POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served in the Army from October 1966 to October 1968, appeals the denial of an increased rating for his post-traumatic stress disorder (PTSD) and the propriety of a combined rating for his traumatic brain injury (TBI) and PTSD. The veteran is currently rated at 70 percent for PTSD, effective January 13, 2016. The Board reviewed evidence including VA examinations from April 2016, January 2017, August 2022, and August 2024, along with lay testimony from the veteran and his spouse. The August 2024 examination noted symptoms consistent with a 50 percent rating, but the Board found the overall evidence, including lay testimony and other medical notes, supported the existing 70 percent rating due to deficiencies in most areas of occupational and social functioning, such as irritability, memory loss, and difficulty with relationships. The Board denied the increased rating for PTSD, finding the evidence did not support total occupational and social impairment. The case was remanded for a new TBI examination by a qualified specialist due to concerns about the adequacy of the prior examination and the veteran's contention that his TBI residuals, including tinnitus and headaches, were not properly assessed. Additionally, the case was remanded for further development regarding entitlement to a higher rating for liver disease, as the prior rating decision did not fully resolve the increased rating claim for the entire appeal period.

Rationale

Veteran's symptoms do not meet criteria for total occupational and social impairment.; Evidence does not show gross impairment in thought processes, persistent delusions/hallucinations, or grossly inappropriate behavior.; Veteran maintains relationships and has good hygiene/appearance, contradicting total impairment.

Full Decision Text

Citation Nr: 25003801
Decision Date: 03/20/25	Archive Date: 03/20/25

DOCKET NO. 20-11 234
DATE: March 20, 2025

ORDER

Entitlement to a rating higher than 70 percent for post-traumatic stress disorder (PTSD) is denied.

REMANDED

Entitlement to a separate compensable rating for traumatic brain injury (TBI) is remanded.

Entitlement to a compensable rating prior to August 20, 2024, and a rating higher than 30 percent thereafter, for cirrhosis of the liver with hepatitis C with laceration, liver, residuals (previously rated as hepatitis C with laceration, liver, residuals, shell fragment wound) is remanded.

FINDING OF FACT

For the entirety of the appeal period, the severity, frequency, and duration of the Veteran's PTSD symptoms have more closely approximated occupational and social impairment with deficiencies in most areas; total occupational and social impairment has not been shown.

CONCLUSION OF LAW

The criteria for a disability rating higher than 70 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.126 ,4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Army from October 1966 to October 1968. 

This matter was previously before the Board of Veterans' Appeals (Board) in August 2023, and remanded for additional development to include obtaining contemporaneous VA examinations that address the nature and severity of the disabilities on appeal. The matter has returned to the Board for appellate review.

Regarding the characterization of the issues on appeal, prior to August 20, 2024, the Veteran was in receipt of a noncompensable for TBI, effective January 13, 2016, under Diagnostic Code 8045. However, in a December 2024 rating decision, the Agency of Original Jurisdiction (AOJ) awarded a 70 percent rating for the Veteran's posttraumatic stress disorder (PTSD) with TBI, effective January 13, 2016, pursuant to Diagnostic Code 9411.

Notably, the rating criteria for TBI instructs that related pathology, such as an acquired psychiatric disorder, should be evaluated separately pursuant to the rating criteria for that distinct disorder. Given this context, the Board has interpreted the Veteran's claim for a higher rating for his TBI to encompass consideration of the propriety of a separately assigned rating for his TBI.

This appeal has been advanced on the Board's docket. 38 U.S.C. § 7107 (a)(2); 38 C.F.R. § 20.902 (c).

Increased Rating

Disability evaluations 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. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that 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 a veteran. 38 C.F.R. § 4.3.

Entitlement to a rating higher than 70 percent for post-traumatic stress disorder (PTSD)

The Veteran contends that he is entitled to an increased rating for his PTSD because his symptoms are more severe than contemplated by the currently assigned rating. He is currently rated at 70 percent disabling for PTSD effective January 13, 2016 (date of increased rating claim). 

When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant's capacity for adjustment during periods of remission. VA shall assign a rating 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
Entitlement to a rating higher than 70 percent for post-traumatic stress disorder (PTSD)

The Veteran contends that he is entitled to an increased rating for his PTSD because his symptoms are more severe than contemplated by the currently assigned rating. He is currently rated at 70 percent disabling for PTSD effective January 13, 2016 (date of increased rating claim). 

When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant's capacity for adjustment during periods of remission. VA shall assign a rating 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). When rating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b).

Psychiatric disabilities are rated based on the General Rating Formula codified in 38 C.F.R. § 4.130, which provides disability ratings are based on a spectrum of symptoms. "A veteran may qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of a similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. See Mauerhan v. Principi, 16 Vet. App. 436, 44243 (2002). VA is to engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran's service connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017).

Pursuant to the General Rating Formula for Mental Disorders, a rating of 70 percent 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 work like setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411.

A rating of 100 percent 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. Id.

The "such symptoms as" language of the diagnostic codes for mental disorders in 38 C.F.R. § 4.130 means "for example" and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, as the Court also pointed out in that case, "[w]ithout those examples, differentiating a 30 percent rating from a 50 percent rating would be extremely ambiguous." Id. The Court went on to state that the list of examples "provides guidance as to the severity of symptoms contemplated for each rating." Id. Accordingly, while each of the examples needs not be proven in any one case, the particular symptoms must be analyzed in light of those given examples. Put another way, the severity represented by those examples may not be ignored.

Although the General Rating Formula for Mental Disorders provides specific examples of symptoms that may result from various acquired psychiatric disorders, the Board emphasizes that its analysis should not be limited to only these symptoms but should also consider any other relevant criteria outside of the rating code in order to determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). As such
 list of examples "provides guidance as to the severity of symptoms contemplated for each rating." Id. Accordingly, while each of the examples needs not be proven in any one case, the particular symptoms must be analyzed in light of those given examples. Put another way, the severity represented by those examples may not be ignored.

Although the General Rating Formula for Mental Disorders provides specific examples of symptoms that may result from various acquired psychiatric disorders, the Board emphasizes that its analysis should not be limited to only these symptoms but should also consider any other relevant criteria outside of the rating code in order to determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). As such, the Board has also considered the extent to which there are other indications of occupational and social impairment, such as difficulty in adapting to stressful circumstances or the inability to establish and maintain effective relationships that may cause total social and occupational impairment.

The issue in this appeal is whether the Veteran's associated PTSD symptoms have caused the level of impairment required for a disability rating higher than 70 percent.

A review of the record reveals that the Veteran has sought mental health treatment from the VA for his PTSD. To the extent that the Veteran's treatment records contain information relevant to the severity of his mental health, to include mental health screenings, the Board will summarize this evidence.

At the April 2016 VA examination, it was observed that the Veteran's grooming and hygiene were good. His eye contact was good. Mood was agitated. Affect was congruent and appropriate. Speech was of normal tone, rate, and prosody. Thought process and content were within normal limits. There were no signs of thought disorder, delusions, or hallucinations. He was fully oriented to person, place, time, and circumstance. The Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment, impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks, inability to establish and maintain effective relationships, impaired impulse control, such as unprovoked irritability with periods of violence, and low frustration tolerance. The examiner opined that the Veteran's PTSD resulted 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 normal routine behavior, self-care, and conversation. See April 2016 C&P Examination.

In a January 2017 VA treatment report, the Veteran endorsed items on a self-report measure, indicating mild signs and symptoms of depression. It was noted that overall, his cognitive functioning remains intact from a neurocognitive point of view. He demonstrated no symptoms of cognitive decline. It was noted that his day-to- day experience of attentional difficulties was likely a reflection of comorbid factors, including disrupted sleep, and emotional state. It was recommended that the Veteran follow up with mental health to address mood issues and mild depression. See CAPRI.

In an August 2022 Mental Health Note, the Veteran denied suicidal/homicidal ideation. He reported that he still struggles daily with memory of injury event and was trying to put the pieces together because he does not remember anything about his injury occurrence. He endorsed having nightmares and stated that gardening helps to keep him calm. See CAPRI.

Following the Board's remand directives, the Veteran was afforded a VA examination in August 2024. The Veteran stated that he currently lives with his wife, that they have been married for 15 years, and that he has five children. He stated that he has a good relationship with his children and his grandchildren. The Veteran reported he is a fisherman, that most of the time he fishes alone and sometimes he fishes with other Vietnam veterans. He stated that he used to go on date nights with his wife, but that they have different personalities, and it often clashes and therefore they don't go out as much. The Veteran stated some marital issues and discord between him and his current wife.  He reported he lives on his farm, and he enjoys growing his own vegetables and fruits. The Veteran reported he has moments of lashing out towards others and becomes emotionally charged in his relationships, which sometimes can be verbal and physical towards others. The Veteran reported that he enjoys traveling and visiting his family but also reported that he has cut off a lot of friends and family. The Veteran reported that he is currently not receiving any mental health treatment, although he stated that from the late 1980s to the early 2000s, he received treatment, which he pointed were ineffective. The Veteran stated that he is not currently taking any psychiatric medications and has not been hospitalized due to mental health reasons, nor does he harbor suicidal thoughts. He reported that marijuana does helps him to stay calm and rested. The Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment, mild memory loss, such as forgetting names
 emotionally charged in his relationships, which sometimes can be verbal and physical towards others. The Veteran reported that he enjoys traveling and visiting his family but also reported that he has cut off a lot of friends and family. The Veteran reported that he is currently not receiving any mental health treatment, although he stated that from the late 1980s to the early 2000s, he received treatment, which he pointed were ineffective. The Veteran stated that he is not currently taking any psychiatric medications and has not been hospitalized due to mental health reasons, nor does he harbor suicidal thoughts. He reported that marijuana does helps him to stay calm and rested. The Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting. The examiner remarked that the Veteran's mental disorders have overlapping symptoms with residual symptoms from TBI making it difficult to differentiate which symptoms attribute to each diagnosis. On behavioral observations, the examiner made the following notations: "The Veteran was polite, open, and cooperative. The Veteran was dressed casually and appropriately with good hygiene. Affect was appropriate to the content of the Veteran's speech. Thought process was tangential and often required redirection to answer questions more directly, he engaged in a lot of storytelling that ended up being off topic to the questions asked. There were other times when his expressed thoughts were logical and organized. There was no delusional thought content and no evidence of responding to internal stimuli. Speech and motor activity were within normal limits. Memory, attention, and concentration appeared intact. Veteran denied SI/HI, intent, and/or plan. The Veteran was alert and oriented x4." The examiner opined that the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity. See August 2024 C&P Examination.

Based on the evidence, the Board finds that although the Veteran suffers from significant impairment, as described above, there is not however a showing of total impairment as required for the 100 percent rating level under the diagnostic criteria. In order to warrant a 100 percent rating, a showing of "total occupational and social impairment" must be made. In this regard, the evidence of record does not show the Veteran's condition rising to the level of total social impairment. The record shows that the Veteran does maintain a relationship with his family. On the VA treatment reports and the April 2016 and August 2024 VA examinations, there were no report of neglect of personal appearance and hygiene. The Veteran denied hallucinations and delusions. The Veteran also reported that he is able to care for himself, and he appeared to be generally well oriented.

The Board finds that the evidence does not rise to the level of severity of 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; disorientation to time or place; or gross memory loss. In this regard, there is no evidence of perceptual disturbances such as hallucinations, mania or psychosis found on the VA mental status examinations. The Veteran's thought processes were found to not be impaired while his thought content was not found to include delusions. Furthermore, the Veteran has consistently been found to have appropriate hygiene and appearance.

The Board acknowledges that the August 2024 VA examiner found that the Veteran's service-connected PTSD resulted in occupational and social impairment with reduced reliability and productivity. Although this finding is consistent with a 50 percent rating under the General Rating Formula for Mental Disorders, the Board emphasizes that the record also documents the Veteran's internal struggles with his anxiety and depression, including his ability to interact appropriately with others, irritability and frustration, chronic sleep impairment, difficulty with concentration, along with the presence of mild memory loss. Therefore, the record as a whole, reasonably demonstrates that the Veteran's service-connected PTSD resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, such that a 70 percent disability rating is warranted.

In assessing the severity of PTSD, the Board has also considered the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In this regard, during the September 2022 Board hearing, the Veteran and his spouse testified that the Veteran is sometimes homicidal, has difficulties maintaining relationships due to his anger, impulsivity, and tendency to isolate by staying home (which the Veteran attributes to two unsuccessful marriages). The Veteran also expressed that he sometimes
 and/or mood, such that a 70 percent disability rating is warranted.

In assessing the severity of PTSD, the Board has also considered the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In this regard, during the September 2022 Board hearing, the Veteran and his spouse testified that the Veteran is sometimes homicidal, has difficulties maintaining relationships due to his anger, impulsivity, and tendency to isolate by staying home (which the Veteran attributes to two unsuccessful marriages). The Veteran also expressed that he sometimes has to be reminded to take a bath, that he forgets people's names especially his cousins, nieces, and nephews. The Veteran did not endorse hallucinations but stated that he has had "intuitive thoughts." See September 2022 Hearing Transcript. Here, although the Veteran has divorced twice, he maintains a marriage with his current wife. He is also involved in his children and grandchildren's lives. While the Veteran has also stated that he could be socially isolated and avoidant at times, he is fairly socially active with some leisure activities, and indicated that he goes fishing with some Vietnam veteran friends. Even though the evidence supports a finding that the Veteran is unable to establish and maintain effective relationships, it does not show that he has total social impairment. Similarly, the record reflects the Veteran's barrier to employment is due to the combination of his service connected conditions and not solely due to his PTSD symptoms. It is also not shown that the Veteran suffers from gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, disorientation to time or place, or other symptoms comparable to total occupational and social impairment throughout the entire period on appeal. While the Veteran also reported poor hygiene during the September 2022 Board hearing, this contradicts the rest of the evidence where it has been noted that hygiene was good. 

The criteria needed to support higher ratings involve medical findings that are within the province and purview of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the Veteran's lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of a 100 percent rating pursuant to the applicable criteria at any point pertinent to this appeal. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his acquired psychiatric disability according to the appropriate diagnostic codes. Layno v. Brown, 6 Vet. App. 465, 469 (1994).

Accordingly, the Board concludes that the weight of evidence is against the claim and an increased disability rating higher than 70 percent for PTSD is not warranted for the entire appeal period. The benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

REASONS FOR REMAND

1. Entitlement to a separate compensable rating for traumatic brain injury (TBI) is remanded.

As previously stated, the Veteran was originally service connected for TBI, rated as noncompensable, effective January 13, 2016, under Diagnostic Code 8045. However, a December 2024 rating decision awarded a combined 70 percent rating for PTSD and TBI effective January 13, 2016, on the basis of an August 2024 VA examination. In this regard, the August 2024 examiner made the following remarks: "The claimant has an additional confirmed/documented mental health disorder of: Depression, Anxiety It is not possible to differentiate symptoms of TBI and each confirmed/documented mental health disorder because: Both TBI and mental health disorders, such as depression, anxiety, and post-traumatic stress disorder (PTSD), can present with very similar symptoms. These include mood swings, irritability, sleep disturbances, fatigue, difficulty concentrating, memory problems, and social withdrawal. Because these symptoms are not unique to either condition, it can be difficult to pinpoint their origin without a detailed medical and psychological evaluation." See August 2024 C&P Examination. Subsequently, the Veteran's TBI was encompassed in his PTSD disability rating by the AOJ.

However, the Veteran contends he is entitled to a separate, compensable rating as his TBI is a separate manifestation from his PTSD. Further, the Veteran through his representative has contended that the August 2024 TBI examination was inadequate in assessing his TBI because the examiner did
umatic stress disorder (PTSD), can present with very similar symptoms. These include mood swings, irritability, sleep disturbances, fatigue, difficulty concentrating, memory problems, and social withdrawal. Because these symptoms are not unique to either condition, it can be difficult to pinpoint their origin without a detailed medical and psychological evaluation." See August 2024 C&P Examination. Subsequently, the Veteran's TBI was encompassed in his PTSD disability rating by the AOJ.

However, the Veteran contends he is entitled to a separate, compensable rating as his TBI is a separate manifestation from his PTSD. Further, the Veteran through his representative has contended that the August 2024 TBI examination was inadequate in assessing his TBI because the examiner did not address residual symptomology related to his TBI, to include tinnitus and headaches. See February 2025 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief).

In this regard, the Board also notes that the August 2024 TBI examiner is a physician assistant who practices General Medicine. However, per VA guidelines, only four medical specialties are qualified to address TBI injuries, to include a psychiatrist, physiatrist, neurosurgeon, and neurologist.

Therefore, in light of the Veteran's psychological diagnosis, including his neurocognitive disorder, the Board finds a TBI examination conducted by one of the four medical specialties is warranted in order to determine the current nature and severity of his diagnosed TBI.

2. Entitlement to a compensable rating prior to August 20, 2024, and a rating higher than 30 percent thereafter, for cirrhosis of the liver with hepatitis C with laceration, liver, residuals (previously rated as hepatitis C with laceration, liver, residuals, shell fragment wound) is remanded.

During the pendency of the appeal, the AOJ issued a December 2024 rating decision that granted a 30 percent rating, effective August 20, 2024, for the Veteran's service connected liver disease. The AOJ did not, however, issue a supplemental statement of the case (SSOC) at that time, which was required because the grant of the 30 percent rating effective August 20, 2024, did not resolve the Veteran's increased rating claim. Indeed, while an increased rating was granted in the December 2024 rating decision, the maximum schedular rating was not assigned for the entire period on appeal. Here, the record contains additional relevant records that were associated with the file prior to re-certification. As a result, the AOJ was required to issue an SSOC with respect to the issue of an increased rating for the service-connected liver disease for the entire appeal period.

The matters are REMANDED for the following action:

1. Request the Veteran identify any private health care providers who have evaluated or treated his disabilities on appeal and, after obtaining any necessary authorization from the Veteran, all outstanding records should be obtained and associated with the file.

Also obtain any outstanding VA treatment records pertinent to the claims.

All attempts to obtain the records should be documented in the file. If no records are found and additional requests would be futile, notify the Veteran in accordance with 38 C.F.R. § 3.159(e).

2. Schedule the Veteran for a VA examination, by an appropriate medical professional, i.e., a psychiatrist, physiatrist, neurosurgeon, or neurologist to determine the nature and severity of his TBI. The record, to include a copy of this Remand, should be provided to the examiner, and any indicated evaluations, studies, and tests should be conducted. Thereafter, the examiner should address the following inquiries:

(a) The examiner should describe the current nature and severity of all manifestations of the Veteran's TBI, to specifically include the resulting functional impairment of such disability from January 13, 2016, to the present.

(b) The examiner must also discuss whether the Veteran's TBI residuals are separate and distinct from his PTSD, for which the symptoms thereof can be distinguished from those of his TBI.

Specifically, the examiner must address whether the Veteran's complaints related to tinnitus and headaches, are subjective complaints associated with residuals of his TBI or are manifestations of a distinct comorbid diagnosis.

A rationale for any opinion offered must be provided.

3. Thereafter, if the remanded claims are not granted in full, provide the Veteran and his representative a supplemental statement of the case (SSOC) that addresses all evidence associated with the claims file since the last statement of the case was issued for the TBI and liver disabilities. The Veteran and his representative should be afforded the applicable time period in which to respond.

 

 

R.R. Watkins

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rogers, Nyella M. (she
 Veteran's complaints related to tinnitus and headaches, are subjective complaints associated with residuals of his TBI or are manifestations of a distinct comorbid diagnosis.

A rationale for any opinion offered must be provided.

3. Thereafter, if the remanded claims are not granted in full, provide the Veteran and his representative a supplemental statement of the case (SSOC) that addresses all evidence associated with the claims file since the last statement of the case was issued for the TBI and liver disabilities. The Veteran and his representative should be afforded the applicable time period in which to respond.

 

 

R.R. Watkins

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rogers, Nyella M. (she/her/hers)

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.