disability rating of 100 percent for service-connected posttraumatic stress disorder (PTSD), previously rated as schizophrenia undifferentiated type, from July 22, 1971 is granted, subject to controlling regulations governing the payment of monetary awards. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities prior to December 16, 1972 is dismissed. FINDINGS OF FACT 1. From July 22, 1971, the Veteran's service-connected PTSD, previously rated as schizophrenia undifferentiated type, more nearly approximates psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability. 2. As the 100 percent rating for service-connected PTSD is awarded for the entire rating period from July 22, 1971 and the Veteran is not service connected for any additional disability prior to December 16, 1972, the issue of entitlement to a TDIU prior to December 16, 1972 is rendered moot. CONCLUSIONS OF LAW 1. From July 22, 1971, the criteria for a 100 percent disability rating for service-connected PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.129, 4.130, 4.132, Diagnostic Code (DC) 9204 (1971); DC 9411. 2. The question of whether the Veteran is entitled to a TDIU, during the period prior to December 16, 1972, is rendered moot by his receipt of a 100 percent rating from July 22, 1971, leaving no question of law or fact to decide regarding the TDIU issue during this period. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.340, 3.341, 4.14, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1969 to July 1971 with service in the Republic of Vietnam. This case has a long and complicated history that was recounted in the August 2019 Board of Veterans’ Appeals (Board) decision. The case comes before the Board on appeal from a January 2006 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The January 2006 rating decision granted service connection for PTSD, which was formerly diagnosed as undifferentiated schizophrenia, and assigned a 70 percent initial rating effective January 9, 1991. The Veteran timely appealed the assigned initial rating and effective date from this rating decision. In August 2019, the Board, in pertinent part, denied an initial rating in excess of 70 percent for PTSD from July 22, 1971 until March 23, 2016. The Veteran appealed this denial to the United States Court of Appeals for Veterans Claims (Court). Before the Court issued a decision, the parties agreed to a Joint Motion for Partial Remand (joint motion) that vacated the portion of the August 2019 Board decision denying a rating in excess of 70 percent for service-connected PTSD from July 22, 1971 until March 23, 2016 and remanded this claim to the Board for adjudication consistent with the terms of the joint motion. The Court granted the joint motion in September 2020, and this issue has returned to the Board. In August 2019, the Board remanded entitlement to a total disability rating based upon individual unemployability (TDIU) from July 22, 1971 until March 16, 2006. In September 2020, the RO granted entitlement to a TDIU from December 16, 1972. The Board has recharacterized the TDIU claim to reflect the remaining rating period under consideration. I. Duty to notify and assist The Veterans Claims Assistance Act of 2000 as amended (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The claim is also subject to compliance with the September 2020 joint motion. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The September 2020 joint motion found that the Board did not provide an adequate statement of the reasons and bases for its denial of a rating in excess of 70 percent for service-connected PTSD. Specifically, the August 2019 Board decision did not discuss the rating criteria amendments over the course of the rating period and did not consider an extraschedular rating as raised by the report of frequent psychiatric hospitalizations. As explained below, the instant decision results in a grant of a 100 percent rating for service-connected PTSD from the effective date of service connection July 22, 1971. This benefit grant renders the issue of extraschedular rating for PTSD moot. Colayong v. West, 12 Vet. App. 524, 537 (1999) (“Hence, on remand the Board is required to address an extraschedular rating for the veteran’s service-connected Pott’s disease if it is not rated 100% as a schedular matter”) (emphasis added). Further discussion of VCAA compliance or prior remand compliance is not needed since the instant decision results in a complete grant of the benefit sought. II. Entitlement to a higher initial rating for service-connected PTSD from July 22, 1971 until March 23, 2016 Disability evaluations are determined by application of the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. Staged ratings are appropriate for any 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) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran is service-connected for PTSD, previously rated as schizophrenia disorder undifferentiated type, with a 70 percent disability rating from July 22, 1971 until March 23, 2016. 38 C.F.R. § 4.130, DC 9411. Of note, prior to April 11, 1980, PTSD was not incorporated into the rating schedule and the disability characterization references undifferentiated schizophrenia for the period prior to this amendment. Id.; 45 Fed. Reg. 26,326 (April 18, 1980). As noted in the September 2020 joint motion, the applicable rating criteria has changed over the rating period. Where a law or regulation changes during the pendency of a claim for increased rating, the Board should first determine whether application of the revised version would produce retroactive results. In particular, a new rule may not extinguish any rights or benefits the claimant had prior to enactment of the new rule. VAOPGCPREC 07-03. However, if the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The schedular criteria for mental disorders that were in effect at the beginning of the rating period at issue in this appeal were amended effective September 9, 1975, March 10, 1976, April 11, 1980, February 3, 1988 and November 7, 1996. The criteria from the November 1996 General Rating Formula for Mental Disorders is currently in effect. See 61 Fed. Reg. 52695 (October 8, 1996) (amending the sections of the VA schedule for rating mental disorders); see also 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders) (2020). As such, the Veteran's claim must be considered under all the rating amendments during the claims period. In this case, the Board finds that the Veteran’s service-connected PTSD, previously rated as schizophrenia disorder undifferentiated type, warrants a 100 percent rating from July 22, 1971 under the version of DC 9204, Schizophrenic reaction undifferentiated type that was in effect at the beginning of the rating period. 38 C.F.R. §§ 4.129, 4.130, 4.132 (1971). Given the favorable disposition, the Board will limit its consideration of the rating criteria to the version in effect from July 22, 1971. From July 22, 1971, DC 9204 pertained to schizophrenic reaction, chronic undifferentiated type. It assigned ratings based upon General Rating Formula for Psychotic Reactions (General Rating Formula). The General Rating Formula assigned a 100 percent rating for active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability. A 70 percent rating contemplated lesser symptomatology such as to produce severe impairment of social and industrial adaptability. Id. Although the more recent Court guidance in rating Mental Disorders pertains to the rating schedule in effect since November 7, 1996, the general rating principles from this guidance are instructive. The Court had held that the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria.  Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130.  The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages.  Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating.  Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).  The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating.  On the other hand, if the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned.  Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004); Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002).  Turning to the evidence, on examination in October 1971, the Veteran was shown to have a realistic thought process and normal flow of ideas. He had a pleasant mood and adequate affect. He reported no disorders of perception or sleep disturbances and was oriented in three spheres. Concentration was normal, and judgment was adequate. The impression was no mental disease found at present time. A December 1971 private physician’s note reported that the Veteran had “extreme nervousness.” The Veteran was hospitalized for approximately two months beginning on November 21, 1973, when it was noted that he had severe anxiety, restlessness, and irritability. His affect was noted to be dull and his mood was depressed. He was discharged from the hospital on January 29, 1974. On private psychiatric evaluation in October 1974, mental status examination showed he was tense and very angry. His speech was coherent and logical with no thought process disorder. There was referential and paranoid content and the Veteran reported hearing voices and seeing things at night. Affect was inappropriate. He was depressed and admitted to both homicidal and suicidal ideations. He was unable to relate to other people. He felt despondent and was disoriented to time. The Veteran was hospitalized on October 30, 1974 for complaints of low back pain and of aggressivity, insomnia, destructive behavior, visual hallucinations and suicidal ideation. He was discharged on November 7, 1974. The Veteran was again hospitalized on November 13, 1974. At that time, he had complaints of restlessness, anger, and outbursts as well as visual and auditory hallucinations. On objective evaluation, he was disheveled, but coherent and relevant. He was fully oriented and cooperative. He was assessed with loosening of associations, ideas of reference, aggressive ideas and feelings of hopelessness and worthlessness. The pertinent diagnosis was schizophrenia. He was discharged on January 16, 1975. The Veteran was again hospitalized from March 26, 1975, to May 20, 1975 for complaints of anxiety, insomnia, aggressiveness, and hallucinatory episodes. VA outpatient treatment records show that in September 1975 he was seen for complaints of insomnia and hallucinations. He had had problems with his wife and had decided to kill himself. His medications were adjusted. On private psychiatric evaluation in December 1975, it was noted that the Veteran was seen for psychiatric treatment once per month. Despite medication, he continued to have auditory hallucinations, illusions and insomnia. On mental status evaluation, he was well groomed and well dressed. He was tense and very angry, with difficulty controlling his feelings. There was no thought disorder in process or looseness of association. Thought content was referential and paranoid. Affect was appropriate. Mood was very labile. He was depressed and despondent with feelings of wishing he was dead. He was impulsive and admitted to beating his wife. He became uncontrollably angry. Orientation was good, but concentration and attention were poor. He had no frustration tolerance. Judgement was poor and there was no insight. The examiner opined that the Veteran would be unable to handle funds as a result of his psychiatric disorder. On private psychiatric evaluation in November 1976, it was noted that the Veteran looked “sleepy” as a result of the antipsychotic medication that he was taking. He never stopped smoking during the interview but spoke normally. Affect was depressed and flat. At times, he laughed for no reason. Thought process was normal, but he was unable to interpret proverbs. He had severe ideas of reference and delusions of persecution. He continued to complain of auditory and visual hallucinations, specifically of hearing footsteps behind him, but stated that these were “less than before.” Memory was poor, but judgement was normal. He was oriented to place only. The diagnosis was paranoid schizophrenia, in remission, but chronic. The examiner stated that the Veteran had no ability to work. An examination was conducted by VA in January 1977. At that time, the Veteran was noted to have a “sour and resentful disposition.” He was correctly oriented for all spheres and capable of establishing adequate rapport. He stated that he slept restlessly, with nightmares and dreams of combat experiences. He was generally sullen, irritable and hostile, although he described his marital relations as congenial. He stated that he felt better when alone. He sometimes heard footsteps behind him but found nobody there when he stopped to investigate. He felt that everyone disliked him and was talking about him. Mood was sour, querulous, plaintive and resentful. He talked of preferring to be dead. The impression was depressive neurosis with mild schizoid traits. On private psychiatric evaluation in November 1977, it was noted that the Veteran was well dressed and cooperative with the interview. He presented some psychomotor retardation and seemed to be under the influence of medication. He did not look anxious and affect was stable and appropriate. No formal thought disorder presented. He was coherent and relevant. He was oriented on three spheres. He gave history details without difficulty. He described himself as violent and described incidents of such. He explained that he heard voices that called his name. He heard footsteps behind him stating that he believed this to be the Devil. His mood varied, and he stated that he sometimes wished “God would take him and send him to hell.” He sometimes felt that he could read the minds of others and he believed others were always talking and laughing about him. He characterized his sleep as plagued with terrifying nightmares. On private neurologic examination in September 1981, the Veteran was shown to be alert and oriented to time, place and person. Speech, memory, calculation and judgement were normal. Affect was anxious, and mood was depressed. In a March 1988 statement from the Veteran’s private psychiatrist, it was noted that the Veteran had been treated monthly since October 1981. The examiner noted that, in spite of treatment with different medications, the Veteran continued to present with delusional thinking, auditory and visual hallucinations, multiple somatic complaints and disturbed and hostile behavior. The Veteran was unable to establish normal interpersonal relationships, adapt himself and get along well in the social and industrial environment. He consequently presented a definite and considerable impairment in both areas. He was considered to be totally and permanently disabled for gainful employment and the prognosis was considered to be poor. VA outpatient treatment records, dated in July 1990, show that the Veteran was shown to be logical, coherent and oriented in three spheres. It was noted that the Veteran had reported an increase in PTSD symptomatology. An examination was conducted by VA in March 20, 1992. At that time, it was noted that the Veteran had been undergoing approximately 10 years of treatment with a private psychiatrist and was taking multiple anti-psychotic medications. The Veteran’s psychiatric complaints centered on the remembrance of the death of fellow soldiers while in Vietnam. He complained of irritability, bad temper, and not being understood by his spouse. He reported hearing voices calling him and of hearing steps behind him. He appeared disheveled with decreased psychomotor activity. He was alert and oriented in three spheres. His mood was depressed, and his affect was blunt. He kept poor eye contact. Speech was clear, coherent and soft. He was not hallucinating and not suicidal or homicidal. He exhibited good impulse control. In February 1995, the Veteran was hospitalized at a VA facility. He was admitted for loss of contact with reality, audiovisual hallucinations, crying, ideas of harming his neighbors, insomnia, and anxiety. He was admitted for psychiatric stabilization and treated with medication. After transfer to the open ward, he was noted to be relevant, coherent, and without delusions or hallucinations. He was also well oriented as to time, place and person. He had poor judgement and insight. Affect was blunted, and his mood was depressed. He was discharged after eight days. In November 1997, the Veteran was hospitalized for 11 days. He was admitted due to being unable to sleep, depressive mood and ideas to hurt himself. On mental status evaluation, he was found to be well nourished with good personal hygiene. The Veteran was cooperative and alert. He had slow speech and a depressed mood. Affect was congruent with mood. He was logical, coherent and relevant. There were no delusions or hallucinations. Memory was well preserved. There was no evidence of suicidal or homicidal ideas. He was oriented in three spheres. Judgement was poor, and insight was fair. In December 1997, the Veteran had another VA examination. He appeared clean and well-groomed but overly sedated. He was alert and oriented in three spheres. Mood was depressed. Affect was blunted. Attention was good. He kept no eye contact. He had an “oddness of behavior.” Concentration was good, and speech was clear and coherent. Mood and emotional reactions remained constant throughout the evaluation. Memory was fair. He was not hallucinating, homicidal or suicidal. Insight and judgment were fair. He exhibited good impulse control. From November 8, 2004, to December 21, 2004, the Veteran had a psychiatric hospitalization at a VA facility. In November 2005, the Veteran had another VA examination. On mental status evaluation, the Veteran was cooperative and talkative, but observed to be “fidgety.” Speech was adequate, mood was anxious and sad, affect was restricted and inappropriate at times. There was no suicidal or homicidal ideas and no delusional ideas. There were no audio or visual hallucinations or illusions. Thought process was coherent, circumstantial and illogical at times. There were no loose associations, flight of ideas, or thought blocking. He was alert and oriented in three spheres. Memory was intact to most events, but he required frequent cues to continue his train of thought. Insight was superficial, and judgement was fair. The examiner opined that the Veteran was unable to handle stressful situations due to emerging marked irritability that interfered with concentration and memory. Management of funds could be very stressful, demanding concentration, consistency and a high level of responsibility. VA treatment records dated in February 2007 show that the Veteran appeared well in general. His concentration was somewhat altered. He was dressed casually and appropriately. Attitude was cooperative and spontaneous. Affect was congruent to a euthymic mood. Thought process was logical, coherent and relevant. He stated that he had daytime flashbacks and illusions about hearing voices at times. He denied suicidal or homicidal ideation. Insight was superficial, and judgement was improved. The assessment was PTSD. The Veteran had another VA examination in July 2007. He presented as neatly groomed and casually dressed. He was hyperactive and tense. Speech was clear and coherent. He was cooperative and attentive. Affect was blunted, and mood was depressed. Attention was intact. He was oriented to person and place. Thought process and content were unremarkable. There were no delusions or hallucinations. The Veteran understood the outcome of his behavior. He reported poor sleep with nightmares. He was irritable and aggressive. He did not have panic attacks, homicidal or suicidal thoughts or obsessive or ritualistic behavior. He was able to maintain minimum personal hygiene and had no problems with daily activities. In March 2016, the Veteran had another VA examination with a psychologist. The psychologist assessed PTSD symptoms with total occupational and social impairment. He reported that the Veteran’s last VA examination was in July 2007 and his assessment would cover the period since then. The Veteran continued to live with his second wife as well as an adult daughter and grandchild. The psychologist noted the most recent VA outpatient treatment record from the past month. He summarized the Veteran’s symptoms as the following: depressed mood, anxiety, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances and inability to establish and maintain effective relationships. Behavioral observations were remarkable for the following: avoidant eye contact, fair insight and judgment, and affect congruent with mood. Additional PTSD symptoms included inability to enjoy formerly pleasurable activities, social isolation and difficulty in interpersonal relationships. In the November 2018 substantive appeal, the representative recited medical records dating to December 1971 as supporting her contention of total occupational and social impairment. She requested a retrospective medical opinion if more information was needed. In January 2021, the attorney asserted that the Veteran’s psychiatric symptoms had been consistent throughout the appeal and have caused total occupational and social impairment. She referred to the arguments and cited evidence from the November 2018 substantive appeal as supporting a total rating claim. For the following reasons, the Board finds that a 100 percent rating for service-connected PTSD, previously rated as schizophrenia disorder, undifferentiated type, is warranted from the July 22, 1971 effective date of service connection. 38 C.F.R. §§ 4.3, 4.7, 4.132, DC 9204 (1971). PTSD was not formally recognized as a psychiatric disability at the beginning of the rating period. However, the Veteran’s service-connected disability was previously rated as schizophrenia disorder, undifferentiated type to comport with the rating criteria under the General Rating Formula then in effect. 38 C.F.R. § 4.132, DC 9204 (1971). The attorney argues in the November 2018 substantive appeal and January 2021 brief that the evidence shows total occupational and social impairment due to PTSD symptoms from the July 22, 1971 effective date of service connection. Although her argument references the current rating criteria, it is persuasive to show total social and industrial inadaptability under the previous rating criteria as explained below. The 100 percent rating criteria in effect from July 22, 1971 contemplate active psychotic manifestations that produce total social and industrial inadaptability. Id. Although there are some conflicting reports about the Veteran’s work history, it is clear that he held a series of short duration jobs after separation and stopped working in December 1972. Prior to December 1972, it does not appear that he had been able to secure gainful employment for any appreciable length of time. (See March 2005 and April 2006 TDIU claims (listing intermittent employment following separation); October 1971 VA examination (reporting unemployment)). The Board notes that the initial mental health evaluation from October 1971 did not reveal mental disease. However, this report was contradicted shortly later by a December 1971 physician’s statement. The December 1971 private physician note confirms the presence of severe anxiety type symptoms at this time, and the Veteran began a series of psychiatric hospitalizations in November 1973. It is reasonable to infer that the Veteran could not maintain gainful employment due to psychiatric symptoms prior to December 1972 by the brief nature of his listed employment. From November 1973 onward, the Veteran had periodic inpatient and outpatient treatment for psychiatric symptoms. Although the Veteran was only hospitalized for limited periods over the course of this appeal, he repeatedly required psychiatric hospitalization from poor general function due to psychiatric symptoms outside hospitalization periods. The Board finds the March 1988 treating psychiatrist (Dr. T) letter especially probative to show that total social and industrial inadaptability is present. Dr. T regularly treated the Veteran for almost seven years preceding the letter and had in-depth knowledge about the severity of the Veteran’s symptoms. His conclusion that the Veteran had total impairment due to psychiatric symptoms is highly probative. Then, the March 2016 psychologist stated that his assessment concerned the rating period from July 2007 and confirmed total occupational and social impairment due to PTSD symptoms during this period. There is no evidence that the Veteran’s had a sustained period of remission in psychiatric symptoms. Given these considerations, the Board find that the extent, severity, depth, persistence and bizarreness of this service-connected psychiatric symptoms more closely approximated total social and industrial inadaptability from the July 22, 1971 effective date of service connection. For the foregoing reasons, the evidence is thus at least evenly balanced as to whether the Veteran's service-connected PTSD, previously rated as schizophrenia undifferentiated type, more nearly approximates psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to a 100 percent rating for service-connected PTSD, previously rated as schizophrenia undifferentiated type, from the July 22, 1971 effective date of service connection is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. III. TDIU prior to December 16, 1972 The instant decision results in a 100 percent disability rating for service-connected PTSD from July 22, 1971, the day following separation. The Board is cognizant of the fact that the receipt of a 100 percent schedular disability rating for a service-connected disability or disabilities does not necessarily moot the issue of entitlement to a TDIU because a TDIU rating may still form the basis for assignment of SMC pursuant to 38 U.S.C. § 1114(s) as noted below. See Bradley v. Peake, 22 Vet. App. 280 (2008). In this case, prior to December 16, 1972, the Veteran is not service-connected for any additional disability, and the award of a 100 percent rating for service-connected PTSD from July 22, 1971 renders the issue of entitlement to a TDIU prior to December 16, 1972 moot. IV. Additional rating considerations The September 2020 joint motion raised the issue of an extraschedular rating for service-connected PTSD prior to March 23, 2016. The award of a 100 percent rating for PTSD from the effective date of service connection renders this issue moot. Colayong v. West, 12 Vet. App. at 537. The Veteran now has a 100 percent rating for PTSD and from December 23, 1977 is additionally service-connected for lumbar strain and myositis. Special Monthly Compensation (SMC) under 38 U.S.C. § 1114(s)(1) is payable when a veteran has a single service-connected disability rated as 100 percent and has additional service-connected disability or disabilities independently ratable at 60 percent or more, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. 38 U.S.C. § 1114(s)(1); 38 C.F.R. § 3.350(i)(1). Although the lumbar spine disability is not rated as 60 percent disabling, the Board has considered whether the service-connected lumbar strain alone warrants referral for extraschedular TDIU consideration under 38 C.F.R. § 4.16(b) as an alternative basis for SMC(s)(1) compensation. The Board last considered an increased rating for back disability in an August 1997 decision. The evidence from December 1977 through August 1997 is voluminous and generally pertains to service-connected PTSD. The January 1978 VA lumbar spine examination included an assessment of moderately severe chronic fibromyositis. A private September 1981 neurological evaluation confirmed a diagnosis of chronic lumbalgia (probably fibromyositis) residual after lumbar sprain and schizophrenia reaction by history. The physician assessed that the Veteran was partially incapacitated by his back disability, but his psychiatric disorder appeared more incapacitating. In his February 1992 increased rating claim, the Veteran did not assert unemployability exclusively due to his lumbar spine disability. At an April 1993 hearing, the Veteran reported a nervous condition precluded him from working. The June 1995 VA spine examination report showed tenderness and severely restricted lumbar spine motion. In March 2006 and April 2006 TDIU claims, the Veteran identified both service-connected disabilities as productive of unemployability. VA treatment records from 2006 to 2018 refer to a history of chronic low back pain, lumbar disc displacement and mild lumbar spondylosis. In June 2016, the Veteran started long-term opioid therapy for chronic low back pain management. Although the Veteran experiences chronic low back pain associated with his service-connected lumbar spine disability, the evidence does not include any assertion or report that could reasonably be construed as indicative or suggestive of total occupational impairment exclusively due to service-connected lumbar strain and myositis. The weight of the evidence does not show inability secure and follow a substantially gainful occupation exclusively due to impairment from service-connected lumbar strain and myositis. Further consideration of an extraschedular TDIU exclusively based upon service-connected lumbar strain and myositis is not warranted at this time. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. D. Simpson, 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.