Case A26037456

VICTORIA MOSHIASHWILI · 2026 · Case ID: A26037456

DENIED

Summary

The veteran, who served from December 1984 to May 1986, appeals the denial of an earlier effective date for service connection for PTSD and the denial of an increased rating for PTSD. The veteran's service was administratively discharged under honorable conditions due to homosexuality. The veteran filed an initial claim for service connection for PTSD on August 15, 2019, based on military sexual trauma (MST). Prior to this date, no claim for PTSD had been filed. The Board reviewed extensive evidence, including the veteran's testimony, VA treatment records from 2001 to 2019, a November 2023 VA psychologist's review examination, and statements from his caregiver, sister, and cousin. The Board found the November 2023 VA examination report, which noted total occupational and social impairment due to PTSD symptoms like suicidal ideation, hallucinations, and isolation, to be highly probative. The Board assigned a 100 percent rating for PTSD effective August 15, 2019, finding that the veteran's symptoms met the criteria for total impairment. The Board denied the claim for an earlier effective date, citing that the claim was first filed on August 15, 2019, and no prior claim or entitlement arose before that date. The Board also dismissed the implicit claim for TDIU as moot, as the 100 percent rating for PTSD already reflects total disability.

Rationale

Claim for earlier effective date denied as initial claim filed August 15, 2019.; No prior claim or entitlement arose before August 15, 2019.; Evidence weighs against the claim, not in approximate balance.

Special Benefit

TDIU; EARLIER EFFECTIVE DATE

Docket No.

201027-119113

Full Decision Text

Citation Nr: A26037456
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 201027-119113
DATE: April 22, 2026

ORDER

An earlier effective date than August 15, 2019 for service connection for posttraumatic stress disorder (PTSD) is denied.

Effective August 15, 2019, an initial evaluation of 100 percent disabling for PTSD is granted.

Effective August 15, 2019, total disability based on individual employability (TDIU) is dismissed as moot.

FINDINGS OF FACT

1. On August 15, 2019, the Department of Veterans Affairs (VA) received the Veteran's initial claim of entitlement to service connection for PTSD.

2. Prior to August 15, 2019, there was no formal claim, informal claim, or written attempt to file a claim of entitlement to service connection for PTSD.

3. From August 15, 2019, the Veteran's PTSD was characterized by total occupational and social impairment, including gross impairment of thought processes or communication; persistent visual hallucinations; persistent danger of hurting himself; intermittent inability to perform activities of daily living (including maintenance of minimal hygiene); disorientation to time and place, and memory loss for names of relatives.

4. The evidence of record, including the Veteran's testimony, reasonably raised the question of whether the Veteran is unemployable due to his PTSD; the implicit claim for TDIU is part and parcel to the claim for an increased evaluation of PTSD.

5. Effective August 15, 2019, the Veteran has a 100 percent disability rating for PTSD; this is his sole service-connected disability.

CONCLUSIONS OF LAW

1. Prior to August 15, 2019, the criteria have not been met for an earlier effective date for service connection for PTSD. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.

2. Effective August 15, 2019, the criteria have been met for a 100 percent rating for PTSD. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411.

3. Effective August 15, 2019, the criteria have been met for dismissal of the implicit TDIU claim. 38 U.S.C. §§ 1155, 5107.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1984 to May 1986. The Veteran was administratively discharged under honorable conditions, with the reason for separation noted as homosexuality. See DD Form 214.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a August 2020 rating decision of the Department of Veterans Affairs (VA) Regional Office. See August 2020 Rating Decision.

The Veteran submitted a timely Board Appeal (Notice of Disagreement), reflecting his wishes to appeal the August 2020 rating decision to the Board via the Hearing docket.?See October 2020 VA Form 10182; Decision Review Request: Board Appeal (Notice of Disagreement). A hearing was held before the undersigned Veterans Law Judge (VLJ) in July 2024. The transcript is of record. See July 2024 Hearing Transcript.

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, VA will issue another decision on the claim[s], 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. An earlier effective date for service connection of PTSD prior to August 15, 2019

2. An increased disability rating for PTSD in excess of 70 percent disabling

Legal Criteria for an Earlier Effective Date

In claims for direct service connection, the effective date will be the day following separation from active service or the date entitlement arose if the claim is received within 1 year after separation from service. 38 C.F.R. § 3.400(b)(i). Otherwise, the effective date for a grant of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later date. 38 U.S.C. §
for service connection of PTSD prior to August 15, 2019

2. An increased disability rating for PTSD in excess of 70 percent disabling

Legal Criteria for an Earlier Effective Date

The only exception to this rule is the following situation. Once a decision establishing an effective date becomes final, the only way that that decision can be revised (that is, changed) is if VA finds that the decision was based on "clear and unmistakable error" (CUE), because any other result would vitiate the rule of finality. Rudd v. Nicholson, 20 Vet. App. 296, 299-300 (2006).

General Legal Criteria for Increased Disability Ratings

Disability ratings 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 various disabilities. 38 U.S.C. §1155; 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 clearly 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. If the evidence is not in approximate balance or nearly equal, the claim is to be denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 271 F.3d 1361, 1364 (Fed. Cir. 2001). In evaluating a disability's severity, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991).

Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the evidence since the grant of service connection is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999).Where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7?Vet. App.?55 (1994).

In all claims for increased ratings, the Veteran is presumed to be seeking the maximum possible evaluation. See A.B. v. Brown, 6?Vet. App.?35 (1993).

Legal Criteria for an Increased Disability Rating for PTSD

Under the General Rating Formula for Mental Disorders, a 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to symptoms such as: suicidal ideations; 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. See 38 C.F.R. § 4.130, DC 9411, General Rating Formula for Mental Disorders.

The maximum 100 percent rating is warranted when the evidence shows total occupational and social impairment, due to such symptoms as: gross impairment of thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger or hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id.

Under the 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). The use of the term "such symptoms as" in 38 C.F.R. § 4.130 indicates that the list of symptoms that follows is non-exhaustive but rather are to serve as examples of the type and degree of the symptoms, or their effects, which would justify a particular rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013); see Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004); Mauerhan v. Principi, 16 Vet. App. 436 (2002). When determining the appropriate disability evaluation to assign, the Board's "primary consideration" is the Veteran's symptoms. Vazquez-Claudio, 713 F.3d at 118.

"[T]he presence of suicidal ideation alone, that is, a Veteran's thoughts that of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas." See Bankhead, 29 Vet. App. at 19. There are no descriptors, modifiers, or indicators as to suicidal ideation in the 70 percent criteria. Bankhead, 29 Vet. App. at 18. Both "passive" and "active" suicidal ideation are comprised of thoughts; that is, passive suicidal ideation entails thoughts, such as wishing that you were no longer alive or wouldn't wake up in the morning, while active suicidal ideation entails thoughts of self-directed violence and death. Id.

Factual Background

In the years following separation from service, the Veteran received mental health treatment for psychiatric conditions including anxiety disorder, major depressive disorder and PTSD. See e.g. Medical Treatment Records from June 2001, September 2016 and January 2018.

In April 2019, the Veteran presented for mental health care. He reported symptoms of anxiety, depression, panic attacks and sleep difficulties. He reported sexual trauma while in military service which had recently been triggered by a conversation. He reported that he isolated himself from his sisters and no longer socializes with his friends because he doesn't trust them. The clinician noted that the Veteran was very anxious, talked rapidly and gave long detailed responses to questions. The clinician noted that the Veteran wasn't currently experiencing thoughts of suicide. See April 2019 CAPRI records.

In May 2019, the Veteran attended a mental health appointment. He described anxiety including "sleeping with the light on" related to traumatic incidents while in service as well as being beaten by correctional officers at his job in 2019. He also reported nightmares, intrusive thoughts, high levels of arousal and avoidance of social contact because of his anxiety. See May 2019 CAPRI records.

On August 15, 2019, the Veteran filed an initial claim for service connection of PTSD based on military sexual trauma (MST). See August 2019 VA 21-526EZ.

In August 2019, the Veteran was referred for military sexual trauma treatment. He reported a recent crisis where he called a suicide hotline, felt very emotional and "felt my hip" (referring to long term feelings of disconnection to his body). He reported that he "eliminated people from my life even my family" in order to focus on his difficulties. The Veteran reported symptoms of "overwhelming anger," distrust of others, nightmares "all the time," lack of energy, overwhelming tension, fear of abuse and violence, and depression. The Veteran reported that he continued to isolate himself from everyone but his caregiver and that "I don't feel safe anywhere." He has been cut off from others since leaving his last job and avoids people in general. Following his mother's passing, he doesn't maintain contact with his sisters and has no other family. The Veteran reported that his concentration was affected by flashbacks and anxiety. He is irritable and raises his voice. He has difficulty calming down, and physical reactions included nausea, vomiting
people from my life even my family" in order to focus on his difficulties. The Veteran reported symptoms of "overwhelming anger," distrust of others, nightmares "all the time," lack of energy, overwhelming tension, fear of abuse and violence, and depression. The Veteran reported that he continued to isolate himself from everyone but his caregiver and that "I don't feel safe anywhere." He has been cut off from others since leaving his last job and avoids people in general. Following his mother's passing, he doesn't maintain contact with his sisters and has no other family. The Veteran reported that his concentration was affected by flashbacks and anxiety. He is irritable and raises his voice. He has difficulty calming down, and physical reactions included nausea, vomiting and a racing heart. He reported intrusive memories and negative thoughts about the world ("I don't know if I want to be here"). The clinician noted that the Veteran's affect was anxious and he indicated suicidal ideation with no plan or intent (thinks about it all the time but would not do it because of spiritual beliefs). See August 2019 CAPRI records.

In October 2019, the Veteran attended a session with his psychologist. He reported that he was not doing well and was feeling disorganized ("I can't think.") See October 2019 CAPRI Records.

In November 2019, the Veteran was seen for a mental health appointment. He reported chronic hypervigilance since service, including a "hyper alert" perception of violence. See November 2019 CAPRI Records.

In December 2019, the Veteran attended a session with his psychologist. The clinician discussed the difference between pathological avoidance and engaging in enjoyable activities (e.g. shopping as an avoidance activity to "get lost for the day)." See December 2019 CAPRI Records.

In December 2019, the Veteran's claim for service connection of PTSD was denied. See December 2019 Rating Decision.

In July 2020, the Veteran filed a supplemental claim for service connection of PTSD. See July 2020 Supplemental Claim Application. The Veteran filed supporting evidence including photographs, letters and copies of military personnel records in support of his PTSD claim. See July 2020 Statement in Support of Claim; See e.g. July 2020 Correspondence; see also August 2020 Correspondence.

In August 2020, the Veteran was afforded a VA examination related to his PTSD. The Veteran reported that he "had a mental breakdown" in April 2019 because he was "overly stressed" after several loved ones passed away. He reported daily anxiety with panic attacks, depressed mood, disturbance of motivation and mood, hopelessness, irritability with quickness to anger, hypervigilance, impaired concentration, trust issues ("I do not trust anyone, do not want anyone near me"), avoidance of social situations and negative cognitions ("the world is completely dangerous"). He reported two previous suicide attempts, including soon after being released from service and in 2003. He denied current suicidal ideations or a plan, means or intent. The examiner noted symptoms of depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, impairment of short and long term memory, circumstantial, circumlocutory or stereotyped speech, speech intermittently illogical, obscure or irrelevant, difficulty in understanding complex commands, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationship and an inability to establish and maintain effective relationships. The examiner found that the Veteran had 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 August 2020 Initial PTSD Disability Benefits Questionnaire; see also August 2020 Medical Opinion Disability Benefits Questionnaire.

In August 2020, the AOJ granted service connection for PTSD with an evaluation of 70 percent effective August 15, 2019 (the date of the initial claim). The AOJ stated that "an evaluation of 70 percent is assigned from 8/15/19, the date we received your original claim. We were able to assign this date because your claim has been continuously pursued from that time." See August 2020 Rating Decision.

In July 2024, the Veteran testified that during service, he was threatened with jail instead of receiving treatment for sexual assault. He reported that he was hospitalized for a suicide attempt in 1988 and was diagnosed with anxiety and depression around that time. The Veteran reported that in 1993, he had rocks thrown at him when he tried to go to the VA to get benefits. He reported that in 2010, he was found totally disabled by the Social Security Administration for his psychiatric conditions. He reported that in 2019, he had a nervous
/19, the date we received your original claim. We were able to assign this date because your claim has been continuously pursued from that time." See August 2020 Rating Decision.

In July 2024, the Veteran testified that during service, he was threatened with jail instead of receiving treatment for sexual assault. He reported that he was hospitalized for a suicide attempt in 1988 and was diagnosed with anxiety and depression around that time. The Veteran reported that in 1993, he had rocks thrown at him when he tried to go to the VA to get benefits. He reported that in 2010, he was found totally disabled by the Social Security Administration for his psychiatric conditions. He reported that in 2019, he had a nervous breakdown and was referred to VA at that time. See July 2024 Hearing Transcript. See also June 2024 SSA Benefit Verification Letter.

As for his symptoms of PTSD, the Veteran testified that he struggled with suicidal and homicidal ideations on a daily basis. He described difficulty communicating with people because their "faces change" and he can't focus on what they are saying and "keeps getting lost" in the conversation. He finds it very difficult to be around people. He also finds it difficult to leave his bedroom because "sometimes I see things, and I don't understand what I am seeing." He explained that he doesn't trust himself because he doesn't always understand what he is seeing, and this leads to anxiety ("always like on a tightrope, or always jittery"). He has to have people repeat things, and if he doesn't understand, he starts to have a panic attack. For these reasons, he isolates himself. Due to his isolation, he loses track of time ("I don't know what day it is, I don't know if its day or night...because in isolation it doesn't really seem to matter.") He also experienced sleep difficulties, including night sweats and awakenings which lead to daytime fatigue and difficulty cognitively computing things because of the fatigue. He described difficulty with maintenance of personal hygiene due to low energy and depressed mood. He experienced difficulty remembering the names of relatives and needed a reminder. The Veteran testified that he cannot work full time based on his PTSD symptoms because he can't concentrate or focus- "when someone tells me something...no one wants to spend time repeating themselves and then I start having panic attacks again." Id.

In July 2024, the Veteran submitted further miscellaneous evidence including correspondence and personal notes. In December 2019 correspondence, he described "high levels of anxiety", "severe depression," and difficulty leaving his home. He also submitted timeline of traumatic events leading up to his 2019 nervous breakdown. See e.g. July 2024 Correspondence.

In July 2024, the Veteran also submitted a review VA examination report completed by his psychologist and dated November 2023. The clinician noted diagnoses of PTSD and major depressive disorder (single episode, unspecified). The clinician noted that the Veteran became depressed due to overwhelming symptoms of panic, anger and hopelessness. The clinician noted additional symptoms of PTSD (from the August 2020 VA examiner) including near continuous panic or depression effecting ability to function independently, impaired judgment, suicidal ideations and intermittent inability to perform activities of daily living. The examiner also noted a significant history of sensitivity to LGBTQ discrimination and that his fear escalates with psychogenic vomiting. The examiner noted irritable behavior and angry outbursts, hypervigilance, problems with concentration and sleep disturbance causing clinically significant distress and impairment. The examiner attributed the Veteran's symptoms of intrusions, avoidance and negativity (including diminished interest, persistent and exaggerated negative beliefs, feelings of detachment and inability to experience positive emotions) to his PTSD. The examiner noted occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, as well as total occupational and social impairment. The clinician noted that the Veteran was medically retired and currently unable to work. The clinician recommended home health care to assist the Veteran with activities of daily living and obtaining health care. The clinician opined that the Veteran was a danger to himself in the sense that he had a "significant difficulty appropriately advocating for himself, using judgment to ascertain threat level and is highly defensive" which interferes with his ability to obtain and keep health care. See November 2023 Review Initial PTSD Disability Benefits Questionnaire and Addendum (p. 27).

The Veteran submitted a July 2024 statement from his caregiver. The caregiver explained how the Veteran deals with depression, anxiety and panic attacks. The caregiver reported that the Veteran is "hypervigilant and very untrusting, especially around new people and places," "has lots of sleeping issues" and fear of the dark, prefers to be left alone in a quiet environment and that he "needs lots
that the Veteran was a danger to himself in the sense that he had a "significant difficulty appropriately advocating for himself, using judgment to ascertain threat level and is highly defensive" which interferes with his ability to obtain and keep health care. See November 2023 Review Initial PTSD Disability Benefits Questionnaire and Addendum (p. 27).

The Veteran submitted a July 2024 statement from his caregiver. The caregiver explained how the Veteran deals with depression, anxiety and panic attacks. The caregiver reported that the Veteran is "hypervigilant and very untrusting, especially around new people and places," "has lots of sleeping issues" and fear of the dark, prefers to be left alone in a quiet environment and that he "needs lots of reminders when it comes to hygiene and ADL's mostly due to a lack of energy." The caregiver included letters that described peer support services received by the Veteran, including "isolation packages" for use at therapy sessions. See July 2023 Statement of Caregiver; See also July 2024 Correspondence from Visalia Wellness Center (pp. 77-78)

The Veteran also submitted July 2024 statements from his sister and his cousin. The Veteran's sister expressed concern for the Veteran due to his isolation at home and his depression. See July 2024 Correspondence from M.T (p. 81). The Veteran's cousin also expressed concern about the Veteran's condition, and how "she hardly knows the person he has become." See July 2024 Correspondence from R.C. (p. 82).

Analysis

Earlier Effective Date

The Veteran asserts that an earlier effective date for the grant of service connection for PTSD is warranted. The Veteran believes that the effective date should date back to April 1986, when in-service abuse and MST was experienced. See October 2020 Notice of Disagreement; See also July 2024 Hearing Transcript.

A review of the record shows that the Veteran filed an initial claim for entitlement to service connection for PTSD that was received by VA on August 15, 2019. Prior to August 2019, there was no formal claim, informal claim or written attempt to file a claim of entitlement to service connection for PTSD.

With regard to the date entitlement arose, to the extent that the Veteran was shown to have a psychiatric disability that may have been related to service, or otherwise warranting service connection prior to August 15, 2019, such a finding is immaterial to the claim of entitlement to an earlier effective date regarding PTSD. In this regard, as noted, the effective date of service connection will be the date of claim or the date entitlement arose, whichever is later. As such, the effective date of service connection for PTSD cannot precede the August 15, 2019 date of claim which is the currently assigned effective date of service connection.

Moreover, the decision cannot be changed based on the "clear and unmistakable error" exception because the August 2020 rating decision has not yet become final, and the appeal remains open. Rudd v. Nicholson, 20 Vet. App. 296, 299-300 (2006). The Veteran cannot assert a valid CUE claim as to any non-final rating decision.

The Board acknowledges the Veteran's sincere belief that difficulties prevented him from filing at VA sooner. However, the rules for effective dates are controlled by statute, and because the claim is without legal merit, it must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994). Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence weighs persuasively against the claim and is not in approximate balance. Therefore, entitlement to an effective date earlier than August 15, 2019, for the grant of service connection for PTSD is not warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Increased Rating for PTSD from August 15, 2019

After a thorough review of the evidence of record, the Board finds that the Veteran's PTSD has resulted in total occupational and social impairment warranting a 100 percent rating.

Specifically, the Board finds that the Veteran has gross impairment in his thought processes brought on by overwhelming symptoms of panic, anger, anxiety, depression, exaggerated negative beliefs, hopelessness and daily suicidal and homicidal ideations. His intrusive thoughts also contribute to his gross impairment, causing difficulty communicating with others, anxiety, irritability, sleep difficulties, hypervigilance, avoidance and negative perceptions. His sleep difficulties, including fear of the dark, contribute to daytime fatigue and difficulty with cognition. He has persistent visual hallucinations, which cause difficulty with focus and understanding while in conversations. His difficulty with comprehension leads to anxiety and inability to trust his perceptions and ultimately, panic attacks. As a result of his symptoms, the Veteran finds it very difficult to be around others and isolates himself at home. He only sees his caregiver, choosing not to maintain contact with his sisters and friends. Due to his isolation, he becomes disoriented from time or day. He is intermittently unable to perform activities of daily living due to depressed mood and low energy, and his psychologist recommended that he have a caregiver. He experiences memory loss for names of his relatives and needs reminders. His treating psychologist found that the Veteran is a danger to himself because his "significant difficulty appropriately advocating for himself, using judgment to ascertain threat level" and "highly defensive" nature interferes with his ability to obtain and keep health care.

The Board assigns significant probative weight to the November 2023 VA examination report by the Veteran's treating psychologist finding that the Veteran demonstrated total occupational impairment. There is no evidence that the clinician is not competent or credible and the reports are based on the clinician's observations as well as the Veteran's treatment records, statements, and in-person examinations. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

The Board assigns less probative weight to the August 2020 VA examination report because the report is based on an inaccurate factual premise. The examiner disregarded the Veteran's lay statements regarding his PTSD symptoms that led to isolation from others and found that the Veteran experienced only an "occasional decrease in work efficiency" and was "generally functioning satisfactorily, with normal routine behavior, self-care and conversation." Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise has no probative value).

While the Veteran does not exhibit symptoms such as grossly inappropriate behavior and is not a persistent danger to others, the Board notes that the symptoms list in the general rating formula is non-exhaustive and finds that the overall severity of the Veteran's symptoms, particularly his visual hallucinations, impairment of thought processes and difficulty with communication as well as his isolation from others warrants a 100 percent rating.

The Board has considered the requirement of 38 C.F.R. § 4.3 to resolve any reasonable doubt regarding the level of the Veteran's disability in his favor. As the Veteran has been found to have total occupational and social impairment, a 100 initial rating for PTSD with an effective date of August 15, 2019 is warranted. 38 C.F.R. § 4.130, DC 9411.

3. TDIU and SMC

Legal Criteria

It is the established policy of VA that all veterans who are unable to obtain and maintain a substantially gainful occupation because of service-connected disabilities shall be rated as totally disabled. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.16, 3.340. If a claimant or the record reasonably raises the question of whether a veteran is unemployable due to the disability for which an increased evaluation is sought, then part and parcel to that claim for an increased evaluation is whether TDIU as a result of that disability is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009).

A total disability rating for compensation may be assigned, where the schedular rating is less than total, when a veteran is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disabilities to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a). Nevertheless, even when the percentage requirements are not met, entitlement to TDIU on an extraschedular basis may be granted in exceptional cases when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16 (b). For VA purposes, the term "unemployability" is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91, 57 Fed. Reg. 2317 (Jan. 21, 1992).

The Veterans Court has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001).

However, a grant of a 100 percent disability does not always render the issue of TDIU moot. VA's duty to maximize a claimant's benefits includes consideration of whether his disabilities establish entitlement to special monthly compensation (SMC). 38 U.S.C. § 1114 . See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, SMC may be warranted if a veteran has a 100 percent disability rating for a single disability, and VA finds that TDIU is warranted based solely on the disabilities other than the disability that is rated 100 percent. See Bradley, 22 Vet. App. 280. Alternatively, SMC may be warranted where a TDIU is warranted for a single service-connected disability, and a veteran has a disability or disabilities that are independently ratable as 60 percent or more and which do not form the basis for the TDIU.

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Factual Background and Analysis

Based on a thorough review of the evidence, the Board finds that the issue of TDIU has been implicitly raised by the Veteran's claim for an increased rating of his PTSD. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (a TDIU rating claim is part of a claim for a higher rating when raised by the record or asserted by the Veteran or raised by the record, for example, by evidence of unemployability).

The Veteran has a nursing degree and has worked as a nurse. He has also worked in other occupations, including as a hairstylist, makeup artist, caregiver and in customer service. However, he has not been employed since 2010, when he was found to be totally disabled through SSA (based on his psychiatric conditions). The Veteran also testified that he could not work based on PTSD symptoms, including the inability to concentrate or focus on what people are saying, leading to panic attacks. See August 2019 CAPRI records; See also July 2024 Transcript.

As noted above, the Board has assigned a 100 percent rating for the Veteran's PTSD from August 15, 2019. The Veteran is not service connected for any other disabilities; therefore the 100 percent total disability rating is based solely on the service-connected PTSD and TDIU would not be warranted under any other service-connected disabilities. While TDIU may be warranted for a single service-connected disability, the Veteran does not have a disability or disabilities that are independently ratable as 60 percent or more (which do not form the basis for TDIU).

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Adjudicating the issue of a TDIU would be necessary when the granting of a TDIU could result in a Veteran receiving SMC. 38 U.S.C. § 1114 .
from August 15, 2019. The Veteran is not service connected for any other disabilities; therefore the 100 percent total disability rating is based solely on the service-connected PTSD and TDIU would not be warranted under any other service-connected disabilities. While TDIU may be warranted for a single service-connected disability, the Veteran does not have a disability or disabilities that are independently ratable as 60 percent or more (which do not form the basis for TDIU).

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Adjudicating the issue of a TDIU would be necessary when the granting of a TDIU could result in a Veteran receiving SMC. 38 U.S.C. § 1114 . See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). However, SMC is not an issue because the Veteran has no other service-connected disabilities. Therefore, the grant of a 100 percent disability rating for PTSD renders the issue of TDIU moot at this time.

VICTORIA MOSHIASHWILI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board De Angelis, A.

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.

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