Citation Nr: 21032178 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 20-28 515 DATE: May 26, 2021 ORDER Entitlement to an initial 100 percent rating for post-traumatic stress disorder (PTSD) prior to March 11, 2013 is granted. Entitlement to an earlier effective date of December 13, 2011, for the award of Dependents' Educational Assistance (DEA) benefits is granted. REMANDED Entitlement to a cardiovascular disability, including as secondary to Agent Orange or PTSD is remanded. FINDINGS OF FACT 1. The Veteran's PTSD has caused total social and occupational impairment since December 13, 2011, the date of his claim. 2. The Veteran has been shown to be permanently and totally disabled as of December 13, 2011. CONCLUSIONS OF LAW 1. The criteria for a 100 percent rating for PTSD as of December 13, 2011 are met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.16, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for an earlier effective date of December 13, 2011, for the award of DEA benefits are met. U.S.C. §§ 3510, 5110, 5113; 38 C.F.R. §§ 3.400, 3.807, 21.3021. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from January 1963 to January 1966, including service in Vietnam. These matters come before the Board of Veterans' Appeals (Board) on appeal of November 2012 and September 2018 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). With regard to the claim for increased rating for PTSD, the November 2012 rating decision granted service connection for PTSD and assigned a 50 percent rating effective January 18, 2012. The Veteran timely disagreed with the rating assigned. A December 2014 rating decision granted a temporary 100 percent rating for PTSD from October 8, 2013 through March 1, 2014 due to hospitalization over 21 days. A January 2015 rating decision then granted a 70 percent rating for PTSD. The Veteran continued to disagree with the rating assigned, as well as its effective date. A September 2018 rating decision found clear and unmistakable error in the effective date of the award of service connection for PTSD and granted a 50 percent rating effective December 13, 2011. The RO also assigned a 100 percent rating effective March 11, 2013. The Veteran continued to disagree with the effective date for the 50 percent rating. Although the Veteran has asserted an earlier effective date for his 100 percent rating is warranted, the Board notes that the claim for an initial increased rating has been pending throughout the appeal. In April 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript has been associated with the claims file. Increased rating for PTSD The Veteran argues that his symptoms of PTSD have remained the same since he filed his claim for compensation on December 13, 2011. His PTSD is currently rated as 50 percent disabling from December 13, 2011, and 100 percent disabling from March 11, 2013. In a December 2011 statement in support of claim, the Veteran reported that in the past year he had been having increasing PTSD symptoms, including trouble sleeping due to nightmares, survivor's guilt, increasing irritability and anger outbursts, problems with maintaining relationships, and issues with his work. He reported that he had been demoted three times in the last four years. He felt himself isolating and numbing from his family, resentful of his superiors, and distant from his friends. He was easily moved to tears about anything having to do with war or combat. In January 2012, the Veteran was laid off from his employment, and has not been able to maintain employment since. The record reflects that the Veteran initially presented for psychiatric treatment in March 2013, and subsequently entered an inpatient treatment program for 120 days. However, the Veteran and his deceased spouse have reported that his symptoms were at least the same (or worse) prior to treatment. In a January 2015 statement, the Veteran's spouse indicated that the Veteran's symptoms had worsened over the previous five years but had especially worsened since his January 2012 layoff. During the April 2021 Board hearing, the Veteran similarly stated that his symptoms were severe prior to his layoff, but that they "triggered more by being fired." The Board notes that the Veteran is competent to report the onset of his severe psychiatric symptoms, and the Board finds him credible in this regard. Based on the foregoing, the Board finds that the Veteran's symptoms have been the same throughout the appeal period. Therefore, a 100 percent rating is warranted from the date of his claim. The appeal is thus granted. Earlier effective date for DEA benefits Given the Board's grant here of an effective date of December 13, 2011 for the 100 percent evaluation for PTSD, entitlement to DEA arose on December 13, 2011. Therefore, an effective date of December 13, 2011, for the award of DEA is granted. REASONS FOR REMAND Service connection for cardiovascular disability, including on a secondary basis The Veteran asserts that his cardiovascular disability, diagnosed as cardiomyopathy and congestive heart failure, is related to his service in Vietnam. In the alternative, he asserts that the stress related to his PTSD has caused or aggravated his cardiovascular disability. A March 2012 VA examiner found that the Veteran did not have ischemic heart disease and thus did not qualify for presumptive service connection. However, the examiner failed to render an opinion as to whether the Veteran's cardiovascular disability is directly related to service, to include his exposure to Agent Orange. Consequently, the opinion is inadequate. Moreover, given the Veteran's contentions regarding a relationship between his PTSD and his cardiovascular disability, an opinion regarding this theory of secondary service connection should be rendered as well. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination with a qualified clinician to determine the nature and etiology of any cardiovascular disability/ies present. Following review of the claims file, interview of the Veteran, and any diagnostic testing deemed necessary, the examiner should respond to the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's diagnosed cardiovascular disability is related to service, to include conceded Agent Orange exposure? (b.) Is it at least as likely as not that the Veteran's diagnosed cardiovascular disability is caused or aggravated by the Veteran's post-traumatic stress disorder? A complete rationale must be provided. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Roya Bahrami, 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.