Citation Nr: 0812914 Decision Date: 04/18/08 Archive Date: 05/01/08 DOCKET NO. 06-07 181A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. Entitlement to an evaluation in excess of 10 percent disabling for cephalalgia prior to October 3, 2006. 2. Entitlement to an evaluation in excess of 10 percent disabling for cephalalgia on or after October 3, 2006. 3. Entitlement to an initial evaluation in excess of 10 percent disabling for post traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD S. Heneks, Associate Counsel INTRODUCTION The veteran served on active duty from October 1964 to August 1968. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an August 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California, which granted service connection for PTSD and assigned a 10 percent rating and increased the evaluation for cephalalgia to 10 percent. On a claim for an increased rating, the claimant will generally be presumed to be seeking the maximum benefit allowed by law and regulation, and it follows that such a claim remains in controversy where less than the maximum available benefit is awarded. AB v. Brown, 6 Vet. App. 35, 38 (1993). Since the grant of the 10 percent rating for each disability on appeal here is not a full grant of the benefits sought on appeal, and since the veteran did not withdraw his claims of entitlement to a higher ratings, the matters remain before the Board for appellate review. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. Prior to October 3, 2006, the veteran's cephalalgia was not productive of migraine headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. 3. On or after October 3, 2006, the veteran's cephalalgia was not productive of migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 4. The veteran's PTSD was not productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. CONCLUSIONS OF LAW 1. Prior to October 3, 2006, the criteria for an evaluation in excess of 10 percent disabling for cephalalgia were not met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.124a, Diagnostic Code 8100 (2007). 2. On October 3, 2006, the criteria for a 30 percent rating for cephalalgia, and no higher, were met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.124a, Diagnostic Code 8100 (2007). 3. The criteria for an initial evaluation in excess of 10 percent for PTSD were not met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.130, Diagnostic Code 9411 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). VA must request that the claimant provide any evidence in the claimant's possession that pertains to a claim. 38 C.F.R. § 3.159. Prior to initial adjudication of the veteran's claims, letters dated in January and May 2005 fully satisfied the duty to notify provisions. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The letters advised the veteran what information and evidence was needed to substantiate the claims decided herein and what information and evidence must be submitted by him, namely, any additional evidence and argument concerning the claimed conditions and enough information for the RO to request records from the sources identified by the veteran. He was specifically was advised of the need to submit any evidence in his possession that pertains to the claims. Finally the letters advised him what information and evidence would be obtained by VA, namely, records like medical records, employment records, and records from other Federal agencies. During the pendency of this appeal, on March 3, 2006, the United States Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. The Court held that "upon receipt of an application for a service- connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application." Dingess/Hartman, 19 Vet. App. at 486. Additionally, this notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. Regarding the claim for PTSD, the veteran is challenging the initial evaluation assigned following the grant of service connection. In Dingess, the Court of Appeals for Veterans Claims held that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id. at 490-91. Thus, because the notice that was provided before service connection was granted was legally sufficient, VA's duty to notify with regards to PTSD has been satisfied. However, turning to the claim for cephalalgia, in order to satisfy the first Pelegrini II element for an increased- compensation claim that is not arise from an initial grant of service connection, section 5103(a) compliant notice must meet the following four part test: (1) that the Secretary notify the claimant that, to substantiate a claim, the claimant must provide, or ask the Secretary 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, which typically provide for a range in severity of a particular disability from noncompensable to as much as 100 percent (depending on the disability involved), based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment and daily life; (4) the notice must also provide examples of the types of medical and lay evidence that the claimant may submit (or ask the Secretary to obtain) that are relevant to establishing entitlement to increased compensation, e.g., competent lay statements describing symptoms, medical and hospitalization records, medical statements, employer statements, job application rejections, and any other evidence showing an increase in the disability or exceptional circumstances relating to the disability. Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). For the following reasons, the Board finds that the elements of the Vazquez-Flores test have either been met or that any error is not prejudicial. Preliminarily, the Board notes that the notice provided in this case was issued prior to the decision in Vazquez-Flores. As such it does not take the form prescribed in that case. Failure to provide pre-adjudicative notice of any of the necessary duty to notify elements is presumed to create prejudicial error. Sanders v. Nicholson, 487 F.3d 881 (2007). The Secretary has the burden to show that this error was not prejudicial to the veteran. Id., at 889. Lack of prejudicial harm may be shown in three ways: (1) that any defect was cured by actual knowledge on the part of the claimant, (2) that a reasonable person could be expected to understand from the notice what was needed, or (3) that a benefit could not have been awarded as a matter of law. Id., at 887; see also Mayfield v. Nicholson, 19 Vet. App. 103, (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Federal Circuit indicated that this was not an exclusive list of ways that error may be shown to be non prejudicial. See Sanders, at 889. In order for the Court to be persuaded that no prejudice resulted from a notice error, the record must demonstrate that, despite the error, the adjudication was nevertheless essentially fair. See also Dunlap v. Nicholson, 21 Vet. App. 112, 118 (2007). The May 2005 letter requested that the veteran provide evidence describing how his disability had worsened. In addition, the veteran was questioned about the effect that worsening had on his employment and daily life during the course of the June 2005 and December 2006 VA examinations performed in association with his claim. Further, in his September 2005 notice of disagreement (NOD) and March 2006 Form 9, the veteran described the number and severity of his headaches and the impact they had on his daily life. The Board finds that the notice given, the questions directly asked and the responses provided by the veteran during his examinations show that he knew that the evidence needed to show that his disability had worsened and what impact that had on his employment and daily life. As the Board finds veteran had actual knowledge of the requirement, any failure to provide him with adequate notice is not prejudicial. See Sanders, supra. The Board finds that the first criterion is satisfied. See Vazquez-Flores. As to the second element, the Board notes that the veteran is service connected for cephalalgia. As will be discussed below, his cephalalgia is rated under Diagnostic Code 8100, 38 C.F.R. § 4.124a. Diagnostic Code 8100 provides that the rating is dependent on the frequency of prostrating attacks. There is no mention of a specific measurement or test result that is required for a higher rating. As such, entitlement to a higher disability rating would be satisfied by the claimant demonstrating a noticeable worsening or increase in severity of his headaches and the effect of that worsening has on the claimant's employment and daily life. Therefore, the Board finds that the May 2005 notice letter satisfied element two for the claim for the veteran's service-connected cephalalgia. See Vazquez-Flores. As to the third element, an August 2007 letter fully satisfied this element. The August 2007 notice letter notified the veteran that should an increase in disability be found, a disability rating will be determined by applying relevant Diagnostic Codes, which typically provide for a range in severity of a particular disability from noncompensable to as much as 100 percent based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment and daily life. That letter indicated that disability rating can be changed when there are changes in the condition. The letter stated that a rating will be assigned from 0 percent to 100 percent depending on the disability involved and explained that VA uses a schedule for evaluating disabilities that is published in Title 38, Code of Regulations, Part 4. It was also noted that a disability evaluation other than the level found in the schedule for a specific condition can be assigned if the impairment is not adequately covered by the schedule. The August 2007 letter further indicated that evidence of the nature and symptoms of the disability, the severity and duration of the symptoms, and the impact of the condition and symptoms on employment would be considered in determining the disability rating. The Board finds that the August 2007 letter satisfied the third element of Vazquez-Flores and the requirements of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). As to the fourth element, the May 2005 letter did provide notice of the types of evidence, both medical and lay, including employment records, which could be submitted in support of his claim. The Board finds that the fourth element of Vazquez-Flores is satisfied. In light of the foregoing, the Board finds that the requirements of Vazquez-Flores are met for the claim for an increased rating on appeal. The Board, therefore, finds that the requirements of Pelegrini II are met and that the VA has discharged its duty to notify on the increased rating for cephalalgia. See Pelegrini II, supra. VA has satisfied its duties to inform and assist the veteran at every stage of this case. All available service medical records as well as all VA and private medical records pertinent to the years after service are in the claims file and were reviewed by both the RO and the Board in connection with the veteran's claims. VA has also assisted the veteran and his representative throughout the course of this appeal by providing them with a SOC and SSOC, which informed them of the laws and regulations relevant to his claims. The duty to assist includes, when appropriate, the duty to conduct a thorough and contemporaneous examination of the veteran. Green v. Derwinski, 1 Vet. App. 121 (1991). In addition, where the evidence of record does not reflect the current state of the veteran's disability, a VA examination must be conducted. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 3.327(a) (2007). The RO provided the veteran appropriate VA examinations in March 2005, June 2005, and December 2006 in connection with his claims. There is no objective evidence indicating that there has been a material change in the severity of the veteran's service-connected disabilities since he was last examined. 38 C.F.R. § 3.327(a). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). LAW AND ANALYSIS Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the "present level" of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where VA's adjudication of an increased rating claim is lengthy, a claimant may experience multiple distinct degrees of disability that would result in different levels of compensation from the time the increased rating claim was filed until a final decision on that claim is made. Thus, VA's determination of the "present level" of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased rating claim has been pending. Hart v. Mansfield, 21 Vet. App. 505 (2007). Similarly where a veteran appeals the initial rating assigned for a disability at the time that service connection for that disability is granted, evidence contemporaneous with the claim and with the initial rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous . . . ." Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id. 1. Entitlement to an evaluation in excess of 10 percent disabling for cephalalgia prior to October 3, 2006. The veteran's cephalalgia is rated under Diagnostic Code 8100, for migraine headaches. A 10 percent rating is assigned for migraine headaches, when there are characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is assigned for migraine headaches when there are characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent disability evaluation is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic adaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The rating criteria do not define "prostrating," nor has the Court. Cf. Fenderson, supra (in which the Court quotes Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack.). In considering the evidence of record under the laws and regulations as outlined above, the Board finds that the veteran is not entitled to an increased evaluation in excess of 10 percent for his service-connected cephalalgia prior to October 3, 2006. In this regard, the evidence of record did not demonstrate characteristic prostrating attacks occurring on an average once a month over the last several months. During his June 2005 VA neurological disorder examination, the veteran reported frontotemporal headaches two to three times per week, which he either ignored or took Tylenol when they occurred. He added that he worked through his headaches, some which lasted six to eight hours. The veteran was unable to report a pain level of these headaches but stated that when they occurred, he was slightly nauseated on occasion but had no vomiting or photophobia. Upon examination, cranial nerves II-XII were within normal limits and motor and sensation testing were intact. As such, his headaches do not appear to be prostrating in nature. In sum, the veteran has not been shown to have met the criteria for an evaluation in excess of 10 percent prior to October 3, 2006. Therefore, the Board finds that the preponderance of the evidence is against the veteran's claim for a higher evaluation for cephalalgia during this period. 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100. 2. Entitlement to an evaluation in excess of 10 percent disabling for cephalalgia on or after October 3, 2006. In considering the evidence of record under the laws and regulations as outlined above, the Board finds that the veteran is entitled to a 30 percent evaluation, and no higher, for his service-connected cephalalgia as of October 3, 2006. Although characteristic prostrating attacks occurring on an average once a month over the last several months were shown, migraines with very frequent completely prostrating and prolonged attacks productive of severe economic adaptability were not shown. In this regard, in his September 2005 notice of disagreement (NOD) and in his March 2006 Form 9, the veteran reported experiencing headaches twice a week and prostrating headaches at least two to three times per month. The veteran treated his headaches with Tylenol and Excedrin and also massage and stayed in bed when they were severe. During his December 2006 VA neurological disorder examination, the examiner noted that the veteran was asked to keep a diary of his totally disabling headaches, which he did not do. The veteran did report experiencing eight headaches he described as prostrating in the prior three months, the first one beginning October 3, 2006, varying in length from four to six hours during which he stayed in bed and took Tylenol. The veteran described his headaches as mostly in the frontotemporal area and did not have nausea, vomiting, but did report a lack of appetite. There was no photophobia or aura. His less severe headaches occurred two to three times a week. The cerebellar examination was normal and all the cranial nerves were intact except hearing. Importantly, the examiner indicated that Tylenol had fairly effective results and no side effects with the prostrating headaches. Further, although the veteran is currently unemployed, there has been no showing that this is due to his service-connected cephalalgia. As such, the evidence of record more nearly approximates the criteria for a 30 percent rating, and no higher, effective October 3, 2006. 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100. In reaching this decision, the potential application of various provisions of Title 38 Code of Federal Regulations have been considered, whether or not they were raised by the veteran. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In particular, the Board has considered the provisions of 38 C.F.R. § 3.321(b)(1). In this case, however, there has been no showing that the veteran's service-connected cephalalgia has caused marked interference with employment beyond that contemplated by the schedule for rating disabilities, necessitated frequent periods of hospitalization, or otherwise renders impractical the application of the regular schedular standards utilized to evaluate the severity of his disability. As noted during his December 2006 PTSD examination, the veteran reported he left his job as an illustrator due to downsizing and he also received an inheritance so he made the decision not to seek another job. In the absence of such factors, the Board finds that the requirements for an extraschedular evaluation for the veteran's service-connected cephalalgia under the provisions of 38 C.F.R. § 3.321(b)(1) have not been met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). 3. Entitlement to an initial evaluation in excess of 10 percent disabling for PTSD. The pertinent provisions of 38 C.F.R. § 4.130 relating to rating mental disorders, including PTSD, read as follows: 30 percent 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, mild memory loss (such as forgetting names, directions, recent events). 10 percent Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. 38 C.F.R. § 4.130, Diagnostic Code 9411. GAF scores are a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness." See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), p. 32). GAF scores ranging between 61 and 70 reflect some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, and has some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect more moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co- workers). Scores ranging from 41 to 50 reflect 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). See 38 C.F.R. § 4.130 (incorporating by reference the VA's adoption of the DSM-IV, for rating purposes). The use of the term "such as" in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. Id. Under the criteria when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. See 38 C.F.R. § 4.126 (2007). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. Id. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the veteran is not entitled to an initial evaluation in excess of 10 percent for his service-connected PTSD. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks have not been shown. In this regard, during his March 2005 VA examination, the veteran denied occupational difficulties due to his PTSD, reported good relationships with his daughters, had friends that he socialized with, but did report difficulty with emotional closeness. Further, he indicated that his mood was generally hopeful and the examiner commented that his social adjustment did not appear to have been significantly affected by his PTSD symptoms. The veteran presented with no obvious grooming defects, was alert, oriented and cooperative throughout the interview, and had a broad affect. There were no gross defects in cognitive or memory functioning and he denied perceptual distortions, delusions, or other symptoms of psychosis. There were no recent thoughts of suicidal ideation and no evidence of homicidal ideations. His insight and judgment were intact and his rate and content of speech were within normal limits. Moreover, he denied concentration or attention problems. Although the veteran did report chronic sleep impairment and hypervigilent behaviors, after reviewing the veteran's claims folder, the examiner diagnosed chronic mild PTSD and assigned a GAF score of 65, which reflected mild symptoms with no impairment in occupational or social functioning. In contrast, a March 2005 private evaluation from M.T., who treated the veteran from September 2004, reflected that the veteran created an isolated lifestyle and work that he could do from home due to his problems with authority and scrutiny. The veteran also had symptoms of depression, anxious mood, lack of sleep, hypervigilence, avoidance of intimacy, authority and trust issues, and dissociation. M.T. assigned the veteran a GAF score of 50. However, during his December 2006 VA PTSD examination, the veteran reported monthly meetings with other veterans, weekly meetings with friends, and monthly contact with his daughters. There was no history of suicide attempts or violence. Upon examination, the veteran was clean in appearance, cooperative, had appropriate affect, was oriented, and had normal thought processes, content, judgment, insight, and a normal memory. The veteran had sleep impairment but no obsessive ritualistic behavior, panic attacks, homicidal or suicidal thoughts. The veteran denied any loss of motivation or interest in activities or any sense of foreshortened future and concentration difficulties. He did report hypervigilance and exaggerated startle response. After reviewing the veteran's claims file, the examiner concluded that the veteran's PTSD symptoms were in the mild range and his depression and anxiety were secondary to his PTSD symptoms. The veteran's GAF score was 65. Although the Board acknowledges the March 2005 evaluation from M.T. and the December 2006 VA examination notations of depression and anxiety, sleep problems, and hypervigilence, the Board finds it significant that after contemplating these findings, the December 2006 VA examiner concluded that the veteran's PTSD symptoms were not severe enough to have significantly affected his occupational functioning or relationships with others. In particular, the VA examiner specifically noted that the veteran had depression and anxiety but still concluded that his PTSD symptomatology, when considered as a whole, was in the mild range. Importantly, the examiner added that there was no occasional decrease in work efficiency and there as no intermittent period of inability to perform occupational tasks due to PTSD signs and symptoms, which is what is necessary for a 30 percent rating. The Board also notes that M.T.'s GAF score of 50 is not supported by the other evidence of record, including the statements of the veteran. As such, the Board finds after considering the evidence as a whole, the evidence does not more nearly approximate the criteria for a higher rating. 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411; Hart, 21 Vet. App. 505. In reaching this decision, the potential application of various provisions of Title 38 Code of Federal Regulations have been considered, whether or not they were raised by the veteran. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In particular, the Board has considered the provisions of 38 C.F.R. § 3.321(b)(1). In this case, however, there has been no showing that the veteran's service-connected PTSD has caused marked interference with employment beyond that contemplated by the schedule for rating disabilities, necessitated frequent periods of hospitalization, or otherwise renders impractical the application of the regular schedular standards utilized to evaluate the severity of his disability. As noted during his December 2006 PTSD examination, the veteran reported he left his job as an illustrator due to downsizing and made the decision not to seek another job. There is also no evidence that the veteran stopped working as a massage therapist because of his PTSD. In the absence of such factors, the Board finds that the requirements for an extraschedular evaluation for the veteran's service-connected PTSD under the provisions of 38 C.F.R. § 3.321(b)(1) have not been met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). ORDER Entitlement to an evaluation in excess of 10 percent disabling for cephalalgia prior to October 3, 2006, is denied. Entitlement to a 30 percent disabling evaluation for cephalalgia, and no higher, on October 3, 2006, is granted. Entitlement to an initial evaluation in excess of 10 percent disabling for PTSD is denied. ____________________________________________ KATHLEEN K. GALLAGHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs