Citation Nr: 18148119 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 17-38 950 DATE: November 7, 2018 ORDER New and material evidence has been submitted to reopen a claim of service connection for an eye disorder, and the appeal is granted to that extent. New and material evidence has been submitted to reopen a claim of service connection for a skin disorder, and the appeal is granted to that extent. Entitlement to service connection for right ear hearing loss is denied. Service connection for prostate cancer is granted. Entitlement to a restoration of a 50 percent disability rating for service-connected posttraumatic stress disorder (PTSD) effective February 1, 2016, is denied. Entitlement to a disability rating in excess of 50 percent for PTSD prior to February 1, 2016, is denied. Entitlement to a disability rating in excess of 30 percent for PTSD since February 1, 2016, is denied. REMANDED Entitlement to service connection for an eye disorder is remanded. Entitlement to service connection for a skin disorder is remanded. FINDINGS OF FACT 1. A May 2004 rating decision denied entitlement to service connection for a chronic condition to account for visual impairment on the basis that there was no evidence of a current eye disorder. The Veteran was notified of that decision, but did not perfect an appeal of that decision. 2. A February 2017 VA treatment record noting that the Veteran has cataracts, posterior vitreous detachment, and suspected glaucoma, when considered by itself or in connection with evidence previously assembled, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for an eye disorder. 3. A May 2013 rating decision denied the reopening of entitlement to service connection for a chronic condition to account for itching on the basis that there was no evidence of a current skin disorder. The Veteran was notified of that decision, but did not perfect an appeal of that decision. 4. VA treatment records dated in 2015 and 2016 that note the Veteran has had chronic pruritus, chronic folliculitis of the scalp, tinea pedis, and onychomycosis, when considered by itself or in connection with evidence previously assembled, relate to unestablished facts necessary to substantiate the claim, and raise a reasonable possibility of substantiating the claim of service connection for a skin disorder. 5. The weight of the evidence is against a finding that the Veteran currently has or has had a hearing loss for VA disability purposes in the right ear since he filed his claim in April 2015. 6. The Veteran served in the Republic of Vietnam. 7. The Veteran has prostate cancer that is presumptively related to his in-service herbicide-agent exposure. 8. In a November 2015 rating decision, the RO reduced the disability rating for PTSD from 50 percent disabling to 30 percent disabling effective February 1, 2016. 9. At the time of the reduction in the assigned disability rating from 50 to 30 percent on February 1, 2016, the weight of the evidence demonstrated a material improvement in the severity of the Veteran’s service-connected PTSD had actually occurred and that any such improvement would be maintained under ordinary conditions of life. 10. The weight of evidence shows that PTSD prior to February 1, 2016, was not been manifested by an occupational and social impairment with deficiencies in most areas. 11. The weight of evidence shows that PTSD since February 1, 2016, has not been manifested by an occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The May 2004 rating decision, which denied the Veteran’s claim of entitlement to service connection for a chronic condition to account for visual impairment, is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156, 20.201, 20.302, 20.1103 (2017). 2. The evidence received since the May 2004 rating decision is new and material, and the claim of entitlement to service connection for an eye disorder is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156. 3. The May 2013 rating decision, which denied the reopening of the Veteran’s claim of entitlement to service connection for a chronic condition to account for itching, is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 20.201, 20.302, 20.1103. 4. The evidence received since the May 2013 rating decision is new and material, and the claim of entitlement to service connection for a skin disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The criteria for entitlement to service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385 (2017). 6. The criteria for entitlement to service connection for prostate cancer as secondary to herbicide-agent exposure have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 7. The reduction in the rating assigned for the Veteran’s PTSD from 50 to 30 percent effective February 1, 2016, was warranted. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.105, 4.1, 4.2, 4.10, 4.130, Diagnostic Code 9411 (2017). 8. The criteria for a disability rating in excess of 50 percent for PTSD prior to February 1, 2016, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Code 9411 (2017). 9. The criteria for a disability rating in excess of 30 percent for PTSD since February 1, 2016, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1967 to July 1969, to include service in the Republic of Vietnam. This case comes before the Board of Veterans’ Appeals (the Board) on appeal from July 2015 (all issues except PTSD) and November 2015 (reduction of rating for PTSD) rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The July 2015 rating decision reflects that the RO stated that an April 2015 claim is a claim for an increased rating. In the April 2015 claim, the Veteran indicated that he is seeking service connection for social phobia and major depression. At the time of the filing of the April 2015 claim, the Veteran’s only service-connected disability was PTSD. In a May 2016 notice of disagreement, the Veteran indicated that a 100 percent disability rating is warranted for PTSD effective the date of the reduction. The RO certified for appeal the issue of the propriety of the reduction of the disability rating for PTSD from 50 percent disabling to 30 percent disabling effective February 1, 2016. Given the Veteran’s intent to seek an increased rating, the issue on appeal includes not only the reduction matter but also an increased rating matter. Therefore, the issues before the Board include the following: the propriety of the reduction of the disability rating for PTSD from 50 percent disabling to 30 percent disabling effective February 1, 2016; entitlement to a disability rating in excess of 50 percent for PTSD prior to February 1, 2016; and entitlement to a disability rating in excess of 30 percent for PTSD since February 1, 2016. The Veteran is not prejudiced by the Board’s consideration of the increased rating issues because the November 2015 rating decision and a May 2017 statement of the case discussed whether an increased rating is warranted. Bernard v. Brown, 4 Vet. App. 384 (1993). The RO denied entitlement to service connection for an enlarged prostate (abnormal prostate specific antigen (PSA)). VA treatment records reveal a diagnosis of prostate cancer. Pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009), the issue on appeal includes prostate cancer. Service Connection 1. Entitlement to service connection for right ear hearing loss Duties to notify and assist VA’s duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The Veteran and his representative have not raised any issues with the duty to notify or duty to assist as to this service connection claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Governing law and regulations In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110. Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service. 38 C.F.R. § 3.303(a). Certain chronic disabilities, such as sensorineural hearing loss, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Where chronicity of certain diseases is not shown in service, service connection may yet be established by showing continuity of symptomatology between the currently claimed disability and a condition noted in service. 38 C.F.R. §§ 3.303(b), 3.309(a). The mere fact of an in-service injury is not enough; there must be evidence of a chronic disability resulting from that injury. Showing chronic disease in service requires a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a veteran’s claim. See 38 C.F.R. § 3.303(b). The chronicity provision of 38 C.F.R. § 3.303(b) applies when evidence, regardless of its date, establishes that a veteran had a chronic condition in service and still has that condition. There must be competent medical evidence unless the evidence relates to a condition as to which lay observation is competent to identify its existence. To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (1997). To be present as a current disability, the claimed condition must be present at the time of the claim for benefits, as opposed to sometime in the distant past. Gilpin v. West, 155 F. 3d 1353 (Fed. Cir. 1998). The Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Service connection for impaired hearing shall only be established when hearing status as determined by audiometric testing meets specified pure tone and speech recognition criteria. Audiometric testing measures threshold hearing levels (in decibels) over a range of frequencies (in Hertz). See Hensley v. Brown, 5 Vet. App. 155, 158 (1993). The determination of whether a veteran has a disability based on hearing loss is governed by 38 C.F.R. § 3.385. See Palczewski v. Nicholson, 21 Vet. App. 174 (2007). For the purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Analysis As for a current hearing loss disability in the right ear, Hickson element (1), the Board has reviewed the VA treatment records and the July 2015 VA examination report. The VA treatment records and the examination report do not show that the Veteran currently has or has had a hearing loss disability for VA purposes in the right ear since he filed his claim in April 2015. At the July 2015 VA examination, there were no auditory pure tone thresholds greater than 25 decibels in the right ear except for a pure tone threshold of 30 decibels at 2000 Hertz. Speech recognition was 96 percent. An October 2015 VA treatment record shows that the Veteran underwent a hearing-aid evaluation. The audiologist noted that the Veteran has a diagnosis of bilateral sensorineural hearing loss, worse in the left ear. The audiologist further noted that noted a comprehensive audiometric examination administered during his VA examination demonstrated a significant hearing loss, which was determined to be amenable to amplification in the form of a hearing aid for the left ear. The audiologist performed an otoscopic examination of the auditory canals that indicated the tympanic membranes were visible with little or no accumulations of cerumen. There is no indication that the audiologist performed an audiological examination. Instead, the evidence shows that the audiologist relied on the findings from the July 2015 VA examination in determining the existence of a hearing loss. Although the audiologist noted a sensorineural hearing loss in the right ear, as noted above the July 2015 VA examination report does not show a hearing loss disability for VA purposes in the right ear. Thus, the October 2015 VA treatment record does not contain evidence of a hearing loss disability for VA purposes in the right ear. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board notes that although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the existence of a hearing loss based on specific pure tone thresholds and speech recognition scores falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not competent to diagnose cancer). As for continuity of hearing difficulty symptomatology, the Veteran is competent to report this symptomatology and the Board finds him credible. That said, supporting medical evidence is required because a claim based on continuity of symptomatology can only be granted if there must be competent evidence of a current disorder for which there is continuity of symptomatology. The weight of the evidence is against a finding that the Veteran currently has or has had a right ear hearing loss for VA disability purposes in either ear since he filed his claim in April 2015. In other words, the Veteran, while entirely competent to report difficulty hearings, is not competent to state that such symptoms are manifestations of a hearing loss disability for VA purposes. In short, the Board finds that Hickson element (1), current disability, is not satisfied as to the claim of entitlement to service connection for right ear hearing loss. In summary, for the reasons and bases set forth above, the Board concludes that the most credible and probative evidence weighs strongly against finding that the Veteran has or has had a hearing loss for VA disability purposes in the right ear during the appellate term. Therefore, the preponderance of the evidence is against the claim, and it is denied. 2. Service connection for prostate cancer Governing law and regulations For prostate cancer, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. See 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Pertinent VA law and regulations provide that a veteran who served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). The diseases that are listed at 38 C.F.R. § 3.309 (e), including prostate cancer, shall be presumptively service connected if there are circumstances establishing herbicide agent exposure during active military service, even though there is no record of such disease during service. The regulation applies where prostate cancer becomes manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307 (a)(6)(ii). Analysis Hickson element (1), current disability, has been met. While VA treatment records show that in April 2015 the Veteran has a single elevated PSA, by December 2015 prostate cancer was diagnosed. Malignant neoplasms of the genitourinary system are initially rated 100 percent disabling. Thus, the weight of evidence shows that the prostate cancer is disabling to a compensable degree. 38 C.F.R. § 4.115b, Diagnostic Code 7528 (2017). With respect to Hickson element (2), the Board will separately discuss in-service disease (to include the one-year presumptive period after service) and injury. The Veteran’s service treatment records do not reflect a diagnosis of prostate cancer. Moreover, prostate cancer was not diagnosed until well after a year after separation from active service. Therefore, the preponderance of the competent evidence shows that there was no diagnosis of prostate cancer in service or during the one-year presumptive period. Turning to the matter of in-service injury, the claimed injury is exposure to herbicide agents in the Republic of Vietnam. The Veteran’s DD Form 214 reflects that he served in the Republic of Vietnam. Therefore, Hickson element (2), in-service injury, is therefore established on a presumptive basis. Turning to Hickson element (3), medical nexus, the nexus presumption found in 38 C.F.R. § 3.309(e) is applicable as to this claim. There is no affirmative evidence to support a conclusion that the Veteran’s prostate cancer was not incurred in service. Accordingly, Hickson element (3) is established on a presumptive basis. In summary, the Board is of the opinion that the Veteran has met all requirements needed to establish service connection for prostate cancer. The benefit sought on appeal is accordingly allowed. Increased Rating 3. Entitlement to a restoration of a 50 percent disability rating for service-connected PTSD effective February 1, 2016 4. Entitlement to a disability rating in excess of 50 percent for PTSD prior to February 1, 2016 5. Entitlement to a disability rating in excess of 30 percent for PTSD since February 1, 2016 Duties to notify and assist The Veteran and his representative have not raised any issues with the duty to notify or duty to assist as to these claims except for requesting another VA examination. See Scott, 789 F.3d at 1381 (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens, 814 F.3d at 1361 (applying Scott to duty to assist argument). In the June 2017 VA Form 9, the Veteran essentially argued that another examination is warranted because a July 2015 VA examiner may have been biased against him because of his refusal to seek treatment for PTSD. The Board finds that the July 2015 VA examination is adequate to satisfy VA’s duty to assist in that was based on a thorough review of the record, consideration of the Veteran’s contentions, and contained sufficient findings to rate the service-connected PTSD. The examination report does not contain any evidence indicating that the examiner was biased against the Veteran because of his refusal to seek treatment for PTSD. Governing law and regulations Ratings reductions The law provides that where a rating reduction was made without observance of law, although a remand for compliance with that law would normally be an adequate remedy, in a rating reduction case the erroneous reduction must be vacated and the prior rating restored. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). A veteran’s disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. 38 U.S.C. § 1155 (2012). When a veteran’s disability rating is reduced by a RO without following the applicable regulations, the reduction is void ab initio. See Greyzck v. West, 12 Vet. App. 288, 292 (1999). Prior to reducing a veteran’s disability rating, VA is required to comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10. These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of the veteran’s disability. Schafrath, 1 Vet. App. at 594. Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran’s ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 350 (2000). In certain rating reduction cases, VA benefits recipients are to be afforded greater protections, set forth in 38 C.F.R. § 3.344 (2017). The provisions of 38 C.F.R. § 3.344(c), however, specify that the provisions of 38 C.F.R. § 3.344(a) and (b) are only applicable for ratings which have continued for long periods at the same level (five years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. In a March 2008 rating action, the RO granted service connection for PTSD effective November 17, 2004, and assigned a 30 percent disability rating effective that same date. In a May 2013 rating decision, the RO assigned a 50 percent disability rating for PTSD effective September 27, 2011. The effective date of the reduction is February 1, 2016. Therefore, the greater protections, set forth in 38 C.F.R. § 3.344, do not apply in this case because the 50 percent disability rating for PTSD was not in effect for five or more years at the time of the reduction on February 1, 2016. Generally, when reduction in the evaluation of a service-connected disability is contemplated and the lower evaluation would result in a reduction or discontinuance of compensation payments, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary must be notified at his latest address of record of the contemplated action and furnished detailed reasons therefore. The beneficiary must be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at the present level. 38 C.F.R. § 3.105(e). Increased rating Pursuant to Hart v. Mansfield, 21 Vet. App. 505 (2007), the Board must consider the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in the claimant’s favor. 38 C.F.R. § 4.3. PTSD is evaluated under the general rating formula for mental disorders. Under those criteria, a 30 percent rating is assigned 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, and mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent rating is assigned for 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 effective work and social relationships. Id. A 70 percent rating is assigned for 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 work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. The Board notes that effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations to remove outdated references to the DSM -IV and replaced them with references to the recently updated Fifth Edition (DSM-5). See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the agency of original jurisdiction (AOJ) on or after August 4, 2014. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In December 2017, the RO certified the appeal to the Board and as such, this claim is governed by DSM-V. Global assessment of functioning (GAF) scores are assigned based on a scale reflecting the “psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness.” See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (citing the DSM-IV, p. 32). A GAF score from 60 to 51 reveals moderate symptomatology (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). Though this claim is governed by DSM-V, a GAF score is still pertinent evidence. Analysis Reduction In an August 7, 2015, letter, the Veteran was informed of a proposed reduction in the rating assigned to PTSD. He was afforded 60 days to respond. Thereafter, the RO promulgated a rating decision in November 2015, implementing the proposed reduction, effective from February 1, 2016. The RO properly applied the regulations regarding the procedure for notification of reductions in ratings. The decision to reduce the Veteran’s disability rating was based on the report of a July 2015 VA examination. PTSD in partial remission was diagnosed. The examiner noted that the Veteran has chronic sleep impairment and did not indicate that he had any other symptoms that are examples of occupational and social impairment for rating purposes. The examiner stated that a mental disorder has been formally diagnosed, but that symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication. As to the finding of PTSD being in partial remission, the examiner noted that the Veteran does not currently endorse persistent symptoms of avoidance of stimuli associated with previously documented combat traumas or at least two symptoms of negative alternations in cognitions and mood. The examiner added that his report of chronic sleep disturbance is notably inconsistent with recent VA treatment records. The examiner indicated that there is no evidence of impaired occupational efficiency or ability to complete work-related tasks secondary to PTSD. Regarding social functioning, the examiner noted that while the Veteran endorsed a feeling of detachment from his peers, he also endorsed appropriate social interaction with others. The examiner added that the Veteran reported that others would describe him as a someone with a “big heart” who is always willing to help. A March 2012 VA examination report shows that the examiner also stated that a mental disorder has been formally diagnosed, but that symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication. That examiner, however, assigned a GAF of 60 for current impairment. In addition to chronic sleep impairment, the Veteran had anxiety, suspiciousness, impaired judgment, and mild memory loss, such as forgetting names, directions, or recent events. The examiner noted that the Veteran does not want to be around people because he gets nervous when in the company of others because of a concern about a terrorist attack. VA treatment records show that in March 2015 the Veteran’s affect was congruent and that in April 2015 his affect was full. The Board places great weight on the findings in the March 2012 and July 2015 VA examination reports. While both examiners stated that symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication, the Veteran had more symptoms at the March 2012 VA examination that are examples of occupational and social impairment. In particular, he had impaired judgment, an example of a symptom showing an occupational and social impairment with reduced reliability and productivity. The July 2015 VA examiner did not indicate that the Veteran has impaired judgment or any other symptom that is an example of an occupational and social impairment with reduced reliability and productivity. Moreover, the March 2012 VA examiner assigned a GAF that reflects moderate symptomatology (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning. The March 2012 VA examiner also described a more severe social impairment than the social impairment reported by the July 2015 VA examiner. In the June 2017 VA Form 9, the Veteran argued that the rating decisions and notice letters regarding the reduction contain a superficial analysis and that the RO was in essence biased against him. In that regard, the Veteran noted that the May 2017 statement of the case discusses the April 2015 VA treatment record showing that he refused to seek mental-health treatment. He noted that 38 C.F.R. § 4.126(a) (2017) states, “The rating agency shall assign an evaluation based on all evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.” The May 2017 statement of case reflects that the RO considered more than just the July 2015 VA examination report because, as the Veteran noted, the RO considered VA treatment records. As such, the RO’s analysis was not superficial. As to the Veteran’s claim of RO bias, there is no indication in the rating decision proposing the reduction, the rating decision implementing the reduction, or the statement of the case that the reduction was made based on the Veteran’s refusal to seek mental-health treatment. While the statement of the case notes some details from the April 2015 VA treatment record, the statement of the case also discusses findings from the July 2015 VA examination report. Based on the VA treatment records and the March 2012 and July 2015 VA examination reports, the weight of the evidence demonstrated a material improvement in the severity of the Veteran’s service-connected PTSD had actually occurred and that any such improvement would be maintained under ordinary conditions of life. In other words, there is of record no evidence that would justify the maintenance of the assigned 50 percent rating under Diagnostic Code 9411. Accordingly, the reduction from 50 percent to 30 percent effective February 1, 2016, was warranted based on the evidence of record. Prior to February 1, 2016 Given that the reduction was proper, the next matter is whether a rating in excess of 50 percent prior to February 1, 2016, is warranted. As for a 70 percent disability rating, the VA examination reports and VA treatment records show no evidence of any of the following: 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 work-like setting); inability to establish and maintain effective relationships. An April 2015 VA treatment record reflects that there was no suicidal ideation. The July 2015 VA examiner noted that that symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication. That examiner did not report any symptoms that are examples of an occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Simply put, the weight of evidence shows that PTSD prior to February 1, 2016, was not been manifested by an occupational and social impairment with deficiencies in most areas. 38 C.F.R. §§ 4.7, 4.130 Diagnostic Code 9411. As for the criteria for a 100 percent disability rating, VA examination reports and VA treatment records show no evidence of any of the following: 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. The March 2015 VA treatment record reveals that the thought process was linear and that the thought content was appropriate. The April 2015 VA treatment record shows that there were no auditory or visual hallucinations and that there were no delusions or thought disorder. There was no paranoid or homicidal ideation. The July 2015 examiner did not report any symptoms that are examples of a total occupational and social impairment. In sum, the weight of evidence shows that PTSD prior to February 1, 2016, was not manifested by a total occupational and social impairment. 38 C.F.R. §§ 4.7, 4.130 Diagnostic Code 9411. Since February 1, 2016 Given that the reduction was proper, the next matter is whether a rating in excess of 30 percent since February 1, 2016, is warranted. As for a 50 percent disability, there is no evidence of any of the following: 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 effective work and social relationships. The latest VA treatment records reveal that in 2015 the Veteran’s affect was described as congruent and full. At the latest VA examination, done in July 2015, the examiner did not report any symptoms that are examples of an occupational and social impairment with reduced reliability and productivity. The VA examiner noted that that symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication. In sum, the weight of evidence shows that PTSD since February 1, 2016, has not been manifested by an occupational and social impairment with reduced reliability and productivity. 38 C.F.R. §§ 4.7, 4.130 Diagnostic Code 9411. As for a 70 percent disability rating, there is no evidence of any of the following: 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 work-like setting); inability to establish and maintain effective relationships. At the latest VA examination, done in July 2015, the examiner did not report any symptoms that are examples of an occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Therefore, the weight of evidence shows that PTSD since February 1, 2016, has not been manifested by an occupational and social impairment with deficiencies in most areas. 38 C.F.R. §§ 4.7, 4.130 Diagnostic Code 9411. As for the criteria for a 100 percent disability rating, there is no evidence of any of the following: 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. At the latest VA examination, done in July 2015, the examiner did not report any symptoms that are examples of a total occupational and social impairment. Thus, the weight of evidence shows that PTSD since February 1, 2016, has not been manifested by a total occupational and social impairment. 38 C.F.R. §§ 4.7, 4.130 Diagnostic Code 9411. REASONS FOR REMAND A VA examination is necessary to determine whether a current eye disorder is related to an in-service eye pain complaint in May 1968 and his reporting of color blindness at an August 1969 separation examination. A VA examination is required to determine whether his current skin disorder is related to the in-service ulceration on the left foot that was diagnosed as a jungle ulcer in February 1967. As these issues being remanded for VA examinations, the RO should ask the Veteran to identify any treatment for his eye and skin disorders. The matter is REMANDED for the following action: 1. Ask the Veteran to identify any treatment for his eye and skin disorders and obtain any identified records. 2. After the development in 1 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any eye disorder. As to any congenital or development defect of the eye, to include refractive error, the examiner should opine whether it is at least as likely as not the Veteran now has additional disability due to an in-service disease or injury superimposed upon such defect. For any other vision disability that is not congenital or developmental in nature, the examiner must opine whether it is at least as likely as not that any current eye disorder is related to an in-service injury, event, or disease, including an in-service eye pain complaint in May 1968 and his reporting of color blindness at an August 1969 separation examination. 3. After the development in 1 is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any skin disorder. The examiner must opine whether it is at least as likely as not that any current skin disorder is related to an in-service injury, event, or disease, including the in-service ulceration on the left foot that was diagnosed as a jungle ulcer in February 1967. 4. After completing the above action, the AOJ should readjudicate the Veteran’s claims. If any claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case and afforded an opportunity to respond before the file is returned to the Board for further appellate consideration. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Cherry, Counsel