Citation Nr: 1306129 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 09-12 491 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to an initial rating in excess of 30 percent for service-connected posttraumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD D. Rogers, Associate Counsel INTRODUCTION The Veteran served on active duty from January 1968 to July 1971. This case comes before the Board of Veterans' Appeals (the Board) on appeal from a March 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, which granted service connection for PTSD and assigned a 30 percent disability rating, effective August 22, 2007, the date the claim for service connection for PTSD was received by VA. The Veteran has contended that he is unable to work due to his service-connected disabilities, to include PTSD. The Board is aware that under Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009), the issue of a entitlement to total disability based upon individual unemployability due to service-connected disabilities (TDIU) would be raised in such a situation. However, the Board notes that the Veteran is in receipt of a 100 percent evaluation for his service-connected heart disability. A TDIU is provided where the combined schedular evaluation for service-connected diseases and disabilities is less than total, or 100 percent. 38 C.F.R. § 4.16(a) (2012). A 100-percent rating under the Schedule for Rating Disabilities means that a veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding request for TDIU moot where 100 percent schedular rating was awarded for the same period). Therefore, the issue of a TDIU is not raised in this case. A review of the Veteran's Virtual VA electronic claims file is negative for any additional information of evidence relevant to the claims on appeal. In the February 2013 informal hearing presentation, the Veteran's representative raised the issue of entitlement to special monthly compensation. This issue has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDING OF FACT The Veteran's symptoms of PTSD have resulted in 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). CONCLUSION OF LAW The criteria for an initial evaluation in excess of 30 percent for PTSD have not been met at any time during the claim. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist In correspondence dated in September 2007, prior to the March 2008 rating decision, the RO satisfied its duty to notify the Veteran under 38 U.S.C.A. § 5103(a) (West 2002) and 38 C.F.R. § 3.159(b) (2012). Specifically, the RO notified the Veteran of: information and evidence necessary to substantiate the claim; information and evidence that VA would seek to provide; and information and evidence that the Veteran was expected to provide. He was informed of the types of evidence that could be submitted to support his claim. The September 2007 letter provided the Veteran with the notice required for the initial claim of service connection for PTSD. Service connection was subsequently granted, and the Veteran appealed the initial rating assigned. In cases such as this, where service connection has been granted and an initial disability rating and effective date has been assigned, the typical service connection claim has been more than substantiated, it has been proven, thereby rendering 38 U.S.C.A. § 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 490 (2006); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). The Veteran bears the burden of demonstrating any prejudice from defective (or nonexistent) notice with respect to the downstream elements. Goodwin v. Peake, 22 Vet. App. 128, 137 (2008). That burden has not been met in this case, as neither the Veteran nor his representative has alleged such prejudice. VA has done everything reasonably possible to assist the Veteran with respect to his claim for benefits in accordance with 38 U.S.C.A. § 5103A (West 2002) and 38 C.F.R. § 3.159(c) (2012). Service treatment records have been associated with the claims file. All identified and available treatment records have been secured. In this regard, the Board acknowledges that the Veteran has been in receipt of disability benefits from the Social Security Administration (SSA) since April 2001. Correspondence received from the SSA in September 2008, however, show that a search for records pertaining to the Veteran indicated that there are no medical records available for review. Where records are unavailable, "VA has no duty to seek to obtain that which does not exist." Counts v. Brown, 6 Vet. App. 473, 477 (1994). Additionally, the Veteran was afforded VA PTSD examinations in February 2008 and March 2010. The reports of these examinations reflect that the examiners reviewed the Veteran's documented and reported past medical history, recorded his current complaints, conducted appropriate evaluations of the Veteran, rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record, and provided sufficient evidence to evaluate the disability. Neither the Veteran nor his representative have indicated that those examination reports are deficient. Although the most recent VA examination pertaining to the Veteran's PTSD is dated in March 2010, the Veteran has not stated nor is there evidence indicating that there has been a material change in the severity of his PTSD since he was last examined in March 2010. See 38 C.F.R. § 3.327(a) (2012). The duty to assist does not require that a claim be remanded solely because of the passage of time since an otherwise adequate VA examination was conducted. See VAOPGCPREC 11-95 (April 7, 1995). The Board concludes that the examination reports are adequate for purposes of rendering a decision in the instant appeal. See 38 CF.R. § 4.2 (2012); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Although the Veteran's representative requested that the claim be remanded so that the Veteran may be considered for special monthly compensation, the representative explicitly referred to the RO's August 2011 grant of a 100 percent evaluation for a heart disability. Neither the Veteran nor his representative have contended that the Veteran's PTSD has worsened since the March 2010 examination. The Board additionally observes that all appropriate due process concerns have been satisfied. See 38 C.F.R. § 3.103 (2012). The Veteran has declined the opportunity to present testimony before a Veterans Law Judge. Therefore, the duties to notify and assist have been met. PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1 (2012). Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2 (2012); resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3 (2012); where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7 (2012); and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10 (2012). See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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. The rating agency shall assign a rating 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. See 38 C.F.R. § 4.126 (2012). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. See Fenderson v. West, 12 Vet. App. 119 (1999). The Board will accordingly determine whether staged ratings are warranted. The Veteran contends that he is entitled to a higher initial disability rating for PTSD. Such disability has been rated under 38 C.F.R. § 4.130, Diagnostic Code 9411, as 30 percent disabling. Under Diagnostic Code 9411, which is governed by a General Rating Formula for Mental Disorders, a 30 percent rating is warranted for 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 and recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and/or difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating 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 symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 work-like setting); and an inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted where there is evidence of total occupational and social impairment due to 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; disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term "such as" 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 the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the DSM-IV (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994)). 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. 38 C.F.R. § 4.126 (2012). One factor for consideration is the Global Assessment of Functioning (GAF) score, which is a scale reflecting the "psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness." Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (citing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)). GAF scores ranging from 71 to 80 reflect that if symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in school work). GAF scores ranging from 60 to 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. A GAF score of 51 to 59 reflects 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). Scores ranging from 31 to 40 reflect some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work). A GAF score of 21 to 30 indicates that behavior is considerably influenced by delusions or hallucinations, or serious impairment in communication or judgment (e.g., sometimes incoherent, acting grossly inappropriately, suicidal preoccupation), or an inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends). A GAF score of 11 to 20 indicates that there is some danger of hurting oneself or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement), or an occasional failure to maintain minimal personal hygiene, or gross impairment in communication. While the Rating Schedule does indicate that the rating agency must be familiar with the DSM-IV, it does not assign disability percentages based solely on GAF scores. See 38 C.F.R. § 4.130 (2012). In this case, in July 2007, the Veteran presented for an initial private psychiatric evaluation with Dr. EWH, M.D. His symptoms at that time included nightmares; panic attacks four or five times a month lasting from 30 to 60 minutes; flashbacks two to three times a month; impaired sleep, averaging only three to four hours a night; a hyper startle response; hypervigilance and an inability to tolerate anyone behind him; "severely impaired" recent memory in that he could not remember what he read; impaired working memory by 25 percent; anger; occasional episodes of fear without a known cause, which was said to be indicative of a dysfunctional prefrontal cortex; auditory hallucinations once a week or less of hearing his name called or a car drive up, and; feeling depressed 50 percent of the time with no energy and little interest in things. Although Dr. EWH's letter to the Veteran's VSO dated in July 2007 states that intrusive thoughts were reported, the clinical record pertaining to the July 2007 initial psychiatric assessment show that the Veteran denied experiencing intrusive thoughts. Socially, the Veteran frequently socialized with both family and friends. Again, while Dr. EWH's July 2007 letter stated that the Veteran had been martially separated for five years, the clinical record indicated that the Veteran was living with his girlfriend of four years. Occupationally, the Veteran had been unemployed since 2000. The July 2007 clinical record listed the Veteran's post-military occupational history but did not state why the Veteran became unemployed in 2000. Dr. EWH diagnosed PTSD with a GAF score of 45. He stated that the Veteran was moderately compromised in his ability to sustain social relationships and he was unable to sustain work relationships. Thus, he opined that the Veteran was permanently and totally disabled, and unemployable. The Veteran was afforded a VA PTSD examination in February 2008. His symptoms at that time included impaired sleep; infrequent nightmares once every other week; intrusive memories; some decreased concentration and attention, especially when reading; occasional panic attacks; startle; hypervigilance; some irritability; isolation; avoidance; mild depression, and; mild to moderate anxiety. The Veteran denied any history of psychiatric treatment with the exception of the above psychiatric evaluation at the suggestion of his VSO. He denied any current alcohol or drug abuse and legal problems. Socially, the Veteran lived with his girlfriend with whom he got along with fairly well. He enjoyed walking his dogs, fishing with his girlfriend, going to church and out to eat, going to Virginia twice a month to visit, and working on cars and handyman projects. Otherwise, he did not have a lot of friends and tended to keep to himself. When out with a group of people, he became irritated. Occupationally, he was on disability due to medical problems (heart attack/diabetes). He was independent in his activities of daily living. Mental status examination in February 2008 revealed that the Veteran was neatly groomed and dressed with normal behavior and a pleasant, cooperative, and polite attitude. His speech was spontaneous and logical and he was a good communicator. There was no flight of ideas, loose associations, hallucinations, delusions, paranoia, or ideas of reference. His concentration and insight were fair, his fund of information and judgment were good, and his intelligence was average. The examiner diagnosed PTSD and assessed a GAF score of 55. Socially, the Veteran tended to keep to himself, he disliked being out in social settings, and he got a little irritated when going out in a group. Occupationally, the Veteran had some problems dealing with the public and co-workers and keeping attention for 8 hours a day. He could get along with supervisors, follow instructions, and handle some work stress. His problems included anxiety, depression, and poor sleep. In his notice of disagreement dated in May 2008, the Veteran stated that he was permanently and totally disabled due to his service-connected PTSD. He referenced Dr. EWH's July 2007 psychiatric evaluation and opinion. In May 2008, symptoms of PTSD included nightmares two to three times a week; flashbacks three to four times a month; hyperstartle response; hypervigilance; decreased energy and interest level, and; impaired memory in misplacing things, forgetting what he was told, and an inability to read. Hallucinations were denied. He was prescribed medication for sleep. In August 2008, the Veteran indicated that he felt "so good." The frequency of nightmares decreased to two times a month and flashbacks decreased to once a month. He slept for 8 to 9 hours per night on average and he no longer experienced panic attacks. He reported auditory hallucinations of hearing a car drive up two to five times per week and he continued to experience problems with his energy level, interest level, and memory. He was assessed with a GAF score of 50. Upon undergoing a VA heart examination in December 2008, it was noted that the Veteran had stopped working secondary to a cardiac condition. In February 2009, the only psychiatric symptoms endorsed by the Veteran included hypervigilance, auditory hallucinations once a week or less of hearing a car drive up, and problems with his energy, interest, and memory. A GAF score of 50 was assessed. The Veteran was afforded an additional PTSD VA examination in March 2010. His symptoms were somewhat better with private treatment and medication. His overall anxiety and depression levels had become less severe, his anger problems were significantly better, and he was sleeping somewhat better. He did not have much trouble socializing as he had in the past. Notwithstanding, the Veteran rated himself as moderately depressed due to medical problems and he slept for no more than 5 to 6 hours a night with difficulty falling asleep despite medication. He had mild to moderate insomnia and some decreased energy. He avoided exposure to and had a startle response to trauma-related triggers with emotional numbing. He denied any suicidal/homicidal ideations and panic attacks. Occupationally, he was not working "mainly due to physical reasons." Socially, he lived with his fiancé with whom he had been with for seven years and he had a good relationship with her. He was independent in his activities of daily living and he went out with his fiancé a few times a week to visit friends and relatives. He enjoyed fishing and occasionally going to church. Mental status examination in March 2010 showed that the Veteran was alert, oriented, and cooperative. There were no signs of a thought disorder, loosened associations, flight of ideas, hallucinations, delusions, obsessions, compulsions, or phobias. His insight and judgment appeared reasonably intact. His intellectual capacity appeared grossly intact and he denied any major problems with concentration or attention. The examiner diagnosed PTSD in partial remission with mild to moderate impairment in social, occupational, recreational, and familial functioning. The examiner assessed a GAF score of 60 and stated that the Veteran did not appear to have more than mild to occasionally moderate impairment in either social or occupational functioning. It was noted that his current level of functioning was dependent upon continuing psychotropic medication. Having carefully considered the Veteran's contentions in light of the evidence of record and the applicable law, the Board finds that the Veteran's symptoms of PTSD are appropriately evaluated as 30 percent disabling throughout the duration of the claim. At the outset, the Board notes that the Veteran has been unemployed since long before the date that his claim for service connection for PTSD was received. The Veteran's numerous contemporaneous statements documented during VA examinations and medical treatment overwhelmingly suggest that he has been unemployed since approximately 2000 due to cardiovascular and medical disability as opposed to a psychiatric disability. See February 2008 PTSD VA examination; December 2008 VA heart examination; April 2009 statement from Dr. PP, and; March 2010 VA PTSD examination. Notwithstanding, the Board acknowledges Dr. EWH's July 2007 opinion that the Veteran was totally disabled and unemployable due to PTSD. Significantly, however, he provided no supporting rationale for his opinion. Although he stated that the Veteran was unable to sustain work relationships, neither the July 2007 clinical record nor the July 2007 letter provided any supporting background information or rationale in support of that statement. The July 2007 clinical treatment note and letter merely stated that the Veteran was last employed in or around 2000 but did not state why he became unemployed. As noted above, the record overwhelmingly suggests that the Veteran has been unemployed in or around 2000 due to medical (physical) disability as opposed to psychiatric disability. Significantly, he is in receipt of a 100 percent evaluation for his service-connected heart disability demonstrating total disability due to that disorder. Moreover, during the February 2008 examination, it was noted that the Veteran had some problems dealing with the public and co-workers, however, he got along with supervisors and he could follow instructions. During the March 2010 examination, the examiner opined that the Veteran would have only mild to occasionally moderate impairment in occupational functioning depending on the severity of the stress level of the job and the need for interaction with others. In light of the foregoing, while the July 2007 treatment note and letter are certainly reflective of some occupational impairment due to symptoms of PTSD, the Board can find nothing in those documents to support or explain the conclusion that the Veteran is unable to sustain work relationships. Moreover, that conclusion is not consistent with the remainder of the evidence of record. As Dr. EWH's opinion was not supported by any rationale and it is contradictory to the Veteran's own report documented in the February 2008 examination report, it is accorded no probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (noting that a medical opinion that contains only data and conclusions is accorded no weight); also see Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (finding that a medical opinion based upon an inaccurate factual premise has no probative value). Also, the Veteran has not demonstrated the majority of the types and severity of symptoms contemplated for the assignment of the next-higher 50 percent evaluation at any time. Indeed, there is simply no evidence that he was found to have a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty understanding complex commands; impairment in short- and long-term memory; impaired judgment; impaired abstract thinking; and difficulty establishing and maintaining effective work and social relationships. See supra 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). In fact, he has demonstrated clear and relevant speech at all times. He reported panic attacks anywhere from four to five times a month one time in July 2007, twice a month in May 2008, and he has consistently denied experiencing panic attacks since. While the Veteran has complained of impaired short-term memory, his short- and long-term memory were found to be intact during mental status examinations throughout the duration of the claim. Moreover, his insight and judgment have also been intact at all times, and his thought processes and content have been void of any evidence of impaired abstract thinking. Additionally, the weight of the evidence is not reflective of difficulty in establishing and maintaining effective work and social relationships. The Veteran indicated that he had no problem establishing and maintaining effective work relationships with supervisors, rather, he had difficulty with co-workers and the public. As to his social relationships, he maintained a stable long-term relationship with his fiancé with whom he lived with and admittedly shared a good relationship with. Although it was noted in February 2008 that he did not like going out in groups because it made him irritable, he consistently reported, to include during the July 2007 private psychiatric assessment, that he frequently socialized with both friends and family. It was also noted on more than one occasion that he went to Virginia to visit family and friends approximately twice a month. During the March 2010 examination, the Veteran stated that he got out as much as he could to socialize. Accordingly, the weight of the evidence reflects some difficulty establishing and maintaining effective work relationships with co-workers but not supervisors, and there is very little evidence showing difficulty establishing and maintaining effective social relationships with friends and family which appears to have been only transitory and for only a brief period of time. Given the isolated and apparently minimal nature of any difficulty in establishing and maintaining effective work and social relationships, the Board concludes that the greater weight of evidence is against a finding that the Veteran's disability was manifested by difficulty in establishing and maintaining effective work and social relationships so as to warrant a higher 50 percent evaluation at any time. Although the Veteran frequently reported disturbances in motivation and mood, he was also documented to have felt "so good" in August 2008. Thereafter, he was consistently shown to have reported that his symptoms had improved and that there was only some disturbance in his motivation and mood. Thus, the Board concludes that the greater weight of evidence is against finding that the Veteran's PTSD has been manifested by the degree of disturbances of motivation and mood contemplated by the criteria for a 50 percent rating. Moreover, the Veteran's GAF scores have ranged from 45 at worst in July 2007 to 60 at best in March 2010. Scores from 45 to 60 reflect transient and expectable reactions to psychosocial stressors (e.g. difficulty concentrating after family argument) and no more than serious impairment in social, occupational, or school functioning (e.g. no friends, unable to keep a job). Although the Veteran GAF scores have widely varied throughout the applicable period, on a whole, they are congruent with the current 30 percent evaluation. Furthermore, for the reasons previously explained, the Board ultimately places greater probative weight on the specific symptomatology and clinical findings noted in the VA examinations, which demonstrate that the severity of Veteran's PTSD more closely approximate the criteria for a 30 percent disability rating currently assigned. Finally, the Veteran's symptoms described above have not been shown to be of the type and severity of symptoms contemplated by the criteria necessary for the assignment of higher 70 and/or 100 percent evaluations. See 38 C.F.R. § 4.130 (2012). In conclusion, the Board finds that the evidence more closely approximates the criteria for a 30 percent rating for the Veteran's PTSD for the entire period. See 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. §§ 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991); see also supra Fenderson v. West, 12 Vet. App. 119 (1999). Other Considerations The Board has also considered whether this case should be referred to the Director of the VA Compensation and Pension Service for extra-schedular consideration. The United States Court of Appeals for Veterans Claims has held that the threshold factor for extra-schedular consideration is a finding on part of the RO or the Board that the evidence presents such an exceptional disability picture that the available schedular evaluations for the service-connected disability at issue are inadequate. Therefore, initially, there must be a comparison between the level of severity and the symptomatology of the claimant's disability with the established criteria provided in the rating schedule for the disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the disability picture is contemplated by the rating schedule, the assigned evaluation is therefore adequate, and no referral for extra-schedular consideration is required. Thun v. Peake, 22 Vet. App. 111 (2008). In the case at hand, the Board finds that the rating criteria contemplate the Veteran's service-connected PTSD. The evidence reflects that such disability is primarily productive of symptoms such as panic attacks, sleep impairment, and difficulty dealing with co-workers and the public, and this type of symptomatology is contemplated in the rating criteria. The rating criteria are therefore adequate to evaluate the Veteran's disability and referral for consideration of extraschedular rating is not warranted. ORDER Entitlement to an initial rating in excess of 30 percent for service-connected PTSD is denied. ______________________________________________ LANA K. JENG Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs