Citation Nr: 1306340 Decision Date: 02/25/13 Archive Date: 03/01/13 DOCKET NO. 10-22 252 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to an initial evaluation in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to October 31, 2012. 2. Entitlement to an initial evaluation in excess of 70 percent for PTSD beginning on October 31, 2012. ATTORNEY FOR THE BOARD K. Osegueda, Associate Counsel INTRODUCTION The Veteran served on active duty from March 1969 to October 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. In that decision, the RO granted service connection for PTSD and assigned a 30 percent disability evaluation effective from March 5, 2009. During the pendency of the appeal, in a November 2012 rating decision, the RO increased the evaluation for the Veteran's service-connected PTSD to 70 percent effective from October 31, 2012. Applicable law mandates that when a veteran seeks an increased evaluation, it will generally be presumed that the maximum benefit allowed by law and regulation is sought, and it follows that such a claim remains in controversy where less than the maximum benefit available is awarded. See AB v. Brown, 6 Vet. App. 35 (1993). Therefore, the issue remains on appeal. Additionally, the Board notes that in the November 2012 rating decision, the RO granted a total disability evaluation based on individual unemployability due to service connected disabilities (TDIU) effective from October 31, 2012. The claims file does not reflect that the Veteran has appealed the effective date assigned for a TDIU. Accordingly, the issue is not currently before the Board. A review of the Virtual VA paperless claims processing system reveals additional VA treatment records pertinent to the present appeal. FINDINGS OF FACT 1. For the period prior to October 31, 2012, the Veteran's PTSD 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). 2. Prior to October 31, 2012, the Veteran had not experienced occupational and social impairment with reduced reliability and productivity. 3. As of October 31, 2012, the Veteran's PTSD has been productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood. 4. On or after October 31, 2012, the Veteran's PTSD has not resulted in total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 30 percent for PTSD have not been met or approximated for the period prior to October 31, 2012. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.130, Diagnostic Code 9411 (2012). 2. The criteria for an initial evaluation in excess of 70 percent for PTSD have not been met or approximated for the period beginning on October 31, 2012. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.130, Diagnostic Code 9411 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a substantially complete application for benefits, VA must notify the claimant what information or evidence is needed in order to substantiate the claim and it must assist the claimant by making reasonable efforts to get the evidence needed. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The notice required must be provided to the claimant before the initial unfavorable decision on a claim for VA benefits, and it must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and, (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103(a); 38 C.F.R. § 3.159(b)(1); Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (Court) held that, upon receipt of an application for a service connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. With respect to the claim for an increased evaluation, the Veteran in this case is challenging the initial evaluation assigned following the grant of service connection for PTSD. In Dingess, the Court held that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id. at 490-91. See also VAOPGCPREC 8- 2003 (December 22, 2003). Thus, VA's duty to notify has been satisfied with respect to the issue of entitlement to a higher initial evaluation for PTSD. In addition, the duty to assist the Veteran has also been satisfied in this case. All identified and available service and VA treatment records are in the claims file and were reviewed by both the RO and the Board in connection with the claim. The Veteran has not identified any other outstanding records that are pertinent to the issue currently on appeal. The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the Veteran was afforded VA PTSD examinations in May 2009 and October 2012. There has been no allegation that those examinations were inadequate. VA has further assisted the Veteran and his representative throughout the course of this appeal by providing them with a Statement of the Case (SOC) and a Supplemental Statement of the Case (SSOC), which informed them of the laws and regulations relevant to the Veteran's claim. The Board concludes that the Veteran was provided the opportunity to meaningfully participate in the adjudication of his claim, and he did, in fact, participate. Washington v. Nicolson, 21 Vet. App. 191 (2007). For these reasons, the Board concludes that VA has fulfilled the duty to assist the Veteran in this case. Hence, there is no error or issue that precludes the Board from addressing the merits of this appeal. The Veteran has not made the RO or the Board aware of any additional evidence that needs to be obtained in order to fairly decide the particular claim on appeal. He has been given ample opportunity to present evidence and argument in support of his claim. All relevant evidence necessary for an equitable disposition of the Veteran's appeal of this issue has been obtained, and the case is ready for appellate review. General due process considerations have been complied with by VA. See 38 C.F.R. § 3.103 (2012). Laws and Regulations Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.10 (2012). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). 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, as here, the question for consideration is a higher initial rating since the grant of service connection, evaluation of the medical evidence since the grant of service connection to consider the appropriateness of "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). Pursuant to 38 C.F.R. § 4.130 , Diagnostic Code 9411, a 30 percent rating for PTSD will be assigned where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent rating will be assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; 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, and mood, due to such symptoms as: suicidal ideations; 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); and the inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; gross 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; memory loss for names of close relatives, own occupation or own name. Id. However, 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, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). When evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126 (2012). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. That portion of the rating schedule that addresses service-connected psychiatric disabilities is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (also known as "the DSM-IV"). 38 C.F.R. § 4.130 (2012). The DSM-IV contains a Global Assessment of Functioning (GAF) scale, with scores ranging between zero and 100 percent, representing the psychological, social, and occupational functioning of an individual on a hypothetical continuum of mental health illness. Higher scores correspond to better functioning of the individual. GAF scores ranging between 61 and 70 are assigned when there are 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 when the individual is functioning pretty well and has some meaningful interpersonal relationships. American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th. ed., 1994). GAF scores ranging between 51 and 60 are assigned when there are moderate symptoms (like flat affect and circumstantial speech, and occasional panic attacks), or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Id. A GAF score ranging 41 to 50 is contemplated for serious symptoms (e.g. suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning. A GAF score between 31 and 40 reflects 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. Period prior to October 31, 2012 In a March 2009 VA treatment note, the Veteran indicated that his psychiatric symptoms had never presented a crisis, but stated they were longstanding. He complained that he had difficulty sleeping, and he reported that he was a "functional alcoholic" and drank to help him sleep. He related that he worked as a truck driver for his entire life. He stopped working in January 2008 because he lost his license, but it was reinstated in February 2009. He also reported that he was divorced and living with his girlfriend and stated that he maintained contact with his grown children. He indicated that he had a few friends and maintained relationships with his brothers. He stated that he spent his free time working on his car and completing chores for himself and others. The Veteran reported having symptoms of depression, but he denied having any suicidal and homicidal ideations. He also denied having auditory hallucinations, but he acknowledged having visual hallucinations after drinking heavily. The examiner diagnosed "mild" PTSD and assigned a GAF score of 65. In an April 2009 VA treatment note, the Veteran stated, "I don't ever want to stop working, if I can, as long as I can. I think you have to keep yourself busy to be happy, be around people, sometimes even when it's hard or whatever." He reported that he worked at a steel mill for a number of years and noted that a lot of his coworkers did not speak to him because he was "pretty wild" and he scared them. He indicated that he had been in numerous fights in the past, but he admitted that most of them were "bar fights" in the context of alcohol use and occasional cocaine abuse. He also noted that he had a startle response to noises, such as thunder, and related that his sleep had "always been bad." The Veteran indicated that he had trouble falling asleep and staying asleep. He stated that he tended to sleep more lightly lately and that he punched, squirmed, snored, dreamed, and was restless during sleep. He stated that he was divorced, but that he had a "civil" relationship with his ex-wife. He also maintained relationships with his adult children and saw them frequently, and he reported living with his girlfriend and her son. He indicated that he had a hard time being around crowds and related that he recently left a concert early because he felt a "need to escape, a panicky feeling" while he was in the crowd; however, he denied having any panic attacks. The examiner noted that the Veteran maintained eye contact within normal limits and spoke loudly, openly, and directly. He demonstrated a full-range affect and stated that his mood was "well, not as good as it had been in the past but I'm not gonna (sic) jump off the bridge or nothin (sic)." The Veteran's thinking was linear and coherent, and he denied having any suicidal or homicidal ideation. His insight and judgment seemed good, and his cognition appeared grossly intact. The examiner opined that the Veteran had what appeared to be longstanding, mild PTSD. He also noted that the Veteran's mild symptoms appeared to have affected his life. In a subsequent April 2009 VA treatment record, the examiner noted that the Veteran had recently had his license reinstated and that he was looking for a job. The Veteran reported that his job search was unsuccessful due to the "down economy" and his record with a past DUI. He was living on unemployment compensation. The examiner noted that he previously indicated that the Veteran's PTSD was mild, but on the current examination, he opined that the Veteran had chronic and severe PTSD. During a May 2009 VA PTSD examination, the Veteran reported that he was a "terrible sleeper," but usually had six to eight hours of uninterrupted sleep. He related that he had difficulty falling asleep so he drank alcohol and took medication. He stated that his girlfriend complained that he "fights" in his sleep and she often refused to sleep in the same bed as him. The Veteran indicated that he made a conscious effort to avoid conversation, activities, people, and places that triggered recollections of service. He reported that he felt "somewhat detached" from others. He stated that he used to enjoy concerts, but in the previous two years, he left concerts early because he did not like the crowds. He indicated that he felt "socially uncomfortable." He related that he felt that he spent more time socially isolated. With respect to personal relationships, the Veteran stated that he felt he did not "need them anymore." He indicated that he had very few friends and that he only confided in one person. He stated that he saw people a lot, but he did not consider them friends. However, he also reported that he attended Narcotics Anonymous meetings with a friend one night per week and that he typically stopped at the bar where his daughter worked on the way home from the meeting. He indicated that he looked for work doing projects around his and his children's homes during the day, he enjoyed working on an old car, and he spent time with his girlfriend's son. The Veteran reported that he had difficulty with irritability and anger outbursts for much of his life, but noted that he was much better at managing his behavior and rarely acted out in anger. He endorsed feelings of hypervigilance and an exaggerated startle response. He stated that he always felt "on guard" and watchful of other people and noted that he had feelings of feat or anger when he heard helicopters flying overhead or when he heard thunder. He reported that his mood was "generally good," but he had occasional "bad days." He noted feelings of depression for hours at a time on average of three days per week. The examiner commented there was no significant impairment in the Veteran's thought process or communication during the examination. He had a neat appearance, and he was cooperative and engaging. His eye contact was good, and he was alert and oriented to person, place, and time. The Veteran's thought processes were logical and goal-directed, and there was no evidence of tangentiality, circumstantiality, looseness of associations, or signs of a formal thought disorder. His speech was normal in rate, rhythm, and prosody, and his affect was full and his mood was good. The Veteran denied the presence of suicidal ideation, plan, or intent, and there was no evidence of homicidal ideation. There was also no evidence of perpetual disturbance in the form of hallucinations or illusions. His concentration and attention appeared generally intact, although he did report an increase in difficulty focusing and maintaining his train of thought. He demonstrated basic reasoning skills, and his insight and judgment appeared intact. The examiner noted that the Veteran had developed a variety of coping skills that helped the Veteran live a "functional life overall." The Veteran reported that he had been unemployed since January 2008. He noted that he had been working as a local truck driver until he lost his license after receiving a DUI. In the past, he worked as a steel worker and a bricklayer, but he lost his job in the steel mill when it closed. He stated that he was always a consistent worker until he lost his job in January 2008. He reported that he had always struggled to deal with people in positions of authority and that he did his best work when he worked autonomously and/or interacted with similar personalities to his own. He indicated that he was looking for additional work, but he felt discouraged by the state of the economy. The Veteran admitted that he did not feel that his PTSD symptoms had ever significantly interfered with his ability to obtain or maintain employment in the past, and he did not feel that his symptoms were interfering with his current job search. The examiner opined that PTSD did not appear to be significantly interfering with the Veteran's employment at the time of the examination. The examiner opined that the Veteran's psychiatric disability did not appear to "significantly interfere with his normal daily activities or employment." She noted that there appeared to be some "mild impairment" in his day-to-day activities; however, she opined that the Veteran was "going about his daily activities without undue distress caused by his PTSD symptomatology." She also indicated that the Veteran appeared to be functioning socially "quite well," as he had some meaningful relationships; however he did exhibit decreased social motivation and involvement for years. In a June 2009 VA treatment note, the Veteran reported that, following his May 2009 VA examination, he "felt awful" and was "a wreck." He stated that he called into work the next day and that he sat on the couch all day because he felt "shook up." He indicated that he was going to visit with his brothers and that he was going to "start seriously thinking about getting some organization" to his life. He reported that he was continuing to look for employment from Monday through Friday. The Veteran stated that he worried about whether he would be able to find a job, but he also admitted, "I haven't really put forth an earnest effort yet." He noted that he continued to have intermittent difficulty sleeping. He stated that he no longer drank alcohol and reported that he continued to live with his girlfriend and her son. He stated, "I'd be gone, actually outta (sic) there, if it wasn't for that boy." The Veteran stated that he was the only father the child knew and he lived with him since the boy was a toddler. He acknowledged continued irritability which he "rein[ed] in with success," but he worried that he could "explode." A mental status examination revealed findings consistent with previous findings. In a September 2009 VA treatment note, the Veteran stated that he was "doing about the same." He reported that he was unable to find employment because "they won't even touch me for insurance purposes" due to a three year-old DUI. He noted that he always found work throughout his life, but he was too old now and no one wanted to hire him. He related that he continued to look for work on a daily basis and that he was frustrated with the process and felt like a failure. The Veteran stated that he continued to date his girlfriend, and he indicated that it was possible that she could find him a job, but he felt they would fight and "it would be bad." He stated, "She likes me not working, I work around the house." He also indicated that he went to see his brother in July, but he had since passed from a massive coronary. He continued to have poor sleep with nightmares. The Veteran also acknowledged irritability, a tendency to isolate himself, difficulty concentrating, anxiety, an exaggerated startle response, and a tendency to image a foreshortened future. A mental status examination revealed findings consistent with previous findings. The examiner opined that the Veteran had longstanding, mild PTSD. In an October 2009 VA treatment note addendum, the examiner noted that he prescribed a trial of a low-dose prescription for the Veteran's anxiety. He also indicated that the Veteran had "ensure[d]... repeatedly by phone that he ha[d] no thoughts whatsoever of self-harm or harming others, vehemently." In a December 2009 VA treatment note, the Veteran reported that things were "terrible." He noted that he was still not working and that he felt "useless." He stated, "I'm still getting unemployment, I'm 60 years old, what am I looking forward to here?" He also stated, "You've got this axe hanging over your head, gonna (sic) run out of money." He continued, "I'm getting fat, I'm getting lazy, I'm getting stressed, there's no work out there, there's nothing going on, nothing." He indicated that he remained sober "pretty much." The Veteran noted that he had some beers on holidays and events and that he rarely went to Alcoholics Anonymous meetings anymore, but he reported that he occasionally met up with an Alcoholics Anonymous friend and talked to him if he felt he was "weakening." He related that he watched the History Channel and the Military Channel more than he should and answered his stepson's questions about the war. The Veteran reported that his relationship with his girlfriend was "okay" and that he continued to love her son. He acknowledged the same symptoms as he did in September 2009, and a mental status examination revealed findings consistent with previous findings. The examiner noted that the Veteran reported he did not want to take any more medication. The examiner stated, "I think on some level [the Veteran] does think he needs medication but is resisting it as much as he can. I can't convince him today to take med[ications] though." In a May 2010 VA treatment note, the Veteran reported that he continued to apply for truck driver and general labor jobs. He stated that, if he could, he would just collect unemployment until he turned he turned 62 and then he would retire. He complained that he was "sleeping horribly." He stated that he fell asleep at 11:30 p.m., but woke at 1:30 a.m. and was unable to wind down to sleep again. He also complained of continued nightmares. The Veteran noted increased irritability, and he stated, "I feel like I could just kill somebody in that stop-and-go traffic." He also acknowledged symptoms of isolation, difficulty concentrating, anxiety, a foreshortened future, an exaggerated startle response, and hypervigilance. The examiner noted that the Veteran made eye contact within normal limits, and his speech was loud, open, and direct. His affect was generally full-range, but he described his mood as "pretty bad lately." He indicated that he felt "useless" and frequently thought about the war. The Veteran's thinking was linear and coherent, and he denied any auditory or visual hallucinations. He also denied any suicidal or homicidal ideations, his insight and judgment were good, and his cognition appeared intact. The examiner noted that the Veteran denied sleep aid medication and stated, "If I was working all day[,] I'd be exhausted and probably sleep at night." In a May 2011 VA treatment note, the Veteran reported having symptoms of poor sleep, hypervigilance, and mistrust. He stated that he continued to drink alcohol and drank up to nine cans of beer per night. He indicated skepticism about psychiatric treatment, and he noted that his brother committed suicide after taking prescription Chantix, which the Veteran thought was the reason for his brother's suicide. He reported that his two brothers had died and that he was the only surviving member of his family. He also indicated that he was considering separating from his long-term girlfriend because she wanted to move and he was not interested in moving. The examiner noted that the Veteran was adequately groomed and casually dressed, and he was polite and cooperative. His speech was a normal rate and tone. His affect was guarded and anxious, and his thought processes were logical and goal-oriented. The Veteran denied having suicidal and homicidal ideations, as well as auditory and visual hallucinations. He was alert and oriented to person, place, and time. His short and long term memory was grossly intact, his insight was fair, and his judgment was good. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an initial evaluation in excess of 30 percent for the period prior to October 31, 2012. A 30 percent rating is warranted where the Veteran demonstrates 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). Under Mauerhan, supra, the Veteran's PTSD symptoms are of a level consistent with those symptoms generally outlined in the Diagnostic Criteria list - depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss. 38 C.F.R. § 4.130, Diagnostic Code 9411. To warrant a 50 percent rating, the evidence must demonstrate 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 and maintaining effective work and social relationships. Id. Upon review of the evidence, the Board finds that the Veteran's PTSD symptoms more closely approximate the rating criteria for a 30 percent evaluation for the period prior to October 31, 2012. As to work, the Veteran reported that he had stopped working as a truck driver because he lost his license due to a DUI. Although it was reinstated in February 2009, the Veteran reported that he had difficulty finding employment due to his DUI and the state of the economy. Notably, during the May 2009 VA examination, the Veteran reported that he did not feel that his PTSD symptoms had ever significantly interfered with his ability to obtain or maintain employment in the past, and he did not feel that his symptoms interfered in his job search at the time of the examination. The May 2009 VA examiner also opined that the Veteran's PTSD did not appear to be significantly interfering with his employment at that time. The evidence suggests that the Veteran did not have reduced reliability or productivity in his occupation due to his PTSD symptoms. As to social impairment, the Veteran indicated that he socialized very little, was isolative, and was "socially uncomfortable" during the May 2009 VA examination. He also stated that he felt that he did not need personal relationships anymore. However, throughout the record, he consistently reported that he maintained relationships with his girlfriend, his girlfriend's son, his adult children, his brothers, a few friends, and his brothers. In an April 2009 VA treatment note, the Veteran even indicated that he maintained a "civil" relationship with his ex-wife. Thus, while the Veteran may have had some social impairment, the evidence shows that he was able to establish and maintain social relationships. Overall, the Veteran has not demonstrated symptoms consistent with the general level of impairment warranting a 50 percent evaluation, or akin to the symptoms listing as found in the Diagnostic Code. Mauerhan, supra. The evidence suggests that the Veteran had a full affect, normal speech, panic attacks no more than once a week, fair insight, good judgment, and normal thought processes. The Board does acknowledge that the Veteran was noted to have chronic and severe PTSD on one occasion in April 2009; however, examinations both prior and after that treatment record document him as having only mild PTSD. In fact, another treatment note dated in April 2009 indicated that his PTSD was mild, and the May 2009 VA examiner stated that there was only mild impairment. The examiner also indicated that there was no significant impairment with respect to the Veteran's normal daily activities and employment and noted that he had a "functional life overall." In addition, the Veteran's only assigned GAF score was 65, indicating some mild symptoms. See March 2009 VA treatment note. When all of the evidence and findings contained therein are considered in totality, the Board finds that that the Veteran has been shown to have occupational and social impairment with reduced reliability and productivity. The Board concludes that the preponderance of the evidence is against a finding that a 50 percent evaluation is appropriate for the period prior to October 31, 2012, and the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. at 54-56. Period beginning October 31, 2012 During an October 2012 VA examination, the Veteran reported that he had just ended his long-term relationship with his girlfriend. He stated that he found his partner too demanding and unable to accept his PTSD-related limits. He indicated that he had no friends because his only friend passed away within the last year. He reported that he had a motorcycle that he rode once in awhile. He stated, "I don't even know what fun is. I've been trying to watch the World Series because normal people do that. I don't know what fun is. I'm just hoping to get through the next day." The examiner noted that, since the May 2009 VA examination, the Veteran had cut back on his alcohol intake as, he reported that he consumed two to four beers a couple of nights per week. The Veteran endorsed the following symptoms: depressed mood; anxiety; suspiciousness; panic attacks occurring weekly or less often; chronic sleep impairment; mild memory loss; impairment of short and long term memory; flattened affect; impaired judgment; disturbances of motivation and mood; inability to establish and maintain effective relationships; obsessional rituals which interfere with routine activities; neglect of personal appearance and hygiene; and suicidal ideation. He stated, "Sometimes it seems to me it would be simpler not to be here." He admitted to having a suicide plan, and he indicated that he would shoot himself or overdose on heroin so he did not feel pain. The examiner noted that the Veteran was casually dressed and that he was oriented to person, place, and time. His speech was slow and low in volume. His mood was anxious with underlying irritability and sadness, and his affect was flat. His thought processes were goal-directed and coherent, and his thought content provided no evidence of delusions or hallucinations. He described some symptoms of reexperiencing, avoidance, and increased arousal. The Veteran also had obsessive-compulsive features and panic level reactivity that was subsumed by PTSD. He acknowledged and reported mostly passive suicidal thoughts, but he noted that he had episodic active suicidal thoughts with a plan. He denied having an intent to act on his suicidal thoughts. He also denied homicidal ideation. With respect to employment, the Veteran reported that he had so many jobs after service that it was hard for him to provide the examiner with a number. He said that he was recently fired over a "misunderstanding." He said that he became violent and physical during a strike in 2010 or 2011. He reported that he was yelling, acted in a threatening manner, and used a sling shot to shoot out the windows of a truck. He stated, "It was like war again. They were aggressing against my rights and my principles, and I was defending myself. I felt like I was back in combat in Vietnam." He indicated that he was found guilty of low level disorderly conduct. He reported that, after that incident, he found it difficult to get a job due to his age and "other factors." He reported that, unless he could find a job that allowed him to work on his own without contact with other people, he would not be able to maintain it due to his anger and other PTSD symptoms. He also noted that he was a poor job candidate due to a record of his PTSD-impacted work history published on the internet. The examiner opined that the Veteran used work as a major coping strategy to distract him from his symptoms in the past. She also opined that the Veteran's PTSD had significantly limited his work-life. The examiner opined that the Veteran's PTSD caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. A GAF score of 40 was assigned. The examiner noted that the assigned GAF score summarized the Veteran's report of mostly severe symptoms of reexperiencing, avoidance, and increased arousal in number, category distribution, and intensity consistent with the DSM-IV diagnosis of PTSD. The foregoing evidence indicates that the Veteran warrants a 70 percent rating, but no higher, for his service-connected PTSD for the period beginning on October 31, 2012. A 70 percent rating is warranted where the Veteran demonstrates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood. Under Mauerhan, supra, the Veteran's PTSD symptoms are of a level consistent with those symptoms generally outlined in the Diagnostic Criteria list-suicidal ideations; 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); and the inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; gross 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; memory loss for names of close relatives, own occupation or own name. Id. The Veteran's PTSD symptoms more closely approximate the criteria for a 70 percent evaluation for the period beginning on October 31, 2012. As to occupational impairment, the Veteran previously reported that he remained unemployed since he lost his license due to a DUI in January 2008. However, during the October 2012 VA examination, he stated that he was recently fired from a job after he became violent and physical during a strike in 2010 or 2011. He reported that he was yelling, acted in a threatening manner, and used a sling shot to shoot out the windows of a truck. He reported that, after that incident, he found it difficult to get a job due to his age and "other factors." He reported that, unless he could find a job that allowed him to work on his own without contact with other people, he would not be able to maintain it due to his anger and other PTSD symptoms. The examiner did opine that the Veteran's PTSD had significantly limited his work life, but she did not state that there was total occupational impairment. Indeed, the Veteran himself that his age and other factors have contributed to his unemployment. The examiner further noted that the Veteran had another DUI in 2011 and lost his license, which is the reason he could not work. Thus, while the Veteran may have occupational impairment, it does not appear that his PTSD alone has resulted in his unemployment. As to social impairment, the Veteran indicated that he had no friends and that he had recently ended a long-term relationship with his girlfriend. He found that his girlfriend was too demanding and unable to accept his PTSD-related limits. He also noted that one friend had recently died. The record clearly demonstrates occupational and social impairment. Additionally, the Veteran endorsed suicidal ideations and impaired impulse control during an employment strike. 38 C.F.R. § 4.130, Diagnostic Code 9411. However, at no time during the appeal period has the Veteran shown symptoms consistent with the general level of impairment warranting a 100 percent evaluation, or akin to the symptoms listing as found in the Diagnostic Code. Mauerhan, supra. Rather, the Veteran demonstrated appropriate affect, his speech content was not abnormal, he denied persistent delusions or hallucinations, and he was oriented to person, place, and time. Although he endorsed suicidal ideations, he denied an intent to act on the thoughts and acknowledged mainly passive thoughts of suicide. Id. In addition, the October 2012 VA examiner specifically chose not to endorse the Veteran as having total social and occupational impairment. Instead, she indicated that he had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood, which is consistent with a 70 percent rating. The Board does observe that the Veteran has been evaluated as having a Global Assessment of Functioning (GAF) score of 40 during this time period. A GAF score between 31 and 40 reflects 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. See 38 C.F.R. §§ 4.125, 4.130 (incorporating the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, of the American Psychiatric Association in the rating schedule). While the Board has considered the degree of functioning as evidenced by this reported scale score, it is but one factor for consideration in assigning a rating in this case. As outlined above, the Board finds that when all of the evidence and findings contained therein are considered, including the degree of functioning as evidenced by these reported scales, the Board concludes that the Veteran has not been shown to have total occupational and social impairment. Accordingly, the Board finds that the schedular criteria for the next higher 100 percent disability evaluation have not been met. Therefore, the Board finds that the preponderance of evidence is against the Veteran's claim for an initial evaluation in excess of 70 percent for PTSD on or after October 31, 2012. The preponderance of the evidence is against a finding that a 100 percent evaluation is appropriate; therefore, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. at 54-56. Conclusion In reaching this decision, the potential application of various provisions of Title 38 Code of Federal Regulations have been considered, whether or not they were raised by the Veteran. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In particular, the Board has considered the provisions of 38 C.F.R. § 3.321(b)(1). However, in this case, the Board finds that the record does not show that the Veteran's PTSD disability is so exceptional or unusual as to warrant the assignment of a higher rating on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Thun v. Peake, 22 Vet. App. 111 (2008). In this regard, there must be a comparison between the level of severity and symptomatology of the claimant's service- connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule and the assigned schedular evaluation is therefore adequate, and no extraschedular referral is required. Id., see also VAOGCPREC 6-96 (Aug. 16, 1996). Otherwise, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, VA must determine whether the claimant's exceptional disability picture exhibits other related factors, such as those provided by the extraschedular regulation (38 C.F.R. § 3.321(b)(1) ) as "governing norms" (which include marked interference with employment and frequent periods of hospitalization). The evidence in this case does not show such an exceptional disability picture that the available schedular evaluation for the service-connected disability is inadequate. A comparison between the level of severity and symptomatology of the Veteran's assigned rating with the established criteria found in the rating schedule shows that the rating criteria reasonably describe the Veteran's disability level and symptomatology. The manifestations of the Veteran's PTSD, including occupational impairment, social impairment, sleep disturbance, depressed mood, and suicidal ideation, are contemplated by the schedular criteria set forth in the General Rating Formula for Mental Disorders. The evidence does not suggest that there is an exceptional disability picture with symptoms not represented in the Rating Schedule. There is no indication that the average industrial impairment from the disability would be in excess of that contemplated by the assigned ratings. Based on the foregoing, the Board finds that the requirements for an extraschedular evaluation for the Veteran's service-connected PTSD under the provisions of 38 C.F.R. § 3.321(b)(1) have not been met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995); Thun v. Peake, 22 Vet. App. 111 (2008). ORDER An initial evaluation in excess of 30 percent for PTSD for the period prior to October 31, 2012, is denied. An initial evaluation in excess of 70 percent for PTSD on or after October 31, 2012, is denied. ____________________________________________ JESSICA J. WILLS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs