Citation Nr: 1328459 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 08-19 654 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to an initial rating in excess of 30 percent prior to March 31, 2011, and in excess of 50 percent thereafter for posttraumatic stress disorder (PTSD). REPRESENTATION Veteran represented by: Tennessee Department of Veterans' Affairs ATTORNEY FOR THE BOARD Jeanne Schlegel, Counsel INTRODUCTION The Veteran had active service from October 1968 to June 1970. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2006 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in Denver, Colorado, which granted service connection for PTSD and assigned an initial 30 percent evaluation, effective August 31, 2005. The record reflects that the Veteran moved to Tennessee during the pendency of this appeal and the RO in Nashville, Tennessee, currently has jurisdiction of the case. While the appeal was pending, a September 2011 rating action was issued granting a 50 percent evaluation for PTSD, effective March 31, 2011. Subsequently, in a June 2013 rating action, a 100 percent evaluation was granted for PTSD for the portion of the appeal period extending from May 10, 2013, forward. Therefore, as staged ratings have been assigned during the course of this appeal period, the issue has been characterized as shown on the first page of this decision. See Fenderson v. West, 12 Vet. App. 119, 126-127 (1999). The Board observes that, in his June 2008 substantive appeal (VA Form 9), the Veteran requested a Board hearing before a Veterans Law Judge sitting at the RO. Thereafter, in a July 2013 letter, he was advised that his requested hearing was scheduled for August 2013. However, in an August 2013 communication, received prior to his hearing date, the Veteran indicated that he would not attend the hearing and requested that his appeal move forward for review and adjudication by the Board based upon the evidence of record. Therefore, the Board finds that the Veteran has withdrawn his request for a Board hearing. 38 C.F.R. § 20.704(e) (2012). The Board also notes that, in addition to the paper claims file, there is a paperless, electronic (Virtual VA) claims file associated with the Veteran's claim. A review of the Virtual VA claims file reveals additional VA treatment records dated through April 2013, which were reviewed by the agency of original jurisdiction (AOJ) in the The Board notes that a September 2011 rating decision granted a rating of 50 percent for bilateral hearing loss and denied entitlement to a total disability rating due to individual unemployability as a result of service-connected disabilities (TDIU). In October 2011, the Veteran filed a timely notice of disagreement as to the assigned rating for his bilateral hearing loss and the denial of a TDIU. A statement of the case was issued in June 2013; however, the Veteran failed to timely perfect the appeal. Accordingly, these issues are not properly before the Board. FINDINGS OF FACT 1. Since the August 31, 2005 effective date of the award of service connection for PTSD, the Veteran has had psychiatric symptoms and manifestations of the type, frequency and/or severity which most nearly approximate occupational and social impairment with reduced reliability and productivity with difficulty in establishing and maintaining effective work and social relationships, consistent with the assignment of a 50 percent rating. 2. At no point during the appeal period prior to May 10, 2013, has the Veteran's PTSD been productive of symptoms indicative of occupational and social impairment with deficiencies in most areas and an inability to establish and maintain effective relationships, or total occupational and social impairment. CONCLUSION OF LAW As of August 31, 2005, the criteria for an initial rating of 50 percent, but no higher, for PTSD are met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.125-4.130, Diagnostic Code 9411 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION VA's Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012), 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012), requires VA to assist a claimant at the time that he or she files a claim for benefits. As part of this assistance, VA is required to notify claimants of what they must do to substantiate their claims. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). Specifically, VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that the claimant is to provide; and (3) that VA will attempt to obtain. See Beverly v. Nicholson, 19 Vet. App. 394, 403 (2005) (outlining VCAA notice requirements). VA's 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/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In rating cases, a claimant must be provided with information pertaining to assignment of disability ratings (to include the rating criteria for all higher ratings for a disability), as well as information regarding the effective date that may be assigned. Id. VCAA-compliant notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the AOJ. Id.; Pelegrini, 18 Vet. App. at 112. See also Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). However, the VCAA notice requirements may, nonetheless, be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Id. With respect to the initial rating claim on appeal, the VCAA's notice requirements were satisfied by way of a letters sent to the Veteran dated in September 2005, January 2006, and March 2006, (addressing the elements of service connection prior to the grant of service connection for PTSD). As this is an appeal arising from the award of service connection for this condition, the notice that was provided before service connection was granted was legally sufficient and the VCAA's notice requirements have been satisfied. See Hartman v. Nicholson, 483 F.3d 1311 (2006); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). The Board also finds that all of the relevant facts have been properly developed, and that all available evidence necessary for an equitable resolution of the issue on appeal has been obtained. The Veteran's service treatment records (STRs) and post-service VA and private treatment records were obtained for the file. A decision and supporting documentation from the Social Security Administration (SSA) is also on file, as well as documentation relating to the Veteran's employment. The Veteran has not identified any additional, outstanding records that have not been requested or obtained. VA's duty to assist includes obtaining an examination and medical opinion when necessary to make an adequate determination. See Duenas v. Principi, 18 Vet. App. 512 (2004). During the appeal period, VA examinations were conducted in 2006, 2009, 2011, and 2013. The Veteran and his representative have not alleged that any of these examinations were inadequate. See Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011) (in the absence of a challenge to the adequacy of the examination, the Board is not required to explicitly explain why each medical opinion is adequate). Moreover, the Board finds that the examinations are adequate in order to evaluate the Veteran's service-connected PTSD as they include an interview with the Veteran, a review of the record, and a full mental status examination, addressing the relevant rating criteria. Therefore, the Board finds that the examination reports of record are adequate to adjudicate the Veteran's initial rating claim and no further examination is necessary. Accordingly, the Board finds that VA has complied, to the extent required, with the duty-to- assist requirements found at 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c)-(e). Factual Background The Veteran filed a service connection claim for PTSD that was received by VA on August 31, 2005. A Vet Center intake evaluation report of September 2005 reveals that the Veteran's complaints included: repeated/disturbing memories of military experiences; loss of interest in activities previously enjoyed; emotional numbing; trouble falling asleep; irritability or angry outbursts; and difficulty concentrating. It was noted that the Veteran experienced anger/explosive outbursts towards loved ones that was negatively impacting his intimate relationships. Mental status evaluation revealed that the Veteran was well oriented. His appearance was described as unkempt. Speech and affect were appropriate and memory was normal. Judgment was described as fair. A VA PTSD examination was conducted in November 2006 and the claims folder was reviewed. A history of PTSD and alcohol dependence with treatment since the 1980's was noted. Social history indicated that the Veteran had been married to his 3rd wife for 6 1/2 years, and had an adult daughter from his second marriage who he kept in touch with. The report mentioned that the Veteran had quit drinking 4 years previously and had been drug free for 7 years. It was noted that he had been a city employee for more than 5 years, working as an equipment operator. Difficulty motivating himself to bathe was mentioned, but with largely daily tending. The report indicated that the Veteran's only social contact was with his wife. Evaluation revealed symptoms of hyper-arousal, re- experiencing, and avoidance behaviors. Frequent awakening, occurring 2 to 3 times a night, was reported. High levels of anxiety/frustration and intrusive daytime memories occurring multiple times a week were reported. A history of assaults since the 1970's, the last occurring in around 2004 when the Veteran had an argument with his wife and choked her (unreported) was mentioned. The report indicated that the Veteran had been in trouble with the police for physical confrontations with extended family members, but the Veteran reported that counseling had helped him manage his temper better. Short term memory and concentration were described as fair. Thought process was unimpaired. He described hearing noises when nothing was there, but denied hearing voices. Chronic PTSD, moderate to severe, and depressive disorder as likely as not secondary to PTSD were diagnosed and a Global Assessment of Functioning (GAF) score of 55 was assigned. The examiner stated that the Veteran was able to maintain activities of daily living including hygiene. It was mentioned that there was some inappropriate behavior with regard to physical violence and aggressiveness, which had improved with treatment. Thought process and communication were described as unimpaired on examination. Social function was evaluated as impaired by isolativeness due to PTSD. It was determined that the Veteran was competent for VA purposes and was employable from a psychiatric standpoint. Due to PTSD symptoms including hyperarousal, high anxiety and poor control of temper, the examiner opined that the Veteran would be best employed in setting in which he had little public contact and very loose supervision. In a December 2006 rating decision, the RO granted service connection for PTSD and assigned an initial 30 percent evaluation, effective August 31, 2005. In October 2007, the Veteran underwent a PTSD evaluation conducted by a private clinical psychologist. The report reflects that the Veteran experienced unwanted and distressing memories of Vietnam several times each week. It was noted that he was numb and disinterested in hobbies and interests he had before Vietnam, and that he felt misunderstood and tried to avoid relationships with others. He also reported having daily thoughts of dying and explained that it would not matter if he was not here. Continued sleep impairment was reported and concentration was described as a problem. It was noted that his anger could trigger quickly and without warning. The psychologist concluded that the Veteran met the criteria for a PTSD diagnosis and observed that nearly all of the areas in his life were negatively affected by his combat experience. It was commented that, in the absence of PTSD, the Veteran would probably be making more money with less physical effort, would have a very different social life, and would find intimate relationships to be less difficult. A VA record of November 2007 mentions that the Veteran continued to maintain sobriety, but that he had blown up at his supervisor that week. A VA mental health note of January 2009 indicated that the Veteran had continued the use of Fluoxetine and thought it helped his irritable temper. It was noted that his wife noted a big difference and never wanted him to stop taking it. The entry also noted that there was no evidence of suicidal ideation or psychosis, and no substance abuse for many years. A VA PTSD examination was conducted in September 2009. The report mentioned that, for the past 9 years the Veteran had been a city employee, working as an equipment operator, and that he had a high school education with some trade certifications. The Veteran indicated that, over time, the job had become more difficult and that he was outspoken and had been passed up for several promotions. He also reported having interpersonal tensions on the job, but such did not result in being written up or in any disciplinary actions. The Veteran complained of frequent symptoms of depression and anxiety, with additional symptoms including isolation, sleep disturbance, and nightmares. Some ongoing suicidal thinking was reported, without active plans or attempts. He also mentioned having some intermittent violent angry thinking, without active plans or attempts, or assaultive behavior. The Veteran denied having panic attacks, or auditory/visual hallucinations. On examination, the Veteran was well groomed. Speech was articulate and thought process was logical. Testing revealed deficits in short-term memory, attention, and concentration. The examiner assessed that the Veteran could maintain the activities of daily living including hygiene. Chronic, moderate PTSD was diagnosed. Depressive disorder secondary to PTSD was also assessed. A GAF score of 53 was assigned. The examiner opined that PTSD was productive of reduced reliability and productivity. On May 10, 2011, the Veteran underwent another PTSD examination. The report mentioned that he had been released from work in September 2010 due to hearing loss, after working for 9 years as a senior equipment operator. The Veteran's complaints included sleep impairment, intrusive memories, isolation, mild paranoia, and nightmares. The Veteran denied having panic attacks, auditory/visual hallucinations, or suicidal/homicidal ideation. On examination, the Veteran was appropriately groomed and thought process was intact. The examiner assessed that the Veteran could maintain the activities of daily living including hygiene. Chronic, moderate PTSD was diagnosed. Depressive disorder secondary to PTSD was also assessed. A GAF score of 56 was assigned. The examiner assessed that overall, PTSD was productive of reduced reliability and productivity. In a September 2011 rating decision, an increased evaluation of 50 percent was granted for PTSD, effective from March 31, 2011. The file contains evidence from the Social Security Administration indicating that disability benefits were approved, effective from August 31, 2010, due to hearing loss and anxiety related disorders. A January 2012 VA treatment record reflects that the Veteran was living with his wife of 11 years and her 18 year old son. He was twice divorced. It was noted that he was unemployed and was not looking for another job due to his hearing. Upon mental status examination, his appearance was appropriate. His speech, to include rate, tone, and volume was average. He was alert and oriented times four. The Veteran remained seated calmly, was readily engaged, and made good eye contact. His affect was in a fair range and he was not tearful. The Veteran's through process/content was logical without psychotic content. He denied audio and visual hallucinations as well as suicidal or homicidal ideation, intent, or plan. In November 2012, the Veteran had good hygiene and was appropriately addressed. He was also alert and oriented times three with a pleasant affect. Most recently, the Veteran underwent a VA psychiatric examination on May 13, 2013. PTSD and depression were diagnosed and a GAF score of 48 was assigned. The examiner determined that the Veteran's enmeshed PTSD and depression were productive of total occupational and social impairment based on symptomatology that includes depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, suicidal ideation, obsessional rituals that interfere with routine activities, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. In a June 2013 rating decision, an increased evaluation of 100 percent was granted for PTSD, effective from May 10, 2013. Analysis The Veteran is seeking entitlement to an initial disability rating for PTSD in excess of 30 percent for the portion of the appeal period extending from August 31, 2005 to March 30, 2011; and entitlement to a disability rating in excess of 50 percent for the portion of the appeal period extending from March 31, 2011 to May 9, 2013. The Board notes that a maximum schedular evaluation of 100 percent was granted for PTSD effective from May 10, 2013; accordingly, the possibility of a higher schedular rating need not be discussed for that portion of the appeal period. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and there must be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.1. The Board attempts to determine the extent to which the Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service- connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson, supra The Veteran's service-connected PTSD is evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9411. The psychiatric symptoms listed in the rating criteria below are not exclusive, but are examples of typical symptoms for the listed percentage ratings. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Under the general rating formula for mental disorders, a 30 percent disability evaluation is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation envisions occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation envisions 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); and an inability to establish and maintain effective relationships. A 100 percent schedular evaluation is warranted when there is 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 of names of close relatives, own occupation, or own name. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM- IV), which VA has adopted, under 38 C.F.R. §§ 4.125 and 4.130, a GAF score of 51 to 60 indicates moderate symptoms or moderate difficulty in social, occupational, or school functioning. A GAF score of 41 to 50 indicates serious symptoms or a serious impairment in social, occupational, or school functioning. Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); Richard v. Brown, 9 Vet. App. 266, 267 (1996). At the outset, the Board notes that in addition to PTSD, depression has also been diagnosed, and this condition has been described as secondary to and enmeshed with the diagnosis of PTSD and its symptoms. Where it is not possible to distinguish the effects of a nonservice- connected condition from those of a service-connected condition, the reasonable doubt doctrine dictates that all symptoms be attributed to the Veteran's service-connected disability. See Mittleider v. West, 11 Vet. App. 181 (1998). As it is clear that given the enmeshed and overlapping symptomatology relating to diagnosed PTSD and depression, it is not possible to clearly distinguish the symptomatology associated with each condition, the Board will consider all psychiatric symptoms attributable to both diagnosed PTSD and depression, in evaluating his service- connected PTSD, as applicable. The above-cited evidence reflects that, since the August 31, 2005, effective date of the award of service connection, the Veteran's PTSD has primarily been manifested by depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation in mood, difficulty in establishing work and social relationships, panic attacks, and symptoms of agitation and anger. On VA examinations conducted between November 2006 and May 2011,GAF scores have consistently been assigned in the 53 to 56 range, indicative of moderate symptoms or moderate difficulty in social, occupational, or school functioning. Given the relatively stable nature of the Veteran's PTSD symptomatology between August 31, 2005 and May 9, 2013 as evidence by both the Veteran's symptoms and GAF scores; it appears inconsistent that staged ratings of 30 and 50 percent were assigned during that time period. In this regard, as early as November 2006, the Veteran's PTSD was assessed as overall moderate to serious in terms of impairment. When examined in 2009, the examiner opined that PTSD was productive of reduced reliability and productivity, consistent with the assignment of a 50 percent evaluation as described in the schedular criteria, suggesting that a 50 percent evaluation should have been assigned at least from that date. Accordingly, having considered the record closely, and resolving all reasonable doubt in the Veteran's favor, the Board concludes that the criteria for an initial 50 percent rating, but no higher, are, in fact, met for the portion of the appeal period extending from August 31, 2005 to March 30, 2011. However, the Board also finds that a rating greater than 50 percent for PTSD is not warranted at any point pertinent to this appeal. In this respect, the lay and medical evidence establishes that between August 31, 2005 to May 9, 2013, the Veteran's PTSD was not productive of occupational and social impairment with deficiencies in most areas, an inability to establish and maintain effective relationships, or total occupational and social impairment. In this regard, at no point during the applicable appeal period was there any evidence of symptoms and/or manifestations such as impairment in reality testing, communication, or speech, nor had major impairment been shown in areas such as judgment, thinking, or mood, which are the type of symptoms indicative of a 70 percent rating. In fact, during the period under consideration, the evidence fails to show nearly all of the enumerated symptoms and/or manifestations, or symptoms of the type, frequency, and/or severity that, while not specifically enumerated, would otherwise be indicative of a 70 percent rating. See Mauerhan, supra. In this regard, there was during this time no evidence of: 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; spatial disorientation; or neglect of personal appearance and hygiene (except for a sole notation to this effect made in September 2005, and not made again thereafter). In addition, throughout this portion of the appeal period there were no recorded or reported incidents of impaired impulse control or violence, or police involvement. Further the 2009 and 2011 VA examination reports, as well as a January 2012 VA treatment record, reflect that there was no indication of suicidal or homicidal ideation or plan. Moreover, the symptoms associated with the Veteran's PTSD, which are not enumerated in the rating criteria, do not rise to the level of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Specifically, the record reflects that the Veteran was able to maintain gainful employment until August 2010. Additionally, he has remained married to his current wife and keeps in touch with his daughter for the duration of the appeal period. Moreover, mental status examinations during the appeal period fail to show impairment in judgment or thinking. Therefore, the Board finds that the Veteran's PTSD symptomatology, as a whole, does not more nearly approximate occupational and social impairment with deficiencies in most areas. Pertaining to occupational impairment, the Board acknowledges that the SSA has found the Veteran to be disabled due to PTSD since August 31, 2010. However, the criteria utilized by VA and the SSA in determining entitlement to disability benefits are not same and VA is not bound by the findings of disability and/or unemployability made by other agencies, including SSA. See Collier v. Derwinski, 1 Vet. App. 413, 417 (1991). As such, the Board is not compelled to reach the same determination as did SSA. Significantly, when evaluated by VA on May 10, 2011, chronic, moderate (as opposed to severe) PTSD was diagnosed. Further, the examiner opined that PTSD was productive of reduced reliability and productivity, but not of greater or total occupational impairment. The Board also points out that none of the enumerated symptoms and/or manifestations, or symptoms of the type, frequency, and/or severity that, while not specifically enumerated, would otherwise be indicative of a 100 percent rating were shown prior to May 10, 2013. See Mauerhan, supra. In this regard, there was no documentation or indication of symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; or memory loss of names of close relatives, own occupation, or own name. Accordingly, at no point between August 31, 2005 to May 9, 2013 did the evidence indicate symptoms/manifestations of PTSD consistent with total occupational and social impairment. Such findings were not evident until May 10, 2013, as described on a VA examination report of that date. Essentially, between the August 31, 2005 claim date and May 9, 2013, the evidence reflects symptoms of the type, frequency and/or severity (as appropriate) to indicate occupational and social impairment with reduced reliability and productivity with associated manifestations, consistent with the assignment of a 50 percent rating, but fails to reveal evidence of symptoms indicative of occupational and social impairment with deficiencies in most areas with associated manifestations, or of total occupation and social impairment. The Board has considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service- connected PTSD; however, the Board finds that his symptomatology has been stable throughout the appeal. Therefore, assigning staged ratings for such disability is not warranted. Accordingly, by virtue of this decision, the Board is awarding a higher initial 50 percent rating for PTSD from the August 31, 2005 effective date of the award of service connection, but is denying a rating in excess of 50 percent for any portion of the appeal period. In reaching these conclusions, the Board has favorably applied the benefit- of-the-doubt doctrine, as applicable. See 38 U.S.C.A. § 5107(b),38 C.F.R. § 3.102, Gilbert, 1 Vet. App. at 53-56. Extraschedular Consideration and TDIU the Board has contemplated whether the case should be referred for extra-schedular consideration. An extra- schedular disability rating is warranted 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 that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1) . In Thun v. Peake, 22 Vet. App. 111 (2008), the 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 a Veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe a Veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. If the RO or the Board finds that the schedular evaluation does not contemplate a Veteran's level of disability and symptomatology, then either the RO or the Board must determine whether a Veteran's exceptional disability picture includes other related factors such as marked interference with employment and frequent periods of hospitalization. Id. at 116. If this is the case, then the RO or the Board must refer the matter to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for the third step of the analysis, determining whether justice requires assignment of an extraschedular rating. Id. In this case, the symptoms and manifestations described by the lay and clinical evidence fit within the criteria found in the relevant diagnostic code (9411) used for evaluating PTSD. In short, the rating criteria contemplate not only the symptoms but also the severity of the disability. In addition, there has been no evidence of frequent, or in fact any hospitalizations, for this condition. In short, for the reasons already set forth above, the rating criteria contemplate not only the Veteran's symptoms but also the severity of his condition as is reflected by the currently assigned 50 and 100 percent staged disability ratings. Therefore, as these ratings are adequate, analysis of the next step of whether an exceptional disability picture is presented is not for consideration and referral for extraschedular consideration is not warranted. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim for total disability rating for compensation based on individual unemployability (TDIU) is part of an increased rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. The Court further held that when evidence of unemployability is submitted at the same time that the Veteran is appealing the initial rating assigned for a disability, the claim for TDIU will be considered part and parcel of the claim for benefits for the underlying disability. Id. During the course of the Veteran's claim for higher initial ratings for his PTSD, a claim for TDIU was considered and denied by the RO in a September 2011 rating decision. The Veteran filed a timely notice of disagreement in October 2011 and a statement of the case was issued in June 2013; however, the Veteran failed to timely perfect his appeal. Such adjudication reflects the permissive bifurcation of the increased initial rating claim from the TDIU claim. See Roebuck v. Nicholson, 20 Vet. App. 307, 315 (2006) (acknowledging that the Board can bifurcate a claim and address different theories or arguments in separate decisions); Holland v. Brown, 6 Vet. App. 443, 447 (1994) (holding that "it was not inappropriate" for the Board to refer a TDIU claim to the RO for further adjudication and still decide an increased-ratings claim). Moreover, while acknowledging the Rice decision, in Locklear v. Shinseki, 24 Vet. App. 311 (2011), the Court held that it is permissive for VA to address a claim for TDIU independently of other claims, including increased rating and service connection claims. Id. at 315. Given the foregoing, the Board concludes that the TDIU claim was separately adjudicated and not perfected for appellate review. Accordingly, the Board does not have jurisdiction over the claim and need not refer or remand the matter. ORDER As of August 31, 2005, an initial 50 percent rating, but no higher, for PTSD is granted, subject to the provisions governing the award of monetary benefits. ____________________________________________ A. JAEGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs