Citation Nr: 21032690 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 19-17 119 DATE: May 27, 2021 ORDER Entitlement to an effective date earlier than December 3, 2015 for the grant of entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and other specified trauma-and-stressor-related disorder, is denied. Entitlement to an effective date earlier than July 5, 2017 for the grant of entitlement to service connection for a traumatic brain injury (TBI) is denied. Entitlement to an initial rating in excess of 50 percent for PTSD is denied. REMANDED Entitlement to service connection for vertigo, claimed as dizziness, is remanded. Entitlement to service connection for a prostate disorder is remanded. Entitlement to an initial compensable rating for a TBI is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) prior to March 30, 2017, is remanded. Entitlement to special monthly compensation (SMC) based upon the need for aid and attendance of another person or by reason of being housebound is remanded. FINDINGS OF FACT 1. The Veteran filed a claim for entitlement to service connection for PTSD on December 3, 2015, and there was no formal claim, informal claim, or written intent to file a claim of entitlement to service connection for an acquired psychiatric disorder prior to that date. 2. The Veteran filed a claim for entitlement to service connection for a TBI on July 5, 2017, and there was no formal claim, informal claim, or written intent to file a claim of entitlement to service connection for a TBI prior to that date. 3. Throughout the period on appeal, the impairment associated with the Veteran's PTSD was productive of occupational and social impairment with reduced reliability and productivity without occupational and social impairment with deficiencies in most areas or total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an effective date earlier than December 3, 2015 for the grant of service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.400. 2. The criteria for entitlement to an effective date earlier than July 5, 2017 for the grant of service connection for a TBI have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.400. 3. The criteria for an initial rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from December 1963 to March 1968, to include service in the Republic of Vietnam. These matters come to the Board of Veterans' Appeals (Board) on appeal from April 2016 and March 2018 rating decisions issued by the Department of Veterans Affairs (VA) in Providence, Rhode Island. The Veteran requested an additional 90 days to submit evidence November 2020 and the Board granted that request in February 2021. This requested extension of time has now expired. This case was before the Board in September 2019, at which time the issues currently on appeal were remanded for additional development. Specifically, the Board remanded the instant matters to obtain updated VA treatment records and to obtain identified private treatment records. Updated VA treatment records have been associated with the record and the Veteran submitted appropriate authorization forms to allow VA to obtain private treatment records in October 2019. VA requested the private treatment records from the providers identified on the completed authorization forms in November 2019 and those requested records were received by VA in November 2019. The Board therefore determines that there has been substantial compliance with its previous remand. The case has now been returned to the Board for further appellate action. In an August 2020 rating decision, the agency of original jurisdiction (AOJ) granted entitlement to service connection for migraine headaches, representing a full grant of the matter previously on appeal. Accordingly, that matter is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). In an October 2020 rating decision, the Veteran was assigned an increased rating for his service-connected PTSD from 30 percent to 50 percent, effective December 3, 2015, as well as entitlement to a TDIU, effective March 30, 2017. As the Veteran is presumed to seek the maximum available benefits, those issues remain on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Effective Dates According to applicable law and regulation, except as otherwise provided, the effective date of an award of compensation based upon an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The date of entitlement to an award of service connection will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). The effective date of an evaluation and an award of compensation based on a reopened claim is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(2), (r). Thus, once a previous decision has become final, the earliest effective date of service connection generally is the date of the petition to reopen rather than the date of the initial claim. Exceptions to this rule include a later grant of service connection based in whole or in part on newly obtained service department records under certain circumstances, as provided in 38 C.F.R. § 3.156(c), and when the decision is revised or reversed on the basis of clear and unmistakable error, as provided in 38 U.S.C. § 5109A(a) and 38 C.F.R. § 3.105(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of doubt is afforded the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to an effective date earlier than December 3, 2015 for the grant of entitlement to service connection for acquired psychiatric disorder, now characterized as PTSD The Veteran generally asserts that an effective date earlier than December 3, 2015 is warranted for the grant of service connection for an acquired psychiatric disorder. Specific argument in support of this appeal has not been submitted. The basic facts in this case are not in dispute. The Veteran filed a formal claim for, in pertinent part, entitlement to service connection for PTSD on December 3, 2015. On the December 2015 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ), the Veteran checked "no" to the question "[h]ave you ever filed a claim with VA?." The claim was granted and classified as an other specified trauma-and stressor related disorder in a March 2018 rating decision, effective March 30, 2017. In a May 2019 rating decision, the RO assigned an effective date of December 3, 2015 which is the date the Veteran filed the VA Form 21-526EZ. There are no formal claims, informal claims, or written intent to file a claim of entitlement to service connection for a psychiatric disorder to include PTSD of record prior to December 3, 2015 and the Veteran has not contended otherwise subsequent to that date. As noted above, the assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Generally, the effective date of an evaluation and award compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. In this case, the date of claim is the later of the two dates, and, as such, is the appropriate effective date. 38 C.F.R. § 3.400. The Board acknowledges that the Veteran may have had a diagnosis of a psychiatric disorder prior to filing his claim for service connection for that disability, indicating that entitlement to service connection for such disability arose prior to the December 3, 2015 date of claim. However, the effective date of service connection will be the date of claim or the date entitlement arose, whichever is later. Here, the date of claim is the later of the two dates and as such, is the appropriate effective date. 38 C.F.R. § 3.400; see Ingram v. Nicholson, 21 Vet. App. 232 (2007); see also McGrath v. Gober, 14 Vet. App. 28, (2000). Thus, the claim for an earlier effective date is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Entitlement to an effective date earlier than July 5, 2017 for the grant of entitlement to service connection for a TBI The Veteran generally asserts that an effective date earlier than July 5, 2017 is warranted for the grant of service connection for a TBI. Specific argument in support of this appeal has not been submitted. The basic facts in this case are not in dispute. The Veteran filed a formal claim for, in pertinent part, entitlement to service connection for a TBI on July 5, 2017. The claim was granted in a March 2018 rating decision, effective July 5, 2017. There are no formal claims, informal claims, or written intent to file a claim of entitlement to service connection for a TBI of record prior to July 5, 2017 and the Veteran has not contended otherwise subsequent to that date. As noted above, the assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Generally, the effective date of an evaluation and award compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. In this case, the date of claims is the later of the two dates, and, as such, is the appropriate effective date. 38 C.F.R. § 3.400. The Board acknowledges that the Veteran may have had a diagnosis of a TBI prior to filing his claim for service connection for that disability, indicating that entitlement to service connection for such disability arose prior to the July 5, 2017 date of claim. However, the effective date of service connection will be the date of claim or the date entitlement arose, whichever is later. See Ingram v. Nicholson, supra; see also McGrath v. Gober, supra. The Board notes that the Veteran filed claims for, in pertinent part, headaches, tinnitus, PTSD, sleep issues and dizziness in March 30, 2017. The claims for tinnitus and headaches were subsequently granted and assigned effective dates of March 30, 2017, respectively. The Veteran's service treatment records show that the Veteran experienced an August 1967 in-service motor vehicle accident in which he was knocked unconscious for a few minutes. In his March 2017 VA Form 21-526EZ, the Veteran did not indicate that any of the above-mentioned disabilities were related to an in-service TBI. While VA has an obligation to interpret a claimant's submissions broadly, VA is not required to conjure up issues not raised by claimant. That is to say, VA is not required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. Brannon v. West, 12 Vet. App. 32, 35 (1998) (medical records cannot constitute an initial claim for service connection but rather there must be some intent by the claimant to apply for the benefit); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). Rather, it is the "unequivocal command" of 38 U.S.C. § 5110 (a) that the effective date of benefits cannot be earlier than the filing of an application therefore. Rodriguez v. West, 189 F.3d 1351, 1354 (Fed. Cir. 1999). Here, there is no probative evidence that the Veteran identified a TBI in conjunction with his March 2017 formal claims for service connection for headaches, tinnitus, PTSD, sleep issues and dizziness at any time before his July 2017 formal claim. Hence, it cannot be said that this claim was "raised by the evidence" until the submission of the July 2017 claim. In this case, there is no evidence that the Veteran raised the issue of entitlement to a TBI prior to his July 5, 2017 claim. Here, the date of claim is the later of the two dates and as such, is the appropriate effective date. 38 C.F.R. § 3.400. Thus, the claim for an earlier effective date is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Increased Rating Claim Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. 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. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant's current symptoms. See Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). 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 concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); 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 basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claim. PTSD The Veteran generally asserts that he should have a higher rating for his PTSD as it is worse than contemplated by the currently assigned rating. This appeal stems from a claim dated in December 2015. During the period on appeal, the Veteran's PTSD is rated 50 percent under Diagnostic Code 9411, which assigns ratings based upon the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. 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 such as, retention of only highly learned material, forgetting to complete tasks; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. 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 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, or 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; and the inability to establish and maintain effective relationships. Id. A maximum 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 and place; memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed in the General Rating Formula for Mental Disorders are not intended to constitute an exhaustive list. Rather, the symptoms serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the Veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all 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. The Board notes that with regard to the use of the phrase "such as" in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment. The Board acknowledges that psychiatric examinations frequently include assignment of a global assessment of functioning (GAF) score. The American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5), and 38 C.F.R. § 4.130 has been revised to refer to the DSM-5. The DSM-5 does not contain information regarding GAF scores. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, without change, the interim final rule and clarified that the provisions of the final rule did not apply to claims that were pending before the Board, this Court, or the U.S. Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In Golden v. Shulkin, 29 Vet. App. 221 (2018), the Court held that given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. This appeal was certified to the Board in March 2021. As such, the DSM-5 applies, and the GAF scores will not be considered. In October 2017, the Veteran was afforded a VA examination and the examiner diagnosed other specified trauma-and-stressor-related disorder. At that time, the Veteran reported that had retired two years prior. The Veteran indicated that he was married for 50 years and that he lived with his wife and two sons, with who he had a good relationship. On examination, the Veteran presented as casually dressed and appropriately groomed. He was pleasant and cooperative, and he maintained good eye contact. His thought-process was linear and goal-oriented, and he was well-oriented to person, place and time. The Veteran's attention, concentration and memory were intact, and he demonstrated good insight and judgment. The Veteran denied experiencing delusions, ritualistic behavior, and hallucinations, as well as suicidal or homicidal ideation or intent. The examiner reported that the Veteran's other specified trauma-and-stressor-related disorder was productive of depressed mood, anxiety, chronic sleep impairment, irritability, exaggerated startle response, problems with concentration, sleep disturbances and avoidant behavior. The examiner opined that the Veteran's other specified trauma-and-stressor-related disorder was most productive of 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. In an April 2019 letter from the Veteran's wife, N.G., she indicated that the Veteran's anxiety had worsened since he stopped working, and that he experienced hypervigilance, exaggerated startle response, intrusive memories, nightmares and irritability. In a July 2019 letter from the Veteran's friend, D.W., he indicated that the Veteran had experienced anxiety for several years. In a subsequent July 2019 letter from the Veteran's sister-in-law, D.G., she commented that the Veteran experienced increased moodiness, he tended to avoid social interactions, and he had difficulty sleeping and difficulty with work engagements. At an August 2020 VA examination, the examiner diagnosed PTSD. At that time, the Veteran indicated that he lived with his wife of more than 50 years. He reported that he had a good relationship with his two sons and his six grandchildren. He commented that he had very positive relationships with all of his family members and that he had a great marriage. The Veteran reported that he had a couple of friends with who he talked with once or twice a month by phone. He indicated that he primarily spent time with his wife, sons and their families. The Veteran indicated that he took care of the house, and that he enjoyed gardening. As for employment, he reported that he had been retired for approximately five years. On examination, the Veteran presented as appropriately dressed and well groomed. He was well oriented to person, place and time. He had flattened affect and presentation was congruent with slightly depressed mood. The Veteran denied experiencing delusions, ritualistic behavior, and hallucinations, as well as suicidal or homicidal ideation or intent. The examiner reported that the Veteran's PTSD was productive of depressed mood, anxiety, irritability, avoidant behavior, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbances, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, including work or a work like setting. The examiner opined that the Veteran's PTSD was most productive of occupational and social impairment with reduced reliability and productivity. A review of the record shows that the Veteran receives treatment at the VA Medical Center for various disabilities. However, there is no indication from the record that his acquired psychiatric disorder symptoms are manifestly different than those reported at above-mentioned examinations and in buddy statements. Of note, throughout the appeal period, the Veteran has denied experiencing suicidal ideations. Indeed, as much was noted in the VA treatment records as well as the private and VA examination reports of record. Based on the evidence of record, lay and medical, the Board finds that the Veteran is not entitled to a rating in excess of 50 percent at any time during the appeal period. In this regard, the Veteran's overall disability picture more closely approximates the criteria for a 50 percent rating, which, as mentioned above, contemplates occupational and social impairment with reduced reliability and productivity without social and occupational impairment with deficiencies in most areas or total social and occupational impairment. Impairment to mood was demonstrated as the Veteran consistently reported anxiety and depression. Impairment to family relations was not shown as the Veteran reported that he had good relationships with his wife and family. For instance, the Veteran reported that he lived with his wife of more than 50 years and that he had a good relationship with his sons and six grandchildren in an August 2020 VA examination. Impairment to judgment or thinking was not shown as he exhibited no delusions, hallucinations, obsessive rituals, or suicidal ideations. Neither school nor work were attempted during the appeal period, as the Veteran indicated that he had retired. The Veteran reported, among other symptoms, depressed mood, anxiety, irritability, avoidant behavior, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbances, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, including work or a work like setting. 38 C.F.R. § 4.130, Diagnostic Code 9411. Moreover, the October 2017 an August 2020 VA examiner reported that the Veteran's acquired psychiatric disorder was productive of, at worst, occupational and social impairment with reduced reliability and productivity. The Veteran appeared well groomed at each examination, and his speech was not illogical, obscure, or irrelevant. Further, the Veteran was able to appropriately engage with the examiner and was described as cooperative and well-oriented to all spheres during the above-mentioned examinations. Additionally, there is no evidence that the Veteran's acquired psychiatric disorder significantly interfered with his ability to perform his job, as he reported that he had not worked for several years because he retired. The Board acknowledges that the August 2020 examiner reported that the Veteran's acquired psychiatric disorder was productive of difficulty in adapting to stressful circumstances, criteria associated with a 70 percent rating. However, the Board does not find that the Veteran's symptomatology in terms of frequency, duration, or severity more closely approximates a 70 percent rating for social and occupational impairment with deficiencies in most areas. To that end, when taking into account all of the symptomatology of record, social, and occupational impairment was to a lesser degree than deficiencies in most areas. See Bankhead v. Shulkin, No. 15-2404 (Vet. App. May 9, 2017) (noting that the presence or lack of evidence of a specific sign or symptom listed in the evaluation criteria is not necessarily dispositive of any particular disability level); Vazquez-Claudio, 713 F.3d at 117 -18. Additionally, the Board finds that at no point pertinent to the higher rating claim has the Veteran displayed a total social and occupational impairment as indicated by symptoms such as spatial disorientation, gross impairment in thought processes or communication, persistent delusions, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place and memory loss for names of close relatives, own occupation or own name. The Veteran was not totally socially impaired as he reported that he had a good relationship with his wife and family and that he had a few friends with who he stayed in contact. Therefore, a total level of impairment had not been demonstrated in the clinical evidence or alleged by the Veteran. For these reasons, a total rating for a PTSD is not warranted. See 38 C.F.R. § 4.130, Diagnostic Code 9411. In assessing the severity of the PTSD, the Board has considered the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. The Board notes the contentions of the Veteran that his PTSD is more severe than currently shown on examination; and the Board observes that the Veteran, while competent to report his observable symptoms, he is not competent to report that his mental health symptoms are of sufficient severity to warrant a higher rating under VA's tables for rating such disabilities because such an opinion requires medical expertise which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002). Despite the foregoing, the Board acknowledges the Veteran and his representative's reports of the Veteran's symptoms. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher 70 or 100 percent ratings are not met. The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). This argument is therefore without merit. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning a staged rating is not warranted. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In this case, the preponderance of the evidence is against a rating in excess of 50 percent for the Veteran's PTSD and the claim must, accordingly, be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND The Board finds that additional information is required before the remaining claims on appeal may be decided. Service Connection Vertigo In October 2017, the Veteran was afforded a VA examination. The examiner diagnosed benign paroxysmal positional vertigo and opined that it was less likely than not related to an in-service injury or event. In support of this conclusion, the examiner commented that there was no evidence of pre-syncope or vertigo in the Veteran's service treatment records and that the Veteran's given history described symptoms that began long after his separation from service. The Board finds that it is unable to decide the claim based on the findings contained within the October 2017 VA etiology opinion. In this regard, the examiner relied heavily on the absence of documented treatment or a diagnosis of vertigo until several years following the Veteran's separation from service in forming the negative nexus opinion. Moreover, the examiner did not explain the significance, if any, of self-reported symptoms occurring several years following the Veteran's separation from service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran's vertigo. Prostate Disorder In October 2017, the Veteran was afforded a VA examination. The examiner diagnosed benign prostatic hypertrophy and opined that it was less likely than not related to an in-service injury or event. In support of this conclusion, the examiner commented that there was no evidence of a prostate condition in the Veteran's service treatment records and that benign prostatic hypertrophy is caused by hormonal changes that naturally occur with age. The Board finds that it is unable to decide the claim based on the findings contained within the October 2017 VA medical opinion report. In this regard, the examiner did not address whether the Veteran's prostate disorder was related to his presumed exposure to herbicide agents. Moreover, the examiner relied heavily on the absence of in-service treatment of a prostate cancer in forming the negative nexus opinion. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran's prostate disorder. Increased Rating Claims TBI The Veteran asserts that his TBI symptoms are more severe than contemplated by the currently assigned noncompensable rating. The Veteran has reported that he experiences dizziness and the record shows that dizziness could be related to an in-service head injury. The Board has determined that a remand is necessary for that claim in order to obtain medical nexus opinions. As the outcome of that claim may affect the rating assigned for the Veteran's TBI, the Board finds that it is appropriate to defer adjudication of the TBI claim until a determination is made with regard to entitlement to service connection for dizziness. Entitlement to SMC The Board notes that the issues of entitlement to SMC is inextricably intertwined with the claims remanded herein, as the Veteran's SMC claim is predicated on those claims. Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). Hence, a determination on the claim for entitlement to SMC should be deferred pending final disposition of the each of the Veteran's claims on appeal. Entitlement to a TDIU prior to March 30, 2017 The issue of entitlement to TDIU is inextricably intertwined with the claims remanded herein. Harris, 1 Vet. App. 180, 183. Hence, a determination on the claim for entitlement to a TDIU prior to March 30, 2017 should be deferred pending final disposition of the claims for entitlement to an increased rating for a TBI as well as entitlement to service connection for dizziness and a prostate disorder. The matters are REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records dated from September 2020 to the present. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to address the nature and etiology of the Veteran's vertigo. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is at least as likely as not (50 percent or better probability) that any currently present vertigo had its onset during his active service or is otherwise etiologically related to such service, to include to include in-service exposure to herbicide agents (notwithstanding the fact that there may not be a presumed association)? (B) Is at least as likely as not (50 percent or better probability) that the Veteran's vertigo was caused OR aggravated by his service-connected residuals of a TBI? The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 3. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to address the nature and etiology of the Veteran's prostate disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present prostate disability, to include benign prostatic hypertrophy, had its onset during his active service or is otherwise etiologically related to such service, to include to include in-service exposure to herbicide agents (notwithstanding the fact that there may not be a presumed association)? The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 4. Following the completion of the above, as well as development for the claim of entitlement to service connection for a left knee disability, the Agency of Original Jurisdiction should consider whether additional development is warranted as a result of the above (e.g., development for entitlement to an increased rating for a TBI, and entitlement to SMC and a TDIU). KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher O'Donnell, 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.