Citation Nr: 1318790 Decision Date: 06/10/13 Archive Date: 06/21/13 DOCKET NO. 09-08 509 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an initial rating higher than 30 percent for service-connected posttraumatic stress disorder (PTSD), prior to February 27, 2008, on an extraschedular basis. 2. Entitlement to a total disability rating based on individual unemployability (TDIU), prior to February 27, 2008, on an extraschedular basis. REPRESENTATION Appellant represented by: Florida Department of Veterans Affairs ATTORNEY FOR THE BOARD A. M. Clark, Counsel INTRODUCTION The Veteran had active duty from May 1968 to May 1970. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2008 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. This case was initially before the Board in April 2010 when the claims were remanded for further development, to include obtaining outstanding treatment records and a VA examination. The case was most recently before the Board in March 2011 when a claim for entitlement to a rating in excess of 30 percent for PTSD, prior to February 26, 2008, on a schedular basis was denied. A 70 percent disability rating was awarded for PTSD and a claim for entitlement to TDIU on a schedular basis were granted. Both awards were made effective from May 1, 2008. A 100 percent schedular rating for PTSD had been in effect from February 27, 2008 to April 30, 2008. The Veteran's claims for an initial rating higher than 30 percent for PTSD, prior to February 26, 2008, on an extraschedular basis and for TDIU, on an extraschedular basis, prior to February 26, 2008, were remanded for referral to the Director of the VA Compensation and Pension Service or Under Secretary for Benefits for extraschedular consideration. The AMC/RO engaged in that development. A supplemental statement of the case was issued in May 2012; and, the appeal is once again before the Board. The Board parenthetically notes that although the prior March 2011 Board decision and remand listed the claims on appeal as a claim for "higher than 30 percent for service-connected PTSD, prior to February 26, 2008" and "entitlement to TDIU . . . prior to February 26, 2008" the correct date should have been listed as "February 27, 2008" with respect to both issues. This is because the Veteran was not awarded a 100 percent disability rating for PTSD until February 27, 2008. FINDINGS OF FACT 1. Prior to February 27, 2008, the Veteran's service-connected PTSD did not result in an exceptional or unusual disability picture so as to render impractical the application of the regular schedular standards. 2. Prior to February 27, 2008, the Veteran was service-connected for two disabilities: PTSD, for which he had a 30 percent disability rating, and tinnitus, for which he had a 10 percent disability rating; and, these awards, in combination, represented a 40 percent disability rating. 3. The Veteran did not meet the schedular requirements of 38 C.F.R. § 4.16(a) for the rating of his disabilities, prior to February 27, 2008. 4. Prior to February 27, 2008, the evidence fails to establish that the Veteran's service-connected disabilities precluded him from securing and following substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for an initial rating higher than 30 percent for service-connected PTSD, prior to February 27, 2008, on an extraschedular basis, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 3.321 (2012). 2. The criteria for entitlement to a TDIU rating, prior to February 27, 2008, on an extraschedular basis, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.321, 3.340, 3.341, 4.16, 4.25 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Assist and Notify VA has a duty to notify and a duty to assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326(a). Proper notice from VA must inform the claimant and his representative, if any, prior to the initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ) of any information and any medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002). These notice requirements apply to all five elements of a service-connection claim (Veteran status, existence of a disability, a connection between the Veteran's service and the disability, degree of disability, and effective date of the disability). Dingess v. Nicholson, 19 Vet. App. 473 (2006). Information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded must be included. Id. Neither the Veteran nor his representative has alleged prejudice with respect to notice, as is required. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009); Goodwin v. Peake, 22 Vet. App. 128 (2008); Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). None is found by the Board. Indeed, VA's duty to notify has been more than satisfied. The Veteran was notified via letter dated in February 2008 of the criteria for establishing TDIU, the evidence required in this regard, and his and VA's respective duties for obtaining evidence. He also was notified of how VA determines disability ratings and effective dates if service connection is awarded. This letter accordingly addressed all notice elements and predated the initial adjudication by the AOJ/RO in June 2008. Nothing more was required. The Veteran's increased rating claim arises from his disagreement with the initial evaluation following the grant of service connection. Courts have held that once service connection is granted the claim is substantiated, and additional notice is not required and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). No further notice is needed under VCAA. VA also has a duty to assist a veteran in the development of the claims. This duty includes assisting him or her in the procurement of service treatment records and other pertinent records, and providing an examination when necessary. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2012). After a careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained service treatment records and VA treatment records. An initial request was made to obtain records from the Social Security Administration (SSA), which yielded negative results. The Veteran has since clarified that he is not receiving SSA disability benefits. See Veteran's statement received in October 2010. No outstanding evidence has been identified that has not otherwise been included with the record. The Board recognizes that a VA examination and/or opinion addressing the issues on appeal. Such is not necessary. Any opinion pertaining to the level of severity of the Veteran's PTSD, to include his employability, prior to February 27, 2008 would be based on a review of the record. While sparse, that record already gives a very accurate picture of the nature and severity of the Veteran's PTSD and its effect on his employment. Put another way, as discussed below, there is already sufficient medical evidence on file for VA to make a decision on the claim. McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board concludes that all the available records and medical evidence have been obtained in order to make adequate determinations as to these claims. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). II. Extraschedular rating for PTSD, prior to February 27, 2008 The Veteran seeks an evaluation in excess of 30 percent for PTSD, prior to February 27, 2008, on an extraschedular basis. As noted above, in a decision of March 2011, the Board denied entitlement to a schedular evaluation in excess of 30 percent for PTSD, prior to February 27, 2008. Pursuant to § 3.321(b)(1), the Director of C&P Service, is authorized to approve an extraschedular evaluation if the case 'presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards' 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); aff'd Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). First, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability and the established criteria found in the rating schedule for that disability to determine whether the disability picture is adequately contemplated by the rating schedule. Id. In the second step of the inquiry, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation 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 rating schedule is inadequate to evaluate the claimant's disability picture and that picture has related factors such as marked interference with employment or frequent periods of hospitalization, then the third step is to refer the case to the Under Secretary for Benefits or the Director of C&P Service for a determination whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. Id. In other words, the Board may not address the issue in the first instance. In July 2011, the Director of C&P Service considered the issue of entitlement to an extraschedular rating for the Veteran's PTSD in accordance with 38 C.F.R. § 3.321(b). The Director determined that the rating schedule adequately addresses the Veteran's level of disability and that the evidence in this case did not present such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. The Director of C&P noted that the evidentiary record failed to demonstrate an exceptional or unusual disability picture for PTSD prior to February 2008 that renders application of the regular rating criteria as impractical. He noted that the Veteran's service-connected PTSD did not cause "marked" interference with employment or hospitalizations, and the clinical evidence was wholly consistent with the requisites under 38 C.F.R. § 4.130, DC 9411, for the assignment of a 30 percent evaluation. The Director of C&P stated that the symptomatology demonstrated in the evidentiary record, such as nightmares, anger, and depression were appropriately rated under the applicable diagnostic code contained in the rating criteria. Because the appropriate first line authority has adjudicated entitlement to an extraschedular rating, the Board may now consider the issue. The threshold question is whether the rating criteria adequately contemplate the Veteran's disability. Prior to February 27, 2008, the Veteran was rated as 30 percent disabled under 38 C.F.R. § 4.130 Diagnostic Code (DC) 9411. A rating of 30 percent is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupation tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: a depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130 Diagnostic Code 9411. A rating of 50 percent is warranted 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 (retention of only highly learned material, forgetting to complete tasks); impaired judgment, impaired abstract thinking; disturbances of motivation and mood; and difficulty establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is objective evidence demonstrating that the Veteran has occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to suicidal ideation; obsessional rituals which interfere with his routine activities, speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, or 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 the inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted for 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; memory loss for names of close relatives, own occupation, or own name. Id. As discussed in the Board's March 2011 decision, the evidence of record, prior to February 27, 2008, was most consistent with a 30 percent rating. The Board highlighted that the evidence during that period failed to show many of the symptoms delineated under the General Schedule for rating psychiatric disorders, which would have supported a higher rating. The Veteran was not shown to have exhibited symptoms such as flattened affect, circumstantial, circumlocutory, or stereotyped speech difficulty in understanding complex commands, impairment of short and long-term memory, impaired judgment, impaired abstract thinking, or disturbances of motivation and mood. Indeed, on review, there were no symptoms of similar severity, frequency, and/or duration that would have supported a higher rating. See Vazquez-Claudio v. Shinseki, ___F.3d___, No. 2012-7114, 2013 WL 1395804 (Fed. Cir. April 8, 2013). The Board's attention is drawn to a July 2007 report that documents the Veteran's initial assessment for PTSD. He denied earlier psychiatric treatment at that time. He also reported that he had worked for many years as a heavy equipment operator until 2007, which was when he sustained an injury to his back. He said he had been on worker's compensation since that time. He endorsed frequent nightmares and being easily angered. He also described a history of drug and alcohol dependence. He denied suicidal or homicidal ideation. A Global Assessment of Functioning (GAF) score of 65 was assigned. The GAF scale reflects the psychological, social, and occupational functioning on a hypothetical continuum of mental-health illness. Richard v. Brown, 9 Vet. App. 266, 267 (1996). A GAF score of 65 is indicative of mild impairment. Indeed, even at the time of his hospitalization on February 27, 2008, the Veteran was shown to be oriented times three. His mood and affect were within normal limits as was his speech and insight. There was also no evidence of impairment of thought, cognition, or judgment. The focus of the treatment was to help him manage anxiety/stress, leisure education, increase self-esteem and comfort level in group settings, and improve communications skills. Put another way, as cited in the March 2011 decision, the evidence did not demonstrate the schedular criteria for a rating in excess of 30 percent for the period prior to February 27, 2008. Further, although the schedular criteria provided for evaluations higher than the assigned 30 percent rating, the Veteran's PTSD was not shown to have been manifested with symptoms required to achieve such higher ratings, prior to February 27, 2008. The evidence during this period, albeit sparse, shows that the Veteran's disability picture was adequately, and appropriately, contemplated by the applicable schedular rating criteria. The schedule provides for a greater evaluation for additional or more severe symptoms but no such symptoms were present in this case, prior to February 27, 2008. His symptoms at that time would best be described as mild. The assigned schedular evaluation was therefore adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Because the schedular criteria adequately compensated the Veteran for the level of disability and symptomatology of his PTSD, prior to February 27, 2008, the threshold for an extraschedular rating were not met and the second step of the inquiry need not be addressed. Nevertheless, even if the available schedular evaluation for his PTSD was inadequate (which it manifestly is not), the Veteran did not exhibit other related factors such as those provided by the regulation as 'governing norms.' In this respect, the evidence of record, prior to February 27, 2008, did not show that his PTSD required frequent periods of hospitalization. Moreover, contrary to his assertions, the Veteran's service connected disabilities are not shown to have caused marked interference with his past employment prior to February 27, 2008. He is shown to have left his last job due to a non-service connected back disability. The schedular criteria adequately compensate the Veteran for the level of disability and symptomatology of his PTSD, prior to February 27, 2008. Consequently, an extraschedular rating for his service-connected PTSD, prior to February 27, 2008, is denied. III. TDIU A total disability evaluation may be assigned where the schedular evaluation is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Prior to February 27, 2008, the Veteran did not satisfy the percentage requirements noted above. His service-connected disabilities included PTSD, for which he had a 30 percent disability rating and tinnitus for which he had a 10 percent disability rating. These awards, in combination, represented a 40 percent rating under 38 C.F.R. § 4.25, Table I. Consequently, the only remaining question in this case is whether prior to February 27, 2008, the Veteran was unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities, for purposes of a possible extraschedular evaluation. 38 C.F.R. § 4.16(b). The Board emphasizes that entitlement to an extraschedular rating under 38 C.F.R. § 3.321(b)(1) and a TDIU extraschedular rating under 38 C.F.R. § 4.16(b), although similar, are based on different factors. See Kellar v. Brown, 6 Vet. App. 157, 162 (1994). An extraschedular rating under 38 C.F.R. § 3.321(b)(1) is based on the fact that the schedular ratings are inadequate to compensate for the average impairment of earning capacity due to the Veteran's disabilities. Exceptional or unusual circumstances, such as frequent hospitalization or marked interference with employment, are required. In contrast, 38 C.F.R. § 4.16(b) merely requires a determination that a particular Veteran is currently rendered unable to secure or follow a substantially gainful occupation by reason of his or her service-connected disabilities. See VAOPGCPREC 6-96. The Veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed under 38 C.F.R. § 4.16(b). The Board itself cannot assign an extraschedular rating in the first instance. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). Although Bagwell and Floyd only dealt with ratings under § 3.321(b)(1), the analysis in those cases is analogous to TDIU ratings under § 4.16(b) as well, in view of that section's similar requirement of referral to the Director of VA's Compensation and Pension Service, in addition to Court precedents requiring consideration of § 4.16(b) when the issue is raised in an increased-rating case. See Stanton v. Brown, 5 Vet. App. 563, 570 (1993); Fanning v. Brown, 4 Vet. App. 225, 229 (1993). That is, since the Board itself cannot assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case to the Director of Compensation and Pension (C&P) Services for an extraschedular evaluation when the issue is either raised by the claimant or is reasonably raised by the evidence of record. See Thun v. Peake, 22 Vet. App. 111, 115 (2008); Barringer v. Peake, 22 Vet. App. 242 (2008). If, and only if, the Director determines that an extraschedular evaluation is not warranted, does the Board then have jurisdiction to decide the extraschedular claim on the merits. In fact, the Court held that although the Board is precluded from initially assigning an extraschedular rating, there is no restriction on the Board's ability to review the adjudication of an extraschedular rating once the Director of C&P determines that an extraschedular rating is not warranted. Anderson v. Shinseki, 22 Vet. App. 423, 427-8 (2009). See also Floyd, 9 Vet. App. at 96-97 (stating that once Board properly refers an extraschedular rating issue to Director of C & P for review, appellant may "continue[ ] to appeal the extraschedular rating aspect of this claim"); see also 38 U.S.C.A. §§ 511(a), 7104(a) ("All questions in a matter ... subject to decision by the Secretary shall be subject to one review on appeal to the Board."). Here, prior to the Board's consideration of this matter, the issue was referred to the Director of C&P Service for extraschedular consideration pursuant to the March 2011 Board remand, who in turn concluded in July 2011 that a TDIU rating, prior to February 27, 2008, under 38 C.F.R. § 4.16(b) was not warranted. While the RO denied the claim based on this determination, it is not binding on the Board. Fisher v. Brown, 4 Vet. App. 405 (1993) (denying reconsideration). Thus, entitlement to a TDIU rating under 38 C.F.R. § 4.16(b), prior to February 27, 2008, will be considered. Where, as in this case, a Veteran fails to meet the applicable percentage standards, an extraschedular rating is for consideration where the Veteran is found unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16(b) (2012). Individual unemployability must be determined without regard to any non-service connected disabilities or a veteran's advancing age. 38 C.F.R. §§ 3.341(a), 4.19 (2012); see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a veteran's favor. 38 C.F.R. § 4.3. While the regulations do not provide a definition of "substantially gainful employment," VA Adjudication Procedure Manual, M21-1 MR, Part IV, Subpart ii, Chapter 2 (Dec. 13, 2005) (previously cited at M21-1, Part IV, paragraph 7.09), defines the term as that "at which non-disabled individuals earn their livelihood with earnings comparable to the particular occupation in the community where the veteran resides." Also, in Faust v. West, 13 Vet. App. 342 (2000), the Court defined "substantially gainful employment" as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran's earned annual income. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a Veteran is entitled to TDIU is whether his service-connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-332 (1991). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the Veteran. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102 (2012). The Veteran contends that prior to February 27, 2008, he was entitled to a TDIU rating. In his VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) initially submitted in February 2008, the Veteran indicated that he became too disabled to work as of March 2007. He reflected that he left his last place of employment in April 2007 due to his back. The Board notes that the Veteran is not service-connected for his spine. The medical evidence of record, prior to February 27, 2008, does not directly address the Veteran's employability. As noted above, the claim was sent to the Director of C&P service for review. Following a review of the complete record, the Director of C&P Service concluded in July 2011, that the evidence of record, prior to February 2008, demonstrated that the Veteran was unable to work due to his nonservice-connected back disorder. The Director of C&P noted that in March 2007 the Veteran injured his back while performing his occupational duties as a truck driver. He noted that the Veteran filed a claim for individual unemployability in February 2008 and listed his non service-connected back disorder as the disability that prevented him from securing or following gainful employment. The Director essentially found that the evidence of record, prior to February 2008, does not support the notion that the Veteran was unemployable due to his service-connected disabilities. Therefore, entitlement to extraschedular TDIU is not shown. The Board concurs. In recognition of the severity of and impairment caused by his service-connected disabilities, the Veteran was rated as a combined 40 percent disabled, prior to February 27, 2008. However, based on the evidence discussed above, the Board finds that a preponderance of the evidence of record does not demonstrate that the Veteran's service-connected disabilities alone actually precluded him from engaging in substantially gainful employment, prior to February 2008. The Board emphasizes that it is not bound by the determination made by the Director of C&P Service. However, in the present case, the Board wholly agrees with his determination and analysis. The evidence of record prior to February 2008 reflects that the Veteran unemployability was due to a non service-connected disability. As such, entitlement to a TDIU rating due to the Veteran's service-connected disabilities, prior to February 2008, is not warranted. In support of his claim, the Veteran now asserts that his service-connected disabilities precluded him from working, prior to February 2008. The Board acknowledges the Veteran's assertions that he was unable to work, prior to February 2008, due to his service-connected disabilities. It must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir.1996) (table); Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). 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'). Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the evaluation of psychiatric and audiological/neurological disabilities falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). PTSD is not the type of condition that is readily amenable to mere lay diagnosis or probative comment as to its level of severity, as the evidence shows that psychiatric testing and evaluations are needed to properly assess and diagnose the disorder. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); and Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). That is, although the Board readily acknowledges that Veteran is competent to report symptoms of anger or sleep disturbances, there is no indication that the Veteran is competent to assess the level of severity of his psychiatric disorder and its effect on his employment. The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or an opinion as to occupational and social impairment. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating psychiatric disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed.Cir.2012). Further, while tinnitus is a purely subjective disorder that can be diagnosed by a lay person, it is questionable whether the Veteran possesses the clinical expertise to provide an opinion that his tinnitus, which can never be rated greater than 10 percent disabling, results in unemployment. Accordingly, this lay evidence does not constitute competent medical evidence and lacks probative value. Moreover, and rather significantly, the Board places a great deal of probative value on the Veteran's February 2008 statement wherein he stated that "[m]y back is so sore I had to leave my job." Put another way, at the time he initially filed his claim for benefits, the Veteran did not attribute his unemployment to any service connected disability. He instead related his unemployment to a non-service connected low back disability. The Veteran's present statements are inconsistent with these earlier statements. The Board finds that his assertions of unemployability lack credibility and are without probative value. See, e.g. Madden v. Gober, 125 F.3d 1477, 1481 (1997) (the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration a veteran's statements, it may consider whether self-interest may be a factor in making such statements). The Board finds that the claim for entitlement to a TDIU rating, prior to February 27, 2008, must be denied. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). As such, the appeal is denied. ORDER An initial rating higher than 30 percent for service-connected PTSD, prior to February 27, 2008, on an extraschedular basis is denied. Entitlement to TDIU, prior to February 27, 2008, on an extraschedular basis is denied. ____________________________________________ MICHAEL A. HERMAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs