Citation Nr: 1323760 Decision Date: 07/25/13 Archive Date: 08/06/13 DOCKET NO. 06-34 230 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to an initial evaluation in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD). 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) prior to August 20, 2008. REPRESENTATION Appellant represented by: Kenneth M. Carpenter, Attorney at Law WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. W. Loeb INTRODUCTION The Veteran had active service from March 1968 to March 1972. This appeal to the Board of Veterans' Appeals (Board) arose from an October 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In pertinent part, the October 2005 rating decision granted service connection for PTSD, and assigned a 30 percent initial rating, effective from May 24, 2005. The Veteran presented testimony at a Travel Board hearing in March 2008 before the undersigned Veterans Law Judge (VLJ). A June 17, 2008 Board decision denied, in pertinent part, entitlement to an initial rating in excess of 30 percent for PTSD. The Veteran appealed the June 2008 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a May 25, 2010 memorandum decision, the Court vacated that part of the Board's decision that denied entitlement to an initial rating in excess of 30 percent for PTSD. In January 2011, the Board of Veterans' Appeals (Board) remanded the issues of entitlement to an initial evaluation in excess of 30 percent for PTSD and entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) to the Department of Veterans Affairs (VA) regional office in St. Louis, Missouri (RO) for Veterans Claims Assistance Act of 2000 (VCAA) notice on the TDIU issue and a current evaluation of the Veteran's PTSD. The January 2011 Board remand was in response to the May 2010 Memorandum Decision of the Court of Appeals for Veterans Claims (Court), which vacated and remanded the Board's June 2008 denial of an initial evaluation in excess of 30 percent for PTSD because it failed to provide an adequate statement of reasons and bases with respect to the schedular rating assigned for PTSD. A VA psychiatric evaluation was conducted in November 2012. A December 2012 rating decision granted an increased initial evaluation of 50 percent for PTSD, effective from May 24, 2005, the date of service connection and granted TDIU, effective August 20, 2008. Consequently, there has been substantial compliance with the January 2011 remand instructions. Stegall v. West, 11 Vet. App. 268 (1998) (Holding that a remand by the Court or the Board confers on the Veteran or other claimant, as a matter of law, the right to compliance with the remand orders); see Dyment v. West, 13 Vet. App. 141 (1999) ((Holding that remand not required under Stegall v. West, 11 Vet. App. 268 (1998) where there was substantial compliance with remand directives)). FINDINGS OF FACT 1. Throughout the rating period on appeal from May 24, 2005, the service-connected PTSD has been shown to be manifested by depression, suicidal thoughts, irritability/anger, panic attacks, flachbacks, nightmares, impaired concentration, avoidance, anhedonia, and startle response, productive of functional impairment comparable to social and occupational impairment with deficiencies in most areas, without demonstration by competent medical, or competent and credible lay evidence, that such manifestations approximate total occupational and social impairment due to psychiatric symptomatology at any time during the rating period on appeal. 2. The veteran was working full time as a software engineer prior to August 20, 2008. CONCLUSIONS OF LAW 1. The criteria for the assignment of an initial evaluation of 70 percent, but no higher, for service-connected PTSD, effective from May 24, 2005, have been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2012). 2. The criteria for the assignment of a TDIU prior to August 20, 2008 have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. §§ 4.7, 3.340, 3.341, 4.16 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify and Assist The Board has considered the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 and Supp. 2012). The regulations implementing VCAA have been enacted. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). VA has a duty to notify the claimant of any information and evidence needed to substantiate and complete a claim, which information and evidence, if any, that he is to provide and which information and evidence, if any, VA will attempt to obtain. VA must also request that the claimant provide any evidence in his possession that pertains to the claims. 38 U.S.C.A. §§ 5102, 5103. See also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Additionally, the claimant must be apprised of the factors for consideration in the assignment of a disability rating and an effective date in the event of award of the benefits sought. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The notice and assistance provisions of VCAA should be provided to a claimant prior to any adjudication of the claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). In this case, the veteran is appealing the initial rating assignment as to his PTSD. In this regard, because the October 2005 rating decision on appeal granted the veteran's claim of entitlement to service connection, such claim is now substantiated. His filing of a notice of disagreement as to the initial rating assignment does not trigger additional notice obligations under 38 U.S.C.A. § 5103(a). Rather, the veteran's appeal as to the initial rating assignment here triggers VA's statutory duties under 38 U.S.C.A. §§ 5104 and 7105, as well as regulatory duties under 38 C.F.R. § 3.103. As a consequence, VA is only required to advise the veteran of what is necessary to obtain the maximum benefit allowed by the evidence and the law. This has been accomplished here, as a statement of the case (SOC), under the heading "Pertinent Laws; Regulations; Rating Schedule Provisions," set forth the relevant diagnostic code (DC) for rating PTSD, and included a description of the rating formulas for all possible schedular ratings under this diagnostic code. The appellant was thus informed of what was needed not only to achieve the next-higher schedular rating, but also to obtain all schedular ratings above the initial evaluation that the RO assigned. Therefore, the Board finds that the appellant has been informed of what was necessary to achieve a higher rating for the service-connected disability at issue. In this case, the RO sent the Veteran a VCAA notice letter in August 2012, prior to adjudication of the TDIU issue. VA has a duty to assist the claimant in obtaining information and evidence necessary to substantiate a claim. VCAA also requires VA to provide a medical examination when such an examination is necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159. A psychiatric evaluation was obtained in November 2010. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA evaluation obtained in this case is adequate, as the Veteran's claims folder was reviewed, clinical examination was performed, and the examination report included a discussion of the Veteran's relevant psychiatric symptomatology sufficient for consideration under the applicable rating criteria. There is adequate medical evidence of record, which include VA treatment records in Virtual VA, to make a determination on the increased rating issue in this case. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination relevant to the increased rating issue on appeal has been met. 38 C.F.R. § 3.159(c)(4). The Board concludes that all available evidence has been obtained and that there is sufficient medical evidence on file on which to make a decision on the issue decided herein. The Veteran has been given ample opportunity to present evidence and argument in support of his claim, including at his March 2008 travel board hearing. The Board additionally finds that general due process considerations have been complied with by VA, and the Veteran has had a meaningful opportunity to participate in the development of the claims. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006); 38 C.F.R. § 3.103 (2007). The Board has reviewed the record in regard to whether the Veteran was afforded his due process rights in the development of evidence through testimony. At the March 2008 hearing, the Veteran was afforded an extensive opportunity to present testimony, evidence, and argument. The transcript reveals an appropriate colloquy between the Veteran and the Veterans Law Judge on the evidence relevant to an increased rating for his PTSD, in accordance with Stuckey v. West, 13 Vet. App. 163 (1999) and Constantino v. West, 12 Vet. App. 517 (1999) (relative to the duty of hearing officers to suggest the submission of favorable evidence). In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) recently held that 38 C.F.R. § 3.103(c)(2) (2012) requires that the VLJ who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. The Veteran was assisted at his March 2008 hearing by an accredited representative from the Military Order of the Purple Heart. The representative and the VLJ asked questions relevant to the increased rating issue on appeal. No pertinent evidence that might have been overlooked and that might substantiate a claim on appeal was identified by the Veteran or the representative. The hearing focused on the elements necessary to substantiate the claim, and the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claims for service connection and an increased rating. Therefore, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). Analysis of the Claims Increased Rating Claim The Veteran has contended, including at his March 2008 hearing, that his PTSD is more severe than currently rated due to his psychiatric symptomatology, which includes anger, depression, irritability, and sleep problems. As noted above, service connection has been established for PTSD, with a 50 percent initial rating assigned effective from May 24, 2005, the date of claim. As such, the rating period on appeal is from May 24, 2005. Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Schedule). 38 C.F.R. Part 4 (2012). The percentage ratings contained in the Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1 (2012). Separate diagnostic codes identify the various disabilities. In considering the severity of a disability it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2012). Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the Veteran's entire history is reviewed when assigning a disability evaluation, 38 C.F.R. § 4.1, see Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991), where service connection has already been established, and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, where the Veteran is appealing the initial assignment of a disability rating, as in this case, the severity of the disability is to be considered during the entire period from the initial assignment of the evaluation to the present time. Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis and demonstrated symptomatology. See Butts v. Brown, 5 Vet. App. 532 (1993). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 at 308 (2007) (Observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Pertinent to a claim for an increased rating, lay testimony is competent when it describes symptoms, which supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (holding that, in general, for the need for a VA examination to arise, a claimant would only need submit his competent testimony that symptoms, reasonably construed as related to the service-connected disability, have increased in severity since the last evaluation.). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). Under the rating schedule, a 50 percent evaluation is assignable for psychiatric disability 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 (for example, retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is assignable for psychiatric disability when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation for psychiatric disability is assignable with 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. The global assessment of functioning (GAF) score reflects the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996). A GAF score of 31 to 40 involves some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work). A GAF score of 41 to 50 is defined as serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifter) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF of 51 to 60 is defined as moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A GAF of 61 to 70 is defined as mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household) but generally functioning pretty well, has some meaningful interpersonal relationships. A GAF of 71 to 80 is assigned when symptoms, if present, are transient and are expected reactions to psychosocial stressors (e.g., difficulty concentrating after family argument), with no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). See QUICK REFERENCE TO THE DIAGNOSTIC CRITERIA FROM DSM-IV, 46-7 (1994). The Veteran was afforded a VA examination in September 2005, and has also submitted statements from his private psychotherapist, dated in May 2005 and February 2006. The September 2005 VA examiner diagnosed the Veteran with PTSD. At the time of the examination, the Veteran reported that he had worked as a software engineer at Bowing Company and its predecessor for 27 years. The examination report indicates that the Veteran had increasing trouble getting along with people. He avoided people, had no friends, had very few activities, and spent most of his time working. He described himself as somewhat depressed. The Veteran's irritability improved somewhat with medication, although he did have periods of feeling down for days. He had experienced occasional suicidal thoughts, but had no plans or intent to commit suicide. The Veteran had a high level of anger at work and at home, and had a history of yelling. He startled easily and had occasional panic attacks, although he denied specific fears or phobias. He slept poorly without his medications and had initial insomnia and "mid waking." The Veteran also complained in September 2005 of frequent night sweats and nightmares, although no flashbacks were noted. According to the Veteran, he had an increase in rumination about Vietnam, with thoughts becoming more vivid, frequent, and terrifying. The Veteran avoided talking about his experiences in Vietnam. Upon observation, the Veteran was neat, clean, and well groomed. He was oriented to time, place, and person, and was logical, coherent, and not tangential or circumstantial. He was spontaneous, his voice was well modulated, and his manner was pleasant and cooperative. His attention, concentration, and remote memory were intact, while recent memory showed some interference. The Veteran choked up at times, but no tearing was noted. No hallucinations, delusions, psychosis, or hypervigilance were noted. The examiner noted that the Veteran scored a 30 on the Beck Depression Inventory, placing him in the extremely severe range of depression on that instrument. It was noted that items endorsing severe included having loss of ability to cry, loss of interest in others, fatigue, and no appetite. However, the examiner also noted that the Veteran appeared moderately depressed and mildly anxious on mental status examination. Additionally, a GAF score of 55 was assigned. The Board also recognizes that the Veteran has submitted letters from two private psychotherapists in support of his claim. A letter dated in May 2005 to the Veteran from Dr. J.L., of Liss & Associates, relays that the psychotherapist has diagnosed the Veteran with PTSD and assigned a GAF score of 54. Dr. J.L. indicated that the Veteran suffered from a number of PTSD symptoms, including: alteration in sleep, distraction, difficulty in concentrating, anxiety, avoidance, avoidance of thoughts and conversations associated with the trauma, diminished interest/participation in activities, feelings of detachment, decreased self esteem, sense of foreshortened future, obsessive thoughts, suicidal thoughts, irritability, exaggerated startle response, flashbacks, and survivors guilt. In addition, the letter specified that the Veteran was persistently re-experiencing the events of Vietnam, evidenced by recurring distressing dreams of the events and distress experienced on exposure to cues symbolizing or representing the traumatic experience. Ongoing psychotherapy and medication was recommended for the Veteran. An additional letter, dated in February 2006, was sent to the Veteran's representative from G.D.B., Ph.D., also of Liss & Associates. Dr. G.D.G. maintains that he has been treating the Veteran since May 2005 for severe PTSD related to his experiences in Vietnam. The therapist indicated that while the Veteran had taken small steps in dealing with his PTSD, he was guarded and tended to minimize his discomfort. He described the Veteran as exhibiting classic symptoms of PTSD, including nightmares, startled response, hyper vigilance, crying spells, survivor guilt, and death wish without plans. The Veteran felt isolated at home and at work. Dr. G.D.G . diagnosed the Veteran with PTSD (chronic, severe, recurrent, Vietnam), with a GAF score of 45. The Veteran's wife submitted a statement in support of the Veteran's claim in March 2007 in which she discussed his psychiatric symptomatology. According to a January 2008 report from Dr. L., there was ongoing deterioration in the Veteran's PTSD symptomatology. He was less able to concentrate on work, he had increased avoidance, increased fatigue, and increased content of traumatic flashbacks, nightmares, and remembrances. Dr. L. concluded that the Veteran had a permanent disability of 100 percent of the person as a whole and that his disability rating should be at least 70 percent of the person as a whole, as the Veteran "does modestly continue his employment." The Veteran testified at his travel board hearing in March 2008 that he had no social life and had problems with anger, severe depression, irritability, sleeping, and going to work. VA treatment records for May 2008 reveal that the Veteran complained of lack of friends/social withdrawal, nightmares, concentration and attention problems, emotional numbing, reduced interest/pleasure, and vague hints of existential conflicts related to work. He was noted to be alert and oriented, his mood was neutral with appropriate affect, he did not have a thought disorder, and he did not have any suicidal or homicidal ideation. PTSD was diagnosed, and the GAF score was 65-70. The examiner noted that the Veteran was emotionally shut down and had been in retreat for a long time. A January 2010 decision of the Social Security Administration granted disability benefits effective August 19, 2008 due to anxiety disorders and heart disease. According to an October 2010 statement from Dr. L, the Veteran met the criteria for being 100 percent disabled with unemployability since August 2008. Dr. L found that it was at least as likely as not that, since May 2005, the Veteran's PTSD had resulted in occupational and social impairment with deficiencies in most areas. According to a November 2010 opinion from a VA physician, it was more likely than not that the Veteran's PTSD resulted in occupational and social impairments with deficiencies in most areas since May 2005 and that it was more likely than not that the Veteran was unable to obtain and maintain substantially gainful employment due to the severity of his PTSD since August 2008. VA treatment records for October 2011 reveal a GAF score of 45. VA treatment records for April 18, 2012 reveal that the Veteran felt that his depression was well controlled on medication. He felt good about having lost a substantial amount of weight, having joined the Marine Corps League to reduce his isolation, and having taken several steps to get back on track with his guitar playing. He did continue to complain of poor motivation and the ability to act. A VA compensation and pension psychiatric evaluation was conducted in November 2012. The Veteran had been married to his wife since 1971; he described the relationship as improved since he started treatment with his current VA health care provider. He said that his irritability had diminished over recent years. The Veteran had maintained full-time employment as a software engineer for McDonnell Douglas/Boeing involving combat-related activities, as he related "perfectly" to his colleagues due to their shared combat experiences. When the cold war ended, his job began to change; and he got into arguments with nonmilitary co-workers and supervisors. He retired in 2008. He said that he did not have any associations other than his wife and a United States Marine Corps group. He described his mood as numb on his current medication, which he considered an improvement. The Veteran reported that his sleep was stable on his current medications; he denied nightmares. PTSD symptoms checked by the examiner were depressed mood; anxiety; flattened affect; circumstantial, circumlocutory or stereotyped speech; disturbance of motivation and mood; and an inability to establish and maintain effective relationships. The examiner noted in November 2012 that the Veteran's problems with employment were related to interpersonal relationships with co-workers, as he did not have any difficulty completing his assigned duties. PTSD was diagnosed, with the examiner finding that the Veteran's symptoms were well managed and had not worsened since his last evaluation in 2005. In fact, the Veteran's symptoms of sleep disturbance and reexperiencing service trauma had either significantly improved or completely abated with his current medication regimen. The GAF score was 60. The examiner concluded that the Veteran's functional occupational impairment due to PTSD was likely to be moderate in nature, suggesting that he would be able to maintain some type of gainful employment. According to the examiner, the Veteran's PTSD caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of an inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. A Veteran need not demonstrate the presence of all, most, or even some, of the symptoms listed as examples in the rating criteria. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002); however, as the Court held in Mauerhan, without the examples noted in the rating criteria, differentiating a 50 percent evaluation from a 70 percent evaluation would be extremely ambiguous. The Board is to consider all symptoms of a Veteran's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the DSM-IV. If the evidence demonstrates that a Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating should be assigned. Id. Although there is some conflict in the evidence as to the severity of the Veteran's PTSD symptomatology, the evidence shows a disability picture for the Veteran's service-connected psychiatric disorder that more closely resembles the severity of the criteria for an evaluation of 70 percent throughout the rating period on appeal, from May 24, 2005. Dr. B concluded in February 2006 that the Veteran's PTSD was severe and that his GAF score was 45, which involves serious symptoms or serious impairment in social or occupational functioning. Although the GAF score on VA treatment in May 2005 was 65-70, Dr. L found in January 2008 that there was ongoing deterioration in the Veteran's PTSD symptomatology, as he was less able to concentrate on work, and had increased avoidance, increased fatigue, and increased content of traumatic flashbacks, nightmares, and remembrances. Based on evaluation findings, it was concluded by Dr. L, in October 2010, and by a VA physician, in November 2010, that, since May 2005, the Veteran's PTSD symptoms resulted in occupational and social impairment with deficiencies in most areas, which is the criteria for a 70 percent rating. In November 2012 it was noted that the Veteran had an inability to establish and maintain effective relationships. Although his symptoms were noted in April and November 2012 to be well maintained on his medication, it is clear he required continuous medication treatment of the symptoms, and not that the symptoms had resolved. In view of the foregoing, the Board finds that the most probative competent evidence of record establishes that manifestations of the service-connected PTSD more nearly approximate a 70 percent rating throughout the rating period on appeal, from May 24, 2005. A rating in excess of 70 percent is not warranted at any time during the appeal period for PTSD because the evidence does not show PTSD symptomatology indicative of functional impairment equivalent to that for a 100 percent rating. Indeed, there has been no demonstration that the above noted manifestations of the service-connected PTSD are productive of functional impairment comparable to the criteria for a 100 percent schedular rating. In fact, there is no report in the medical records of any any psychiatric symptoms of similar severity. Despite the Veteran's preference to avoid others, he has been married to his wife for many years and maintains friendships with his Marine Corps group. He maintains adequate grooming and hygiene, does not have suicidal or homicidal ideation, is alert and oriented, and maintains goal-directed speech. The testimony and lay statements on file have been taken into consideration. The Veteran is competent to report his psychiatric symptoms, and other lay persons (e.g. his wife) are competent to report the symptoms they have observed. These lay observations are credible, but must be evaluated in light of the rating schedule described above. The lay statements have been considered in the above noted grant of a 70 percent rating for the service-connected PTSD; however, evaluations for VA purposes have not shown the severity required for a higher schedular at any time time during the rating period, as discussed above. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Extraschedular Consideration The Board has also considered whether the issue on appeal should be referred to the Chief Benefits Director or the Director, Compensation and Pension Service for consideration of an extraschedular evaluation under 38 C.F.R. § 3.321. In Thun v. Peake, 22 Vet. App. 111 (2008), the U.S. Court of Appeals for Veterans Claims (Court) clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. Either the RO or the Board must first determine whether the schedular rating criteria reasonably describe the Veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe the Veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. In this case, the schedular criteria are adequate for rating the disability at issue. Ratings in excess of those assigned are provided in the rating schedule for service-connected PTSD, as noted above, but the medical evidence reflects that the disability does not show the symptomatology warranting a higher rating. See 38 C.F.R. § 4.1 (2012). The record does not reflect (or suggest) any symptoms/impairment of the disability not encompassed by the schedular criteria. There is also no evidence of frequent periods of hospitalization due to this service-connected disability. Consequently, the Board finds that the criteria for referral for the assignment of an extraschedular evaluation for PTSD during the appeal period pursuant to 38 C.F.R. § 3.321(b)(1) are not met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). TDIU Claim As the Veteran was granted TDIU beginning August 20, 2008 by rating decision in December 2012, the Board must now determine whether TDIU is warranted at any time during the rating period on appeal prior to August 20, 2008 (i.e. at any time during the rating period on appeal from May 24, 2005 thru August 19, 2008). In order to establish entitlement to TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2008). In reaching such a determination, the central inquiry is whether the veteran's service connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice- connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2007); Van Hoose v. Brown, 4 Vet. App. 361 (1993). The regulatory scheme for a TDIU provides both objective and subjective criteria. Hatlestad v. Brown, 5 Vet. App. 524 (1993); VAOPGCPREC 75-91 (1991), 57 Fed. Reg. 2317 (1992). The objective criteria, set forth at 38 C.F.R. § 3.340(a)(2), provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. Subjective criteria, set forth at 38 C.F.R. § 4.16(a), provide for a TDIU when, due to service-connected disability, a veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § 4.16(b). Rating boards should refer to the Director of the Compensation and Pension Service for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage requirements set forth in 38 C.F.R. § 4.16(a). 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. 38 C.F.R. § 4.16(b). The above evidence indicates that the veteran had been working full-time at substantially gainful employment as a software engineer thru August 19, 2008, when he stopped working due to service-connected disability. Because the Veteran was able to work full time prior to August 20, 2008, his service-connected disabilities did not preclude substantially gainful employment prior to August 20, 2008. Accordingly, the preponderance of the evidence is against the claim for TDIU prior to August 20, 2008, and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). ORDER An initial evaluation of 70 percent for PTSD is granted, effective from May 24, 2005 and throughout the rating period on appeal, subject to the controlling regulations applicable to the payment of monetary benefits. Entitlement to TDIU prior to August 20, 2008 is denied. ____________________________________________ U. R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs