Citation Nr: 21031504 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-36 423 DATE: May 24, 2021 ORDER 1. Entitlement to a 30 percent rating for posttraumatic stress disorder (PTSD) (from September 26, 2013 to June 12, 2015) is granted, subject to the regulations governing payment of monetary awards; a rating in excess of 50 percent prior to March 8, 2016 is denied. 2. Entitlement to increases in the (0 percent prior to March 30, 2016, and 40 percent from that date) staged ratings assigned for traumatic brain injury with neurocognitive disorder (TBI) is denied. FINDINGS OF FACT 1. Prior to June 12, 2015, the Veteran's PTSD is reasonably shown to have been manifested by symptoms productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; symptoms productive of occupational and social impairment with reduced reliability and productivity were not shown; from that date until March 8, 2016, the PTSD is not shown to have been manifested by symptoms productive of impairment greater than occupational and social impairment with reduced reliability and productivity; symptoms productive of occupational and social impairment with deficiencies in most areas were not shown. 2. Prior to March 30, 2016, symptoms attributable to the Veteran's residuals of TBI are shown to have a highest level of severity of "0" for the applicable 10 facets of disablement; from that date (aside from headaches which are separately rated), they are shown to have a highest level of severity of "2" for the applicable 10 facets of disablement. CONCLUSIONS OF LAW 1. The Veteran's PTSD warrants "staged" ratings of 30 percent from September 26, 2013 to June 12, 2015; and 50 percent from June 12, 2015 to March 8, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.130, Diagnostic Code (Code) 9411. 2. Increases in the 0 percent prior to March 30, 2016, and 40 percent from that date, ratings assigned for residuals of TBI are not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.124a, Code 8045. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from December 1987 to December 1991, and from September 2002 to June 2010. These matters are before the Board on appeal from a June 2014 Department of Veterans Affairs (VA) rating decision. An interim [June 2016] rating decision granted a 50 percent rating for PTSD effective June 12, 2015, and a 100 percent rating effective March 8, 2016. The June 2016 rating decision also granted a 40 percent rating for TBI effective March 30, 2016, as well as [separate] service connection for headaches due to TBI, rated 30 percent effective March 30, 2016. In November 2016 correspondence, the Veteran requested a videoconference Board hearing; however, in September 2019 correspondence, he withdrew the hearing request. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Reasonable doubt regarding degree of disability is to be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings." Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from one year before the claim was filed until VA makes a final decision on the claim. Id. A December 2011 rating decision assigned a 50 percent rating for PTSD from June 21, 2010 and a 0 percent rating from June 1, 2011. The rating decision also granted service connection for TBI and assigned a 0 percent rating from June 1, 2011. In a July 2013 rating decision, the RO continued the assigned noncompensable ratings for PTSD and TBI. The instant claim of entitlement to increased ratings for PTSD and TBI was received in September 2013. August 2013 hospital records reflect that the Veteran reported having bad headaches for 3 weeks, and a brain computerized tomography (CT) scan showed a large subdural hematoma. He was unable to give a precise history of any trauma that might have caused this, reporting that he "may have fallen in a pool while playing with his kids, but he is unsure." He was given a platelet transfusion because he had been taking aspirin. A repeat computerized tomography (CT) scan was stable from the previous day; he was then discharged to home from the emergency department. On April 2014 VA PTSD examination, the Veteran reported having a good relationship with his mother and distant relationships with his four siblings. He reported that he was divorced in 2012, but had resumed a relationship with his ex-wife three months earlier; he reported a good relationship with his ex-wife and great relationships with his two young children. He reported having a few friends with whom he kept in touch. He reported that he lived alone, but had daily contact with his sons. He reported that he enjoyed spending time with his family and riding his motorcycle, he prepared meals and completed household chores, and he drove and was able to manage activities of daily living independently. The Veteran reported having sporadic distressing thoughts and memories about his military service in Iraq. He reported sleep disturbance characterized by problems with sleep onset due to racing thoughts and paranoia. He reported mildly depressed mood, mild anxiety, mild insomnia, okay self-esteem, no guilt or hopelessness, no impulsivity or mania, infrequent passive thoughts of death, and no suicidal or homicidal ideation. He took Celexa, which he reported was somewhat beneficial. The Veteran reported that he did not drink alcohol or use illicit drugs. On mental status examination, the Veteran was casually dressed and groomed with good hygiene. His behavior was normal with no mannerisms. His speech was normal, and he communicated well with good eye contact. His affect was normal and broad in range, and his mood was euthymic. His thought processes were normal, logical, and goal-directed. His thought content was unremarkable, with no delusions, obsessions, or auditory or visual hallucinations. He was fully oriented with good attention and concentration. His insight was fair and judgment was good; his memory was within normal limits. His reported symptoms included anxiety. The examiner opined that the Veteran's PTSD resulted in a mental condition having been formally diagnosed, but symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. The examiner opined that the Veteran's PTSD symptoms did not appear to pose any significant functional impairment at that time; he complained of migraines that appeared to be related to the mild TBI diagnosed in service. On April 2014 VA TBI examination, the Veteran reported that he had not worked since 2010. His current ongoing symptoms included migraines, inability to remember what he has just read, and memory problems including inability to remember much from the 1990s, although he could remember things from before the 1990s. The examiner noted that, in August 2013, the Veteran was treated for a right-sided subdural hematoma following complaints of a severe migraine; his migraines were now back to baseline or a little better with no recurrence of the severe headache, and he had generally felt a bit better since then overall. He had no complaints of impairment of memory, attention, concentration, or executive functions. His judgment was normal. The Veteran's social interaction was routinely appropriate. He was always oriented to person, time, place, and situation. His motor activity and visual spatial orientation were normal. He had no subjective TBI symptoms and no neurobehavioral effects. The Veteran was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. His consciousness was normal. He had no additional residuals attributable to a TBI. Mild weakness of the entire left lower extremity was noted; otherwise, motor, deep tendon reflexes, sensation, heel-toe, finger-nose, and Romberg testing were all intact. On neuropsychological testing, the results likely did not represent a valid estimation of memory functioning; the examiner opined that the Veteran's level of performance suggests a strong possibility of an attempt to exaggerate memory deficits. The examiner cited 2009 TBI evaluations in which the examiners similarly noted test scores that were considered invalid and inconsistent with observed behaviors, with possible exaggeration or feigning of cognitive impairment. Magnetic resonance imaging (MRI) of the brain showed no significant abnormality. The examiner opined that the Veteran's residual conditions attributable to a TBI did not impact his ability to work. The VA examiner noted that the Veteran was diagnosed with a TBI in service and opined, based on the Veteran's report of the incident, that it was likely a very mild TBI with transience of any loss of consciousness and no post-event amnesia. The examiner noted that the records indicate the Veteran had onset of migraines during the deployment during which the TBI was also incurred, but neither he nor the STRs provide a chronology linking the migraines to the TBI; the examiner opined that, given this and the mild nature of the TBI, the migraines are less likely than not due to the TBI and more likely related to other psychosocial stressors. The examiner noted that the Veteran had a much more severe TBI post-service with an associated subdural hematoma. The examiner opined, given the mild nature of the in-service TBI, the highly inconsistent and invalid performance on multiple neuropsychological tests which are also inconsistent with his overall cognitive presentation, and his concomitant diagnosis of PTSD, the facets evaluated on the examination are all designated as negative in terms of representing sequelae of the Veteran's TBI and especially of his in-service TBI. The examiner opined that if there are any true neurobehavioral sequelae related to a TBI, which cannot be determined because of his invalid testing results, it is much more likely that they would be related to the more recent and severe TBI event. The examiner noted the Veteran's report of multiple subjective symptoms such as memory problems, poor judgment at times (including legal problems that he did not want to discuss), irritability/anger/aggressiveness at times, losing his train of thought at times, and headaches. However, the examiner opined that the relevant facets are designated as normal because a relationship to his in-service TBI was not found. The examiner opined that the left lower extremity weakness is unrelated to any TBI as it was found to be due to radiculopathy. On April 2014 VA headaches examination, the Veteran reported having migraines about once per week, described as frontal, with severe pain, sometimes constant and sometimes throbbing, with associated eye watering, nausea, malaise, photophobia, and phonophobia. He reported generally turning off the lights and crawling into bed; even if at somebody else's house, he will ask for a room when he can rest. He reported the headaches generally lasted a few hours or up to a day, and Tramadol sometimes aborted the headache. The pain was on both sides of the head and worsened with physical activity. He reported characteristic prostrating attacks of migraine/non-migraine headache pain once every month. He denied having very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic inadaptability. The examiner opined that the Veteran's headache condition impacts his ability to work, noting the Veteran's subjective report (not corroborated by any medical records) that he is unable to perform any type of work during prostrating headaches. Based on this evidence, the June 2014 rating decision on appeal continued 0 percent ratings for PTSD and TBI. On June 12, 2015 private treatment, the Veteran reported that he was living with his ex-wife and children. He reported that he had attempted some mental health treatment, but when his PTSD "kicked in", the providers "kicked him out". He reported having become verbally aggressive with past providers. He reported that he was not taking medications to treat his PTSD. He reported daily moderate (high) psychiatric symptoms, with some symptoms severe such as aggression toward others. He reported that he did not interact well with people, and he gets irritable and angry. He reported symptoms including intrusive recollections, nightmares, avoidance behaviors, difficulty concentrating, hypervigilance, irritability, anger, insomnia, anhedonia, an exaggerated startle response, depressed mood, tiring easily, appetite disturbance, fidgetiness, and low self-esteem. He reported being arrested multiple times for physical aggression, but had never served time in prison; his most recent violent behavior was about one year earlier, during which he wrecked his car because he thought someone was following him. He reported withdrawing socially over time, feeling emotionally detached from others including his ex-wife and children, and not having any friends, hobbies, or activities he enjoyed. On mental status examination, there were no impairments in the Veteran's thought processes. He denied any symptoms that would suggest a psychotic disorder or a bipolar condition. He was cooperative, amicable, and polite. He denied active suicidal or homicidal ideation, reporting that he periodically had morbid ruminations that his family would be better off if he were dead. He had the ability to maintain minimal hygiene and take care of basic activities of daily living. He was fully oriented. He reported having memory difficulties, such as forgetting to eat for up to two days, forgetting to take his medication, forgetting where he has placed items, and not remembering conversations or parts thereof. He reported being unable to recall a significant portion of memories from the 1990s, and he sometimes forgot how to play the drums. He reported difficulty concentrating. He was noted to have poor judgment but routinely appropriate social interaction. He reported no difficulties with motor or sensory systems or spatial orientation. The examiner opined that most of the Veteran's reported symptoms appeared to have the most prominent impact on his social interactions, and that the symptoms may be more related to PTSD than TBI. The examiner further opined that the Veteran's reported irritability, impulsivity, periodic verbal aggression, past physical aggression, and moodiness appeared to have the most salient impact on his social relationships, and that these symptoms may also be more related to PTSD than TBI. His consciousness was normal, and he was able to communicate by spoken and written language and comprehend both. He did not have obsessive-compulsive traits. His rate and flow of speech were normal, with no irrelevant, illogical, or obscure speech patterns present. He reported significant increases in anxiety followed by tremulous hands and difficulty breathing that appeared to "come out of the blue". The examiner opined that the Veteran's depressive symptomatology and anxious mood appeared to be part of his PTSD condition. His overall mood was dysphoric, though his affect appeared to be broad. He reported impaired impulse control patterns in the past. He reported chronic insomnia. The examiner opined that the Veteran's PTSD symptoms resulted in reduced reliability and productivity. In a March 2016 PTSD Disability Benefits Questionnaire (DBQ), the diagnoses included chronic PTSD, depressive disorder not otherwise specified, and cognitive disorder not otherwise specified. The treating psychiatrist who completed the DBQ opined that the Veteran's PTSD affected his occupational and social impairment, whereas TBI caused cognitive deficits and memory problems that impede his ability to function on a daily basis; she opined that he is below average in communication, socialization, and adaptive functioning, and his depression contributes to his decreased socialization and motivation. He was noted to be prescribed Neurontin as several other medications were ineffective or caused side effects. His reported symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, impairment of short and long term memory, circumstantial/circumlocutory/stereotyped speech, difficulty in understanding complex commands, impaired judgment, impaired abstract thinking, gross impairment in thought processes or communication, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances including work or a work-like setting, inability to establish and maintain effective relationships, impaired impulse control such as unprovoked irritability with periods of violence, grossly inappropriate behavior, intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene, and disorientation to time or place. The provider opined that patience was needed for the exam as the Veteran was easily frustrated with his limitations and could become overwhelmed, irritated, and mistrusting. The provider opined that the Veteran's PTSD included symptoms of personality disorder, irritability, social isolation, avoiding large crowds, hyperalertness, and nightmares; his depression included symptoms of depressed mood and tearfulness; and his cognitive disorder included symptoms of limited focus, being easily distracted, losing sense of time, and decreased short term memory. The provider opined that the Veteran's psychiatric diagnoses resulted in total occupational and social impairment, noting that all of the diagnoses affect his level of functioning. In a March 2016 VA PTSD examination, the Veteran reported intrusive memories and nightmares, and his main symptoms were hypervigilance, social withdrawal, and irritability. He reported that his relationship with his ex-wife, with whom he lived with their two young children, was supportive but problematic because of his behavior. He reported having no friends or social contacts in the area. He reported that he was not in touch with his family, though his ex-wife reported that he talks to some of them occasionally. He reported rarely going out, and his ex-wife had to push him to go out; he mostly stayed at home or went to doctor appointments. His main symptoms were noted to be cognitive issues (memory, attention, frontal executive) and he was easily distracted. He reported having nightmares twice a week and getting up to patrol the home during the night, resulting in little sleep. He reported that since the previous exam, he had been arrested for felony fleeing from the police in his car after they tried to pull him over and he crashed his car (in 2014). He reported several incidents of making angry calls to the VA Medical Center and the FBI got involved but no arrests resulted. His reported symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss such as forgetting names/directions/recent events, and disturbances of motivation and mood. On mental status examination, the Veteran was friendly with adequate hygiene and appearance. His responses tended to be hyperverbal, tangential, and he usually deferred to his ex-wife to answer questions as she brought a folder to assist in noting his symptoms and medical history. He and his ex-wife reported he was experiencing significant cognitive issues and behavioral impulsivity which would impair his ability to manage his finances. He denied active suicidal or homicidal ideation with intent but reported some momentary thoughts of violence and occasional thoughts of suicide when depressed. The examiner opined that the nightmares, hypervigilance, and social withdrawal were due to the PTSD; the irritability, emotional dyscontrol, insomnia, and depression could be due to either PTSD or TBI or both; and the headaches and cognitive impairment are due to TBI. The examiner opined that the Veteran's mental diagnoses result in occupational and social impairment with reduced reliability and productivity. In a March 2016 VA TBI examination, the Veteran reported that while deployed to Iraq in 2006, he was in the rare of an open Humvee when the vehicle behind his triggered an IED explosion; he does not remember the explosion, though he was told he was awake, and the next thing he remembers is being among enemy prisoners. He reported that he was on foot patrol a few weeks later when another IED exploded and caused him to be thrown back against a wall; it was unclear whether or not he briefly "blacked out," and he then continued in a firefight. Regarding memory, attention, concentration, and executive functions, the Veteran reported having had memory difficulties since 2006; he was noted to be a very poor historian and quite vague. The examiner noted that performance on the Mini-Mental state examination did not appear to be in keeping with his functioning otherwise. The examiner noted that previous neuropsychological evaluations showed results that were not considered to be valid or showed inadequate effort with a strong possibility of an attempt to exaggerate memory deficits. The examiner noted the history of a hypodense left subdural hematoma in 2013 and opined that any cognitive impairment, if present, is unrelated to the two mild TBI episodes occurring in 2006, and is related instead to the subdural hematoma occurring in 2013, years after separation from active military service. Regarding judgment, the Veteran was noted to have mildly impaired judgment related to his PTSD. Regarding social interaction, impaired social interaction was noted to be related to his PTSD. Regarding orientation, the Veteran was noted to be occasionally disoriented to one of the four aspects (person, time, place, situation), though the examiner opined that the validity of this "disorientation" is uncertain and it is not related to the two episodes of mild TBI occurring in 2006. His motor activity and visual spatial orientation were normal. Regarding subjective symptoms, the Veteran was noted to have posttraumatic migraine headaches with associated sensitivity to light and nausea. Regarding neurobehavioral effects, he was noted to have PTSD and behavioral symptoms which the examiner opined are unrelated to the two mild TBIs occurring during active service. The Veteran was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language, and his consciousness was normal. On March 2016 VA headaches examination, the Veteran reported having headaches since 2006; they were less frequent over the previous year and a half than they had been previously, now occurring on average once per month, with no triggers or auras. The headaches were described as a bilateral pain, steady or throbbing, accompanied by sensitivity to light and nausea, with duration of 2 to 3 hours, and reportedly prostrating; Tylenol was used to treat. He did not have very prostrating and prolonged attacks of migraine/non-migraine pain productive of severe economic inadaptability. The examiner opined that the Veteran's residual conditions attributable to TBI impact his ability to work due to prostrating headaches, lasting 2 to 3 hours, occurring an average of once a month. Based on this evidence, a June 2016 rating decision granted a 50 percent rating for PTSD effective June 12, 2015, and a 100 percent rating effective March 8, 2016. The June 2016 rating decision also granted a 40 percent rating for TBI effective March 30, 2016. The June 2016 rating decision granted service connection for headaches due to TBI, rated 30 percent effective March 30, 2016. The Veteran did not express disagreement with this decision. On January 2020 private psychological examination, the Veteran reported experiencing dissociative flashbacks, significantly impaired sleep, frequent nightmares regarding military trauma, feelings of guilt, paranoia, agitation sometimes severe, significantly diminished memory/concentration/focus, and distrust of others. He reported that his behavior toward VA became abrasive and threatening and he was banned from their services, leading him to seek non-VA treatment. He reported living with his spouse (whom he had re-married in 2016/2017) and two children, and he maintained normal activities of daily living. He reported being capable of driving his car but prefers not to, because the noise triggers his symptoms. He reported being essentially homebound, with limited activities, and he does not like being out in public; he does not socialize and denied any current interests or hobbies other than occasionally riding his motorcycle, but that could also make him paranoid. He reported disrupted sleep and frequent nightmares. He reported nearly daily flashbacks, resulting in daytime agitation and fatigue. He reported significantly impaired memory and concentration. The examiner opined that the Veteran's PTSD had caused a 70 percent disability according to VA criteria for the period from June 2010 to March 2016, based on occupational and social impairment with deficiencies in most areas, with symptoms including impaired impulse control, inability to tolerate stress or maintain effective relationships, and irritability with periods of violence. The Veteran has also submitted lay statements describing his difficulties due to his psychiatric and TBI disabilities. 1. Entitlement to increases in the (0 percent prior to June 12, 2015; and 50 percent from June 12, 2015 to March 8, 2016) staged ratings assigned for PTSD PTSD is rated under 38 C.F.R. § 4.130, Code 9411 and the General Rating Formula for Mental Disorders. A 10 percent rating is warranted when there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events. A 50 percent rating is warranted when there is 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 (retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when 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 worklike setting); inability to establish and maintain effective relationships. 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. 38 C.F.R. § 4.130, Code 9411. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. Mauerhan v. Principi, 16 Vet. App. 436, 443 (2002). Because "[a]ll nonzero disability levels [in § 4.130] are also associated with objectively observable symptomatology," and the plain language of this regulation makes it clear that "the veteran's impairment must be 'due to' those symptoms," "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). "[I]n the context of a 70[%] rating, § 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Id. at 117. Although a veteran's symptoms are the "primary consideration" in assigning a rating under § 4.130, the determination as to whether the veteran is entitled to a 70% disability evaluation "also requires an ultimate factual conclusion as to the veteran's level of impairment in 'most areas.'" Id. at 118. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remissions. 38 C.F.R. § 4.126(a). The rating agency shall 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. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board finds that from the filing of this increased rating claim (September 26, 2013), symptoms and functional impairment reported by the Veteran, and noted by VA and private examiners and treatment providers, reasonably reflect that the Veteran's PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). He showed, and reported, symptoms including depressed mood, anxiety, and chronic sleep impairment. On April 2014 VA examination, he reported symptoms that meet, or at least approximate, the criteria for a 30 percent rating. Additionally, the treatment records reflect a level of functioning consistent with occasional decrease in efficiency since the filing of the September 26, 2013 increased rating claim. Accordingly, a 30 percent rating is warranted from that date. Prior to June 12, 2015, the reports of VA examinations, treatment records, medical statements, hearing testimony, and lay statements, overall, do not show that symptoms of the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity, so as to meet the criteria for the next higher (50 percent) rating. While he reported feeling anxious in crowds and avoiding large crowds, he consistently maintained relations with close family (his mother, ex-wife, and two young children), he kept in contact with a few friends, he enjoyed spending time with his family and riding his motorcycle, and he drove, prepared meals, and completed household chores. There was no evidence of a cognitive or thought disorder or impaired insight or judgment, and he consistently denied having suicidal ideation. The April 2014 VA examiner opined that the Veteran's PTSD symptoms were mild in severity. This disability picture does not reflect that due to PTSD he had occupational and social impairment with reduced reliability and productivity prior to June 12, 2015; instead, it reflects a reasonably well-functioning individual, with no deficiency in daily-activity functioning, thinking, or judgment, and with the ability to maintain familial relationships, several friendships, and regular leisure outings. Continuing the analysis, at no time prior to March 8, 2016 was the PTSD disability picture shown to be of greater severity than occupational and social impairment with reduced reliability and productivity, consistent with the 50 percent rating assigned for that period. The evidence of record does not show that manifestations of, or impairment due to, the Veteran's PTSD met (or approximated) a level of impairment reflective of occupational and social impairment with deficiencies in most areas at any time under consideration, so as to meet the criteria for the next higher (70 percent) rating). Treatment records and examination reports show that during that period he tended adequately to activities of daily living and he consistently denied suicidal ideation. No treatment record or examination report during that period shows a distinct period when there were symptoms of the nature and gravity of those listed in the criteria for a 70 percent rating, or any unlisted symptoms of equivalent nature and severity. While he reported isolating himself socially during that time, he nonetheless maintained relations with close family (his ex-wife, mother, and two young children). While he reported increased irritability and occasional impaired impulse control (aggression toward others), there is no evidence of a cognitive/thought disorder or impaired insight; although he displayed poor judgment at times, he had routinely appropriate social interaction. Notably, he was not taking any psychotropic medications during that time period, suggesting that he functioned adequately without needing such. This disability picture presented does not reflect that due to PTSD symptoms he had occupational and social impairment with deficiencies in most areas; instead, it reflects a reasonably well-functioning individual, with no deficiency in daily-activity functioning, and ability to maintain familial relationships. The June 2015 examiner opined that the Veteran's mental disorder resulted in occupational and social impairment with reduced reliability and productivity. Such findings are consistent with a level of impairment no greater than that associated with the currently-assigned 50 percent rating; the criteria for the next higher (70 percent) rating are not shown to have been met (or approximated) prior to March 8, 2016. The Board notes the lay statements submitted by the Veteran in support of this claim. They describe the types of problems that are associated with his PTSD. The disability picture presented by his own descriptions is encompassed by the criteria for the 30 percent and 50 percent ratings now assigned; even his own lay statements do not support that a further increased rating has been warranted at any time. 2. Entitlement to increases in the (0 percent prior to March 30, 2016, and 40 percent from March 30, 2016 to the present) staged ratings assigned for TBI Under Code 8045 there are three main areas of dysfunction that may result from a TBI and have profound effects on functioning: cognitive (which is common in varying degrees after a traumatic brain injury), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Cognitive impairment is to be evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified". Subjective symptoms may be the only residual of a TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, should be evaluated under the subjective symptoms facet in the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified". However, VA is to separately evaluate any residual with a distinct diagnosis that may be evaluated under another 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 a Traumatic Brain Injury Not Otherwise Classified" table. Emotional/behavioral dysfunction is evaluated 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, evaluate emotional/behavioral symptoms under the criteria in the table titled "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified". Physical (including neurological) dysfunction is evaluated based on the following list, under an appropriate 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. The preceding list of types of physical dysfunction does not encompass all possible residuals of a TBI. Residuals not listed in 38 C.F.R. § 4.124a, Code 8045 that are reported on an examination, are to be evaluated under the most appropriate code. Each condition is to be evaluated separately (as long as the same signs and symptoms are not used to support more than one evaluation), and the evaluations for each separately rated condition are combined under 38 C.F.R. § 4.25. The evaluation assigned based on the "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. The table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" contains 10 important facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 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. A 100 percent evaluation is assigned if "total" is the level of evaluation for one or more facets. If no facet is evaluated as "total", the overall percentage evaluation is assigned 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, a 70 percent evaluation is assigned if 3 is the highest level of evaluation for any facet. Notes following include: (1): There may be an overlap of manifestations of conditions evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. (3): "Instrumental activities of daily living" refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from "activities of daily living", which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. (4): The terms "mild", "moderate", and "severe" traumatic brain injury, which may appear in medical records, refer to a classification of a traumatic brain injury made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under Code 8045. Prior to March 30, 2016, the preponderance of the competent (medical) evidence is against a finding that the Veteran had a compensable level of impairment of any residual of TBI. While he reported some problems with memory, there was no objective evidence on valid testing that the mild impairment of memory is attributable to an in-service TBI; medical opinions in the record have attributed the memory impairment to a TBI after service. The Veteran's subjective symptoms of TBI were consistently reported on VA examinations (described above) as recurring headaches and memory loss. He did not report motor or sensory dysfunction; loss of sense of smell and taste; seizures; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; or endocrine dysfunctions. Therefore, separate ratings for residuals of TBI are not warranted. The Veteran's TBI warrants a 0 percent rating prior to March 30, 2016, based on the greatest impairment level assigned to a facet of TBI impairment being 0. The level of severity of each of the facets of TBI shown has been assessed as level 0 during that period. 38 C.F.R. § 4.124a, Code 8045. Considering the foregoing, the Board finds that a compensable rating for the Veteran's residuals TBI prior to March 30, 2016 is not warranted. The Board has considered the Veteran's subjective reports of his symptoms. However, his reported symptoms during that period (headaches and memory loss) were not attributed by a medical provider to the service connected TBI. Continuing the analysis, from March 30, 2016, service connection has been established for headaches secondary to TBI (the rating for the headaches is not at issue herein). The preponderance of the competent (medical) evidence is against a finding that the Veteran has at any time had a level of impairment of any other residual of TBI warranting a level of severity of "3" or "total". The memory, attention, concentration, and executive functions facet warrants a level of severity of "2" for objective evidence on testing of mild impairment of memory, attention, concentration or executive functions resulting in mild functional impairment. He did not report motor or sensory dysfunction; loss of sense of smell and taste; seizures; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; or endocrine dysfunctions. Therefore, separate ratings for residuals of TBI are not warranted. The Veteran's TBI warrants a 40 percent rating from March 30, 2016, based on the greatest impairment level assigned to a facet of TBI impairment being 2. The level of severity of each of the remaining facets of TBI shown has been assessed as level 0 during that period. 38 C.F.R. § 4.124a, Code 8045. Considering the foregoing, the Board finds that a rating in excess of 40 percent for the Veteran's residuals TBI is not warranted at any time. The Board has considered the Veteran's subjective reports of his symptoms. However, his reported symptoms of impaired judgment, impaired social interaction, and inappropriate behavior are being used to support the 100 percent rating for PTSD, as explained above. Pursuant to Note 1 under the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified", manifestations of a comorbid mental or neurologic or other physical disorder can be separately evaluated under another diagnostic code, if the manifestations are clearly separable. The examiners' opinions have consistently separated the symptoms attributable to PTSD from those attributable to residuals of TBI, and the ratings currently assigned for the Veteran's residuals of TBI reflect the separation accordingly. The Board notes the lay statements by the Veteran in support of this claim. They detail the types of problems he attributes to his TBI. The levels of functioning impairment he described are encompassed by the criteria for the 0 percent and 40 percent ratings assigned; they do not support that a higher schedular rating is warranted at any time. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechner, 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.