Citation Nr: 21027199 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 11-27 746 DATE: May 5, 2021 ORDER Entitlement to an effective date prior to September 4, 2008 for the grant of service connection for generalized anxiety disorder with depressive features is denied. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for speech changes with difficulty chewing/swallowing due to Parkinson's disease is granted. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for constipation due to Parkinson's disease is granted. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for right lower extremity tremors due to Parkinson's disease is granted. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for loss of sense of smell due to Parkinson's disease is granted. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for sexual dysfunction due to Parkinson's disease is granted. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of special monthly compensation for loss of use of a creative organ is granted. Entitlement to an effective date prior to June 17, 2016 for the grant of service connection for left upper extremity tremors due to Parkinson's disease is denied. Entitlement to service connection for obstructive sleep apnea, claimed as respiratory condition, is granted. Entitlement to an evaluation in excess of 70 percent for generalized anxiety disorder is denied. REMANDED The issue of entitlement to an initial, separate evaluation for right upper extremity tremors due to Parkinson's disease is remanded. The issue of entitlement to an initial evaluation in excess of 10 percent for left upper extremity tremors due to Parkinson's disease is remanded. The issue of entitlement to an initial evaluation in excess of 10 percent for right lower extremity tremors due to Parkinson's disease is remanded. The issue of entitlement to an initial evaluation in excess of 10 percent for speech changes with difficulty chewing and swallowing due to Parkinson's disease is remanded The issue of entitlement to an initial compensable evaluation for loss of sense of smell due to Parkinson's disease is remanded. The issue of entitlement to an initial compensable evaluation for sexual dysfunction due to Parkinson's disease is remanded. The issue of entitlement to an evaluation of the minimum 30 percent for Parkinson's disease, for which service connection was granted effective November 16, 2010, is remanded. The issue of entitlement to special monthly compensation based on housebound status is remanded. The issue of entitlement to special monthly compensation based on a need for the regular aid and attendance of another person is remanded. FINDINGS OF FACT 1. In a November 1969 rating decision, the RO denied the Veteran's claim for entitlement to service connection for a nervous condition. The Veteran did not file a timely notice of disagreement, and new and material evidence was not received within one year of the notification, which was sent to the most recent address of record. 2. The claim upon which the grant of entitlement to service connection for an acquired psychiatric disorder was based was filed on September 4, 2008, and no document that can be construed as a claim for entitlement to service connection for this disability was received between the prior final denial and this date. 3. For the Veteran's speech disability, constipation, right lower extremity tremors, loss of sense of smell, sexual dysfunction, as secondary to Parkinson's disease, the earliest date entitlement arose is June 6, 2011, later than the date of claim for Parkinson's disease, which is November 16, 2010. 4. For the Veteran's left upper extremity tremors secondary to Parkinson's disease, the earliest date entitlement arose is June 17, 2016, later than the date of claim for Parkinson's disease, which is November 16, 2010. 5. The evidence is in equipoise as to whether the Veteran's obstructive sleep apnea was proximately due to his service-connected acquired psychiatric disorder. 6. In a March 2021 decision, the Board found that the Veteran's generalized anxiety disorder alone has precluded him from securing or following a substantial gainful occupation as of September 4, 2008. The evidence does not show that the acquired psychiatric disorder has resulted in total social impairment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an effective date earlier than September 4, 2008, for the grant of entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.1 (p), 3.155, 3.156(b), 3.400. 2. The criteria for an effective date of June 6, 2010, but no earlier, for the awards of service connection for speech disability, constipation, right lower extremity tremors, loss of sense of smell, sexual dysfunction, as secondary to Parkinson's disease have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.156, 3.400. 3. The criteria for an effective date prior to June 17, 2016, for the awards of service connection for left upper extremity tremor, as secondary to Parkinson's disease have not been met. 38 U.S.C. § 5110 ; 38 C.F.R. §§ 3.156, 3.400. 4. With resolution of reasonable doubt in the Veteran's favor, the criteria for service connection for obstructive sleep apnea as secondary to service-connected acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 5. The criteria for a rating in excess of 70 percent for generalized anxiety disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1966 to June 1968. As the Board communicated in February 2020 with the Veteran and Counsel Liberman, the most recent power of attorney, dated March 2017, restricts Counsel Liberman's representation on the issues of pension and service connection for psychiatric disorder, respiratory disorder, skin disorder, triglycerides, high blood pressure, and hand cramps and the Board asked clarification on the scope of representation. The Veteran has not responded to the request. Although Board considers all argument submitted by the counsel, so as not to disadvantage the Veteran, the Board assumes, as stated in the February 2020 letter, that the Veteran is represented by Counsel Liberman only on the issues of entitlement to pension and service connection for psychiatric disorder, respiratory disorder, skin disorder, triglycerides, high blood pressure, and hand cramps. As for the issue of service connection for a chronic respiratory disability, to include sleep apnea, the Board denied the claim in March 2020. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (CAVC); and the Secretary and the Veteran filed a Joint Motion for Remand (JMR) which was granted by the CAVC in a September 2020 Order. The parties to the JMR determined that the Board failed to provide an adequate reasons or bases on the grounds that it did not discuss a February 2020 private medical opinion. The case was remanded for the Board to readjudicate the issue accordingly. Since the appeal for the issue of initial evaluation for Parkinson's disease, for which service connection was granted in a June 2011 rating decision, was not successfully perfected (see July 2017 Board decision), the June 2011 rating decision became final. Thus, the assignment of the effective date of November 16, 2010 for the grant of service connection for Parkinson's disease is not an issue on this appeal. However, the Board notes that when implementing the July 2017 Board decision in an October 2017 rating decision, the Agency of Original Jurisdiction (AOJ) erroneously noted the effective date of the grant of service connection for Parkinson's disease was June 17, 2016 in the accompanying rating decision, codesheet, and this mistake has been carried over to the most recent March 2021 rating decision, codesheet. Thus, for adjudication of the effective date and higher initial evaluation claims on this appeal, the Board considers the correct effective date of November 16, 2010, as decided originally in the June 2011 rating decision, for the grant of service connection for Parkinson's disease. Earlier Effective Date Generally, the effective date of an award of a claim is 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. Unless otherwise provided, the effective date of compensation will be fixed in accordance with the facts found, but will not be earlier than the date of the claimant's application. 38 U.S.C. § 5100 (a); see also 38 C.F.R. § 3.400 (r) (effective date of reopened claim is date of receipt of claim or date entitlement arose, whichever is later); Comer v. Peake, 552 F.3d 1362, 1370 (Fed. Cir. 2009) ("The earliest effective date for an award based on a veteran's request to reopen a final decision based on new and material evidence is generally the date that the application to reopen was filed"). As awards of secondary service connection are not awards of increased compensation within the meaning of the statute, the effective date can be no earlier than the date of the claim for service connection on a secondary basis. Ellington v. Nicholson, 22 Vet. App. 141, 145 (2007) (finding that the effective date for a grant of service connection for diabetes and hypertension as secondary to leukemia was the date of the claim for secondary service connection, not the date of the claim of service connection for leukemia), aff'd sub nom. Ellington v. Peake, 541 F.3d 1364 (Fed. Cir. 2008); Ross v. Peake, 21 Vet. App. 528, 532-33 (2008) (holding that the effective date for a grant of secondary service connection for depression with anxiety was the date of the secondary service connection claim, not the date of the claim for service connection for the primary heart condition). A claim is defined as 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); 3.155. The Board recognizes that this regulation was amended; however, the version above is applicable to this appeal. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). Any communication or action from a claimant indicating an intent to apply for one or more benefits under the laws administered by VA and which identified the benefit sought, may be considered an informal claim. 38 C.F.R. § 3.155 (a). Thus, the essential elements for any claim, whether formal or informal are "(1) an intent to apply for benefits, (2) an indication of the benefits sought, and (3) a communication in writing." Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). 1. Entitlement to an effective date prior to September 4, 2008 for the grant of service connection for generalized anxiety disorder with depressive features is denied. The Veteran contends that he is entitled to an effective date, no later than July 1, 1969, the date of original claim, because the notice of the rating decision denying his claim was mailed to a [REDACTED] address, not a [REDACTED] address. The law provides for a presumption of regularity with regard to processes and procedures throughout the VA administrative process. See generally, Marsh v. Nicholson, 19 Vet. App. 381, 386-87 (2005); Crain v. Principi, 17 Vet. App. 182, 186 (2003); Redding v. West, 13 Vet. App. 512, 515 (2000). Yet we recognize that the presumption of regularity is not absolute and may be rebutted by the submission of "clear evidence to the contrary." Warfield v. Gober, 10 Vet. App. 483, 486 (1997). In this regard, the Court has held that the question of whether clear evidence exists to rebut the presumption of regularity is a question of law. See Crain v. Principi, 17 Vet. App. 182, 188 (2003). An 'assertion of nonreceipt, standing alone, does not rebut the presumption of regularity in VA's mailing process.' Jones v. West, 12 Vet. App. 98, 102 (1998). Clear evidence sufficient to rebut the presumption of regularity has been found when VA addressed communications to a wrong street name, wrong street number, or wrong zip code in circumstances indicating that such errors were consequential to delivery. See, e.g., Fluker v. Brown, 5 Vet. App. 296, 298 (1993) (finding the existence of clear evidence to rebut the presumption of regularity where the Board mailed a decision to [REDACTED]' when the claimant's correct address was [REDACTED]); Piano v. Brown, 5 Vet. App. 25, 26-27 (1993) (per curiam order) (finding the existence of clear evidence to rebut the presumption of regularity where the Board mailed its decision to [REDACTED] when the claimant's correct address was [REDACTED]). Turning to the evidence, the Veteran's DD 214 indicates that the Veteran's home address of record was at [REDACTED] at the time of enlistment in June 1966. When he filed an application for dental claim and education in 1968, the Veteran reported the [REDACTED] address. When the Veteran filed a claim for anxiety reaction with headaches in July 1969, he indicated that his home address was at [REDACTED]. A July 1969 VA letter for claim development was mailed to the address in [REDACTED]. At an August 1969 psychiatric evaluation, the Veteran reported he had returned from New York in June 1969. An August 1969 VA examination and a September 1969 VA dental examination indicate that his home address was at [REDACTED]. A November 1969 rating decision denied the claim for lack of in-service incurrence. The notification of the decision was mailed in December 1969 to the [REDACTED] address. The claims file does not contain any returned mail subsequent to the December 1969 notification. A November 1970 VA financial letter was mailed to the [REDACTED], the address noted in the Veteran's DD 214. Thus, the evidence shows that there were two addresses associated with the Veteran, one at [REDACTED] and the other at [REDACTED]. However, the Board does not find clear evidence that the November 1969 notification letter was mailed to a wrong address. In fact, the evidence shows that the notification letter was mailed to the address of record at the time the Veteran filed the claims in July 1969 and there is no indication that the Veteran ceased to use the [REDACTED] address at any time after the July 1969 claim and before the November 1969 notification of decision. Additionally, there is no returned mail notification of record associated with the November 1969 notification. In sum, there is no clear evidence to rebut the presumption of regularity. Since no notice of disagreement or new evidence was associated with the claims file within one year after the notification, the November 1969 rating decision became final. 38 C.F.R. §§ 3.104, 19.118, 19.153 (1969). Moreover, there is no written communication with intent to apply for a benefit concerning his psychiatric disorder until his formal application for service connection for a psychiatric disorder was received on September 4, 2008. Therefore, an effective date prior to September 4, 2008 for the grant of service connection for an acquired psychiatric disorder is not warranted. 38 U.S.C. § 5100 (a); 38 C.F.R. § 3.400 (r). 2. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for speech changes with difficulty chewing/swallowing due to Parkinson's disease is granted. 3. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for constipation due to Parkinson's disease is granted. 4. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for right lower extremity tremors due to Parkinson's disease is granted. 5. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for loss of sense of smell due to Parkinson's disease is granted. 6. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of service connection for sexual dysfunction due to Parkinson's disease is granted. 7. Entitlement to an effective date of June 6, 2011, but not earlier, for the grant of special monthly compensation for loss of use of a creative organ is granted. As noted in the introduction, the Veteran is in receipt of service connection for Parkinson's disease, effective November 16, 2010. Thus, the Board finds that the earliest date of claim for disabilities secondary to Parkinson's disease is November 16, 2010. Here, the evidence demonstrates that the Veteran's speech disability, constipation, right lower extremity tremors, loss of sense of smell, sexual dysfunction were noted for the first time in the evidence of record and determined as secondary to Parkinson's disease in a disability benefits questionnaire for Parkinson's disease, conducted on June 6, 2011, prior to the original effective date of June 17, 2016, on which a VA examination for Parkinson's disease was conducted. Thus, the date entitlement arose is June 6, 2011, when these disabilities were specifically noted as secondary to Parkinson's disease for the first time by a medical provider. Since June 6, 2011 is later than the date of claim, an earliest effective date for the grant of service connection for speech disability, constipation, right lower extremity tremors, loss of sense of smell, sexual dysfunction is June 6, 2011. An earlier effective date of June 6, 2011 is warranted for entitlement to special monthly compensation for loss of use of a creative organ is warranted since that effective date is warranted for the grant of service connection for sexual dysfunction secondary to Parkinson's disease. 8. Entitlement to an effective date prior to June 17, 2016 for the grant of service connection for left upper extremity tremors due to Parkinson's disease is denied. The Veteran has left upper extremity tremors secondary to Parkinson's disease. Here, unlike the other disabilities due to Parkinson's disease addressed above, the June 2011 Parkinson's disease disability benefits questionnaire did not indicate that he had tremor in the left upper extremity. In fact, a VA examination conducted on June 17, 2016 shows that he had tremor in the left upper extremity secondary to Parkinson's disease for the first time in the evidence of record. As such, the date entitlement arose is June 17, 2016, which is later than the date of claim, November 16, 2010. Thus, an effective date prior to June 17, 2016 for the grant of service connection for left upper extremity tremors due to Parkinson's disease is not warranted. Service Connection 9. Entitlement to service connection for obstructive sleep apnea, claimed as respiratory condition, is granted. The Veteran maintains that he has sleep apnea that is related to his service, to include his service-connected disabilities. In support of his claim, the Veteran submitted a result of January 2020 sleep study and a February 2020 private medical opinion. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a veteran 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). This permits service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the case of aggravation by a service-connected disability, a veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Id; see also 38 C.F.R. § 3.310 (b). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Here, the January 2020 sleep study confirms the current diagnosis of obstructive sleep apnea. A review of the Veteran's service treatment records does not indicate any sleep disability noted while in service. However, the Veteran is currently service connected for Parkinson's disease and an acquired psychiatric disorder. As such, the issue before the Board is whether the Veteran's obstructive sleep apnea is proximately due to or aggravated beyond natural progression by a service-connected disability or otherwise etiologically related to his service. Here, the February 2020 private medical opinion states that it is more likely than not that a combination of the Veteran's service-connected disabilities caused his obstructive sleep apnea. The rationale provided was that the literature shows the medications used to treat depression and anxiety, such as alprazolam, Klonopin, and bupropion that the Veteran was taking for his generalized anxiety disorder could relax the respiratory airway and contribute to obstructive sleep apnea. Moreover, a June 2011 disability benefits questionnaire, a June 2016 and a December 2018 VA examination for Parkinson's disease note that the Veteran has sleep disturbance (insomnia or daytime sleep attacks). The Board finds that the February 2020 opinion affords probative weight, as it is consistent with the fact found in the record and supported by medical principles. Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). Other opinions of record are based on insufficient evidence, for they found no diagnosis of sleep apnea, and they are not up to date. Accordingly, resolving reasonable doubt in the Veteran's favor, the claim is granted. Increased Rating 10. Entitlement to an evaluation in excess of 70 percent for generalized anxiety disorder is denied. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 ; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The Veteran's generalized anxiety disorder is initially and currently evaluated as 70 percent disabling from September 4, 2008 under Diagnostic Code 9400, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. He contends that such disability is more severe than as reflected by the currently assigned rating, and as such, a higher initial rating is warranted. Under the General Rating Formula, a 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, 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 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); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when there is 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; memory loss for names of close relatives, own occupation, or own name. Id. The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation...requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.3d at 117-118 ; 38 C.F.R. § 4.130, DC 9411. Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38 C.F.R. § 4.126 (a). Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and replace them with references to the recently updated DSM-5. See 79 Fed. Reg. 149, 45094 (August 4, 2014). 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 (AOJ) on or after August 4, 2014. 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, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In the instant case, the Veteran's claim for service connection was certified to the Board in February 2017. The Board granted service connection for acquired psychiatric disorder in a July 2017 decision and the current appeal on the issue of initial evaluation originates with the Board grant. As such, the DSM-IV does not apply to his claim. In this regard, the Board notes that the DSM-5 removed reference to Global Assessment of Functioning (GAF) scores. In the March 2021 decision, the Board already found that the Veteran's acquired psychiatric disorder alone prevents him from securing and following gainful employment. The same evidence considered there also shows that his acquired psychiatric disorder has not resulted in total social impairment. While there has been significant work and social impairment that is demonstrated by the rating assigned. Such disorientation or other findings suggestive of a total schedular rating have not been shown. An October 2008 VA examiner noted that his psychiatric signs and symptoms resulted in deficiencies in areas such as judgment, thinking, family relations, mood, and work, as well as poor impulse/anger control. In addition, November 2010, March 2012 statements by Dr. O. and May 2011 statement by Dr. R.-V. also indicate that the Veteran's emotional disturbance caused by his psychiatric disorder affected his inability to maintain effective relationship with people. A December 2015 report by Dr. F. indicates that he had sleeping difficulty, irritability, range outbursts, concentration difficulties, and hypervigilance due to his mental health condition; the doctor opined that his psychiatric disability has caused clinically significant handicap in areas associated with social and occupational functioning. These findings are contemplated by the 70 percent rating, and an increase is not in order. REASONS FOR REMAND 1. The issue of entitlement to an initial, separate evaluation for right upper extremity tremors due to Parkinson's disease is remanded. 2. The issue of entitlement to an initial evaluation in excess of 10 percent for left upper extremity tremors due to Parkinson's disease is remanded. 3. The issue of entitlement to an initial evaluation in excess of 10 percent for right lower extremity tremors due to Parkinson's disease is remanded. 4. The issue of entitlement to an initial evaluation in excess of 10 percent for speech changes with difficulty chewing and swallowing due to Parkinson's disease is remanded 5. The issue of entitlement to an initial compensable evaluation for loss of sense of smell due to Parkinson's disease is remanded. 6. The issue of entitlement to an initial compensable evaluation for sexual dysfunction due to Parkinson's disease is remanded. 7. The issue of entitlement to an evaluation of the minimum 30 percent for Parkinson's disease, for which service connection was granted, effective November 16, 2010, is remanded. Under Diagnostic Code 8004, a minimum 30 percent rating is assigned if there are "ascertainable residuals" of the disability. VA must also analyze individual chronic symptoms residual to Parkinson's disease under the appropriate Diagnostic Codes for that body system. See 38 C.F.R. §§ 4.120, 4.124a, Diagnostic Code 8004. If there are identifiable residuals that can be rated under a separate diagnostic code and the combined disability rating resulting from these residuals exceeds 30 percent for any period, then the separate ratings will be assigned for that period in place of the minimum rating assigned under Diagnostic Code 8004. Id. Neurological conditions such as Parkinson's disease are evaluated under the section of the Rating Schedule beginning at 38 C.F.R. § 4.120, conducting evaluations by comparison. 38 C.F.R. § 4.120 provides that disability in this field is ordinarily to be rated in proportion to the impairment of motor, , or mental function. The rater is to consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, injury to the skull, etc. In rating such disability, the rater is to refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. The provisions of 38 C.F.R. § 4.124a provide that evaluations of neurological conditions such as Parkinson's disease, and their residuals may also be rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. Psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc. are to be considered. With partial loss of use of one or more extremities from neurological lesions, the rating is by comparison with mild, moderate, severe, or complete paralysis of peripheral nerves. In light of the pertinent regulations, the Board is unable to adjudicate the claims for entitlement to a higher initial evaluation for residuals of Parkinson's disease due to lack of information. As the evidence shows, the Veteran's Parkinson's disease has residuals of tremors in the right upper extremity, left upper extremity, and right lower extremity. In order to evaluate them neurological impairment analogously under 38 C.F.R. § 4.120, which nerve is implicated for the neurological impairment. Such information is missing in the evidence, to include VA examination reports for Parkinson's disease. Moreover, the VA examination reports and disability benefits questionnaires are not consistent in finding whether the Veteran has certain residual symptoms of Parkinson's disease. For instance, a June 2011 disability benefits questionnaire reflects a finding of loss of memory and concentration, but a June 2016 and a December 2018 VA examination have no such finding. Moreover, the last examination to assess severity of the Veteran's Parkinson's disease was conducted in December 2018. The VA treatment records since then do not reflect any treatment for Parkinson's disease. Therefore, the Board finds that a new VA examination must be scheduled to ascertain the current severity of the Veteran's Parkinson's disease. Any outstanding VA treatment records, as well as private treatment record for Parkinson's disease and residual symptoms thereof, must be obtained with proper release authorization. Moreover, a medical opinion evaluating which nerves are implicated in the tremors must be obtained. 8. The issue of entitlement to special monthly compensation based on housebound status is remanded. This issue of special monthly compensation based on housebound status is inextricably intertwined with the issues of entitlement to higher rating, which are remanded for further development. As such, the AOJ must adjudicate this issue after adjudicating the higher rating claims on remand. 9. The issue of entitlement to special monthly compensation based on a need for the regular aid and attendance of another person is remanded. The Veteran claims that he is entitled to special monthly compensation based on a need for regular aid and attendance of another person. The AOJ must develop this claim appropriately, for instance, administering a proper examination and notifying the Veteran what evidence needs to be submitted for consideration. The matters are REMANDED for the following action: 1. Obtain outstanding VA treatment records. Ask the Veteran to complete a VA Form 21-4142 for any private treatment he has received for Parkinson's disease for the period from November 16, 2010 to the present. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected Parkinson's disease. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In particular, the examiner must opine which nerves are affected by the Veteran's tremors. If the examiner determines that a separate examination for a symptom of Parkinson's disease, e.g., neurological impairment, constipation, or sexual dysfunction, the examiner must conduct such separate examinations as appropriate. 3. Develop the Veteran's claim for special monthly compensation based on aid and attendance. 4. . Finally, readjudicate the claims, to include the claim for special monthly compensation based on housebound status. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Taylor 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.