Citation Nr: 1320653 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 07-04 454 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to a disability rating in excess of 30 percent for posttraumatic stress disorder, prior to January 12, 2012. 2. Entitlement to a disability rating in excess of 50 percent for posttraumatic stress disorder, beginning on January 12, 2012. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. Schechter, Counsel INTRODUCTION The Veteran served on active duty from August 1968 to July 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2006 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in New York, New York. Jurisdiction of the case has been subsequently transferred to the RO in St. Petersburg, Florida. In November 2011, the Board issued a decision that denied a disability rating in excess of 30 percent for the Veteran's posttraumatic stress disorder (PTSD). The Veteran appealed the Board's November 2011 decision to United States Court of Appeals for Veterans Claims (Court). Pursuant to an April 2012 Joint Motion for Partial Remand (Joint Motion), the Court issued a July 2012 Order that remanded the issue of a disability rating in excess of 30 percent for the Veteran's PTSD for further action. In accordance with that Court-ordered Joint Motion, the Board in February 2013 issued an order vacating the Board's prior decision of November 2011. In a September 2012 rating decision, the rating for PTSD was increased from 30 percent to 50 percent, effective January 12, 2012. As the rating for the Veteran's PTSD is less than the maximum available rating, the issue remains on appeal. AB v. Brown, 6 Vet. App. 35 (1993). The Board in February 2013 remanded the appealed issue of entitlement to increased ratings from those assigned for PTSD, as styled hereinabove. Following such additional development, the case now returns to the Board for further review. FINDINGS OF FACT 1. For the rating period prior to January 12, 2012, and for any lesser intervals during that period, the Veteran's PTSD was not manifested by occupational and social impairment with reduced reliability and productivity, with the weight of competent and probative evidence of record against such conclusions. As a result of a psychiatric disability, he did not have symptoms causative of that level of psychiatric disability, to include, for example, 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. 2. For the rating period beginning January 12, 2012, and for any lesser intervals thereafter, the Veteran's PTSD has not been manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, or mood, with the weight of competent and credible evidence of record against such conclusions. He has not experienced symptoms causative of that level of psychiatric disability, to include, for example, suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty adapting to stressful circumstances; or inability to establish or maintain effective relationships. CONCLUSIONS OF LAW 1. Prior to January 12, 2012, and for any lesser intervals during that period, the criteria for a disability rating in excess of 30 percent for a psychiatric disorder have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). 2. Beginning January 12, 2012, and thereafter, the criteria for a disability rating in excess of 50 percent for a psychiatric disorder have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist VA has met all statutory and regulatory notice and duty to assist provisions. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The Veteran was afforded the required notice letters in July 2007, September 2008, February 2010, March 2010, and February 2013. While such notice was not afforded the Veteran prior to the appealed April 2006 rating action, the multiple subsequent notice letters were followed by appropriate development and readjudication of the claim by the RO. The letters informed the Veteran of the required notice and duty-to-assist provisions, and of the information and evidence necessary to substantiate the claim for an increased rating, as well as informing of the respective roles of the Veteran and VA in developing the claim and obtaining evidence, with the ultimate responsibility for ensuring that relevant evidence is obtained being on the Veteran. The Veteran was also then provided with general notice of the evidence required to satisfy the claim for increased rating. Additionally, he was then afforded notice of how disability ratings and effective dates are assigned. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). VA's duty to assist the Veteran in the development of the claim includes assisting him in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that the RO appropriately assisted the Veteran in obtaining indicated VA treatment and private treatment and evaluation records. The Veteran in a May 2010 submission emphasized a failure of VA to obtained records of Dr. B., informing that the Veteran's own review of records obtained confirmed that those records were not present. The Veteran was contacted in June 2010 and the address of Dr. B. was obtained from the Veteran. The Veteran was duly informed by a June 2010 letter that a request for records had been sent to Dr. B., but that it was ultimately the Veteran's responsibility to see that VA received the records. A reply received from the medical facility at the address provided by the Veteran informed that they had no records of the Veteran as a patient. The Veteran has been informed of this negative reply, and has informed that he has no additional evidence to submit. Records from the Social Security administration were also obtained, in furtherance of the claim. The RO made appropriate efforts to develop the record as directed by the Board's February 2013 remand. The Board in its February 2013 remand required that the RO seek any additional treatment records for the Veteran's PTSD, including records of VA treatment, to include any at the VA Medical Center (VAMC) in Tampa, Florida. Responsive to a February 2013 letter, the Veteran in February 2013 submitted a complete two-page copy of a record of treatment by a VA psychiatrist in June 2012. Upon subsequent VA examination for compensation purposes in February 2013, the examiner informed that the Veteran only saw a mental health professional on that single occasion in June 2012, with no other mental health visits between the prior VA examination in May 2012 and the current VA examination in February 2013. The record of that February 2013 VA examination is contained in the claims file. Subsequently, following the RO's issuance of a supplemental statement of the case in March 2013, the Veteran in March 2013 submitted an additional single page from a record of a February 2013 VA psychiatric treatment visit subsequent to the February 2013 VA examination. The Veteran waived RO review of this additional record prior to Board adjudication of his increased rating claim, but failed to provide a complete copy of that February 2013 treatment record, notably only providing the first page. However, the record of that treatment was already previously associated with the claims file prior to the RO's readjudication of the claim by the supplemental statement of the case in March 2013. Hence, the incomplete record submitted in March 2013 was duplicative of the record of February 2013 treatment already associated with the claims file, and necessitates no further action prior to the Board's instant adjudication of the claim. The Board finds that the RO substantially complied with all development required by the Board's February 2013 remand. This included affording appropriate development notice and a request for assistance by a letter to the Veteran in February 2013, obtaining and associating with the claims file all indicated records of treatment, and obtaining the required VA examination for compensation purposes in February 2013, followed by the RO's readjudication of the claim by an issued supplemental statement of the case in March 2013. Only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). VA's duty to assist the Veteran by providing examinations when necessary was also adequately fulfilled. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. Over the course of the current claim, the Veteran was afforded VA examinations for compensation purposes, including most recently in February 2013, addressing his claimed PTSD. The VA examinations, records of VA and private evaluation and treatment, and statements and testimony by the Veteran, as well as other evidence of record, are adequate for the Board's adjudication herein. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The VA examinations, particularly the most recent examination in February 2013, addressed both the medical findings upon current examination and the Veteran's history, and presented findings and conclusions adequately addressing the nature of current and past PTSD symptoms for purposes of the present adjudication. The February 2013 examiner found that an evaluation of the severity of the Veteran's PTSD was not possible due to several psychological tests verifying the Veteran's substantial over-reporting of symptoms, most likely for secondary gain, with the prior evaluations indicating severity of disability thus invalidated or unreliable because of their failure to perform such validity testing, particularly in light of the invalid self-reporting of symptoms upon current examination. These findings upon current examination present a circumstance whereby there is no reasonable possibility of achieving any assessment of true or credible symptoms of PTSD by further examination, and examination development in this case must be at an end. Further examination would constitute unreasonable delay and expenditure of scarce VA resources. See 38 C.F.R. § 3.303; Counts v. Brown, 6 Vet. App. 473, 478- 9 (1994); Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992) (finding VA's statutory duty to assist is not a license for a "fishing expedition"). No further statement has been received by the Veteran indicating the existence of additional pertinent evidence not requested. The case presents no reasonable possibility that additional evidentiary requests would further the appealed claim adjudicated herein. 38 U.S.C.A. § 5103A(a)(2); 38 C.F.R. § 3.159. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist the Veteran in the development of the claim. In short, in this case, with regard to the increased rating claim herein adjudicated, the Board finds that any error in notice and development assistance cannot "reasonably affect the outcome of the case," and hence will not affect "the essential fairness of the [adjudication]" for the ratings assigned for the rating period in question, for the appealed claim. ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998); Mayfield v. Nicholson, 19 Vet. App. 103 (2005). In view of the foregoing, the Board finds that all notification and development actions needed to render a decision on the Veteran's claim on appeal herein adjudicated have been accomplished. II. Claim for Increased Ratings for PTSD Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The Veteran's service-connected PTSD is rated under the provisions of 38 C.F.R. § 4.130, Diagnostic Code 9411, which provide for rating under the General Rating Formula for Mental Disorders. Prior to January 12, 2012, a 30 percent disability rating was assigned for the Veteran's service-connected PTSD. A 30 percent evaluation contemplates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411. Beginning on January 12, 2012, a 50 percent evaluation for the Veteran's service-connected PTSD was assigned, which contemplates 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. A 70 percent disability rating is warranted when the Veteran experiences occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work like setting); inability to establish and maintain effective relationships. Id. A 100 percent disability rating is warranted when the Veteran has 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; or memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The evaluation must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a) (2012). Although the extent of social impairment is a consideration in determining the level of disability, the rating may not be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board notes that the symptoms listed in Diagnostic Code 9411 are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Physicians often apply a measurement known as the Global Assessment of Functioning (GAF) in assessing a patient. The GAF score assigned thereon reflects the "psychological, social, and occupational functioning on a hypothetical continuum of mental health - illness." Richard v. Brown, 9 Vet. App. 266, 267 (1997), quoting The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV). GAF scores ranging between 61 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. Scores ranging from 51 to 60 reflect 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). Over the course of the current claim period, the Veteran has reported a myriad of symptoms as due to his service-connected PTSD. For example, upon treatment by a VA psychiatrist in June 2012, the Veteran reported that he continued to have intrusive thoughts, feelings, and memories related to PTSD. Upon his most recent treatment as reflected in the record, on February 26, 2013, the Veteran reported that he had difficulty sleeping upon running out of Seroquel, and that his PTSD nightmares increased without that medication. He also then endorsed being chronically anxious and hypervigilant, as well as self-isolating at home and having a minimal social life. However, at that treatment, as upon past treatments, behavior suggesting psychiatric impairment was not observed, with the Veteran alert, well oriented, and in no distress. The Veteran was also then noted to have no acute affective symptoms, no suicidal or homicidal ideation, no psychosis, no cyclic moods, and no acute paranoia. These negative objective findings are consistent with the findings and conclusions of the VA examination for compensation purposes in February 2013. Objective findings were similarly negative upon the June 2012 VA outpatient treatment. At the VA psychological examination for compensation purposes in February 2013, the examiner administered a battery of tests, as well as a clinical interview to ascertain the nature and extent of the Veteran's claimed PTSD. The examiner summarized these findings as follows: The Veteran showed significant evidence of extreme over-reporting of mental disorder symptoms to a point that there is a greater than 99% chance that he exaggerated symptoms in his responses to the MMPI-2 items. Test results from the M-FAST were consistent with research data indicating his score was 100% predictive of malingering. The results from the SIMS was more than twice the cut-off score recognized in the literature for feigning mental health and cognitive symptoms. The SIRS has long been established as the "Gold Standard" in the assessment of feigning/malingering and his score on the SIRS was highly consistent with feigning/malingering. The examiner noted that these results were also consistent with the results of the MMPI-2 administered as part of the Veteran's prior VA examination for compensation purposes conducted in May 2012. The examiner assessed, "The only reasonable conclusion one can draw from these results is that the Veteran exaggerated mental disorder symptoms in the context of seeking compensation benefits." The February 2013 examiner was careful to note that a patient may have a mental disorder and also be exaggerating the symptoms of that disorder. However, the examiner informed that it was impossible, without resorting to mere speculation, to ascertain the symptoms which are actually present where, as here, the Veteran is determined to be grossly exaggerating symptoms. The examiner concluded that a diagnosis of PTSD could not be established because the presence of symptoms required for that diagnosis could not be relied upon. In short, the examiner concluded that because it was established that the Veteran was feigning psychiatric illness, the presence of psychiatric illness and the severity of any psychiatric illness which may be present could not be established. The Board finds the February 2013 VA examiner's assessments and conclusions to be highly reliable and based on both psychological research studies and the current state of medical knowledge, as supported by studies and medical treatises cited at the end of the examination report, and by convincing and authoritatively endorsed psychological testing methodologies. The Board thus concludes that the findings and conclusions of the February 2013 VA examiner are competent, credible, and highly probative. The Board recognizes that the Veteran is competent to address his symptoms of disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, because the February 2013 VA examiner's competent, credible, and highly probative conclusions are to the effect that the Veteran grossly exaggerates the nature and extent of symptoms of psychiatric disability, and that the Veteran is thus malingering for purposes of the secondary gain, inclusive most relevantly of VA disability benefits, the Board concludes that the Veteran's assertions of symptoms of psychiatric disability, for the entire duration of the rating period in question, are entirely lacking in credibility, and are entitled to no weight in the Board's adjudication of the claim. Caluza v. Brown, 7 Vet. App. 498, 506 (1995); Layno v. Brown, 6 Vet. App. 465, 469 (1994); Evans v. West, 12 Vet. App. 67, 74 (1997). The February 2013 examiner further noted that upon prior examination and treatment of the Veteran, diagnoses and assessments of the Veteran's PTSD relied upon the Veteran's subjective self-reporting of symptoms, with those examinations failing to assess the Veteran's "response style" for exaggeration or malingering. As the February 2013 examiner informed: The Veteran has undergone several [Compensation and Pension] mental health assessments for PTSD and in none of those examinations with the exception of the 5/2012 examination was the Veteran assessed for his response style (e.g., administered objective measures such as the MMPI-2 or PAI). His diagnosis and GAF scores were based entirely on his self-reported history. Although the Veteran has been previously administered scales such as the PCL and Mississippi Scales for assessment of PTSD, research has shown these scales are ineffective in distinguishing between individuals with genuine PTSD and persons who simulate PTSD[,] and given his results on the MMPI-2 in May 2012 and February 2013[,] the scores of these face-valid measures (i.e., the person taking the test knows what is being measured) are highly suspect and most likely to be inaccurate. I did a complete search of all his VA medical records and I was unable to find any evidence that this Veteran has ever been assessed with objective measures such as the MMPI-2. There is no evidence to suggest he has ever been assessed for his response style in endorsing symptoms. All of the records appear to be based completely on the Veteran's self-reports without assessment of response style. The February 2013 examination further noted that the GAF scores assigned by prior examiners were "inapplicable to the current examination" because they were based on these inaccurate assessments relying on subjective self-reports by the Veteran "without an objective assessment of response style." Thus, in light of these prior failures and the currently established exaggeration/malingering of the Veteran upon extensive testing in February 2013, all these prior assessments of PTSD and severity of PTSD must be rejected as not reliable and hence not probative. A medical opinion based on an inaccurate factual premise is not probative. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). While these prior examining and treating medical professionals are competent to address the nature and extent of psychiatric disability, the probativeness of their assessments is completely undermined by their reliance on the Veteran's now discredited, and hence non-credible subjective assertions of psychiatric disability and the examiners' failure to rely on more objective sources of information, such as the psychological testing with validity testing as administered for the February 2013 examination. The February 2013 examiner further noted that the Social Security Administration (SSA) disability determination similarly relied on subjective self-reporting of symptoms to arrive at its conclusion that the Veteran was disabled including due to psychiatric symptoms. The February 2013 examiner concluded that the SSA disability determination was thus similarly based on an inaccurate assessment relying substantially on self-reported symptoms which were in all likelihood exaggeration and malingering, rather than objective or otherwise reliable evidence. The Board accordingly concludes that the findings and conclusions of the SSA in its disability determination are unreliable as based on non-credible self-reported symptoms of psychiatric disability, and hence are not to be considered probative in the present adjudication. Id. The February 2013 examiner concluded, "Given the Veteran's significant exaggeration of symptoms, I am unable to determine his true functional impairment (social or occupational) without the use of mere speculation." The Board accepts this February 2013 examiner's conclusion of inability to assess functional impairment without mere speculation as reasonably based on informed medical judgment and the sound medical assessment of the unreliability of the medical evidence upon which the examiner was forced to rely. The Board similarly concludes no increase in severity of the Veteran's claimed PTSD may be supported by the evidence presented, because prior clinical and examination evidence are discounted as non-credible and hence non-probative, the Veteran's own assertions are discounted as non-credible and hence non-probative, and the probative, objectively-based examination findings are to the effect that no PTSD disability may be reliably established, and neither may the severity of such disability. Generally, evaluating a disability using either the corresponding or the analogous diagnostic codes contained in the Rating Schedule is sufficient. See 38 C.F.R. §§ 4.20, 4.27 (2012). However, because the ratings are averages, it follows that an assigned rating may not completely account for each individual veteran's circumstance, but nevertheless would still be adequate to address the average impairment in earning capacity caused by disability. However, in exceptional cases where the rating is inadequate, it may be appropriate to assign an extraschedular rating. 38 C.F.R. § 3.321(b) (2012). 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. Id.; see also Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff'd, 572 F.3d 1366 (Fed. Cir. 2009); see also Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating [S]chedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Therefore, there must be a comparison between the level of severity and symptomatology of the Veteran's service-connected disability with the established criteria found in the Rating Schedule for that disability. Thun, 22 Vet. App. at 115. If the criteria reasonably describe the Veteran's disability level and symptomatology, the Rating Schedule contemplates the Veteran's disability picture, and the assigned schedular evaluation is adequate, and no referral is required. The Board finds any manifestations the Veteran's service-connected PTSD, are not so unusual or exceptional in nature as to render the assigned ratings inadequate. The Veteran's service-connected PTSD is evaluated under the rating criteria for mental disabilities, the criteria of which is found by the Board to specifically contemplate the level of occupational and social impairment caused by this disability. 38 C.F.R. § 4.130, Diagnostic Code 9411. For the rating period prior to January 12, 2012, and for any lesser intervals during that period, the Veteran's PTSD was not manifested by occupational and social impairment with reduced reliability and productivity, with the weight of competent and probative evidence of record against such conclusions. As a result of a psychiatric disability, he did not have symptoms causative of that level of psychiatric disability, to include, for example, 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. For the rating period beginning January 12, 2012, and for any lesser intervals thereafter, the Veteran's PTSD has not been manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, or mood, with the weight of competent and credible evidence of record against such conclusions. He has not experienced symptoms causative of that level of psychiatric disability, to include, for example, suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty adapting to stressful circumstances; or inability to establish or maintain effective relationships. When comparing this disability picture with the level of disability contemplated by the Rating Schedule, the Board finds that the schedular evaluation is not inadequate. Higher ratings are provided for certain findings, but the evidence reflects that those findings are not present in this case. Consequently, the Board concludes that a schedular evaluation is adequate and that referral of the Veteran's case for extraschedular consideration is not required. Accordingly, the Board concludes that the preponderance of the evidence is against the claims for entitlement to an evaluation for PTSD in excess of 30 percent assigned prior to January 12, 2012, and a rating in excess of 50 percent beginning on January 12, 2012, and thereafter. See Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the benefit of the doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER A rating in excess of 30 percent for PTSD prior to January 12, 2012, is denied. A rating in excess of 50 percent for PTSD beginning on January 12, 2012, is denied. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs