Citation Nr: 0814392 Decision Date: 05/01/08 Archive Date: 05/12/08 DOCKET NO. 06-09 392 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for left ear sensorineural hearing loss. 2. Entitlement to service connection for right ear sensorineural hearing loss. 3. Entitlement to an evaluation greater than 30 percent for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Richard J. Mahlin, Attorney ATTORNEY FOR THE BOARD Christopher Murray, Associate Counsel INTRODUCTION The veteran had active military service from September 1963 to September 1966. This case comes before the Board of Veterans' Appeals (Board) on appeal of October 2005, January 2006 and September 2006 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. FINDINGS OF FACT 1. The veteran is not currently diagnosed with right ear sensorineural hearing loss for VA purposes. 2. Left ear sensorineural hearing loss was not manifested in service or within one year of service discharge, and is not etiologically related to such service. 3. PTSD is manifested by no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, mild memory loss, chronic sleep impairment, anxiety and panic attacks occurring twice per month. CONCLUSIONS OF LAW 1. Right ear sensorineural hearing loss was not incurred in or aggravated by service, and may not be presumed to have been incurred therein. 38 U.S.C.A. §§ 1110, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309(a) (2007). 2. Left ear sensorineural hearing loss was not incurred in or aggravated by service, and may not be presumed to have been incurred therein. 38 U.S.C.A. §§ 1110, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309(a) (2007). 3. The criteria for an evaluation for PTSD in excess of 30 percent have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Under the Veterans Claims Assistance Act (VCAA), when VA receives a complete or substantially complete application for benefits, it must (1) notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, (2) which information and evidence VA will obtain, (3) and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a) (West 2002). (4) VA must also request that the claimant provide any evidence in the claimant's possession that pertains to a claim. 38 C.F.R. § 3.159 (2007). See also Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). With regards to all VCAA notice elements of the veteran's service connection claims, and VCAA notice elements two through four of the veteran's increased ratings claims, the Board finds that July 2005 and July 2006 notice letters fully satisfied these duties 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). In this regard, these notice letters requested that the veteran provide enough information for the RO to request records from any sources of information and evidence identified by the veteran. He was also expressly advised of the need to submit any evidence in his possession that pertains to the claim decided herein. Finally, the notice letters advised the veteran 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, the Court of Appeals for Veterans Claims (Court) issued a decision in Vazquez-Flores v. Peake, 22 Vet App. 37 (2008), which held that, for an increased compensation claim, section 5103(a) requires first element notice which, at a minimum, notifies the claimant that he 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 his 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 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. Additionally, 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. 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, 22 Vet. App. at 41. In this case, the veteran was provided pertinent information in the July 2006 VCAA notice letter. Specifically, the July 2006 letter informed the veteran of the need to provide on his own, or by VA, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the veteran's employment. He was also told that should an increase in disability be found, a disability rating will be determined by applying relevant diagnostic code(s) from 38 Code of Federal Regulations, Part 4, and that his disability would be assigned a rating between 0 and 100 percent. Finally, the July 2006 letter provided the veteran with examples of pertinent medical and lay evidence that he may submit (or ask the Secretary to obtain) relevant to establishing entitlement to increased compensation. The Board acknowledges the July 2006 letter did not specifically inform the veteran that he must provide evidence demonstrating the effect any worsening of his service- connected disability has on his daily life. However, this letter advised him that he may submit statements from persons who have witnessed how his disability symptoms affect him. The Board finds that the veteran could be reasonably expected to understand the need to provide evidence regarding the impact of his service-connected disability on his daily life, as opposed to his employment, from this statement. Moreover, the Board concludes that the veteran demonstrated actual knowledge of the need to submit evidence regarding the impact of his disability on his daily life at his August 2006 VA examination, at which the veteran indicated he avoids going out to eat because he feels uncomfortable when away from home. Under these circumstances, the Board finds that any VCAA notice error with respect to this provision of first element notice is non-prejudicial to the veteran, and that the Board may proceed with its decision. See Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007) (all VCAA notice errors are presumed prejudicial and require reversal unless the VA can show that the error did not affect the essential fairness of the adjudication, such as by demonstrating that any defect was cured by actual knowledge on the part of the claimant, that a reasonable person could be expected to understand from the notice what was needed, that a benefit could not have been awarded as a matter of law, or perhaps where the claimant has stated that he or she has no further evidence to submit, or where the record reflects that VA has obtained all relevant evidence). In Vazquez-Flores, supra, the Court stated that "[n]othing in law or common sense supports a conclusion that the Court should put on blinders and ignore [the 'extensive administrative appellate process'] or a conclusion that a notice error prior to the initial decision by the Secretary could not be rendered non-prejudicial when the full panoply of administrative appellate procedures established by Congress are provided to the claimant. It is well settled that a remand is not warranted when no benefit would flow to the claimant." Id. See also Bernard v. Brown, 4 Vet. App. 384, 394 (1993); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). As a final matter, on March 3, 2006, the Court issued a decision in Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006), which held that the VCAA 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. Both March 2006 and July 2006 VCAA letters provided such notice. In light of the above, the Board finds that nearly all notice required by VCAA and implementing regulations was furnished to the veteran. For those elements of notice that the veteran was not specifically informed, the Board has demonstrated that any defective predecisional notice error is non-prejudicial in terms of the essential fairness of the adjudication and that no useful purpose would be served by delaying appellate review to send out additional VCAA notice letters. VA must also make reasonable efforts to assist the appellant in obtaining evidence necessary to substantiate the claim for the benefit sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159 (2007). Service medical records are associated with claims file. The veteran has provided a private audiological examination and opinion as well as a private psychological evaluation. He has not identified any additional medical records that should be obtained. The veteran was afforded a VA audiological examination in November 2005 and VA examinations to determine the severity of his PTSD in February and August 2006. See 38 U.S.C.A. § 5103A(d); see also 38 C.F.R. § 3.159 (c)(4) (2007); Wells v. Principi, 327 F. 3d 1339, 1341 (Fed. Cir. 2002). In light of the foregoing, the Board is satisfied that all relevant facts have been adequately developed to the extent possible; no further assistance to the appellant in developing the facts pertinent to the issue on appeal is required to comply with the duty to assist. 38 U.S.C.A. §§ 5103 and 5103A; 38 C.F.R. § 3.159. Analysis Under 38 U.S.C. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence. In Timberlake v. Gober, 14 Vet. App. 122 (2000), the Court held, in pertinent part, that the law requires only that the Board address its reasons for rejecting evidence favorable to the claimant. The Federal Circuit has also held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). It is VA's defined and consistently applied policy to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim. Reasonable doubt is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2007). I. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. § 1110. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic disabilities, including organic diseases of the nervous system, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 C.F.R. §§ 3.307, 3.309. In an October 4, 1995, opinion, VA's Under Secretary for Health determined that it was appropriate to consider high frequency sensorineural hearing loss an organic disease of the nervous system and therefore a presumptive disability. Right ear sensorineural hearing loss The veteran maintains that he currently suffers from hearing loss as a direct result of his active service. He asserts that he experienced a significant amount of in-service acoustic trauma as a radio operator aboard helicopters. In reviewing the veteran's service records, the Board notes that the veteran received gunner wings and an aircraft crewman badge. As such, the RO has conceded in-service acoustic trauma; the Board concurs. For purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, and 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the frequencies at 500, 1000, 2000, 3000, and 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2007). Upon review, service medical records are negative for a hearing loss disability in the right ear. Post service medical evidence includes an August 2005 private audiogram and a November 2005 VA audiology examination. The examinations indicated the following puretone thresholds in the right ear: HERTZ 500 1000 2000 3000 4000 AUG. 2005 15 15 10 15 30 NOV. 2005 5 5 0 5 30 Speech audiometry revealed speech recognition ability in the right ear of 100 percent in both August and November 2005. Considering the results of the August and November 2005 audiological examinations, it is clear that the veteran does not currently suffer from a current right ear hearing loss disability for VA benefit purposes. His puretone thresholds, at 500, 1000, 2000, 3000, and 4000 Hertz, were less than 40 in all frequencies, and he did not show puretone thresholds of 26 or more in 3 or more frequencies in his right ear. His scores on the Maryland CNC Test were not less than 94 percent at either examination. The veteran has not identified any post-service testing revealing the presence of hearing loss disability for VA compensation purposes. To prevail on the issue of service connection, there must be medical evidence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997) (a "current disability" means a disability shown by competent medical evidence to exist at the time of the award of service connection); Brammer v. Derwinski, 3 Vet. App. 223 (1992) (in the absence of proof of a present disability, there can be no valid claim for service connection as Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability). Other than the veteran's contentions, the record contains no competent evidence of a current diagnosis of right ear sensorineural hearing loss. As such, the Board concludes that the preponderance of the evidence is against a finding that the veteran has a right ear hearing loss disability for VA purposes. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Left ear sensorineural hearing loss As discussed above, the veteran asserts he suffers from sensorineural hearing loss as a result of acoustic trauma suffered during active service. The RO has conceded in- service acoustic trauma. The reports of an August 2005 private and November 2005 VA audiology examination both show current left ear sensorineural hearing loss for VA purposes. See 38 C.F.R. § 3.385. Service medical records are negative for any findings of treatment or diagnosis of left ear hearing loss. An audiological examination pending service discharge in September 1966 indicates the veteran's hearing to be normal. See Hensley v. Brown, 5 Vet. App. 155 (1993). His ears and drums were normal. There were no findings or complaints pertaining to hearing loss. There is no evidence of record to indicate the veteran complained of or sought treatment for left ear hearing loss until August 2005, over 35 years post- service. As there was no left ear hearing loss for VA purposes shown within one year of service discharge, the presumption of service connection does not apply. See 38 C.F.R. §§ 3.307, 3.309(a). In addition, the lapse in time between service and the first complaints of hearing loss also weighs against the veteran's claim. The Board may, and will, consider in its assessment of a service connection the passage of a lengthy period of time wherein the veteran has not complained of the malady at issue. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Forshey v. Principi, 284 F.3d 1335, 1358 (Feb. Cir. 2002) (en banc). As noted above, the veteran was provided a private audiological examination in August 2005 and a VA audiological examination in November 2005. Dr. Foss, a private audiologist, opined that "it is quite likely that [exposure to helicopters and machine guns in service] was the beginning of [the veteran's] hearing loss." However, the VA examiner found that the veteran's left ear hearing loss is not likely due to military noise exposure. In deciding whether the veteran's left ear hearing loss is etiologically related to his active service, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Evans v. West, 12 Vet. App. 22, 30 (1998). That responsibility is particularly onerous where medical opinions diverge. At the same time, the Board is mindful that it cannot make its own independent medical determinations and that there must be plausible reasons for favoring one medical opinion over another. Id; see also Colvin v. Derwinski, 1 Vet. App 171 (1991). Here, there are legitimate reasons for accepting the November 2005 VA examiner's unfavorable medical opinion over the favorable August 2005 opinion of Dr. Foss. With regard to medical evidence, an assessment or opinion by a health care provider is never conclusive and is not entitled to absolute deference. Further, a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Also, a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty. Bloom v. West, 12 Vet. App. 185, 187 (1999). While Dr. Foss offers a favorable opinion, he indicates that the veteran's hearing loss began during his military service. However, as noted above, the veteran's hearing was found to be normal upon service separation, and evidence of record shows the veteran did not suffer from a hearing disability until 2005. Therefore, the Board finds that Dr. Foss's statement is not supported by the evidence of record and thus is not probative evidence upon which service connection may be granted. See Miller v. West, 11 Vet. App. 345, 348 (1998) (medical opinions must be supported by clinical findings in the record; bare conclusions, even those made by medical professionals, which are not accompanied by a factual predicate in the record, are not probative medical opinions). In comparison, the November 2005 VA examiner supported his negative opinion based on the evidence of record, namely citing the veteran's normal hearing at service separation. In addition, the VA examiner noted that exposure to loud noises can result in damage to the inner ear, but such damage would result immediate permanent hearing loss. Since the damage is done upon exposure to the noise, a normal audiogram subsequent to noise exposure, as exists in the present case, verify that the hearing had recovered without permanent hearing loss. Thus, the Board finds that the VA examiner's November 2005 medical opinion is accordingly more probative than that rendered by Dr. Foss. The Board also acknowledges that the veteran himself has claimed he currently suffers from a left ear sensorineural hearing loss disability that is etiologically related to active service. However, as a layman, the veteran has no competence to give a medical opinion on the diagnosis or etiology of a condition. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Consequently, lay assertions of medical diagnosis or etiology cannot constitute evidence upon which to grant the claim for service connection. Lathan v. Brown, 7 Vet. App. 359, 365 (1995). In sum, the veteran has not submitted probative medical evidence establishing that he currently suffers from left ear sensorineural hearing loss that is etiologically related to acoustic trauma suffered in service. While the evidence of record does contain a private medical opinion in support of the veteran's claim, the Board finds that this opinion is not probative, as it is not supported by the evidence of record. In addition, a VA audiologist found that the veteran's current hearing loss is not likely etiologically related to in-service acoustic trauma. Also, the absence of any medical records of a diagnosis or treatment for over 35 years after service is probative evidence against the claim for direct service connection. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for left ear sensorineural hearing loss, and the benefit of the doubt rule does not apply. See 38 U.S.C.A. § 5107 (West 2002). II. Increased Rating Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is reviewed when making disability evaluations. See generally, 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where, as in the present case, entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Therefore, although the Board has thoroughly reviewed all evidence of record, the more critical evidence consists of the evidence generated during the appeal period. Further, the Board must evaluate the medical evidence of record since the filing of the claim for increased rating and consider the appropriateness of a "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts). See Hart v. Mansfield, 21 Vet. App. 505 (2007). The veteran is currently assigned a 30 percent disability evaluation for PTSD pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411 (2007). Under this diagnostic code, a 30 percent evaluation is warranted 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, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent evaluation is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereo-typed speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent disability evaluation is warranted when there is 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 work like setting); inability to establish and maintain effective relationships. Id. A 100 percent disability evaluation is warranted when there is total occupational and social impairment, due to such symptoms as: 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 and place; memory loss for names of close relatives, own occupation, or own name. Id. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the veteran does not meet the criteria for an evaluation in excess of 30 percent for PTSD. February and August 2006 VA examination reports and an April 2006 private psychological evaluation report indicate that the veteran's PTSD is characterized by a depressed mood, irritability, anxiety, panic attacks once or twice a month, chronic sleep impairment and mild memory loss. Additionally, these records indicate that the veteran reports feeling uncomfortable leaving the house and avoids social situations. As will be discussed in more detail below, such symptoms indicate some occupational and social impairment; however, they do not warrant a disability rating in excess of 30 percent. The Board observes that a higher rating is not warranted because the competent evidence of record does not demonstrate that the veteran's symptomatology most closely approximates a 50 percent evaluation or higher. In this regard, the Board notes that the veteran's medical records do not contain evidence which supports a finding that the veteran suffers from delusions or obsessive rituals. Similarly, the April 2006 psychological evaluation indicates the veteran suffers from panic attacks or flashbacks approximately one or two times a month, a symptom contemplated by a 30 percent evaluation. Finally, no mention is made in the evidence of record of any obsessional rituals congruent with a higher evaluation. With regards to speech impairment, a symptom contemplated by a 50 percent evaluation, the Board notes that the April 2006 psychological evaluation notes the veteran's speech to be impaired in terms of elocution and articulation, but also notes that his associations are logical, stream of mental activity within normal limits, and articulation and syntax are within intelligible limits. In addition, the August 2006 VA examination report notes the veteran's speech to be spontaneous, clear and coherent. Higher ratings also take into account the inability to attend to basic personal appearance and hygiene and impaired thought and judgment. Both the February and August 2006 VA examinations and the April 2006 psychological evaluation indicate the veteran appeared clean, well groomed and appropriately dressed. Finally, both the February and August 2006 VA examination reports and the April 2006 psychological evaluation indicate that the veteran was oriented in all spheres. With regard to the veteran's ability to establish and maintain personal relationships, the Board notes that the veteran has indicated he avoids social situations. In this regard, the April 2006 psychological evaluation notes that, while the veteran is a member of the Veterans of Foreign Wars and American Legion, he does not attend meetings because he "doesn't like to be around crowds." However, the veteran's records demonstrate that he and his current wife are happily married, and travel together recreationally and to visit relatives. Thus, the Board concludes that, although the veteran may have some relationship difficulties, particularly with society in general, he is capable of maintaining successful relationships. The Board acknowledges that the April 2006 psychological evaluation indicates the veteran has some difficulty in establishing effective work relationships, which is contemplated by higher ratings. For instance, the psychological evaluation notes that the veteran's inability to relate to others is becoming more impaired and would unquestionably present an impossible hurdle to gainful employment. However, the evidence of record also indicates the veteran is capable of maintaining successful, gainful employment. In this regard, the August 2006 VA examination report notes that, while the veteran enjoys work less, he pushes himself to continue his employment. In addition, the evidence of record also indicates that the veteran has a normal affect and depressed mood, no suicidal ideation, is able to understand complex commands and does not meet the majority of the criteria for higher evaluations. Thus, although the Board finds that the veteran exhibits some symptoms associated with a higher evaluation, it concludes that the veteran's overall disability picture continues to most closely approximate that contemplated by a 30 percent evaluation. Also of record are the veteran's Global Assessment of Functioning (GAF) scores. 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). The Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) contemplates that the GAF scale will be used to gauge a person's level of functioning at the time of the evaluation (i.e., the current period) because ratings of current functioning will generally reflect the need for treatment or care. The Board notes that while GAF scores are probative of the veteran's level of impairment, they are not to be viewed outside the context of the entire record. Therefore, they will not be relied upon as the sole basis for an increased disability rating. The veteran's GAF scores have fluctuated over the course of the rating period. The February 2006 VA examination reports notes the veteran's GAF score as 64, the April 2006 private psychological evaluation finds the veteran's GAF score to be 49 to 51, and the August 2006 VA examination report indicates the veteran's GAF score was then 58. A GAF score of 41 to 50 is indicative of serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social occupations, or school functioning (e.g., no friends, unable to keep a job). GAF scores ranging between 51 and 60 indicate moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social or occupational functioning (e.g., few friends, conflicts with peers or co-workers). Finally, GAF scores ranging between 61 and 70 indicate some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational or social functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well and has some meaningful interpersonal relationships. The Board recognizes that the veteran's GAF scores indicate he suffers from some moderate PTSD symptoms. However, the Board again notes that GAF scores are just one component of the veteran's disability picture, and that it does not have a "formula" that it follows in assigning evaluations. Rather, the Board considers the veteran's entire disability picture, including GAF scores. Furthermore, the Board need not accept a GAF score as probative. See Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995) (it is the responsibility of the Board to weigh the evidence, including the medical evidence, and determine where to give credit and where to withhold the same). As such, in viewing the evidence of record in its entirety, the Board finds that the veteran's overall disability picture continues to most closely approximate that contemplated by a 30 percent evaluation. The Board must consider the entire evidence of record when analyzing the criteria laid out in the ratings schedule. Although the veteran is competent to provide evidence regarding symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology. Such evidence must come from a medical professional. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). In sum, the evidence of record demonstrates that the veteran successfully maintains a relationship with his wife and family as well as gainful employment. Although the veteran reports anxiety and occasional irritability problems, there is no evidence of any physical outbursts, nor does he report a lack of self-control with respect to his anger. The record also demonstrates that he is able to function independently, and has no delusions, weekly panic attacks or obsessional rituals. He does, however, exhibit a depressed mood and chronic sleep impairment. Overall, the Board concludes that the evidence discussed above supports no more than a 30 percent rating. The Board acknowledges that the evidence of record demonstrates that the veteran has some moderate symptoms such as difficulty establishing and maintaining effective social relationships, but his overall disability picture does not warrant a higher rating in excess of 30 percent. In reaching its decision, the Board considered the benefit-of-the-doubt rule. However, the preponderance of the evidence is against an evaluation higher than 30 percent, and therefore, does not apply. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). ORDER Service connection for right ear sensorineural hearing loss is denied. Service connection for left ear sensorineural hearing loss is denied. An evaluation in excess of 30 percent for PTSD is denied. ____________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs