Citation Nr: 0810506 Decision Date: 03/28/08 Archive Date: 04/09/08 DOCKET NO. 05-39 542 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York THE ISSUE Entitlement to an initial rating in excess of 30 percent for anxiety disorder claimed as post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Vavrina, Counsel INTRODUCTION The veteran served on active duty from July 1943 to March 1946. This present matter came before the Board of Veterans' Appeals (Board) initially on appeal from a September 2005 rating decision in which the RO granted the veteran service connection for anxiety disorder claimed as PTSD, and assigned an initial 10 percent rating, effective April 30, 2002. In November 2005, the veteran filed a notice of disagreement (NOD). The RO issued a statement of the case (SOC) in January 2006, and the veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) in January 2006. In June 2006, the veteran testified during a hearing before the undersigned Veterans Law Judge at the RO; a transcript of that hearing is of record. During the hearing, the undersigned granted the veteran's motion to advance this appeal on the Board's docket, under the provisions of 38 U.S.C.A. § 7107 (West 2002) and 38 C.F.R. § 20.900(c) (2006). In March 2007, the Board remanded the veteran's claim to the RO via the Appeals Management Center (AMC), in Washington, DC for additional notice and development. As reflected in a supplemental SOC (SSOC) and a September 2007 rating decision issued in February 2008, the AMC awarded the veteran an initial 30 percent rating for anxiety disorder claimed as PTSD, effective April 30, 2002, but denied a higher rating. Thereafter, the claim was returned to the Board for further appellate consideration. Because the veteran has disagreed with the initial rating assigned following the grant of service connection, the Board has characterized the issue in light of the distinction noted in Fenderson v. West, 12 Vet. App. 119, 126 (1999) (distinguishing initial rating claims from claims for increased ratings for already service-connected disability). Moreover, although the RO (through the AMC) has assigned a higher, 30 percent, initial rating for anxiety disorder claimed as PTSD, as higher ratings are available, the veteran is presumed to seek the maximum available benefit for a disability, the claim for higher rating remains viable on appeal. Id; AB v. Brown, 6 Vet. App. 35, 38 (1993). As final preliminary matters, the Board notes that in a January 2006 statement, the veteran raised claims for service connection for dizziness and for exposure to residual radiation from the Nagasaki A-Bomb blast and asked to reopen his previously denied claim for service connection for bilateral tinnitus. In a May 2006 statement, he also raised claims for service connection for a back condition and a bilateral leg condition, to include both hips and both knees. As the RO has not adjudicated these matters, they are not properly before the Board, and are referred to the RO for appropriate action. Further, the Board notes that, in a December 2005 rating decision, the RO denied entitlement to a total disability rating for compensation purposes based on individual unemployability due to service-connected disability (TDIU); it is unclear whether the veteran intended that a VA Form 9 dated December 1, 2005 to be an NOD with regard to the December 2005 rating decision. In any event, with the award of a 30 percent rating for anxiety disorder claimed as PTSD, the veteran now meets the schedular criteria for entitlement to a TDIU; hence, this matter is also referred to the RO for appropriate action. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate the claim on appeal has been accomplished. 2. Prior to January 31, 2007, the veteran's anxiety claimed as PTSD had been manifested by depression, hopelessness, feelings of despair, nightmares, and some sleep impairment and loss of interest in activities; these symptoms are indicative of no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 3. From January 31, 2007, the veteran's anxiety claimed as PTSD has been manifested by sleep disturbance, intrusive thoughts, nightmares, anger, anxiety and difficulty controlling it, irritability, memory loss, and a few instances of shoplifting; these symptoms are indicative of no more than occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 30 percent for anxiety disorder claimed as PTSD, prior to January 31, 2007, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Codes 9413 and 9411 (2007). 2. The criteria for a 50 percent rating for anxiety disorder claimed as PTSD, from January 31, 2007, have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Codes 9413 and 9411 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2007)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA have been codified, as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2007). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim(s), as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim(s); (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim(s), in accordance with 38 C.F.R. § 3.159(b)(1). In rating cases, a claimant must be provided with information pertaining to assignment of disability ratings (to include the rating criteria for all higher ratings for a disability), as well as information regarding the effective date that may be assigned. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In addition, the Board is aware of the recent decision of the United States Court of Appeals for Veterans Claims (Court) in Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008), applicable to claims for increased ratings. In Vazquez-Flores, the Court found that, at a minimum, adequate VCAA notice requires that VA notify the claimant that, to substantiate such a claim: (1) the claimant must provide, or ask 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; (2) 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 Secretary must provide at least general notice of that requirement to the claimant; (3) the claimant must be notified that, should an increase in disability be found, a disability rating will be determined by applying relevant diagnostic codes; and (4) the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask VA to obtain) that are relevant to establishing entitlement to increased compensation VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include AMC). Id.; Pelegrini,18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. In this appeal, in a March 2007 letter, the AMC provided notice to the veteran regarding what information and evidence was needed to substantiate the claim for a higher rating, as well as what information and evidence must be submitted by the veteran and what information and evidence would be obtained by VA. This letter specifically informed the veteran to submit any evidence in his possession pertinent to the claim, thus satisfying the fourth element of the duty to notify. After issuance of the letter, and opportunity for the veteran to respond, the September 2007 SSOC reflects readjudication of the claim. The Board also notes that the January 2006 SOC and the September 2007 SSOC provided notice of the criteria for a higher rating (which suffices for Dingess/Hartman). Hence, the veteran is not shown to be prejudiced by the timing of VCAA-compliant notice. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as in an SOC or SSOC, is sufficient to cure a timing defect). The Board acknowledges that the March 2007 notice letter provided to the veteran does not contain the level of specificity set forth in Vazquez-Flores. However, the Board finds that (to the extent that Vazquez-Flores applies to claims for higher initial rating) any such procedural defect does not constitute prejudicial error in this appeal. The claims file reflects evidence of actual knowledge on the part of the veteran that the claimant must provide, or ask 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 and other documentation in the claims file reflecting such notification that a reasonable person could be expected to understand what was needed to substantiate the claim(s). See Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007). In this regard, the veteran has provided testimony at a Board hearing, has described how his symptoms affect his daily activities at two VA examinations, and has submitted statements from his private clinical social worker addressing the severity of his psychiatric disability and the effects it has on his daily life. The Board notes that the veteran stopped working when he was 65; he is now 82. His testimony and statements and those of his social worker indicates an awareness on the part of the veteran that information about such effects, with specific examples, is necessary to substantiate a claim for a higher rating. Significantly, the Court in Vazquez-Flores held that actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what was necessary to substantiate his or her claim." Id., at 48, citing Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007). The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matter on appeal. Pertinent evidence associated with the claims file consists of the veteran's service medical records, post-service private medical records, as well as treatment records from the New York, New York VA Medical Center (VAMC) and the reports of VA examinations. Also of record and considered in connection with the claim on appeal are the veteran's hearing transcript and various written statements provided by the veteran, his private social worker, and his representative, on his behalf. In summary, the duties imposed by the VCAA have been considered and satisfied. Through notices of the RO/AMC, the claimant has been notified and made aware of the evidence needed to substantiate his claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with the claim on appeal. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the claimant or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of the matter being decided. See Mayfield, 20 Vet. App. at 543 (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Background Historically, in the September 2005 rating decision on appeal, the RO granted service connection for anxiety disorder claimed as PTSD and assigned an initial 10 percent rating, effective April 30, 2002. This decision was based on a September 2005 VA PTSD examination report, in which the examiner felt that the veteran did not meet the criteria for a diagnosis of PTSD. However, she did feel that the veteran suffered from anxiety disorder which she felt was at least as likely as not related to his verified stressor of a kamikaze plane crashing into the veteran's ship. During that examination, the veteran was cooperative. His mood was described as mellow; his affect was noted to be full range. Speech and thought processes were within normal limits. The veteran denied suicidal and homicidal ideations as well as hallucinations and delusions. He also denied memory difficulties and attention and concentration problems. The veteran's insight and judgment were described as good. The diagnosis was anxiety disorder. The examiner added that it appeared that when the veteran first returned from the war, he had more acute symptoms of PTSD; however, over time these symptoms had resolved to some extent but he remained with a mild level of overall generalized anxiety. She felt that the veteran's incapacity as a result of this was mild and that it did not appear to have interfered with his employability or his interpersonal relationships. A Global Assessment of Functioning (GAF) score of 68 was assigned. In September 2003 and July 2005 statements, the veteran's private therapist (social worker) indicated that the stress resulting from the veteran's in-service stressor event causes significant impairment in social, occupational, and other areas of functioning-that is, depression, hopelessness, feelings of despair, and intense fear. In a statement submitted by the veteran during his June 2006 hearing, this therapist added that the veteran's symptoms include irritability or outbursts of anger, difficulty staying asleep, recurrent distressing dreams of the event, markedly diminished interest in significant activities and feelings of depression and hopelessness and an assigned a GAF score of 48. VA treatment records reflect that the veteran was initially seen in February 2005 for evaluation of treatment with an antidepressant. During that evaluation, the veteran stated that for the past year, he had felt more "down" and that he had decreased his physical activity (which involved going to the gym a few times a week) partially due to knee pain and partially due to "mental". The veteran reported decrease in motivation, fatigue (although his sleep was "fair"), and decrease in libido. He did enjoy some activities like reading and spending time with family and friends. The veteran was very active in AA and had been sober for 24 years. He had no history of psychiatric hospitalization or medication. He denied any history of suicidality/homicidality, mania/psychosis/anxiety or any clinically significant depression. The veteran lived with his wife and was a successful television director until he retired at 65. He denied nightmares and flashbacks of World War II. On examination, the veteran was pleasant and cooperative. He had no abnormal movements; his speech was spontaneous and of normal rate. His mood was "down" and his affect was full and appropriate. Thought process was goal directed. The veteran denied any suicidal or homicidal ideation, audio or visual hallucinations, or persistent illness. No delusions were elicited. He was alert and oriented times person, place and time. Insight and judgment were good. Wellbutrin was prescribed. At a March 2005 follow-up visit, the veteran reported that he had not taken Wellbutrin yet due to physical ailments and continued to have feelings of lethargy, lack of motivation, and some depressed mood. Examination findings were similar to those in February 2005, except that the veteran's mood was described as "so-so." After taking Wellbutrin, later in March 2005, the veteran reported that he had had two or three episodes of dizziness which could have possibly been due to this medication. So he had stopped taking Wellbutrin and had not had recurrence. His mood was "okay" and he denied suicidal ideation. At an April 2005 follow-up, the veteran reported that he was feeling "fine" and that he had been feeling more motivated and active. He stated that he was out in the garden and was planning a vacation with his wife. He added that by being more active he felt better. At that time, he was not interested in another trial of antidepressant and did not feel that he needed it. On examination, the veteran was pleasant and walked with a cane. His speech was spontaneous and of normal rate. His mood was "fine" and his affect was brighter and appropriate. Thought process was goal directed. At that time, there was no need for any psychiatric intervention. During the June 2006 Board hearing, the veteran testified that his psychiatric disability results in nightmares at least once a month, sleep impairment, hyperstartle response to loud noises, anxiety, obsessive rituals such as checking windows and doors, unprovoked irritability and angry outbursts two or three times a week, and that he had anxiety attacks, especially when driving. He reported that he has been seeing the same therapist weekly for the past twelve years. Therefore, he asserted that he warrants a higher rating for his service-connected anxiety claimed as PTSD. During a January 31, 2007 VA psychiatric visit, the veteran stated that he had been depressed since November 2006, which he described as being sad and worried. He believed this started after a family argument with his oldest daughter about babysitting one of his grandchildren. Since he was depressed over the holidays, he thought of drinking but did not do so. The veteran had a history of flashbacks and nightmares. On examination, he was cooperative and pleasant; he was not in distress. He had no abnormal movements; his speech was of normal rate and tone. His mood and affect were depressed. The veteran denied any suicidal or homicidal ideations, hallucinations, delusions or illusions. His insight was good; his judgment was fair. He was oriented to person, place, and time. The veteran was alert and his attention span, memory and concentration were good. However, he admitted to stealing (candy and Rolaids). The diagnosis was dysthymia with alcohol dependence in remission. A GAF score of 60 was assigned. When seen at the end of March 2007, the veteran was not suicidal, homicidal or psychotic. He was cooperative and pleasant; he was not in distress. He had no abnormal body movements; his speech was of normal rate and tone. His mood and affect were depressed. The veteran denied any hallucinations, delusions or illusions. He denied stealing candy and Rolaids. Thought process and association was goal directed. He talked about nightmares of his war experiences. His insight was good; his judgment was fair. The diagnoses were dysthymia, PTSD - mild; and anxiety disorder, NOS. A GAF score of 60 was assigned. Citalopram was prescribed. At a May 2007 VA follow-up, the veteran reported no more shoplifting and that his depression was stable. He was cooperative and pleasant; he was not in distress. He had no abnormal body movements; his speech was of normal rate and tone. His mood was okay; his affect was full range. He denied any suicidal or homicidal ideations, hallucinations, delusions or illusions. Thought process and association was goal directed. He talked about nightmares of his war experiences. His insight was good; his judgment was fair. The diagnoses were dysthymia, PTSD - mild; and anxiety disorder, NOS. A GAF score of 60 was assigned. In the report of a July 2007 VA PTSD examination, the examiner noted that the veteran was receiving Celexa 30 mg. daily for depression which he said had helped lift his depression. The veteran reported recurrent nightmares occurring once or twice a month of his war experiences, and that often he had trouble falling asleep as a result. He stated that experienced a chronic level of irritability and anxiety with occasional difficulties controlling his emotions particularly when in arguments or conflicts with family members. The veteran claimed that it had become increasingly difficult for him to control his anxiety; that it emerged at various times, particularly when certain events occur such as being exposed to loud noises or to airplanes or if he sees ships or things that remind him of ships. He felt that his overall coping ability and adaptive function had diminished over the past several years with an increasing awareness of his anxiety and traumatic memories of his war experiences. The veteran reported a degree of memory loss. His overall cognitive testing was significant for a variety of global deficits in the areas of constructional ability, concreteness of thought, difficulty with short-term recall and with simple calculations, and some impairment in his ability to retrieve long-standing information. The veteran denied any active panic attacks. His sleep was moderately impaired to where he often woke up in the middle of the night and had trouble falling asleep. There was no evidence of impaired judgment. He was not psychotic and did not show any lapses in reality testing. His speech was slightly hesitant and, at times, he had difficulties finding words and naming objects. His impulse control was good. There was no evidence of suicidal ideations, delusions or hallucinations. There was no neglect of personal hygiene or appearance. The examiner noted that the veteran experienced a moderate degree of anxiety symptoms which could best be classified as being related to traumatic events in service and his memories of which had become increasingly problematic as far as his day-to-day emotional control. The veteran still functioned well in his marriage, interacting with his wife. He was able to perform most of his daily chores and to leave the apartment. But the veteran did not go out as much as he had in the past because he found that certain places and situations reminded him of past traumatic events. There were some difficulties with his relationship with his daughters. His primary disability would appear to be the veteran's feeling state, being constantly anxious, experiencing the memories that keep reemerging and the discomfort this causes. There was also some difficulty with sleep. The diagnosis was chronic PTSD, which is sort of a late emerging disorder. The examiner noted that the veteran also had had depression, NOS, currently in remission, and there was a cognitive decline NOS. A GAF score of 50 was assigned. During a July 2007 VA follow-up, the veteran had no new complaints. He was cooperative and pleasant; he was not in distress. He had no abnormal body movements; his speech was of normal rate and tone. His mood was okay; his affect was full range. He denied any suicidal or homicidal thoughts, hallucinations, delusions or illusions. Thought process and association was goal directed. He talked about nightmares of his war experiences. His insight was good; his judgment was fair. The diagnoses were dysthymia, PTSD - mild; and anxiety disorder, NOS. A GAF score of 60 was assigned. III. Analysis Disability evaluations are determined by comparing a veteran's symptomatology with the criteria set forth in 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 (2007). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating applies. 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 entitlement to a higher initial rating assigned following the grant of service connection, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. Fenderson, 12 Vet. App. at 126. The veteran's initial 30 percent rating for anxiety disorder claimed as PTSD has been assigned under Diagnostic Codes 9413 (for anxiety disorder, not otherwise specified (NOS)) and 9411 (for PTSD). The Board notes that psychiatric disabilities other than eating disorders are actually rated pursuant to the criteria of a General Rating Formula. See 38 C.F.R. § 4.130 (2007). A 30 percent rating is assigned when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), 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 percent 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 percent rating is assigned 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 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self 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, own occupation, or own name. Psychiatric examinations frequently include assignment of a GAF score. According to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), GAF is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." Under the DSM-IV, GAFs between 61 and 70 are indicative of some mild symptoms (e.g., depressed mood, mild insomnia and occasional panic attacks) or some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships. A GAF score of between 51 and 60 indicates moderate symptoms, e.g., flattened affect, circumstantial speech, occasional panic attacks, or moderate difficulty in social, occupational or school functioning; e.g., having few friends or having conflicts with peers or co-workers. A GAF score between 41 and 50 indicates 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). There is no question that the GAF score and interpretations of the score are important considerations in rating a psychiatric disability. See e.g., Richard v. Brown, 9 Vet. App. 266, 267 (1996); Carpenter v. Brown, 8 Vet. App. 240 (1995). However, the GAF score assigned in a case, like an examiner's assessment of the severity of a condition, is not dispositive of the evaluation issue; rather, the 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). A. Period prior to January 31, 2007 Collectively, the medical evidence reflects that prior to January 31, 2007, the veteran's psychiatric symptoms were manifested by depression, hopelessness, feelings of despair, nightmares, and some sleep impairment and loss of interest in activities. These symptoms are reflective of occupational and social impairment no greater than what is contemplated in the currently assigned 30 percent rating. At no point during the period in question had the objective evidence shown that the veteran's overall symptomatology met the criteria for a rating in excess of 30 percent. In this regard, the medical evidences does not reflect that the veteran had flattened affect; circumstantial, circumlocutory, or stereotyped speech; difficulty in understanding complex commands; impairment of short-and long-term memory; impaired judgment; impaired abstract thinking; or other symptoms that are characteristic of a 50 percent rating. Rather, the September 2005 VA examiner described the veteran's mood as mellow and his affect was noted to be full range. Speech and thought processes were within normal limits. The veteran denied memory difficulties and attention and concentration problems. His insight and judgment were described as good. The VA examiner felt that the veteran's incapacity as a result of his anxiety was mild and did not appear to have interfered with his employability or his interpersonal relationships. VA treatment records during this period show that the veteran was prescribed Wellbutrin for depression at a February 2005 evaluation. However, he discontinued it almost immediately due to two or three episodes of dizziness. By April 2005, the veteran reported that he was feeling fine and that he had been more motivated and active. At that time, he was not interested in another trial of antidepressant and did not feel he needed it. The VA physician noted that he had improved and, at that time, there was no need for any psychiatric intervention. As noted above, except for a GAF score of 48, given by the veteran's private therapist (social worker) in a statement received in June 2006, all of the veteran's GAF scores during this time period had been 65 or above, clearly indicating mild symptomatology. The Board has considered the letters submitted by the veteran's private therapist, which suggest that his symptoms meet the criteria for a rating in excess of 30 percent prior to January 31, 2007. However, it is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion reached; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). While the letters from the veteran's social worker include reports of symptoms described in the criteria for a rating of 50 or 70 percent, including irritability and outbursts of anger and markedly diminished interest in significant activities and an opinion that the stress from the veteran's in-service stressor event causes significant impairment in social, occupational, and other areas of functioning, these findings appear to be based on the veteran's subjective assertions, and not on any review of the veteran's claims file or other objective medical evidence. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (holding that a bare transcription of lay history is not transformed into "competent medical evidence" merely because the transcriber happens to be a medical professional). In this regard, the Board notes that although the veteran has been asked to sign authorizations for release of his private treatment records, he has never signed one for this therapist. Instead, he has only submitted cursory written statements for her in response to VA requests for relevant records. Therefore, there are no private treatment records showing, if and when, the veteran's symptoms may have increased during this period. By contrast, the September 2005 VA examiner specifically acknowledged review of the claims file and performed a thorough examination, to include an extensive recitation of the veteran's history and complaints. As such, the objective medical findings included in this examination report are assigned more probative value in evaluating the veteran's psychiatric disability. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the physician's access to the claims file and the thoroughness and detail of the opinion). Based on the foregoing, the Board finds that the veteran's anxiety disorder claimed as PTSD symptomatology has more nearly approximated the criteria for the 30 percent rather than a 50 percent rating for the period since the effective date of the grant of service connection through January 30, 2007. As the criteria for the next higher, 50 percent, rating have not been met during this period, it logically follows that the criteria for higher rating of 70 or 100 percent likewise are not met during this time frame. B. Period from January 31, 2007 Comparing the manifestations of the veteran's symptom prior to January 31, 2007, to the applicable criteria, and affording the veteran the benefit of the doubt, the Board finds that the veteran's symptoms more nearly approximate the criteria for a 50 percent rating from January 31, 2007. The above evidence reflects that, from January 31, 2007, the veteran's psychiatric disability had been manifested by sleep disturbance, intrusive thoughts, nightmares, anger, anxiety and difficulty controlling it, irritability, and a few instances of shoplifting. The veteran's symptoms during this period are not shown to meet the criteria for a rating higher than 50 percent. In this regard, the assignment of the next higher, 70 percent rating, is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to certain symptoms. Here, the July 2007 VA examiner noted that the veteran still functions well in his marriage and interacts with his wife. However, the veteran does have some difficulties with his relationship with his daughters and becomes easily irritated when they do not do what he tells them or when they do things that upset him. The veteran has consistently denied any suicidal or homicidal thoughts, hallucinations, delusions or illusions. His thought process and association have been goal directed. He has always been well groomed and he has not neglected his personal hygiene. During the July 2007 VA examination, the veteran denied any active panic attacks. During a January 31, 2007 VA psychiatric visit, the veteran reported that he had been depressed since November 2006, after a family argument. He gave history of flashbacks and nightmares. He even admitted to stealing candy and Rolaids (shoplifting). His mood and affect were depressed at both this visit and a follow-up visit in March 2007. He was assigned a GAF score of 60 and prescribed Citalopram for depression at this and subsequent VA follow-up evaluations. A GAF score of 60 is indicative of moderate symptoms, such as occasional panic attacks or flat affect. In the report of a July 2007 VA PTSD examination, the examiner indicated that the veteran experienced a moderate degree of anxiety symptoms which had become increasingly problematic as far as his day-to-day emotional control. The veteran reported that it had become increasingly difficult for him to control his anxiety and that it would emerge at various times, particularly when certain events occur such as being exposed to loud noises or to airplanes or if he saw ships or things that remind him of ships. His sleep was moderately impaired to where he often woke up in the middle of the night and had trouble falling asleep. The veteran did not go out as much as he had in the past because he found that certain places and situations reminded him of past traumatic events. His speech was slightly hesitant and, at times, he had difficulty finding words and naming objects. The veteran reported a degree of memory loss. His overall cognitive testing was significant for a variety of global deficits in the areas of constructional ability, concreteness of thought, difficulty with short-term recall and with simple calculations, and some impairment in his ability to retrieve long-standing information. A GAF score of 50 was assigned. Although a GAF score of 50 is indicative of some serious symptoms such a frequent shoplifting or any serious impairment on social functioning, the objective evidence does not reflect occupational and social impairment with deficiencies in most areas, such as family relations, judgment, thinking, or mood. Thus, the Board finds that the evidence is indicative of no greater impairment than that contemplated by a 50 percent rating. See 38 C.F.R. § 4.7. As the criteria for the next higher, 70 percent, rating have not been met during this period, it logically follows that the criteria for higher rating of 100 percent likewise are not met during this time frame. C. Conclusion The Board points out that, in addition to the medical evidence, the lay statements and testimony regarding the veteran's psychiatric symptoms have been considered. However, to the extent that the veteran attempts to assert that he is entitled to higher ratings during each of the above periods, the Board finds that his assertions are not entitled to more weight than the objective findings rendered by trained medical professionals in evaluating the veteran's psychiatric disability, to include the findings of the various VA examiners. See 38 C.F.R. § 3.159 (a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). See also Bostain v. West , 11 Vet. App. 124, 127 (1998); Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). In short, the testimony and statements offered in support of the veteran's claim do not constitute persuasive medical evidence in this appeal, and none of this evidence is of sufficient probative value to controvert the objective medical findings. Under the circumstances presented, the Board finds that the most probative evidence in this appeal establishes that, prior to January 31, 2007, the veteran's symptomatology more nearly approximated the criteria for a 30 percent rather than a 50 percent rating and that, from January 31, 2007, his symptomatology has more nearly approximated the criteria for the 50 percent rather than a 70 percent rating. See 38 C.F.R. § 4.7 (2007). As indicated, above, the Board has favorably applied the benefit-of-the-doubt doctrine in reaching the decision to award the 50 percent rating from January 31, 2007, but finds that the preponderance of the evidence of the evidence is against assignment of a rating greater than 30 percent prior to that date. See 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2007); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER An initial rating in excess of 30 percent rating for anxiety disorder claimed as PTSD, prior to January 31, 2007, is denied. A 50 percent rating for anxiety disorder claimed as PTSD is granted from January 31, 2007, subject to subject to the law and regulations governing the payment of VA compensation benefits. ____________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs