Citation Nr: A25035323 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 231201-398468 DATE: April 16, 2025 ORDER Entitlement to an earlier effective date (EED) of April 12, 2022, but no earlier, for special monthly compensation (SMC) based on housebound criteria is granted. Entitlement to service connection for adjustment disorder is denied. Entitlement to an EED of April 12, 2022, but no earlier, for a rating of 60 percent for chronic fatigue syndrome (CFS) is granted. Entitlement to a rating in excess of 60 percent for service-connected CFS from April 12, 2022 is denied. Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) (claimed as PTSD with depression) for the entire period on appeal is denied. FINDINGS OF FACT 1. From April 12, 2022, but no earlier, the Veteran did have a 100 percent service-connected disability with additional service-connected disabilities independently ratable at 60 percent. 2. The Veteran does not have and has not had a current disability of adjustment disorder during or proximate to the period on appeal. 3. For the year prior to the April 12, 2023, namely April 12, 2022, it is factually ascertainable that the symptoms of the Veteran's CFS more nearly approximated symptoms that were nearly constant and restricted routine daily activities to less than 50 percent of the pre-illness level. 4. From April 12, 2022, the symptoms of the Veteran's CFS more nearly approximated symptoms that were nearly constant and restricted routine daily activities to less than 50 percent of the pre-illness level. 5. For the period on appeal, the Veteran's PTSD was manifested by symptomatology resulting in occupational and social impairment with deficiencies in most areas, without more severe manifestations that more nearly approximate total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for an effective date of April 12, 2022, but no earlier, for the award of entitlement to SMC based on housebound criteria are met. 38 U.S.C. §§ 1114 (s)(1); 38 C.F.R. §§ 3.350, 3.400. 2. The criteria for service connection for adjustment disorder are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 3. From April 12, 2022, the criteria for entitlement to a rating of 60 percent for CFS are met. 38?U.S.C. §§ 5101, 5107, 5110; 38 C.F.R. § 3.102, 3.400, 4.7, 4.104, Diagnostic Code (DC) 6354. 4. For the period from April 12, 2022, the criteria for entitlement a rating in excess of 60 percent for CFS are not met. 38?U.S.C. §§ 5101, 5107, 5110; 38 C.F.R. § 3.102, 3.400, 4.7, 4.104, DC 6354. 5. Throughout the rating period on appeal, the criteria for a rating in excess of 70 percent rating for PTSD are not met. 38 U.S.C. §§1155, 5107; 38 C.F.R. §§4.1, 4.3, 4.7, 4.126, 4.130, DC 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Navy from January 28, 1988 to August 9, 1991. This matter comes to the Board of Veterans' Appeals (Board) from a July 2023 rating decision. The July 2023 rating decision: (1) granted SMC based on housebound criteria, effective from August 10, 2022; (2) denied a rating in excess of 70 percent for PTSD; (3) granted a 60 percent rating, effective April 12, 2023, for CFS; and (4) denied service connection for adjustment disorder. In the December 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the July 2023 agency of original jurisdiction (AOJ) decision. 38 C.F.R. § 20.301. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, the AOJ will readjudicate the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 1. Entitlement to an EED of April 12, 2022, but no earlier, for SMC based on housebound criteria is granted. The Veteran generally contends that he is entitled to an EED than August 10, 2022 for SMC based on housebound criteria. See VA Form 10182 of December 2023. SMC is a statutory benefit payable in addition to the compensation a veteran receives based on the Schedule for Rating Disabilities. 38?U.S.C. §?1114. SMC rates vary depending on the specific nature of a veteran's disability picture and eligibility requires a veteran to show specific disabling conditions. In order to establish entitlement to SMC under 38 U.S.C. § 1114(s), a veteran must have: (1) a single service-connected disability rated as "total," and (2) additional service-connected disability or disabilities independently ratable at 60 percent or more. 38 U.S.C. § 1114(s)(1); 38 C.F.R. §?3.350(i)(1). The first requirement can be satisfied by a total disability rating based on individual unemployability (TDIU), but only if the TDIU award is predicated on a single disability. See Buie v. Shinseki, 24?Vet. App.?242, 249-50 (2011); see also Bradley v. Peake, 22?Vet. App.?280, 289-93 (2008). Unless a veteran has a single disability that is sufficient to warrant a TDIU rating (or a 100% schedular rating for a single disability), he or she does not meet the criteria for SMC under section 1114(s). In the July 2023 rating decision, the Veteran was awarded entitlement to SMC(s)(1) with an effective date of August 10, 2022, the date he met the criteria. See July 2023 rating decision and Codesheet. In the instant decision on appeal, the Board has granted the Veteran an EED of April 12, 2022, for a 60 percent rating for CFS. As a result, the Veteran now meets the statutory requirements for the award of SMC under 38 U.S.C. § 1114(s)(1) as of that date, April 12, 2022. As such, an EED of April 12, 2022, but no earlier, is warranted for entitlement to an award of SMC(s)(1). 2. Entitlement to service connection for adjustment disorder is denied. The Veteran generally contends that he is entitled to service connection for adjustment disorder. See VA Form 10182 of December 2023. To establish service connection, it is required that the evidence demonstrates a current disability resulted from an injury or disease incurred or aggravated in active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In general, service connection requires the following: (1) evidence of a current disability; (2) evidence of an in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The initial question for the Board is whether the Veteran has a current disability that began during service or is related to an in-service injury, event, or disease based on the evidence of record at the time of the July 2023 AOJ rating decision that denied service connection for adjustment disorder. See 38 C.F.R. §§ 20.300(a), 20.301. In a June 2023 VA examination, the examiner conducted a video telehealth examination and reviewed the records. The examiner diagnosed the Veteran with PTSD and stated that "Adjustment Disorder is subsumed under PTSD." In a separate medical opinion by the examiner, the examiner stated that there was not a diagnosis made for adjustment disorder, as "Symptoms relevant to an adjustment disorder are subsumed under his PTSD diagnosis. No additional diagnosis was made." The record reflects that the Veteran has been awarded service connection for PTSD since June 2013. The Board finds that the examination and opinion of the June 2023 VA examination examiner highly probative as they reflect consideration of all relevant facts, including the Veteran's statements, and the examiners provided a rationale for the conclusions reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As a result, the Board finds that there is not an independent separate diagnosis of adjustment disorder. Based on the evidence of record, the Veteran does not have a current diagnosis of adjustment order and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Even though by filing his claim he asserts his belief that he has adjustment disorder and that it should be service-connected, the Veteran is not competent to provide a diagnosis or opinion in this case as he lacks the requisite medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Without evidence of a current disability, the claim for service connection for an adjustment disorder must be denied. 38 C.F.R. § 3.303(a); Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). Based on the foregoing, the Board finds the evidence persuasively weighs against the claim as there is no diagnosis, and the benefit-of-the-doubt doctrine is not for application. The claim therefore must be denied. 38 U.S.C. § 5107(b); see also See Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc); 38 C.F.R. § 3.102. 3. Entitlement to an EED of April 12, 2022, but no earlier, for a rating of 60 percent for chronic fatigue syndrome (CFS) is granted. 4. Entitlement to a rating in excess of 60 percent for service-connected CFS from April 12, 2022 is denied. The Veteran is seeking an EED and increased rating for his service-connected CFS. See VA Form 10182 of December 2023. The July 2023 rating decision on appeal granted an increased rating of 60 percent rating, from 40 percent, for CFS with the effective April 12, 2023 (date of the claim for an increased rating) under 38 C.F.R. § 4.104, DC 6354. Under DC 6354 for CFS ratings are provided for symptoms including debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms. 38 C.F.R. § 4.88b. Under DC 6354, a 40 percent rating is warranted for signs and symptoms of chronic fatigue syndrome that are nearly constant and restrict routine daily activities to 50 to 75 percent of the pre-illness level, or; the signs and symptoms wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year. A 60 percent rating is warranted for signs and symptoms of chronic fatigue syndrome that are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level, or signs and symptoms that wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year. A 100 percent rating is warranted for signs and symptoms of chronic fatigue syndrome that are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care. Here, on April 12, 2023, the Veteran submitted a new claim for his service-connected CFS via VA Form 21-526EZ. At that time, the Veteran was service-connected for CFS at 40 percent, effective June 12, 2013. See Rating decision Codesheet, received March 2, 2022. As a result, the claim filed for CFS was for an increased rating and the appeal period for the claim is from the date of the claim April 12, 2023, plus a one-year look back period that dates back to April 12, 2022. 38 C.F.R. 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Here, three possible dates may be assigned depending on the facts of a case: (1) if an increase in disability occurs after the claim is filed, the date that the increase is shown to have occurred (date entitlement arose) (38 C.F.R. § 3.400(o)(1)); (2) if an increase in disability precedes the claim by a year or less, the date that the increase is shown to have occurred (factually ascertainable) (38 C.F.R. § 3.400(o)(2)); or (3) if an increase in disability precedes the claim by more than a year, the date that the claim is received (date of claim) (38 C.F.R. § 3.400(o)(2)). See Harper v. Brown, 10 Vet. App. 125, 126 (1997). On April 25, 2023, a VA psychiatric clinic note showed the Veteran was having low energy and fatigue. In an examination dated June 5, 2023, the Veteran underwent a VA CFS examination and the examiner diagnosed the Veteran with CFS, and the current symptoms were "generalized muscle aches, fatigue lasting longer than 24 hours after exercise, headaches, depression, insomnia, migratory joint pain." The examiner noted that the Veteran was not taking any medications for the CFS, and that there was "debilitating fatigue reduced daily activity level to less than 50% of pre-illness level" and that has occurred for over six months. His symptoms associated with the CFS were debilitating fatigue, generalized muscle aches or weakness, fatigue lasting 24 hours or longer after exercise, headaches (of a type, severity or pattern that is different from headaches in the pre-morbid state), migratory joint pain, sleep disturbances, neuropsychological symptoms and sleep disturbance. The examiner reported no cognitive impairment and noted that the symptoms waxed and waned. Here, the Board finds the June 5, 2023, VA CFS examination is most probative and that via its finding that found there was "debilitating fatigue reduced daily activity level to less than 50% of pre-illness level" and that has occurred for over six months, that it is factually ascertainable that the condition worsened a year prior to the filing of the claim. As such, the Board finds that, when resolving reasonable doubt in the Veteran's favor, that the evidence demonstrates that he is entitled to a 60 percent rating as of April 12, 2022 (one year prior to the filing of the increased rating claim), which is the earliest possible effective date for the increase. 38 C.F.R. 3.400(o)(2); Gaston, 605 F.3d at 982. The Veteran is not entitled to a rating in excess of 60 percent for any period on appeal as that requires signs and symptoms of CFS that are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care. The record is devoid of any evidence showing any of the criteria in the 100 percent rating. As such, for the foregoing reasons, and resolving reasonable doubt in the Veteran's favor, the criteria for a rating of 60 percent are met as of April 12, 2022, but no earlier. 5. Entitlement to an EED and a rating in excess of 70 percent for PTSD is denied. The Veteran asserts that he is entitled to an EED and a rating in excess of 70 percent for his service-connected PTSD. See VA Form 10182 of December 2023. The July 2023 rating decision on appeal denied a rating in excess of 70 percent for PTSD, including depression, under 38 C.F.R. § 4.130, DC 9411. The Veteran was originally granted service connection for PTSD with depression with a 50 percent rating, effective June 12, 2013. See January 27, 2014, Rating decision. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned 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; or memory loss for names of close relatives, own occupation or own name. Here, on April 12, 2023, the Veteran submitted a claim for his service-connected PTSD with depression via VA Form 21-526EZ. At that time, the Veteran was service-connected for PTSD at 70 percent. See Rating decision Codesheet, received March 2, 2022. As a result, the claim filed for PTSD with depression was for an increased rating and the appeal period for the claim is from the date of the claim, April 12, 2023, plus a one-year look back period that dates back to April 12, 2022. 38 C.F.R. 3.400(o)(2); Gaston, 605 F.3d at 982. The evidence of record for the appeal period consists of a January 4, 2023 VA psychiatric consult record that noted that the Veteran reported that he has historically experienced symptoms of depression, irritability, and anger, and successfully completed therapy and medication management in the past. But that the recent loss of his brother and a changed relationship with his son, caused a reemergence of symptoms. The Veteran stated he had a strong relationship with his brother until his passing in 2022, but that his relationship with his other siblings was limited and that he "completely isolates." The Veteran has a son and they have a limited relationship at this time. Upon examination, the Veteran was well groomed, spoke in a normal rate and tone, had a dysphoric mood, had a logical and linear thought process, did not have delusions or hallucinations, did have suicidal ideation, but without a plan/intent, was oriented and had fair insight and judgment. The Veteran was diagnosed with major depressive disorder, recurrent severe without psychotic features, and PTSD. A January 19, 2023 VA psychiatric note reflects that the Veteran had depression and reported no difficulty with concentration. An April 25, 2023 VA psychiatric clinic note shows that the Veteran did not have any current suicidal ideation. In June 2023, the Veteran underwent a VA PTSD examination, via video telehealth. The Veteran was diagnosed with PTSD, and the examiner found that adjustment disorder was subsumed under the PTSD. See also VA Medical Opinion of June 2023. The examiner checked the box indicated that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner noted that the Veteran takes "Provigil. Insomnia. Impaired working and short-term memory. Angry outbursts. Obsessively checks/rechecks locks, disrupting routine." The Veteran's symptoms were: depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, impairment of short and long term memory, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting, obsessional rituals which interfere with routine activities and impaired impulse control. The Veteran was oriented to time and mood, affect, and cognition were normal and there was no current plan or intent for suicide. For the period on appeal which dates back to April 12, 2022 (with the 1 year look back from the filing of the claim for an increase on April 12, 2023), the above-mentioned evidence supports the conclusion that the Veteran's service-connected PTSD warrants a 70 percent rating, but no higher. The evidence shows the Veteran's symptoms including depressed mood, anxiety, sleep impairment and fatigue are symptoms associated with a 30 percent rating for PTSD. The symptoms of disturbances of motivation and mood, strained relations with his family are symptoms associated with a 50 percent rating and the suicidal ideation is a symptom of a 70 percent rating. The Board finds that when looking at the record as a whole, the severity, frequency, and duration of the Veteran's symptoms more closely approximate the symptoms (listed and unlisted) contemplated by a 70 percent rating throughout the entire period on appeal. Comparatively, the Board denies assigning the next higher rating of 100 for PTSD in the instant case. Specifically, during the claim period, the Veteran has not displayed symptoms listed or analogous to the criteria for a 100 percent. There is no showing of total social and occupational impairment due to the service-connected PTSD as to warrant the assignment of a schedular 100 percent rating evaluation at any time during the period of this appeal. Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). The weight of evidence shows that the service-connected PTSD causes social and occupational impairment with deficiencies in work and family relations, not total impairment and he does have a relationship with his family, albeit strained. Further, while the Veteran expressed passive suicidal ideation, which could rise to a persistent danger of self-harm, which is contemplated by the 100 percent criteria, the severity, frequency, and duration of the Veteran's passive suicidal ideation came and went and was relatively infrequent during the appeal period. As such, the Board finds it does not rise to the level contemplated by the 100 percent disability rating criteria, rather a 70 percent rating. Moreover, during the appeal period, medical examiners noted the Veteran was alert and oriented, had a logical and linear thought process, and did not have delusions or hallucinations. Thus, the weight of evidence of record does not reflect that during the period on appeal the symptoms were so severe, or frequent, or of such duration to cause total occupational and social impairment to warrant a 100 percent rating. In sum, the Board finds that the evidence of record demonstrates persuasively that the Veteran does not have total occupational and social impairment due to his PTSD. Based on the foregoing, the Board finds the evidence persuasively weighs against the claim for a rating in excess of 70 percent and the benefit-of-the-doubt doctrine is not for application. Thus, the Board concludes the criteria for a 100 percent disability rating are not met. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; see also See Lynch, 21 F.4th at 781-82. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Imber, M. 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.