Citation Nr: 0633590 Decision Date: 10/30/06 Archive Date: 11/14/06 DOCKET NO. 03-16 180 ) DATE ) ) On appeal from the U.S. Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky THE ISSUE Entitlement to an initial rating in excess of 30% for a post- traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Kentucky Department of Veterans Affairs ATTORNEY FOR THE BOARD Thomas A. Pluta, Counsel INTRODUCTION The veteran had active service from February 1966 to April 1968. This appeal to the Board of Veterans Appeals (Board) arises from a February 2002 rating action that granted service connection for PTSD and assigned an initial rating of 30% therefor. Because the appeal involves a request for a higher rating assigned following the initial grant of service connection, the Board has characterized it in light of the distinction noted by the U.S. Court of Appeals for Veterans Claims (Court) in Fenderson v. West, 12 Vet. App. 119, 126 (1999) (distinguishing initial rating claims from claims for increased ratings for already service-connected disability). In his May 2003 Substantive Appeal, the veteran requested a Board hearing at the RO. In an August 2003 statement, the veteran withdrew his request for a Board hearing. By decision of March 2004, the Board remanded this case to the RO for further development of the evidence and for due process development. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate the claim on appeal has been accomplished. 2. The veteran's PTSD is primarily manifested by a mildly depressed mood and anxiety, mild short-term memory problems, and a chronic sleep disturbance (to include nightmares); these symptoms reflect no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. CONCLUSION OF LAW The criteria for an initial rating in excess of 30% for PTSD are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.10, 4.126, 4.130, Diagnostic Code 9411 (2006). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duties to Notify and Assist Initially, the Board notes that in November 2000, the Veterans Claims Assistance Act of 2000 (VCAA) was signed into law. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002). To implement the provisions of the law, the VA promulgated regulations at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2006). The VCAA and its implementing regulations include, upon the submission of a substantially complete application for benefits, an enhanced duty on the part of the VA to notify a claimant of the information and evidence needed to substantiate a claim, as well as the duty to notify him what evidence will be obtained by whom. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In addition, they define the obligation of the VA with respect to its duty to assist a claimant in obtaining evidence. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). Considering the record in light of the duties imposed by the VCAA and its implementing regulations, the Board finds that all notification and development action needed to fairly adjudicate the claim on appeal has been accomplished. September 2001 pre-rating and March 2004 and March 2006 post- rating RO letters informed the veteran and his representative of the VA's responsibilities to notify and assist him in his claims, and to advise the RO as to whether there was medical evidence showing treatment for his PTSD. The March 2006 letter also provided notice of what was needed to establish entitlement to a higher rating (evidence showing that the disability had worsened). After each, the veteran and his representative were afforded opportunities to respond. The Board finds that the veteran has thus received sufficient notice of the information and evidence needed to support his claims, and has been provided ample opportunity to submit such information and evidence. The 2001, 2004, and 2006 RO letters also notified the veteran that the VA would make reasonable efforts to help him get evidence necessary to support his claims, such as medical records (including private medical records), if he gave it enough information, and, if needed, authorization, to obtain them. Those letters further specified what records the VA had received; what records the VA was responsible for obtaining, to include Federal records, and the type of records that the VA would make reasonable efforts to get. The March 2004 RO letter requested the veteran to furnish any evidence or information that he had that pertained to his claim. The Board finds that, collectively, these letters satisfy the statutory and regulatory requirement that the VA notify a claimant what evidence, if any, will be obtained by him and what evidence will be retrieved by the VA. See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The Board points out that, in the recent decision of Pelegrini v. Principi, 17 Vet. App. 412 (2004), the Court held that proper VCAA notice should notify the veteran of: (1) the evidence that is needed to substantiate a claim; (2) the evidence, if any, to be obtained by the VA; (3) the evidence, if any, to be provided by the claimant; and (4) a request by the VA that the claimant provide any evidence in his possession that pertains to this claim. As indicated above, all 4 content of notice requirements have been met with in this appeal. Pelegrini also held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant pursuant to the VCAA be provided at the time that, or immediately after, the VA Secretary receives a complete or substantially complete application for VA-administered benefits. In that case, the Court determined that the VA had failed to demonstrate that a lack of such pre-adjudication notice was not prejudicial to the claimant. In the matters now before the Board, documents fully meeting the VCAA's notice requirements were not furnished to the veteran prior to the February 2002 rating action on appeal. However, the Board finds that the delay in issuing the 38 U.S.C.A. § 5103(a) notice did not affect the essential fairness of the adjudication, in that his claims were fully developed and readjudicated after notice was provided. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). As indicated below, as a result of RO development and the Board remand, comprehensive documentation, identified below, has been associated with the claims folder and considered in evaluating the veteran's appeal. After the issuance of the RO's March 2004 notice letter and additional opportunities to provide information and/or evidence pertinent to the claim under consideration, the RO readjudicated the veteran's claim on the basis of all the evidence of record in May 2006, as reflected in the Supplemental Statement of the Case (SSOC). Hence, the Board finds that the VA's failure in not fulfilling any VCAA's notice requirements prior to the RO's initial adjudication of the claim is harmless. See ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998); Cf. 38 C.F.R. § 20.1102 (2005). More recently, in March 2006, during the pendency of this appeal, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that, in rating cases, a claimant must be informed of the rating formula for all possible schedular ratings for an applicable rating code. In this case, the Board finds that this was accomplished in the Statement of the Case and the SSOC, and that this suffices for Dingess/Hartman. The Court also held that the VA must provide information regarding the effective date that may be assigned; such notice was provided by letter of March 2006 as well as in the May 2006 SSOC. Additionally, the Board finds that all necessary development on the claim currently under consideration has been accomplished. The RO, on its own initiative as well as pursuant to the Board's remand, has made reasonable and appropriate efforts to assist the appellant in obtaining all evidence necessary to substantiate his claim, to include obtaining available post-service VA medical records through 2005. In January 2002 and June 2005, the veteran was afforded comprehensive VA psychiatric examinations in connection with his claim, reports of which are of record and have been considered in adjudicating this claim. Significantly, neither the veteran nor his representative has identified, and the record does not otherwise indicate, any existing, pertinent evidence, in addition to that noted above, that has not been obtained. The record also presents no basis for further development to create any additional evidence to be considered in connection with the matter currently under consideration. Under these circumstances, the Board finds that the veteran is not prejudiced by appellate consideration of the claim on appeal at this juncture, without directing or accomplishing any additional notification and/or development action. II. Analysis Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. When a question arises as to which of 2 ratings apply under a particular diagnostic code (DC), the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. See Fenderson, 12 Vet. App. at 126. The veteran's PTSD has been rated as 30% disabling under the provisions of 38 C.F.R. § 4.130, DC 9411. Under that DC, a 30% rating is assigned for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment; and mild memory loss (such as forgetting names, directions, recent events). A 50% rating is assigned when there is occupational 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; and difficulty in establishing and maintaining effective work and social relationships. A 70% rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, 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 ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. A 100% rating is warranted for total occupational and social impairment, due to such symptoms as: grossly inappropriate behavior; persistent danger of hurting oneself or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives or one's own occupation or name. Considering the pertinent evidence in light of the criteria of DC 9411, the Board finds that the veteran's PTSD has not been more than 30% disabling at any time since the initial grant of service connection in 2001. The medical evidence of record documents that the PTSD is primarily manifested by symptoms of a mildly depressed mood and anxiety, mild short- term memory problems, and a chronic sleep disturbance (to include nightmares). However, the Board finds that they are, nonetheless, reflective of current, overall impairment that is no more than mild to moderate in intensity, and the various VA clinical records reveal a disability picture that is consistent with that assessment. On May 2001 VA outpatient assessment, the veteran was noted to have lost his long-term job in December 1999 when his company went out of business; he currently drove a coal truck, and did not like the job. He complained of sleeping only 5 or 6 hours per night, nightmares, and intrusive thoughts. There were no current suicidal or homicidal thoughts or history of hallucinations or psychotic features. On examination, mood was moderately depressed and anxious. The veteran became tearful at times when talking about killing in Vietnam. There was an appropriate, full range of affect consistent with anxiety and depression. He was well- groomed and cognition was all right. There was some hopelessness, but this was not out of control. The assessment was that the veteran was functioning adequately on the job and at home, even though he was in some distress emotionally and not sleeping well. A Global Assessment of Functioning (GAF) score of 60 was assigned. On June 2001 VA outpatient assessment, the veteran complained of nightmares, sleeping only 4 to 6 hours per night, impatience, easy irritability, intolerance of being around people, exhaustion, and no motivation. He lived with his 2nd wife of 28 years and reported no marital problems. He was employed on a full time basis as a coal mine truck driver, which he found very stressful. On current examination, mood was anxious and depressed, and the veteran appeared tired. He was well-groomed, polite, and cooperative, but not sleeping well, having combat nightmares 2 or 3 times per week. There was no suicidal ideation. Affect was anxious and consistent with fatigue. A GAF score of 55 was assigned. On June 2001 VA psychiatric examination, the veteran complained of a depressed mood since a January heart attack, as well as fatigue, increased irritability, no longer enjoying recreational activities, sleep problems, and a decreased energy level. On mental status examination, the veteran was moderately groomed, pleasant, and cooperative. The thinking process was logical and goal-oriented, and all answers were appropriate. Mood was depressed, and he reported crying spells at times. He had suicidal thoughts a couple of months ago, but not currently. He denied hallucinations, delusional ideas, or paranoid ideation. He reported hypervigilance at times. Cognitive function was good. He reported good relationships with his family (children and siblings). He had a couple of friends with whom he used to keep in contact, but had not done so recently. The impressions were delayed PTSD and major depression (single episode), and a GAF score of 60 was assigned. On mid-July 2001 VA outpatient assessment, the veteran complained of continuing sleep problems, with vivid nightmares of Vietnam and frequent intrusive thoughts. He avoided social situations. On examination, mood was within normal limits, and the veteran was well-groomed. He appeared to be fatigued and in need of sleep. There was a full range of affect, and he had a realistic outlook. A GAF score of 60 was assigned. On August 2001 VA outpatient assessment, the veteran enjoyed being at home with his family. He continued to work, but reported that this was difficult. He was able to control his temper. He complained of continuing sleep problems and fatigue. On examination, mood was depressed, and affect consistent therewith, but was also in the full range. The veteran had a good sense of humor. He was well-groomed and all right cognitively, and there was no hopelessness. A GAF score of 60 was assigned. On September 2001 VA outpatient assessment, the veteran reported that prescribed medication was helping his mood somewhat, in that he was less depressed and irritable. He had enjoyed a recent grandparents day at church with his granddaughter, and got along well with his wife. He reported continuing sleep problems and nightmares of combat experiences. On current examination, mood was within normal limits, and affect mildly anxious and restricted. The veteran was well-groomed but appeared tired and sleepy. He had a good sense of humor and a realistic outlook, and there was no hopelessness. On October 2001 VA outpatient assessment, the veteran complained of flashbacks, intrusive thoughts, nightmares, and hypervigilance due to war and terrorism. He got pretty good sleep 2 or 3 nights per week, and medication helped and lessened his irritability. He continued to do all right at work, but this remained stressful. On current examination, mood was mildly depressed and anxious. He was polite and cooperative, and insight and judgment were all right. There were no suicidal ideas. The assessment was that the veteran was doing fair and coping with increased PTSD symptoms, and that medications were helping. A GAF score of 60 was assigned. On late October 2001 VA psychiatric examination, the veteran reported doing better since taking prescribed medication, feeling less depressed and irritable and better able to deal with his family. He continued to have sleep problems, with nightmares, intrusive thoughts, and flashbacks. He had crying spells on and off, but was able to walk away from situations that caused him difficulty in his job. On mental status examination, the veteran was oriented, alert, and coherent, with a depressed mood but no psychotic features, hallucinations, or delusional, suicidal, or homicidal ideations. Cognitive function was fair. The impressions were chronic PTSD and major depression (single episode), and a GAF score of 65 was assigned. On early January 2002 VA psychiatric examination, the veteran complained of flashbacks and nightmares of his Vietnam experiences, which led to sleep problems and fatigue. He socialized less with co-workers, and had less interest in things. He continued to work as a coal truck driver. He reported getting along well with his wife of 29 years, and stated that he had a few good friends, but had withdrawn from them. He used to hunt, fish, and ride a motorcycle, but had not done so for a couple of years, and instead just sat inactively at home or worked in his garage. On mental status examination, the veteran reported on time and was neatly dressed, and answered questions sufficiently well. He was oriented in 3 spheres. Mood was slightly depressed, but there was no apparent thought disorder, and memory was intact, and insight and judgment good. There was no impairment of thought process, and no delusions, hallucinations, or recent suicidal or homicidal thoughts. Eye contact was good, and he maintained personal hygiene. The veteran reported some problems remembering what had occurred that day before, but the examiner felt that this did not seem out of the ordinary. There was no obsessive or ritualistic behavior, and speech was relevant and logical. He had no real panic attacks. The veteran stated that he could become a little anxious, depressed, and shaky at times, and felt sad, hopeless, and cried about his situation, but medications helped somewhat. There was no problem with impaired impulse control. The veteran reported being tired and run-down when he had sleep problems. The diagnosis was PTSD, and a GAF score of 60 was assigned, indicating moderate symptoms of impaired social functioning, sleep problems, and withdrawal from others, significant activities, and leisure pursuits, and a good history of family relationships. On late January 2002 VA outpatient assessment, the veteran complained of continuing sleep problems, nightmares, and hypervigilance. On examination, mood was mildly anxious and depressed, and there was a range of affect. The veteran was well-groomed and had good insight and judgment. Cognition was all right, and there was no hopelessness or suicidal or retaliation ideas. The veteran was assessed to be coping all right, and a GAF score of 60 was assigned. On early February 2002 VA outpatient assessment, the diagnoses were chronic PTSD and major depression (single episode), and a GAF score of 65 was assigned. On mid-February 2002 VA outpatient assessment, the veteran was noted to be doing fairly well, but still having nightmares. On examination, mood was within normal limits, and there was a good range of affect and sense of humor. The veteran was well-groomed and had a realistic outlook. He was assessed to be coping all right, and a GAF score of 60 was assigned. On March 2002 VA outpatient assessment, the veteran was noted to be doing fair overall, still able to do his job despite stress. He slept pretty well for 6 to 8 hours, 3 or 4 nights per week. His energy level was fair, and he got tired easily. He had good interest, but his motivation was low, and it was difficult to get going on home projects. On examination, mood was within normal limits, and there was some range of affect. Grooming was good, and the veteran was sociable, but he appeared tired. The assessment was mixed results of increased prescribed medication, and a GAF score of 60 was assigned. On April 2002 VA outpatient assessment, prescribed medication was noted to be helping the veteran some, but it was possible that he was having sexual side-effects. He still had nightmares, flashbacks, and intrusive thoughts, but he was doing all right at work. On examination, mood was mildly depressed and anxious, but there was some range of affect, and the veteran was well-groomed. Judgment was all right, the veteran was spontaneous, and there were no self- destructive ideas. The assessment was improved mood with medication, but with increased intrusive symptoms and sexual problems. A GAF score of 60 was assigned. On April 2002 VA psychiatric examination, the veteran was oriented, alert, and coherent. Mood was depressed, but there was no suicidal or homicidal ideation or psychotic features. He continued to have intrusive thoughts and nightmares, and he avoided any news and movies related to war and Vietnam. Cognitive function was fair. The impressions were chronic PTSD and recurrent major depression, and a GAF score of 60 was assigned. On May 2002 VA outpatient assessment, the veteran complained of a worsening mood, irritation, and fatigue, as well as continuing nightmares. However, the examiner felt that he was doing fair overall, and the veteran was getting along well with his wife. On examination, mood was mildly depressed and anxious. However, the veteran was alert, well- groomed, cooperative, and had a good sense of humor. A GAF score of 60 was assigned. On June 2002 VA outpatient assessment, the veteran reported a worsening mood and irritability, but sexual function was a little better. On examination, mood was mildly depressed, but there was a good range of affect. The veteran appeared sleepy, but grooming and hygiene were good, and he had a realistic outlook. A GAF score of 60 was assigned. On July 2002 VA psychiatric examination, the veteran reported that his mood was up and down, with continuing nightmares several time per week and sleep difficulty. On mental status examination, the veteran was oriented, alert, and coherent. Mood was depressed, but cognitive function was fair. He denied suicidal or homicidal ideations, and no psychotic features were noted. The impressions were chronic PTSD and recurrent major depression, and a GAF score of 60 was assigned. On August 2002 VA outpatient assessment, the veteran was noted to be doing pretty well, but still not sleeping very well, with disturbing vivid nightmares of Vietnam combat several times per week. He continued to work, although he didn't like it, because he had to make a living. He occasionally rode his motorcycle for fun, and he was doing well with his wife, and recently drank a few beers with a friend. On examination, mood was within normal limits, and the veteran was alert, spontaneous, and well-groomed, with a realistic outlook. His medication was assessed to be helping his mood and anxiety, and a GAF score of 60 was assigned. On September 2002 VA outpatient assessment, the veteran complained of continuing nightmares, but he was doing all right at work, although it was tiring driving a truck. Overall he felt that he was coping well, and that his medications were helping. On examination, mood was mildly anxious. The veteran was alert, with a full range of affect and a realistic outlook. He was well-groomed, but he appeared tired. The assessment was that medications were helping and that the PTSD symptoms were under a little better control, and a GAF score of 60 was assigned. On November 2002 VA outpatient assessment, the veteran was noted to be doing fairly well. He had a new job in the mine above ground running a plant, which was less difficult, paid better than driving a truck, and reduced his stress, and he was glad that he could work alone in the new job. Mood had been fairly good, and he had normal emotional reactions. He slept for 6 hours per night, had nightmares 2 or 3 times per week, and appetite was all right. On examination, mood was within normal limits, but affect was sad (his sister-in-law had been murdered by strangulation). The veteran was well- groomed, alert, and spontaneous, and there was no hopelessness. The assessment was that medications had been helping, and that the veteran was coping with increased stress from the recent murder in his family. A GAF score of 60 was assigned. On January 2003 VA psychiatric examination, the veteran reported doing better, but still complained of nightmares and feelings of depression at times. He had changed jobs and was currently running a plant, a job he liked. On examination, the veteran was oriented, alert, and coherent. Mood was mildly depressed, but there were no suicidal or homicidal ideations. He continued to have intrusive thoughts and nightmares often, and an occasional depressed mood. Cognitive function was fair, and there were no psychotic features. The impressions were chronic PTSD and recurrent major depression, and a GAF score of 60 was assigned. On January 2003 VA outpatient assessment, the veteran stated that he appreciated being able to be supportive of his wife due to the recent death of her sister. He liked his new job, and had been attending church with his wife. He continued to experience nightmares and sleep problems, but overall was doing fair. On examination, mood was within normal limits, and there was a good range of affect. The veteran was well- groomed, alert, and insightful, and he had a realistic outlook. A GAF score of 60 was assigned. On February 2003 VA outpatient assessment, the veteran reported that he was doing all right at work, and getting along well at home. He had a good appetite, but he did not sleep well. Energy was fair, but he got irritable easily and sometimes became too angry. On examination, mood was within normal limits, and the veteran was alert, talkative, and well-groomed. Affect was anxious. A GAF score of 60 was assigned. On March 2003 VA outpatient assessment, the veteran reported that prescribed medications were helping him sleep and helping his mood. He was frequently tired due to long work hours, and he had little family time. On examination, mood was within normal limits, and the veteran was alert but tired. He was well-groomed, there was a range of affect, and he had a realistic outlook. A GAF score of 60 was assigned. On April 2003 VA outpatient assessment, the veteran complained of fatigue, intrusive thinking, and not sleeping as well. He enjoyed doing things with his wife, and had been attending church with her and continuing to be supportive. He stated that medications continued to help some. On examination, mood was within normal limits, and there was a range of affect. The veteran appeared sleep-deprived, but he was well-groomed, and had a realistic outlook. A GAF score of 55 was assigned. On July 2003 VA outpatient assessment, the veteran was noted to be stressed due to working overtime; he also continued to have nightmares several times per week.. He was paid well, but needed time off to be with his family and to sleep more. On examination, mood was low, mostly due to fatigue. There was a range of affect, the veteran was cooperative, pleasant, and well-groomed, and he had a realistic outlook. The assessment was that the stress of extra work hours was causing increased PTSD symptoms, especially nightmares, but that the veteran was coping all right. A GAF score of 55 was assigned. On October 2003 VA psychiatric examination, the veteran complained of depression on and off, nightmares, mild irritability, and fatigue from working overtime. On mental status examination, the veteran was oriented, alert, and coherent. Mood was mildly depressed, but there were no suicidal or homicidal ideations, psychotic features, hallucinations, or delusional ideas. He continued to have intrusive thoughts and nightmares. The impressions were chronic PTSD and recurrent major depression, and a GAF score of 60 was assigned. On June 2005 VA psychiatric examination, the veteran was noted to have taken an early retirement from his job as a coal miner after he was laid off approximately 2 years ago. He reported good relationships with his children and grandchildren, and saw them often. Socially, the veteran reported having a couple of good friends, but that he had been isolating himself the past couple of years, and did not socialize with them as much as he used to, as he no longer had an interest in fishing. His current social supports mainly consisted of his immediate family members. He had lost interest in hunting, fishing, and riding his motorcycle, and currently reported no hobbies. Stressors during the past 2 years were the loss of his job, the murder of his sister- in-law, his heart attack, and having to file for bankruptcy. The veteran currently complained of nightmares and intrusive thoughts about his Vietnam combat experiences, increased arousal, easy irritability, concentration and short-term memory problems, continuing sleep problems, anxiety around people, loss of interest in activities he used to enjoy, and suicidal thoughts, but no ideations, plan, or intent. On mental status examination, the veteran was oriented, alert, neatly dressed, cooperative, and maintained good eye contact. Grooming was good, and he maintained his personal hygiene, mowed the lawn, maintained the family vehicles, and helped his wife around the house. Speech was normal, and mood was appropriate to the context of conversation and congruent. Thought processes showed goal-directed answers, and there were no hallucinations or delusions. There was no inappropriate, obsessive, or ritualistic behavior. Long-term memory was intact, but the veteran reported short-term memory problems such as losing or misplacing items. There were no panic attacks or impaired impulse control. The diagnosis was chronic PTSD, and a GAF score of 55 was assigned. Considering the evidence in light of the criteria noted above, the Board finds that the veteran's psychiatric symptoms are indicative of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, thus meeting the criteria for no more than a 30% rating. In reaching this determination, the Board has considered the medical evidence which shows that he has multiple social interactions with family, and the ability to perform the activities of daily living. His grooming and hygiene have been consistently normal, he has appeared to generally function satisfactorily in his family social relationships, and his psychiatric impairment never significantly impaired his ability to work; rather, his occupational impairment in his final working years was attributed to fatigue from working overtime. The Board finds that the symptoms associated with the veteran's PTSD simply do not meet the criteria for at least the next higher 50% rating, that is, occupational and social impairment with reduced reliability and productivity due to certain symptoms; rather, the Board finds that those delineated symptoms are not characteristics of the veteran's current psychiatric disability. Specifically, the veteran has not been shown to have a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; or difficulty in understanding complex commands. While he has complained of short-term memory problems, long-term memory has been intact, and he does not suffer from impaired judgment or abstract thinking, or difficulty in establishing and maintaining effective work and social relationships. Further, as noted above, neither the veteran nor any psychiatric examiner has related his current unemployment to his PTSD. On the contrary, the most recent 2005 VA examiner noted that he had taken an early retirement after he was laid off from his job. The Board also notes that the veteran has been assigned GAF scores ranging from 55 to 65, as consistently reflected in numerous VA clinic records and examination reports from 2001 to 2005. According to the 4th Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), GAF scores between 51 and 60 are indicative of moderate symptoms (e.g., a flat affect and circumstantial speech, occasional panic attacks), or moderate difficulty in social, occupational, or school functioning (e.g., having few friends, having conflicts with peers or co- workers). GAF scores between 61 and 70 are indicative of some mild symptoms (e.g., a depressed mood and mild insomnia), or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but indicate that the subject generally functions well, and has some meaningful interpersonal relationships. There is no question that a GAF score and its interpretations are important considerations in rating a psychiatric disability; however, the GAF scores assigned in a case, like an examiner's assessment of the severity of a condition, are not dispositive of the percentage disability rating issue; rather, a GAF score must be considered in light of the actual symptoms of the veteran's disorder (which provide the primary basis for the rating assigned). See 38 C.F.R. § 4.126(a). In this case, the medical evidence of record fails to show that the veteran's PTSD symptoms include a flat affect, circumstantial speech, occasional panic attacks, having conflicts with peers or co-workers, occasional truancy, or theft within the household; rather, they indicate that he generally functions well, and has some meaningful interpersonal relationships. For all the foregoing reasons, the Board finds that there is no basis for staged rating, pursuant to Fenderson, and that the claim for an initial rating in excess of 30% for PTSD must be denied. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53- 56 (1990). ORDER An initial rating in excess of 30% for PTSD is denied. ____________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs