Citation Nr: 22014993 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 16-03 250 DATE: March 16, 2022 ORDER Entitlement to service connection for vertigo is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for diabetes is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to an evaluation of 100 percent, for both appeal periods (which includes prior to October 27, 2020), for an unspecified anxiety disorder, now characterized as a major depressive disorder with anxious distress, is granted, subject to controlling regulations governing the payment of monetary awards. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is dismissed as moot. REMANDED Entitlement to service connection for fibromyalgia is remanded. FINDINGS OF FACT 1. The Veteran does not have vertigo that manifested in service or to a compensable degree within one year thereafter or that is otherwise related to his military service. 2. The Veteran does not have sleep apnea that manifested in service or to a compensable degree within one year thereafter or that is otherwise related to his military service. 3. The Veteran does not have diabetes that manifested in service or to a compensable degree within one year thereafter or that is otherwise related to his military service. 4. The Veteran does not have headaches that manifested in service or to a compensable degree within one year thereafter or that is otherwise related to his military service. 5. The Veteran does not have PTSD that manifested in service or to a compensable degree within one year thereafter or that is otherwise related to his military service. 6. For both appeal periods, the Veteran's symptoms related to his diagnosed unspecified anxiety disorder, now characterized as a major depressive disorder with anxious distress has resulted in total occupational and social impairment. 7. The Veteran is now in receipt of a 100 percent rating for service-connected major depressive disorder with anxious distress and a TDIU would not assist him in obtaining special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114(s). CONCLUSIONS OF LAW 1. Vertigo was not incurred in active service, nor may it be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 2. Sleep apnea was not incurred in active service, nor may it be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. Diabetes was not incurred in active service, nor may it be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 4. Headaches was not incurred in active service, nor may it be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 5. PTSD was not incurred in active service, nor may it be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 6. The criteria for entitlement to an evaluation of 100 percent, for both appeal periods, for major depressive disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Code (Code) 9434. 7. The issue of entitlement to a TDIU is moot. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty in the United States Army from December 1972 to July 1973. These matters come before the Board of Veterans' Appeals (Board) on appeal from February 2015 and October 2016 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The claims were remanded in October 2018 for further development. They have since been returned for appellate review. The Board notes the claims were remanded to the RO to attempt to obtain records related to compensation the Veteran reported receiving from the state and the United States Department of Agriculture (USDA) due to his disabilities. Moreover, an additional VA examination was necessary for the Veteran's service-connected anxiety disorder and headaches. A review of the claims file shows that the RO attempted on various occasions to obtain records from the USDA. Additionally, it notified the Veteran of its attempts and that they were unsuccessful. Moreover, other development has been conducted. Therefore, the Board finds there has been substantial compliance with the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). See also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial compliance would be required, not strict compliance). The appeal originally included a service connection claim for depression. In a November 2020 rating decision, during the pendency of the claim, the RO granted service connection for depression. It then recharacterized the Veteran's anxiety disorder claim to include depression and combined the evaluations for both disabilities. Therefore, the claim is now an increased evaluation claim for a major depressive disorder with anxious distress evaluated at 70 percent, effective October 27, 2020. Because the decision is not a full grant of benefits sought, the claim remains in appellate status. Also, additional evidence has been associated with the claims file since the February 2021 supplemental statement of the case. However, some of the records are not relevant to the claims being decided. Additionally, the Veteran submitted a waiver of additional evidence not previously considered by the RO. Thus, remand for RO consideration is not warranted for the claims decided in this decision as none of the records are pertinent to the claims. The Board notes that the Veteran has not been afforded a VA medical examination in connection with the claims for service connection for diabetes or sleep apnea. However, the Board finds that an examination is not warranted. Under the law, an examination or medical opinion is considered necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; (2) establishes that the veteran suffered an event, injury, or disease in service; and, (3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability. 38 C.F.R. § 3.159(c)(4). In the case of McLendon v. Nicholson, 20 Vet. App. 79 (2006), the United States Court of Appeals for Veterans Claims (Court) held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. In this case, a VA examination is unnecessary to decide the claims of service connection for diabetes or sleep apnea because the Veteran has not been shown to have an injury, disease, or injury in service. As discussed below, his service treatment records are negative for any complaints, treatment, or diagnosis of diabetes or sleep apnea, and he has not made any specific assertions that his conditions began in service or were caused by military service. Additionally, as it relates to the Veteran's diabetes and headaches, the records show that the Veteran did not have service in Vietnam, and the evidence does not otherwise establish exposure to herbicide agents. Therefore, because there is no event, injury, or disease in service to which a current disorder could be related, the Board finds that a VA examination is unnecessary in this case. 38 C.F.R. § 3.159(c)(4)(i) cf. Duenas v. Principi, 18 Vet. App. 512, 517 (2004), citing Paralyzed Veterans of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334, 1355-57 (Fed. Cir. 2003) (noting that a medical examination conducted in connection with claim development could not aid in substantiating a claim when the record does not already contain evidence of an in-service event, injury, or disease); Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). The Board notes the Veteran's representative requested additional time to submit evidence related to the claims. This extension was granted in a July 2021 correspondence. In October 2021, the Veteran's representative submitted additional evidence to be considered along with a waiver of the AOJ's consideration and any remaining time resulting from the extension. Lastly, the Board notes that the Veteran asserted that he could not retain employment due to his service-connected major depressive disorder. See October 2021 brief in support of Veteran's claims. In Rice v. Shinseki, the Court held that a request for TDIU is not a separate claim and that, "[w]hen entitlement to TDIU is raised during the adjudicatory process of the underlying disability or during the administrative appeal of the initial rating assigned for that disability, it is part of the claim for benefits for the underlying disability." 22 Vet. App. 447, 453-54 (2009). Therefore, the issue of entitlement to a TDIU was raised as part and parcel of the rating claim before the Board. Harper v. Wilkie, 30 Vet. App. 356, 361-62 (2018) (confirming that when the issue of entitlement to a TDIU is raised as part and parcel of a rating claim, it should be treated separately from a formal claim for TDIU in all aspects of the appeal). Neither the Veteran nor his representative has raised any other issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including headaches and diabetes, are presumed to have been incurred in service if they manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The Board notes the Veteran did not service in the Republic of Vietnam. Therefore, service connection based on a presumptive connection is not warranted in this case. Additionally, the Veteran has not asserted such fact. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Entitlement to service connection for vertigo is denied. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for vertigo. The Veteran's service treatment records are silent for any complaints, diagnosis, or treatment of vertigo. A December 1972 entrance examination noted that his systems were normal. However, the Board notes the Veteran's report of medical history indicated that he experienced a head injury before service, and he experienced dizziness and fainting spells. Upon separation, the Veteran's systems were noted as normal and he had no complaints. Some post-service treatment records show the Veteran experienced dizziness or lightheadedness with coughing. See November 2019 treatment record. See also March 2015 treatment record. However, VA treatment records do not provide an etiology for his dizziness and lightheadedness. Conversely, the Veteran has also denied having dizziness or lightheadedness. See November 2019 VA treatment record. Lastly, it does not appear the Veteran has a formal diagnosis of vertigo. The Veteran was afforded a VA examination in connection with his claim in February 2015. At that time, the examiner found the Veteran had not been diagnosed with an ear or peripheral vestibular condition. The examiner noted that the Veteran indicated in his entrance examination that he was occasionally dizzy but there is no evidence of treatment for such while he was in service. Ultimately, he opined that it is less likely than not the Veteran's vertigo was incurred in or caused by his military service. The Board notes the Veteran has not made any specific assertions regarding the etiology of his claimed vertigo or how it was caused or aggravated by his military service. Additionally, he has not submitted or identified any evidence of a currently diagnosed condition for which service connection may be granted. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of present disability there can be no successful claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328 (1997) (interpreting 38 U.S.C. § 1131 as requiring the existence of a present disability for VA compensation purposes). To be present as current disability, there must be evidence of the condition at some time during the claim period or approximate thereto. See Gilpin v. West, 155 F. 3d 1353, 1356 (Fed. Cir. 1998); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013) (the Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency). The Board also acknowledges the Veteran has filed a claim indicating his vertigo is related to his military service. However, he is not competent to render an official diagnosis of vertigo, but he is competent to attest to his symptomatology. The Board finds that the specific opinion of the February 2015 VA examiner as to diagnosis and etiology of the condition is of greater probative weight than the more general lay assertions in this regard. The VA examiner has medical training, knowledge, and expertise on which he relied. Moreover, there is no medical opinion otherwise indicating that the Veteran has current vertigo that is related to his military service. Based on the foregoing, the Board finds that the preponderance of the evidence weighs against the claim. Therefore, service connection is not warranted for vertigo. Entitlement to service connection for sleep apnea is denied. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for sleep apnea. The Veteran's service treatment records are negative for any complaints, treatment, or diagnosis of sleep apnea. A June 1973 separation examination indicated the Veteran's systems were normal and he had no complaints. VA treatment records show the Veteran was diagnosed with sleep apnea around 1986, more than 12 years after discharge from service. The Veteran has not made a specific assertion that his sleep apnea began in service. In addition to the lack of evidence showing that sleep apnea manifested during service or within close proximity thereto, the weight of the evidence of record does not otherwise relate the disorder to the Veteran's military service. As noted above, the record shows that there were no complaints, treatment, or diagnosis of sleep apnea in service, and the Veteran has not asserted otherwise. Indeed, he has not identified any injury, disease, or event in service to which a current disorder could be related. See 38 C.F.R. § 3.159 (c)(4)(i); cf. Duenas v. Principi, 18 Vet. App. 512, 517 (2004), citing Paralyzed Veterans of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334, 1355-57 (Fed. Cir. 2003) (noting that a medical examination conducted in connection with claim development could not aid in substantiating a claim when the record does not already contain evidence of an in-service event, injury, or disease). There is no medical opinion otherwise relating the Veteran's current sleep apnea to his military service. As noted above, the Veteran has not been afforded a VA examination in connection with his claim. However, the Board has found it is unnecessary as it has not been shown to have an injury, disease, or injury in service. Additionally, the Veteran has not made any specific assertions regarding his sleep apnea and its etiology. For the reasons outlined above, the Board concludes that the weight of the evidence is against a finding of entitlement to service connection for sleep apnea. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for diabetes is denied. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that service connection is not warranted for diabetes. The medical evidence clearly shows that the Veteran has a diagnosis of diabetes mellitus. See VA treatment records. See also December 2019 VA treatment record that shows diagnoses of medical comorbidities including morbid obesity, poorly controlled diabetes, cerebrovascular disease, poor exercise, tolerance. However, the service treatment records do not document any complaints, treatment, or diagnosis of diabetes mellitus. The Veteran's September 1963 separation examination noted that the Veteran's endocrine and genitourinary systems were found to be normal. Thus, the evidence does not suggest that diabetes mellitus manifested in service. Moreover, the Veteran has not identified any in-service injury or event which would have caused his diabetes. The evidence of record also shows that the Veteran did not seek treatment immediately after his military service or within one year thereafter for the condition. Rather, the evidence indicates that he was first diagnosed with diabetes mellitus many years after his military service. As noted above, the Veteran had never alleged that the disease had its onset in service, that there was a continuity of symptomatology since service, or that the disorder manifested within one year of his separation. Therefore, the Board finds that diabetes mellitus did not manifest in service or within one year thereafter, and there is no injury, disease, or event to which a current disorder could be related. See 38 C.F.R. § 3.159 (c)(4)(i); cf. Duenas v. Principi, 18 Vet. App. 512, 517 (2004), citing Paralyzed Veterans of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334, 1355-57 (Fed. Cir. 2003) (noting that a medical examination conducted in connection with claim development could not aid in substantiating a claim when the record does not already contain evidence of an in-service event, injury, or disease). There is no medical opinion otherwise relating the Veteran's current diabetes to his military service. As noted above, the Veteran has not been afforded a VA examination in connection with his claim. However, the Board has found it is unnecessary as it has not been shown to have an injury, disease, or injury in service. Additionally, the Veteran has not made any specific assertions regarding what he believes caused or relates his sleep apnea to his military service. Based on the foregoing, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for diabetes. As the preponderance of the evidence is against the claim, the benefit of the doubt provision does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, the Board concludes that service connection for diabetes is not warranted. Entitlement to service connection for headaches is denied. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for headaches. The Veteran's service treatment records are silent for any complaints, diagnosis, or treatment of headaches. As noted above, the Veteran's entrance and separation examinations indicated that all his systems were normal. See December 1972 and June 1973 examination reports. The Board does note that in his entrance report of medical history, the Veteran indicated that he experienced a head injury prior to service. Some post-service treatment records show the Veteran experienced throbbing headaches at the top of his head. See June 1991 VA treatment record. Ultimately, during that visit, he was diagnosed with hypertension, intermittent left side chest pain, obesity, and left facial numbness. Id. Due to the Veteran's history, of hypertension and headaches, the physician was concerned whether the Veteran had a small stroke. Another June 1991 treatment record shows the Veteran's final diagnosis was severe essential labile hypertension and morbid exogenous obesity. VA treatment records from March 2015 and July 2016 show that he experiences headaches. VA treatment records also show that the Veteran had occasional headaches with coughing. See December 2019 treatment record. However, the records do not contain a possible etiology of such. Conversely, there is evidence in the record in which the Veteran denied having headaches. See, e.g., March 2018 psychology note in which the Veteran denied chronic headaches or memory-related difficulties. A December 2017 physical report noted the Veteran did not experience any unusual headaches. In an April 2018 addendum for the mental health VA examination report, the examiner indicated the Veteran denied having chronic headaches. Indeed, after a review of the claims file, it appears the Veteran has not been diagnosed with a headache disorder. The Veteran was afforded a VA examination in connection with his claim in October 2020. The examiner noted the Veteran's assertions in which he stated that his headaches were caused by his anxiety disorder and other related symptoms and that his headaches are aggravated when he is stressed due to his disorder. He also referenced the Veteran's submission of medical journals in support of his claim. Following, the examiner detailed the Veteran's history of headaches. The examiner noted that the Veteran's service treatment records are silent for complaints and a diagnosis of headaches in service and that VA treatment records note the Veteran experiences headaches but not linked to his military service. He noted that the Veteran did not have a medical diagnosis for headaches and that there was no competent medical evidence to link the Veteran's anxiety and headaches. Therefore, he found there was presumably no connection between the Veteran's anxiety and headaches. In his opinion, the examiner opined it is less likely than not the Veteran's headaches were incurred in or caused by service. He relied on the fact that the Veteran denied his headaches began in service, the lack of complaints, treatment, and diagnosis in service, and noted that the Veteran's headaches did not start until years later, around 2000. He found that the Veteran's headaches were likely to rebound as he takes ibuprofen daily, and aggravated due to an esophageal condition that causes choking and coughing. He also found that it is less likely the Veteran's headaches were due to his service-connected condition as they began in the mid-2000s. He noted that during the examination the Veteran reported that his headaches began spontaneously and were aggravated by an esophageal condition, achalasia, that causes coughing and choking. Further, the Veteran did not describe his anxiety provoked or aggravated his headaches. The examiner found that, based on the Veteran's reports, there is no history showing the service-connected anxiety caused his headaches. He indicated there was no pathologic mechanism between anxiety and headaches, although he noted stress can provoke an existing headache condition. Lastly, for the same reason, the examiner opined that the Veteran's service-connected anxiety did not aggravate his headaches, adding that the Veteran's achalasia causes food and water to back up in the trachea which leads to coughing and chocking. He reiterated that, during the examination, the Veteran did not provide a history of his headaches being related to his anxiety but rather his achalasia. Lastly, the examiner noted that the Veteran achalasia was unrelated to his military service. The Board finds the examiner's opinion to be highly probative as it is based on a review of the claims file and medical history, including the Veteran's own reports and assertions during the VA examination. Further, he provided an adequate rationale for the conclusions reached. There is no medical opinion otherwise indicating that the Veteran has current headaches that are related to his military service or service-connected anxiety disorder. The Board also acknowledges the Veteran has filed a claim that indicated his belief that he has headaches are related to his military service and/or his service-connected disability. However, even assuming that he is competent to opine on this matter, the Board finds that the specific opinion of the October 2020 VA examiner is of greater probative weight than the more general lay assertions in this regard. The VA examiner has medical training, knowledge, and expertise on which he relied to form his opinion. He also considered the evidence of record, including the Veteran's reported history, and provided a rationale for the conclusions reached. Based on the foregoing, the Board finds that the preponderance of the evidence weighs against the claim. Therefore, service connection is not warranted for headaches. Entitlement to service connection for PTSD is denied. The Veteran has filed a claim asserting that he has PTSD related to service. However, after considering the merits of the claim, the Board finds that service connection for PTSD is not warranted. VA treatment records indicate the Veteran has been diagnosed with PTSD. A February 2015 psychiatric VA examination also notes this fact. In that examination report, however, the examiner indicated the Veteran has PTSD related to his pre-service history, namely being in foster care and abusive and neglectful environments. Thus, she found his PTSD was not connected or aggravated by his military service. The Board acknowledges that, in a March 2015 initial psychiatric assessment, the Veteran indicated he had PTSD due to a group of guys putting a hit out on him because they thought he turned them in for misconduct. As noted above, the service connection claim for PTSD was remanded in October 2018 for development. In December 2019, the RO sent the Veteran a subsequent development letter requesting specifics about his claimed stressful incident and in-service stressors. To date, the Veteran has not returned the questionnaire. In a February 2021 supplemental statement of the case (SSOC), the RO denied the claim noting that the Veteran did not respond to the request and indicating that, overall, the evidence did not show PTSD was incurred in or caused by his military service. Thus, currently, the probative evidence of record does not support the Veteran's claimed in-service stressor during his service. Therefore, the Board finds that entitlement to service connection for PTSD must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56 (1990). Increased Evaluations Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Entitlement to an evaluation of 100 percent, for both appeal periods (which includes prior to October 27, 2020), for an unspecified anxiety disorder, now characterized as a major depressive disorder with anxious distress, is granted. The Veteran's psychiatric disorder is currently rated at 30 percent evaluation prior to October 27, 2020, and 70 percent thereafter under the General Rating Formula for Mental Disorders (General Formula), to 38 C.F.R. § 4.130, Diagnostic Code 9434. Under Diagnostic Code 9434, a 30 percent evaluation is warranted when the psychiatric disorder results 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), due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation is warranted when the psychiatric disorder results in 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 evaluation is warranted when the psychiatric disorder results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. A 100 percent evaluation is warranted when the psychiatric disorder results in 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; and memory loss for names of close relatives, own occupation, or own name. The use of the term "such as" in the general rating formula for mental disorders 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 as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. 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. Id. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that "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." It was further noted that "§ 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." VA treatment records show that the Veteran experienced suicidal thoughts in connection with his wife's illness. However, he did not have a plan to hurt himself. See July 2016 VA record. Additionally, a November 2015 record indicated his depression had worsened. In a June 2016 evaluation by a private physician, the Veteran endorsed having panic attacks more than once a week, stress, and anxiety. The physician noted the Veteran experienced near-continuous panic or depression, intermittently illogical speech, gross impairment in thought processes and communication, difficulty adapting to stressful circumstances, suicidal ideations, obsessional rituals, impaired impulse control, unprovoked periods of violence, neglectful personal appearance and hygiene, intermittent periods of inability to perform daily activities, and disorientation to time and place. See June 2016 disability benefits questionnaire. He indicated these symptoms resulted in occupational and social impairment with deficiencies in most areas. In an April 2018 addendum to a mental health VA evaluation, the physician noted the Veteran had trouble managing his symptoms including avoidance, hypervigilance, and sleep impairment. He also endorsed intrusive thoughts, distress, and irritability. During a February 2015 psychiatric VA examination, the examiner noted the Veteran's military service aggravated this pre-existing anxiety disorder. At that time, she noted he experienced depressed mood, anxiety, chronic sleep impairment, mild memory loss, and neglect of personal appearance and hygiene resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. In a February 2015 addendum opinion, the examiner indicated that his anxiety disorder that produced symptoms of depressed mood, anxiety, chronic sleep impairment, mild memory loss, and neglect of personal appearance and hygiene resulted in an occupational and social impairment due to mild or transient symptoms. The Veteran was afforded another VA examination in connection with his claim in October 2020. He endorsed symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur more than once a week, chronic sleep impairment, mild memory loss-, short- and long-term memory loss, flattened affect, circumstantial speech, disturbance of mood and motivation, difficulty in relationships and stressful circumstances, neglect of personal appearance and hygiene, and intermittent ability to perform activities of daily living. The examiner found the symptoms resulted in total occupational and social impairment. After considering the Veteran's testimony and the evidence of record, the Board finds that his service-connected major depressive disorder manifested in total occupational and social impairment throughout both appeal periods. Here, evaluating the totality of the Veteran's symptoms during the entire claims period show that the Veteran has suffered from symptoms such as continuous panic attacks, irritability, to include unprovoked periods of violence, an inability to maintain relationships, and neglect of personal hygiene. In considering the totality of the Veteran's condition the Board finds that the Veteran, with irritability and suicidal ideations, throughout the claims period, has been a danger to both himself and others, and as such must be considered totally impaired, both occupationally and socially. As a result, an evaluation of 100 percent is warranted. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is dismissed as moot. Although a TDIU is warranted "where the schedular rating is less than total," a 100 percent schedular rating does not necessarily render the issue of entitlement to a TDIU moot, as the TDIU could in certain circumstances render the Veteran eligible for special monthly compensation benefits pursuant to 38 U.S.C. § 1114 (s). See Buie v. Shinseki, 24 Vet. App. 242 (2010); Bradley v. Peake, 22 Vet. App. 280 Under that statute, additional compensation is warranted when the Veteran has a "service-connected disability rated as total" and "additional service-connected disability or disabilities independently ratable at 60 percent or more." 38 U.S.C. § 1114 (s)(1). If a TDIU were based on a disability other than major depressive disorder, that other disability could serve as the service-connected disability rated total and the major depressive disorder could serve as the additional disability ratable at 60 percent or more. In this case, however, there is no evidence or argument that the Veteran's other service-connected disabilities tendinitis of the right leg and foot-- render him unemployable. Consequently, those disabilities could not satisfy the "disability rated total" criterion of 38 U.S.C. § 1114 (s) by serving as the basis for a grant of TDIU. Given that the Veteran has been granted a 100 percent rating for major depressive disorder in this decision, a TDIU based on the condition would not assist him in meeting the criteria of 38 U.S.C. § 1114 (s), as the combined rating for the other service-connected disabilities is less than 60 percent. Consequently, the issue of entitlement to a TDIU is moot. REASONS FOR REMAND Entitlement to service connection for fibromyalgia is remanded. A review of the claims file shows that the Veteran was diagnosed with fibromyalgia by a private physician. See July 2016 records in which the VA physician notes the Veteran's takes outside medications for pain and fibromyalgia. These records may contain pertinent evidence related to the etiology of the Veteran's condition. To date, the RO has not attempted to obtain these records. Therefore, remand is necessary to secure the records. The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for fibromyalgia. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA treatment records. 2. After completing these actions, the AOJ should conduct any other development as may be indicated. Zi-Heng Zhu Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M. Walker 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.