Citation Nr: 0810129 Decision Date: 03/27/08 Archive Date: 04/09/08 DOCKET NO. 05-36 382 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUE Entitlement to an increased rating from an original grant of service connection for post traumatic stress disorder (PTSD), rated as 70 percent disabling. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD S.M. Cieplak, Counsel INTRODUCTION The veteran served on active duty from September 1964 to August 1968. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from a November 2004 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, which established entitlement to service connection for PTSD with a 50 percent disability evaluation. Thereafter, a June 2004 rating action increased the rating to 70 percent effective January 27, 2003, the date of the originals claim. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate the claim on appeal has been accomplished. 2. Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name is not demonstrated or approximated. CONCLUSION OF LAW The criteria for an initial rating in excess of 70 percent for PTSD, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), and as interpreted by the United States Court of Appeals for Veterans Claims (the Court) have been fulfilled by information provided to the veteran in letters from the RO dated in March 2003, April 2004, July 2005 and October 2006. Those letters notified the veteran of VA's responsibilities in obtaining information to assist the veteran in completing his claim, identified the veteran's duties in obtaining information and evidence to substantiate his claim, and requested that the veteran send in any evidence in his possession that would support his claim. (See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a)), Quartuccio v. Principi, 16 Vet. App. 183 (2002), Pelegrini v. Principi, 18 Vet. App. 112 (2004). See also Mayfield v. Nicholson, 19 Vet. App. 103, 110 (2005), reversed on other grounds, 444 F.3d 1328 (Fed. Cir. 2006), Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); Mayfield v. Nicholson (Mayfield II), 20 Vet. App. 537 (2006). The Board acknowledges a recent decision from the Court that provided additional guidance of the content of the notice that is required to be provided under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) in claims involving increased compensation benefits. See Vazquez-Flores v. Peake, No. 05- 355 (U.S. Vet. App. Jan. 30, 2008). In that decision, the Court stated that for an increased compensation claim, 38 U.S.C.A. § 5103(a) requires, at a minimum, that the VA notify the claimant that, to substantiate a claim, the claimant must provide, or ask the VA to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life. Further, if the Diagnostic Code under which the claimant is rated contains criteria necessary for entitlement to a higher disability rating that would not be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of the disability and the effect of that worsening has on the claimant's employment and daily life (such as a specific measurement or test result), the VA must provide at least general notice of that requirement to the claimant. See Vazquez-Flores v. Peake, No. 05-355, Slip op at 5-6. While the veteran was clearly not provided this more detailed notice, the Board finds that the veteran is not prejudiced by this omission in the adjudication of his increased rating claim. In this regard, during the course of this appeal the veteran has been represented at the RO and before the BVA by a National Veterans Service Organization (VSO) recognized by the VA, specifically the American Legion and the Board presumes that the veteran's representative has a comprehensive knowledge of VA laws and regulations, including particularly in this case, those contained in Part 4, the Schedule for Rating Disabilities, contained in Title 38 of the Code of Federal Regulations. In addition, after the veteran and his VSO representative were provided copies of the Statement of the Case by the RO, the representative submitted a VA Form 646 (Statement of Accredited Representative in Appealed Case) in which the representative essentially acknowledged receipt of the Statement of the Case and provided additional argument in response to that document, which the Board notes contained a list of all evidence considered, a summary of adjudicative actions, included all pertinent laws and regulation, including the criteria for evaluation of the veteran's disability, and an explanation for the decision reached. In the Board's opinion all of this demonstrates actual knowledge on the part of the veteran and his representative of the information that would have been included in the more detailed notice contemplated by the Court in the Vazquez- Flores case. As such, the Board finds that the veteran is not prejudiced based on this demonstrated actual knowledge. The veteran has been made aware of the information and evidence necessary to substantiate his claim and has been provided opportunities to submit such evidence. The RO has properly processed the appeal following the issuance of the required notice. Moreover, all pertinent development has been undertaken, examinations have been performed, and all available evidence has been obtained in this case. The appellant has not identified any additional evidence that could be obtained to substantiate the claim. Clearly, from submissions by and on behalf of the veteran, he is fully conversant with the legal requirements in this case. Thus, the content of these letters complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). No further action is necessary for compliance with the VCAA. Factual Background The veteran filed a claim of entitlement to service connection for PTSD on January 27, 2003. Service treatment records are silent as to complaints, findings, treatment or diagnoses relating to any mental disorder. A December 2002 VA mental assessment noted an extensive family history of mental disorders as well as substance abuse. At the time of the assessment, the veteran's own substance abuse was the foremost disorder and, furthermore, a diagnosis of PTSD was explicitly noted as unsupported. Treatment records reflected that the veteran was not interested in learning how to stay clean from his drug problems. VA outpatient treatment records dated in November 2003 reveal that veteran sought treatment for his drug abuse. On mental status examination, he was not expressing suicidal or homicidal ideation, he did not have auditory or visual hallucinations, denied major depression. He verbalized and agreed to the treatment program. The following day, he was seen by a staff psychologist. He reported nightmares that awoke him from his sleep, reexperiencing the killing he did in Vietnam. He did not have flashbacks, but did have intrusive memories of Vietnam. He was uncomfortable if his back was to a door. He reported social isolation, discussed his drug problem, and expressed an interest to detoxify. On mental status examination, he was alert and oriented, and his affect was full-range and appropriate. Mood was neutral. His associations were goal oriented, and he denied suicidal or homicidal ideation, he did not have auditory or visual hallucinations, no delusions, and no referential thinking. Speech was normal in rate and spontaneity. His intellect was intact, his insight and judgment were good. Similar findings were reported by the staff psychologist in December 2003, and in January, February, March and April 2004. An April 2004 outpatient treatment record recorded by a staff psychiatrist noted that the veteran did not manifest suicidal or homicidal ideation. There were no audio or visual hallucinations, and no delusions. His affect was full and appropriate and he was alert and oriented. The veteran was afforded a VA examination in April 2004. He was casually and appropriately dressed. His speech was clear and he was quite talkative throughout the interview. He was in good reality contact and oriented in all three spheres. There was no evidence of delusions or hallucinations. Reasoning and judgment appeared normal. Short and long term memory appeared intact. Affect was anxious and depressed. He suffered from sleep disturbance, anger problems and social isolation. Global Assessment of Functioning (GAF) was assessed as 45. In March 2005, a VA nurse counselor provided correspondence in support of the veteran's claim. She reported that he perceived potential threats in his day to day life. His response was usually anger. He did not carry it out, however, because he knew of the consequences. She reported that he was extremely protective and engaged in checking and other typical PTSD behavior. The nurse also commented that his extensive drug use was commonly associated with PTSD. She summarized that although the veteran saw his life as normal, it is not. The veteran was afforded a VA mental disorders examination in April 2006. The examiner reviewed the claims file. The veteran's parents were deceased. As to his education and employment history, the veteran went to the 11th grade and then got a GED. He also went to community college for one year but did not complete it. For a period of time many years ago, he installed safes and vaults in banks. At another time he was a roofer. His last job six years ago was a telephone marketer. He held that only part-time. He was not able to hold any of them for many years and so he remains unemployed. His only source of income at the present time is the service connected disability. He was in debt but went into bankruptcy a few years ago. He states he now just gets by on the money coming in. The veteran was in his third marriage and had a daughter and they lived together in their home. The veteran did not socialize nor was he close to his wife. He had no friends. He stated his daily activities included trying to help do the chores at home while his wife worked. He had no interests, hobbies, or activities he liked to pursue. He did take care of the dog and the cat. He was casually dressed and talkative. He made good eye contact and was able to walk without any problems. His mood was anxious and depressed. His affect was constricted; he was sad, anxious, irritable and depressed. His speech was clear. Thought processes reflected good reality contact. Thought content was appropriate. Cognition, insight and judgment were thought to be fair and normal. The veteran described himself as depressed and angry. However, he denied any current suicidal or homicidal ideation. He denied auditory hallucinations. He acknowledged occasional visual hallucinations thinking he saw something and then realized that it was not there. The veteran was oriented times three and was not psychotic. Diagnosis was PTSD chronic severe GAF score 45. The examiner noted that veteran's GAF scores varied over the years. His last compensation examiner gave him a GAF of 45, his current ARU GAF scores were 65. However, based on his PTSD symptoms, the examiner would judge it to be around 45. Analysis Disability ratings are rendered upon the VA's Schedule for Rating Disabilities as set forth at 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity in civil occupations. The disability must be viewed in relation to its history. 38 C.F.R. § 4.1. The higher evaluation shall be assigned where the disability picture more nearly approximates the criteria for the next higher evaluation. 38 C.F.R. § 4.7. While lost time from work related to a disability may enter into the evaluation, the rating schedule is "considered adequate to compensate for considerable loss of working time from exacerbations proportionate" with the severity of the disability. 38 C.F.R. § 4.1. The United States Court of Appeals for Veterans Claims (hereinafter, "Court") has held that, in a claim of disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). General Rating Formula for Mental Disorders: Ratin g Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name 100 Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships 70 38 C.F.R. § 4.130, Diagnostic Code 9411 (2007) Global Assessment of Functioning (GAF) Scale 50 ? 41 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUE Entitlement to an increased rating from an original grant of service connection for post traumatic stress disorder (PTSD), rated as 70 percent disabling. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD S.M. Cieplak, Counsel INTRODUCTION The veteran served on active duty from September 1964 to August 1968. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from a November 2004 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, which established entitlement to service connection for PTSD with a 50 percent disability evaluation. Thereafter, a June 2004 rating action increased the rating to 70 percent effective January 27, 2003, the date of the originals claim. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate the claim on appeal has been accomplished. 2. Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name is not demonstrated or approximated. CONCLUSION OF LAW The criteria for an initial rating in excess of 70 percent for PTSD, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), and as interpreted by the United States Court of Appeals for Veterans Claims (the Court) have been fulfilled by information provided to the veteran in letters from the RO dated in March 2003, April 2004, July 2005 and October 2006. Those letters notified the veteran of VA's responsibilities in obtaining information to assist the veteran in completing his claim, identified the veteran's duties in obtaining information and evidence to substantiate his claim, and requested that the veteran send in any evidence in his possession that would support his claim. (See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a)), Quartuccio v. Principi, 16 Vet. App. 183 (2002), Pelegrini v. Principi, 18 Vet. App. 112 (2004). See also Mayfield v. Nicholson, 19 Vet. App. 103, 110 (2005), reversed on other grounds, 444 F.3d 1328 (Fed. Cir. 2006), Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); Mayfield v. Nicholson (Mayfield II), 20 Vet. App. 537 (2006). The Board acknowledges a recent decision from the Court that provided additional guidance of the content of the notice that is required to be provided under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) in claims involving increased compensation benefits. See Vazquez-Flores v. Peake, No. 05- 355 (U.S. Vet. App. Jan. 30, 2008). In that decision, the Court stated that for an increased compensation claim, 38 U.S.C.A. § 5103(a) requires, at a minimum, that the VA notify the claimant that, to substantiate a claim, the claimant must provide, or ask the VA to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life. Further, if the Diagnostic Code under which the claimant is rated contains criteria necessary for entitlement to a higher disability rating that would not be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of the disability and the effect of that worsening has on the claimant's employment and daily life (such as a specific measurement or test result), the VA must provide at least general notice of that requirement to the claimant. See Vazquez-Flores v. Peake, No. 05-355, Slip op at 5-6. While the veteran was clearly not provided this more detailed notice, the Board finds that the veteran is not prejudiced by this omission in the adjudication of his increased rating claim. In this regard, during the course of this appeal the veteran has been represented at the RO and before the BVA by a National Veterans Service Organization (VSO) recognized by the VA, specifically the American Legion and the Board presumes that the veteran's representative has a comprehensive knowledge of VA laws and regulations, including particularly in this case, those contained in Part 4, the Schedule for Rating Disabilities, contained in Title 38 of the Code of Federal Regulations. In addition, after the veteran and his VSO representative were provided copies of the Statement of the Case by the RO, the representative submitted a VA Form 646 (Statement of Accredited Representative in Appealed Case) in which the representative essentially acknowledged receipt of the Statement of the Case and provided additional argument in response to that document, which the Board notes contained a list of all evidence considered, a summary of adjudicative actions, included all pertinent laws and regulation, including the criteria for evaluation of the veteran's disability, and an explanation for the decision reached. In the Board's opinion all of this demonstrates actual knowledge on the part of the veteran and his representative of the information that would have been included in the more detailed notice contemplated by the Court in the Vazquez- Flores case. As such, the Board finds that the veteran is not prejudiced based on this demonstrated actual knowledge. The veteran has been made aware of the information and evidence necessary to substantiate his claim and has been provided opportunities to submit such evidence. The RO has properly processed the appeal following the issuance of the required notice. Moreover, all pertinent development has been undertaken, examinations have been performed, and all available evidence has been obtained in this case. The appellant has not identified any additional evidence that could be obtained to substantiate the claim. Clearly, from submissions by and on behalf of the veteran, he is fully conversant with the legal requirements in this case. Thus, the content of these letters complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). No further action is necessary for compliance with the VCAA. Factual Background The veteran filed a claim of entitlement to service connection for PTSD on January 27, 2003. Service treatment records are silent as to complaints, findings, treatment or diagnoses relating to any mental disorder. A December 2002 VA mental assessment noted an extensive family history of mental disorders as well as substance abuse. At the time of the assessment, the veteran's own substance abuse was the foremost disorder and, furthermore, a diagnosis of PTSD was explicitly noted as unsupported. Treatment records reflected that the veteran was not interested in learning how to stay clean from his drug problems. VA outpatient treatment records dated in November 2003 reveal that veteran sought treatment for his drug abuse. On mental status examination, he was not expressing suicidal or homicidal ideation, he did not have auditory or visual hallucinations, denied major depression. He verbalized and agreed to the treatment program. The following day, he was seen by a staff psychologist. He reported nightmares that awoke him from his sleep, reexperiencing the killing he did in Vietnam. He did not have flashbacks, but did have intrusive memories of Vietnam. He was uncomfortable if his back was to a door. He reported social isolation, discussed his drug problem, and expressed an interest to detoxify. On mental status examination, he was alert and oriented, and his affect was full-range and appropriate. Mood was neutral. His associations were goal oriented, and he denied suicidal or homicidal ideation, he did not have auditory or visual hallucinations, no delusions, and no referential thinking. Speech was normal in rate and spontaneity. His intellect was intact, his insight and judgment were good. Similar findings were reported by the staff psychologist in December 2003, and in January, February, March and April 2004. An April 2004 outpatient treatment record recorded by a staff psychiatrist noted that the veteran did not manifest suicidal or homicidal ideation. There were no audio or visual hallucinations, and no delusions. His affect was full and appropriate and he was alert and oriented. The veteran was afforded a VA examination in April 2004. He was casually and appropriately dressed. His speech was clear and he was quite talkative throughout the interview. He was in good reality contact and oriented in all three spheres. There was no evidence of delusions or hallucinations. Reasoning and judgment appeared normal. Short and long term memory appeared intact. Affect was anxious and depressed. He suffered from sleep disturbance, anger problems and social isolation. Global Assessment of Functioning (GAF) was assessed as 45. In March 2005, a VA nurse counselor provided correspondence in support of the veteran's claim. She reported that he perceived potential threats in his day to day life. His response was usually anger. He did not carry it out, however, because he knew of the consequences. She reported that he was extremely protective and engaged in checking and other typical PTSD behavior. The nurse also commented that his extensive drug use was commonly associated with PTSD. She summarized that although the veteran saw his life as normal, it is not. The veteran was afforded a VA mental disorders examination in April 2006. The examiner reviewed the claims file. The veteran's parents were deceased. As to his education and employment history, the veteran went to the 11th grade and then got a GED. He also went to community college for one year but did not complete it. For a period of time many years ago, he installed safes and vaults in banks. At another time he was a roofer. His last job six years ago was a telephone marketer. He held that only part-time. He was not able to hold any of them for many years and so he remains unemployed. His only source of income at the present time is the service connected disability. He was in debt but went into bankruptcy a few years ago. He states he now just gets by on the money coming in. The veteran was in his third marriage and had a daughter and they lived together in their home. The veteran did not socialize nor was he close to his wife. He had no friends. He stated his daily activities included trying to help do the chores at home while his wife worked. He had no interests, hobbies, or activities he liked to pursue. He did take care of the dog and the cat. He was casually dressed and talkative. He made good eye contact and was able to walk without any problems. His mood was anxious and depressed. His affect was constricted; he was sad, anxious, irritable and depressed. His speech was clear. Thought processes reflected good reality contact. Thought content was appropriate. Cognition, insight and judgment were thought to be fair and normal. The veteran described himself as depressed and angry. However, he denied any current suicidal or homicidal ideation. He denied auditory hallucinations. He acknowledged occasional visual hallucinations thinking he saw something and then realized that it was not there. The veteran was oriented times three and was not psychotic. Diagnosis was PTSD chronic severe GAF score 45. The examiner noted that veteran's GAF scores varied over the years. His last compensation examiner gave him a GAF of 45, his current ARU GAF scores were 65. However, based on his PTSD symptoms, the examiner would judge it to be around 45. Analysis Disability ratings are rendered upon the VA's Schedule for Rating Disabilities as set forth at 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity in civil occupations. The disability must be viewed in relation to its history. 38 C.F.R. § 4.1. The higher evaluation shall be assigned where the disability picture more nearly approximates the criteria for the next higher evaluation. 38 C.F.R. § 4.7. While lost time from work related to a disability may enter into the evaluation, the rating schedule is "considered adequate to compensate for considerable loss of working time from exacerbations proportionate" with the severity of the disability. 38 C.F.R. § 4.1. The United States Court of Appeals for Veterans Claims (hereinafter, "Court") has held that, in a claim of disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). General Rating Formula for Mental Disorders: Ratin g Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name 100 Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships 70 38 C.F.R. § 4.130, Diagnostic Code 9411 (2007) Global Assessment of Functioning (GAF) Scale 50 ? 41 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). 40 ? ? ? 31 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). See DSM-IV (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) at 44-47. The Board acknowledges that the veteran would have difficulty securing employment as a result of his service connected mental disorder and additionally observes that, as a consequence, he has been awarded entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities. The effective date of that TDIU award coincided with the date of his claim for entitlement to service connection for PTSD and, likewise coincides with the disability evaluation award for PTSD. Examinations throughout the pertinent period recognize that the veteran's symptoms are much less severe than those contemplated by a 100 percent schedular evaluation for PTSD. The veteran has consistently demonstrated the absence of thought disorder or disorientation, and even though he has anger issues, they are apparently well controlled. The evidence fails to show gross impairment in thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of harm to himself of others, inability to perform the activities of daily living, disorientation or memory loss. On the contrary, the clinical findings and described symptoms in virtually every one of these categories are inconsistent with the criteria for a 100 percent evaluation. Accordingly, the Board finds the negative evidence clearly outweighs the positive evidence as to the question of whether a rating in excess of 70 percent is warranted. Under these circumstances, the benefit of the doubt doctrine is not for application. 38 U.S.C.A. 5107. Under the circumstances, the preponderance of the evidence is against the assignment of a total schedular rating for PTSD. There is no competent evidence of record which indicates that the veteran's PTSD has caused marked interference with employment beyond that which is contemplated under the schedular criteria, or that there has been any necessary inpatient care. Thus, there is no basis for consideration of an extraschedular evaluation under the provisions of 38 C.F.R. § 3.321(b)(1). Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). There is nothing in the evidence of record to indicate that the application of the regular schedular standards is impractical in this case. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996). ORDER Entitlement to increased evaluation for PTSD is denied. ____________________________________________ RENÉE M. PELLETIER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs