Citation Nr: 0003335 Decision Date: 02/09/00 Archive Date: 02/15/00 DOCKET NO. 95-26 624 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to an increased disability rating for service-connected post traumatic stress disorder (PTSD), currently rated as 50 percent disabling. 2. Entitlement to a total rating based on individual unemployability. 3. Entitlement to service connection for drug and alcohol abuse secondary to service-connected PTSD. 4. Whether there was clear and unmistakable error (CUE) in a September 1988 rating decision of the Phoenix, Arizona, Regional Office (RO) in assigning a 30 percent rating for PTSD rather than a higher rating, in not adjudicating a claim for a total rating based on individual unemployability, and in not granting service connection for drug and alcohol abuse. REPRESENTATION Appellant represented by: Kenneth M. Carpenter, Attorney at Law ATTORNEY FOR THE BOARD K. Gallagher, Counsel INTRODUCTION The veteran served on active duty from September 1965 to September 1968. This matter comes before the Board of Veterans' Appeals (Board) from July 1994 and August 1995 rating decisions of the Department of Veterans Affairs (VA). The July 1994 rating decision was rendered by the VA RO in Phoenix, Arizona, and the August 1995 rating decision was rendered by the Columbia, South Carolina, RO, which presently has jurisdiction of the veteran's claims. The July 1994 rating decision granted a 50 percent rating for PTSD. The August 1995 rating decision continued the 50 percent rating for PTSD and denied a total rating based on individual unemployability; service connection for drug and alcohol abuse as secondary to PTSD; and a claim that there was CUE in a September 1988 rating decision. The Board remanded the case in November 1997. In May 1998, the Board denied service connection for drug and alcohol abuse as secondary to PTSD and the claim of CUE in a September 1988 rating decision and remanded the claims for an increased disability rating for PTSD and for a total rating based on individual unemployability. On remand from the Board, the RO, in an August 1998 rating decision, continued a 50 percent rating for PTSD and denied a total rating based on individual unemployability. The veteran appealed the two issues that were denied in the May 1998 Board decision to the United States Court of Appeals for Veterans Claims (Court). In an October 1998 order, the Court granted a Joint Motion for Remand submitted by the parties, thereby vacating the May 1998 Board decision as to the two issues decided by the Board. In the Joint Motion, the parties requested that the claim for service connection for alcohol and drug abuse as secondary to PTSD be remanded for further development and requested the Court to stay further proceedings on the claim for CUE in the September 1988 rating decision and made no argument pertaining to that claim. In the October 1998 order granting the motion, the Court remanded the issue of service connection for alcohol and drug abuse as secondary to PTSD and stated, "The appeal to establish [CUE] in the rating decision of September 1988 remains before the Court." In December 1998, the Board notified the veteran's attorney that additional evidence or argument on the veteran's claim must be submitted to the Board within 30 days. In January 1999, the Board received argument from the veteran's attorney on the claim for service connection for alcohol and drug abuse as secondary to PTSD, which had been remanded to the Board by the Court, and on the claims for an increased rating for PTSD and for a total rating based on individual unemployability which had been denied by the RO on remand from the Board. In January 1999, the Board remanded the case to the RO for further development of the evidence on the claim of service connection for alcohol and drug abuse as secondary to PTSD. In a March 1999 order, the Court granted a Joint Motion for Remand by the parties on the issue of CUE in the September 1988 rating decision. In June 1999, the Board notified the veteran's attorney that additional evidence or argument on the veteran's claim must be submitted to the Board within 90 days. In September 1999, the veteran's attorney requested an extension of time to submit arguments which the Board granted in October 1999. In November 1999, the Board received argument from the veteran's attorney on the claim for CUE in the September 1988 rating decision as well as on the claims for an increased rating for service-connected PTSD and for a total rating based on individual unemployability. FINDINGS OF FACT 1. PTSD is currently manifested by occupational and social impairment of a considerable degree manifested by such symptoms as disturbances of motivation and mood; restricted range of affect, chronic sleep impairment, and recurrent and intrusive distressing recollections of Vietnam and nightmares more than once a week. 2. It is not shown that the appellant is unemployable due to PTSD alone so as to warrant referral to the Director, VA Compensation and Pension Service for consideration of an extraschedular total rating based on individual unemployability. 3. No medical evidence has been presented showing that alcoholism or drug abuse was caused or aggravated by service-connected PTSD. 4. The September 1988 rating decision arose from a claim for service connection for PTSD, granted service connection for PTSD, and assigned a 30 percent rating for the disorder. 5. The veteran did not appeal the September 1988 rating decision to the Board. 6. Claims for an increased rating for PTSD, for a total rating based on individual unemployability, and for service connection for alcohol and drug abuse as secondary to PTSD were not before the rating board when it rendered its September 1988 rating decision. CONCLUSIONS OF LAW 1. A rating in excess of 50 percent for PTSD is not warranted. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996); 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). 2. Referral of the case to the Director, Compensation and Pension Service, for consideration of a total rating based on individual unemployability is not warranted. 38 C.F.R. § 4.16(b) (1999). 3. The claim for service connection for alcohol and drug abuse as secondary to PTSD is not well grounded, and there is no statutory duty to assist the appellant in developing facts pertinent to this claim. 38 U.S.C.A. § 5107(a) (West 1991). 4. The September 1988 rating decision is a final decision; there was no CUE in that decision in assigning a 30 percent rating for PTSD, in not adjudicating a claim for a total rating based on individual unemployability, and in not granting service connection for drug and alcohol abuse. 38 C.F.R. § 3.105(a) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Background. The veteran claimed service connection for PTSD in June 1987. Service medical records revealed that during service the veteran received counseling and treatment for depression, irritability, nervousness, and excessive drinking. It was reported that he was reduced in grade as a result of his behavior related to drinking. Since he was nearing his time for discharge, he was advised to seek counseling after his discharge from service. Records from a private hospital revealed that the veteran was hospitalized from August 1985 to March 1986 for treatment of obsessive-compulsive symptoms following recovery from alcohol abuse. Diagnoses were obsessive-compulsive disorder (OCD) with paranoid trends, possible PTSD associated with Vietnam War and a recovered alcoholic and atypical mixed personality disorder. The veteran was hospitalized in a private hospital in July 1986. It was noted that he had been previously treated as an in-patient and as an out-patient dating back to August 1985 for OCD that appeared to be further complicated by a probable PTSD in connection with his experiences in the Vietnam War. It was also noted that he was a recovering alcoholic who had been dry for approximately eleven years. He was treated with various treatment modalities from July 1986 to June 1987 within an inpatient, outpatient, and day patient environment. Examination revealed that he was oriented in all spheres, alert and articulate. His affect was depressed with psychomotor retardation and slow speech. He was almost exclusively preoccupied with obsessive ideation and compulsive behavior patterns. There was no evidence of delusions or hallucinations. He was a conscientious worker, but had lost interest in social and recreational activities. He achieved good symptomatic relief with treatment but would drop out of treatment prematurely and experience a recurrence of symptoms. On the outpatient discharge summary, an examiner noted that numerous diagnoses had been rendered during the course of treatment and that it was the examiner's opinion that the staff at the private facility "had little experience with veterans suffering from a delayed [PTSD] which to a large extent may have confused the diagnostic process." The diagnoses rendered on the report were OCD, PTSD, and atypical mixed personality disorder with borderline traits. During the period of treatment at the private facility, the veteran was hospitalized in October 1986 complaining of depression. Examination revealed that he was alert and well oriented. His affect was depressed and his speech was slowed. There was mild psychomotor retardation. Diagnoses were single episode of major depression and borderline personality disorder. In an August 1987 letter from a private physician who treated the veteran at the private hospital noted above in 1986, it was stated that the primary discharge diagnosis in August 1986 was schizophreniform disorder with mixed depressive and paranoid features, but was changed during the second admission to depression which, the doctor stated, was a more correct diagnosis. Specifically, it was noted that the veteran suffered from a recurrent major depression with psychotic features. The near-catatonic state which he had recurrently experienced, his attempts at rigidly controlling himself, and obsessive thoughts which occurred during his psychotic depressions were all defenses against highly disturbing thoughts and memories of combat experiences in Vietnam. On VA examination in August 1987 the veteran complained of periods of depression, not trusting people, and recurring dreams about Vietnam. Examination revealed that he was alert and oriented for time, place, and person. He answered questions in a measured, careful, slow manner. Thought processes were coherent and goal directed. Mood was on the depressed side and affect was blunted. The examiner noted that the veteran stated that he read a lot about what Vietnam veterans had gone through and that this reading was reflected on the VA Form on which the veteran listed his symptoms which the examiner noted appeared to be a list of something read from a book because they included distrust of authority, flashbacks to Vietnam, problems with intimate relationships and emotional distancing from his children and family. The examiner diagnosed OCD and dysthymic disorder. A social and industrial survey revealed that the veteran was employed as a construction worker and that he liked his job and wished to stay there. The social worker stated that the veteran did not indicate that his psychiatric problems prevented him from working. In a November 1987 rating decision, the RO denied service connection for PTSD, noting that the diagnosis was not shown on the most recent examination. In December 1987, the RO received a report of hospitalization at a VA facility in June 1987. The veteran complained of feeling lost and alone. He reported difficulty sleeping, loss of 20 pounds, poor concentration, lack of energy, lack of interest in daily activities, and depression. Examination revealed that his affect was sad and his eyes downcast. He had poor eye contact and soft slow speech. It was noted that the veteran suffered from severe OCD as well as fitting the diagnostic criteria for PTSD. The diagnoses were major affective disorder, OCD, PTSD, and alcohol abuse. The doctor noted that the veteran was employable. The veteran was seen at a VA out-patient clinic in December 1987 complaining of depression and recurrent alcohol abuse. He reported that he had been dry for the past ten years and recent problems with his wife had led him to begin drinking. He had just gotten off a ten-day binge. The examiner noted that the past medical history included a diagnosis of PTSD. On mental status examination, the veteran was alert and oriented. Speech was normal, not slurred. His mood was good and affect was mood congruent. There were no thought disorder, hallucinations, or suicidal ideation. He realized he should not and would not hurt himself. Judgment and insight were good. The diagnoses were OCD and recurrent alcoholism. The veteran was hospitalized at a VA facility in December 1987 to February 1988 for treatment of PTSD, alcohol abuse and OCD. Examination revealed that he was alert, oriented and cooperative. He was very uncomfortable and somewhat hypervigilant in a group setting. Abstract thought, memory and judgment seemed intact. In February 1988, he was admitted to a VAMC primarily for treatment of alcohol abuse, acute and chronic. Diagnoses were alcohol abuse, acute and chronic; multiple other drug use, in remission; and PTSD. He completed the alcohol treatment program in March 1988 and was scheduled to begin treatment for PTSD in April 1988. The veteran was hospitalized at a VA facility from April to June 1988. It was reported that since service he had felt isolated, estranged, avoided crowds, was suspicious, had bursts of anger and had a great deal of rage at society or the government. He had had periods of severe depression during which he withdrew and used alcohol. He reported recurrent nightmares of combat. He indicated that he drank heavily for a year at Fort Carson after he returned from Vietnam and continued to drink heavily until 1977. He was detoxified and remained sober until 1987, when he resumed drinking until February 1988. Examination revealed that he was alert and oriented. He was extremely depressed. Mental arithmetic and similarities were accurate and abstract without any false starts. He was very tense with psychomotor retardation. He gave a history of problems with obsessive thinking and at times compulsive avoidance and some rituals. He was treated with group therapy and at the time of his discharge from the hospital was considered competent and able to return to work. Diagnoses were PTSD with depression, alcohol dependence, and OCD. On VA examination in June 1988, the veteran was oriented in time, place and person. He was alert. His thoughts were goal directed and coherent, but preoccupied and involved with combat experience in Vietnam and its aftermath. His affect was blandly mobile and his mood was compatible with the content of his thought, displaying ruefulness and regret about his past behavior, but optimism for the future. Concentration and attention were within normal limits. Judgment was normal and appropriate. He had insight into his problems, and his memory was intact. Intelligence was above average. He exhibited alienation and a need for isolation. Noise bothered him and he had restless sleep with dreams and nightmares of combat situations and intrusive thoughts. In the past, he had had heavy alcohol drinking and difficulty with work. He was often angry, frustrated and irritable with temper outbursts. He had compulsive symptoms. Diagnoses were PTSD, alcoholism in remission and OCD in partial remission. A social and industrial survey in June 1988 revealed that the veteran reported he had difficulty fitting in after his return from Vietnam. He did not get along with his parents or girlfriend. He spent eleven of twelve months of his last year in the military service in a state of drunkenness. He stated that he first got involved in heavy drinking at Fort Carson. He could not hold a job for any length of time without "blowing up." He reported that he had no income. The social worker commented that she would not see the veteran as employable at that time, although he might eventually reach that level. Service connection for PTSD was granted in a rating action in September 1988, and a 30 percent rating was assigned. A statement of the case was issued on claims for service connection for other disabilities. In a statement dated in September 1988, the veteran indicated that he wanted to withdraw his appeal of those issues. On a VA examination in August 1990 the veteran complained of intrusive memories, flashbacks and nightmares of Vietnam. He reported social isolation. He stated that he could be with other people only in small numbers at a time. Examination revealed that he was pleasant and cooperative and in no obvious distress. His affect was somewhat constricted and he was not very spontaneous. He was oriented in three spheres. Memory was intact. Concentration and abstract thinking were good. The impression was PTSD, OCD, and alcoholism. The examiner noted that the veteran was employed 20 hours per week in food service and liked his job. The examiner also noted that the veteran did have significant impairment which probably prohibited him from more productive and higher level work. The RO continued the 30 percent rating in an August 1990 rating decision and the veteran was notified of that decision in August 1990. In January 1994, the veteran's representative claimed an increased rating for PTSD on the veteran's behalf. The veteran was hospitalized at a VA facility from October 1993 to March 1994. He complained of exacerbation of his old PTSD symptoms and related depression with increasing social isolation and withdrawal. He reported increasing depression, insomnia, nightmares, anergia, anhedonia, social isolation and withdrawal. He complained of racing thoughts and impaired concentration. Examination revealed that he was somewhat haggard, tense, anxious, worried and depressed. He spoke in a deliberate, measured manner. He was alert, oriented and coherent. There was no evidence of gross confusion or disorganization. Thought content was influenced by a chronic sense of frustration and futility. His intellectual functioning was within the average range, and there was no major impairment of concentration, memory, judgment or abstract reasoning. Affect was constricted, but not inappropriate. Diagnoses were PTSD, OCD and alcohol dependence, in remission. The current rating on the Global Assessment of Functioning (GAF) Scale was 35. The highest GAF for the last year was 60. In a July 1994 rating decision, the RO granted an increased rating to 50 percent. The veteran appealed this rating decision to the Board. In March 1995, the RO received a lay statement and incident reports from a County Sheriff's Office from the veteran's attorney in support of the veteran's claim. The layperson, apparently a friend or girlfriend of the veteran, stated that in June 1994 she feared that the veteran would kill her brother and therefore called the police. A police report regarding that incident and another on November 1994 are of record. The June 1994 reports showed that the veteran and a friend were having a verbal confrontation and the friend wanted advice on what to do about the veteran's drinking problem. The November 1994 report showed that the veteran was emotionally distraught, had a history of a mental disorder, and was threatening to commit suicide. The veteran was transported to a county hospital for evaluation. In June 1995, the RO received claims for a total rating based on individual unemployability; for service connection for alcohol and drug abuse secondary to service-connected PTSD; and for CUE in a September 1988 rating decision. In July 1995, the RO wrote to the veteran with a copy to his representative requesting that the veteran set forth specifically the claimed errors in the September 1988 rating decision and provide medical evidence to support the claim for service connection for alcohol and drug abuse as secondary to PTSD. In July 1995, the RO received another police report, dated in June 1995, showing that the veteran threatened to commit suicide and was transported to the county hospital. The hospital report is also of record and shows diagnoses of alcohol abuse and intoxication; depression; and PTSD. In an August 1995 rating decision, the RO denied the claims for an increased rating for PTSD; for a total rating based on individual unemployability; for service connection for alcohol and drug abuse as secondary to PTSD; and for CUE in the September 1988 rating decision. In September 1995, the RO received VA Form 21-8940, Veteran's Application for Increased Compensation Based on Individual Unemployability, which had been completed by the veteran. In a October 1995 rating decision, the RO continued the denial of a total rating based on individual unemployability. In November 1995, the RO received from the veteran's attorney a copy of the veteran's request to the Social Security Administration (SSA) for reconsideration of the denial of benefits by that agency. In an accompanying letter, the attorney stated that the veteran had been "found unemployable and was awarded Social Security Benefits based on his psychological problems and PTSD." In March 1996, the RO received a copy of the veteran's entire Social Security file from the veteran's attorney. A Disability Determination and Transmittal Form, in March 1995, showed that the veteran had been granted disability benefits from SSA, that the primary diagnosis was PTSD and the secondary diagnosis was OCD, and that the disability began in March 1993. Duplicate medical reports from the private facility from the period from 1985 to 1986 that were already in the claims file were among the reports submitted with the SSA file. Duplicate VA medical reports that were already in the claims file were also among the reports submitted. Among the medical reports that were not copies of reports already in the claims file was a report from the private facility dated in January 1977 which showed that the veteran had been referred for an evaluation concerning excessive drinking of alcohol. The diagnostic impression was habitual excessive drinking in a schizoid personality. In addition, a December 1987 inpatient admission summary from the private facility was also submitted. On mental status examination, the veteran was slow answering and somewhat slowed in his movements. He was intoxicated, although still speaking clearly. Short term memory was impaired. He denied suicidal ideation, but was worried about homicidal impulses. There were no obvious delusions or hallucinations. The diagnoses were PTSD; alcoholism, episodic; intoxication; history of paranoia; and history of major affective disorder, probable. It was noted that the private facility would attempt to transfer the veteran to a VA hospital, "as many of his issues do seem related to post traumatic stress, but this is complicated by his divorce, his drinking, and his overall psychological state." Also among the reports in the SSA file were VA outpatient treatment notes from a mental health clinic dated in 1988 and 1989 showing outpatient treatment for PTSD, alcohol dependence, and depression. VA outpatient treatment notes dated in 1994 showed treatment for disorders including PTSD, OCD, panic disorder, alcohol abuse, and recurrent depression. Two notes from June and July 1994 showed an assessment of "features of PTSD." Also among the reports in the SSA file was a November 1994 report from a private examiner. The veteran reported he last worked in a cafeteria in 1993 and that most of his adult life he worked in construction. He had not worked regularly in recent years due to concerns with his irritability. He was fearful he would hurt someone when angered, although he acknowledged that he had never physically attacked anyone. On mental status examination, the veteran was alert and fully oriented, neatly groomed and attired. He was cooperative with the evaluation process. His speech was normal in rate, rhythm, and volume. There was no evidence of disorder thought processing or delusional thinking. He described his mood as irritable and depressed. His affect was extremely constricted and there was evidence of some irritability on occasion. He denied any hallucinations, ideas of reference, or paranoia. He described some passive suicidal ideation but denied any suicidal plan or intent. He described being fearful of harming someone should he become angered. His recent and remote memory appeared grossly intact. His insight and judgment appeared fair. The diagnoses were PTSD; OCD; panic disorder without agoraphobia; alcohol abuse; and major depression, recurrent. The examiner noted that the veteran's psychiatric conditions had significantly impaired his personal, social, and occupational functioning. On April 1996 VA PTSD examination, the examiner recorded the veteran's detailed psychiatric history. The veteran reported that he last worked, part time in a kitchen, in 1992 or 1993, and that he had to quit because people would not leave him alone, which made him very irritable. He carried around of people who had irritated him in the past and stated that if he ever got a terminal illness he wanted "to take them with me." The examiner noted that the veteran's chief reason for seeking an increase in VA compensation was that he no longer worked and had been in and out of the hospital. The veteran stated that he had been doing "okay" since he was last discharged from the hospital. He denied suicidal ideation, but was apathetic about living. He referred to the list of names that he carried around, but denied any thoughts of hurting these people, stating that only if he were to get a terminal illness would he think about hurting anyone. He checked things all the time such as checking the hot water heater 20 times a night in approximately three to four hours. He complained of depressed mood, crying spells, feelings of worthlessness, difficulty with concentration, and worsening in his motivation for weeks at a time. He also reported suicidal ideation associated with this constellation of symptoms. With regard to PTSD, he reported that he continued to have recurrent, intrusive distressing recollections of events in Vietnam. The examiner noted that the veteran endorsed flashbacks and psychogenic amnesia and reported persistent sleep disturbance and exaggerated startle response. With regard to objective findings on examination, the examiner noted that the veteran was casually but neatly dressed, polite, cooperative. He made little to no eye contact during the interview. His speech was slightly monotone but normal in rate, latency and duration of utterance. His behavior was negative for psychomotor agitation or retardation. His thought form was linear and goal-directed. Thought content was negative for suicidal or homicidal ideation, auditory or visual hallucinations, delusions or paranoia. His mood was "okay." His affect was restricted predominantly but did become slightly tearful when describing an incident that happened during the war. He was alert and oriented times four with a clear sensorium. His memory was three out of three at zero and five minutes. His remote memory was intact. His attention and concentration were both good, as he completed serial sevens correctly. He was able to abstract proverbs and interpret similarities correctly. His insight and judgment were good. The impression was that the veteran continued to suffer from moderate symptoms of PTSD as evidenced by recurrent and intrusive distressing recollections of Vietnam and nightmares on a daily basis and occasional flashbacks and certain other symptoms. The examiner noted that these symptoms caused the veteran difficulty working, but felt that the veteran might be able to maintain some form of employment in the proper situation. The examiner noted that the veteran also suffered from recurrent major depressive disorder, as well as OCD. The diagnoses were PTSD, chronic, moderate; OCD; major depressive disorder, recurrent, without psychotic features; alcohol dependence; and rule out antisocial personality traits. In May 1996, the RO received an additional medical report from the private hospital showing inpatient treatment for 9 days in March 1996. On mental status examination, his general appearance was somewhat unkempt although with appropriate dress. His mood was cooperative although depressed and suspicious at times. He was extremely anxious. His affect was guarded. His speech was age appropriate and coherent. He denied any history of auditory or visual hallucinations. He reported Vietnam flashbacks. His motor activity was slowed with poor eye contact. He was oriented to time, place, and person. His insight appeared to be absent. He was able to do serial sevens. He was able to do analogies. He was able to demonstrate abstract reasoning with some proverb interpretation. He admitted to helpless feelings and suicidal ideation. He denied that he had an active plan but stated that if anyone asked him what he would do, he would readily admit that he would overdose. He denied any history of previous suicide attempts. At discharge, he was able to commit to self-safety and verbalize that alcohol was a significant problem for him. Plans were to continue with outpatient chemical dependency treatment. He agreed to contact a professional prior to harming himself in anyway and to go to a group home if he continued to have problems with drinking. Discharge diagnoses were PTSD; alcohol dependence; and rule out OCD. The current GAF was 40 and the highest GAF in the past year was 60. In November 1997, the Board remanded the case to assure the veteran's rights of due process because neither the veteran nor his attorney were notified before the case was sent to the Board for review on appeal or given an opportunity to submit additional evidence or argument. With regard to the issue of service connection for alcohol and drug abuse as secondary to PTSD, the Board advised the veteran's attorney of then recent amendments to the provisions of section 1110 of the statute by Pub. L. No. 101-508 and of an opinion of the General Counsel, VAOPGCPREC 2-97. Concerning the issue of CUE in the September 1988 rating decision, the Board noted that on remand the attorney should address the opinion of the Court in Fugo v. Brown, 6 Vet. App. 40 (1993). The Board instructed the RO to notify the veteran's attorney on remand that the case was ready for submission to the Board and provide him an opportunity to advance any additional argument or submit any additional evidence in connection with the appealed claims. The RO sent the letter to the veteran's attorney using an old post office box number and the letter was sent back to the RO from the post office because the forwarding order had expired. The RO returned the case to the Board. In a May 1998 decision, the Board denied the claims for service connection for alcohol and drug abuse as secondary to PTSD and CUE in the September 1988 rating decision. The decision on those claims was vacated on appeal to the Court. Also in May 1998, the Board remanded the issues of an increased rating for PTSD and a total rating based on individual unemployability, noting that the rating criteria for evaluating mental disorders had been revised in November 1996 and the RO should review the claim for the increased rating under those criteria in the first instance. See Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). The veteran underwent a VA PTSD examination in July 1998. The examiner noted the history of the veteran's experiences in the military including duty in Vietnam and that he reported he had suffered extensively from profound alcoholism since discharge from the military and had undergone treatment for alcoholism many times. The veteran stated that he had not worked for 12 months, being unable to hold a job. Regarding his psychiatric symptoms, he stated that he continued to have anxiety episodes and panic feelings daily, but that they were less severe with the medication he was now taking and he was able to get out of the house and attend to some business now more than ever. The examiner stated that the length of remissions from symptoms was unclear, but that it was safe to say that there had been no protracted remission of symptomatology since diagnosis. Significant PTSD symptoms included recurrent nightmares which have continued and remain fairly unchanged. Symptoms consistent with OCD included a history of checking the hot water heater. Although the veteran reported not checking the hot water heater as much since treatment, he continued to check his house, the door, the refrigerator, and the outside area. He denied suicidal ideation, although he noted that from time to time he had suicidal thoughts. He also reported that there were several people for whom he had a strong distaste and that, if he were terminally ill and had nothing to lose, he could seek to harm them. He stated that he only drank a six- pack of beer a day now and was able to be more socially interactive now than before. The examiner noted that the veteran endorsed all symptoms associated with PTSD. The examiner stated that the veteran met the criteria for PTSD, moderate to severe, and that he also had characteristics consistent with obsessive-compulsive traits. There were also symptoms of dysthymic disorder and alcohol dependence. The doctor stated that the level of functioning over the last 12 months had been about 30 to 40 percent and that it would probably remain the same. In an August 1998 rating decision, the RO considered the service-connected PTSD under both the old and the revised rating criteria for evaluating mental disorders and continued the 50 percent rating assigned for service-connected PTSD. The RO also denied a total rating based on individual unemployability, noting that the percentage requirements of section 4.16(a) were not met in this case and that this was not an exceptional case warranting submission to the Director of the Compensation and Pension Service for extra-schedular consideration. See 38 C.F.R. § 4.16 (1999). As noted in the Introduction to this decision, the veteran appealed the two issues that were denied in the May 1998 Board decision to the Court, requesting that the Court remand both. The arguments for remand were made in two separate Joint Motions by the parties, one in September 1998, regarding the claim for service connection for drug and alcohol abuse as secondary to PTSD, and the other in February 1999, regarding the claim of CUE in the September 1988 rating decision. Both Joint Motions for Remand were granted by the Court in orders in October 1998 and March 1999, respectively, thereby vacating the Board's May 1998 decision on the two claims. In December 1998, the Board notified the veteran's attorney that additional evidence or argument on the veteran's claim must be submitted to the Board within 30 days. In January 1999, the Board received argument from the veteran's attorney on the claim for service connection for alcohol and drug abuse as secondary to PTSD, which was on remand from the Court, and on the claims for an increased rating for PTSD and for a total rating based on individual unemployability, which were denied by the RO on remand from the Board. In January 1999, the Board remanded the case to the RO for further development of the evidence on the claim for service connection for alcohol and drug abuse as secondary to PTSD. Following the March 1999 Court order, the Board, in June 1999, notified the veteran's attorney that additional evidence or argument on the veteran's claim must be submitted to the Board within 90 days. In September 1999, the veteran's attorney requested an extension of time to submit arguments, which the Board granted in October 1999. In November 1999, the Board received argument from the veteran's attorney on the claim for CUE in the September 1988 rating decision as well as on the claims for an increased rating for PTSD and for a total rating based on individual unemployability. An Increased Rating For PTSD. The Board concludes that this claim is well grounded. See Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992) (holding that, where a veteran asserted that his condition had worsened since the last time his claim for an increased disability evaluation for a service-connected disorder had been considered by VA, he established a well grounded claim for an increased rating). Disability ratings are intended to compensate reduction in earning capacity as a result of the specific disorder. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such disorder in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. In considering the severity of a disability it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The criteria pertaining to PTSD in the VA Schedule for Rating Disabilities that were in effect prior to November 7, 1996, provided a 50 percent rating for a "considerable" impairment in the ability to establish or maintain effective or favorable relationships with people and when reliability, flexibility, and efficiency levels were so reduced as to result in "considerable" industrial impairment. A 70 percent rating was provided when the ability to maintain effective or favorable relationships was "severely" impaired and when the psychoneurotic symptoms were of such severity and persistence that there was severe impairment in the ability to obtain and retain employment. A 100 percent rating was warranted when the attitudes of all contacts except the most intimate were so adversely affected as to result in virtual isolation in the community; or when there were totally incapacitating psychoneurotic, symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior; or when the veteran was demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996); see Johnson v. Brown, 7 Vet. App. 95, 97 (1994) (holding that the criteria in 38 C.F.R. § 4.132, Diagnostic Code 9411, for a 100 percent rating were each independent bases for granting a 100 percent rating). The criteria for evaluating the degree of disability resulting from service-connected PTSD that have been in effect since November 7, 1996, provide a 50 percent rating for "[o]ccupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships." The next higher or 70 percent rating may be assigned for "[o]ccupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships." The highest or 100 percent evaluation may be assigned for "[t]otal 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." At the time of the January 1994 claim for an increased rating, service connection for PTSD had been in effect since June 1987 and the disorder was rated 30 percent disabling. The RO had confirmed the 30 percent rating in August 1990. With regard to application of the revised criteria to the evidence of record relevant to the January 1994 increased rating claim, the Board notes that the evidence has repeatedly ruled out the presence of symptoms contemplated by the 100 percent schedular rating. The reports show no gross impairment in thought processes. The October 1993-March 1994 VAMC report showed that, although thought content was influenced by a chronic sense of frustration and futility, there was no evidence of gross confusion or disorganization and no major impairment of abstract reasoning. The November 1994 private report noted no evidence of disorder of thought processing. The March 1996 private hospital report noted that the veteran was able to demonstrate abstract reasoning with some proverb interpretation. Likewise, the April 1996 VA PTSD examination showed that form of thought was linear and goal-directed and that he was able to abstract proverbs and interpret similarities correctly. The medical reports also consistently rule out gross impairment in communication -- it was noted that the veteran spoke in a deliberate, measured manner and was coherent in the October 1993-March 1994 VAMC report; speech was normal in rate, rhythm and volume in November 1994; speech was age appropriate and coherent in March 1996; and speech was slightly monotone but normal in rate, latency and duration of utterance in April 1996. The reports rule out disorientation to time or place -- he was alert and oriented in October 1993-March 1994; he was alert and fully oriented in November 1994; he was oriented to time, place, and person in March 1996; he was alert and oriented times four with a clear sensorium in April 1996. Contrary to the 100 percent criterion requiring memory loss for names of close relatives, own occupation or own name, the reports since 1994 show no major impairment of memory (October 1993-March 1994) and that recent and remote memory were grossly intact or intact (November 1994 and April 1996). Moreover, the reports rule out persistent delusions or hallucinations; grossly inappropriate behavior; and inability to perform activities of daily living including maintenance of minimal personal hygiene -- all criteria for a 100 percent rating. In October 1993-March 1994 the veteran's affect was described as constricted but not inappropriate. In the November 1994 private report, the veteran was cooperative with the evaluation process, neatly groomed and attired, and there was no delusional thinking, no hallucinations, no ideas of reference, and no paranoia. In March 1996, his general appearance was somewhat unkempt although with appropriate dress and his mood was cooperative. There were no auditory or visual hallucinations. The April 1996 VA examination report described the veteran as casually but neatly dressed, polite, and cooperative, and there were no auditory or visual hallucinations, delusions, or paranoia. Although the three police reports from 1994-95 submitted by the veteran show that on one occasion a friend of the veteran was afraid that he would hurt her brother and on two other occasions the veteran had threatened to commit suicide, the medical evidence contemporaneous to this period and thereafter showed that the veteran did not exhibit a "persistent" danger of hurting himself of others. Although in November 1994, the veteran described some passive suicidal ideation, he denied any plan or intent. Similarly, in March 1996, he admitted suicidal ideation but denied that he had an active plan and denied any history of previous suicide attempts. More recent reports in April 1996 and July 1998 were negative for suicidal ideation. For these reasons and bases, the Board concludes that the veteran does not meet the requirements for a 100 percent schedular rating under the revised criteria for rating mental disorders. 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). For the same reasons, the Board concludes that the veteran does not meet the first of the two independent criteria for a 100 percent rating under the old rating criteria. The evidence of record does not show that attitudes of all contacts except the most intimate were shown to be so adversely affected as to result in virtual isolation in the community ; or that there were totally incapacitating psychoneurotic, symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996); see Johnson v. Brown, 7 Vet. App. 95, 97 (1994) (holding that the criteria in 38 C.F.R. § 4.132, Diagnostic Code 9411, for a 100 percent rating were each independent bases for granting a 100 percent rating). The Board will discuss the third independent basis for a 100 percent rating under the old criteria -- i.e., that the veteran be demonstrably unable to obtain or retain employment as a result of service-connected PTSD -- below. With regard to the criteria for a 70 percent rating, the veteran has not exhibited such symptoms not contemplated by the criteria for the 50 percent rating that it may be concluded that the degree of impairment resulting from PTSD more nearly approximates the criteria for a 70 percent rating under the revised criteria. 38 C.F.R. § 4.7, 4.130, Diagnostic Code 9411 (1999). Although his mood had been described on examination reports as anxious and depressed (October 1993-March 1994 and March 1996) disturbances of motivation and mood and the presence of anxiety to include panic attacks more than once a week are contemplated by the 50 percent rating assigned. Although the evidence does show that the veteran exhibits obsessional rituals which interfere with routine activities, these symptoms have been attributed over the years to nonservice-connected OCD. Similarly, the Board notes that the degree of severity of symptomatology contemplated by the criteria for the 70 percent rating has either not been shown at all by the evidence (speech intermittently illogical, obscure, or irrelevant; spatial disorientation; neglect of personal appearance and hygiene;) or has been associated by examiners not with the service-connected PTSD but instead has been specifically attributed to separately diagnosed nonservice-connected psychiatric disorders such as OCD (obsessional rituals, for example, "characterized by recurrent intrusive thoughts many of which are not related to Vietnam at all . . . ." See August 1990 VA examination report), alcoholism, panic disorder, and recurrent depression. For example, the Board notes that, although the 70 percent rating contemplates impaired impulse control (such as unprovoked irritability with periods of violence) and the veteran's complaints of irritability and the fear of hurting others when angry have been noted on examination reports, the private examiner noted on the November 1994 report that the veteran acknowledged that he had never physically attacked anyone. Moreover, the police reports of 1994 and 1995 and the July 1995 county hospital report show that, on the occasion that the veteran's friend called the police because of fears that the veteran would harm her brother and on the occasions that the veteran threatened to commit suicide, he was intoxicated. In this regard, the veteran's friend sought advice from the police about the veteran's drinking problem and the July 1995 county hospital report showed a diagnosis of intoxication. In addition, on the March 1996 inpatient report from the private facility -- the only report of record depicting the veteran as having a "somewhat unkempt appearance" and describing anxiety as "extreme" as well as noting the presence of suicidal ideation -- the focus of the treatment plan was the veteran's alcohol dependency. The goals of the treatment included detoxification, having the veteran commit to sobriety and complete the "First Step" prior to dismissal from the hospital, and having the veteran commit to outpatient chemical dependency treatment. It was noted that, at the time of discharge, the veteran was able to verbalize that alcohol was a significant problem for him. Similarly, on the July 1998 VA examination report, the examiner noted that the veteran had reported having suffered extensively from profound alcoholism and having undergone treatment for alcoholism many times. Thus, although a few of the symptoms associated with the criteria for a 70 percent rating have been noted on occasion over the years, they have not been of the "persistence" noted in the "old" criteria to warrant a 70 percent rating or to conclude, under the revised criteria, that the severity of the symptomatology resulting from the service-connected PTSD more nearly approximates the criteria for the 70 percent rating. Concerning the latter, the Board notes that often these symptoms have been associated -- at least in part if not entirely -- with nonservice-connected disorders. Moreover, the examiners have indicated that the severity of the symptoms associated with PTSD is in a range contemplated by the 50 percent rating, i.e., "moderate" (April 1996 VA examination) or "moderate to severe" (July 1998 VA examination report). Finally, based on the examiners' indications of the "global" assessment of psychiatric functioning, it is reasonable to conclude that the level of severity resulting from the service-connected PTSD is appropriately rated as 50 percent when viewed in comparison with the "global" or total level of severity of psychiatric symptoms resulting from all psychiatric disorders, service-connected and nonservice-connected. In this regard, for example, the March 1996 private examiner assigned numerical designations on the GAF scale to indicate the level of the veteran's global functioning at that time and in the past year. The current GAF was 40, indicating "some impairment in reality testing or communication . . . or major impairment in several areas, such as work school, family relations, judgment, thinking, or mood." The highest GAF in the past year was 60 indicating "moderate symptoms or moderate difficulty in social, occupational or school functioning." See Quick Reference to the Diagnostic Criteria from DSM-IV, 46-47 (1994). Thus, if the "global" assessment of functioning -- that is, the assessment that includes the "total" combination of all psychiatric symptomatology and not just the symptomatology stemming from the service-connected PTSD -- is in a range from 40 to 60, it follows that the symptomatology stemming from the PTSD alone must be of a somewhat lesser degree of severity than that depicted by the GAF designation. Moreover, the Board notes that a GAF designation is only one item of evidence that must be considered when assigning a rating as are examiner's descriptions of a disorder as "moderate" or "severe", etc. The Board must interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2. In so doing, the Board observes that the July 1998 VA examiner -- similar to the examiner who had assigned the GAF score -- noted that the veteran's level of functioning for the past year had been at about 30 to 40 percent. Stated another way, the veteran was seen as 60 to 70 percent disabled by psychiatric symptoms. However, given the profound disabling effects of the nonservice-connected disorders, such as alcoholism (described as a "significant problem" on the March 1996 private report and as "profound" alcoholism on the July 1998 VA examination report) OCD (described as a "severe" obsessive, compulsive disorder on July 1987 VAMC report) and other nonservice-connected disorders noted by the medical evidence of record as a whole, the Board concludes that the total or "global" psychiatric symptomatology is not attributable to service-connected PTSD. It is clear from the paragraph in the July 1998 VA examination report in which the examiner noted the assessment of a 60 to 70 percent disability level that that level of disability included symptoms resulting from PTSD as well as from "obsessive-compulsive traits", "dysthymic disorder" and "alcohol dependence." Likewise, the Board concludes, with regard to the third independent basis for a 100 percent schedular rating in the old rating criteria -- that the veteran be shown to be demonstrably unable to obtain or retain employment as a result of the service-connected PTSD -- that it is not shown by the evidence of record that he is unable to obtain or retain employment as a result of the service-connected PTSD alone. Concerning this, the Board notes that, although the SSA has granted disability benefits to the veteran, that agency may grant benefits where a person is shown to be disabled, regardless of the disorder or combination of disorders from which the disability stems. However, VA, unlike the SSA, provides compensation only for disability resulting from service-connected disorders. Finally, the Board finds that the PTSD is currently manifested by occupational and social impairment of a considerable degree manifested by such symptoms as disturbances of motivation and mood; restricted range of affect, chronic sleep impairment, and recurrent and intrusive distressing recollections of Vietnam and nightmares more than once a week. In light of the evidence as a whole and for the reasons and bases articulated above, the Board concludes that the severity of disability resulting from the service-connected PTSD is appropriately compensated by the 50 percent rating assigned and does not more nearly approximate the degree of severity contemplated by the 70 percent or 100 percent ratings under either the old or the revised criteria for evaluating mental disorders in the VA Schedule for Rating Disabilities. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996); 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). A Total Rating Based On Individual Unemployability. A total rating for compensation purposes based on individual unemployability "may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure and follow a substantially gainful occupation as a result of service-connected disabilities," provided that certain percentage ratings are met for the service-connected disabilities. 38 C.F.R. § 4.16(a) (1999). If, as in this case, the veteran has only one service-connected disability, that disability must be rated at 60 percent or more. If, as in this case, the schedular rating assigned for the service-connected disorder does not meet the percentage requirements under section 4.16(a) but the veteran is unemployable by reason of service-connected disabilities, the rating board may refer the case to the Director, Compensation and Pension Service, for extraschedular consideration. Here, the RO decided not to refer the case to the Director, Compensation and Pension Service because, in the judgment of the rating agency, the veteran was not unemployable due to PTSD, alone. The Board agrees with that decision because there is no evidence of unemployability due to PTSD which could support a total rating based on individual unemployability. See VAOPGCPREC 6-96 at para. 18 (Aug. 16, 1996) (where claimant has raised the issue of entitlement to total rating based on individual unemployability the Board may conclude that there is no evidence of unemployability due to the service-connected disability which could support a total rating based on individual unemployability). In addition, the April 1996 VA examiner expressed the opinion that, although the symptoms of PTSD have caused the veteran difficulty working, as he is irritable and does not like to be around people, this did not preclude all forms of employment. Service Connection for Drug and Alcohol Abuse as Secondary to PTSD. Disability that is proximately due to or the result of a service-connected disease or injury is itself service connected. 38 C.F.R. § 3.310(a). A disability that is proximately due to or the result of a service-connected disease or injury is referred to as "a secondary condition" in section 3.310, and therefore service connection under 3.310(a) of such disability is often referred to as "secondary service connection". Id. Where a service-connected disability aggravates a nonservice connected disability, the degree of disability over and above the degree of disability existing before the aggravation is compensable. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Section 8052 of the Omnibus Budget Reconciliation Act of 1990 (OBRA), Pub. L. No. 101-508, § 8052, 104 Stat. 1388, 1388-351, made two amendments to statutes governing entitlement to [VA] benefits. First, section 8052(a)(1) amended 38 U.S.C. § 105(a) to provide that an injury or disease incurred during active service will not be deemed to have been incurred in line of duty if the injury or disease was "a result of the person's own . . . abuse of alcohol or drugs." Second, section 8052(a)(2) and (3) amended former 38 U.S.C. §§ 310 and 331 (now designated §§ 1110 and 1131) to prohibit payment of compensation for any disability that is the result of the veteran's own . . . abuse of alcohol or drugs." These two amendments apply "to claims filed after October 31, 1990." OBRA 1990 § 8052(b), 104 Stat. at 1388- [1]351. VAOPGCPREC 2-98 at para. 1 (Feb. 10, 1998). In Precedent Opinion 2-98, the General Counsel held that section 8052 of the law enacted in 1990 precluded service connection for a disability resulting from alcohol or drug abuse on the basis of the disability's incurrence or aggravation in service or of a death resulting from such disability. However, the General Counsel held that, for the purposes of all VA benefits other than disability compensation, "the amendments made by section 8052 do not preclude eligibility based on a disability . . . secondarily service-connected under 38 C.F.R. § 3.310(a) as proximately due to or the result of a service-connected disease or injury." VAOPGCPREC 2-98 at 16. In Barela v. West, where the veteran claimed service connection for alcohol and drug abuse secondary to service-connected PTSD with depression, the Court held that, although the amendments to the law precluded payment of compensation for disability that is a result of the veteran's abuse of alcohol or drugs, the 1990 amendments did not preclude the allowance of service connection for such disability. Barela v. West, 11 Vet. App. 280, 283 (1998). The Court noted that the distinction between an award of compensation for a disability and an award of service connection for a disability "is a distinction with a real difference since compensation is but one of the potential title 38 benefits which could flow from a determination that a disability is service-connected." Id. In a precedent opinion issued since the Court's decision in Barela, the General Counsel noted that, concerning the effect of the amendments made to the law in 1990, the Court's decision is consistent with the holding in VAOPGCPREC 2-98 that section 1110 precludes the payment of compensation for substance abuse disability. The General Counsel also noted that the Court's decision was not inconsistent with the holding in VAOPGCPREC 2-98 that section 105(a), which the Court did not address in Barela, also precludes direct service connection of such disability. VAOPGCPREC 7-99 at para. 9 (June 9, 1999). The terms of the September 1998 Motion for Joint Remand in this case, which was granted by the Court in an October 1998 order vacating the Board's May 1998 decision on the claim for service connection for alcohol and drug abuse secondary to service-connected PTSD, require the Board to address the claim in light of the Court's holding in Barela v. West. In the argument on this claim submitted to the Board in January 1999, the veteran states that section 1110 prohibits the payment of "compensation" for disability due to alcohol and drug abuse but it does not bar an award of secondary service connection. The fact that there is no legal bar to an allowance of service connection for alcohol and drug abuse secondary to a service-connected disability does not mean that such an allowance must be made in every case in which it is claimed. As with any other claim for service connection, the requirements for establishing service connection and for establishing a well grounded claim for service connection must be met before service connection may be allowed. 38 U.S.C.A. §§ 1110, 5107(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Like all claims for service connection, a claim for service connection for a disorder on a secondary basis must be well grounded. Buckley v. West, 12 Vet. App. 76, 84 (1998); Locher v. Brown, 9 Vet. App. 535, 538 (1996); Dinsay v. Brown, 9 Vet. App. 79, 86 (1996); Jones v. Brown, 7 Vet. App. 134, 137 (1994). With regard to a claim for secondary service connection, a claimant must provide competent evidence that the disability claimed is proximately due to or the result of a service-connected condition. See Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). The credibility of the evidence is presumed when determining whether a claim is well grounded. See Robinette v. Brown, 8 Vet. App. 69, 75-76 (1995); King v. Brown, 5 Vet. App. 19, 21 (1993). However, the presumption of credibility does not apply where a fact asserted is beyond a person's competency or where the evidence is inherently false. See id. A lay person is competent to testify as to symptoms he experienced, but he is not competent to opine as to a link between those symptoms and his present diagnosis. See Jones, 7 Vet. App. at 137. With regard to the evidence needed to render the claim for service connection for alcohol and drug abuse secondary to service-connected PTSD plausible or well grounded, the veteran argued the following in the January 1999 submission to the Board: The veteran's medical records are replete with evidence of substance abuse. The veteran has made it quite clear that his abuse of alcohol and drugs was an effort to counteract the intrusive thoughts and nightmares of his Vietnam experience. See the 7/13/98 C&P [Compensation & Pension] examination. This allegation by a combat veteran is a plausible claim and triggers the duty to assist. The VARO has failed in that duty by not inquiring of his treating psychiatrist whether his self-medicating behavior is proximately due to or the result of his service connected PTSD. In the alternative, the VARO should have scheduled a C&P exam to address the issue of etiology of the alcohol and drug abuse. The Board notes that the diagnosis of alcoholism and alcohol abuse has been rendered many times on numerous medical reports in the file. However, no medical report, to include the July 1998 VA examination cited in the veteran's argument above, has included among the veteran's subjective complaints a statement that "his abuse of alcohol and drugs was an effort to counteract" symptoms of PTSD or of his other nonservice-connected mental disorders. Nevertheless, even if the veteran had stated his belief that his alcohol abuse was caused by his PTSD in this way, whether there is a relationship between the alcoholism and the PTSD is a medical matter requiring medical evidence for its support and resolution, and the veteran's own statements are not competent evidence to render plausible this element of the claim for service connection because he is not competent to opine as to a link between one disorder and another or between symptoms and a diagnosis See Jones, 7 Vet. App. at 137. Because no medical evidence has been presented or secured in this case to render plausible a claim that alcoholism or alcohol abuse was caused or aggravated by service-connected PTSD, the Board concludes that the claim for service connection for alcohol and drug abuse secondary to PTSD is not well grounded. 38 U.S.C.A. § 5107(a). With regard to the veteran's January 1999 argument that the VA should have obtained medical evidence or scheduled a C&P examination to address the etiology of the drug and alcohol abuse, the Board notes that the veteran has the initial burden to bring evidence to establish a well grounded claim for service connection. Until he does, the VA does not have the duty to assist him in developing facts pertinent to his claim, including assisting him by affording him a VA medical examination. 38 U.S.C.A. § 5107(a); Morton v. West, 12 Vet. App. 477 (1999). Where a claim is not well grounded, VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim, but VA may be obligated under 38 U.S.C.A. § 5103(a) to advise a claimant of evidence needed to complete his application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69, 78 (1995). Here, unlike the situation in Robinette, the appellant has not put the VA on notice of the existence of any specific, particular piece of evidence that, if submitted, could make the claim for service connection for alcohol and drug abuse secondary to service-connected PTSD well grounded. See also Epps v. Brown, 9 Vet. App. 341 (1996). Moreover, the Board notes that, in July 1995, the RO wrote to the veteran with a copy to his attorney informing him that he must provide medical evidence to support the claim for service connection for alcohol and drug abuse secondary to service-connected PTSD and, in January 1999, pursuant to a remand by the Board, the RO again wrote to the veteran with a copy to his attorney allowing additional time for such evidence to be submitted. However, there was no response to these letters; no evidence was submitted and VA was not put on notice of the existence of any evidence that could make the claim well grounded. Accordingly, the Board concludes that VA did not fail to meet its obligations under 38 U.S.C.A. § 5103(a). CUE in A September 1988 Rating Decision in Assigning a 30 Percent Rating for PTSD, in Not Adjudicating a Claim for a Total Rating Based on Individual Unemployability, and in Not Granting Service Connection for Drug and Alcohol Abuse. The February 1999 Joint Motion for Remand on this claim for CUE, which was granted by the Court in a March 1999 order, states that the claim must be remanded to the Board "in order to cure a procedural error." Specifically, the parties noted that the Board had remanded the claim for CUE in November 1997 and instructed the RO to notify the veteran's attorney that the case was ready for submission to the Board and to provide him with an opportunity to advance any additional argument or evidence in connection with the claim. The RO sent the letter to the veteran using an old post office box number, although the new address was of record at that time, and the letter was sent back to the RO from the post office because the forwarding order had expired. The RO returned the case to the Board. The parties concluded that, because of this error, the RO failed to satisfy the directives of the November 1997 remand order in violation of the principle set forth in the Court's opinion in Stegall v. West, 11 Vet. App. 268 (1998). The parties did not state exactly how this matter was to be cured on remand by the Court to the Board but "[t]he parties agree that Appellant shall be provided an opportunity to submit additional argument or evidence in support of his claim." In June 1999, the Board wrote to the veteran's attorney, advising him that the case had been returned to the Board pursuant to the March 1999 Court order and allowing him 90 days to submit additional evidence or argument pertaining to the case. The attorney requested an extension of time to do so, which was granted, and then submitted a written argument to the Board, including an argument on the claim for CUE in the September 1988 rating decision, which was received by the Board in November 1999. Because the veteran and his attorney had actual notice of the right to submit additional evidence and argument pertaining to this claim and because such an argument has been submitted, the procedural error committed by the RO in 1997 when it sent the letter to the wrong address has been cured and the principle in Stegall has been complied with in full for all practical purposes. Therefore, the Board concludes that further remand of this claim to the RO for the RO notify the veteran and his attorney of the due process rights of which they are already aware is unnecessary because the law does not require a useless act. See Winters v. West, 12 Vet. App. 203, 207 (1999) (en banc) (noting that "the law does not require a useless act".). Turning to the claim of CUE in the September 1988 rating decision, the Board notes that the veteran submitted an original claim for service connection for several disabilities including a nervous condition and PTSD in June 1987. In a November 1987 rating decision, the RO denied service connection for PTSD, noting that the diagnosis was not shown on a recent VA examination, and denied service connection for OCD and dysthymic disorders on the basis that the evidence did not show these disorders to be related to service. After its November 1987 rating decision, the RO continued to receive medical evidence, including a report of hospitalization at a VA facility in June 1987 and several reports thereafter which showed a diagnosis of PTSD. In the rating action in September 1988, service connection for PTSD was granted and a 30 percent rating was assigned. The RO continued the denial of the veteran's claims for service connection for other disabilities and the veteran later withdrew his appeal of those claims. The RO also noted on the September 1988 rating decision document that alcohol dependency was considered a disability resulting from the veteran's own willful misconduct. With regard to the claim of CUE in the September 1988 rating decision, the Board notes that CUE is special type of error; it is an error that the claimant alleges was made in a prior rating decision that the claimant did not appeal within the one-year time limit for filing an appeal to the Board. 38 U.S.C.A. § 7105(b)(1), (c); 38 C.F.R. § 3.105. It is not just any error but rather it is the sort of error that, had it not been made, would have manifestly changed the outcome of the rating decision so that the benefit sought would have been granted. Russell v. Principi, 3 Vet. App. 310, 313 (1992); cf. Fugo v. Brown, 6 Vet. App. 40, 44 (1993) (noting that "[i]t is difficult to see how either failure in 'duty to assist' or failure to give reasons or bases could ever be CUE"); see Caffrey v. Brown, 6 Vet. App. 377, 383-84 (holding that failure to fulfill duty to assist cannot constitute clear and unmistakable error). It is not simply a disagreement with how the facts were weighed or evaluated. Rather, either the correct facts, as they were known at the time, were not before the adjudicator or the statutory or regulatory provisions extant at the time were incorrectly applied. Russell, 3 Vet. App at 313. A claim for benefits based on clear and unmistakable error in a prior final rating decision entails special pleading and proof requirements to overcome the finality of the decision by collateral attack because the decision was not appealed during the appeal period. Fugo, 6 Vet. App. at 44; Duran v. Brown, 7 Vet. App. 216, 223 (1994). The Court has held that, in order for a claimant to successfully establish a valid claim for clear and unmistakable error in a final RO rating decision, the claimant must articulate with some degree of specificity what the alleged error is, and, unless the alleged error is the kind of error that, if true, would be clear and unmistakable error on its face, the claimant must provide persuasive reasons explaining why the result of the final RO rating decision would have been manifestly different but for the alleged error. Luallen v. Brown, 8 Vet. App. 92, 94 (1995); Fugo, 6 Vet. App. at 44, review en banc denied, 6 Vet. App. 162, 163 (1994) (noting that pleading and proof are two sides of the same coin; if there is a heightened proof requirement, there is, a fortiori, a heightened pleading requirement). The veteran has set forth his arguments as to how the September 1988 rating decision was the product of CUE in a letter dated December 15, 1994, which was received by the RO in June 1995 and in his November 1999 submission to the Board. In the December 1994 letter, the veteran contended essentially as follows: (1) that the repeated "severity references" in the veteran's medical records clearly supported a rating in excess of 30 percent; (2) that certain repeated references in the medical records "suggest[ed] quite clearly a severe impairment of the veteran's earning capacity as a result of the veteran's service-connected condition" and that, because of these references, the September 1988 rating decision was the product of CUE because that rating decision (3) "fail[ed] to develop a claim for individual unemployability; and (4) that denial in the September 1988 rating decision of service connection for alcohol abuse was CUE because "there is no reference to the fact that the claim was ever considered" and "[i]t is evident from this omission that the veteran's claim for drug and alcohol abuse as secondary was never properly developed." Concerning the proposition set forth in (2) and (3), the veteran provides examples of the "references" in the medical records, namely, an August 1987 medical examination report which "describes loss of interest in work and activities"; a September 1987 Social and Industrial Survey which "indicates the veteran complained of being disinterested in work, at times overwhelmed with his job, and the fact that he would minimize these conditions"; an August 1987 letter from "Dr. W. Hail . . . which described disorganized thinking, "a close to catatonic state"; and a June 1988 Social and Industrial Survey "which indicates that the veteran was functioning at a 'relatively marginal level' and further reference by the author, 'I would not see him as employable at this time.'" In the November 1999 argument before the Board, the veteran relies on a decision of the United States Court of Appeals for the Federal Circuit in Hayre v. West, 188 F.3d. 1327 (Fed. Cir. 1999), and states that, rather than being the product of CUE, the RO in September 1988 "failed to fulfill its duty to assist under 38 C.F.R. § 3.103(a) when the rating decision of September 1988 failed to grant 'every benefit that can be supported in law.'" He argues that "[t]he failure to fulfill this regulatory duty constitutes a grave procedural error which effectively prevented the September 1988 ratings decision from becoming final." Turning to the first argument in the December 1994 letter -- that the repeated "severity references" in the veteran's medical records clearly supported a rating in excess of 30 percent -- the Board notes that the argument goes no further than this allegation. The veteran provides no analysis for his premise that a rating higher than 30 percent should have been granted for service-connected PTSD. He cites no provisions of law or regulation, extant at the time, that were misapplied. He refers to "severity references" but points to no examples from the medical evidence that was before the September 1988 rating board at the time which demonstrate that the assignment of the 30 percent rating was not only error but CUE. In short, he alleges a factual error but never discusses the facts. Thus, he has not articulated with any degree of specificity what the alleged error was or provided persuasive reasons explaining why the result of the final September 1988 rating decision would have been manifestly different but for the alleged error but instead has simply stated a disagreement with how the facts were weighed or evaluated. Luallen, 8 Vet. App. at 94; Fugo, 6 Vet. App. at 44, review en banc denied, 6 Vet. App. 162, 163 (1994); Russell, 3 Vet. App at 313. Accordingly, the Board concludes that the veteran has failed to adequately plead a claim of CUE in the September 1988 rating decision with regard to the assignment of the 30 percent rating for service-connected PTSD, and therefore such claim of CUE in that decision must be denied. With regard to the proposition that the RO failed to adjudicate a claim for a total rating based on individual unemployability and that such a failure was CUE -- the Board observes that the term "clear and unmistakable error" as used in section 3.105(a) of VA regulations refers to an error that has been made in a final rating decision. 38 C.F.R. § 3.105(a). A prior final rating decision may be revised based on CUE in that decision. "By its express terms, 38 C.F.R. § 3.105(a) refers to 'determinations on which an action was predicated.'" Russell, 3 Vet. App. at 313. It is difficult, therefore, to see how an alleged failure to adjudicate a claim could ever constitute CUE because the alleged error is predicated on inaction rather than action and by definition of the alleged offense itself there is no rating decision to revise. 38 C.F.R. § 3.105 (1999); cf. Fugo, 6 Vet. App. at 44 (noting that "[i]t is difficult to see how either failure in 'duty to assist' or failure to give reasons or bases could ever be CUE"); see Caffrey v. Brown, 6 Vet. App. 377, 383-84 (holding that failure to fulfill duty to assist cannot constitute clear and unmistakable error). In this case, there is no rating decision, including the September 1988 rating decision, which denied a claim for a total rating based on individual unemployability. Rather, such an issue was not adjudicated at all. The Board notes that -- although Court has held that an notice of disagreement (NOD) can attach to an RO's failure to adjudicate a claim which was properly before it so long as the NOD can be fairly read as encompassing the RO's failure to adjudicate that particular claim -- expressing disagreement in a timely filed NOD which initiates a timely appeal of a rating decision is not the same as collaterally attacking a final rating decision years later for the same offense. See Isenbart v Brown, 7 Vet. App. 537 (1995); Garlejo v. Brown, 10 Vet. App. 229 (1997). CUE is not the same as ordinary, garden-variety error. Fugo, 6 Vet. App. at 45 (noting that "simply to label garden-variety types of error as CUE" is not sufficient to raise viable CUE claim). Nevertheless, the Board is mindful that the Court has held that a veteran need not specify with precision the appropriate legal provision for a benefit he is seeking and that the VA's statutory duty to assist requires a liberal reading of documents and evidence to include consideration of issues reasonably raised therein. Stanton v. Brown, 5 Vet. App. 563, 570 (1993); McGrath v. Brown, 5 Vet. App. 57, 60 (1993); EF v. Derwinski, 1 Vet. App. 324, 326 (1991); Akles v. Derwinski, 1 Vet. App. 118, 121 (1991). The Court has held that, where a veteran claims an increased rating for a service-connected disability, a claim for a total rating based on individual unemployability -- which is a special type of increase -- also may be raised under certain circumstances. See McGrath, 5 Vet. App. at 60; see also Servello v. Derwinski, 3 Vet. App. 196, 200 (1992). However, the September 1988 rating decision in this case did not arise from a claim for an increased rating. Rather, it arose from a claim for service connection and, in the rating decision, the RO granted the benefit sought and assigned an initial rating of 30 percent for that disorder. See Fenderson v. West, 12 Vet. App. 119 (1999) (distinguishing between an original rating and an increased rating). The veteran did not appeal that initial rating. Accordingly, the Board concludes that it was not CUE for the September 1988 RO not to have adjudicated a "claim" for a total rating based on individual unemployability where the veteran did not disagree with the rating assigned. See Brannon v. West, 12 Vet. App. 32, 35 (1998) (while the Board must interpret appellant's submissions broadly, the Board is not required to conjure up issues that were not raised by the appellant). The Board notes incidentally, with regard to the examples cited by the veteran from the medical evidence before the September 1988 rating board which he claims demonstrate unemployability, that there was also evidence of record that the veteran was employable -- specifically, the June 1987 report of VA hospitalization in which the VA examiner specifically found that the veteran was employable. Concerning the proposition that denial of service connection for alcohol abuse in the September 1988 rating decision was CUE because "there is no reference to the fact that the claim was ever considered" and "[i]t is evident from this omission that the veteran's claim for drug and alcohol abuse as secondary was never properly developed" -- the Board notes that not only was a claim for drug and alcohol abuse secondary to PTSD not considered by the September 1988 rating board but also it was not made by the veteran. Before the RO can adjudicate an original claim for benefits, the claimant must submit a written document identifying the benefit and expressing some intent to seek it. Brannon, 12 Vet. App. at 35. In Brannon, there was medical evidence before the RO -- as it was adjudicating claims for an increased rating for a service-connected skin condition and for service connection for asthma -- indicating that a service-connected skin condition may have been affecting psychological functioning. The veteran argued before the Court that this medical evidence reasonably raised a claim for service connection for a psychiatric condition secondary to the service-connected skin condition that the RO erred when it failed to adjudicate that claim. However, the veteran had never claimed service connection for a psychiatric disorder. The Court held that the mere presence of medical evidence in the record which may have established a well grounded claim if such a claim had been made did not establish an intent on the part of the veteran to seek secondary service connection for the psychiatric condition and that the RO and the Board had not erred in not adjudicating such an issue. The Board notes that, if not adjudicating such an issue in Brannon did not constitute garden-variety or ordinary error in a timely appealed rating decision, it cannot constitute CUE in a final rating decision. Moreover, this case also may be distinguished from Brannon because no medical evidence in this case, including the medical evidence that was before the RO in September 1988, indicated that drug and alcohol abuse was secondary to service-connected PTSD. Hence, the Board concludes that it was not CUE for the RO not to have adjudicated an issue of service connection for drug and alcohol abuse as secondary to PTSD in the September 1988 rating decision. Turning to the argument advanced in the November 1999 submission to the Board -- that the RO in September 1988 "failed to fulfill its duty to assist under 38 C.F.R. § 3.103(a) when the rating decision of September 1988 failed to grant 'every benefit that can be supported in law'" and that "[t]he failure to fulfill this regulatory duty constitutes a grave procedural error which effectively prevented the September 1988 ratings decision from becoming final", the Board notes that veteran further asserts that an examiner stated as follows in a June 1988 Social and Industrial Survey: My impression is that he has the potential for violent behavior and that it may be difficult to predict what stressors may precipitate this behavior. I would not see him employable at this time . . . ." The veteran then alleges that "[t]his record clearly establishes that the veteran was unable to obtain and maintain employment in June of 1988." He argues that, therefore the schedular rating criteria for a 100 percent rating as well as the criteria for assigning a total rating based on individual unemployability "clearly were required to be considered by the AOJ based upon this record." He states that it is equally clear that the RO did not consider this criteria and that this failure constituted a breach in the duty to assist and of section 3.103(a) which "mandate that consideration be given to 'every benefit to which the veteran is entitled under law." He argues that this breach of the duty to assist constituted a grave procedural error which "vitiates the finality of the September1988 ratings decision". He cites the decision of the Federal Circuit in Hayre in connection with this argument. The Board notes that in Hayre, the Federal Circuit held that a veteran, under appropriate circumstances, can attack the finality of an unappealed RO decision by showing that such a decision was based on a breach of the statutory duty to assist. See Jones v. West, No. 99-7031, slip op. at 8 (Fed. Cir. 1999). Specifically, the Federal Circuit held in Hayre that where there is a breach in the duty to assist in which the VA failed to obtain pertinent service medical records specifically requested by the claimant and failed to provide the claimant with notice explaining the deficiency, the claim does not become final for purposes of appeal. Hayre, 188 F. 3d at 1334. In contrast to the holding in Hayre, the veteran here does not allege the RO breached its duty to assist by failing to obtain service medical records and by failing to explain such a deficiency, but instead he argues that the RO breached its duty to assist by not giving consideration to "every benefit to which the veteran is entitled under law" as he alleges is mandated by section 3.103(a). Concerning this, the Board notes that section 3.103(a), concerning procedural due process and appellate rights, provides today, as it did in September 1988 when the RO rendered its rating decision, as follows: (a) Statement of policy. Every claimant has the right to written notice of the decision made on his or her claim, the right to a hearing, and the right of representation. Proceedings before VA are ex parte in nature, and it is the obligation of VA to assist a claimant in developing the facts pertinent to the claim and to render a decision which grants every benefit that can be supported in law while protecting the interests of the Government. The provisions of this section apply to all claims for benefits and relief, and decisions thereon, within the purview of this part 3. 38 C.F.R. § 3.103(a) (1999). The duty articulated in section 3.103(a) "to render a decision which grants every benefit that can be supported in law while protecting the interests of the Government", when read in the context of the whole provision of the regulation, clearly contemplates that the decision rendered will be one on a claim that has been made by a claimant. 38 C.F.R. § 3.103(a) (1999); see Rhodan v. West, No. 96-1080 (U.S. Vet. App. Dec. 1, 1998) (Holdaway, J., concurring) (stating that, "even given the putatively non adversarial and paternalistic nature of the [VA] proceeding [at the administrative level], the veteran's interest is not the only one that the Secretary and his delegates must consider"; "[t]here is a duty to ensure that, insofar as possible, only claims established within the law are paid."). In this case, the veteran argues that the RO, in adjudicating a claim for service connection for PTSD, also should have granted a 100 percent schedular rating for the disorder or a total rating based on individual unemployability for the PTSD and should have granted secondary service connection for drug and alcohol abuse, when no claims for those benefits had been brought by the veteran. The Board concludes that essentially the same argument is advanced here as was advanced in the December 1994 letter -- although this time, instead of arguing for revision of a final rating decision based on CUE, the veteran argues that the September 1988 rating decision never became final because of a "grave procedural error". Nevertheless, the error alleged -- whether clear and unmistakable or grave procedural -- remains the same, i.e., the September 1988 rating decision assigned an initial rating of 30 percent rather than a higher schedular rating, particularly a 100 percent schedular rating or a total rating based on individual unemployability and did not grant service connection for drug and alcohol abuse. The veteran cites to one part of a June 1988 Social and Industrial Survey as dispositive evidence of the RO's alleged error in September 1988 and states that this record clearly establishes that the veteran was unable to obtain and maintain employment in June 1988. However, the September 1988 rating board had more medical reports before it than just the June 1988 Social and Industrial Survey and, by regulation, the responsibility of the rating specialist is to interpret reports of examination in light of the whole recorded history, reconciling various reports into a consistent picture. 38 C.F.R. § 4.2. In this regard, the September 1988 rating board also had before it a VAMC report from June-July 1987 which found that the veteran was employable. More importantly, however, all of the reports which the September 1988 rating board had before it -- including the June 1988 Social and Industrial Survey -- showed not only diagnoses of, and treatment for, PTSD but also diagnoses of and treatment for nonservice-connected disorders, particularly OCD and alcoholism, and it was the rating board's task to determine the level of disability resulting from the PTSD alone at that time. To argue that it was a grave procedural error for the September 1988 rating board not to have determined that the severity of the PTSD was more than that contemplated by the 30 percent rating assigned is merely to express disagreement with how the facts were weighed and evaluated by the rating board. Such disagreement cannot be CUE and it is also not comparable to the breach of the duty to assist described by the Federal Circuit in Hayre. ORDER A rating in excess of 50 percent for PTSD is denied. A total rating based on individual unemployability is denied. Service connection for drug and alcohol abuse as secondary to PTSD is denied. The appeal for revision of a September 1988 rating decision of the Phoenix, Arizona, Regional Office based on CUE in assigning a 30 percent rating for service-connected PTSD rather than a higher rating, in not adjudicating a claim for a total rating based on individual unemployability, and in not granting service connection for drug and alcohol abuse is denied. GEORGE R. SENYK Member, Board of Veterans' Appeals