Citation Nr: 1305192 Decision Date: 02/12/13 Archive Date: 02/21/13 DOCKET NO. 09-41 783 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD), from May 21, 2007, to May 22, 2011. REPRESENTATION Appellant represented by: Ralph J. Bratch, Attorney at law WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD M. C. Graham, Counsel INTRODUCTION The Veteran had active service from August 1966 to August 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2008 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO), located in Nashville, Tennessee, which granted service connection for PTSD and assigned an initial 10 percent evaluation effective from April 13, 2004 to May 20, 2007; followed by the assignment of a 30 percent rating from May 21, 2007, forward. In October 2010, a Board video conference hearing was held before the undersigned Veterans Law Judge. A transcript of that hearing is of record. At the hearing, the parties agreed to hold the record open for 30 days to allow for the submission of additional evidence. Additional evidence was added to the record during that time period, which was accompanied by a waiver. In a February 2011 decision, the Board granted a higher evaluation, to 30 percent, for the portion of the appeal period extending from April 13, 2004, to May 20, 2007, and remanded the issue of a higher evaluation for the period from May 21, 2007 forward, to include consideration of entitlement to a total disability rating based upon individual unemployability (TDIU). Subsequently, in an October 2012 rating decision, a 100 percent rating was granted for PTSD, effective May 23, 2011. This appeal arises from initial rating award, and in this case, staged ratings have been assigned for various periods of the appeal period. See Fenderson v. West, 12 Vet. App. 119 (1999). FINDINGS OF FACT 1. From May 21, 2007, to March 30, 2009, the evidence demonstrates that the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity; however, the evidence does not demonstrate occupational and social impairment in most areas such as work, school, judgment, thinking or mood. 2. From March 31, 2009, the evidence demonstrates that the Veteran's PTSD resulted in total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for a rating of 50 percent, but no higher, for PTSD, from May 21, 2007, to March 30, 2009, have been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.321, 3.326, 4.130, Diagnostic Code (DC) 9411 (2012). 2. The criteria for a 100 percent rating for PTSD have been met from March 31, 2009. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.321, 3.326, 4.130, Diagnostic Code (DC) 9411 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000, 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012), 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012), requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of what they must do to substantiate their claims. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). Specifically, VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that the claimant is to provide; and (3) that VA will attempt to obtain. See Beverly v. Nicholson, 19 Vet. App. 394, 403 (2005) (outlining VCAA notice requirements). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). As an initial matter, as the Board is awarding a full grant, a 100 percent rating, for PSTD for the period from March 31, 2009 to May 22, 2011. Therefore, there is no need to discuss the duties to notify and assist with this claim for that period of the appeal. The VCAA duty to notify was satisfied by way of letters sent to the Veteran dated in May 2004 (addressing the elements of service connection prior to the grant of service connection for PTSD) and again in April 2009 (addressing the elements pertinent to the claim for a higher rating). As this is an appeal arising from a grant of service connection, the notice that was provided before service connection was granted was legally sufficient and VA's duty to notify the Veteran in this case has been satisfied. See Hartman v. Nicholson, 483 F.3d 1311 (2006); Dunlap v. Nicholson, 21 Vet. App. 112 (2007) To the extent that the claim on appeal includes a component of increased (staged) ratings, the VCAA requirement is generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. Sept. 4, 2009). This notice was provided to the Veteran in the April 2009 letter. A January 2012 letter addressed TDIU and extraschedular consideration. Subsequently, the RO readjudicated the claim, most recently in a Statement of the Case issued in November 2012. See Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of fully compliant notification followed by readjudication of the claim, such as an Statement of the Case or Supplemental Statement of the Case, is sufficient to cure a timing defect). The Board concludes that during the administrative appeal process, the Veteran was provided the information necessary such that the purposes of the notification have been met. Vazquez-Flores, 22 Vet. App. at 49. The Board also finds that all of the relevant facts have been properly developed, and that all available evidence necessary for an equitable resolution of the issue on appeal has been obtained. The Veteran's service treatment and post-service treatment records were obtained and the file includes arguments, contentions and statements of the Veteran and his attorney. The Veteran provided testimony at a Board video conference hearing held before the undersigned Veterans Law Judge in October 2010. Additional evidence was added to the record at ,or shortly after the hearing, which was accompanied by a waiver. The Board remanded the claim in February 2011 in order to develop additional treatment records, including VA treatment records dated from September 2010 forward; in order to provide the Veteran with appropriate notice with respect to TDIU and extraschedular evaluations; and in order to afford the Veteran a VA psychiatric examination to assess the current severity of his service-connected PTSD. VA treatment records from September 2010 forward were associated with the claims folders, a January 2012 VCAA notice letter addressed the requirements for TDIU and extraschedular ratings, and additional VA PTSD examinations were provided in May 2011 (which served as the basis for the 100 percent rating) and February 2012, to include an April 2012 addendum. The Board is therefore satisfied there was substantial compliance with this remand directive. See Stegall v. West, 11 Vet. App. 268 (1998) and Dyment v. West, 13 Vet. App. 141, 146- 47 (1999). A Court or Board remand confers upon the appellant the right to substantial, but not strict, compliance with that order. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). VA's duty to assist includes obtaining an examination and medical opinion when necessary to make an adequate determination. See Duenas v. Principi, 18 Vet. App. 512 (2004). The Veteran was afforded a VA examination in May 2008, during the period of time currently on appeal. The Veteran's representative has contended that this examination is inadequate as it fails to comprehensively account for and address the lay and clinical evidence of record. These concerns have been considered by the Board; however, the Board finds that the May 2008 examination report, along with the lay and clinical evidence on file relating to this appeal period is sufficient for rating purposes. See Charles v. Principi, 16 Vet. App. 370 (2002); see also 38 C.F.R. § 3.159(c)(4) (2009) (a medical examination or opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim). The 2008 examiner specifically noted that the claims folders had been reviewed and identified three relevant VA treatment records with specificity. The Board notes that the Veteran's attorney criticized the report because the examiner did not specifically mention additional treatment records or the Veteran's wife's numerous lay statements. See October 2010 written statement from attorney. However, in the recent case of Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) the Court held that "[t]here is no requirement that a medical examiner comment on every favorable piece of evidence in a claims file." Monzingo at 7 (citing Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that the law imposes no reasons-or-bases requirement on examiners)). The Court instead has held that "examination reports are adequate when they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion." Id. The Board finds that the 2008 VA examination report is adequate under this standard as the examiner provided his judgment on the severity of the Veteran's PTSD, taking into account the VA treatment records and the Veteran's lay statements, and provided the essential rationales for his opinions. See also Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA must provide an examination/medical opinion that is adequate for rating purposes). The Board also notes that the Veteran's 2012 VA examination report contains a reference to his receipt of Social Security Administration (SSA) benefits. The Veteran, however, did not report to VA that there are Social Security Administration records that would be pertinent to his claim, and particularly to the remaining period on appeal for which he is receiving less than a full grant, from May 21, 2007, to March 30, 2009. There is no reference to SSA records in the contemporaneous records from that period. In Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010), the Court noted that 38 U.S.C.A. § 5103A did not require VA to obtain all medical records or all SSA disability records, only those that are relevant to the Veteran's claim. The Court also stated that VA was not required to obtain records in every case in order to rule out their relevance. Rather, the standard is: as long as a reasonable possibility exists that the records are relevant to the veteran's claim, VA is required to assist the veteran in obtaining the identified records. In this instance, the Veteran himself did not identify any SSA records that would be relevant to his claims, and it is not at all clear that there exist SSA records that would be relevant to his claim. The Board, therefore, concludes that the record does not establish a reasonable possibility that there are such records that are relevant to these claims. Accordingly, the Board finds that VA has complied, to the extent required, with the duty-to-assist requirements found at 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c)-(e). II. Initial Rating Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Separate diagnostic codes (DCs) identify the various disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2012). When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. See Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2012). The Veteran is currently assigned a 30 percent initial disability rating for PTSD, for the period from May 21, 2007, to May 22, 2011, pursuant to the rating criteria in 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). Diagnostic Code 9411 addresses the criteria for rating PTSD. Under that code, ratings may be assigned ranging between 0 and 100 percent. A 30 percent rating requires 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 warranted where 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; difficulty in establishing effective work and social relationships. A 70 percent rating requires 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); and inability to establish and maintain effective relationships. Id. A 100 percent rating requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. Reports of psychiatric examination and treatment frequently include a Global Assessment of Functioning (GAF) score. According to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a GAF scale includes scores ranging between zero and 100 which represent the psychological, social, and occupational functioning of an individual on a hypothetical continuum of mental health illness. The GAF score and the 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, an assigned GAF score, like an examiner's assessment of the severity of a condition, is not dispositive of the percentage rating issue; rather, it must be considered in light of the actual symptoms of a psychiatric disorder (which provide the primary basis for the rating assigned). See 38 C.F.R. § 4.126(a) (2012). The DSM-IV describes a GAF score of 41 to 50 as indicating serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious difficulty in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A 51 to 60 rating indicates 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). A 61 to 70 rating indicates 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, has some meaningful interpersonal relationships. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, American Psychiatric Association (DSM-IV). The Board notes that 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. Rating from March 31, 2009, to May 22, 2011 In examining the evidence in this case, the Board concludes that although the Veteran is not shown to have all of the psychiatric symptoms listed in the Rating Schedule for the assignment of a 100 percent disability rating, the evidence is at least in equipoise that he has total social and occupational impairment as a result of service-connected PTSD from March 31, 2009. As noted above, the Veteran's was awarded a 100 percent rating for PTSD in an October 2012 rating decision. The effective date of the increase, May 23, 2011, was the date of a VA examination which found that there was total occupational and social impairment due to PTSD symptoms. The examiner noted that medications used to treat PTSD, which he listed as risperidone (anti-psychotic), bupropion (anti-depressant) and alprazolam (anti-anxiety) "while slightly effective for treating symptoms, can cause impairment that would prohibit veteran from working as an over the road truck driver." The examiner added that "[s]evere difficulty with interpersonal relationships would likely prevent even sedentary employment." Records from the Veteran's former employer show that he stopped working on March 30, 2009. During the 2011 examination, the Veteran reported that he stopped working because of "problems with driving, concentration, medications, sleep." The examiner noted that the Veteran's contentions were supported by the examiner's objective findings that "PTSD symptoms and prescribed medication prevent adequate occupational performance." A review of the medical record shows that the Veteran was taking the medication buproprion (wellbutrin), in May 2007 and that the medication buspar was added at that time. A November 2008 VA treatment record showed that he was taking diazepam only on the weekends. The evidence of record shows that the Veteran reported in February 2009 that it was becoming hard for him to continue driving and be on the road, and he reported anger, anxiety, and depression issues, as well as sleep issues. Resolving reasonable doubt in favor of the veteran, the Board finds that the veteran satisfied the necessary criteria for an evaluation of 100 percent for his PTSD as of March 31, 2009. Based on the foregoing, it is evident from the medical evidence that his PTSD was productive of total occupational impairment on that date, as he was no longer able to work due to his PTSD symptoms in conjunction with the medication regime prescribed during this time. Mauerhan, 16 Vet. App. at 442. The Veteran's last day of work was March 30, 2009, according to his former employer. Accordingly, the Board finds that the severity of the disability at issue was more appropriately reflected by a 100 percent evaluation from March 31, 2009. Rating from May 21, 2007, to March 30, 2009 In examining the evidence in this case, the Board concludes that although the Veteran is not shown to have all of the psychiatric symptoms listed in the Rating Schedule for the assignment of a 50 percent disability rating, the evidence is at least in equipoise that a 50 percent rating, but no higher, is warranted for the period from May 21, 2007 to March 30, 2009. Specifically, during this period the May 2008 VA examination report, VA outpatient treatment records, and lay statements demonstrate decreased occupational and social impairment with reduced reliability and productivity due to disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships. The Board acknowledges that the December 2008 VA examination report and VA outpatient treatment records do not support findings of all of the elements of the 50 percent rating criteria. For example, the evidence does not demonstrate flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once per week; difficulty understanding complex commands; or impaired abstract thinking. However, as noted above, the symptoms recited in the criteria in the rating schedule for evaluating mental disorders are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms. Mauerhan, 16 Vet. App. 436, 442 (2002). In accordance with Mauerhan, the Board has considered all symptoms of the Veteran's service-connected PTSD that affect the level of occupational or social impairment. Regarding the Veteran's overall mental disability, following a thorough VA psychiatric examination and interview with the Veteran, the May 2008 VA examiner noted that poor sleep and sedation from sleep medication interfered with his ability to work full-time. The Veteran estimated that he was working 4 to 5 days a week. The examiner also noted that intrusive memories of Vietnam led to decreased concentration. Regarding disturbances of motivation and mood, the Veteran's wife reported in a May 2007 treatment record that his mood had deteriorated, and in a November 2008 VA treatment record she reported that he "gets upset easily and would not communicate for days at a time." In November 2008, the Veteran reported nightmares, flashbacks, and feelings of anxiety, irritability, and depression. The Board also acknowledges that GAF scores are consistently in the upper end (closer to the mild range) of the moderate range during this period. The Veteran's GAF score was 60 at the time of the May 2008 VA examination. VA treatment records during this period show his GAF was consistently assessed at 60. See VA treatment records dated May 2007, July 2008, September 2008, November 2008, and February 2009. As noted above, GAF scores from 51 to 60 represent moderate symptoms, and scores ranging from 61 to 70 represent mild symptoms. In reaching the conclusion that the Veteran's disability warrants a 50 percent disability rating, the Board has considered the Veteran's symptoms as well as his GAF scores. In this regard, the Board observes that the VA treatment records support symptoms that are consistent with a 50 percent disability rating despite GAF scores that demonstrated mild or moderate symptoms. Specifically, as noted above, the treatment records support a finding of disturbance of mood and difficulty in establishing effective work and social relationships. Based on the totality of the evidence, the Board finds that the Veteran's disability warrants a 50 percent disability rating but no higher. Having determined that the Veteran is entitled to a 50 percent disability rating, the Board will consider whether he is entitled to a higher evaluation under the criteria for evaluating mental disorders under 38 C.F.R. § 4.130 (2012). As noted above, in order to be assigned the next-higher 70 percent rating, the evidence must show that the Veteran's PTSD causes occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, DC 9411. In this case, the May 2008 VA examination report and VA outpatient treatment records during this period are against a finding of that his PTSD more nearly approximates symptoms such as those listed in the 70 percent rating criteria, including obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or an inability to establish and maintain effective relationships. Specifically, the May 2008 VA examination report noted that the Veteran's orientation was intact to person, time and place. His thought process and content were unremarkable. He had no delusions or hallucinations. He had no inappropriate behavior. He had no panic attacks. He and his wife both denied any episodes of physical violence. He was clean and neatly groomed. VA outpatient treatment records also do not support findings of symptoms such as these elements. In fact, VA treatment records dated from May 2007 to March 2009 have noted that the Veteran is alert and oriented, with euthymic mood and that he denied auditory or visual hallucinations or suicidal or homicidal ideation. See, for example, May 21, 2007 and February 26, 2009 VA treatment records. Additionally, while the Veteran has difficulty in establishing and maintaining effective work and social relationships, the evidence fails to show that he had an "inability" to establish and maintain effective relationships. Although in a January 2010 statement, B.A.L., a former co-worker of the Veteran, noted that the Veteran was "pretty much of a loner", he stated that he and the Veteran kept in touch when they worked together and the fact that they had both been in the Marine Corps "gave us somewhat of a bond." The Board acknowledges that the Veteran, his wife, and his daughters have all reported that he is moody, suspicious, angry, and depressed. However, he has lived with his wife for many years, he associates with his children, and he went boating five times with his wife from May 2007 to May 2008. See May 2008 VA examination report. Even though the May 2008 VA examiner noted that the Veteran isolates himself most of the time, the Board finds that he is able to have some sort of relationship with other people and does not have an inability to establish and maintain effective relationships, as contemplated by the criteria for a 70 percent disability rating. Regarding impaired impulse control (such as unprovoked irritability), the Board has considered the Veteran and his wife's sworn testimony that he gets irritable and angry and his report that he has "come to blows a few times" with his son, and that he once pushed his wife. See October 2010 hearing transcript at 6, 8, and 11. However, the Board finds that the preponderance of the evidence is against a finding of occupational and social impairment, with deficiencies in most areas as contemplated by the 70 percent rating criteria for PTSD. As noted above, throughout the period from May 21, 2007, to March 30, 2009, the Veteran's GAF was consistently reported as 60. Such a score demonstrates moderate, not serious symptoms. Based on an evaluation of all the evidence of record, and irrespective of whether the individual criteria for a 70 percent disability rating have been met, the Board finds that the Veteran's psychiatric symptoms from May 21, 2007, to March 30, 2009 are consistent with "difficulty" in establishing and maintaining effective relationships, but not an "inability" to do so. Further, the Board finds that the May 2008 comprehensive psychiatric examination supports a finding of an increased rating to 50 percent but no higher, and places a high probative value on the report as the examiner had the benefit of a full review of the claims folders and provided a thorough mental status examination. The Board has also considered the January and February 2010 statements of the Veteran's wife, his daughters, and his co-worker, as well as statements from the Veteran and his attorney that his disability warrants a 70 percent disability rating during this period. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In this case, the Veteran is competent to report symptoms of his PTSD because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. Similarly, his wife, daughters, and former co-worker/friend are competent to report their observations of the Veteran's behavior. The Board finds that the probative value of the statements of the Veteran, his wife, his daughters, and his friend are not, however, competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. The Veteran, his family members, and his friend have not been shown to possess the requisite medical training, expertise, or credentials needed to render a specific assessment of the severity of his psychiatric disorder. Nothing in the record demonstrates that any of them received any special training or acquired any medical expertise in evaluating psychiatric conditions. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed.Cir.2012). There are indications in the record that the Veteran's wife is a nurse; however, there is no indication in the record, and she does not assert, that she has a specialized knowledge of psychiatry or psychology. See Black v. Brown, 10 Vet. App. 279, 284 (1997) (rejecting the medical opinion of the appellant's wife, a nurse, because she did not show that she had specialized knowledge of cardiology). Accordingly, this lay evidence lacks probative value. The Board gives more weight to the opinions of the May 2008 VA examiner and the various medical professionals who assessed his service-connected PTSD during the period in question as they have received special training in evaluating psychiatric conditions and their assessments are based on mental health evaluations as well as the statements of the Veteran and his wife. The medical findings (as provided in the examination reports) directly address the criteria under which this disability is evaluated. As noted above, VA examination and VA outpatient treatment records during the period in question, from May 21, 2007, to March 30, 2009, have indicated symptoms and GAF scores that support a finding of moderate disability, at most. In this case, the Board has afforded the Veteran the benefit of the doubt in assigning the next-higher 50 percent disability rating for the entire period on appeal. Based on the evidence, the Board finds that a rating of 50 percent but no higher, is warranted for the Veteran's service-connected PTSD for the period from May 21, 2007, to March 30, 2009. Further, the disability does not warrant referral for extraschedular consideration. In exceptional cases where schedular ratings are found to be inadequate, consideration of an extraschedular rating is made. 38 C.F.R. § 3.321(b)(1) (2012). There is a three-step analysis for determining whether an extraschedular rating is appropriate. Thun v. Peake, 22 Vet. App. 111 (2008). First, there must be a comparison between the level of severity and symptomatology of the Veteran's service-connected disability and the established criteria found in the rating schedule to determine whether the Veteran's disability picture is adequately contemplated by the rating schedule. Id. If not, the second step is to determine whether the claimant's exceptional disability picture exhibits other related factors identified in the regulations as governing norms. Id.; see also 38 C.F.R. § 3.321(b)(1) (governing norms include marked interference with employment and frequent periods of hospitalization). If the factors of step two are present, the third step is to refer the case to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. Id. In this case, there has been no showing that the Veteran's disability picture for his PTSD could not be contemplated adequately by the applicable schedular rating criteria discussed above. The criteria provide for higher ratings, but as has been explained thoroughly herein, the currently assigned rating adequately describes the severity of the Veteran's symptoms for this disability during the period from May 21, 2007 to March 30, 2009. Given that the applicable schedular rating criteria are adequate, the Board need not consider whether the Veteran's disability picture includes such exceptional factors as periods of hospitalization and interference with employment. Referral for consideration of the assignment of a disability rating on an extraschedular basis is not warranted. See Thun, 22 Vet. App. at 111. Lastly, although the Veteran has submitted evidence of a medical disability and made a claim for the highest rating possible, he has not submitted evidence of unemployability, or claimed to be unemployable from May 21, 2007, to March 30, 2009. In fact, his statements and the report from his former employer show that he was employed until March 30, 2009, and in the preceding twelve months he had earned in excess of $55,000. Therefore, the question of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities has not been raised from May 21, 2007, to March 30, 2009. See Rice v. Shinseki, 22 Vet. App. 447 (2009); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). ORDER A disability rating of 50 percent but no higher for PTSD is granted from May 21, 2007, to March 30, 2009, subject to the laws and regulations governing the award of monetary benefits. A disability rating of 100 percent for PTSD is granted from March 31, 2009, subject to the laws and regulations governing the award of monetary benefits. ____________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs