Citation Nr: 21040050 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 16-56 189 DATE: July 2, 2021 ORDER Restoration of a 70 percent disability rating for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder), is granted effective February 26, 2015. Entitlement to a rating in excess of 30 percent for migraine headaches is denied. Entitlement to service connection for gastritis is denied. REMANDED Entitlement to a rating in excess of 10 percent for lumbosacral strain is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Entitlement to a rating in excess of 70 percent for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder) is remanded. FINDINGS OF FACT 1. At time of the reduction, the 70 percent rating for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder) had been in effect for less than five years. 2. The preponderance of the evidence does not reflect improvement in the Veteran's acquired psychiatric disorder and improvement in the Veteran's ability to function under the ordinary conditions of life and work. 3. The preponderance of the evidence fails to establish that the RO's decision to reduce the Veteran's rating for an acquired psychiatric disorder complied with the applicable regulations. 4. The most probative evidence shows that the Veteran's symptoms of migraine headaches most closely approximate a 30 percent rating with characteristic prostrating attacks occurring on average of once per month over the last several months. 5. The preponderance of the evidence is against a finding that the Veteran's gastritis is related to service. CONCLUSIONS OF LAW 1. The reduction in the Veteran's disability evaluation from 70 percent to 50 percent for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder) was improper and the 70 percent rating is restored, effective February 26, 2015. 38 U.S.C. §§ 1155, 5112; 38 C.F.R. §§ 3.102, 3.105, 3.344, 4.130. 2. The criteria for entitlement to a rating in excess of 30 percent for migraine headaches are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a. 3. The criteria for entitlement to service connection for gastritis are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102. 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 2005 to June 2010. He served in Afghanistan and received the Afghanistan Campaign Medal with one Service Star, among other citations. This matter comes before the Board of Veterans' Appeals (Board) on appeal from April 2015 and August 2015 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO), the agency of original jurisdiction (AOJ). The Veteran was scheduled to attend a Board hearing on October 1, 2019. However, he did not appear for the Board hearing and did not provide good cause for failing to appear. Therefore, his hearing request is deemed to have been withdrawn. 38 C.F.R. § 20.704(d). Increased Rating Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Mental Disorders are rated under 38 C.F.R. § 4.130. A 50 percent rating is warranted for 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 (e.g., 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 for 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 for 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. 1. Entitlement to a rating in excess of 50 percent for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder) A January 2013 rating decision granted service connection for posttraumatic stress disorder (PTSD) and assigned a 70 percent evaluation effective July 1, 2010. The Veteran filed a claim for an increased evaluation on August 4, 2014. An April 2015 rating decision decreased the Veteran's evaluation to 50 percent for a changed diagnosis of depressive disorder with anxious distress. The Veteran filed a claim for an increased evaluation on May 11, 2015. Rating Reduction A Veteran's disability will not be reduced unless an improvement in the disability is shown to have occurred. 38 U.S.C. § 1155. When the propriety of a rating reduction is at issue, the focus is on the actions of the RO in effectuating the reduction, both in terms of compliance with the special due process considerations applicable to reductions, and in terms of whether the evidence at the time of the decision reducing the evaluation supported the reduction. The burden is on VA to justify a reduction in a rating. Such claim must be resolved in the veteran's favor unless the Board concludes that a preponderance of evidence weighs against the claim. Brown v. Brown, 5 Vet. App. 413 (1993). There are specific procedural requirements applicable to rating reductions. 38 C.F.R. §§ 3.105(e), 3.105(i). In this case, the rating decision that implemented the rating reduction did not decrease the Veteran's overall disability rating (combined evaluation for compensation). Therefore, the procedural requirements outlined in 38 C.F.R. § 3.105(e) and (i) were not applicable. Criteria governing certain rating reductions are found under 38 C.F.R. § 3.344. The provisions of 3.344(a) and (b) apply to ratings that have been continued for five years or more. Here, the rating was not in existence for five years or more and therefore, the provisions of 38 C.F.R. § 3.344 (a) and (b) do not apply. The provisions of paragraphs (a) and (b) apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating. 38 C.F.R. § 3.344 (c); Simon v. Wilkie, 30 Vet. App. 403, 410 (2018). In Brown v. Brown, 5 Vet. App. 413 (1993), the United States Court of Appeals for Veterans Claims stated that there are general VA regulations that apply to all rating reductions regardless of whether the rating has been in effect for five years or more. Id. at 420-421, citing 38 C.F.R. § 4.1, 4.2, 4.10, 4.13. Specifically, 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history. 38 C.F.R. § 4.2 establishes that it is the responsibility of the rating specialist to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Furthermore, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms. Additionally, not only must it be determined that an improvement in a disability has actually occurred, but that such improvement reflects improvement in ability to function under ordinary conditions of life and work. Brown, 5 Vet. App. at 420-21. In the instant matter, the Veteran was afforded a VA examination in February 2015. The examiner noted that the Veteran was previously diagnosed with PTSD but she determined that the Veteran did not meet the criteria for a diagnosis of PTSD. She opined that the Veteran's statements during the examination and his stressor statement "did not fit" with the stressors named in the initial PTSD evaluation. The examiner diagnosed the Veteran with depressive disorder with anxious distress. The examiner noted symptoms of depressed mood; anxiety; suspiciousness; chronic sleep impairment; impaired judgment; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. She opined that the Veteran's symptoms caused occupational and social impairment with reduced reliability and productivity. Based on this examination, in an April 2015 rating decision, the RO recharacterized the Veteran's psychiatric disorder as persistent depressive disorder with anxious distress. The RO stated that this reflected a change in the diagnosis of the Veteran's mental health condition but continuous service connection of his mental health symptoms remained. Then, the RO decreased the evaluation of the Veteran's psychiatric disability from 70 percent to 50 percent disability effective February 26, 2015, the date of the most recent examination. The RO found that this examination demonstrated improvement in the Veteran's mental health condition. The RO therefore assigned a 50 percent evaluation for persistent depressive disorder with anxious distress (previously rated as posttraumatic stress disorder) was based on: disturbances of motivation and mood impaired judgment difficulty in establishing and maintaining effective work and social relationships occupational and social impairment with reduced reliability and productivity chronic sleep impairment anxiety suspiciousness depressed mood. The RO noted that the Veteran's combined evaluation remained 70 percent or higher, therefore, the 60-day due process period was not warranted. The Veteran filed a claim for increased evaluation that was received on May 11, 2015. In determining whether the reduction was proper, the Board must focus upon evidence available to the RO at the time the reduction was effectuated, although post-reduction medical evidence may be considered in the context of evaluating whether the condition had actually improved. Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-282 (1992). Pertinent post-reduction evidence favorable to restoring the rating must be considered. Id. Here, the Board finds that the April 2015 VA examiner's rationale that supported the reduction in rating was inadequate. The examination report was internally inconsistent and the evidence discussed therein did not support a reduction in view of the history of the Veteran's disability, and other VA examinations and VA medical records indicating diagnosis and treatment of PTSD. The Board notes that this examination was ordered to ascertain the Veteran's current symptoms in relation to his claim for an increased rating for PTSD. The examiner noted that the Veteran received all of his post-military mental health treatment through the VA and that his mental health diagnoses included PTSD. The examiner focused much of her attention on challenging the Veteran's PTSD diagnosis when the Veteran's symptoms, rather than diagnosis, form the basis of his appeal for an increased rating. In turn, the RO did not adequately address the Veteran's symptoms in the context of the history of his disability or its effect on the Veteran's ability to function under the ordinary conditions of life and work. The United States Court of Appeals for the Federal Circuit has explained that evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir.2013). Also, the symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). When evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38 C.F.R. § 4.126 (a). Notably, the Veteran's medical records concerning the Veteran's suicidal ideation were not adequately addressed by the examiner or the RO. The file includes multiple reports of suicidal ideation and some reports of homicidal ideation. In June 2011, the Veteran expressed that sometimes he feels like things would be better if he were dead but denied any actual plan to end his life. He also expressed that sometimes he feels things would be better if his two brothers were dead but denied thinking about ending their lives. In January 2012, the Veteran reported previous suicidal ideation "when he was in a very dark place." The Board notes that the Veteran's symptom of suicidal ideation continued following the 2015 rating decision, and supports a 70 percent rating. Suicidal ideation is a symptom that is first addressed in a 70 percent evaluation and there is no distinction between passive and active suicidal ideation. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). In a January 2016, a psychiatric consultation notes that the Veteran reported a prior suicidal action described by the Veteran as trying to overdose on his medication and wrecking his car. The Veteran expressed feelings of hopelessness and reported that he had suicidal thoughts earlier that day. A May 2017 social worker assessment indicates that the Veteran reported that he was hearing voices arguing over his body and "over his soul" and had been homeless for the past year and a half. He was admitted to the hospital via emergency room with complaints of feeling exhausted and having thoughts of harming himself. He stated that if discharged, he would kill himself that night. A November 2019 treatment plan note indicated a history of "parasuicidal behaviors." The Veteran was afforded an examination in May 2021 for mental disorders. The examiner diagnosed persistent depressive disorder and generalized anxiety disorder. The Veteran's symptoms were differentiated between diagnoses as follows: Persistent Depressive Disorder - mood/motivation problems, chronic depression, problems with excessive guilt, problems coping with negative feedback, problems with self-destructive thoughts, memory issues, concentration problems, issues with finishing tasks. Generalized Anxiety Disorder - sleeping problems, irritability issues, problems with realistic thinking, problems coping with reality, problems with panic, issues with coping with stress, problems with adaptation, problems with impulse control, problems with judgment, problems with reality, problems with anger management, paranoia, hypervigilance, intrusive thoughts, and problems with exaggerated startle response. The examiner noted that the Veteran's Persistent Depressive Disorder/Generalized Anxiety Disorder creates issues with emotional stability, problems getting along with people, problems with concentration, memory, issues with stress, and problems with adaptation. The examiner found that the Veteran's diagnoses cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner differentiated the Veteran's impairments as follows: Persistent Depressive Disorder - impaired mood/motivation problems, impaired memory, impaired concentration, impaired ability to deal with negative feedback, and impaired ability to finish tasks. Generalized Anxiety Disorder - impaired ability to be emotionally stable over time, sleeping problems, hypervigilance, problems coping with reality, problems with anxiety, panic problems, issues with stress, impaired ability to handle stress, experiencing problems with paranoia, problems getting along with people, having issues with impulse control, and problems with judgment. The examiner stated that the Veteran has nightmares, intrusive thoughts, flashbacks, and sleeping issues. The Veteran suffers from anxiety around people, hypervigilance. The Veteran stays to himself. The Veteran does not want to be seen by people. Excessive worry, excessive anxiety, problems with negative thinking, and negative expectation were noted. The Veteran has low motivation, low energy, and has "given up things he has liked to do because of depression." The Veteran stated he has not been on a date in years. He has attachment problems and communication problems. The Veteran has not done anything athletic in years. He goes to the store when he must and then hurries home. The Veteran reported that he has struggled with anxiety and with people post-service. The Veteran stated that his concentration was affected and he had issues with learning. He reported that an assault in 2016 increased his PTSD symptoms. The Veteran stated that he has not been able to work and was homeless for 2 years. The examiner noted that the Veteran has had problems with emotional stability and continues in VA therapy. The Veteran reported suicidal ideation, including a prior attempt, and has no active plan. For rating purposes, the following symptoms were noted: depressed mood; anxiety; panic attacks that occur weekly or less often; near continuous panic or depression affecting the ability to function independently, appropriately and effective; chronic sleep impairment; impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks; flattened affect; having speech intermittently illogical obscure, or irrelevant; impaired judgment disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or work like setting; inability to establish and maintain effective relationships; obsessional rituals which interfere with routine activities; impaired impulse control, such as unprovoked irritability with periods of violence; persistent delusions or hallucinations; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene The examiner noted that the Veteran was cooperative and had good eye contact. He was agitated and depressed, and had flat affect. The examiner noted problems being coherent and illogical speech, sometimes not relevant and obscure. For the VA established diagnosis of persistent depressive disorder with anxious distress, the examiner stated that the diagnosis is changed to Persistent Depressive Disorder and Generalized Anxiety Disorder and is a progression of the previous diagnosis. The Veteran reported having suicidal ideation but has no plans at this time and the risk level was described as "low acute." Viewing the Veteran's symptoms along with his medical record and history, the Board finds that his symptoms at least approximate a 70 percent rating with occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/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; experiencing 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 an inability to establish and maintain effective relationships. The preponderance of the evidence does not demonstrate an improvement of the Veteran's service-connected acquired psychiatric disorder and improvement in the Veteran's ability to function under the ordinary conditions of life and work so as to warrant a rating reduction from 70 percent to 50 percent, effective from February 26, 2015, the date of the VA examination. 38 C.F.R. § 3.105 (e). In reduction cases, the burden of proof lies with VA to show that the Veteran's disability has undergone an observable improvement. The burden is on VA to establish by a preponderance of evidence that the rating reduction was warranted. Brown v. Brown, 5 Vet. App. 413, 421 (1993). The Board finds that VA has not met its burden and that the reduction in the Veteran's disability evaluation for his PTSD was therefore improper. The 70 percent rating is therefore restored. 38 C.F.R. § 3.105 (e). Entitlement to a rating in excess of 70 percent will be discussed in the remand section below. Entitlement to a rating in excess of 30 percent for migraine headaches An August 2012 rating decision granted service connection for migraines with a noncompensable evaluation from July 1, 2010. The Veteran filed a claim for an increased evaluation on August 4, 2014. Under Diagnostic Code 8100, a 30 percent evaluation is warranted for migraine headaches with characteristic prostrating attacks occurring on average of once per month over the last several months. The maximum schedular disability rating of 50 percent is assigned for migraine headaches with very frequent and completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a. The April 2015 rating decision increased the evaluation of the Veteran's migraine headaches from 0 percent disabling to 30 percent disabling effective June 28, 2014. The RO noted medical evidence which shows that the Veteran was treated by the emergency department for migraine headaches with associated photophobia and nausea six times beginning on June 28, 2014. Thus, six prostrating migraines were shown over a nine-month period. The Veteran did not attend a scheduled VA examination, and did not show good cause for his failure to do so. Therefore, medical evidence that could have been useful to support his claim was not available. A 30 percent evaluation was assigned based on: characteristic prostrating attacks occurring on an average once a month over last several months. The effective date of this grant was set as June 28, 2014, the date of the VA medical evidence showing an increase in disability. The Veteran filed a claim for increased evaluation that was received on May 11, 2015. An October 2016 Disability Benefits Questionnaire indicated diagnoses of migraines and tension headaches. The examiner noted a history of TBI with no residuals. The Veteran reported headaches had worsened in the past few months with worsening sensitivity to light and visual aura. He also reported nausea. The examiner noted pulsating or throbbing head pain, pain on both sides of the head and tension, sensitivity to light and sound, and changes in vision. The duration of the pain is typically less than one day. Characteristic prostrating attacks of migraine headache pain were noted once in two months. The examiner noted the Veteran has very frequent prostrating and prolonged attacks of migraine headache pain, and non-migraine headache pain more frequently than once per month. The Veteran was afforded a VA examination in May 2021 for headaches (including migraines). The examiner noted a diagnosis of migraine including migraine variants. The examiner interviewed the Veteran by telephone. The Veteran reported the onset of migraines while on active duty, in approximately 2009. He reported increasing severity and frequency of symptoms over time. The Veteran reported head pain, throbbing, involving frontal area and top of head. The Veteran reported occasional light and sound sensitivity, and visual changes described as "blurred vision, at times double vision." His headaches last approximately several hours, occurring 1-6 times per month, with occasional nausea. Treatment includes Imitrex, Tylenol or Ibuprofen. The examiner noted that the Veteran experiences pulsating or throbbing head pain and pain on both sides of the head. Non-headache symptoms were noted as nausea. sensitivity to light, sensitivity to sound, changes in vision (such as scotoma, flashes of light, tunnel vision). The duration of migraine headaches is less than one day. The examiner noted characteristic prostrating attacks of migraine/non-migraine headache pain with less frequent attacks. The examiner noted that the Veteran does not have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. The examiner stated that symptoms impact the Veteran's ability to work in that the Veteran should have the ability to rest in a work environment briefly (30-60 minutes) at the time of a moderate to severe headache. The Board finds that the Veteran's symptoms most closely approximate a 30 percent rating for migraine headaches with characteristic prostrating attacks occurring on average of once per month over the last several months. While the Veteran reported headaches 1-6 times per month, the examiner found characteristic prostrating attacks of migraine/non-migraine headache pain with less frequent attacks. The Veteran does not experience migraine headaches with very frequent and completely prostrating and prolonged attacks productive of severe economic inadaptability to warrant a 50 percent rating. Entitlement to a rating in excess of 30 percent is therefore denied. 3. Entitlement to service connection for gastritis The Veteran was diagnosed with gastritis in a VA emergency department in May 2015. He presented with complaints of persistent intermittent epigastric pain. He stated that he believed the fumes from the chemicals he was using at work made him ill. He reported relief with medication. In addition, the Veteran specifically denied any gastrointestinal complaints in the months leading to his discharge from active service in June 2010. An August 2015 rating decision denied service connection for gastritis. There is scant evidence in the file regarding any complaints of gastritis aside from that set forth above which indicates an acute gastritis occurrence that is, by the Veteran's report at that time, unrelated to service. Service treatment records also do not contain complaints, treatment, or diagnosis for this condition. The evidence of record does not show an event, disease or injury in service. There is no evidence of a link between the Veteran's gastritis and military service. A medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006); 38 U.S.C. § 5103(d)(2); 38 C.F.R. § 3.159(c)(4)(i). The Board finds that the evidence does not support a finding that an examination is required. The preponderance of the evidence is against the grant of service connection for gastritis. REASONS FOR REMAND 1. Entitlement to a rating in excess of 10 percent for lumbosacral strain An August 2012 rating decision granted service connection for lumbosacral strain and assigned a noncompensable evaluation from July 1, 2010. The Veteran filed a claim for increased evaluation that was received on May 11, 2015. An August 2016 rating decision increased the disability rating for service-connected lumbosacral strain from 0 percent to 10 percent, effective May 11, 2015. The RO stated this was an administrative change to reflect an erroneous evaluation. The Veteran's most recent examination took place in July 2015. The Board finds that a remand is necessary for a contemporaneous examination to determine the current level of impairment caused by the Veteran's disability. 38 C.F.R. § 3.327. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) As of this decision, the Veteran's rated service-connected disabilities are as follows: persistent depressive disorder with generalized anxiety disorder (previously rated as PTSD), 70 percent; migraine headaches, 30 percent; lumbosacral strain, 10 percent; and tinnitus, 10 percent. He therefore meets the criteria for entitlement to a schedular TDIU. 38 C.F.R. § 4.16(a). In addition, there must be evidence that the Veteran is unable to secure or follow a substantially gainful occupation. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Marginal employment is not considered substantially gainful employment. The central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran's claim for a TDIU is inextricably intertwined with his appeal for an increased rating and the proposed development will encompass that issue. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Therefore, a remand is required. Also, the Veteran submitted several VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability forms. He stated that he was unable to secure a full-time career and complete his education because of his disabilities. He reported on one such form that he last worked on November 30, 2015, in a part-time job that began on May 20, 2014. However, he also reported other dates as his last date of work. A VA Form 21-4192 Request for Employment Information in Connection with Claim for Disability Benefits completed by the Veteran's former employer on January 26, 2015 indicates the Veteran's May 20, 2014 starting date but noted that he was still working. The Veteran submitted pay stubs in 2015, however it is unclear whether any of the Veteran's employment was marginal. The file does not include complete employment and financial information and a remand is necessary to obtain such records. 3. Entitlement to a rating in excess of 70 percent for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder) In this decision, the Board has restored the Veteran's 70 percent rating for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder). 38 C.F.R. § 3.105 (e). The issue of whether the Veteran is entitled to a rating in excess of 70 percent remains on appeal. The Board finds the appeal for a rating in excess of 70 percent is inextricably intertwined with the pending development for entitlement to a TDIU, requiring remand. 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 In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in 'most areas.'" Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130, Diagnostic Code 9411. The remand of the Veteran's TDIU claim will result in further development of the occupational impairment caused by his service-connected disabilities. As such, the Veteran's claim for a rating in excess of 70 percent for an acquired psychiatric disorder to include persistent depressive disorder and generalized anxiety disorder (previously rated as posttraumatic stress disorder) is inextricably intertwined with the Veteran's TDIU claim and the requested development for that claim. The Board therefore remands the Veteran's increased rating claim for a psychiatric disorder until the completion of the requested further development related to his TDIU claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. The AOJ should schedule the Veteran for an examination with an appropriate examiner to determine the current manifestations and functional impairment caused by his service-connected lumbosacral strain disability. 2. The AOJ must conduct all necessary development to obtain evidence relevant to the issue of entitlement to a TDIU and to obtain from the Veteran complete financial status reports, including allowing him to submit financial information which substantiates his assertions of entitlement to a TDIU, such as W-2 tax forms, tax filings, salary pay stubs, billing statements, or any other pertinent information. 3. After the requested development is completed, the AOJ should request an addendum opinion addressing the manifestations and functional impairment caused by the Veteran's service-connected acquired psychiatric disorder. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Debra B. McLoughlin, Associate 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.